Arteriovenous fistulas for hemodialysis and the diabetic. A report on eighteen patients. Twenty-three subcutaneous arteriovenous fistulas were created for hemodialysis in 18 patients with terminal renal failure due to juvenile diabetes. Seventeen patients received well-functioning fistulas. Four patients needed reoperations due to late failure and the reoperations were successful in three. Venous hypertension syndrome developed in two patients because of thrombosis of the vein proximally to the anastomosis. In one patient extensive arteriosclerotic disease was the cause of late failure of two fistulas. Sepsis with low flow state was the cause of failure in one patient. None of the patients developed clinical signs of arterial insufficiency in the operated limb.


The distribution of proquazone and three of its metabolites in serum and synovial fluid. In 13 patients with hydrarthrosis of the knee, samples of synovial fluid and blood were drawn at regular intervals, following a single oral dose of 600 mg proquazone. The concentrations of the unchanged drug were measured fluorimetrically and those of its three principal, active metabolites by high pressure liquid chromatography. The absorption and distribution of proquazone and its metabolites were rapid. Measurable--in some cases considerable--concentrations were to be found in both the synovial fluid and serum as early as 30 minutes after intake. High concentrations were still present up to 7 hours after intake. Considerable variations were observed, both between patients and over time for each patient, so that only qualitative rather than quantitative kinetic conclusions could be drawn from the results. The concentrations were generally lower in the synovial fluid than in the serum, which may be ascribed to the drug's high protein binding.


Influence of proquazone (Biarison) on the levels of complement components (C3 and C4) in synovial fluid and on IgM in serum in patients with active rheumatoid arthritis. A preliminary report. Four patients with erosive rheumatoid arthritis and one with psoriasis arthropathy were treated with 600-900 mg/day proquazone for 4-7 weeks. All patients had acute knee effusions. The complement components C3 and C4, as well as IgG, IgA, IgM and total protein, were measured in both the synovial fluid and serum before and after treatment. In the 4 patients with rheumatoid arthritis, a marked increase in C3 and/or C4 levels in the synovial fluid was found, correlating in 3 cases with a good clinical response. However, no corresponding changes in complement levels were recorded in the serum. The patient with psoriasis arthropathy did not show any reaction. These preliminary results suggest that proquazone may influence the immunological processes in rheumatoid arthritis.


Pharmacokinetic studies on diclofenac sodium in young and old volunteers. A singel 50 mg enteric-coated tablet of diclofenac sodium (Voltaren) was administered to two groups, each consisting of eight female subjects. The subjects in the one group were young adults all aged less than 22 years, while those in the other were all over the age of 62 years. The plasma concentration/time profiles, relative bio-availability, and urinary excretion pattern of the drug in the two groups were similar. Thus, in the absence of interacting factors, such as drugs and disease, the ability to absorb, metabolise, and excrete diclofenac sodium does not appear to be influenced by age.


[Bone and soft tissue sarcomas].

[Bone and soft tissue sarcomas]. Great progress has been made both in the treatment of metastatic sarcomas and in adjuvant treatment of Ewing's, rhabdomyo- and osteogenic sarcomas. This is due partly to new and more effective cytostatic drugs and combinations, but to a greater extent to an improved systematic multimodal approach. In patients with metastatic sarcoma, better and longer remissions can be achieved, whereas real cures are possible in Ewing's, rhabdomyo- and osteosarcoma if properly managed using an interdisciplinary approach. Patients with these rare malignancies should be referred to specialized cancer centers, in view of the problems and possible complications of their necessarily intensive therapy.


Dermatomyositis complicated by acute granulocytic leukeumia. In this case of dermatomyositis, the patient's clinical course was complicated by the development of acute granulocytic leukemia. Various malignancies complicating dermatomyositis have been reported in the literature. Rarely have these been of the hematopoietic system.


Successful treatment of invasive pulmonary aspergillosis in the immunocompromised host. We have reported the successful treatment of a patient with acute leukemia complicated by pulmonary aspergillosis, a commonly fatal situation. Specific diagnosis was obtained easily by transbronchial lung biopsy. Our therapeutic approach included aggressive treatment of both the underlying malignant process and the aspergillosis with a combination of amphotericin B and rifampin.


Early lymphatic spread of osteogenic and soft-tissue sarcomas. Records of 374 patients referred to the National Cancer Institute with a diagnosis of sarcoma over a 24-year period were reviewed to study the incidence of lymph node involvement in this disease. One hundred and thirteen patients had operations involving the draining nodal area and evaluation of these nodes for tumor. Only three patients (2.6%) had evidence of sarcoma metastatic to draining lymph nodes. Prophylactic removal or radiotherapy of draining lymph node areas in most adults with sarcomas does not appear to be worthwhile. A comprehensive analysis of the literature is presented.


Resection of pulmonary metastatic osteogenic sarcoma in children. Over a three year period, 28 children or young adults up to 20 years of age underwent 60 thoracotomies for pulmonary metastatic osteogenic sarcoma. These patients also received adjuvant chemotherapy. Sixteen of the 28 patients are currently alive and 13 of these are free of disease. The patients have been followed for 6 to 48 months after the initial thoracotomy; median survival is 25 months. Actuarial survival curves produced a 4 year survival of 57%. Although a tumor-free interval of more than 1 year greatly enhanced survival, three patients survived with tumor-free interval of 6 months or less. Patients with disease confined to one lobe at the initial thoracotomy did very well, and yet survivors were seen when disease involved more than one lobe or was bilateral. An aggressive surgical approach toward the pulmonary metastases thus appears to be justified.


[Reconstructive microsurgery in traumatic amputations of wrist and fingers (authors transl)]. A specialised department for vascular microsurgery was established in the Research Institute for Clinical and Experimental Surgery in 1973. 58 replantations of fingers in 42 patients were made. Total percentage of healing was 52 (30 fingers). Doppler's flowmetry is very useful for the control of microanastomoses of the arteries in fingers. Reconstruction of vessels in fingers was made with an operative microscope (magnification 16--24 times), special microtechnique and 10/0 sutures. Successful replantation is possible even 10--12 hours after severance, it the finger is kept in hypothermia at + 4 degrees C. Rapid admission of the patients to the hospital, i.e. improved information and emergency transport may shorten ischaemic time. The first stage of replantation is the marking of arteries and veins in the finger and in the stump. It is essential to suture not less than 2--3 veins for one artery and nerve. Thorough rehabilitation is of utmost importance to get the best functional results.


[Protective effect of sodium hydroxybutyrate and mexamine on the body and cerebral cortex neurons during hypoxia]. Experiments on white non-pure male mice have established that NA oxybutirate in doses 100 mg/kg and mexamine in doses 2.5 mg/kg possess antihypoxic properties in conditions of severe hypoxia corresponding to a height of 10 000 m. In a combined introduction of Na oxybutirate and mexamine in the above-mentioned doses there is an increase of their antihypoxic action. It was demonstrated that Na oxybutirate, mexamine and their combination exposes a distinct protective effect on the cortical neurons on rats in conditions of hypoxia. It is assumed that the protective action of the studied antihypoxants on the cortical neurons is realized with the aid of the same mechanisms as in a physiological adaptation to hypoxia.


The incidence of carcinoma in the gastric remnant after resection for benign ulcer disease. During the period 1950-1953, gastric resection was performed on 569 patients for benign ulcer disease at the Serafimer Hospital, Stockholm, Sweden. The purpose of this investigation uas to assess the incidence of cancer and precancerous lesions in the gastric remnant. There were 15 postoperative deaths. 223 patients when traced were dead, and in 130 of these follow-up was adequate. Two cases with carcinoma in the gastric remnant were found among these. 72 patients were lost from follow-up. 253 patients when traced were alive, and in 111 of these, endoscopy and biopsy have been performed. In one patient there was a severe dysplasia but no invasive carcinomas were found. 130 dead patients and 111 living patients have been adequately followed after gastric resection for benign ulcer disease. Two carcinomas were found which makes the incidence 0,8%.


Decreasing frequency of cholecystectomies in the counties of Stockholm and Uppsala, Sweden. The frequency of cholecystectomies was followed in the counties of Stockholm and Uppsala during an eight-year period (1969--1976). In both counties there was a highly significant decrease. This was mostly marked for males under 50 and females under 40 years in Stockholm and for females, regardless of age, in Uppsala. It is unlikely that these figures represent a decrease in the prevalence of gall-stone disease even if a small change is possible. A major alteration in the financing system of out-patient care has taken place during the investigated period and this has probably had an important influence on the cholecystectomy rate. Another important factor may be the consideration of a etiological factors other than gall-stones for minor abdominal disorders.


The incidence of carcinoma of the gallbladder and bile ducts in Sweden 1958 to 1972. Between 1958 and 1972, 5913 carcinomas of the gallbladder and bile ducts were diagnosed in Sweden. These patients were divided into three groups, each covering a five year interval. The mean incidence was calculated for each group and related to age and sex. During the fifteen years of study a marked increase in the incidence was found, especially in elderly women.


Pulmonary function in extreme obesity. Influence of weight loss following intestinal shunt operation. Airway closure (CV), functional residual capacity (FRC) and the distribution of inspired gas (nitrogen washout delay percentage, NWOD %) and arterial oxygen tension (PaO2) was measured by standard electrodes in eight extremely obese patients before and after weight loss (mean weights 142 and 94 kg, respectively) following intestinal shunt operation. Prior to weight loss, airway closure occurred within a tidal breath in six out of eight patients. This was associated with a low FRC, and NWOD % was higher than in the non-obese. PaO2 was lower than normal. CV was unchanged after weight loss, but due to an increase in FRC, airway closure did not occur within a tidal volume and NWOD % was normal. PaO2 was also normal. It is concluded that weight reduction in extremely obese patients improves arterial oxygenation because of an increase in FRC, whereby CV no longer occurs within a tidal volume. Intrapulmonary gas mixing becomes more even.


