Familial cancer on a Scottish island.

Familial cancer on a Scottish island. When the causes of death were determined in 18 relations of a child with Fanconi's anaemia 10 deaths were found to be due to carcinoma of various organs. Cases of osteogenic sarcoma, leukaemia, and Marfan's syndrome were also discovered among relatives. The family was from a remote community in the hebrides and there was considerable intermarriage. Suggestive evidence of heterozygosity was found by chromosome analysis.


The role of irradiation in central nervous system treatment and prophylaxis for acute lymphoblastic leukemia. The results of central nervous system (CNS) treatment with craniocervical irradiation and intrathecal methotrexate in 117 children with ALL achieved at the Joint Center for Radiation Therapy. The Children's Hospital Medical Center, and The Sidney Farber Cancer Center are presented. A classification related to meningeal disease which correlated with prognosis is presented and the patients are analyzed within these groups. Of 80 patients classified in the most favorable groups (I and II), no child has suffered primary CNS relapse. Of the remaining 37 patients in less favorable groups (III, IV, and V), eight patients have experienced CNS relapse, five following or in conjunction with bone marrow relapse. The technical features of irradiation are reviewed and related to success of the treatment.


Ceruloplasmin levels in sera from human patients with osteosarcoma. Ceruloplasmin (Cp) levels in sera of osteosarcoma patients, women on chemical contraceptives, and normal individuals were determined by radial immuno-diffusion (RID) and rocket electroimmunophoresis (REP) techniques; serum copper levels (SCL) were determined by atomic absorption spectroscopy. Ratios of SCL/Cp were constant in all groups tested, indicating that the ratio of bound to unbound copper in the serum is maintained relative to normal levels both in osteosarcoma patients and in women receiving chemical contraceptives. There was a highly significant increase over normal levels in Cp concentration in sera from patients with osteosarcoma and from women on chemical contraceptives, in agreement with our previous data on SCL. Either RID or REP can be used to measure serum Cp. The latter method appears to be faster and  more sensitive, whereas the former is easier to perform. It appears that the determination of serum Cp in osteosarcoma patients may be of value in differential diagnosis of the disease in selected patients, and in evaluation of the efficacy of therapy.


Fourteen-year remission of acute leukemia in a patient exposed to thorotrast. A case report of a patient who developed acute myelogenous leukemia 15 years after injection of Thorotrast and who has been in a sustained long term remission for 14 years is presented with a review of the problems associated with Thorotrast, subsequently shown to be radioactive with long term sequelae.


Prognosis in adult acute myelogenous leukemia related to performance status and other factors. Pretreatment factors of prognostic value were sought in 54 consecutively treated cases of adult acute myelogenous leukemia. Twenty of 37 patients with a good (greater than 50%) pretreatment Karnofsky performance status (P.S.) achieved complete remission (C.R.), while only 1/17 with a poor P.S. achieved C.R. This difference was highly significant (p=0.004). Complete remissions correlated with a median survival of 21 months. Patients with a good P.S. had a median survival of 8 months, while those with a poor P.S. had a median survival of only 1 month. This difference was also highly significant (p less than 0.002). Older patients with a good P.S. did as well as younger patients. The P.S., although imprecise, undoubtedly reflects the extent to which the disease, as well as intercurrent problems, have affected the patient. Attention to this aspect of patient selection for current drug regimens is indicated.


A psychophysiological study of determinants for detection of deception. Three studies were conducted to obtain available data on the determinants for detection of deception rates. (a) Psychophysiological measures were evaluated for effectiveness in detecting deception. A relevant-irrelevant method was used with two conditions; neutral stimulus and personal stimulus. Of the physiological variables, skin potential response, skin resistance response, finger pulse volume, and skin blood flow were significant indicators of deception. (b) Three experiments were conducted to study the psychophysiological effects of false and true feedback of skin potential response on the detection rates. It was concluded that the subjects receiving information that they were detectable were easier to detect than the subjects who believed that they were not detected and the subjects who received feedback of actual responses. (c) With the use of skin potential response channel, significant detection rates were obtained for all experiments under the condition that subjects verbally lied by means of "No" responses. On the other hand, the subjects who were motivated to deceive produced differentially augmented responses in the absence of any verbal response and also when the subjects told the truth to critical items and lied to irrelevant ones.


Dextran degrading activity of oral microbial flora. Dextran degrading activity of the human oral microflora was detected by culturing in TYD broth (Tryptose 1.0%, Yeast extract 0.3%, Dextran T-150 (Pharmacia, MW 150,000) 0.15%). All of the plaue and saliva samples collected from 10 subjects showed a dextran degrading activity, both cultured aerobically and anaerobically, while the anaerobic culture was more active than the aerobic. Furthermore, some individual differences were observed in their activity. Crude enzyme(s) was extracted from the supernatant of a mixed culture of plaque sample by adding ammonium-sulfate to 0.6 and 0.8 saturation (called E-1 and E-2, respectively). E-1 contained 2 dextran-degrading enzymes, one being thought to be an endo-enzyme, with the optimal of H being 5.0 and the other an exo-enzyme with the optimal pH being 7.0-7.5. On the other hand, E-2 contained 1 enzyme of the endo-type. Thirteen strains producing dextranase were isolated from the plaque and were identified as Bacteroides oralis-like organisms. Several other organisms were thought to produce dextranase, although we failed to isolate them in this experiment.


Dextran degrading bacteria in human oral cavity and their activity against insoluble glucan from Streptococcus mutants. The distribution of dextran-degrading microorganisms in the saliva and plaque samples from the human oral cavity was assayed on 9 subjects. Approximately 2/3 of the saliva samples degraded Dextran T-150 (Pharmacia, M.W. 150,000) and 1/10 the Blue Dextran (Pharmacia), while 2/5 and 1/8 of the plaque samples degraded Dextran T-150 and Blue Dextran, respectively. Thirty-seven strains of the Blue Dextran degrading bacteria were isolated from the saliva and plaque samples and were classified into 6 groups by their morphology, gram staining and oxygen tolerance. The 24 strains from the 37 isolates, more or less, were shown to degrade the insoluble glucan extracted from Streptococcus mutans FA-1 on the agar plate. The 8 strains, selected from each group, were tested for their activity against the insoluble glucan extracted from Str. mutans (FA-1, HS-6, BHT, CHT, GS-5, LM-7 and PK-1) and Str. salivarius (HHT). The strains belonging to Groups I, II, IV and V showed activity against the insoluble glucan used. Among them, the strains of Group IV (gram negative facultative cocci) and Group V (gram negative strict anaerobic rod) were the most active against the insoluble glucan.


Precipitation hardening in gold-cobalt alloys. The precipitation hardening in gold-cobalt alloys containing less than 5 wt.%Co was studied by means of resistivity, hardness, X-ray diffraction, and optical microscopic examination. The hardness curves showed two hardness peaks after isothermal ageing below the temperature of 250 or 300 degrees C. It was considered that the first peak was due to the formation of G.P. zone which was confirmed by reversion phenomenon. The second peak was due to the growth of metastable cobalt-rich precipitate, and this stage was found to make a major contribution to the age-hardening in the present alloys. The nodular products at grain boundary do not play an important role in age-hardening. Acitvation energies, order of the reaction involved, and the rate constant for the growth process were established. The difference in growth mechanism of the metastable precipitate was deduced from the kinetics data.


Gingival architectural forms in periodontal diseases. Changes in the gingival architectural form and the incidence were observed on 1,700 interdental papillae and 3,791 parts of the gingival margin of 89 patients, both males and females, with periodontal diseases. The effects of improperly adapted restoration, tooth irregularity, depth of periodontal pocket and degree of bone loss on the gingival changes were also examined. Of the four types of changes observed in the marginal gingiva, the recessed form occurred most frequently. Next in order of frequency of occurrence were the ledged, festoon and cleft forms. The greater part of the gingival changes observed in the interdental papilla were both of the blunted and enlarged forms. In the interdental papilla, the blunted and cratered forms increased and the enlarged form decreased according to the degree of bone loss. Improperly adapted restoration and tooth irregularity influenced the gingival changes observed. The depth of the periodontal pocket was not found to influence the gingival form.


Craniofacial growth in complete unilateral cleft lip and palate: a roentgeno-cephalometric study. This study investigated craniofacial growth in unilateral complete clefts using lateral roentgenographic cephalograms. The cleft sample was composed of 135 males and 120 females aged four, six, eight, ten, twelve and eighteen years. Control subjects included 120 non-cleft males and 120 non-cleft females of similar age to the cleft subjects. The cleft group differed from the control group in several major respects: (1) Their over-all growth trend showed a more downward or vertical direction; (2) The cranial base angle was more flattened; (3) The maxilla was smaller and was located in a more posterior and upward position; (4) Ramal height was shorter and the gonial angle was more obtuse. Chin position was generally retrognathic; (5) Skeletal profile showed less convexity; (6) Upper face height was less and lower face height was greater; (7) Both upper and lower central incisors showed a marked lingual inclination; (8) Females in both groups matured about two years earlier than did males. Underdevelopment in both the maxilla and the mandible was more pronounced in cleft females than in cleft males.


Facial and dental relationships of individuals with unoperated clefts of the lip and/or palate. Twelve individuals with unoperated unilateral clefts of the lip and palate and eight with unoperated unilateral clefts of thelip and alveolus were examined clinically and cephalometrically. The two groups were compared to each other and to a matched sample of normal individuals. All subjects were examined in their native India. Based on the findings of this investigation, it is suggested that, in general, the cranial base and skeletal face are not extensively malrelated in individuals with either unoperated unilateral clefts of the lip and palate or of the lip and alveolus when compared to matched normals. Yet, there are distinct differences in dentoalveolar and skeletal relations between both cleft groups and normals and between the two cleft groups.


