Viscoelastic properties of elastomeric impression materials. III. The elastic recovery after removal of strains applied at the setting time. A method of measuring the elastic recovery of impression materials after the application of a strain applied at the setting time is described. The results obtained using this method for a representative selection of impression materials are presented and discussed.


In vitro toxicity tests of zinc phosphate cement. BHK-21 (C-13) cells were exposed to freshly mixed zinc phosphate cement for 0.5, 1 and 2 h in a simulated cavity apparatus. The effect on the cells was evaluated by quantitative measurement of acid phosphatase and succinic dehydrogenase reaction product in order to determine organelle membrane permeability. After 0.5 h cell-material contact there was no significant effect. After 1 h cell-material contact, there was slight labilization of the lysosomal membranes, and a significant decrease in succinic dehydrogenase activity. The mean overall stain density in the experimental cells was 109% and 57% of the control values for acid phosphotase and succinic dehydrogenase respectively. After 2 h cell-material contact, there was significant labilization of the lysosomal membranes, and also labilization of the mitochondrial membranes. The mean overall stain densities were 114% and 75% of the control values for acid phosphatase and succinic dehydrogenase respectively. The relevance of these findings to the in vivo situation is discussed.


Tissue conditioners as functional impression materials. Permanent deformation, strain in compression, flow, dimensional stability, reproduction of detail and gypsum compatibility of three commercial tissue conditioners (Coe-Comfort, FITT and Hydro-cast) and one polysulphide base Type I impression material (Coe-flex) were measured according to ADA Specification No. 19. Although the tissue conditioners generally exhibited higher deformations and lower gypsum compatibility than specified by ADA Specification No. 19, the materials can, in all probability, be considered adequate for the present. It would appear that the development of international standards for tissue conditioners and functional impression materials is badly needed.


Age changes in the perception of comfortable mandibular occlusal positions. It has been shown that a zone of comfort in maxillo-mandibular relationships in edentulous subjects can be identified with some precision. Whilst the neurophysiological mechanism involved has not been explained fully, the phenomenon is influenced by starting position and by fatigue. This experiment was set up to test the hypothesis that age is another significant factor in perception of the comfortable zone. A group of seventeen subjects with a mean age of 62 years and an equivalent younger group, the mean age of which was 28 years, were tested with Timmer screw jacks applied using the central approach to record the upper and lower limits of the zone fifteen times in succession for each subject. A linear statistical model was used to analyse the data from upper and lower borders separately. The results showed that the effect of making successive adjustments, whilst not significant statistically in the young group, was significant in the more elderly. Regression lines from the young group data were horizontal signifying the high degree of accuracy with which their perceptual mechanisms worked: the upwards inclination of those from the more elderly was interpreted as showing that initial appreciations were subjected to constant correction.


The convergence angle in teeth prepared for artificial crowns. The bucco-lingual and mesio-distal convergence angles in vital and rootfilled teeth prepared for complete crowns were measured microscopically on 190 stone dies. In vital teeth the mean convergence angles varied between approximately 19 and 27 degrees. In rootfilled teeth the mean angles varied between 12 and 37.


Measurement of lip posture and interaction between lip posture and resting face height. A method for measurement of lip incompetence is described. Electromyographic techniques were used to obtain relaxation of the muscles of the lip and of a jaw elevator muscle. Standardized photographs were taken of the subject's profile, from which lip separation and face height were measured. Variation was found in successive measurements of lip posture, some of which appeared to depend upon mandibular posture. With the teeth in occlusion, lip separation was reduced. Active maintenance of lip contact by the subject was often associated with a reduction in lower face height, which may have been a direct consequence of the lip muscle activity, or of jaw elevator activity facilitating the lip closure.


Revascularization after surgical repositioning of one-tooth dento-osseous segments. Vascularization, revascularization, and bone healing were studied after two different surgical techniques for surgical repositioning of single-tooth dento-osseous segments in adult mongrel dogs. Microangiographic and histologic studies of both one-stage and two-stage techniques for immediate surgical repositioning of single-tooth dento-osseous segments showed early but transient vascular ischemia, minimal osteonecrosis, and osseous union between most of the osteotomized segments. The attached soft tissue provided an adequate vascular pedicle for immediate repositioning of small dento-osseous segments by interdental and subapical osteotomies. The results of these clinically analogues studies support the clinical use of techniques that maximize the attachment of the gingiva to the mobilized dento-osseous segment.


Comparison of a polyglycolic-polylactic acid suture to black silk and plain catgut in human oral tissues. A polylactic-polyglycolic acid synthetic absorbable suture material (Vicryl, Polyglactin 910) was compared with black silk and plain catgut in human oral tissues. Inflammation was graded clinically and histologically after seven days. Handling characteristics, including suture retention, were evaluated. Vicryl and black silk sutures produced comparable inflammation after seven days. Plain catgut sutures were usually absorbed before seven days, but when retained generally produced a more severe reaction. The polylactic-polyglycolic acid suture is braided and dyed, and has handling characteristics similar to those of black silk. Although they are absorbable, Vicryl sutures may be retained longer than desired and probably should be used like silk when exposed to the oral cavity.


Odontogenic tumors: analysis of 706 cases. From a total of 54,534 oral biopsy specimens, 706 (1.3%) odontogenic tumors were retrieved and reviewed. Odontomas comprised more than 65% of the odontogenic tumors, ameloblastomas about 10%, and the remaining six categories of odontogenic tumors accounted for approximately 25% of the lesions. The distribution by age, sex, and location of these tumors generally supported the data from other previously reported cases. A possible variant of the calcifying epithelial odontogenic tumor was described, and instances of two granular cell ameloblastic fibromas were reported. The myxomas as a group were characterized histologically more by residual bony trabeculae than by the presence of odontogenic rests. Because the clinical, histological, and behavioral features of the ameloblastic fibroma and ameloblastic fibro-odontoma were similar, these lesions were considered to be essentially the same. From limited follow-up information, the ameloblastoma was the only lesion that recurred. With the exception of one ameloblastoma found in the lung, no malignant odontogenic tumors were encountered.


Shortening of the temporalis tendon for hypermobility of the temporomandibular joint. Temporalis shortening by scarification is a relatively simple procedure and deserves further clinical testing, although the initial limitation of mouth opening shows some tendency to diminish. Its relative simplicity could make it the preferred procedure for unacceptable late joint snapping associated with TMJ hypermobility and for recurrent dislocation.


A modified approach to the ilium to obtain graft material. The ilium is a commonly utilized site for obtaining graft material for maxillofacial reconstruction. Pain, decreased mobility, and equivocal esthetics are complications sometimes encountered postoperatively with most current ilium harvesting techniques. A new approach to the ilium for obtaining marrow and cancellous bone was used in 26 cases during a one-year period. No complications encountered in the donor site. The technique is simple, allows simultaneous procedures, and is esthetically acceptable.


Psychological ramifications of facial change in relation to orthodontic treatment and orthognathic surgery. A patient who undergoes orthodontic treatment or orthognathic surgery should be prepared psychologically for the difficulties involved. Information that would assist in communicating with potential patients was compiled from questionnaires distributed by orthodontic and oral surgery departments and by practitioners. Of the patients questioned 14 months after treatment, 93% were satisfied with the results.


The basal cell nevus syndrome associated with cleft lip and cleft palate: report of case. A case of basal cell nevus syndrome with multiple keratocysts, cleft lip and cleft palate, calcification of the falx cerebri, and late appearance of basal cell carcinoma is described.


Malignant melanoma metastatic to the mandible. Metastatic malignant melanoma to the jaws is uncommon and is usually accompanied by generalized involvement. Hematogenous dissemination with deposition and growth in areas of hematopoietic marrow (that is, the mandibular molar region) is the accepted mechanism for involvement of the jaw. Clinical and radiographic findings are nonspecific. Comprehensive history, physical examination, and tissue microscopy are essential to accurate diagnosis and management of the patient. Radiotherapy for palliation is the accepted mode of therapy for symptomatic metastatic melanoma. Prognosis in cases with secondary jaw involvement is grave. A case of malignant melanoma with metastases to the mandible is presented and the literature is reviewed.


Morbidity associated with teeth in the line of mandibular fractures. Complications related to teeth in the lines of mandibular fractures were studied in a retrospective review of 207 fractures; 32.3% resulted in some form of morbidity. Statiistical comparison of fractures in which teeth were removed and fractures in which teeth retained suggests that removal of teeth in fracture lines does not minimize morbidity.


Use of etidocaine hydrochloride in oral surgery: a clinical study. Etidocaine hydrochloride had a rapid onset time, high frequency of surgical anesthesia, long duration and no side effects in 25 healthy patients who had 50 impacted third molars removed. Etidocaine compared favorably to lidocaine and its duration of action was two times longer.


The mural ameloblastoma: a review of the literature. Mural ameloblastomas are estimated to constitute 5% of all ameloblastomas. Although resembling the total ameloblastoma population in terms of predilections for sex and site, the average age of the patients with mural ameloblastoma, in comparison with the total group, was 21.8 vs 38.9 years. Eighty-five percent of the mural ameloblastomas were associated with follicular cysts, all of which were observed before the age of 30. The frequency of recurrence after simple enucleation of the cyst containing this lesion is considerably lower than that for ameloblastomas in general that are treated in a similar manner. Therefore, further and more extensive surgery for mural ameloblastoma is justified only in the event of recurrence.


Topical application of antihemophilic factor after dental extractions in hemophilic patients. In addition to replacement therapy with antihemophilic factor (AHF), its concentrated solution was used topically after dental extractions in hemophilic patients. The results, compared with that of the control extraction sites in the same patients, indicated that the topical application of AHF is effective in producing rapid and tight clot formation and in reducing postoperative oozing of blood.


Surgery in a gravid patient.

Surgery in a gravid patient. A review of salient points in the evaluation and treatment of the gravid patient is presented. Emphasis is on problems arising in the practice of oral surgery. The physiologic mechanisms that form the basis for treatment planning rationale are elucidated.


