Natural history of acute hepatitis B in previously healthy patients: A prospective study. A prospective study of the natural history of acute hepatitis B was performed in 38 patients. Fatigue started median 4 weeks, abdominal symptoms median 3 weeks and signs of cholestasis median 2.5 weeks before peak SGPT values were reached. Extrahepatic manifestations occurred throughout the prodromal stage, the presence of arthropathy, urticaria or skin rashes was not related to the biochemical severity of liver disease. The higher the the maximal values of serum bilirubin and/or the older the patient, the longer the period of bilirubin elevation; a maximal bilirubin elevation less than 20 X the upper limit of normal was associated with normalisation of serum bilirubin within 6 weeks. No such correlations were found between the height of serum glutamic pyruvic transaminase, alkaline phosphatase, thymol turbidity and cholesterol levels and the subsequent duration of their abnormality. The elevation of alkaline phosphatase as well as the abdominal complaints might partly be caused by gastro-intestinal involvement. Immobilisation before peak SGPT was attained was associated with normalisation of serum glutamic pyruvic transaminase levels within 8 weeks after peak levels. 37 patients recovered completely. In one HBs-antigenemia and slight SGPT elevation persisted. Long term follow up was possible in 33 patients for 4 to 7 years, median 5 years.


Congenital dislocation of the hip joint.


Relation between curability and tumor volume in a murine carcinoma and sarcoma. Tumor control doses (TCD50) using single 60CO doses were determined on C3HBA adenocarcinoma and Dunn osteosaroma ranging in size from microscopic pulmonary colonies (3 X 13(-5) mm3) to palpable subcutaneous tumors (300 mm3) in the hind limb. The power function TCD50 =23.57 TV0.15, with TCD50 in GY and TV (tumor volume) in mm3, fits the data for both tumors over the entire range of tumor volumes used.


Comparison of lithium and haloperidol therapy in Gilles de la Tourette syndrome. Three patients suffering from Gilles de la Tourette Syndrome were initially treated with haloperidol. Depressive side effects and symptom breakthrough necessitated the search for another agent. The efficacy of lithium carbonate in treating stereotyped hyperkinetic behavior (such as is seen in Gilles de la Tourette syndrome) prompted the evaluation of lithium carbonate. An objective behavioral observation technique, clinical ratings and the patient's subjective reports were used to systematically record the response to treatment during the entire course of the study. Initially blood plasma Li+ levels in the 0.5 to 0.6 mEq/L range were obtained and these correlated with reduced frequency, as well as intensity, of involuntary motor acts (tics) and sounds. When the Li+ blood levels had stabilized at 0.8 to 0.9 mEq/L the major tics and involuntary sounds cleared dramatically. The patients experienced no side effects and have been followed for several months without recurrence of the original symptoms.


Adjuvant oncotherapy: the treatment of systemic micrometastases.


The Hebrew University's triad of goals.

The Hebrew University's triad of goals.


Dental communications: how to use what with patients.


Bravo! Columbus.

Bravo! Columbus.


The successful one-day seminar.

The successful one-day seminar.


Organized dentistry--where do we go from here.


Acute granulocytic leukemia following successful treatment of rhabdomyosarcoma.


Some new aspects of modern cancer chemotherapy.


Allescheria boydii infections in the immunosuppressed host. Allescheria boydii, a true fungus frequently isolated from soil, is best known as a causative agent of maduromycosis of the foot. In our report we describe two patients under treatment for acute leukemia who died from rapidly progressive A. boydii infections. One patient had signs of central nervous system infection and was found at autopsy to have had a large brain abscess. The second patient had a cavitary necrotizing pneumonia with thoracic inlet obstruction (Pancoast's syndrome) and failed to show improvement despite treatment with amphotericin B. The clinical spectrum of allescheriasis is reviewed with particular emphasis on its role as a pathogen in the compromised host. Since A. boydii may resemble other fungi morphologically in tissue sections and may produce infections clinically similar to other mycoses, culture of the organism is required for definitive diagnosis. Based on recently reported in vitro susceptibility studies, miconazole may have a future role in the therapy of A. boydii infections which are resistant to presently available antifungal agents.