Morphological findings in unoperated cleft lips and palates. A total of 353 children with cleft lips and palates were examined with regard to the morphology of the tissue surrounding the clefts in the lip, jaw, and palate. Photographs, radiograms (panoramic views of the maxilla), and study models were taken prior to operation. Results indicate a close relationship between the degree and condition of the cleft and the extension of the vermilion, the number of tooth buds adjacent to the cleft, the form and size of the alveolar borders, and the number and type of incisors. In isolated cleft palates, the cleft edges are always symmetrical and there is a gradual transition from board-arched, total clefts of the hard palate to the bifid uvula having no impact on articulation.


Treatment principles for the changing arch form in children with complete unilateral cleft lips and palates. Data on maxillary growth for 62 normal and 87 complete unilateral cleft lip and palate subjects presented in 1975 is supplemented and extended. The children ranged in age from six months to four years and were evaluated at four developmental stages. In order to clarify the character of the maxillary arch deformity, measurements of depth, width, height, and length were made and analyzed statistically. Prior to lip repair, cleft and normal subjects showed similar patterns of maxillary growth. This similarity was not apparent by age two. Anterior-posterior growth inhibition of the maxilla appeared to occur after lip repair and to remain a problem by age four. The authors discuss possible ways of minimizing these differences by management techniques.


Nasal deformity in unilateral cleft lip. The author presents his experience with the primary correction of nasal deformity in unilateral cleft lips in twenty five cases ranging in age from five months to 30 years. Emphasis is placed upon the important anatomical characteristics of the deformity, i.e. attenuation of the alar cartilage, displacement of the medial crus, thickening of the alar base as the result of deposition of fibrofatty tissue between the two separated layers of skin, accumulation of fibrofatty tissue between the two separated alar domes, drooping of the involved nostril and the presence of a well marked alar arch web. The technique described includes an adequate exposure through a bilateral gingivolabial sulcus incision connected by an intercartilaginous incision, release of the displaced alar base and columella, freeing of the alar cartilage from the opposite side and from overlying skin, repositioning of the alar cartilage and alar dome to a normal anatiomical position, and maintenance by a through and through mattress suture and a post-operative nasal pack. The immediate results have been satisfactory.


Clinical conference I. Calvarium and cranial base in Apert's syndrome: an autopsy report. A post-mortem examination of a 22-month-old boy with Apert's syndrome is reported. A linear coronal craniectomy performed at 11 months of age had fused completely in spite of the insertion of polyethylene film between the bony edges. Furthermore, progressive synostosis of other cranial sutures was observed. Histological examination of the cranial base showed that the sphenofrontal suture was fused and that the entire cerebral surface, including the sella turcica, was characterized by bone resorption. The sphenooccipital synchondrosis was extremely wide and abnormally shaped, and the chondral growth activity seemed diminished. It was concluded that the patient exhibited primary as well as secondary growth distrubances in the calvarium and cranial base. The premature synostosis of the coronal and sphenofrontal sutures and the anomaly of the sphenooccipital synchondrosis were interpreted as primary defects. The altered shape of the calvarium and the marked resorption and shortening of the cranial base were considered secondary changes. Furthermore, the investigation indicated that the conventional linear coronal craniectomy cannot be expected to improve the craniofacial growth pattern in patients with Apert syndrome. Alternative surgical procedures were suggested.


The number of acetylcholine molecules in a quantum and the interaction between quanta at the subsynaptic membrane of the skeletal neuromuscular synapse. 1. Postsynaptic responses to acetylcholine released from nerve terminals and from iontophoretic micropipettes were investigated in skeletal twitch-muscle fibers of the snake. The preparation consists of thin sheets of muscle fibers in which details of the end plate, including the outlines of individual synaptic boutons, are clearly seen in the living state. After treatment with collagenase, the motor nerve and its terminal boutons can be removed to expose the intact subsynaptic membrane to direct application of ACh by iontophoretic pipettes. 2. The number of ACh molecules in a quanta was estimated to be fewer than 10,000. This was done by developing a sensitive bioassay to measure the output of ACh from iontophoretic pipettes needed to produce synaptic responses closely resembling nerve-released miniature postsynaptic potentials. 3. Postsynaptic receptors are not saturated by the ACh in a quantum, since the peak of the quantal response produced by an appropriate background concentration of ACh from a pipette. 4. When acetylcholine esterase is inhibited, two or more quanta can act upon partially overlapping postsynaptic membrane areas and potentiate each other's effects. This potentiation reveals itself as a prolongation of the synaptic current. Postsynaptic potentiation is a consequence of the nonlinear dose-response characteristics of ACh receptors and can also be demonstrated in a model system in which ACh micropipettes substitute for quantal release from the nerve. 5. With AChE fully active, however, each quantum is functionally isolated from its neighbors and no postsynaptic potentiation is seen. 6. It is suggested that postsynaptic potentiation between quantum may play a role in signaling at synapses which have nonlinear dose-response characteristics and where transmitter is not so rapidly inactivated as at the neuromuscular synapse.


Persistence of junctional acetylcholine receptors following denervation. The relative number of acetylcholine receptors at normal and denervated end plates in rat soleus muscles was studied using the binding of 125I-alpha-bungarotoxin as a quantitative assay. After short-term denervation (up to 2.4 weeks), the extrajunctional binding increased, but there was no change in specific binding to the motor end plate. Denervation for longer periods (up to 7 weeks) reduced binding sites at the end plate by as much as 60-70%. Direct electrical stimulation of these muscles for the entire period of denervation did not prevent the slow loss of junctional binding sites, even though it was adequate to abolish the increase in extrajunctional binding. Cross-innervation by a foreign nerve at a site distant from the original end plates was more effective than stimulation in preserving the old end plates; in cross-innervated muscles, many denervated end plates continued to bind normal amounts of toxin for over 4 months. In comparison with the rapid rate of appearance or disappearance of extrajunctional ACh receptors, however, the number of junctional receptors at all denervated end plates was quite stable, suggesting that the persistence of these receptors is not immediately dependent on the presence of a motor nerve terminal.


[Primary healing of intraoral bone defects under the effect of local and general antibacterial prophylaxis]. On the basis of 4,700 cases, experience is reported which has been gained over 15 years with a method developed in Tübingen for the primary filling of intraoral bone defects which are big and/or especially jeoplardized by infection. To find an optimum antibacterial prophylaxis for undisturbed primary healing, the operative removal of a lower wisdom tooth is used as an example to compare groups of cases in which either only local prophylaxis of additional general prophylaxis was applied. Comparison of the results with the findings of other authors shows that local implantation of antibacterial substances is superior to an exclusively antibiotic general therapy and that the best results may be expected by simultaneous implantation and general therapy. The findings also cast a light on the importance of exact technical skills in the treatment of wounds and on the considerable influence of the type of gelatine sponge on the stabilization of blood coagulation.


[The feasibility of functionally stable compression osteosynthesis by means of percutaneous bone screws]. In order to achieve stability in function by osteosynthesis and consequently primary bony healing, the fragments of a fractured jaw are immobilized under compression by "compression plates". For special cases another method was developed by modification of the Stuttgart model in order to achieve compression osteosynthesis also when percutaneous bone screws are used.


[Radiodensitometric studies on bone structure following tooth extractions]. Radiographs of the human mandible, accurately showing the same location, are made at different times after extraction of lateral teeth and examined with regard to changes in the bone structure during wound healing. The radiograms are evaluated by densography and the photometric graphs thus obtained are evaluated by computer. Compared with histological findings known so far, these examinations furnish information on time and location of resorption and production of bone after dental extractions. The first findings are quantitatively presented.


[The clinic simulator, a new working place]. For the preclinical instruction of dental students and the training of dental assistants a working place has been developed which, in contrast to the phantom tables used so far, better simulates clinical treatment of patients.


[Maturation of residual tissue, left in the jaw after injury]. An eight-year old patient was observed for a period of eleven months: after the traumatic loss of a front tooth, the root of which had not fully grown, the maturing of the remnants of the follicle which were probably injured by the avulsion and not yet fully mineralized, was studied. In the histological examination of the enucleated dental hard material, regions of irregular dentin were found.


X-chromosome inactivation and selection in somatic cells. X-Chromosome inactivation leads to the formation of mosaic cell populations in the somatic cells of mammalian females. Cells have either a maternal or paternal X-chromosome active. If an individual is heterozygous for a cell autonomous X-linked trait, then a set of built-in cellular markers is provided for the investigation of various developmental phenomena, including selection. In the absence of somatic cell selection the tissues of an X-linked heterozygote should all be mosaic and should have a mosaic composition approaching 1:1. If somatic cell selection is occurring, it should be detectable by a significance shift from the random expected 1:1 mosaicism. The system is effective at detecting selection acting on X-linked loci and on newly arisen somatic autosomal variants, and several examples of somatic cell selection are described. However, it is concluded that somatic cell selection, as described above, is not a normal aspect of ontogeny.


Blastic crisis in previously clinically silent chronic myelogenous leukemia. A patient is described in whom CML first presented as blastic crisis. The diagnosis of CML was based upon the findings of Ph(1) chromosome in the bone marrow, basophilia in the peripheral blood, absence of NAP activity in the leukocytes, elevated serum vitamin B(12) and an enlarged firm spleen. CML with blastic crisis as its first expression is relatively rare, as compared to CML in which blastic crisis appears as a phase of prolonged clinically manifest disease.