Negative findings in search for a transmissible agent in Crohn's disease. Affected lymph nodes from 3 patients with Crohn's disease were homogenised and inoculated intramurally into the distal ileum of five piglets. The homogenates were also inoculated intramurally in the distal ileum of 15 rats and also by percutaneous injection intraabdominally in 15 rats and compared with the same number of animals of each species inoculated in the same manner with homogenates prepared from 3 patients with caecal cancer. There was no difference in weight increase between the animals inoculated with Crohn's tissue homogenate or control tissue homogenate. Neither did we find any macroscopic or microscopic changes in the animals inoculated with Crohn's tissue homogenate. We found a rather high frequency of mammary tumors in the rats inoculated with Crohn's tissue homogenate, although compared to the rats inoculated with control tissue homogenate there was no statistically significant difference. The negative results may be due to the method of preparing the tissue homogenate or to the use of lymph nodes instead of the bowel in preparing the homogenate, but may also be taken as support against the suggestion that a transmissible agent is present in Crohn's disease.


Contamination of germfree animals with intestinal Crohn tissue. A preliminary report. The preliminary results of one of a series of prospective studies in the investigation of a possible transmissible agent in Crohn's disease are presented. Filtered human Crohn tissue homogenates was inoculated into eight germfree Sprague-Dawley rats, to test the reproducibility of recent reports suggesting a transmissible agent in regional ileitis. No histological changes were evident after 150 days, and no changes were observed in animals inoculated with non-Crohn tissue homogenates.


Results of the treatment of rectal prolapse operated according to Ripstein. 59 patients have been submitted to abdominal rectopexi according to Ripstein. The operative mortality was 5%, which was, however, not wholly due to the operation. The mortality-rate shows, however, that patients older than 60 years of age must be carefully evaluated preoperatively. The recurrence-rate was 5,4% with a mean observation period of 5 years. The method appears to be satisfactory for treatment of rectal prolapse.


Fistula-in-ano. A six year follow up study of 143 operated patients. Of 143 patients operated upon for anal fistulae, all but eight have healed satisfactorally, Impaired healing was seen in patients with high fistulae operated with a modified Elting repair, and in patients suffering from Crohn's disease. When the internal opening was localized and the fistula laid open and excised, healing took place in almost all cases. This method may cause incontinence with high fistulae, and other methods must be used. A loop suture technique gave satisfoactory results both in regard to healing and anal control. Following a modified Elting repair in nine cases, recurrence was seen in four. However, we still believe this method is of value since it leaves the sphincters intact.


Angiography with vasoactive drugs in diagnosis of diverticular disease and carcinoma of the sigmoid colon. 39 patients with sigmoid lesions have been examined with angiografphy, using epinephrine and propranolol. 11 had carcinoma, all were diagnosed angiographically. Fibrosis may appear similar on phamacoangiography whereas the inflammatory reaction is different.


Practical considerations of the vascular surgical "out-patients". Continuity in vascular patient control is important. Physiological methods useful in diagnosis and follow-up of vascular surgical out-patients are discussed. Measurement of systolic blood pressure in the big toe gave good assessment of their peripheral perfusion pressure and helped in selecting patients for vascular reconstruction. Walking capacity was measured on a treadmill together with simultaneous ECG. We recommended that all our patients stop smoking.


Roux-en-Y loop reconstruction as remedial operation for reflux gastritis after gastric resection. Reflux gastritis is a symptom-complex consisting of antacid-resistent epigastric pain, nausea and frequent vomiting, weight loss and anaemia, sometimes with evident gastrointestinal haemorrhage. Gastric secretory studies usually show achlorhydria. The onset of symptoms is usually abrupt in previously healthy subjects. From 1973 to 1977, eleven patients with the established diagnosis of reflux gastritis have been treated with a Roux-en-Y reconstruction, as a remedial operation. There was no mortality in the series. At follow-up after a mean time of two years, the result was graded as excellent in ten patients and as fair in one. It is concluded that the Roux-en-Y procedure can be recommended in patients with reflux gastritis.


Acute arterial occlusion.

Acute arterial occlusion. During the years 1969--1976, 66 patients were subjected to surgery for acute arterial occlusion. Arterial occlusion was due to emboli in 67% of the patients, and to acute thrombosis in 33%. There was no difference in the mean age for the two groups. More than 50% of the occlusions, embolic as well as thrombotic, were located in the femoral artery. In the embolic group limb salvage rate was 93% and patient survival rate 82%. The corresponding figures for the thrombotic group were both 73%. There was no direct correlation between the number of amputations and the time interval from occlusion to operation in either of the two groups. In the embolic group, adequate backflow was reestablished in 82%, while the corresponding figure in the thrombotic group was only 45%.


Reconstruction of the deep femoral artery. Deep femoral artery reconstruction was performed on 54 extremities. Best results were obtained in patients with severe rest pain and minor ischemic ulcerations. Intermittent claudication generally did not improve significantly. The mean operative flow to deep femoral artery was 170 mg/min. and the increase in peripheral pressure 20 mm Hg.


Sympathetic blocks.

Sympathetic blocks. The results of permanent chemical block of the lumbar symmpathetic chain in patients with inoperable vascular conditions, treated during the three-year period 1973--1975 is presented. The results show that, when unsuitable patients have been rejected by their poor response to continuous local aneasthetic blocks, good results with permanent phenol blocks are attainable. These are mainly in patients whose presenting symptom is pain at rest. The complication-rate was low.


Circulatory effects of gastrointestinal hormones and related peptides. Circulatory effects of gastrointestinal hormones and related peptides are surveyed. Only experiments using low peptide dosages, non-extensive surgery and intravenous infusions give relevant data in this field. Glucagon, secretin, vasoactive intestinal peptide, gastrin, cholecystokinin, Substance P and Somatostatin are vasoactive within the splanchnic area, each fraction in a specific pattern.


Phagocyte function in various situations in surgery. A brief presentation is given of granulocyte physiology, as well as some techniques in use for assessing the adherance, the migration, the uptake and bacterial killing and finally the metabolic activity of these cells. Also the activities of the reticuloendothelial system and an in vivo method to measure the phagocytic and metabolic function of macrophages are described. A change, most often a decrease, in phagocytic function has been noted in several circumstances common in surgical practice. So is the case after open heart surgery, during infusion with colloids for blood replacement, and during treatment with immunosuppressive drugs. Further, various forms of malnutrition, such as total starvation, obesity and the hypertriglyceridemia following excessive infusion of fat emulsions may impair granulocyte function.


The Mallory-Weiss syndrome. A review of 23 cases with special reference to coagulation defects. The Mallory-Weiss syndrome is defined as bleeding from longitudinal tears in the gastro-oesophageal junction. The characteristic history consists of repeated vomiting followed by sudden haematemesis. During the past 4 1/2 years, 23 patients, 17 males and 6 females with the diagnosis of Mallory-Weiss syndrome were treated in our institution. An aetiological factor has been sought for. In a review of the case-records, we discovered that many patients had coagulation defects on admission. This was verified with extended coagulation tests at later follow-up. It is proposed that non-bleeding lacerations in the cardiac orifice in conjunction with vomiting is a common occurence, and that the Mallory-Weiss syndrome may be regarded as a complication occuring predominantly in patients with some coagulation defect.


A new method for the visualization of the epidermal Langerhans cell and its application on normal and allergic skin. When skin specimens are exposed in vitro to L-dopa and catecholamines these substances accumulate in the Langerhans cells where they can be visualized with the histofluorescence method of Falck and Hillarp. Some methodological aspects are discussed and a preliminary study of Langerhans cells in contact allergy is reported.


In vitro uptake of L-dopa and catecholamines into the epidermal Langerhans cell. The Langerhans cells are capable of taking up L-dopa and the catecholamines dopamine and noradrenaline when exposed to these substances in vitro. Within the cell L-dopa is found in the cytoplasm as well as in the nucleus, whereas the catecholamines are confined to cytoplasmic granules. The L-dopa uptake is most probably carrier-mediated and the hypothesis is brought forward that L-dopa enters the cell by exchange diffusion. At present little is known about the nature of the amine uptake mechanism.


Molecular weights of haptens.

Molecular weights of haptens. Most haptens have a molecular weight below 400. Oligomers with increasing molecular weight have a decreasing sensitizing capacity. This is of both practical and theoretical interest.


The morphology of chromium allergic skin reactions at electron microscopic resolution: studies in man and guinea pig. Previous studies on clinical patch test reactions have been expanded to short-term studies in humans hypersensitive to chromium. Preliminary results are discussed in relation to experiments in normal and sensitized guinea pigs.


The cellular infiltrate and its measurement in contact dermatitis. It is well known that in the fully developed allergic contac reaction a marked cellular infiltrate takes place in the upper corium and epidermis. In the first part of this paper a short survey is given about the different cells taking part in the infiltrate and the efforts to differentiate both mononuclear and polymorphonuclear cells. In the second part is an account of our quantitative cell studies in experimental contact allergy in guinea pigs. Variations in the increase of mononuclear cell infiltration in epidermis or in the upper dermis seem to reflect the degree of hypersensitivity. Similarly a highly significant polymorphonuclear cell increase is seen in the allergic contact reaction compared to normal control skin, and basophils seem to predominate. The influence of cyclophosphamide methotrexate and corticosteroids on the cellular infiltrate of allergic contact reactions during its development has been studied.


Some immunomodulating factors in allergic contact dermatitis. The effect of adult thymectomy on antibody production and on the development of contact sensitivity to picryl chloride in mice of different ages was studied. An age-dependent decline in the ability to develop contact sensitivity was found to be counteracted by thymectomy. In contrast, antibody production was regularly decreased by thymectomy in mice of all ages. The results suggest that the development of contact sensitivity is regulated by long-lived thymus-dependent suppressor cells which do not affect antibody formation. In addition, the effect of antibody and of lysolecithin-analogues on the development of contact sensitivity is reported.


Theoretical considerations on the potential hazards of hyperventilation during anaesthesia. The purpose of this paper is to evaluate the effect of hyperventilation on cerebral oxygenation. The best estimate of cerebral oxygenation is cerebral venous PO2 (PVO2). PVO2 has been considered in relation to PaCO2 during normoxaemia. In order to compare the effects of hyperventilation with the effects of hypoxaemia, PVO2 has also been considered in relation to PaO2 when PaCO2 is constant. The results indicate that the low PaCO2 values which may be seen in the operating room with manual ventilation have the same effect on cerebral oxygenation as severe hypoxaemia. It is emphasized that the brain is better protected against threats to cerebral oxygenation, e.g. hypotension, if PaCO2 is kept close to normal during anaesthesia. During neurosurgical anaesthesia the advantages of excessive hyperventilation must be weighed against the threat it poses to oxygenation in healthy areas of the brain.