Management of a patient with hereditary angioneurotic edema. Patients with a history of hereditary angioneurotic edema can adequate and safely have nonelective surgical procedures performed with proper preoperative and postoperative management. Deficient amounts of C1 esterase inhibitor can be replaced with fresh frozen plasma; capillary permeability and spreading edema can be prevented with antifibrinolytic agents such as Amicar. Once edema has occurred peripherally and no laryngeal symptoms are present, conservative treatment is advisable. When epiglottic and laryngeal edema occurs, intubation or tracheostomy is preferred for maintenance of airway until the edema subsides. During oral surgical procedures, minimal surgical trauma must be achieved. Edema that involves the airway presents the greatest danger to patients. These attacks are usually associated with dental or some sort of oral or pharyngeal manipulation.


Fracture of the mandibular body and ramus during horizontal osteotomy for augmentation genioplasty. A fracture of the body and ramus of the mandible occurred during a horizontal esteotomy for augmentation genioplasty. Care must be exercised when using osteotomes to free the posteroinferior border during this procedure.


Mikulicz disease of a minor salivary gland. The third recorded instance of Mikulicz disease of a minor salivary gland is described; this is the first case in which a surgical specimen, in addition to the biopsy specimen, was obtained for microscopic examination. A brief description of the disease and its treatment is also presented.


Carcinoma of the maxillary sinus: report of case. A well-documented case of undifferentiated carcinoma of the right maxillary sinus has been presented. Results of initial evaluation and examination were consistent with an acute ulcer, but complete resolution did not occur when the denture was removed. Expansion of the buccal vestibule became evident, and biopsy was done. The expansion probably caused increased pressure under the denture flange, resulting in ulceration. As is so common in malignancy of the maxillary sinus, symptoms did not appear until late in the course of the disease and diagnosis was not made until the tumor was inoperable. Moreover, the initial symptoms were unusual for a tumor of the maxillary sinus. Conventional panoramic radiographs did not show any significance changes, although an advanced tumor had destroyed the lateral wall of the maxilla as confirmed on the Waters projection. We suggest that the panoramic oral radiograph is a valuable tool in evaluating disease of the maxillary sinus but that it does not replace the conventional views used to evaluate the paranasal sinuses.


Self and peer perception of male and female dental students. In order to investigate the similarity and differences between male and female dental students, the Bentler inventories, which utilize both self and peer report formats, were administered to first year students at U.C.L.A. Results indicated that male and female dental students are basically similar in terms of a wide range of personality traits both in terms as well as self perceptions. The only differences involved males' describing themselves as more masculine and orderly while females were portrayed by their peers as more feminine and clothes-conscious. In addition, comparison between self and peer report inventories for the same sex revealed few trait differences. Although caution should be made in generalizing these findings beyond the UCLA School of dentistry, the results suggest that it is not appropriate to admit nor exclude male or female students based upon any assumptions that doing so would dramatically change the personality characteristics of dental practitioners. However, more research is needed using a more representative national sample of students.


Snack food consumption of 12 year old inner-city children and its relationship to oral health. The relations between reported frequency of consumption of 18 common snack foods, SES variables, and oral health scores were studied in 92 12-year-old children from three inner-city schools in Rochester, New York. The group was composed of 44 males and 48 females who were either black or had a Spanish surname. The study documented only a few significant relations between consumption of snack foods and DMF scores or overall oral health. Reported cake consumption correlated positively with total debris and gingivitis, and consumption of chewy candy and ice cream was positively related to DMF scores. Black females exhibited the greatest number of decayed and DMF teeth, and both male and female black children had significantly greater amounts of total debris, gingivitis and decayed teeth.


Immunologic relationship between breast carcinoma and benign breast disease as detected by the leukocyte migration inhibition assay. Patients with benign diseases of the breast reacted in a migration inhibition assay with extracts of breast cancer and benign breast lesions and a human breast cancer-derived cell line, MCF-7. The incidence of reactivity of the patients with benign breast diseases against these antigens was similar to that of breast cancer patients. In addition, patients with breast cancer reacted to some extracts of benign breast lesions. The reactivity occurred in patients with several different histopathologic types of breast lesions, but was not found in women with no detectable pathologic lesions.


Second primary neoplasms following ovarian cancer. Follow-up surveys of patients with ovarian cancer revealed an increased risk of second primary cancers of the uterine corpus, colon, bladder, breast, and hematopoietic system. The excess risk or uterine corpus cancer was independent of therapy. The risk of colon cancer was increased in all treatment groups but was especially high among patients receiving radiation or chemotherapy. The predisposition to other neoplasms was limited to certain treatment groups: bladder cancer to irradiation, leukemia to chemotherapy, and lymphoma to either modality. The pattern of second neoplasms following ovarian cancer appears to be influenced by therapy as well as by common etiologic factors.


Identification of a macromolecule containing an anticarcinoembryonic antigen-reactive substance and immunoglobulin M in human pancreatic cancer. Ascitic fluid from a patient with carcinoma of the pancreas was fractionated by ammonium sulfate precipitation. The fraction precipitated between 25 and 50% saturation of ammonium sulfate was sequentially chromatographed on Sephadex G-200 and Sepharose 6B. A macromolecular fraction (greater than 10(6) daltons) obtained was found to react with both antihuman IgM and antiserum to carcinoembryonic antigen (CEA). This fraction was further purified by adsorption with protein A-Sepharose CL-4B and chromatography on DEAE-Sephacel. The purified macromolecular fraction had a sedimentation value of 28S as determined by ultracentrifugation. Upon dissociation of the purified macromolecule at pH 2.3 and purification of the dissociated components on Sepharose CL-2B and BioGel A 1.5M, a 19S protein and a 5S protein were recovered. The 19S protein showed a complete line of identity with a reference human IgM when reacted with antihuman IgM in gel diffusion, whereas the 5S protein showed a partial immunologic identity with colon CEA against anti-CEA. These results indicated the existence of an IgM-containing macromolecular complex with an anti-CEA cross-reactive substance in the extracellular fluid of human pancreatic cancer.


Cytologic correlates of chemical carcinogens in respiratory tracts of dogs. During canine respiratory carcinogenesis studies with benzo[a]pyrene (BP) and N-methyl-N-nitrosourea (NMU), a stereotypic pattern of cytomorphology characteristic for each carcinogen was observed. In the early stage, BP induced changes primarily in the cytoplasm. These changes consisted of incresaed size, basophilia, and vacuolization. In contrast, NMU induced primarily nuclear enlargement and enhanced the prominence of the nucleolus. Subsequently, cells exposed to BP demonstrated pleomorphism of the cytoplasm and nucleus, whereas cells exposed to NMU formed bizarre spindle-shaped cells. Cells were generally more scattered from one another following BP treatment than after NMU treatment. When the mucosa was exposed to NMU after the previous use of BP, the cytologic findings promptly became those characteristic of NMU.


Cytochemical study on uptake of exogenous peroxidase by Vx2 carcinoma cells transplanted into the rabbit. When horse-radish peroxidase (HPO) was administered iv to Vx2 carcinoma-bearing rabbits, an HPO reaction product was detected in the lumina of blood vessels and the extracellular spaces between tumor cells in the first few minutes after administration. HPO was also seen in vesicles in tumor cells. Fifteen minutes to 1 hour after administration, the HPO reaction product was found mainly in the large membrane-bound vacuoles. Within 6--12 hours, the HPO activity gradually diminished in large membrane-bound vacuoles (lysosomes). In conclusion, exogenous HPO was rapidly incorporated into Vx2 carcinoma cells by pinocytosis, and then pinocytotic vesicles were fused with lysosomes.


Effect of anesthetic agent on lung tumor induction in hamsters given benzo[a]pyrene-ferric oxide. The effects of an anesthetic agent on lung tumor induction in noninbred Syrian golden hamsters were investigated after intratracheal instillation of a benzo[a]pyrene-ferric oxide mixture. Inhalation anesthesia with ether or methoxyflurane was accomplished with a closed recirculatory system that allowed a short induction time for anesthesia and a good control over the concentration of anesthetic. This type of anesthetic induction was compared with systemic induction by Brevital. Survival rates during the 10 weekly instillations were least for the Brevital-treated group and greatest for the methoxyflurane-treated group. Body weight gain was lower in both the ether- and Brevital-treated groups as compared to the group anesthetized with methoxyflurane. The animals anesthetized with Brevital had the shortest tumor latency, but the tumor incidence during the weeks of the experiment was similar in the group treated with this agent and the group treated with ether. Exposure to methoxyflurane and the carcinogen produced a slow onset of deaths from tumors and lower tumor incidence. These results are discussed in relation to retention of the dose of carcinogen in the respiratory tract and effect of inhalation anesthia on consequent lung tissue pathology.


Effect of chemotherapeutic agents on natural cell-mediated cytotoxicity in mice. Spleen natural killer (NK) activity was investigated in cells from C57BL/6J mice treated with various chemotherapeutic agents; 51Cr-labeled YAC-1 lymphoma cells were used as targets. Treatment with azathioprine (a single injection of 100-400 mg/kg ip or 5 daily doses of 80 mg/kg lp) and cyclophosphamide (a single injection of 50--200 mg/kg ip or 5 daily doses of 25 mg/kg ip) resulted in a marked dose-dependent inhibition of NK activity 2 days later. NK cells recovered rapidly from drug-induced suppression; by 7 days after drug treatment, no difference from control values was observed. Dimethyltriazenoimidazole carboxamide (20--200 mg/kg ip) and adriamycin (10--15 mg/kg iv) did not impair natural cytotoxicity per unit number of lymphoid cells, daunomycin (10 mg/kg iv) caused borderline impairment of NK acitivity, and N-trifluoroacetyl-adriamycin-14-valerate (80 mg/kg iv) markedly suppressed natural cytotoxicity. These results are discussed in light of the known effects of these agents on T-cells, B-cells, and K-cells and on hematopoietic histocompatibility-type reactions.