In vitro differentiation of Rauscher-virus-induced myeloid leukemia cells. Three cell lines were established in vitro from myeloid leukemias of C57Bl/6 strain mice which had been inoculated with Rauscher virus at birth. The use of heated conditioned medium from peritoneum proved helpful for the initial growth of leukemic cells. At early in vitro passage levels, cell line R433 differentiated only to macrophages after contact with conditioned medium from peritoneum but it appeared to have lost the ability to differentiate during an extended period of cultivation. Cell line R448 was cytologically promyelocyte. When exposed to conditioned medium, this cell line differentiated only to neutrophilic granulocytes. Cell line R453 maintained the ability to differentiate either to neutrophilic granylocytes or to macrophages. Single cells recloned three times still gave rise to both types of mature cells containing conditioned medium. Occasional cases of "spontaneous" differentiation in clonal lines of R453 also occurred.


Non-random karyotypic evolution in chronic myeloid leukemia. The chromosome banding pattern was analyzed in bone-marrow cells and/or spleen cells of 10 patients in the blastic phase of chronic myeloid leukemia (CML). It was obvious from the karyotype analysis that the chromosome aberrations occurring addition to the Philadelphia chromosome (Ph1) were strictly non-random. An extra Ph1, trisomy 8 and/or trisomy for the long arm of chromosome 17 were observed in all cases. This consistent pattern of chromosome involvement in CML was confirmed in 57 cases from the literature studied with banding techniques. In 88% of the total number of cases with further changes at least one of the three main chromosomal aberrations was found ("major route" of karyotypic evolution).


Non-random chromosome changes in acute myeloid leukemia. Chromosome banding examination of 30 cases at diagnosis. Bone-marrow chromosomes were examined with the G-banding technique in 30 patients with acute myeloid leukemia at the time of diagnosis. In 13 of the 30 patients (43%) only normal diploid bone-marrow cells were found, and no deviations from the normal banding pattern could be detected in these cells. In bone-marrow cells of 17 patients (57%), distinct chromosome abnormalities were found; in 10 of the patients only abnormal cells were observed, whereas in 7 of the patients the abnormal cells coexisted with normal diploid cells without any visible chromosome banding abnormality. The results of the detailed analysis of the karyotypic aberrations demonstrated that when chromosome aberrations occurred they were clearly non-random. All patients except two displayed trisomy 8,9 or 21 or monosomy 7. Analysis of cases of acute leukemia from other laboratories indicated that the same consistent pattern of chromosome involvement prevailed in them.


A dying patient: the question of euthanasia. Mrs. A. B., a 61-year-old woman who presented with carcinoma of the breast in 1964, was readmitted to the hospital in 1974 in respiratory distress ensuing from chronic lung disease and metastatic illness. An active member of Alcoholics Anonymous for the past sixteen years, she had a living pattern in which she felt in control of herself, and from which she derived an important sense of self-esteem. Although in the hospital she requested that no extraordinary measures be taken to prolong her life, when she went into respiratory failure the house staff on duty intubated her and placed her in the Intensive Care Unit. Even though her physical condition rapidly improved, the patient told her own physician that she wanted to be extubated and off Intensive Care, despite her knowledge of a probable short survival. When her request was agreed to, contrary to expectations, she continued to improve. A lawyer, interested in problems of dying and euthanasia, interviewed her, and subsequently Psychosocial Rounds were held. The general conclusions at the Rounds were that she would die an appropriate death, and that euthanasia would not be possible under current circumstances. The staff at the Conference decided to accept at face value her request that she be allowed to die without heroic measures and with dignity.


Group process: an adjunct in liaison consultation psychiatry. Many liaison psychiatrists have advocated staff meetings as a means of enhancing communications on a medical ward. This paper, based on a one year experience as a psychiatric consultant to a medical ward in a major teaching institution, describes the implementation of a weekly group meeting of nursing and social service staff as a component in the structure of an effective liaison service. Case material is presented to document the efficacy of group process as a teaching and therapeutic modality. By encouraging the verbalization of cogent feelings and anxieties in a weekly group meeting, members developed a sense of mutual trust and openness. In an atmosphere conducive to promoting clarification, understanding, and insight, the group members increased their self awareness of the psychological aspects of physical disease and the effect of their own emotions on the interpersonal process of patient care.


A "desperation-reaction" model of medical diffusion. Knowledge about the adoption and diffusion of innovations is briefly reviewed. A model is then proposed to explain how certain innovations, intended to address dire medical problems, might diffuse in a manner not previously reported, with extensive diffusion occurring during what would be a period of small-scale experimentation and limited adoption in the conventional innovation-diffusion environment. The model is illustrated with findings from a case study of the diffusion of drug therapies for four types of leukemia. Possible implications of "desperation-reaction" diffusion are suggested.


Acute lymphoblastic leukaemia after treatment of nephrotic syndrome with immunosuppressive drugs. The authors present a 4-year-old girl with nephrotic syndrome who developed actue lymphoblastic leukaemia 5 months after the start of a combined treatment of alternate day prednisone and daily cyclophosphamide during 3 months. The nephrotic syndrome was due to focal segmental glomerulosclerosis. The occurrence of leukaemia might be related to the preceeding treatment with cyclophosphamide.


The teaching of pharmacology in dental schools in the United States and Canada. The teaching of pharmacology in dental schools in the United States and Canada was studied through an analysis of information provided by course directors of 58 schools. The study focuses on the number of courses taught and their position in the curriculum, the faculty and their professional qualifications, the length and content of courses, the textbooks used, methods of teaching, and examinations and other criteria for grading.


Designing and implementing relevant courses in dental management. 1. Dentist managerial behavior as defined by the dimensions described here is significantly related to dental team effectiveness. 2. Dental management courses and clinical experiences should be based, at least in part, on these dimensions of dentist managerial behavior.


Influence of instructional methods on student achievement and attitude in an introductory endodontic course. 1. Self-paced instruction did not improve performance in raw score on achievement by a different amount for each achievement level, but it did bring all the students to the same level of performance as the group-paced treatment in less time. 2. Permitting the self-paced students to take quizzes when they felt prepared improved student performance. 3. Self-paced instruction lends itself readily to flexible scheduling and thus permitted high achievers to complete the course sooner and allowed new students to start the course at any time. 4. The slide-tape method also freed the instructor from formal lectures and thus permitted him to spend one additional hour (the unused discussion hour) each week in laboratory exercises with the students.


Principles for dentist-pharmacist relationships: guidelines developed in Connecticut. The "Guiding principles for dentist-pharmacist relationships in Connecticut" was prepared under the auspices of the Connecticut Joint Dental-Pharmaceutical Committee of the Connecticut State Dental Association and the Connecticut Pharmaceutical Association. The committee is made up of six dentists and six pharmacists who represent their respective state associations. The committee provides a forum in which practicing, academic licensing, and supervisory representatives of both professions meet voluntarily to discuss scientific objects of mutual interest, make pertinent recommendations on matters of professional and public concern and, on request, attempt to resolve occasional differences that arise between responsible pharmacists and dentists. The "Guide" was prepared because of the significant increase in prescription writing by practicing dentists in Connecticut. Further, with the increased involvement of third party programs, the committee thought that the relationship between dentists and pharmacists should be formalized to establish that prescription writing is a significant part of dental practice. The "Guide" was approved by the executive committee of the Connecticut Pharmaceutical Association in January 1975 and the house of delegates of the Connecticut State Dental Association in May 1975.


Partial elimination of Streptococcus mutans from selected tooth surfaces after restoration of carious lesions and SnF2 prophylaxis. This study examined the prevalence of Streptococcus mutans in dental plaque from carious and noncarious sites before and after routine dental treatment in five young men in the US Navy. S mutans was isolated in 96.3% of the samples from carious sites and in 63.3% of the samples from noncarious sites before treatment. After all carious lesions had been restored, the prevalence of S mutans was significantly reduced, but many of the carious and noncarious sites still had detectable levels of S mutans. A further reduction in S mutans was observed after conventional 8.9% stannous fluoride paste prophylaxis and 10% stannous fluoride topical application; however, in no instance was the organism completely eliminated. About 12 to 18 months after the initial examination, new carious lesions were seen in four men who were available for reexamination. Plaque samples of new lesions had high levels of S mutans. Therefore the restorations of lesions and the stannous fluoride prophylaxis treatments given under the conditions of the study were effective but incomplete measures for eliminating S mutans from the tooth surfaces of Navy personnel and were inadequate procedures for arresting the carious process.


Stresses created by occlusal prematurities in a new photoelastic model system. A new photoelastic model system incorporating a simulated periodontal ligament sleeve around an experimental first molar has been developed. The system was used to visualize internal compressive stresses created by various premature occlusal incline relationships in both buccolingual and mesiodistal dimensions. When prematurities were applied singly and observed buccolingually, both class 1 and and class 2 prematurities produced stresses along the lingual aspect of the root, whereas the class 3 prematurity produced stresses along the buccal aspect of the root. When viewed buccolingually, combinations of class 1 and class 2 prematurities resulted in stresses along the lingual aspect of the root. The stress pattern was similar to those created by the single class 1 or class 2 prematurities. A combination of class 2 and class 3 prematurities did not produce a well-defined indication of stress distribution. There was slightly more stress along the buccal aspect of the root. Comparison of this combination with individual class 2 and class 3 prematurities indicates that such a combination tended to diminish tipping of the tooth in any one direction. A combination of class 1 and class 3 prematurities showed slightly greater stress along the buccal aspect of the root surface. Again, the combination produced less tipping of the tooth in any one direction when compared with tipping caused by the individual prematurities. When all three prematurities were tested at the same time, the stress pattern was almost coincident with that achieved in the absence of prematurities. When prematurities were observed mesiodistally, the location of stresses was dependent on the mesial or distal placement of the prematurity, irrespective of its position buccolingually.