The effect of propanidid on systemic vascular resistance in man. We have studied the peripheral vascular effect in man of propanidid 6 mg/kg, administered as a bolus injection during cardiopulmonary by-pass with the aorta cross-clamped and at constant perfusion flow. Ten measurements in eight patients were performed. A decrease was found in systemic vascular resistance: from 150.7 +/- 16.3 to 99.5 +/- 10.1 kPa x s/1. No venous pooling occurred. It is concluded that, in man, propanidid causes a vasodilation which must contribute to the hypotension it causes.


Percutaneous catheterization of the internal jugular vein. Two techniques for catheterization of the internal jugular vein are described in detail. In a group of 108 adults and 54 children, catheterization of the internal jugular vein was attempted 168 times. Failure to achieve catheterization occurred 12 times. The success rate for the first 50 patients was 86%, but it increased with experience, and was nearly 96% for the remaining patients. Almost 90% of catherizations were achieved on the first or second attempt. The success rate was understandably lower in the children's group. Catheter malpositioning occurred infrequently (six times) and was most common in the children's group. There were few complications, although two were of a serious nature. The techniques described are straightforward, easy to master and perform, and are recommended as useful additions to the anaesthetist's clinical armamentarium.


Haemodynamic effects of enflurane in patients with valvular heart disease. In eight patients undergoing cardiac surgery for aortic and/or mitral valvular disease, mean arterial blood pressure (MAP), central venous pressure (CVP), cardiac index (CI), stroke index (SI), pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure (PAMP) were measured after premedications with diazepam-scopolamine (I), after breathing 100% oxygen (II), and on controlled respiration (III) after induction of anaesthesia with enflurane-O2, and endotracheal intubation facilitated by succinylcholine. All measurements were done prior to surgery. Enflurane anaesthesia was found not to affect cardiac index. The average SI decreased by 27%, but was compensated for by an average increase in heart rate (HR) of 33%. The average systemic vascular resistance (SVR) decreased by 14%. All other measured parameters were found to be unaffected by enflurane-O2 anaesthesia. It is concluded that the cardiovascular stability observed in healthy young normals during enflurane anaesthesia is preserved in patients with moderate to severe heart failure, making enflurane an anaesthetic agent well suited for patients with cardiac disease.


Postoperative haemodynamics in patients with and without cardiac disease. The cardiovascular reaction to primarily major vascular surgery was examined in 39 patients without cardiac disease and in 11 patients with cardiac disease. In the immediate postoperative period (24 h), patients without cardiac disease showed significant increases in heart rate and cardiac index and a decreased blood volume. The central pressures were increased during the first postoperative hour. Systemic blood pressure and vascular resistance remained unchanged, or decreased slightly. Postoperative haemodynamics in patients with cardiac disease followed the same trends as in normal patients; there were, however, no significant changes in cardiac index or central pressures, and in general the cardiovascular reaction to operation was less conspicuous than in the group of normal patients. The preoperative haemodynamic differences between the two groups were diminished in the immediate postoperative period because therapy could be guided by measuring central pressures.


Central haemodynamics during induction of neurolept anaesthesia in patients with arteriosclerotic heart disease. The haemodynamic changes occurring during induction of neurolept anaesthesia and intubation in patients with reduced cardiac reserve were compared with the haemodynamic changes observed prior to operation during the stress of moderate physical exercise in the same patients. Anaesthesia consisted of droperidolum NFN (Dehydrobenzperidol), fentanyli citras NFN (Haldid) and nitrous oxide-oxygen with suxamethonium for intubation. The haemodynamic parameters measured were mean arterial blood pressure, central venous pressure, pulmonary artery mean pressure, pulmonary capillary wedge pressure and cardiac output. Blood volume was also measured, as were arterial blood-gas tensions and pH. The haemodynamic changes observed during induction with intubation were significantly smaller than those observed preoperatively during exercise.


Heart rate changes caused by enflurane and halothane anaesthesia in man. Changes in heart rate and arterial pressure caused by enflurane and halothane anaesthesia were investigated in patients premedicated with diazepam and scopolamine. Enflurane caused a significant (12%) increase in heart rate and depression of arterial pressure (23%). Halothane depressed heart rate significantly (14%), whereas arterial pressure was unaffected. The authors conclude that enflurane possesses a positive chronotropic effect.


Transcutaneous oxygen tension measurement I. Age variation and reproducibility. In 20 patients, aged 19-80 y and without pulmonary or cardiovascular disease, transcutaneous oxygen tension (tcPO2) and arterial oxygen tension (PaO2) were measured. tcPO2 was measured with a Radiometer TCM-1 (transcutaneous oxygen monitor) at 43 C degrees. The age regression for tcPO2 was: tcPO2 = 10.4-0.035 x age (r = 0.406); the corresponding equation for PaO2 was: 13.8-0.053 x age (r = 0.687). The mean difference between tcPO2 and PaO2 was 2.6 kPa (s.d = 0.97) and the ratio tcPO2/PaO2 was 0.8. The accuracy of tcPO2 at the level 5.3-13.2 kPa based on 480 measurements was on the average +/-1.28 kPa (maximum +/-1.73 kPa) at the 95% confidence level. The accuracy of tcPO2 measurements is acceptable for clinical use, and in healthy adults tcPO2 reflects PaO2.


Transcutaneous oxygen tension measurement II. The influence of halothane and hypotension. The influence of halothane-oxygen mixtures on three different transcutaneous oxygen electrodes was investigated. The influence of hypotension caused by halothane and halothane-nitroprusside on transcutaneous oxygen tension measurement (tcPO2) in halothane-anaesthetized patients was examined as well. The electrodes differed with respect to polarization voltages (630 mV or 500 mV) and electrolyte composition (silver chloride or silver bromide). A change dependent on halothane concentration was demonstrated in the electrode readings, both with a polarization voltage of 630 mV and with silver bromide as electrolyte. Using an electrode with 500 mV in polarization voltage and silver chloride as electrolyte, no changes were observed in the readings. During induced hypotension, the tcPO2 values fell in proportion to the mean arterial blood pressure. In patients with a mean arterial blood pressure over 11kPa a tcPO2/PaO2 ratio of 0.6 was found. It is concluded that tcPO2 monitoring during halothane anaesthesia can be influenced in at least two ways, apart from changes in PaO2: (1) by oxygen electrode error due to the halothane; and (2) by changes in skin blood flow. In comparison to the changes in tcPO2 due to the haemodynamic effects of halothane anaesthesia, the changes due to halothane error are small.


Halothane anaesthesia and suxamethonium III. Atropine 30 s before a second dose of suxamethonium during inhalation anaesthesia: effects and side-effects. The protection against bradycardia afforded by atropine given intravenously just prior to a second dose of suxamethonium during halothane inhalation anaesthesia was studied in 100 healthy, adult patients randomly allocated to one of five groups characterized by dosage of atropine. ECG monitoring was continuous, and regular determinations were made of serum potassium, PaCO2, PaO2 and blood pressure. Slowing of the heart rate was seen in more than 50% of patients in each group, but bradycardia (heart rate less than 60 beats/min) was seen only in patients receiving the lowest dose of atropine--0.0075 mg/kg. In the other four groups (atropine 0.01 mg/kg-0.02 mg/kg), bradycardia prophylaxis was effective, but at the cost of serious ventricular arrhythmias in 15% of the patients. The incidence of these arrhythmias seemed to increase with increasing atropine dosage. Marked tachycardia was also seen. Because of the incidence of side effects in this and other studies, no absolute recommendation can be made about suxamethonium bradycardia prophylaxis during halothane inhalation anaesthesia, but our present experience suggests that atropine in a dose not exceeding 0.01 mg/kg, given 30 s prior to a second dose of suxamethonium is best.


Ergotism treated with hyperbaric oxygen and continuous epidural analgesia. Eight patients suffering from severe ergotamine-induced peripheral ischaemia were transferred to our institution for hyperbaric oxygen treatment after unsuccessful therapy in the primary hospital. The patients were exposed to 3 ATBS oxygen for 1 hour 2-3 times daily and they were given an epidural block for the purpose of analgesia where there was severe pain. The circulation and vitality of tissue were restored in all patients. One had tarsal amputations performed half a year later. Hyperbaric oxygen in combination with epidural analgesia is recommended in severe cases of ergotism.


Influence of diabetes on metabolism of vascular smooth muscle. Glucose utilization and the conversion of glucose to lactate, CO2, glycogen and lipids are decreased in the aorta from diabetic rats and rabbits. In addition the incorporation of amino acid into protein is reduced in diabetic rat aorta. The metabolic changes produced by diabetes are counteracted by insulin treatment, but there is a time lag of about 2 days before the effect of insulin treatment appears. The membrane transport of glucose in smooth muscle is carried out by a specific transport system of the facilitated diffusion type. A rate limiting influence of membrane transport on glucose metabolism is found in bovine mesenteric arteries and rabbit colon smooth muscle. In these preparations the influence of glucose concentrations on glucose metabolism is most pronounced in the range 0-11.1 mmol exhibiting saturation at higher glucose concentrations. Insulin in a high concentration (0.1 U/ml) has acute (less than or equal to 3 h) metabolic effects in vitro on smooth muscle which are qualitatively similar to those in skeletal muscle, but are weaker and appear later. The threshold concentration for the acute metabolic effects of insulin on smooth muscle in vitro is 10-100 times above the physiological levels, indicating a low acute sensitivity to insulin.