Effect of intestinal microflora on 2,2'-dimethyl-4-aminobiphenyl-induced carcinogenesis in F344 rats. The effect of intestinal microflora on colon and breast carcinogenesis induced by 3,2'-dimethyl-4-aminobiphenyl (DMAB) was studied with the use of germfree and conventional F344 rats of both sexes. At 7 weeks of age, all animals except controls were given 20 weekly sc injections of DMAB in corn oil (100 mg/kg body wt/wk). Male animals were autopsied 15 weeks after the last injection, whereas female animals were autopsied 10 weeks after the last injection. Tumors were induced in the colons, duodena, breasts, ear ducts, salivary glands, and skin of conventional rats, and in the colons, breasts, ear ducts, salivary glands, and skin of germfree rats. No consistent difference was found in the incidence of tumors in the ear ducts, salivary glands, and skin between the germfree and conventional rats. None of the germfree rats showed duodenal tumors, whereas 13% of the female and 53% of the male conventional rats developed duodenal tumors. The incidence of intestinal tumors was lower in the germfree rats than in conventional animals. The mammary tumor incidence was lower in germfree female rats than in the conventional female rats than in the conventional females. DMAB induced fewer intestinal and breast tumors in germfree rats than in conventional rats.


Genetic resistance in Japanese wild mice (Mus musculus molossinus) to an NB-tropic Friend murine leukemia virus. Wild mice (Sk, Hz-Vl, Hz-IV Om, Mol.A, Fu, Te, and Sn) trapped in various areas of Japan were crossed with mice of inbred strains (C57BL/6, C57L, BALB/c, and C57BL/10), and their progeny were infected with NB-tropic Friend nurine leukemia virus. Ten days after infection, the spleens were weighed, examined for macroscopic focal lesions, and assayed for infectious virus by the XC test. Genetic analysis indicated that 4 of 8 mice tested had a dominant gene that suppresses the virus replication; the gene resembles the Fv-4' allele. No mice with the Fv-2' allele were found.


Cell killing and kinetic effects of diglycolaldehyde on dividing and nondividing mammalian cells in vitro. The effects of the anticancer drug diglycolaldehyde (NSC-118994) were studied on Chinese hamster ovary cells growing in vitro. Dividing cells, specifically those in S-phase, were more sensitive to the drug than were nondividing cells, although a large fraction of nondividing cells was also killed by doses up to 800 microgram/ml. Dose-dependent effects on cell progression kinetics were observed in all phases of the cell cycle except in mitosis, during which treated cells progressed at control rates into G1-phase. The inhibition of cell progression from G1- into S-phase (most sensitive phase of the cell cycle) put self-limiting restrictions on the cell killing effects of the drug.


Enhancement of rat hepatocellular-altered foci by the liver tumor promoter phenobarbital: evidence that foci are precursors of neoplasms and that the promoter acts on carcinogen-induced lesions. Altered foci resistant to iron accumulation were induced by N-2-fluorenylacetamide in livers made siderotic by feeding 8-hydroxyquinoline and ferrous gluconate to inbred F344 rats. Following cessation of carcinogen feeding, most foci reverted to iron accumulation and could no longer be detected by 24 weeks, but some persisted for this interval. Futhermore, in 2 groups, 33 and 50% of rats developed liver tumors by 24 weeks after removal of the carcinogen. The addition of phenobarbital to the diet after cessation of carcinogen feeding enhanced persistence of altered foci and increased the incidence of liver tumors to 78--89%.


Tumorigenic effect of 1-hydrazinophthalazine hydrochloride in mice. A solution of 0.125% 1-hydrazinophthalazine hydrochloride, an antihypertensive drug widely used in humans, was given continuously in drinking water for the life-spans of randomly bred Swiss mice. Consumption of the chemical significantly increased the lung tumor incidence from 36 to 60% in females and from 26 to 46% in males, compared to controls. Histopathologically, the tumors were classified as adenomas and adenocarcinomas of the lungs.


[Effector function of acute leukemias in "spontaneous" (SCMC) and antibody dependent cellular cytotoxicity-tests (ADCC) (author's transl)]. Blood lymphocytes from 13 untreated acute leukemia patients, 3 pre-leukemias 3 immunoblastic lymphadenopathias and one infectious mononucleosis showed significantly lower spontaneous (SCMC) and antibody-dependent cellular cytotoxicity (ADCC) against 51Cr-labeled allogeneic melanoma cells of the IGR3 cell line than effector lymphocytes from 20 age- and sex matched control persons. While control lymphocytes exhibited the highest cytotoxic activity after depletion of mononuclear phagocytes (Fraction FFF), followed by the "Ficoll" purified Fraction F and defibrinated whole blood, the reverse was true for acute leukemias: here, the highest cytotoxicity was found in whole blood followed by the lymphocyte fractions F and FFF. Comparatively high cytotoxicity was found with two leukemia patients who had received blood transfusions the day before testing. During the course of an acute erythroleukemia chemotherapy drastically reduced SCMC and ADCC activities. A therapeutical splenectomy, on the other hand, did not affect cellular cytotoxicity in the case of a hairy cell leukemia. The angioimmunoblastic lymphadenopathies showed strikingly high percentages of EA- and EAC-rosettes forming cells and showed a marked increase of SCMC and ADCC activities after elimination of mononuclear phagocytes from the effector cell population.


[Reversible calcification of skeletal muscles in acute renal failure (author's transl)]. The clinical course in two patients with acute renal failure and focal calcifications of skeletal muscle are reported. In the first case renal failure was due to a hypovolemia or shock combined with supercooling and alcoholic intoxication. In the second case a rhabdomyolytic crisis with myoglobinuria occurred. This patient was known to have a McArdle disease. Dialysis treatment was necessary in both cases in order to overcome the oligoanuric phase. Biopsy specimens from biceps muscle showed intense calcium deposits within the necrotic muscle fibres. In the beginning of oliguria remarkable hypocalcemia occurred followed by hypercalcemia. During the polyuric phase which was accompanied by hypercalcemia and hypercalcuria the calcium deposits disappeared completely. This could be demonstrated in our first case by a control biopsy.


Trends and variability in survival from osteosarcoma. Survival of patients with primary osteosarcoma who received traditional surgical management has been very poor. Several studies have reported the percentage of patients alive 3 years after first treatment to be between 20 and 25%. In a study of such patients first treated at the Mayo Clinic between Jan. 1, 1963, and July 1, 1974, the survival noted in the first few years was typical of that of other reports, about 25%. However, by 1972 through mid-1974, the 3-year survival had become 50%. This improvement was not the result of adjuvant treatment or any basic change in type of patient treated, yet it is similar to that reported in connection with some of the new adjuvant therapies used in trials depending on historical controls. Our results cast doubt on findings made in the absence of concurrent, randomly selected controls.


Leukemia in Olmsted County, Minnesota, 1965--1974. Extending a study of the period 1935-1964, we determined the incidence rates of leukemia in Olmsted County during the decade 1965-1974. In this decade, the overall crude annual incidence rate was 9.5 per 100,000. The ratio of males to females was 2.4 to 1; and the incidence rate was significantly higher among males than among females, especially in the older age groups. Adjusted for age and sex, the mean annual incidence rate among males (17.3) was significantly higher than rates reported previously from other areas (ranging from 10.7 to 13); and it had increased significantly during the 40 years 1935-1974 in Olmsted County. The increase was most prominent in males aged 50 and over, and was detectable only in the subgroup with acute myelocytic leukemia. The observed number of farmers (8) was significantly higher than expected (2.8).


Acute myelomonocytic leukemia after irradiation and chemotherapy for Ewing's sarcoma. A case is presented in which the diagnosis of acute myelomonocytic leukemia was made 16 months after the start of irradiation and chemotherapy for Ewing's sarcoma. The association of these two diseases is rare. The etiologic role of therapy in the development of leukemia is speculative in this case. However, there is need for surveillance for secondary neoplasms of all types so that the benefits of therapy may be properly weighed against the risks.


The effects of mandatory quality assurance: a review of hospital medical audit processes. A study of 17 hospitals in the Greater Delaware Valley region was undertaken in order to determine if those hospitals which had participated in an early voluntary effort to initiate medical audit differed qualitatively or quantitatively from a matched group of hospitals which had not participated in the previous project. The study also provided the opportunity to analyze the current status of medical audit in a group of hospitals which varied significantly in size, location, and educational responsibilities. Data regarding audit administrative organization, number of audits performed, type of system used, quality of audit criteria, and utilization of audit findings were gathered and analyzed. For these variables, no discernible differences were found between hospitals which had participated in the early voluntary project and those which had not. Wide variations were found among the hospitals in the extent to which medical audit processes were formalized and implemented. There were also variations in the quality of criteria formulated by the hospitals, but they generally did not receive a high rating. The implications of audit findings were generally not followed up in an organized and appropriate manner. Many hospitals which had received PSRO delegated status were given a low rating by the reviewers. The implications of these findings are discussed.


Spinal nerve compression: a cause of claudication. Thirteen patients were referred with claudication thought by the referring doctor to be vascular in origin. A careful history and physical examination followed by contrast radiculography showed their symptoms to be due to spinal nerve compression. The clinical picture is presented and the main pitfalls in diagnosis is considered. It was stressed that the taking of a careful history is the most important factor in arriving at a correct diagnosis.


Factors associated with planned and unplanned nuptial births. The incidence of unplanned pregnancy in a cohort of 1038 mothers of nuptial children was examined. The major findings were: (1) about one third of the pregnancies were unplanned but there was little evidence that unplanned children were unwanted; (2) there was no evidence to suggest that unplanned birth was related to poor education, low socio-economic status or lack of knowledge of contraception; (3) 40 percent of unplanned births were the result of contraceptive failure; (4) a common denominator in 38 percent of unplanned births was failure or breakdown in the woman's usage of the contraceptive pill.