Cervical enamel projections as an etiologic factor in furcation involvement. Two thousand molars in 200 East Indian skulls were examined for the occurrence, location, and grade of cervical enamel projections. The relationship between the enamel projections and furcation involvements was studied. Several findings resulted. The incidence of cervical enamel projections in molars was 32.6%. The incidence of cervical enamel projections varied between molars. The mandibular second molars showed the highest incidence of enamel projections (51.0%), followed by the maxillary second molars (45.6%). The lowest incidence was seen in the maxillary first molars (13.6%). Grade 1 enamel projections were the most frequently encountered. Cervical enamel projections occurred most frequently on the buccal surfaces of teeth. There was a positive, statistically significant relationship between tooth surfaces with grade 2 and 3 enamel projections and periodontally involved furcations. However, no etiologic relationship was found between grade 1 projections and furcation involvements. There seems to be a physiologic relationship between bone and enamel projections. The alveolar crest has a tendency to follow the outline of the enamel projection, and a channel much wider than a normal periodontal membrane space accommodates the enamel projection as it extends toward the furcation. The results indicate that when cervical enamel projections are severe enough to approach or enter the furcation area (grades 2 and 3), they may be an etiologic factor in the breakdown of these furcations.


Survey of dentists' opinions on issues facing the profession. Dentists in the Seventh District Dental Society of the State of New York were surveyed for their attitudes toward selected health policy issues to determine the extent of attitudinal consensus in the professional community, the bases of significant differences of opinion, and the agreement of the local dentists with official policies of the American Dental Association. Greatest agreement among dentists was found with respect to the issues of licensure and peer review; some significant differences of opinion were found about the existence of manpower problems, expansion of dental schools, recruitment of minorities, expanded-duty auxiliaries, and fee scheduling. Most dentists favored participation in continuing education courses without examination as a requisite for licensure and even more favored peer review by the local dental society. Agreement between opinions of local dentists and official ADA policies was high on all issues except fee posting, for which local opinion was evenly divided. The formation of national policies with regard to fee posting should proceed carefully.


Effect of Skylab missions on clinical and microbiologic aspects of oral health. Clinical and microbiologic measures of oral health were assessed in all crew members of each Skylab mission. Clinical factors included preflight and postflight clinical services, provisions for in-flight emergency dental care, and the preflight and postflight monitoring of alterations in clinical indexes of oral health. Microbiologic measures included the preflight and postflight monitoring of changes in microbial populations at various intraoral sites. Problems involving preflight and postflight clinical services were minimal and easily resolved. In-flight dental problems requiring emergency self-treatment were not encountered. Moderate increases were observed in the in-flight increments of dental plaque, calcalus, and gingival inflammation. With the possible exception of gingival inflammation, mission-related changes in clinical indexes of oral health mainly corresponded to those of comparable periods under more conventional circumstances. Microbiologic assessments showed noteworthy elevations in counts of specific anaerobic components of the oral microflora, streptococci, neisseria, lactobacilli, and enteric bacilli. Since most microbial changes occurred after the preflight incorporation of the space diet, they were believed to be diet related. The most meaningful finding of the study was the relative absence of intraoral changes that are hazardous to one's health.


Surgical repair of tusk injury (pulpectomy) in an adult, male forest elephant (Loxodonta cyclotis). A 15-year-old male forest elephant housed in a zoo sustained a fracture of the right tusk that was 10 cm inside the cheek pouch, thus exposing the tusk canal. Treatment of the cavity by packing, topical application of antibiotics, and administration of various antiseptic preparations failed; however, the tusk grew. To treat the infected, growing tusks's root canal or pulp, surgery--comparable to a pulpectomy in man--was performed with successful results.


[Methods of natural and voluntary sex selection. Value for the prevention of sex-linked malformations and of certain recurrent abortions]. Voluntary selection of the sex of a foetus may have an undeniable value in the prevention of certain diseases of malformations which are sex-linked. An indirect statistical control of the efficiency of these methods was carried out on 100 sterile treated couples. These couples agreed to respect a certain number of parameters which constitute the methods of voluntary selection of the sex of the foetus. Under these conditons and taking care that we were dealing only with cases where the sperm cell count was normal, the results were positive in 77%. It is probable the the results would have been above 80% if the parameter of the low pH of the vagina had been used as well. Attention was then directed to the possibility of using these methods to prevent certain sex-linked congenital malformations on the one hand (a classical idea) and prevention of certain repeated abortions on the other hand (a less well accepted idea). Three characteristic case histories have been reported to support these hypotheses.


Labial and palatal blood flow measurement before and after maxillary operations. In order to quantify the blood flow conditions of the mobilized anterior maxillary fragment after an operation to correct severe maxillary prognathism, maxillary blood flow measurements were carried out using the washout of the inert, radioactive tracer. Xenon-133. It shows that post-operative blood flow is not decreased.


Treatment of zygomatic fractures: internal wiring-antral-packing-reposition without fixation. Fifty-two patients with zygomatic fractures were examined clinically and roentgenologically 1 to 4 years after treatment. Of these patients, 15 were treated with wiring fixation, 26 with antral packing using plastic tubing, and 11 with reduction only, without fixation. In the last group, the hospital stay was the shortest. These patients had also less complications and roentgenological changes when compared with the other groups. This was considered to be due to the fact that fractures not requiring fixation are initially less difficult than fractures requiring other treatment. At clinical examination, internal wiring fixation proved to be better than antral packing when hospital stay, restoration of the function of the infra-orbital nerve, the position of the eye, symmetry of the palpebral fissure and the final cosmetic results are considered. In the antral packing group, the result was better when jaw movements and occurrence of permanent diplopia were compared. The roentgenological examination revealed that the reduction results were more exact with internal fixation than with antral packing.


Lipomata in oral tissues.

Lipomata in oral tissues. The literature on Lipomata and intra-oral Lipomata is reviewed and a series of 24 cases presented. In this series the mean age of presentation of the male patients was 53.8 years, whereas that of females was 63.1 years 33.3% of the tumours occurred on the inner aspect of the checks and of these 8 cases, six were males. Of the eight lesions occurring the floor of the mouth and retromolar areas, all but one occurred in females. Evidence is presented to support to the claim that intra-oral lipomata are indeed common benign neoplasms.


Simultaneous reconstruction of the area of the temporo-mandibular joint including the ramus of the mandible in a posttraumatic case. A case report. A new technique for the simultaneous reconstruction of the glenoid fossa and the ramus of the mandible is described. By combining and adapting procedures already described, the missing bone of the zygomatic arch, temporo-mandibular joint and ramus was replaced in one operation in a post-traumatic case. The indication for this operation is discussed. It is rather limited. The technique can be used for reconstruction of skeletal defects after tumour resection and in congenital aplasias of this region.


Correction of anterior open bite deformity: a study of tongue function, speech changes, and stability. Nine individuals with anterior open bite underwent tongue function and speech evaluation prior to treatment, postoperatively, and at three-month intervals for at least one year. Aberrant tongue function and speech improved in the absence of tongue or speech therapy during the postoperative period. Periodic clinical and cephalometric evaluation demonstrated generally good stability of treatment results for the period of study.


Survey of resident-selection procedures for oral surgery graduate programs. Results of a survey of the resident-selection procedures for oral surgery graduate programs have been reported. Data on the application process, interview mechanisms, decision process, and a retrospective view of past resident selections have been presented. Seventy-one percent of the respondents were satisfied with their current interview process. Eighty-two percent of the residents viewed retrospectively were considered worthy of reselection.


A rational approach to the mandibular parasymphyseal fracture. Facial scarring is avoided when a transoral degloving approach is used for treatment of parasymphyseal fractures. Complete visualization of the fracture line before and after the reduction is an added advantage of this safe, rapid, and technically easy approach. In patients with both parasymphyseal and condylar fractures, Risdon wires can also be used.


Ameloblastic fibro-odontoma: report of case with light and electron microscopic observations. A case of a large ameloblastic fibro-odontoma has been reported. Its clinical behavior was discussed and descriptions of its characteristics under the light and electron microscope were presented. As a special entity, with a prognosis that permits conservation of peripheral bone margins, this lesion should be understood by all clinicians who manage odontogenic tumors. Within the group of odontogenic tumors, the combined observations of light and electron microscopy may introduce additional criteria for more refined classification.


Mandibular involvement in acute lymphocytic leukemia: report of case. A case is presented that involved a lymphocytic leukemic infiltration of the mandible. The only symptoms were those related to the oral region. Biopsy of the mandible resulted in an early diagnosis and the referral of the patient for proper medical treatment.


Cushing's syndrome associated with the intradermal injection of triamcinolone diacetate. A case of long-term Cushing's syndrome after intradermal injection of 160 mg of triamcinolone diacetate has been presented. The evidence of whether this decrease occurred secondary to the intradermal injections of triamcinolone diacetate or to exogenous abuse is not clear. However, because of the extensive use of intradermal steroids in the treatment of keloids as well as other lesions, this case is significant, whatever the cause. Further study is being accomplished and the final results will be reported by the endocrinology service, Wilford Hall Medical Center, in a follow-up article.


Collagen resorption by fibroblasts. A theory of fibroblastic maintenance of the periodontal ligament. Periodontal ligament fibroblasts contain numerous intracellular or cytosegragated collagen fibrils. These fibrils appear to be broken down within the lysosomal apparatus of the cells. There is an increase in this activity in fibroblasts associated with osteoclastic bone resorption. Cytoplasmic microfilaments and attachments to substrata indicate that the fibroblasts of the ligament have the potential of migration and cytoplasmic contraction. A theory of collagen fiber maintenance within the periodontal ligament is proposed which takes into account: (1) the motility and contractility of fibroblasts, (2) the phagocytic and degradative potential of fibroblasts, (3) the presence of intracellular collagen and (4) the reported high turnover rate of acid-insoluble collagen within the periodontium.