Diabetic vascular disease. The importance of insulin deficiency, hyperglycemia and hypophosphatemia on red cell oxygen unloading. Diabetes is associated with a fluctuating impairment in oxygen transport of the erythrocytes. This impairment is correlated with hyperglycemia by the formation of glycosylated hemoglobin (HbAIC) and with inhibitory factors of glycolysis i.e. hypophosphatemia and acidosis which lower the concentration of red cell 2,3-diphosphoglycerate. Diabetic angiopathy may be the ultimate result of innumerable microvascular responses to discrete hypoxic injuries associated with increased plasma permeation through the vessel walls. It is shown that two additional risk factors for atherosclerosis--smoking and hypertriglyceridemia may also lead to arterial wall hypoxia by changing the position of the oxyhemoglobin dissociation curve.


Structural analysis of the molecular evolution of some gastro-entero-pancreatic hormones. By means of a statistical analysis of the occurrence of amino-acid residues in the polypeptide chains of several gastro-entero-pancreatic (GEP) hormones an investigation was undertaken to determine whether any of these hormones might be related to each other--possibly from an evolutionary point of view. Particular interest was paid to the occurrence of small charged segments, i.e. those with acidic or basic amino acid residues, since such segments can be presumed to play a role in hormonal receptor binding mechanisms. By this method hormonal relationships were suggested by the observation that these small charged amino-acid sequences, contained in the hormonal structures, match as a result of non-randomness. It was found that hagfish and human insulin were related on a molecular level not only to the newly discovered (avian, bovine, human) pancreatic polypeptide (PP) but also to some other GEP hormones (VIP, GIP, glucagon) as well as to calcitonin and to the alpha-subunit of the glycoprotein hormones. Interpretation of the statistical data suggests that all these peptide hormones are related by a common hexapeptide sequence which contributed, at an evolutionary point, to their molecular architecture. A hexapeptide segment of APP is statistically related to a sequence of equal size in the carboxy terminal region of the A-chain of both hagfish and human insulin, providing the first instance of their structural similarity. Correlations between PP, insulin, glucagon, VIP, and calcitonin provide a tentative basis for predicting the production of one or more of these peptide hormones by immature or de-differentiated cells of neoplasms and non-neoplastic pathologic lesions of the GEP endocrine system.


The absorption of insulin.

The absorption of insulin. It is desirable to improve metabolic control in diabetics receiving insulin. Studies on insulin kinetics provide information that may be useful in the optimization of the injection scheme. Absorption has been measured using 125I-insulin as marker and counting the residual activity with a crystal detector. Plasma insulin has been measured (by radioimmunoassay) in the absence of insulin antibodies. The relationship between the rate of absorption and exogenous insulinemia was analyzed using a simple mathematical model. The time course of plasma insulin was calculated for various insulin preparations, including mixtures. The data suggest the significance of the injection site for the effect of insulin, e.g., a more rapid effect after injection into the abdominal subcutaneous tissue. The pattern of exogenous insulinemia in patients treated with insulin bears no resemblance to that in normal subjects. The calculated patterns of exogenous plasma insulin after injection of various preparations suggest that insulin therapy might be improved to obtain a better and more physiological metabolic control.


Erythroid hypoplasia. An unusual presentation of childhood acute lymphocytic leukemia. A 3-year-old girl had pancytopenia and bone marrow erythroid hypoplasia. The pancytopenia resolved without therapy, but the erythroid hypoplasia persisted for four months in spite of a five-week course of corticosteroid therapy. She responded briefly when androgens were added to the corticosteroid regimen, but within three weeks of stopping therapy she developed acute lymphocytic leukemia. The differential diagnosis of RBC aplasia in childhood is discussed. To our knowledge, this is the first case reported with erythroid hypoplasia as a prodrome of acute lymphocytic leukemia of childhood.


Cushing's syndrome and acute lymphoblastic leukemia. Cushing's disease developed in a 5-year-old girl with acute lymphoblastic leukemia 18 months after her last therapeutic exposure to adrenal glucocorticosteroids. Obesity, hyperpigmentation, striae, osteoporosis, and hirsutism were accompanied by elevated levels of plasma cortisol. These showed no diurnal fluctuation and they were not suppressed by dexamethasone. At autopsy, the adrenal glands were enlarged and the pituitary gland showed increased numbers of basophils of the adrenocorticotropic hormone (ACTH)/melanocyte-stimulating hormone secreting type. Leukemic infiltrates in brain tissue were prominent in the hypothalamus and in the limbic system. It is postulated that the destructive leukemic infiltrate of the limbic system removed a restraining influence on pituitary function, with basophilic hyperplasia, ACTH hypersecretion, adrenocortical hypertrophy, and clinical Cushing's disease the consequences.


The role of uninhibited occlusal development. Stage A treatment is compatible with contemporary orthodontic treatment. 1. It allows for free and uninhibited occlusal development. 2. It gives the orthodontist and opportunity to make a meaningful diagnosis. 3. It does not inhibit the natural inherent forces of growth and development from expressing themselves within the individual patient. 4. It establishes the position of the lower anterior teeth by their self-alignment. 5. It enables the orthodontists to predict the stability of treatment. 6. It simplifies the treatment when Stage I commences. 7. It helps in developing a good rapport between patient, parent, and orthodontist. Just as Caesar wrote of Gaul in his day, "Omnia [Begg] divisaest in partes tres ... "--Stage I, Stage II, and Stage III. I would like to suggest that new province has been added: Stage A--it being the prelude to the accepted three stages in Begg treatment or any appliance treatment of the past.


Bone reaction to orthodontic forces on vitreous carbon dental implants. On the basis of a very small sample in dogs, it appears that orthodontic techniques cannot be used to move a vitreous carbon implant. Therefore, one should not use implants before the completion of orthodontic treatment in persons who may require orthodontic service unless the implants are to be used for anchorage. Alveolar bone heals in very close apposition to vitreous carbon implants in dogs. Prior experiments with vitreous carbon implants have been conducted with free-standing implants; in this study a substantial number of implants became excessively mobile and exfoliated. Therefore, it is recommended that implants be stabilized through the bone-healing period. Because of the small sample, this study should be considered as only a pilot study and observations made should be considered solely as guidelines.


Early and late electromyographic response to treatment with activators. An EMG analysis of twenty Class II cases treated with activators shows that: 1. During daytime use of activators, the protractor muscles of the mandible are stimulated, while the retractors are inhibited. 2. During nightime use of activators, no functional stimulation can be recorded. The activator appears to be operated mainly by tissue stretching and the accompanying elastic rebound. 3. Before treatment, as well as after the treatment, Class II cases show a balanced EMG pattern during closure in the intercuspal position. 4. A narrow upper arch should be expanded before treatment in order to avoid occlusal interferences and to make it easier for the lower arch to adapt itself to a protruded position.


Occlusal objectives in orthodontic treatment. An attempt has been made to present a means for preventing the temporomandibular joint pain-dysfunction syndrome by treating to the terminal hinge position and using postreatment occlusal adjustment procedures. 1. Any postorthodontic patient who is not in centric relation and has occlusal interferences has the potential for temporomandibular joint pain-dysfunction syndrome symptoms to develop in the future. 2. The orthodontist should manipulate the mandible of every patient at each visit, placing the condyle in the terminal hinge position. He should close the mandible until initial tooth contact is reached and diagnose the patient's problems from this position and not from the centric occlusion position. 3. The case should be finished with the teeth in centric relation occlusion. 4. The orthodontist should equilibrate the occlusion of every completed case to eliminate the minute occlusal interferences which are always present. 5. The case treated to centric relation can be equilibrated effectively without mounting on an articulator. 6. If we have the concept of building an occlusion to fit the jaw mechanism, the temporomandibular joint pain-dysfunction syndrome can be virtually eliminated in the postorthodontic patient.


In vitro angiogenic activity of RNA from leukemic lymphocytes. RNA was extracted from leukemic lymphocytes by a fluorocarbon method, and primary cultures of human amniotic cells were exposed to the lymphocyte RNA. Angioid tubular and cordon-like structures in branching out and criss-cross patterns with budding ends developed in these cultures within 7 to 12 days of the first exposure. Although there was no opportunity to study preparations from nonleukemic lymphocytes, extracts of normal peripheral blood cells and blood rich in granulocytes had no angiogenic effects. In view of the recent renewal of interest in tumor and tissue angiogenic factor as well as in angiogenic activity by transformed lymphocytes, in addition to the intriguing angioblastic component of Lukes-Rappaport immunoproliferative syndromes, this work may point to the ribonucleic acid nature of the vessel-forming principle. Various cell-differentiating properties of RNA preparations have been repeatedly described, and thus it is not altogether surprising that lymphocyte angiogenic factor may originate in RNA.


Missing X chromosome and ring chromosome 21 in a case of acute myelomonocytic leukemia. The karyotypic picture of a female patient with acute myelomonocytic leukemia (A.M.M.L.) consisted in the loss of a sex chromosome and a ring chromosome 21. It is suggested that in A.M.M.L. the loss of sex chromosome may represent an early event, the monosomic cells being the object of further chromosome rearrangements, which involve more frequently a chromosome 21.


Myeloblastoma (granulocytic sarcoma) of the ovary. Myeloblastic neoplasms occur in patients with leukemia. In women, the ovary is a common site. The cells of the tumor are identical histochemically to those in the peripheral blood. The Giemsa stain, PAS stain, and Leder stain assist in the diagnosis. The tumors are responsive to radiation therapy, chemotherapy, and operative removal, but tend to be associated with decreased survival. This report describes a case of myeloblastoma of the ovary in an 18-year-old woman. The clinical and pathologic features of these tumors are described. The literature is reviewed briefly.


A review of the significance of gestational diabetes. One hundred and ninety-six pregnancies complicated by gestational diabetes in a referred private practice over an 18-year period have been reviewed. Initially they were managed as true diabetics and the pregnancies terminated before the 38th week. More recently, pregnancies have been managed on an outpatient basis and allowed to proceed to term, with a higher percentage of vaginal deliveries and no increase in perinatal mortality or morbidity. A high incidence of neonatal jaundice was noted, but no explanation emerged. Differences between true diabetes and gestational diabetes, with particular reference to perinatal mortality are discussed and the good prognosis for the gestational form emphasised. Follow-up suggests that a continuation of the rapport established between physician, obstetrician and patient during pregnancy may be important in delaying or preventing the subsequent onset of diabetes.


Incompetence of the cervix.