Routine serum lipid analysis in New Zealand. For two years pairs of serum specimens with a wide range of cholesterol and triglyceride concentrations were regularly dispatched each month to all New Zealand medical laboratories known to measure blood lipids. Four weeks after specimen dispatch each laboratory received a report which displayed all results along with the overall means, standard deviations, and results from "reference laboratories". Six-monthly summaries were prepared for each laboratory in which the previous 12 results were compared with the corresponding "target values" by regression analysis. This allowed classification of inaccuracy into one or more of three categories. Random error (imprecision) explained most of the discrepancies, but systematic errors also contributed strongly to the observed interlaboratory variation. No single class of laboratories performed significantly differently from any others. Approximately 60 percent of the 16000 cholesterol analyses done each month in New Zealand, and 40 percent of the 10000 triglyceride analyses, are performed with precision thought to be adequate for clinical usage.


Which disinfectant and where?

Which disinfectant and where? The introduction of a disinfection policy for a hospital and its supervision and control, are discussed. The need for total staff co-operation is highlighted with laboratory monitoring, an essential component to determine the success of the policy and to detect breakdowns in techniques.


Cigarette smoking in New Zealand: Results from the 1976 population census. The 1976 New Zealand Census included information about 2 201 178 persons over 15 years. Thirty-eight percent of men and 31 percent of women smoked cigarettes regularly. The peak age for male smoking is from 45-49 years and in men aged 35 to 39 years more than half (55 percent) smoke more than 20 cigarettes a day. In the youngest age group (15 to 19 years) more girls than boys are cigarette smokers. Sixteen percent of the population (353 627) stated that they have given up regular cigarette smoking. Smoking is least prevalent in Nelson, Marlborough and Canterbury, while the greatest percentage of smokers are found in the East Coast of the North Island and Southland. Except for Southland, there are significantly more smokers in the younger age groups (16 to 24 years) in the North Island than in the South Island. Cigarette smoking in New Zealand is probably less prevalent than in the past and the figures compare favourably with those of other countries. However, the high levels of smoking among young people, particularly women, is a major health problem.


Coronary heart disease in Maoris: incidence and case mortality. In a sample of Maoris, the association between a five year incidence of coronary heart disease (CHD) and standard risk factors is examined. Prediction of new cases of CHD is attempted, and systolic blood pressure is found to be the most important predictor in both males and females. Approximately half the new cases are not predicted by the best sets of discriminatory variables.


Per endoscopic sphincterotomy: a minimum trauma technique for the removal of retained common bile duct stones. Drainage of the biliary tree and removal of retained common bile duct stones can be achieved by performing a sphincterotomy of the ampulla of Vater using a diathermy sphincterotome directed through a fibre-optic endoscope. The procedure was successfully performed on two patients considered unfit for abdominal surgery. It is a useful method in selected patients to release stones retained in the common bile duct after cholecystectomy.


Club foot in the Maori: a genetic study of 50 kindreds. A genetic study of 50 Maori kindreds suggests club foot to be inherited as a polygenic trait as in Caucasians. A higher incidence of right foot involvement was present in the Maori. Empiric risk data indicated that if the index patient was female, the chance of subsequent children being affected was four percent. If the index patient was male, the chance of subsequent children being affected was nine percent, and if parent and child were affected, the chance of subsequent children being affected was 30 percent. These risks are much higher than found in Caucasians.


Renal tuberculosis in a multi-racial community. There were 44 new cases of renal tuberculosis at the Waikato Hospital, 1961-1975. Thirty-three patients were Maoris or Polynesians and 10 Europeans. Most patients were adults. Culture of the urine and intravenous urography were the most useful diagnostic tests. The patients were treated with antituberculous chemotherapy. Seventeen had surgical procedures including 10 nephrectomies. In all there was one death. Factors concerned with prevention in high risk groups are discussed.


Smoking habit and psychometric scores: a community study. During the Milton health survey subjects completed a psychometric inventory consisting of the 48 questions of the Middlesex Hospital questionnaire (MHQ) and 26 from the hostility and direction of hostility questionnaire (HDHQ) designed to examine nine psychological dimensions. The 1209 subjects were classified into smoking categories and the scores for each psychometric trait were calculated. Women scored higher than men and heavy smokers scored higher than "never smokers". The psychometric traits and the scores of the four smoking categories after correcting for age and Quetelet's index showed statistically significant differences by analysis of variance in respect of somatic anxiety and depression for both men and women; and free-floating anxiety, phobic anxiety, hysteria, acting out hostility, self criticism and guilt in women. For somatic anxiety the increase in score almost exactly paralleled the increasing quantity of tobacco consumed.


Cytogenetic studies of pesticide and herbicide sprayers. Fifty-seven herbicide and pesticide sprayers were studied for the incidence of sister chromatid exchanges (SCEs) in peripheral blood lymphocyte chromosomes. Overall there was no difference between the control group and the sprayers. Five sprayers had an SCE rate three standard deviations outside the mean of the control group. Possible factors contributing to this elevated SCE rate were (1) the failure to use protective clothing and (2) the length of time spraying. Many sprayers failed to take adequate protective measures when mixing and spraying and chemicals were often improperly stored. It is recommended that all persons using herbicides and pesticides take adequate protective measures so that the risk of fatal poisoning and possible long-term genetic hazard be reduced.


Spontaneous haemophthalmus in leukaemia. Iris involvement in leukaemia has only rarely been described. A case of chronic myeloid leukaemia with uniocular involvement of the iris in particular, presenting with a spontaneous haemophthalmus, is reported, together with the ocular histopathology. The eye was blind due to a preceding injury.


Predisposing and operative factors: effect on the incidence of localized osteitis in mandibular third-molar surgery. Five hundred and four bilateral mandibular third-molar extraction sites were examined postoperatively for localized osteitis. All sites received a mechanical lavage of either 350 ml, or 175 ml. of sterile normal saline solution. No significant differences were observed relative to the effect of lavage volume on the incidence of iocalized osteitis. A preoperative antimicrobial mouthrinse of chloramine-T (sodium-p-toluene sulfonchloramide) was also used by one half of the patients. Although only slight differences were noted in healing with the different lavage volumes of the chloramine-T, certain predisposing factors contributed significant differences.


Oral ulceration associated with hypothyroidism. Report of a case. The case of a 62-year-old woman with idiopathic primary hypothyroidism and persistent lingual ulceration is described. The patient had no previous history of any form of oral ulceration, and the ulcers healed rapidly after treatment of the hypothyroid state. The investigation of patients with suspected hypothyroidism is discussed briefly, together with the possible theoretical mechanisms which might predispose to ulceration.


Acinic cell tumors of minor salivary gland origin. Acinic cell tumors of minor salivary glands are most uncommon. Search of the English language literature revealed twenty previously reported cases. Nine additional cases are newly described. Most patients presented with asymptomatic swellings, but pain and tenderness were experienced by some. Sites of involvement were variable, with the palate, tongue, and floor of the mouth being the most commonly afflicted. One new case occurred centrally within the mandible. There was no sex predominance. A spectrum of histomorphologic characteristics included solid, microcystic, papillary cystic, and follicular patterns composed of acinic, intercalated duct, vacuolated, and nonspecific glandular cells. Follow-up data on ten cases from the literature and the nine new cases revealed that one patient died of tumor, one was alive with distant metastases, and one had been successfully treated for local recurrence. The patient representing the single fatality was treated by irradiation only. Surgical excision with a border of normal tissue seems to be effective treatment. The use of "carcinoma" as an appropriate designation for this neoplasm is questioned.


Oral lesions in Crohn's disease: report of two cases and update of the literature. A review of twenty-two previously reported cases and two new cases of oral lesions of Crohn's disease shows that there is a predilection for occurrence in certain anatomic sites and that the appearance of lesions is dependent on location. The most frequently affected areas and their respective appearances are the buccal mucosa, showing a cobblestone pattern; the vestibule, demonstrating linear, hyperplastic folds and ulcers; and the lips, appearing diffusely swollen and indurated. Less frequent are lesions of the gingiva and alveolar mucosa, which reveal a granular, erythematous swelling, and the palate, represented by multiple ulcers of the aphthous type. The significance of the clinical lesions and their microscopic features id discussed, as is a differential diagnosis in similar-appearing lesions.


Ameloblastic fibrosarcoma. Report of a case in a Nigerian. Ameloblastic fibrosarcoma is very rare and has not previously been reported from Nigeria. The case described here had typical clinical features, but the microscopic findings were unusual and difficult to interpret. The pathogenetic relationship between ameloblastic fibroma and fibrosarcoma is discussed.


Bilateral dens invaginatus with associated radicular cysts. A case report. A case report is presented describing bilateral dens invaginatus of the maxillary lateral incisors. Pulpal disease of the lateral incisors resulted in radicular cysts with the right cyst expanding to cause the eventual loss of four teeth. Removal of the cysts was followed by normal healing. Early detection of the bilateral dens invaginatus might well have resulted in successful interceptive care.


Tissue formation in the root canal after total pulpectomy and partial root filling. In twenty human teeth, total removal of the pulp was attempted, and the root canal was filled 2 to 4 mm. short of the foramen in the same sitting. The root filling consisted of gutta-percha points and Kloroperka N-ö as a sealer. The teeth were extracted after observation periods of 2, 6, and 10 months and committed to histologic examination. Microscopic evaluation demonstrated that after 2 months, the space in the canal between the root filling and the foramen was occupied by connective tissue slightly inflamed in the area adjacent to the root filling. After 6 and 10 months the entire space contained a fully developed cell-rich fibrous tissue, and only a few lymphocytes were observed adjacent to the root filling material.


Single arch stabilization devices for segmental orthognathic surgery. Single arch stabilization of segmental osteotomies is desirable because it eliminates intermaxillary fixation while it, in turn, improves oral hygiene and communication and patient comfort, function, and acceptability. Orthodontic appliances with stabilizing arch wires are the method of choice if available. Arch bars modified for segmental stabilization function very well as an alternative to orthodontic appliances. Cast splints are also useful for these cases, although cost and the need for expert laboratory support limit their acceptability. Certain other devices, such as palatal and lingual plates and interocclusal wafers, provide additional support for several of the above-mentioned stabilization systems.