The relationship between cemental caries, oral hygiene status and fermentable carbohydrate intake. Two groups of patients were evaluated for the presence of active, restored, and recurrent root surface caries. One group of 120 subjects had received treatment for moderate to severe periodontitis. The second group consisted of 124 subjects who were affected by moderate to severe periodontitis but had received no treatment. The two groups were also evaluated for amounts of recession, pocket depth, and the presence of bacterial plaque. In addition, each subject was asked to compile a record of his/her dietary intake for a seven-day period. The treated group was found to brush and floss more frequently than the untreated group and had a lower mean plaque score (45.8), than the untreated group (61.4). There was no difference in the mean plaque scores for the subgroups with and without root surface caries within either the treated groups. The prevalence of root surface caries increased through age 59 in the treated group, then diminished after age 60. In the untreated group the prevalence increased steadily with age. Analysis of the data from the dietary hisories revealed that the subjects in both the treated and the untreated groups who were affected with root surface caries had a significantly higher (P less than 0.01) number of fermentable carbohydrate exposures per week.


Assessment of attached gingiva using the tension test and clinical measurements. The attached gingiva on the facial surface of the mandibular central incisors was evaluated by measurements and the "tension test" on 226 subjects between the ages of 8 and 22 years. Findings of significance were: 1. As age increased a definite increase in width of attached gingiva occurred. 2. There was no increase in the frequency of a positive tension test in older age groups. 3. No relationship was observed when results of the tension test were compared with clinical measurements of attached gingiva.


Gingivitis and periodontal disease in pregnancy. Forty pregnant women in each of three trimesters of pregnancy and forty nonpregnant women of comparable age, socioeconomic status and dietary habit have been examined to evaluate the gingival condition and the calculus and debris deposits. The study has shown that: There is a significant increase in the severity of gingivitis during pregnancy; The gingival changes progressively increase during the course of pregnancy; The gingival changes are more marked than the periodontal changes seen during pregnancy (increase in periodontal disease was seen in only a limited number of cases); There was an appreciable increase in the calculus and debris deposits in the pregnant as compared to the nonpregnant women; Increase in the calculus and debris deposits was apparent in all the trimesters of pregnancy; Gingival changes showed a greater correlation with the calculus and the debris index in the pregnant than in the nonpregnant women; The role of the irritant oral deposits either as a precipitating or perpetuating factor in the genesis of gingivitis during pregnancy can not be excluded.


Effects of two cetylpyridinium chloride-containing mouthwashes on bacterial plaque. The purpose of this single blind clinical study was to determine the effects of two commerical mouthwashes (one containing cetylpyridinium chloride and domiphen bromide and the other containing only cetlypridinium chloride) on existing plaque accumulations. A second purpose was to determine if a residual effect could be shown 2 weeks after cessation of using these mouthwashes. A total of 120 adult subjects, who had been divided into three groups, were initially in the study. For a period of 31 days, the subjects in Group A rinsed with a commercial mouthwash containing cetylpyridinium chloride and domiphen bromide; Group B rinsed with a commercial mouthwash containing only ceytlpyridinium chloride; and Group C served as controls and rinsed with colored flavored water. All subjects continued their normal home oral hygiene practices, except that mothwashes other than as assigned were forbidden. The subjects received three identical examinations to determine their plaque scores. The examinations were conducted the day preceding initiation; the day following cessation; and 15 days after cessation of the rinsing procedures. A total of 105 subjects received the first and second examinations, and 93 subjects received all three examinations. Based upon the data obtained, the daily use of each of the cetylpyridinium chloride mouthwashes tested, appears to be partially effective in reducing existing bacterial plaque accumulations. The cetylpyridinium chloride-domophen bromide product was slightly, but not significantly, more effective than the other commercial mouthwash. Neither commerical product demonstrated a significant residual effect 2 weeks after cessation of use.


The progression of gingivitis to periodontitis in the beagle dog: a histological and morphometric investigation. The spread of the inflammatory cell infiltrate in the progression of gingivitis to periodontitis in the Beagle dog follows the course of blood vessels. Buccolingually this is towards the periosteal surface of the bone and interdentally towards the midpoint and angles of the interdental septum. Interdentally the path of spread may be modified by the local anatomy. Bone resoprtion buccolingually progresses from the periosteal surface towards the tooth and interproximally along the crest of the interdental septa and within marrow spaces. The pathway of spread of the inflammatory cell infiltrate, the anatomic relationships of the teeth to each other and the original morphology of the alveolar bone may influence the pattern of bone loss in periodontitis.


Radiographic assessment of proximal infrabony pocket topography. A method for determining the topography of interproximal infrabony pocket lesions has been presented, utilizing three intraoral radiographys. Three periapical films for the urea to be examined should be taken in a standard manner, one with the central beam angulation horizontal, another at -20degrees and the third at +20degrees. Following processing, the dried films should be examined, commencing with the -0degrees film and comparing the width of the transitional zone with that of the -20degrees film and then the film exposed with the central beam angulation at +20degrees. Following this sequence, if the transitional zone decreases in width between the 0degree and -20degrees film, then the bony destruction is greater for the buccal plate. Should the transitional zone increase in width when the above sequence of examining the film is undertaken, the bone destruction is greater for the lingual plate of bone. In each case the third film will confirm the diagnosis. In the case of horizontal bone destruction in a buccolingual direction, the transitional zone will be absent or of minimal width on the 0degree film when compared with the film exposed at +20degrees and -20degrees.


Histologic study of elastin-like fibers in the attached gingiva. Fifty-seven specimens of attached gingiva have been stained for elastic fibers. The number of elastin-like fibers in the papillary layer and reticular layer of the lamina propria have been scored using a scale of 0 to 3. Using similar H & E stained sections, the amount of inflammation was also scored. The presence of elastinlike fibers in the reticular layer of lamina propria of the attached gingiva has been described. Fibers have been found in the walls of blood vessels and they have been found intermingled with the dense collagenous tissue. While an attempt was made to establish a relationship between the relative number of elastin-like fibers and patient's age or degree of inflammation, lack of sufficient number of specimens at age troups precluded this.


Gingiva and periodontium in lepromatous leprosy. A clinical, radiological, and microscopical study. Thirty patients with lepromatous leprosy of long duration were examined for gingival and periodontal changes. All patients presented with chronic gingivitis and periodontitis of an unspecific type. Etiologic factors affecting the development of gingival and periodontal changes in this disease are: lack of oral hygiene with severe plaque and calculus formation due to the inability of the patients to perform oral hygiene, mouth breathing, specific granulomatous infiltrations, and a possible specific drug action. Specific changes in form of 'facies leprosa' are not pathognomonic of lepromatous leprosy but may be found in 20% of the cases among Thai and Chinese patients. Occurrence and pathogenesis of 'facies leprosa' is described.


The use of thymidine-2-C14 in the study of human gingiva in vitro. Human gingival explants were cultured for 1 or 2 days in a natural medium without serum. After 1 day in vitro the explants were partly encircled by epithelium which had proliferated from the cut edges of the explant and from rete ridges near the cut edge (epiboly). There was also some cell division in the cells of the spinous layer, and a thick parakeratotic layer had developed. These areas of proliferation were disclosed by the uptake of thymidine-2-C14 by the epithelial cells. Degenerative changes were also evident after 1 day in vitro. This began as hydropic degeneration in the spinous layer of the epithelium and resulted in almost total acantholysis and desquamation of the spinous layer after 2 days in vitro. The addition of serum to the medium might have promoted more epithelial proliferation and delayed the degeneration. The use of thymidine-2-C14 in the medium was an effective method of labeling the active epithelial cells.


Examination of topographical gingival anatomy by a filter imprint technique. The Millipore filter imprint technique was applied to oral cytology using modification of the Papanicolaou and Shorr stains. This technique has the major advantage of demonstrating on each imprint the topographic relationship between cellular zones and also allows for repeated sampling of superficial changes in the same area without tissue. This method provides a wide variety of cytological information about gingival anatomy and demonstrates a number of regions of differing cellular composition.


An examination of the cytology of uninflammed and inflammed gingiva using a filter imprint technique. Filter imprint cytologic specimens were obtained from the gingiva of 41 male dental students following clinical assessment of gingival health using a modification of the Loe gingival index. Nineteen of the specimens were from inflamed, and 22 from uninflamed gingiva. The imprints were fixed and stained by a modification of the Papanicolaou method and macroscopic and microscopic examinations showed that: 1. With increasing severity of clinically detectable gingival inflammation,, there appears to be an increase in the width of the bands of inflammatory cells and epithelial cells adjacent to the gingival margin. 2. An inverse relationship is found between keratinization and inflammation in that the percentages of anucleated epithelial cells was reduced at the gingival margin and significantly reduced midway in the attached gingiva of the inflamed groups. 3. No changes associated with inflammation were noted in cell cytology at the mucogingival junction.


Prevalence of dental caries in white and black children in Nelson County, Virginia, a rural southern community. Until a few years ago, the results of most surveys of the prevalence of dental caries among school-age children in the United States, particularly those done in the south, showed that black children had a lower prevalence of dental caries than did white children who lived in the same community.4-6,11,16,19,20-23,25 However, in several recent surveys, the formerly observed race-caries relation has not been detected.2,8,17,18,26 In connection with a study initiated in 1972 in Nelson County, Virginia to determine the effectiveness of a combination of self-applied procedures for the administration of fluoride, baseline data on dental caries experience were collected for 1,374 white and 761 black children attending the County's public schools. The availability of data for large numbers of white and black children prompted a cross-racial comparison of prevalence of dental caries. Findings of the comparative analysis are contained in this report.