Incompetence of the cervix. The author reviews a personal series of 248 cases of incompetence of the uterine cervix. Careful selection of patients and variation of the operative techniques to suit the abnormality have led to a substantial improvement in the success rate. In the past 10 years, 94% of patients have been delivered of living babies. The history of the condition is briefly described.


The genesis and implementation of the Tasmanian obstetric survey. The genesis and implementation of a continuing obstetric audit in Tasmania is described. The survey includes all public and private deliveries in Tasmania. Some of the early difficulties and their resolution are discussed. Because of its simplicity, the suggestion has been made that such a system would be suitable for a national audit.


Pituitary control of ovarian function--concepts derived from gonadotrophin therapy. From experience gained in the monitoring of ovarian responses to gonadotropin therapy, it has been possible to develop concepts concerning the mechanisms which operate during the normal menstrual cycle. It is shown that the ovarian requirement for FSH operates in a very narrow range, involving changes in concentration of only 10%; this range operates from a threshold level, through an intermediate level to a maximum level. After adequate stimulation, the follicle goes through a costing phase during which it is independent of further FSH stimulation and it acquires sensitivity to LH. Methods for determining optimum requirements for FSH and HCG for the induction of singleton pregnancies are presented. The relevance of the findings in providing hypotheses explaining some aspects of ovulatory and anovulatory cycles are discussed.


Oestrogen receptor studies in carcinoma of the endometrium, carcinoma of the uterine cervix and other gynaecological malignancies. The tissues from 30 cases of endometrial cancer and 44 cases of cervical cancer were examined for oestrogen receptor activity. Twenty of the endometrial and 9 of the cervical tumours contained oestrogen receptor levels above 4 fmol/mg protein. The proportion of oestrogen receptor-positive tumours was significantly greater in adenocarcinomas of the cervix than in squamous carcinomas of the cervix. Tissues from 3 mixed mesodermal tumours of the uterus, 2 carcinomas of the vagina, a carcinoma in situ of the cervix and a carcinoma in situ of the endometrium were receptor-negative. One ovarian carcinoma and a single case of uterine sarcoma were receptor-positive. The implications of these findings in relation to hormonal therapies are discussed.


New aspects of the treatment of tubal infertility. Three aspects of the treatment of tubal infertility are discussed: current surgical procedures, including the use of microsurgery; an attempt at tubal transplantation; and the use of in vitro fertilization.


Single dose preoperative prophylactic antibiotic in vaginal hysterectomy. A retrospective study of patients following vaginal hysterectomy showed a postoperative morbidity of 75%. A trial of a single preoperative intravenous injection of cephalothin sodium to patients about to undergo vaginal hysterectomy showed a significant (P less than 0.01) reduction in postoperative morbidity.


Vaginal transposition of the ovary in primates (Papio cynocephalus and Macaca arctoides). Experimental data indicate that the time and mechanism of ovulation play a significant role in some cases of infertility and in a broad range of reproductive abnormalities. In order to establish a new experimental model for the study of these phenomena in primates, transposition of the ovary from the pelvis into the vaginal fornix was attempted in 2 species of monkeys: (a) Macaca Arctoides and (b) Papio Cynocephalus. Particularly in the latter species, ovarian relocation into the anterior and the posterior vaginal fornices proved feasible. Most ovaries continued functioning in their new location during the 2-5 months of the follow-up, despite macroscopic and microscopic evidence of infection. Post mortem examination of one of the experimental animals several years after the surgical procedure revealed the presence of an intact functioning ovary still in close contact with the vaginal fornix.


Acute traumatic tetraplegia during pregnancy. A case of acute traumatic tetraplegia during pregnancy resulting in maternal death is presented, and problems of management are discussed. Difficulties experienced by the mother were intractable urinary tract infection and respiratory insufficiency; those in the neonate were prematurity and the effects of drugs administered to the mother.


Idiopathic pericarditis and pregnancy.

Idiopathic pericarditis and pregnancy. The association of idiopathic pericarditis and pregnancy is described in 3 patients. The disease preceded the onset of pregnancy in 2 patients and appeared during the sixth month in the third. All pregnancies reached term and the deliveries were uneventful. One patient had mild heart failure before the pregnancy. This deteriorated slightly during its course. The remaining 2 patients had no signs of heart failure and none of the 3 had arrhythmias or embolic phenomena. Two patients were treated with aspirin and prednisone and one was treated for heart failure only. All patientts are still symptomatic and require treatment 9 months, 1 year and 21 years after the pregnancy. Two of the patients underwent partial pericardiectomy.


Idiopathic fatty liver of pregnancy with maternal and fetal survival. A case of idiopathic fatty liver of pregnancy with survival of mother and child is reported. The management of this condition is essentially supportive; coagulation disturbances may require special attention. Maternal survival should be the major consideration and is favourably influenced by early delivery. Fetal monitoring aids obstetric management and may indirectly improve fetal survival. Evidence from the literature suggests that the condition does not usually recur in subsequent pregnancies.


Parental relationships during childhood in homosexuality, transvestism and transsexualism. The nature of the relationships of 29 male homosexuals, 34 male transvestites and 29 male transsexuals with their parents, during childhood, was assessed on the basis of the subjects' reports, and on their responses to two tests, namely the Childhood Family Relationship test and a Semantic Differential. If the subjects' reports are valid significantly more mothers of transvestite and transsexual subjects hoped for a girl prior to the subject's birth. During childhood there was a trend for homosexual, transvestite and transsexual subjects to report that their fathers lacked interest in them or were absent from home. There was little evidence to support the view that homosexual, transvestite or transsexual subjects had pathological relationships with their mother. Intrafamilial childhood environmental factors reported by homosexuals, transvestites and transsexuals appear to be non-specific.


A model of violence.

A model of violence. The assessment of the violent individual presents a challenge to psychiatrists. Many theoretical approaches contribute to the understanding of violence, but none are totally adequate for the clinician's purposes. The assessment of violent behaviour can be undertaken using three separate dimensions--"Dehumanisation", "Acceptance of Violence" and "Rage and its Control"--which together form a framework for the formulation of clinical data. This framework is described and the relevance of theoretical contributions to the three dimensions is discussed. It is suggested that this framework assists in the classification of violent individuals and in the prediction of the potential for future violence.


Conversion reactions simulating Guillain-Barré paralysis following suspension of the swine flu vaccination program in the U.S.A. The association of Guillain-Barré Syndrome as a possible complication of swine flu inoculation created the potential for conversion reactions simulating this syndrome. Upon termination of the swine flu vaccination program, a study was initiated in a prepaid health plan to identify and categorize such patients. An estimated 8000 adults were vaccinated and it was hypothesized that a large number of these patients would present to the health plan with conversion symptoms. However, only seven patients met the criteria and they were compared to two control groups (inoculated and uninoculated). The patients with conversion symptoms did show similatities to those previously described in the literature: all were female, of lower educational level, and had great concern with health problems. Other speculations as to why these patients had conversion reactions were made.


A case of lithium poisoning? A cautionary tale. The case of a 58 year old woman on maintenance lithium therapy who developed an acute organic brain syndrome is reported. The patient subsequently showed evidence of persistent brain damage. It is suggested that lithium toxicity was precipitated by electrolyte disturbances possibly caused by self medication with a diuretic, where serum levels of lithium were an unreliable measure of impending toxicity.


Computer analyses of auditory evoked cortical potentials in schizophrenic subjects. Averaged cortical evoked potentials from single clicks were recorded from 51 patients and controls. The patient group consisted of 40 subjects with a diagnosis of 'nuclear' schizophrenia, and 11 subjects with diagnoses including mania, anxiety neurosis and personality disorder. Changes in auditory evoked cortical responses (AECR's) were most marked in clinically stable, dysphoric, chronic schizophrenics. These subjects showed reproducible, low amplitude, 'untidy' responses in which the amplitude of the primary peak was lower than the amplitude of later peaks. Chronic schizophrenics who were rated as being depressed, showed a more 'normal' AECR. AECR changes during the memorising of nonsense syllables demonstrated a functional separation between early and later peaks of the AECR. It was postulated that the AECR changes in schizophrenia and during memorising result from pathological patterns of cortical desynchronisation produced by altered mid-brain activity different from that of anxious arousal, and that the clinical 'steady-state' of chronic schizophrenia is reflected in the 'steady-state' desynchronisation changes in the AECR.


Asthenic personality, myth or reality.

Asthenic personality, myth or reality. One hundred and seventy five subjects admitted to hospital for neurotic conditions were assessed as to their personality types. Forty seven percent were judged as having personality traits consistent with the diagnosis of asthenic personality disorder. Thirteen of the 138 symptom, life history and psychological test items examined were found to be associated with the asthenic traits. Condensation of these thirteen items by factor analysis showed that two features--anxiety proneness and inability to cope with stress--together defined the disorder.


A note on cluster analysis and depression: disparities in results produced by the application of different clustering methods. Cluster analysis is the most logically suited method for establishing psychiatric classifications. Different mathematical methods of clustering do, however, produce disparate results when applied to the same set of data. This study attempted to quantify the extent of such disparities, and found them to be marked. It was concluded that until cluster analysis has undergone further mathematical and statistical development, it should be used with caution.


Probable clonal origin of acute myeloblastic leukemia following radiation and chemotherapy of colon cancer. A 64-yr-old female developed acute myeloblastic leukemia following radiation and drug therapy for colon carcinoma. The patient was heterozygous for glucose-6-phosphate dehydrogenase (G-6-PD) and displayed types A and B isoenzymes in nonhematopoietic tissue. In contrast, only type B G-6-PD was observed in peripheral blood white cells. In addition, a karyotypic abnormality was found in peripheral blood and marrow cells but not in skin fibroblasts. The data are consistent with a clonal origin of this leukemia.