Long-term follow-up and evaluation of transplantation of fully developed teeth. Five cases of transplantation of fully developed third molars to second or first molar sites have been reported. Three of the transplants were in the mandibular molar region and two were in the maxillary molar region. There has been long-term follow-up and evaluation of the patients in these cases up to 13 years postoperatively. None of the patients had any complaint about the transplanted tooth at the long-term follow-up visit. In all five cases, at the long-term follow-up visit, the periodontal tissues were in excellent condition and there was growth of new attachment, as demonstrated by lamina dura and periodontal membrane space in the follow-up radiographs, deposition of secondary calcification of varying amounts within the root canals and pulp chamber, and regeneration of bone in the periapical and lateral areas. There was very little, if any, resorption demonstrated in any of these five cases. The ages of patients ranged from 17 to 23 years at the time of transplantation. Regeneration of the buccal plate was demonstrated by photographs in one of the two cases where there was surgical exposure of the region of the buccal plate at a postoperative follow-up visit.


Eagle's syndrome. Report of a case.

Eagle's syndrome. Report of a case. This case report demonstrates an uncommon, symptomatic elongated styloid process that did not conform to the usual clinical features. The patient was under 30 years of age when the symptoms appeared. He experienced the classic symptoms without prior tonsillectomy; he also experienced carotid artery syndrome symptoms. However, the patient did receive the common diagnosis seen in many cases of unexplained chronic head and neck pain. He was simply labeled a psychotic with no just cause for pain.


Psychosexual dysfunction in patients with immobilized jaws. The purposes of this study were to determine and evaluate the psychosexual behavior of selected patients whose jaws were immobilized. Data for this pilot study were collected by using a standardized interview protocol with ten patients whose jaws were immobilized. The interview questions were designed to ascertain whether sexual problems existed, the nature and management of these problems, and the suggested role the operating surgeon might assume in assisting the patient. The data revealed that sexual difficulties were experienced by nine of these patients, and many of their problems were similar. The chief complaints included: (1) shortness of breath during sexual intercourse, (2) difficulty in oral foreplay, (3) poor verbal communication, (4) altered self-image, (5) sexual dysfunctions induced by pain medication, (6) depression, and (7) a lack of ability to exercise oral-genital sexual contact. Nine of the ten patients agreed that the operating surgeon should inform his or her patients with immobilized jaws of potential sexual disability. We believe that additional studies of these problems could enhance the management of patients with oral and maxillofacial injuries.


Periodic migrainous neuralgia: a cause of dental pain. The clinical findings in thirty-five cases of periodic migrainous neuralgia (PMN) are given. Typical case histories are used to illustrate the fact that the condition may mimic dental pain. The nomenclature and association of the condition with migraine are briefly discussed, and a plea is made that the condition always be considered in cases of facial pain, when other clinical features of the disease are present, in order to save needless loss of teeth and delay in treatment.


Maxillary intraosseous neuroepithelial structures resembling those seen in the organ of Chievitz. Epithelial rests residing within nerve fibers coursing through histologically normal osseous marrow spaces are described. These structures appear to be identical to those found in the pterygomandibular space in a structure known as the organ of Chievitz. Their function is unknown, and yet it is hypothesized that they play a role in neurosensory mechanisms.


Effect of renovascular hypertension of the morphology of oral blood vessels. Renovascular hypertension was created in twenty adult male rats to study the effects of systolic hypertension on the morphology of vessels supplying the gingiva, periodontal membrane, pulp tissue, and alveolar bone. Gingival arterioles showed changes consisting mainly of proliferation of the intima and elastic layers, some hyalinization of the wall, and reduction of the lumen. Similar but less frequent changes were observed in the vessels feeding the periodontal membrane; however, pulp tissue and alveolar arterioles were unaltered.


A draining sinus tract of the chin. Report of a case. A case of a relatively rare occurrence--a draining sinus tract on the chin which originated from an abscessed lower incisor--is presented. The sequence of treatment and mode of healing are discussed, and the importance of an awareness of this phenomenon for the differential diagnosis is stressed.


Radiation exposure during panoramic radiography in children. In an effort to determine the amount of radiation exposure a child receives during a panoramic radiograph and to evaluate the effect of a protective thyroid collar, dosimeter readings were made on twenty-nine child patients at fourteen anatomic sites. The levels of radiation recorded were similar to those previously recorded for adults and phantoms, except for greater doses in the thyroid area. Placement of a lead-lined thyroid collar resulted in significant reduction of the thyroid doses.


The influence of dental restorations on salivary gland scintigraphy with 99mTc-pertechnetate. During sequential salivary gland scintigraphy with 99mTc-pertechnetate, circumscript "cold" areas with less than background activity are sometimes seen in the region of the oral cavity. This phenomenon is due to the presence of extensive dental restorations and should not be misinterpreted in terms of deficient 99mTc-pertechnetate uptake in the minor salivary glands of the oral cavity.


Clinical significance of supplementary innervation of the lower incisor teeth: a dissection study of the mylohyoid nerve. In view of the relevance of the mylohyoid nerve to clinical difficulties in achieving deep analgesia of the lower incisors, a dissection study was undertaken. Dissection from twenty-six adult cadavers of both sexes were studied with the aid of a dissecting microscope. The following observations were made: (1) A supplementary branch of the mylohyoid nerve entered the mandible through accessory foramina in the lingual side of the mandibular symphysis in 50% of the cases. (2) It generally arose from the right side (76.9%) and entered the inferior retromental foramen (84.6%). (3) The mylohyoid nerve branch either ended directly in the incisor teeth and the gingiva or joined the ipsilateral or contralateral incisive nerve. In view of this information concerning the high incidence of possible involvement of the mylohyoid nerve in mandibular sensory innervation, it is advisable to block it whenever intervention in the lower incisors is indicated. Routine mylohyoid injection is recommended after mental nerve block. If the inferior alveolar nerve is chosen for anesthetic purposes, additional mylohyoid injection should be given only if pain persists. The mylohyoid injection should be given at the inferior retromental foramen on the median aspect of the inferior border of the mandible through extraoral approach.


Erythema multiforme. Clinical characteristics and natural history in fifty patients. Erythema multiforme is a chronic mucocutaneous inflammatory disease with a variable recurrent pattern. Thirty female and twenty male patients, ranging in age from 11 to 75 years, were studied. Twelve patients had oral lesions only, nineteen had oral and lip changes, and nineteen had oral, lip, and skin involvements. Most of the patients had a noncyclical pattern of attacks which required systemic corticosteroid therapy. When the disease attacks electively were not treated, healing would vary between 2 and 24 weeks. This study confirmed the idiopathic nature and extremely variable features of erythema multiforme. Frequency, location, duration, and severity of attacks did not shed any clues as to trigger mechanisms (etiology), persons who might be predisposed to such attacks, treatment responses, or prognosis.


Heroin-induced thrombocytopenic purpura. An immunologic response to the quinine used to "cut" heroin caused oral manifestations of thrombocytopenic purpura. The patient had an admission platelet count of 2,000 per cubic millimeter. Treatment with corticosteroids and withholding of the offending resulted in a platelet count of 265,000 per cubic millimeter 13 days after admission. Oral manifestations of purpura disappeared on the fourth day of treatment.


Extracondylar osteochondromas of the jaws. A review of the literature and the addition of two new cases have revealed that according to a histologic criterion there are presently twenty reported cases of osteochondroma of the jaws located outside the condyles. Although most of the extracondylar lesions have occurred on the coronoid process, cases are now reported on the maxilla and the body of the mandible. The clinical features of these lesions are compared with those located in the condyle, and the radiographic and surgical approaches of the extracondylar lesions are discussed.


Paresthesia from N2. Report of a case.

Paresthesia from N2. Report of a case. A number of cases of paresthesia following the use of N2 or other paraformaldehyde-containing root canal cements have been reported. Since paresthesia is longlasting and not only an inconvenience but also disabling at times, such cements should not be used for obturating root canals.


The rheologic properties of endodontic sealers. The rheologic properties of seven endodontic sealers were investigated with a rotational viscometer. The effects of time and rate of shear on the measured viscosities were determined. Results indicated that one material exhibited Newtonian behavior, whereas the others were characterized by pseudoplasticity.


Use of intraoral cassettes for dental xeroradiography. Before clinical trials of intraoral xeroradiography are begun, we felt the need to evaluate the clinical acceptability of the thicker, more rigid xerographic cassettes. We stimulated these cassettes by fastening rigid acrylic plates of appropriate thickness to conventional film packets and then conducted parallel evaluations of simulated cassettes and conventional film packets, using thirty volunteer patients. We found no difference in anatomic placement, operator acceptance, and patient acceptance between the "cassettes" and film packets. The increased thickness and rigidity of intraoral xerographic cassettes should not prove disadvantageous to in vivo intraoral xeroradiography.


Screen-film combinations used for cephalometric radiography. Only two United States dental schools used rare earth screens for cephalometric radiography. Forty-five schools used calcium tungstate or barium lead sulfate screens; most schools combined medium- or high-speed screens with medium-speed films. The fastest conventional screen-film combination used was eight times as fast as the slowest. Twenty-two schools used grids with their screen-film systems.


Acute leukemia in adults.

Acute leukemia in adults. Prospective data on 40 new cases of adult onset (greater than 15 years of age) acute leukemia is presented. Acute lymphoblastic leukemia (ALL) accounted for more than half of all the acute leukemias and represented 75% of the acute leukemias in the 15--25 years. The reasons for this finding remain to be explained. age group. The mean leukocyte count was significantly higher in the ALL group as compared to acute myelogenous leukemia (AML) patients (111.7 x 103 + 26.3 x 103 versus 19.3 x 103 +/- 6.1 x 103, respectively). Thrombocytopenia, anemia and hemorrhagic signs including petechiae, ecchymoses and gum bleeding were more common in the AML group. This study verifies our clinical impression that ALL is more frequent than AML among our adult patients below the age of 25 years. The reasons for this finding remain to be explained.