Projecting shortages and surpluses of dentists from available data. The usefulness of manpower projections are reviewed and methodologies for projecting are reviewed. Estimates of current (1975) and projected (1990) surpluses and deficits of dentists are presented for Illinois. The model used to derive these estimates has the following characteristics. 1. Only generally available data are used. 2. Mortality rates of dentists, production and retention of new dentists, dental productivity by age, and immigration of dentists are all accounted for. 3. It is assumed that the distribution of new dentists in the future will be similar to the distribution of currently practicing dentists. 4. The assumptions regarding the demand variables of dental productivity and patient visits per person per year can be varied according to the specific situation.


Dental needs and costs for patients from three social agencies. This study indicates that for these patients studied from Johnson County, Iowa, the County Home residents have more unmet basic dental needs than do patients from Goodwill Industries or Community Action programs. The mean cost of treating the dental needs of a County home resident was found to be approximately twice that of providing dental services to the other two social service agencies. This cost differential comes about as a result of two major factors: (1) the County Home residents seen have more unmet basic dental needs, and (2) they have proportionately more unmet dental needs in specialty areas that cost more per unit of treatment (i.e. periodontics, fixed prosthodontics, and removable prosthodontics). The mean treatment cost per patient seen from each of these agencies is $851.77 for County Home residents, $407.97 for Goodwill Industry clients, and $341.21 for Community Action clients. A follow-up of this study in regard to specific circumstances that contribute to the higher incidence of dental treatment needs of the Johnson County Home residents is recommended. Such additional information would be helpful to the effective design of dental health programs for implementation at the community level.


Survey of dental needs and estimated cost of dental care of a disadvantaged university population. At the University of Connecticut, 115 disadvantaged students received dental examinations. There was a significant need for emergency dental care. The estimated cost of dental services for this group averaged $318.62 per student. The dental needs of disadvantaged and minority as well as all university students, should be addressed and services should be provided at least for needs of acute nature.


Effects of supervised daily dental plaque removal by children: first-year results. In September 1973, a three-year school-based study was initiated in East Hampton, Connecticut, a rural nonfluoridated community. The purpose of the study is to determine the effect on dental decay, gingival inflammation and oral hygiene of removing dental plaque through supervised daily toothbrushing and flossing in school during a three-year period. To establish baseline data, three indexes were used: the DHC Index to evaluate gingivitis; the DMF Surface Index to quantify dental caries and the PHP Index to measure dental plaque. The examinations for dental caries, including radiographs, are scheduled annually in September, whereas the plaque and gingival examinations are done biannually, in September and June. After the baseline examinations the 481 children were blocked according to grade and sex and then were randomly assigned to either a treatment group or to a control group. In November, the treatment group was provided 10 sessions of instruction in plaque removal. For the remainder of the year (six months) they practiced daily plaque removal, supervised by a dental hygienist and a nurse. The control group was not instructed in oral hygiene procedures. In the treatment group, mean plaque and gingival scores at the June (first follow-up) examination were 14 percent and 29 percent lower, respectively, than at baseline. No change was seen in the control group. At the second follow-up examination in September (after summer vacation), the same indexes were nearly at baseline levels in the treatment group. There was no treatment effect on dental caries increments after one year of study. Considering the nature of the treatment regimen and the few treatments during the first year of the study, it is not surprising that there were no caries-preventive benefits demonstrated among children in the treatment group after one year. The total number of the plaque removal sessions will be greater during the second year of the study. Therefore, the possibility of detecting a caries preventive effect at the twenty-four month examinations, should one exist, will be enhanced.


Chromosomes in cancer and leukemia.

Chromosomes in cancer and leukemia. An important aspect of chromosomes in human cancer is the fact that, with extremely rare exceptions, the chromosomal changes, if present, are confined to the malignant cells. Thus, in the case of cancer of the stomach or bladder, for example, the karyotypic aberrations can only be found in the cancerous cells, whereas the surrounding normal cells or those within the tumor (such as the leukocytes) have a normal chromosomal constitution. In the case of leukemia the chromosomal changes are best observed in the cells of the marrow, though if sufficient leukemic cells are circulating in the blood, the karyotypic changes can sometimes by established on such cells. In any case, in order to ascertain a reliable karyotypic picture in human cancer or leukemia the malignant cells must be examined and the chromosome constitution ascertained either by a direct technique not involving culture conditions or after short-term culture. Long-term culture of leukemic or cancerous cells generally leads to changes in the chromosomal picture either towards diploidy or towards aberrations resulting from in vitro conditions and, in either case, is not representative of the karyotypic picture in the original malignant cells. Since some tumors have a rather low mitotic index (and this applies occasionally to marrows of leukemia), either a repeat examination has to be undertaken or one has to resort to short-term culture.


Human chromatin and chromosomes studied by scanning electron microscopy: progress and perspectives. Scanning electron microscopy (SEM) has been utilized for the past several years for the study of whole-mount preparations of human chromosomes. Cell cycle-dependent changes in chromatin can be demonstrated easily. Chromomeres, which are mass accumulations at complementary points along each chromatid, provide a basis for the "banding" patterns produced by various stains used in light microscopy. In a highly condensed metaphase chromosome, only a rare free fiber end is seen, suggesting that a single chromatin fiber folds into a chromatid. The presence of interchromosomal fibers suggests that the DNA molecule (i.e., the chromatin fiber) might be folded into more than one chromosome. The specificity of the 9q+/22q-Ph1) translocation in chronic myelogenous leukemia and the evidence for nonrandom translocation abnormalities in adult acute leukemia suggest that either the linear integrity of the chromatin fiber comprising several chromosomes is real or that the nuclear membrane attachment site of individual chromosomes results in specific, adjacent chromosomes which are available for induction of nonrandom translocations.


Relationship of Friend murine leukemia virus production to growth and hemoglobin synthesis in cultured erythroleukemia cells. The factors that control oncornavirus formation were analyzed in Friend leukemia cells that undergo hematopoiesis when treated with dimethyl sulfoxide. Suspension cultures of Ostertag FSD-1 cell line were found to enter a G or resting state at the end of their proliferative phase and to simultaneously cease producing helper and dependent components of Friend virus. Whereas the decline in virus production is at least 100-fold, rates of cellular RNA and protein synthesis are only slightly lower in resting than in growing cells. Both resting and growing cells contain similarly large concentrations of the viral proteins P(30) and P(12). Dimethyl sulfoxide induces hemoglobin synthesis in growing cells, but its effects on virus production appear to be indirect results of its action to inhibit cell growth and thus to delay entry of cells into the G resting state. Furthermore, variant cell lines were obtained with differing abilities to synthesize virus or hemoglobin. Some lines no longer produce infectious virus, although they all harbor murine leukemia virus genes which are expressed to varying extents. The major internal protein of these oncornaviruses, P(30), is synthesized in large amounts by all of the cell lines. These results suggest that Friend virus production is not coinduced with erythroid differentiation, as had been proposed, but rather is controlled by a cellular growth cycle.


Population genetics and molecular evoulution. Recent studies of evolution and polymorphism at the molecular level (i.e, at the level of internal structure of the gene) have brought many puzzling as well as enlightening results. It appears that, in addition to natural selection, chance (in the form of random gene frequency drift) is playing a much larger part than previously considered. Futhermore, natural selection is likely to be based more directly on the secondary and the higher order structure of informational macromolecules rather than ecological conditions, usually in the form of negative selection. In this respect, there is growing evidence suggesting that very slightly deleterious mutations whose selective disadvantages are not excessively large as compared with the mutation rates are playing a significant role in variation and evoulution at the molecular level.


Peripheral joint scanning with technetium pertechnetate. Application in clinical practice. Results of a prospective study to evaluate the clinical usefulness of radioisotope joint scanning in the practice of rheumatology are reported. The radiopharmaceutical used was technetium pertechnetate, increased synovial blood flow being the main contributory factor to abnormal joint images. Strict adherence to a procedural protocol was necessary to assure reproducible images. Joint scintigraphy was performed on 56 control subjects without joint disease and 51 patients with different rheumatic disorders. There was excellent agreement between clinical examination and joint scintigraphy in all groups studied. In cases of disagreement, the joint scintigram generally was more sensitive. This high sensitivity for the detection of synovitis was accompanied by a lack of specificity, because it failed to diagnose the nature of the joint involvement. The joint scan was helpful for diagnosing early or steroid-suppressed synovitis and also for suspected nonarticular rheumatism. It aided in delineating the pattern of joint involvement. Joint scintigraphy is the only objective nontraumatic permanent record documenting joint inflammation.


Chloramphenicol-a possible role in the treatment of leukaemia? The effect of chloramphenicol in short term in-vitro bone marrow cultures was studied. There was a striking reduction in the incorporation of tritiated thymidine into DNA in bone marrow cultures with abnormal proliferative properties as compared with normal tissue. A 50% reduction in DNA thymidine incorporation in leukaemia marrow was also obtained with in-vitro chloramphenicol concentrations which in contrast had little or no effect in normal tissue. These in-vitro levels of the antibiotic can be readily achieved in vivo. An in-vivo study confirmed the ability of chloramphenicol to reduce the white cell and blast count in a patient with chronic myeloid leukaemia in blastic transformation.


Genetic mosaicism and the control of cancer. The susceptibility of animal cells to certain lethal agents, including a variety of cytotoxic drugs, is genetically determined; cells which are otherwise identical may therefore differ in terms of which agents are lethal for them. If such genetic diversity existed within a tissue, exposure to any of these lethal agents would not destroy every cell, but only that fraction of the population that was susceptible. In contrast, if a clone of malignant cells arose from any single cell within such a tissue, the entire malignant clone should be susceptible to destruction by whatever agent its progenitor cells was susceptible to. Treatment of a tumor in a host whose tissues displayed such genetic mosaicism might therefore possess the potential for destroying all tumor cells, at the cost of destroying only a fraction of the normal cells. Prophylactic induction of such mosaicism in normal hosts by genetic manipulation represents a potential future strategy for cancer control. Evidence is presented suggesting that women heterozygous for deficiency of the enzyme hypoxanthine-guanine phosphoribosyl-transferase may constitute naturally occurring examples of such exploitable mosaicism.