Colony formation in vitro by leukemic cells in acute lymphoblastic leukemia (ALL). An assay system in vitro for the growth of malignant lymphoblastic colony-forming cells (CFC) was established. Growth of malignant myeloblastic CFC has been previously reported, but this is the first report of growth of malignant lymphoblastic CFC. Established assay systems in vitro have been very helpful in elucidating the control of growth and differentiation of both normal and malignant bone marrow cells. Lymphoblastic CFC were grown from the bone marrow aspirates of 20 children with acute lymphoblastic leukemia. Growth of these colonies was established on an agar assay system and maintained in the relative hypoxia (7% oxygen) of a Stulberg chamber. The criteria for malignancy of these colonies was based upon cellular cytochemical staining characteristics, the presence of specific cell surface markers, and the ability of these lymphoid cells to grow without the addition of a lymphoid mitogen. With this technique, specific nutritional requirements and drug sensitivities can be established in vitro, and these data may permit tailoring of individual antileukemic therapy.


Myeloproliferative syndromes: a unique presentation of chronic myelogenous leukemia (CML) as a primary tumor of bone. A 45-yr-old female presented with a rapidly enlarging bony tumor that was eventually identified as a Philadelphia chromosome (Ph1)-positive myeloproliferative disorder with extramedullary blastic transformation. This transformation occurred in the absence of demonstrable chronic or acute leukemic phase. She had no history of a chronic or prodromal illness in spite of a bone marrow biopsy showing myelofibrosis and liver biopsy documenting extramedullary hematopoiesis. This case represents a unique constellation of features of the myeloproliferative syndrome in which the diagnosis was obscure until special stains of the bony tumor and cytogenetic studies were performed.


Chromosome analysis of spleen and/or lymph nodes of patients with chronic myeloid leukemia (CML). Origin and spread of the chromosomally abnormal cells that appear in chronic myeloid leukemia (CML) after transformation are unknown. Spleen and lymph node may be involved. In 16 patients with CML splenectomy and/or adenectomy were performed before or during the blastic crisis of the disease, followed by a chromosomal analysis of the cells from the removed organ. At the same time, the chromosomes of the blood cell and of the bone marrow were also analyzed. Analyses were done with R banding. The results show that an extramedullary clonal development with duplication of the Ph1 chromosome and other features occurred. From a cytogenetic standpoint, acute blastic phase of CML is frequently characterized by an increased number of chromosomes owing to preferential gain of additional chromosomes. This, then, would clearly point to extamedullary acute transition in CML.


Impact of cancer therapy on survival.

Impact of cancer therapy on survival. Survival rates improved significantly for 28,036 lymphoma and leukemia patients studied between 1950 and 1973. Nine cancers reviewed demonstrated increased one, three and five year survival rates. Greatest improvement was acute lymphocytic leukemia survival. Least improvement was for chronic granulocytic leukemia. Analyses of age-specific trends in U.S. cancer mortality since 1960 indicates death rates decreased 20% for all ages up to 45 years. This included 70% of the population, but less than 10% of all cancer deaths. Age groups over 55 experienced an 8% increase in cancer mortality. Accurate determination of national cancer incidence trends is not presently possible. Available data, representing approximately 15 million population, indicate that cancer incidence rates increased between 1960 and 1973. Age-specific trend analyses indicate unusual divergences. For the group 15 to 29-years-old, incidence increased 28% in 13 years and there was a concomitant decrease of 20% in mortality.


Normal and leukemic hemopoiesis compared. Using colony assays for human erythropoietic (BFU-E, CFU-E) and granulopoietic (CFU-C) progenitors, normal and leukemic myelopoietic differentiation were compared; similar patterns were found in both. However, the origin of blast cells characteristic of the disease could not be established indicating the need for a direct approach to these cells. A colony assay for blast cells in acute myeloblastic leukemia is described. Blast cell colony-formation is significantly correlated with blast cell number, and the colonies contain cells of blast like morphology without differentiation markers. It is proposed that this method, taken in conjunction with results from assays of myelopoiesis and lymphopoiesis, may provide a more complete picture of leukemic differentiation. It is anticipated that such a model will be useful in devising new therapies.


Chronic myelogenous leukemia.

Chronic myelogenous leukemia. Chronic myelogenous leukemia (CML) is a relatively rare disease, with a number of features that make it especially suitable for observations on leukemogenesis in man. These include known etiologic agents, often a prolonged preclinical and active stage, cells with identifiable morphological and histochemical characteristics and the presence of the unique Ph' chromosome. The transition of CML to blast crisis is a catastrophic event; however, recent clinical and biochemical studies have raised important questions as to the nature and origin of blast cells in this disease. During the past 10 years, we have followed 113 cases olf CML throughout their course and results of observations on the clinical, hematological and other apsects of the disease are presented in this communication.


Leukemic distribution of a human acute lymphocytic leukemia cell line (Ichikawa strain) in nude mice conditioned with whole-body irradiation. Induction of leukemia in nude mice (BALB/c nu/nu) was attempted by inoculation with a human acute lymphocytic leukemia cell line (Ichikawa strain, maintained in an ascitic form in our institute). Inoculation of the cells i.v. in normal nude mice failed to produce leukemia. However, conditioning with whole-body irradiation (500 rads) resulted in induction of leukemia after i.v. inoculation, especially when such inocluation was performed 3 days after irradiation. The correlation of survival to inoculum size (10(5) to 10(5)) was inversely exponential. Leukemic infiltration was noted in the spleen, lymph nodes, bone marrow, meninges, liver, kidneys, etc., as seen in human leukemia. These cells retained their original cytological characteristics, ultrastructural features, and surface markers and revealed high terminal deoxynucleotidyltransferase activity as T-derived cells. Chromosome analysis revealed aneuploidy in a hypotetraploid range with a mode of 88 chromosomes.


Effect of alpha-tocopherol on the cardiotoxicity of adriamycin in the rat. Adriamycin (ADR)-induced cardiomyopathy was studied in a rat model by means of electrocardiograms (ECGs), light microscopy, and determination of heart weight. Pretreatment with D-alpha-tocopherol (alpha-T) 24 hours prior to a high dose of ADR diminishes cardiotoxic effects, as judged by ECG changes, decreases in heart weight, and histologic changes. The response of an acute myeloid leukemia in a rat model to ADR was not affected by this pretreatment. The results provide evidence that alpha-T might be used to improve the therapeutic index of ADR.


Acute myelogenous leukemia in patients receiving chlorambucil as long-term adjuvant chemotherapy for stage II breast cancer. Thirteen consecutive stage II breast cancer patients were treated with long-term adjuvant chemotherapy using chlorambucil. At least three of these patients developed acute myelogenous leukemia (AML). All three patients (and possibly a fourth) who developed AML were postmenopausal, received continuous chlorambucil for greater than or equal to 4 years, had acute red cell anemia at the time of treatment, and had a wbc count in the range of 2700-7700/mm3. After the chlorambucil was discontinued, the wbc count began to slowly rise and the patient developed clinical AML. In all three patients, the diagnosis of AML was established by pathologists on the basis of bone marrow biopsy, aspirate, and peripheral smears. Each of these was subsequently reviewed by the hematologist who treated the patients for AML. Patients who have breast cancer (or any other solid tumor malignancy) are at risk to develop a second malignancy. However, an increasing number of reports are appearing suggesting more than just a casual relationship between leukemia and the use of alkylating agents. This may be related to the dose and duration of therapy with these agents.


Psychiatric evaluation of youth with cleft lip-palate matched with a control group. Ten subjects were randomly selected from each of four pools of patients (male CPO, male CLP, female CPO and CLP) age six to 18 years regularly followed by a cleft palate clinic. Forty controls from a family practice clinic were matched for age, sex, and socio-economic status. Congenital second anomalies were present in 13 cleft children, five of whom were male CPO. Significant hearing loss was found in 11 cleft children and speech articulation problems in about 50 per cent of the sample. Both cleft and control groups were interviewed by a child psychiatrist, and mothers completed a behavior rating check list. There were no significant differences in the number of subjects from both groups having psychiatric diagnoses or conflicts. Mother's ratings indicated that cleft group had significantly more subjects with excessive dependency problems while control group had significantly more subjects having problems with resenting correction, talking negatively about self, and projecting blame to others. Significantly more male CPO and female CLP patients had psychiatric diagnoses, particularly mental retardation and developmental deviations, when compared to male CLP and female CPO groups. Cleft children with articulation problems were more likely to have psychiatric diagnoses and conflicts.


Growth of the unilateral cleft lip.

Growth of the unilateral cleft lip. Growth discrepancies have frequently been noted following surgery for the repair of clefts of the lip. A long lip is often noted months or years after LeMesurier, Tennison, or Asensio repair, whereas a short lip is noted after the Millard repair. We evaluated the problem by measuring 112 unrepaired unilateral completed cleft lips in a homogeneous population. Patients of all ages from newborn through adults were included. The study showed that a cleft lip has ten to twenty per cent greater growth in the transverse direction parallel with the orbicularis muscle than in the vertical direction perpendicular to the muscle. Thus, procedures such as those of LeMesurier and Asensio that transpose tissue from transverse to vertical will lead to excessive vertical growth. Lip growth is slightly decreased along the cleft margins but does not account for the short lip seen after the original Millard repair. Lip shortness occurs soon after repair because of scar contracture but tends to resolve with the passage of time.


Cephalometric findings in two cases with unrepaired bilateral cleft lip and palate. Two cases with unoperated bilateral cleft lip and palate were examined clinically and cephalometrically and compared to matched normals. The findings indicate a severe premaxillary skeletal protrusion which results in a maxillary-mandibular discrepancy. The maxillary incisor inclination was acceptable, while the mandibular incisors were relatively more lingually inclined in the cleft group. Surgical management of one case necessitated premaxillary resection.


Selected developmental factors of cleft palate children between two and thirty-three months of age. The literature suggests that cleft palate children and adults perform below their peers on both linguistic and nonlinguistic tasks. The purpose of this investigation was to ascertain if developmental delay could be observed in 24 cleft palate children below the age of three years when compared to matched controls. Three developmental scales were administered to all infants, and complete medical histories and current weights were obtained. Results indicated that the performance of the cleft palate subjects paralleled but fell below their peers on all developmental subtests. The differences were significant (p is less than .05) on three language subtests and on one personal-social and one motor subtest. The mean percentile weight also differed significantly (p is less than .05). Multivariate analysis explored the relationship of 1) extent of cleft, 2) sex, 3) hearing loss, 4) length of hospitalization, and 5) weight to the developmental scores. The extent of the cleft proved to be significant.