Morphological and immunological similarity of the monocytes from pure and mixed monocytic leukaemias. Morphological and immunological marker data on a patient with 'pure' monocytic leukaemia are presented and compared with those of 6 cases of clearly mixed myelomonocytic leukaemia with a variable monocytic component. In all patients studied, the leukaemic monocytes expressed a receptor for the Fc of IgG, and IgG sensitization markedly enhanced phagocytosis of ox erythrocytes. A variable, but lower, percentage of the leukaemic monocytes had a receptor for mouse C3, but the cells uniformly lacked surface immunoglobulin and receptors for the Fc of IgM and for unsensitised mouse erythrocytes. Cytochemical and ultrastructural study also showed no clear difference between the monocytes of the 'pure' and mixed monocytic leukaemias. This report therefore lends no support to the concept of distinct types of monocytic leukaemia.


ECG-tape recording for analysis of syncopal attacks before and during cardiac pacing. ECG-tape recording has been utilized for diagnosis of transient attacks of syncope and dizziness both before and during cardiac pacing. The display unit can be utilized for automatic starting of the ECG writer according to markings made by the patient or bradycardia alarm. The method has proved extremely useful and convenient, which is illustrated by cases with different types of arrhythmia and pacemaker failure.


Patient survival with pacemaker therapy at regional hospital, Orebro, Sweden, 1964-1974. The results of pacemaker therapy in the Regional Hospital, Orebro, during its first 10 years are presented. In general, patients with a history of temporary heart failure either before or at the time of implantation, had a better prognosis than those with such a history. Myocardial infarction had a detrimental effect on the prognosis in the first year of the patients pacing, but not thereafter.


Long-term ECG monitoring in suspected Adams-Stokes disease. Long-term ECG recording techniques have facilitated the diagnosis in atypical cases of Adams-Stockes syndrome. In the use of ambulatory ECG monitoring, new and mainly technical problems have been arisen. In 200 ECG recordings on cassette tape, 78% was considered sufficient for an accurate diagnosis. More than 50% of the unsuccessful recordings were unreadable due to electrode problems. The use of ambulatory monitoring demands that electrode fixation and placement be handled carefully and that the mechanical and electronic equipment be serviced frequently. Patients with third-degree atrioventricular block and syncopes of fainting spells run a high risk of sudden death. It is therefore not recommended to use ambulatory monitoring techniques on these patients.


[Long-term studies on changes in the position between jaw bases and occlusion plane during and after treatment of malocclusion by means of the activator]. A group of 24 unselected cases of marked class II division I malocclusion was treated with the activator therapy after Herren and was kept under long-term observation before, during and after treatment. The patients were reexamined on an average of 5 years without retention, 8 years after the first examination, and the stability of the treatment results was judged very satisfactory. Changes of cephalometric angles, recorded during the 4 main phases of the observation period, were summarized in graphs. In contrast to the relative uniformity of the results in terms of occlusion, a variety of effects on the craniofacial skeleton of different individuals was observed. However, on average, a significant increase of the inclination of the occlusal plane was seen during active therapy, and an excessive decrease in consecutive phases up to the last examination. This pattern of changes in occlusal plane inclination stabilizes the favorable anteroposterior relationship of the jaws, obtained through the activator therapy. Out of retention, the inclination of the mandibular plane decreases parallel to the swing of the occlusal plane. In contrast, the inclination of the palatal plane shows a tendency to slight increase, albeit only during active treatment. The observation that the occlusal plane is tilted under activator therapy and then spontaneously rises again, even excessively, seems to be of interest and deserves of further study.


[The discriminatory force of 3 sagittal measurement relations of the jaw bases]. The angle ANB relates the apical base not only to each other but also to point nasion and the profile. Furthermore, it is influenced by prognathism and inclination of the maxillo-mandibular complex. Both the angle AB/Occlusal plane and the "Wits" appraisal are based on elements within the maxillo-mandibular complex and not influenced by structures outside this complex. Cephalograms of 4 groups of 25 cases each comprising ideal occlusion, class-II/1, class-II/2 and class-III malocclusions were collected. Angle ANB, angle AB/Occlusal plane and "Wits" appraisal in 10 variations using points A and B according to Downs, As and Bs according to Herren and the occlusal plane using Incsup., Incinf. and Incinter and the molar point Mo (Hügli) were determined. By means of a discriminant analysis the discriminatory power of these variations were calculated. Variations using the points As and Bs and point Mo gave better results in separating 100 cases according to their relation of the apical bases. The results of the stepwise discriminant analysis reveal a high percentage of "right" classification. It is possible to draw borderlines in the continuum of values, allowing with high probability a classification of each case according to Angles classification when more than one measurement is utilized.


[Electromyographic findings on the external pterygoid muscle during activator therapy for distal bite]. First the author describes how the activator after Herren works, and the part played by the masticatory muscles. In a long-term study the functional behaviour of the external pterygoid muscle during activator therapy on children was investigated by electromyographic recording. Its results are discussed and compared to conclusions from experiments carried out by Petrović et al. concerning the growth of condylar cartilage in rats treated with a device of the postural hyperpropulsive type ("hyperpropulseur").


[Modification of the whip-mix articulator for reproducible fixation of various jaw relations]. The Whip Mix articulator is an Arcon device, which, in combination with the quick mount face bow, represents a useful prosthetic instrument for practice. Modified as described it enables the practitioner to obtain reproducible THIOP and IOP jaw relations. Also, the concept of "long centric" may be applied to reconstructive work.


[Prospects for success in systematic periodontal treatments--a review of the literature]. Several short- and long-term studies were reviewed to determine which factors favored successful treatment of periodontal disease. Most of the surgical techniques reduced pocket depth. The modified Widman flap proved to be most favourable for maintenance and regeneration of supporting periodontal tissue in several studies when combined with optimal plaque control (home care) and frequent professional prophylaxis. Supervised oral hygiene measure are decisive in preventing periodontal disease.


[Plak-out and Broxojet 3007. Clinical study]. It is known that chlorhexidine, a plaque preventing agent, can cause discolorations and other side effects when used in mouthwashes at the concentration of 0.1% or more. By diluting the amount of chlorhexidine used in a mouthwash in the much greater volume of water used in a pulsating device, one could try to avoid these side-effects and, possible keep the antiplaque properties of chlorhexidine. Furthermore, it was interesting to check whether plaque, which is normally not removed by the mechanical action of a pulsating device, could be removed when the water of the device contains chlorhexidine. In the first part of the study, the effectiveness of chlorhexidine given by mouthwash (10 ml at 0.1%) has been compared to that of the same amount of chlorhexidine diluted in 400 ml of water of a pulsating device (conc. 0.0025%). The average gingival index of inflammation and plaque index, as well as the amount of gingival fluid have been measured, by previously standardized procedures, in a group of 18 students with healthy gingivae before and after a 7-days period of no-brushing. One third of the students used chlorhexidine solution in daily mouthwashes, one third used chlorhexidine in the Broxojet and the last 6 students used Broxojet with a placebo. The part of the study concerning the Broxojet was carried out in double blind. At the concentration of 0.1% in mouthwashes, chlorhexidine was found, as expected, to inhibit plaque formation. The same amount of drug diluted in the liquid of a pulsating device was, on the contrary, much less effective. Staining was noticed in most of the volunteers. The second part of the study was similarly designed and performed in the aim of checking whether higher amounts of chlorhexidine were effective in preventing plaque when used in the Broxojet: in the pulsating device, chlorhexidine was found to be effective only at the concentrations of 0.025%.


[Hydroxylapatite ceramics--a bone-like biomaterial. Preliminary report]. Inorganical materials are being increasingly tried out in surgery and periodontal surgery for reconstructing bone defects. This paper discusses the biocompatibility and biofunctionality of different implant materials and presents a new hydroxyapatite ceramic material, of which a good bioactive behaviour is expected.


Acute febrile neutrophilic dermatosis: Sweet's syndrome. A case of acute febrile neutrophilic dermatosis (Sweet's syndrome) is described in a patient with chronic myelogenous leukemia, with a review of all published reports in the English literature. The disease is characterized by an acute febrile illness with painful plaques involving the extremities, face, and neck, and responds dramatically to corticosteroids with occasional recurrences. Histologically, the skin biopsy shows a dense dermal infiltrate of polymorphonuclear leukocytes without evidence of vasculitis.


Glycogen storage disease type IV diagnosed biochemically. A case report. A case report of a child with glycogen storage disease type IV is presented. The diagnosis was confirmed by enzyme assay on cultured fibroblasts. Some unusual features of this disorder are discussed and the possibility of antenatal diagnosis is emphasized.


Major vascular reconstruction for limb salvage in patients with soft tissue and skeletal sarcomas of the extremities. Thirteen patients with sarcomas of the extremities have been treated with radical en bloc resection requiring vascular reconstruction as initial treatment. In one instance, vascular reconstruction failed. Eight patients are currently alive and free of disease. There were two instances of a local recurrence. Each of the remaining five patients who died had distant metastases develop, none of whom had a local recurrence. Vascular reconstruction with prosthetic bone replacement, when indicated, offers an alternative approach to the treatment of tumors which, because of attachment to major vascular structures, might be considered for radical amputation.


Myeloschisis in a six weeks embryo of a leukemic woman treated by busulfan. A case of myeloschisis in a six weeks old human embryo is reported. The 39-year-old mother was treated by busulfan before and during the early stages of gestation for chronic lymphatic leukemia. Additional histological findings consisted in a decrease of mesenchymal elements together with a somitic disorganisation in the affected area of the embryo. In spite of the well known experience that this drug is well tolerated by leukemic pregnant women, a possible interference of busulfan with the oocyte differentiation in this elderly primipara is proposed.


[Osteosarcoma 1978 a turning point in prognosis through adjuvant chemotherapy following adequate surgery (author's transl)]. Results of surgery and chemotherapy in osteosarcoma are based on a retrospective investigation of 122 patients from 1930 till 1978 treated at the Orthopaedic Department of Vienna University and documented at the Viennese Bone Tumour Registry. Adequate surgery is considered to be the radical elimination of the tumour in an oncological sense, e.g. amputation or resection. Our own patients were examined in this light and different forms of chemotherapy are compared and their efficacy as adjuvant treatment is evaluated. The turning point in the prognosis of osteosarcoma came with the introduction of high-dose methotrexate therapy (HDMTX) in 1972 and which has been employed at the Orthopaedic Department of Vienna University since 1975. So far, HDMTX has been used in the management of 18 patients and the short-term results confirm the excellent results reported in the literature. The consequent change in policy with regard to the current surgical approach to osteosarcoma is discussed in detail.