[Limitations in the opening of the mouth of an arthrogenic nature]. Mouth opening limitations of arthrogenous nature are subdivided according to a personal schedule into indirect and direct types. The former are brought on by occlusal alterations: these affect articular remodelling and may cause anatomical and functional changes of varying gravity in the temporo-mandibular joint with consequent limitations on opening movements. The latter are the consequence of various pathogenic agents (traumatic, neoplastic, inflammatory, degenerative) originating within the articular structures and developing therein, progressively limiting their function. Some significant personal cases are reported and on the basis of the series the aetiopathogenetic problems of the various forms are discussed, with emphasis on those which represent the basic criteria for therapy.


[Mouth oepning limitations due to coronoid-zygomatic-malar interference]. Interferences between coronoid process and bone walls of the zygomatic arch should always be considered among the causes of extra-ankylotic mouth-opening limitation. With the exception of traumatic cases, the event is rare and once correct diagnosis has been made there are excellent opportunities for treatment, largely of surgical nature. The zygomatic-malar area or coronoid process will be operated on depending on the case. When surgery has involved the coronoid process it is advisable to follow up with an adequate period of mechanotherapy.


[Mouth opening limitations due to soft tissue lesions]. Mouth opening limitations following on soft tissue lesions are subdivided according to aetiology into collagen disease connectival lesions, cutaneous and mucosa lesions consequent on the action of physical agents and, finally, cicatricial lesions of the cheeks and lips as a result of surgery for cancer or trauma. The commonest forms of plastic surgery used to correct such lesions are reviewed.


[Evaluation of the effects of some non-steroid anti-inflammatory agents on the gastric mucosa]. 300 mg/day phenylbutazone, 210 mg/day indomethacin, and 600 mg/day pyrasanone were administered for 14 days to three randomised groups of patients respectively, consisting of a total of 76 subjects with various forms of non-infectious inflammation (osteoarthritis, fibrositis, rheumatoid arthritis, gout, phlebitis), in a double-blind trila designed to determine the activity of the three drugs and their tolerance. In 36 cases, gastroscopy was performed before and after the treatment. On the basis of doses that were equivalent as far as their anti-inflammatory effect was concerned, epigastric pain and pyrosis were noted in about 31% of the series, though no significant difference could be made out between the three drugs. Gastroscopic evidence of erythema (8 cases), multiple erosion (2 cases), pomphoid gastritis (1 case), and duodenal ulcer (1 case) was obtained in subjects treated with phenylbutazone or indomethacin, and of erythema only (1 case) after pyrasanone. No relation could be established between the clinical symptoms and the gastroscopic findings.


Multiple-drug chemotherapy in the management of acute lymphocytic leukemia during pregnancy. Acute leukemia associates with pregnancy is relatively uncommon, and because of the age distribution of patients with acute leukemia the majority have had acute granulocytic leukemia. Various combinations of chemotherapeutic agents are commonly employed now to obtain maximal benefit, related to differing pharmacologic activities of single agents. The present case documents the use of multiple cytotoxic drugs in the management of acute lymphocytic leukemia, with successful delivery of a normal infant. In this patient severe anemia and potentially teratogenic drugs did not appear to affect the fetus.


Intentional retention of vital submerged roots in dogs. In this study, intact and untreated roots of twelve teeth in three dogs were submerged 2 mm. below the alveolar bone crest. On eight regeneration of alveolar bone was seen in 3 weeks, with complete bone coverage in 5 weeks. A complete lamina dura surrounded the buried roots, the original root canal tissue remained vital, and vessels and other structures now entered (or exited) from both ends. Cementum covered the cut end, making the end similar to a normal apex. Bone failed to regenerate completely over four of the twelve roots. Two of these had dentinal spicules which impeded complete bone coverage (Fig 9). Another was a case of delayed healing due to the early loss of sutures and subsequent infection where a sinus tract developed, connecting the oral environment with the resected root. This led to bone resorption and a partial pulp necrosis. In the fourth case the decreased depth of root burial and subsequent lack of bone cover led to external resorption of the cut dentin. Histologic examination after 12 weeks revealed the regeneration of bone, a regenerated periodontal membrane, and a layer of cementoblasts over the cut and exposed root dentin in a typical manner. This study suggests that when healthy bone and roots are present, particularly in an otherwise edentulous mandible retaining only a few nonrestorable anterior teeth, the roots can be retained in a nonpathologic state by means of a simple surgical technique.


A dental radiologic health laboratory teaching method. The School of Dental Medicine at Tufts University has given new direction to the understanding of radiologic health through a program in which all students participate in some laboratory activities directly related to the problems of radiologic health in dental practice. This article presents an explanation of the background of this program and the experiments performed and discusses the interest in the program and its effect on the dental students. The laboratory program described is held for 3 1/2 hours on Wednesday afternoons at the Dental School, since this is a period of minimum patient load in the Radiology Department. The course is presented for third-year dental students who already have takin a lecture course in the fundamentals and techniques of radiology and have received training in the proper procedures for taking radiographs. The program is designed as a series of experiments dealing with machine output, filtration, collimation, exposure factors, scatter radiation, film density, patient protection, and shielding. The students are introduced to various radiation-detection instruments and given the opportunity to use these instruments to measure output and scatter-radiation levels under varying conditions. The laboratory teaching method presented can also be reprogrammed for different group sizes and time schedules.


Intraoral-mucosal-xenogenous fascial grafting. Fascia obtained from the abdominal wall of a rat was transplanted into mucosal defects created in six dogs. In all of the dogs, the fascia was found to adhere firmly to the underlying tissue and surrounding epithelium. Biopsy specimens were taken at weekly intervals for 4 weeks. The defects healed without any apparent contracture and were covered by new epithelium. It appears that xenogenous fascia is a potentially useful graft material for intraoral soft tissues.


Congenital arteriovenous malformations of the face. Report of a case. Arteriovenous malformations (AVM) are uncommon vascular abnormalities which can be either developmental defects present from birth, or acquired ones, secondary to trauma. They may cause local swelling and discomfort, and also may present a potential for severe bleeding. Traumatic AVM are usually single fistulous channels, whereas congenital lesions are most often multiple interconnections of vessels of varying caliber that result in a diffuseness which renders clini-al delineation and treatment difficult. The nature of the lesion is determined by the stage of development of the vascular system during which it develops. Congenital lesions range from finely channelled capillary hemangiomas to large-bore, high-flow A-V fistulas. Most lesions are not observed at birth, but become manifest later in life; minor trauma and endocrine change are implicated as the stimuli for the initiation of hemodynamic activity. The diagnosis is clinical, with confirmation by arteriography. The treatment has not been completely satisfactory in all cases. Surgical intervention has been used most often, but newer techniques include cryotherapy and muscle embolization.


Intraoral corroboration of systemic plasma-cell myeloma. Abbreviated case report. A patient with a previously diagnosed case of multiple myeloma was readmitted for a pathologic fracture of the hip. Intraoral examination revealed a soft-tissue swelling over the right posterior mandibular ridge. Radiographs showed multiple radiolucent areas of the maxilla and mandible. A needle-biopsy technique was used to confirm the diagnosis of intraoral manifestations of plasma-cell myeloma.


PTA deficiency (factor XI deficiency). Report of a case. A case of a relatively rare coagulopathy has been presented. The mode of inheritance and the incidence of the disease have been discussed. Methods of screening, diagnosis, and treatment of PTA deficiency have been suggested. We have concluded that if a coagulation screen for patients about to undergo oral surgery in a hospital is contemplated, either a partial thromboplastin time or a thromboplastin generation time should be included.


Periodontosis: a phenotypic and genetic analysis. Two families who provide additional data concerning the metabolic, radiographic, and clinical parameters of periodontosis are presented. These findings include decreased serum alkaline phosphatase levels with absent liver isozyme fractions, decreased tubular bone over-all width and medullary space with relatively increased cortical area, and at least one case of primary dentition alveoloclasia with no permanent dentition alveoloclasia. In addition, a segregation analysis was performed on these two families and all completely reported families found in the literature. The results indicate that periodontosis is most probably inherited as an X-linked, dominant trait with decreased penetrance but relatively consistent gene expressivity. The female: male ratio of affected persons is approximately 2:1, and there is an over-all deficiency of males in these affected families.


Osteogenesis imperfecta. Review of the medical and dental literature and report of a case. Osteogenesis imperfecta is a rare congenital bone disease affecting the mesenchyme and some of its derivatives resulting in three basic clinical entities--fragility of bones, blue sclera, and otosclerosis. The medical and dental literature pertaining to osteogenesis imperfecta is reviewed, and a specific dental case is discussed.