Conductive hearing loss in patients with velopharyngeal insufficiency. This study involved audiologic and otologic evaluations of 77 subjects with VPI not due to overt cleft palate, aged 4-16 years. Audiological findings revealed that: 49 per cent had a hearing loss (74 per cent conductive, 16 per cent sensori neural, 10 per cent mixed) and that 18 per cent of the subjects had inconsistent audiologic findings. Otologic evaluations revealed that 44 per cent had abnormalities of the tympanic membrane. It can be concluded that the VPI subjects differed appreciably from the normal and more closely resembled a cleft palate population.


Congenital and acquired deafness in clefting and craniofacial syndromes. A study of 284 craniofacial defect patients determined factors associated with or predisposing to acquired or congenital hearing loss. Complete otolaryngic and audiologic evaluation was done at the initial assessment of a large group of patients. From there, a smaller number who had had adequate workup and followup was selected. The patients were classified into seven clefting categories, microtia/artresia, facial defects, cranial defects and miscellaneous anomalies of the head and neck. X-ray findings, those present at middle ear surgery and those studied at autopsy, are summarized. The incidence of hearing loss is 88 per cent. The likelihood of congenital hearing loss increases with the number of defects. Certain unifying concepts that may help identify a specific child as being in urgent need of otologic and audiologic testing are presented.


The case for the inferiorly based posterior pharyngeal flap. The superiorly based and inferiorly based posterior pharyngeal flaps are compared. Reasons for choosing one or the other in specific cases are given. The complications with each are enumerated. The results obtained in speech comparing the two flaps in two retrospective series and one prospective series of cases failed to show a significant difference between them. Therefore, with little difference in the results and some good reasons for preferring one or the other under certain conditions, it would seem logical to select the one best suited for the particular problem.


Partial palatal split palatoplasty.

Partial palatal split palatoplasty. A partial palatal split technique is described for use with superiorly based pharyngeal flap palatoplasties. This procedure allows (1) increased facility in dissection, (2) precision in the design of the flap for lateral port control, and (3) construction of a one-piece nasomucosal lining flap in comparison to the standard complete palatal split technique.


Primary veloplasty: long-term results without maxillary deformity. a twenty-five year report. Primary veloplasty during the first year of life enables normal growth of the upper jaw and of the facial skeleton in patients with clefts. In spite of the remaining cleft in the hard palate, intelligible speech can be learned. The closure of the residual cleft of the hard palate is generally postponed until the age of 12 to 14 years, when the normal growth of the jaw is virtually completed. This method has been used in the clinic by the author and his father for thirty years. The results after primary veloplasty for some hundred adult patients show normal maxillary and cranial growth both clinically and radiologically. Primary veloplasty operations constitute acceptable restorative surgical treatment of the maxilla. Various problems of timing and methods of cleft palate treatment are discussed. The author's cases are summarized.


Median cerebrofacial dysgenesis: the syndrome of median facial defects with hypotelorism. Two patients with almost identical median facial defects are described. Both patients manifested a pure Pitressin responsive diabetes insipidus. These two patients are part of a graded series of median cerebrofacial malformations with orbital hypotelorism, which have been grouped under the heading of Median Cerebrofacial Dysgenesis. A revised classification of this group of anomalies is presented. The importance of distinguishing this group of patients from the group with the Median Cleft Face Syndrome with hypertelorism is stressed. Careful attention to face-brain relationships will help elucidate our understanding of the embryogenesis of the facial region, and extend the number of diagnostic facies which currently can be recognized.


Partial molecular characterization of an antigenic structure associated to cells of common acute lymphocytic leukaemia (ALL). A heteroantiserum against common human acute lymphocytic leukaemia (ALL) cells was raised in rabbits. This antiserum was rendered specific for common ALL cells by extensive absorption with different human tissue. A specific antigen associated to common ALL cells was solubilized by sodium deoxycholate from ALL plasma membranes and identified by indirect immunofluorescence. By analytical chromatography, two antigenically active peaks were found. The apparent molecular weights were calculated to be 55,000 and 110,000.


Surface membrane determinants on childhood acute lymphocytic leukemia cells: immunoglobulin, Fc and C3 receptors. Most reports have now described two populations of childhood ALL patients: those with thymic (T) cell receptors and those lacking receptors on their neoplastic cells. Assays for the surface receptors of the T and thymic-independent (B) system were used to study forty-seven patients with ALL whose bone marrow contained a mean of 85% leukaemic cells. Two patients had T-cell disease and thirty-six were non-T and non-B. nine patients were identified whose leukaemic cells had membrane properties associated with the B-cell system: surface immunoglobulin, Fc receptors and/or complement receptors. Combined T and B receptors were found in one case. The same surface characteristics were found on leukaemic cells from these patients' bone marrow, blood, pleural and cerebrospinal fluid. Studies showed that the leukaemic cells were not of monocytic or granulocytic origin. Although a remission was obtained in each patient, the relapse rate of the B-cell group was worse than a similarly treated group of thirty-six non-T, non-B ALL patients (P less than 0.001). Initial total leucocyte counts of the B-cell group were greater than the non-T, non-B group (P 0.05), but when the patients in both groups with total leucocyte counts greater than 25,000/mm3 were compared, the relapse rate of the B-cell patients was significantly worse (P less than 0.025). The results show that patients with leukaemic cells possessing B-cell properties comprise a significant proportion of ALL cases, and their presence on leukaemic cells has an ominous significance.


Tumor immunology of experimental osteosarcoma. A spontaneous AP positive C3H murine OS was used to determine the effects of various treatment modalities. AP served as a useful circulating biomarker of the in vivo tumor growth. In animals whose tumor was amputated, the elevation of the marker indicated the presence of pulmonary metastases. It was used to establish the time of recurrence after a partially effective chemotherapy or combination modality. In this model, when the neoplasm was surgically excised at 10 days posttransplantation, 70--80% of the mice showed presence of lung metastases. Specific immunotherapy with irradiated tumor cells did not alter the course of the disease. Passively transferred immune allogeneic cells to tumor bearing mice at an effector to target cell ratio of 1:1 in vivo were ineffective. The murine OS model is extremely useful to plan and institute different combinations of treatment modalities and optimize the conditions for an effective treatment in a relatively short time.


Efficiency of traditional chewing sticks in oral hygiene programs among Ethiopian schoolchildren. The effect of oral hygiene programs was studied in 248 children from five schoolclasses in Asella, Ethiopia. All children received professional toothcleaning after an initial clinical examination, and were again examined after a trial period of 3 months. The classes were assigned to the following procedures: one class received information and instruction in the use of the toothbrush, and a second class in the use of the mefaka, a wooden chewing stick traditionally used for oral cleaning. The children were advised to clean their teeth daily. Two other classes received similar information and instruction with regard to the toothbrush and the mefaka. Oral cleaning was then performed daily under direction and supervision, in one class with the toothbrush and in the other class with the mefaka. The fifth class was used as control. Instruction only was found to have no effect on the amount of oral deposits. Supervised oral cleaning, on the other hand, improved the oral hygiene of the schoolchildren significantly. The mefaka was found to be as effective as the toothbrush in removing oral deposits. It was concluded that the mefaka should be recommended for use in preventive dental programs in Ethiopia since it is effective, inexpensive, and familiar to the population.


Acceptance, caries reduction and reported adverse effects of fluoride prophylaxis in Norway. Water fluoridation has not been introduced in Norway, although 99% of the population receive water with suboptimal fluoride levels. Alternative methods of fluoride prophylaxis have gained wide acceptance in this country. While less than 1% of the children received fluoride tablet in 1971, sales data in 1976 indicated a daily supply of fluoride tablets to 50% of the 0-5-year-olds and to 20% of the 6-11-year-olds. Most schoolchildren have joined mass prophylactic programs with regular with regular applications of fluoride solutions. Furthermore, fluoride-containing dentifrices have become available and are increasingly used. The increased use of fluoride has been paralleled by a marked reduction in caries and restorative need. During the past 5 years, a reduction of about 45% in the number of fillings inserted in 6-17-year-old children has been noted. In some areas, a 70% reduction has been recorded. The ratio between expenses for prophylaxis and savings in cost of treatment is favorable. The Norwegian Adverse Drug Reaction Committe received 34 case reports of adverse effects ascribed to fluoride prophylaxis, from 1970 to 1977. None of the 25 follow-up studies performed, suggested fluoride to have been responsible for the reported symptoms. In Norway, the benefits of fluoride prophylaxis are becoming increasingly evident.


Utilization of dental care in Finnish industrial population. Ninety-three percent of the 300 employees of a paper mill in central-eastern Finland answered a questionnaire in the context of a clinical dental survey. One third had visited the dentist annually, 22% once in 2 years and the rest irregularly. Dental visit frequency of females was somewhat higher than that of males. People in younger age groups and higher income groups used more dental services, whereas those who had dentures used clearly less dental services than others. Subjective assessment of treatment need was the main reason for dental visits, more than half of the subjects had attended the dentist the last time because of self-assessed need. Thirty-eight percent went to the dentist because of toothache and only 9% for regular check-up. Although more than one third had gone to the dentist because of toothache only one third of those who had toothache during the preceding year had visited the dentist during that period. People without toothache, in fact, used more dental services than those who had had it.


Dental caries indices for primary teeth: the need to comply with internatioanl recommendations. This paper illustrates inconsistent use of abbreviations in indices employed to assess caries prevalence and incidence in the primary dentition. Possible consequences of this practice are discussed and it is suggested that authors, editoris and referees for dental journals should accept and adhere to internationally agreed upon definitions of these indices. As long as there is disagreement on the use of the dmf and def indices these initials should be defined under "methods".


Need of orthodontic treatment in 7-year-old Finnish children. The purpose of the investigation was to determine the need of orthodontic treatment in 7-year-old Finnish children. The series consisted of 200 Finnish children, 100 girls and 100 boys. With regard to the main lines of occlusion a close agreement was observed between the prevalence of malocclusion in this and other. Scandinavian series. The need of orthodontic treatment was assessed using a treatment scale for the age group concerned. No treatment was required in 42% of the children, while 23.5% were in immediate need of orthodontic treatment. In 34.5% it was considered necessary to follow the occlusal development.