[EEG in metabolic and hormonal encephalopathies (author's transl)]. The essentially unspecific EEG-phenomena as expression of the cerebral reaction to extracerebral diseases are described. The most important diseases are dealt with, namely disturbances of the thyroid gland, liver- and kidney disorders, diabetes.


[Psychiatric and neurologic disturbances in thyroid disorders (author's transl)]. The effects of the thyroid gland upon the nervous system with neurologic-psychiatric symptoms are discussed. With hyperthyreosis in younger patients hyperactive and psychotic signs occur, in older patients so-called apathic thyreotoxicosis. Neurologically there appear acute and chronic thyreotoxic myopathies, paroxysmal paralyses, the so-called hyperthyreotic chorea and a series of disturbances of eye muscles. In a thyreotoxic crisis psychotic preliminaries may proceed to a coma. With hyperthyreoses there occur intellectual impairment, showing but also psychoses as well as multiple neurological defect syndromes and epileptic seizures. Neurological defects as a consequence of thyreostatic therapy are rare, mostly these are disturbances of periphal nerves.


[Psychosomatic and somatopsychic aspects of progressive chronic polyarthritis (author's transl)]. By means of psychiatric depth-psychological investigations in more than 100 patients with PCP the somatopsychic aspect of the disease is described, which manifests itself in two thirds of the patients as an inhibited to agitated humble-depressive psychosyndrome. On the basis of family anamneses and analytical inquiries the somatopsychic aspects of the disease is described in more the half of the patients as consistent continuation of a specific way of life, so that psychosomatic and somatopsychic aspects of the disease are mentioned as one strategy persuing the same fictitious goal. Both aspects appear as functions of a seemingly threatened psychic-physical motivity.


Diagnostic problems in extrapyramidal disorders. The diagnostic problems of extrapyramidal disorders (ED) are reviewed. Many of the wide range of ED occur rarely, and clinical experience is difficult to obtain. Despite great advances in pathophysiology and pathological anatomy the diagnosis of ED is still mainly a clinical diagnosis, and the diagnostic problems are discussed principally in relation to the involuntary movements and partly with regard to muscle tone. Except in a few diseases, biochemical and microbiological analyses, EEG, EMG and X-ray examinations offer little contribution to the solution of diagnostic problems in these disorders.


[Iron, copper and iron/copper index in the serum during remission of acute leukemia in children]. In 57 children in remissions of acute lymphoblastic leukaemia 217 determinations of serum iron (Fe) and copper (Cu) levels were done. In 85% of cases serum Fe and Cu were determined simultaneously with bone marrow examination. Raised mean Cu level in complete remission (20.64 mumol/1) decreased with continuing remission to values observed in healthy children (18.40 mumol/1). The considerable rise in Cu serum level in cases with extramedullary location of the disease (26.04 mumol/1), in infections complicating remissions (23.32 mumol/1) and in the group of children with remission in whom recurrence of leukaemia developed after 0,5-2 months (26,84 mumol/1) was associated with a significant fall of serum Fe level in cases with organ location of the disease (12.82 mumol/1) and during bacterial and viral infections (12.67 mumol/1). The Fe/Cu index was highest in the group with remission extending over 3 years (0,89) and it was significantly low in the group with extramedullary location of the disease (0.45) and in infections during leukaemia remission (0.48). Determination of serum level of Fe, and even more of Cu was found to be useful in the management of children during remission of acute lymphoblastic leukaemia.


Computerized tomography for diagnosis of supratentorial tumors. The brains of 1851 patients were examined with 160 X 160 matrix computed tomography (CT) during a period of nine months. The CT patterns of 90 supratentorial tumors (excluding sellar tumors) were reviewed. A great variety of CT patterns were found with glioblastomas, the most typical being a tumor with mixed absorption values. Astrocytomas appeared as low-density lesions. The characteristic appearance for meningiomas was a homogeneous density, with an obvious increase in density after contrast injection. Metastases appeared as low- or high-density lesions with marked edema surrounding the tumor. Some minor groups such as craniopharyngiomas, epidermoid tumors and pineal tumors were described. The lesion was detected in 94% and a correct diagnosis was made in 92% of cases.


[Platelet function in acute myeloid leukemia. II. Aggregation of isolated platelets]. In 22 patients with acute myeloid leukaemia (17 cases of myeloblastic leukaemia, 4 cases of myelomonocytic leukaemia and 1 case of undifferentiated-cell leukaemia) platelets were isolated from the plasma by the method of Nicholls and Hampton as modified by Levy-Toledano by centrifugation in albumin gradient. The aim of platelet isolation was their "concentration" in cases of thrombocytopenia to values making possible aggregation tests, and platelet separation from the influence of plasma factors. Then aggregation of isolated platelets caused by ADP was studied. In 16 out of 22 patients a fall of aggregation was observed, with the mean values of aggregation rate and intensity were significantly lower. Parallelly done determinations of aggregating activity released from the platelets by thrombin showed lower values as compared with platelets from healthy subjects. In might be thought, in this connection, that the demonstrated reduction of isolated platelets is associated with a diminution of the nucleotide pool or disturbances of the platelet release reaction. The disturbances of the platelet release reaction. The disturbances of aggregation of isolated platelets and reduction of the aggregating activity were most pronounced in acute myelomonocytic leukaemia.


Obstetric service and perinatal mortality in Norway. Information on personnel, equipment and care facilities at all maternity institutions has been related to the perinatal mortality among all single births in Norway, 1967--1973. There was a total of 454,358 single births during this seven year period which comprised the study data set. An obstetric score based on personnel and equipment as defined in a previous study has been used to divide the country into three groups of counties, with low, medium and high obstetric scores. Perinatal, fetal and early neonatal (less than seven days) mortality rates specific to birth weight categories in 500 gram intervals have been compared between the county groups. Significant differences were found in the mortality rates between the group of counties with low obstetric score and the two other groups. There is both a relative and absolute increased difference in mortality for births weighing 3000 grams or more compared to births less than 3000 grams. The major component in the perinatal mortality difference is due to a difference between the low and higher obstetric score county groups in the early neonatal mortality rates. Time trends indicate that the relative differences in perinatal mortality are not decreasing over the seven year period, but rather, have increased slightly. Potential differences in the populations at risk in the three county groups are discusses. An adjustment was made to eliminate the effects of some potential confounding variables, namely high parity and maternal age and illegitimacy, without basically changing the results.


Intrauterine growth of twins judged by BPD measurements. Both earlier growth charts of twins composed of birth weight at different gestational ages and recent reports on twin biparietal diameter (BPD) growth, indicate that twins' growth is less than that of singletons during the later period of gestation. In the present study, growth curves are constructed separately for the first and the second twin from 489 paired ultrasonic BPD measurements of 119 twin pregnancies. The distribution of BPD values in twins was found to be slightly wider than our normal range curve for singletons. The mean BPD values of twins were close to those of singletons in the second trimester. From the 32nd week on, the twins' mean weekly BPD increment decreased, this lesser growth rate being more marked than that of singletons. The second twin's BPD growth curve ran consistently below that of the first. Our results agree with the earlier findings that the growth of twins is retarded during the later part of pregnancy. They point to different BPD growth patterns between the first and the second twin.


Monitoring of fetuses with retarded BPD growth. Retarded BPD growth (less than 5th centile) is associated with low birth weight, preterm delivery, and increased perinatal mortality. However, 50% of the fetuses with deviating BPD growth in the 32nd week have normal weight at birth. In this study other biochemical and physical tests were applied to a group of fetuses with deviating BPD growth in order to improve the discriminatory rate between infants subsequently born AGA or SGA. Measurements of the ratio abdomen to head diameter were above the 50th centile in 72% of the infants born AGA and below the 50th centile in 75% of those born SGA. Circumference measurements were less useful in our hands. Urinary oestriol levels were not directly proportional to the intrauterine growth retardation. Recording of fetal breathing movements and nonstressed monitoring of fetal heart rate FHR) had little or no predictive value in the individual case although the incidence of fetal breathing movements was significantly lower in the group with retarded BPD growth.


The extent of slits at the interfaces between luting cements and enamel, dentin and alloy. Four different cements were used to assess the presence of slits at the cement/tooth or the cement/alloy interfaces using a tooth-crown model. The model consisted of ground sections of teeth and plane plates of silver/palladium alloy. The plates were fixed with bolts between two brass plates and with three different dimensions of the cement film between tooth and alloy, i.e. 50 micrometer, 100 micrometer and 200 micrometer. The tooth-alloy specimens were sectioned and the adaption of cements was studied with an indirect technique (replica) in a scanning electron microscope. The extent of slits was expressed as the length of all slits relative to the total length of the interface in each specimen. The results showed that the zinc phosphate cement and polycarboxylate cement exhibited a slight to moderate tendency to formation of slits at the interfaces. The EBA cement had a small extent of slits adjacent to thin cement films, but more slits were observed with increasing film thickness. The composite resin cement had a marked tendency to slit formation independent of the cement film thickness.


In vivo and in vitro study of 59Fe uptake in developing rat molars. Autoradiographic methods were used to study 59Fe uptake in vivo in mineralizing tissues of young rats. Localization of 59Fe was observed in the ameloblastic layers of molars. In vitro studies were performed which demonstrated that 59Fe uptake in developing rat molar enamel was limited by the metabolic activity of the cells of the enamel organ.