The odontogenic keratocyst. A clinicopathologic study of 312 cases. Part I. Clinical features. An analysis was made of the clinical features of 312 acceptable cases of odontogenic keratocysts from the files of the Department of Oral Pathology, Indiana University School of Dentistry. A total of 5.1 per cent of the keratocysts were from patients with the basal-cell nevus syndrome and 5.8 per cent were from patients with multiple keratocysts but with no other features of the syndrome. There was a wide age range, with a peak incidence in the second and third decades of life. The mandible: maxilla ratio was 2:1, with the mandibular third molar area and ramus being the most common sites. Dentigerous cyst was the most frequent clinical as well as histologic diagnosis for the majority of the keratocysts in this study. The primordial cyst comprised the greatest percentage of keratocysts (44.4 per cent). A total of 50.3 per cent of the patients were symptomatic before seeking treatment, the most common finding being intraoral drainage and swelling. Their radiographic appearance was quite variable, although they frequently resembled ameloblastoma. These cysts may be very aggressive clinically. They have a relatively high recurrence rate, as previously reported in the literature, in comparison with other types of odontogenic cyst. The findings in this study support the theory that the histologic appearance of an odontogenic keratocyst may be assumed by any of the odontogenic or nonodontogenic cysts.


The retrocuspid papilla. A clinical survey. 1. As mentioned previously in the literature, RCPs are commonly found in the young but become progressively less evident with advancing age. 2. The incidence of the RCP in Negroes is approximately the same as that in Caucasians. 3. Bilateral RCPs are more common than unilateral papillae. 4. The occurrence of RCPs is consistently more common in females than in males, in both Caucasians and Negroes. 5. Histologically, the RCPs are essentially normal, showing features indicative of those seen in frictional irritation during mastication and phonation. 6. The 72.5 per cent incidence of RCPs in children under 11 years of age confirms the trends of past studies and indicates that the RCP is a normal entity in pediatric dental patients and should be included in the literature as such. 7. The clinical significance of the RCP is that it be recognized as a normal anatomic structure that regresses with age and requires no treatment.


Necrotizing sialometaplasia.

Necrotizing sialometaplasia. Three cases of necrotizing sialometaplasia of minor salivary glands are presented. Clinically and pathologically, this nonneoplastic lesion of the palate can be easily mistaken for carcinoma. The main histologic features are localized infarction of minor salivary glands and extensive squamous metaplasia with retention of the lobular architecture of the involved glands. The possible etiologic factors are discussed.


[Ameloblastoma formation in an extensive follicular cyst]. A case of an unusual extensive dentigerous cyst of the mandible with ameloblastic formations in the cyst wall is presented. The tumor was totally enucleated in a two-step conservative surgical prosedure over 14 months, whereby the continuity of the mandible was preserved. The patient has been followed for two years. There has been a complete bone regeneration and no recurrence of the tumor. The importance of biopsy of odontogenic cysts associated with mandibular third molars is stressed.


[Mixed teeth--a case report and an alternative treatment]. A case of "double" lower incisor is described. The patient also had a supernumerary lower incisor and was treated by removal of the abnormal incisor and transplantation of the supernumerary incisor. The transplanted tooth has normal mobility and healthy gingival tissue 6 1/2 months after the transplantation.


[Refractory anemias with partial myeloblastosis. Analysis of a protocol comprising 79 cases. 1. Clinical characteristics and evolution under androgen therapy]. Seventy-nine patients with a refractory anemia and partial myeloblastic medullary infiltration have been studied, according to a prospective common protocol. All the patients have been treated with androgens, at high dosage and for at least 10 months if surviving. This study enables to precise the natural history of the disease and to define some criteria valuable for the prognosis. It demonstrates that the classification of this clinical entity as a smoldering or pre-leukemia is justified: 63% of the patients died from acute myeloblastic leukemia. The disease is very severe: the median of survival from the diagnosis is only 13 months. Androgen therapy appears to have little if any effect on the anemia, granulocytopenia and thrombocytopenia; it does not seem to increase the patients' life expectancy.


[Refractory anemia with partial myeloblastic medullary infiltration. Examination of marrow biopsies (author's transl)]. 77 marrow biopsies of smouldering leukemia have been examined in triple blind fashion with the following results: the cellularity of the marrow is normal in three quarters of the cases. In one quarter the blast cells were homogenous, which confirms the diagnosis of leukemia. The frequences of the sheets of blast cells increase with the duration of the disease and reached 80% at the 20th month. In the other cases, blasts were seldom seen. Eosinophilia was frequent. Erythroblasts were always rare, in contrast to what is seen in sideroblastic anemias. The reticulin network was thickened in 25% of the cases. Thus, bone marrow biopsy may demonstrate many of the features supporting the diagnosis of smouldering leukemia.


[Attempt at "conservative medical treatment" in the decompensations of chronic respiratory insufficiencies]. Study of 37 acute respiratory decompensations occurring in 28 patients over a 6 years period (1969-1975). They were given a systematic "conservative treatment" associating ventilation with a mask or a mouthpiece, physiotherapy and various drugs, intubation being used only in case of failure of this treatment. On the whole 22 compensations were cured by this treatment alone (59%) and the 15 cases that were not were given classical reanimation. Six deaths were reported (16%). Definitely better than those of DUBOIS and PRIGNOT, these results were perhaps due to differences of recruitment, but also to the systematic use of a mechanical ventilatory assistance instead of a continuous oxygen therapy. With attentive care, this category of patients could be given an assisted external but early ventilation, thus sparing them a tracheal intubation more than once out of twice.


Retinal has a highly dipolar vertically excited singlet state: implications for vision. We have measured the effect of an intense electric field on the absorption spectrum of solutions of all-trans retinal, its unprotonated Schiff base with n-butylamine, and the Cl- salt of this protonated Schiff base. The field-induced change in extinction coefficient as a function of wavelength was analyzed to determine the ground-state dipole moment (mug), the change in dipole moment on excitation (deltamu), and the direction of mug and deltamu). These experiments have shown that all three species become highly dipolar upon excitation to the first allowed excited singlet state (deltamu = 15.6, 9.9, 12D, respectively). The ground-state and excited-state dipole moments are nearly parallel to the long axis of these molecules. Excitation is accompanied by a shift of negative charge toward the carbonyl or Schiff base terminus, making the ionone end of these molecules positively charged. The large excited state dipole moment of all-trans retinal indicates that the vertically excited state, which is of 1Bu parentage (C2h), has become significantly mixed with even-parity states. On the basis of previous theoretical calculations, this mixing is expected to facilitate isomerization in the singlet manifold. We have also found that 11-cis retinal has a large deltamu (12.7 +/- 1.4 D) on excitation. In the visual pigments, the interaction of the excited-state dipole moment of retinal with a suitably located charged group could control the position of the absorption maximum. Also, the large shift in charge density upon excitation of retinal may lead to new electrostatic interactions between the chromophore and the protein that would act as a driving force for the initial conformational changes in visual excitation.


Synthesis of choline from ethanolamine in rat brain. Specific radioactivities of choline, acetylcholine, phosphocholine, lecithin, lysolecithin, and glycerophosphorylcholine have been measured in brain, blood, liver, and muscle after the intravenous injection of three labeled precursors: choline, methyl-labeled methionine, and ethanolamine. In relation to the specific activity of free choline in blood there was significantly more radioactivity in the free choline of brain after administration of methyl-labeled methionine and labeled ethanolamine than after labeled choline. Since the choline moiety of lipids, which returns back to the choline pool, contained less radioactivity after methyl-labeled methionine and labeled ethanolamine than after labeled choline, it is the most likely interpretation of the finding that choline, in brain can be formed by methylation of free ethanolamine. Data from liver confirm that lecithin is formed in the liver by methylation of phosphatidylethanolamine. No indication was found for the synthesis of choline in muscle. Rates of transfer and transport of choline in brain have been calculated as nmol x g-1 x min-1 as follows: turnover rate of choline, 36.5; rate of synthesis of choline by methylation and net loss of choline into the bloodstream, 6.3; inflow from the blood 6.2; outflow into the blood, 12.5; transfer into lipids and vice versa, 20; transfer to acetylcholine and vice versa, 4.


Isolation of an inhibitor of DNA synthesis specific for normal and malignant mammary cells. A small-molecular-weight inhibitor of DNA synthesis, specific for normal and malignant mammary cells but devoid of species-specificity, has been isolated from bovine mammary glands. This factor has very little effect on RNA metabolism.


Structural evidence that human liver and placental alkaline phosphatase isoenzymes are coded by different genes. Human liver alkaline phosphatase [ortho-phosphoric monoester phosphohydrolase (alkaline optimum), EC 3.1.3.1] was purified, and some of its physical and chemical properties were examined and compared to those of human placental alkaline phosphatase. The results indicated a different peptide structure for each, based upon HB2-terminal residue sequence, two-dimensional tryptic peptide maps, and different amino acid compositions. These data are interpreted to indicate that the enzymes are synthesized by different structural genes. Other molecular properties differentiating the two enzymes were a higher apparent molecular weight for the liver enzyme from sodium dodecyl sulfate gel electrophoresis, a higher S20,w value, different carbohydrate content, and a different isoelectric point. The immunochemical specificity of each enzyme was not affected by removal of sialic acid groups. Both enzymes are similar in that they are dimers of equal molecular weight subunits, and are probably homodimers.


Isolation of a novel endogenous opiate analgesic from human blood. Based upon its ability to inhibit opiate receptor binding, a low-molecular-weight substance (600) has been isolated from human plasma by extraction into butanol and ion exchange, molecular sieve, and thin-layer chromatography. When this substance, termed anodynin, is microinjected into rat periaqueductal gray matter, it causes a profound, long-lasting analgesia which is prevented by prior injection of the opiate antagonist naloxone. Anodynin (opiate receptor binding material) levels in serum from hypophysectomized rats are less than 5% of values obtained in sham-operated controls. Anodynin differs from enkephalin, a morphine-like peptide isolated from brain, in its sensitivity to enzymatic loss of opiate receptor inhibitory potency, thin-layer chromatographic mobility, and behavioral effects. Anodynin might be a hormone that acts on peripheral opiate receptors in the classical manner, but might also, due to its lipophilic nature and small size, penetrate into the brain to produce centrally mediated behavioral effects.