Dental caries in rural and urban black preschoolchildren. The dentitions of 439 rural and 192 urban black children aged 1-5 years were examined with mirror and probe. Dental caries was common and the percentage prevalence and dmft values were similar in children of 1-3 years in both groups. At 4 years of age there was a twofold increase in dental caries in the urban children to reach a dmft score significantly greater than that in the rural children (P less than 0.01). Labial caries was common in rural children but rare in urban children while rampant caries (dmft greater than or equal to 5) exhibited the opposite pattern.


Periodontal disease and oral hygiene in Arussi province, Ethiopia. A dental health survey was conducted in the Arussi province in Ethiopia. The survey comprised 1,700 persons between 6 and 54 years of age in five age groups from four regions of the province. Findings concerning periodontal disease and oral hygiene are reported in the present paper. The onset of periodontal disease was early, with 60% of the children in the 6-7 year group having gingivitis. In general, periodontal disease was found in a majority of the surveyed population (83%). Severe periodontal destruction was, however, unusual before the age of 30, but at the age of 45-54 years 52% of the sample exhibited pocket formation. The level of periodontal disease in Ethiopia was judged as low to moderate. A close relationship was observed between oral cleanliness and periodontal condition. A possible favorable influence of the diet and traditional oral cleaning methods is conceivable.


Orthodontic examination of 2,301 Danish children aged 9-10 years in a community dental service. Orthodontic therapy in the Danish Child Dental Health Service is offered according to patient need. In general, systematic screenings of children in specific age groups are carried out to insure uniformity in selection of patients for orthodontic treatment. The screening described in this investigation was carried out among 2,301 3rd grade schoolchildren in order to diagnose symptoms of malocclusion at an early stage with regard to tooth formation, the aim being to evaluate the need for orthodontic observation, prophylactic measures or therapy. Each examination took approximately 3-4 min.


Oral and dental affections in mercury-exposed workers. A total of 222 mercury-exposed workers in the Chlor-Alkali plant in Kuwait were investigated for oral and dental affections. The levels of mercury-vapor ranged from 566.6 microgram/m3 to 0.3 microgram/m3 in different parts of the factory. The periods of exposure varied from 1 to 11 years. Although the level of mercury vapor in the air and the period of exposure proved to be the main factors as regards the oral signs and symptoms, the oral hygiene condition and the individual sensitivity played substantial roles. Oral affections were found not to be due to allergy to mercury.


A combined approach to preventing dental caries in schoolchildren : caries reductions after 3 years. A combination of preventive methods have been used to reduce dental caries in children residing in a fluoridated area of Southeastern Michigan. These children had very low restorative treatment levels. The methods used include dental health education, prophylaxis, pit and fissure sealants, topical application of fluoride and restorative care. Prophylaxis, sealant and fluoride procedures were repeated every 6 months. Sealant was applied to all caries-free posterior teeth in the mouth. Three-year results show reduction of occlusal caries increments of nearly 73% for both 1st and 6th school grades. Although at baseline examination there was no statistically significant difference between the two groups in mean DMF teeth and surface scores, the difference in mean increments at the end of 3 years was statistically significant (P less than 0.01). Percent reductions in caries increment for permanent first molars in 1st graders were 65.6 for DMF teeth and 66.7 for DMF surfaces. Corresponding figures for permanent teeth among 6th graders were 71% and 58.3%.


Effect of a single dental health care instruction and prophylaxis on gingivitis. This study was conducted to evaluate the effect of a single dental health instruction on gingivitis in an adult population. Ninety-eight army recruits from two military camps were randomly allocated to four groups: a control group, a group that received a professional prophylaxis, a group that received dental health care instruction and a group that had both a prophylaxis and dental health care instruction. Treatment effects were measured 1 week, 1 month and 3 months after the initial examinations. The single prophylaxis resulted in a small temporary improvement. The effect of the single dental health care instruction was also small, but lasted until the end of the trial. A single instruction plus prophylaxis resulted in the clearest improvement, which was still present after 3 months. It can be concluded that any single treatment should at least consist of dental health care instruction plus a prophylaxis.


Follow-up study of sealing and filling with composite resins in the prevention of occlusal caries. A diluted composite resin (Concise diluted with Concise Enamel Bond) was used for fissure sealing and filling in 896 permanent first molars of 281 children, initially 5--7 years of age. Ordinary fissure sealing was used for fissures with no apparent caries, while a filling method was used after an explorative drilling with a small round bur (Ash No. 1/2) in fissures with incipient caries. On the basis of clinical evaluation every 6 months, the frequency of total retention of the composite material after different observation periods was calculated using the life table method. The rate of success in the fissure sealing group was 94.8% after 6 months, falling to 75.2% after 30 months. The corresponding data for the filled teeth were 92.6 % and 83.5%. It would seem that diluted composite resin is well suited for the prevention of caries in pits and fissures.


Clinical effectiveness of an autopolymerized fissure sealant after 2 years. The clinical effectiveness of Delton fissure sealant was studied in 205 children, ages 6--10 years (mean age 71/2). 993 children in grades 1, 2, 3 and 4 were screened and subjects were selected if there was evidence of previous dental caries in the mouth, and a pair of contralateral maxillary or mandibular first permanent molar teeth were free of caries. Two pedodontists independently examined the children in a mobile van equipped with two operatories, and each applied sealants to approximately half of the subjects. After 11 months, in 186 subjects there were 10 sealants partially lost, five experimental teeth carious or filled and 53 control teeth carious or filled. After 24 months, in 175 subjects there were four sealants completely lost, 12 sealants partially lost, 11 experimental teeth carious or filled and 89 control teeth carious or filled. Consequently, sealant retention was 92% after 11 months and 85% after 24 months. Percent effectiveness in caries reduction was 90% after 11 months and 88% after 2 years.


A laboratory evaluation of fluoride dentifrices used in Greece. A laboratory investigation of the fluoride dentifrices commonly used in Greece was done in order to evaluate their caries-preventive potential. The evaluation was based on the determination of the free ionic fluoride and the total soluble fluoride present by a potentiometric fluoride electrode technique. Dentifrices containing MFP, NaF and AlF3 were analyzed. The measured total soluble and free ionic fluoride content were discussed in conjunction with the various dentifrice components. Most of the examined dentifrices were MFP type and the free ionic fluoride was found to vary from 130 to 180 parts/10(6) F-.


An evaluation of Knutson's formula for estimating age-specific DMF teeth. The present study evaluated a formula suggested by Knutson for obtaining an age-specific estimate of mean DMFT in a population on the basis of the age-specific percentage of individuals with 1 or more DMFT. A total of 149 previously collected age-specific data sets from low-flouride areas in the U.S.A. were used, and the two parameters K and B were estimated using the method of weighted least squares. The analysis showed that the formula could be used with good accuracy for certain restrictions of age (5--11 years) and percentage of individuals with 1 or more DMFT (less than or equal to 70%).


Age-standardized incidence rates of ameloblastoma and dentigerous cyst on the Witwatersrand, South Africa. Although a great deal is known about the incidence of cancer, including oral cancer, no such study has been done on odontogenic tumors and jaw cysts. There are therefore no standardized data which would allow for comparative incidences in different countries and between different groups. In the present study, cases of ameloblastomas and dentigerous cysts derived from the records of all the hospital pathology departments and private pathology practices on the Witwatersrand, were recorded for the 10-year period 1965--1974. The population at risk (1970 census) was 974,390 Whites and 1,567,280 Blacks. The annual incidence rates, standardized against the standard world population, for ameloblastomas per million population are 1.96, 1.20, 0.18 and 0.44 for Black males, females and White males, females, respectively. The equivalent four figures for dentigerous cysts are 1.18, 1.22, 9.92 and 7.26. These figures show that ameloblastoma is very much more common in Blacks than Whites in the population at risk. Conversely, dentigerous cysts are much more common in Whites.  This makes it unlikely that dentigerous cysts predispose to ameloblastoma formation. These epidemiologic observations give rise to speculation as to whether some component of the South African Black diet or other environmental substance might possibly be an etiologic factor in ameloblastoma.


Prevalence of taurodontism found in radiographic dental examination of 1,200 young adult Israeli patients. The prevalence of taurodontism was studied radiographically in 1,200 young adult Israeli patients. In order to differentiate taurodont teeth from normal teeth, three types of taurodontism (meso-, hypo- and hypertaudodontism) were defined in biometric terms, using radiographic features of molar morphology. All three types according to Shaw's classification were seen. Taurodontism was found to occur in 5.6% of 1,200 individuals and in 1.5% of the 10,204 molar teeth examined. The mandibular second molar was found to be the most prone, being involved in two thirds of all cases found. Hypertaurodontism was found only in three cases, in the third molars. The conditions was seen to involve single and multiple teeth, both unilaterally and bilaterally, with the latter being most predominant.


Prevalence of malocclusion in relation to premature loss of primary teeth. The influence of premature extraction of primary teeth. The influence of the site of extraction was analyzed by studying the frequency of malocclusion in the group of children with extraction in the mandible or maxilla only. It was found that early loss of primary teeth would result in an increased frequency of sagittal, vertical as well as transversal malocclusion. As a consequence the need for treatment would increase significantly by early extraction of primary teeth. Whereas extraction in the maxilla would tend to result in need for extraction of permanent teeth; extraction in the mandible would often lead to need for orthodontic treatment of longer duration. On the basis of these findings it could be concluded that maintaining a high standard of dental service for preschool children must be considered good economy, since the need for premature extractions is reduced.


A survey of edentulous individuals in a district in Amsterdam, the Netherlands. A survey of a representative adult population of a district in Amsterdam (the Jordaan) revealed an overall edentulousness rate of 23%. Proportionally more females than males wore complete dentures, and the lower socioeconomic group was proportionally better represented in edentate group than were the middle and the higher classes. No significant differences were found in comparisons of the edentulousness rate in the Study group and other investigations in Holland and England and Wales. It is suggested that there might be a relationship between the rate of edentulousness and changes in the amount of freely disposable income.