Dental plaque morphology as revealed by direct observation and by replicating techniques. The ability of four elastomer impression materials to reproduce details of bacterial plaque structures was studied by comparing areas of the replica models with corresponding areas of the replicated plaque. Plaque was grown on hydroxyapatite splint segments for 48 hours and replica models were made from three different resins. One of the resins, a methacrylate material, was not suited for this purpose due to its content of spherical particles. The polysulfide and polyether impression materials reacted with the heat curing epoxy resin, and less satisfactory results were obtained with cold curing epoxy resin. Best results were obtained by a combined use of low viscosity silicone impression materials and cold or heat curing epoxy resins as model materials. However, a considerable loss of detail occurred in the replica models compared with observations of plaque directly on splint surfaces. Outlines of individual bacteria could sometimes be seen in the models, but generally several cells seemed to fuse, and appeared like small globular structures where cells and pellicle were difficult to distinguish. The bacterial colonization started near the gingival border of the surface, initiated by attachment of individual bacteria to the pellicle surface.


Characterization of oral in vivo films formed on different types of solid surfaces. Studies were made of oral films formed in vivo, which had been allowed to form on fused silica and Ge-prisms during periods between 2 s and 2 h using a variety of physico-chemical methods. To produce surfaces of different qualities the silica and Ge-prisms had either been detergent-washed, glow discharge treated or covered with polydimethylsiloxane. The following simultaneous analytical techniques were performed on the adsorbed films: a. internal reflection infrared spectroscopy, b. ellipsometry, c. contact potential measurements, d. contact angle measurements, e. scanning electron microscopy and f. energy-dispersive x-ray analysis. The results of these studies show that the formation of oral films proceeds at high speed and is of a certain qualitative selectivity. The formed films were found to be stable over long periods of time, and only showed patches of adhering micro-organisms on some of the prisms which had been exposed in the oral cavity for 2 h.


Porosity of resin filling materials.

Porosity of resin filling materials. Four paste-paste types of resin filling materials and three capsulated products were tested with respect to porosity content and size distribution of the pores. The data were obtained by using an automatic image analyzer. The paste-paste products were inserted into the test cavities by a bulk-packing technique and an injection technique. The results showed that the use of a syringe reduced the porosity content, mainly by the elimination of big pores. The capsulated products were not less porous than the paste-paste materials.


Masticatory function after activator treatment. An analysis of masticatory efficiency, occlusal contact conditions and EMG activity. Masticatory function was investigated in nine patients with relapse and ten patients without relapse of overjet after activator treatment, Masticatory efficiency, evaluated by a chewing test, was related to the number of intermaxillary tooth contacts and the electromyographic (EMG) activity from the temporal and masseter muscles during chewing. The results of the investigation indicated that a reduced masticatory efficiency was connected with fewer intermaxillary tooth contacts and less EMG activity from the temporal and masseter muscles. In patients with relapse of overjet, masticatory efficiency and muscle activity was reduced in comparison with patients without relapse. The relationship between the number of tooth contacts and masticatory efficiency was poor in the relapse patients. Unstable occlusal conditions and atypical tongue function may be an explanation.


Hematogenous development of rat mature granulocytic leukemia--comparison of 2,7-FAA-induced and transplanted leukemia. The oral administration of N,'N-2,7-fluorenylenebis-acetamide (2,7-FAA) induces leukemia, especially mature granulocytic leukemia in rats. We compared the degree of infiltration of 2,7-FAA-induced mature granulocytic leukemia with that of transplanted leukemia for the purpose of proving hematogenous development of leukemia. The bone marrow, spleen and liver were examined in the cases of diffuse lesion of 2,7-FAA-induced and transplanted leukemia. The average degree of infiltration of both 2,7-FAA-induced and transplanted leukemia was high in the bone marrow, medium in the spleen, and low in the liver. Intravenous transplantation of malignant neoplasm is an example of hematogenous metastasis. The similarity of infiltration between 2,7-FAA-induced and transplanted leukemia suggests that the former is spread by hematogenous metastasis.


Site of origin of 2,7-FAA-induced rat leukemia. Oral administration of N,N'-2,7-fluorenylenebis-acetamide (2,7-FAA) induces mature granulocytic and erythroblastic leukemia in rats. We compared the primary site of mature granulocytic leukemia with that of erythroblastic leukemia. The nodular foci of solitary lesions and comspicuously large foci of scattered lesions were considered to be the primary site. They appeared mainly in the bone marrow of various bones. The primary site of mature granulocytic leukemia appeared more frequently in short bones than in long bones. On the contrary, that of erythroblastic leukemia appeared more frequently in long bones than in short bones. The origin of mature granulocytic leukemia seems to be concerned with bone tissue, while erythroblastic leukemia may have little relation with bone tissue.


Rapid platelet consumption in a case of metastatic osteogenic sarcoma of the breast. An operation was carried out on an elderly female because of an osteogenic sarcoma of the breast. One year later she developed a state of rapid thrombocytolysis resistant to high dose prednisolone therapy and spleenectomy. At autopsy a large single metastasis was found in the right atrium and tumour emboli in the pulmonary artery. It is suggested that the shortening in platelet survival might have had an immunological background. Trapping of fibrinous material within tumour emboli and mechanical platelet destruction caused by the tumour appear to have been contributing factors.


Severe infiltration of the kidneys with ultrasonic abnormalities in acute lymphoblastic leukemia. A 3-year-old boy with acute lymphoblastic leukemia had enlarged kidneys with impairment of renal function and hypertension as the presenting features of relapse. Ultrasound demonstrated multiple nodular areas of echolucency within enlarged kidneys that reverted to normal when the patient was in remission but then recurred during relapse. This noninvasive procedure may be useful in patients with acute lymphoblastic leukemia to determine the incidence and prognostic significance of renal involvement at the time of diagnosis, and to follow the course of those who have demonstrable changes.


Non-leukemic dividing cells in the blood of leukemic patients. Spontaneous mitoses in the blood of 67 patients with acute leukemia were enumerated and their identity determined by cytogenetic methods. Most patients were children with acute lymphoblastic leukemia. Simultaneous 16- to 20-hour cultures of blood leukocytes (Bu) and of bone marrow (BM) cells were performed without phytohemagglutinin (PHA). Blood leukocytes were also cultured with PHA for 72 hours (BPHA). Mitoses in Bu cultures were counted, and karyotypic analysis performed on cells from the three culture types. In 21 control subjects, Bu cultures usually yielded no mitoses. Relapse and remission patients both displayed significantly more Bu mitoses than the controls. The karyotypes of Bu, BPHA, and BM mitoses in remission patients were normal. Fifty percent of relapse patients displayed cytogenetically abnormal leukemia cell lines; the percentage of their abnormal karyotypes was significantly higher in BM cells than in Bu or BPHA cells. The majority of the mitotic cells in Bu cultures from both relapse and remission patients appear to be of a nonleukemic origin. The number of mitoses could not be correlated with type of leukemia, hematologic parameters, or prognosis.


A case of acute myelogenous leukemia with an 8--21 translocation, missing Y, and additional karyotypic abnormalities. A patient with acute myelogenous leukemia (AML) whose bone marrow cells had complicated chromosomal abnormalities, in addition to an 8--21 translocation and a missing Y chromosome, is reported. The complex additional abnormalities did not appear to have much influence on the clinical aspects of the disease, eg, cytology of the leukemic cells and the patient's response to chemotherapy, even though the patient did have a rectal tumor due to leukemic cell infiltration.


A growth-related concept for skeletal class II treatment. The use of a combined activator--high-pull headgear appliance for treatment of Class II, Division 1 malocclusion is presented as a preliminary report. The activator itself is equipped with a palatal bar, lower lip pads, and torque-control auxiliaries for the upper incisors. The face-bow is mounted directly on the activator, and the extraoral force vector is equivalent to that of an anterior high-pull vector. During bite registration the veritcal displacement of the mandible is restricted to a minimum, and the anterior displacement should not exceed 6 mm. On the basis of current knowledge of the growth of the bony facial structures, treatment objectives and a specific approach for skeletal Class II correction are defined. Following these objectives, the therapy aims at correcting the malocclusion without diverting the anterior landmarks of the bony face from their specific lines of growth. This is brought about by the corresponding mechanics of the activator-headgear combination. The corrective effect of this appliance may be assumed to be the result of several different factors. The maxillary dentition is restrained in a posterior cranial direction, and an inhibitory effect on the maxilla counter to its line of development is attained. The mandibular dentition is influenced in an anterior downward direction by means of the bite registration, and the occlusion is unlocked during treatment. Any transfer of distally directed headgear forces from the maxilla to the mandible is prevented. Temporary stimulation of condylar growth, possibly combined with temporary posterior deflection of condylar growth, may also be induced. In this way it is possible to take maximum advantage of condylar growth in the sagittal dimension. Thus, not only is the malocclusion corrected but, at the same time, decisive profile improvement is achieved by anterior development of the mandible. From the experience gained so far with a Class II, Division 1 sample undergoing treatment with the activator-headgear combination, it would appear that skeletal control of the direction of facial growth during treatment is possible. A quantitative report on this group of approximately forty patients, some of whom are still receiving treatment, is in preparation.


Indications for autotransplantation in cases of missing premolars. The postoperative behavior of premolars transplanted before completion of root formation and the long-term prognosis for such teeth have recently been studied. After postoperative observation periods ranging between 3 years 4 months and 13 years 9 months, all of the thirty-four teeth in question were found to still be in place. Root formation had continued, supporting tissues had developed, and the teeth had erupted. In most instances they had functioned normally without giving rise to problems of any kind. Their status during the re-examination implied that most of them would function normally for many years to come, perhaps for a lifetime. Autotransplantation of missing premolars in many cases is the only alternative to prosthetic substitution, and it is our method of preference. However, substitution by autotransplantation cannot be applied unless a suitable transplant is available. Any premolar destined to be extracted for orthodontic reasons is a possible transplant. In young patients it is also a suitable one. In orthodontic extraction cases, therefore, suitable transplants are usually available. In nonextraction cases, none is available unless teeth in other dental arch quadrants are "sacrificed." In the present report six cases are presented as examples of solutions to the problem of missing premolars by autotransplantation. The main combinations of missing teeth and types of malocclusion in which premolars extracted for orthodontic reasons can advantageously be used as substitutes for other premolars are defined. Also, the justification for "sacrificing" a premolar in one quadrant to the advantage of another quadrant is discussed.