The Takaoka respiratory for use during pneumoencephalography. The Takaoka respiratory was used during lumbar pneumoencephalography in 12 patients in a rotatory chair of X-ray apparatus. Anaesthesia and ventilation were maintained with oxygen or 50% nitrous oxide in oxygen supplemented by neuroleptanalgesia. The mean minute volume of ventilation was 84.5+/- 5.4 ml/min/kg and the mean respiratory rate was 8.5 +/- 1.7 breaths/min. Under these ventilatory conditions the blood gas data were acceptable (PaCO2: 35.0 +/- 4.3 torr). The Takaoka respirator can be fixed to the rotatory chair with no risk of accidental disconnection and there is no disturbance of the general monitoring or of the manipulations of the X-ray technicians. I provides adequate ventilation independent of position.


Depression following myocardial infarction: the effects of distance running. A proportion of postcoronary patients seen 16 to 18 months after infarction are seriously depressed (high D score on Minnesota Multiphasic Personality Inventory). A follow-up of 44 such depressed patients showed a significant (p less than 0.001) decrease of standardized D scores, from 80 to 72 units over 4 years of exercise-based rehabilitation. There were associated decreases in scores for hysteria, hypochondriasis, and psychasthenia. A decrease of D score was associated with exercise compliance. An increase of D score was associated with a significant (p less than 0.05) worsening of ST segmental sagging, suggesting that progression of the disease process had contributed to the increase of depression. All of the patients had high (feminine) scores on the masculinity/femininity scale of the MMPI test. This finding was unrelated to the daily running distance or medication; it could represent a "feminine" personality, or be a typical response in a well-educated white collar group. Evidence of successful group interaction may be indicated by reduction in scores for social introversion and schizophrenic traits.


Influence of exercise mode and selected ambient conditions on skin temperature.


Heat stroke and hyperthermia in marathon runners.


Work-heat tolerance of distance runners. Physical training in a cool environment by subjects not previously trained improves their work-heat tolerance, but can not replace heat acclimatization to the standard heat stress conditions employed by a variety of investigators. This is attributed to the inability of these subjects to sustain prolonged work at high metabolic rates. Thus, they are not maintaining high core body temperatures long enough to bring about an adaptive change to heat. On the other hand, the intense and prolonged (years) training of long distance runners in a temperature environment at high metabolic rates has acclimatized them for at least 4 hours of mild work (MR 160 kcal/m2-hr) in both hot dry (50/27 C db/wb) and hot wet (36.7/33.1 C db/wb) environments, but not for work at high energy expenditures (MR 540 kcal/m2-hr) in a less severe thermal stress (35/21 C db/wb). These highly trained athletes can improve their work-heat tolerance at high metabolic rates in a warm climate by training at competitive speeds in a cool environment dressed in sweat clothing or by training at near competitive speeds in the heat. In either of these situations the athlete is cautioned to consume water at frequent intervals to offset the dehydration associated with excessive sweating under these conditions.


Renal function during prolonged exercise.


Sweating: its composition and effects on body fluids.


Potassium deficiency during training in the heat.


Central circulatory function during prolonged exercise.


Regulation of skin circulation during prolonged exercise.


Myocardial blood flow and oxygen consumption during exercise.


The interplay between peripheral and central factors in the adaptive response to exercise and training. (1) Local adaptation of skeletal muscles (fibers) only occurs in the extremity involved in the training. (2) Work performance and maximal oxygen uptake were significantly increased only in the trained leg, and the "transfer" to the untrained leg was very small. (3) The classical sign of a training effect with a lowered submaximal heart rate response could only be elicited when exercising the trained leg. Lactate concentration and release of lactate were also lower when the trained leg performed the exercise. (4) The present results suggest that the local adaptation of skeletal muscle to training is of primary importance for enhancing work capacity and oxygen uptake. (5) The results also indicate that there may exist a peripheral factor in the regulation of the heart rate response during exercise. Moreover, the data favor the hypothesis of a chemical receptor playing a role in such a peripheral control system.


Possible role of muscle receptors in the cardiovascular response to exercise.


Pulmonary adaptation to exercise: effects of exercise type and duration, chronic hypoxia and physical training.


The hemodynamic and metabolic alterations associated with acute heat stress injury in marathon runners. Studies of clinical, metabolic, and hemodynamic responses to heat stress in eight marathon runners have demonstrated several important differences from those observed in nonconditioned subjects. Three marathoners manifested a nonanhidrotic form of heat stroke, a phenomenon not observed in our Marine recruits. Five patients with heat exhaustion evidenced signs of severe mental confusion despite apparently adequate hemodynamic function. Heart rate was significantly lower in all eight marathoners in comparison to the 15 Marine recruits. This latter observation suggests that either selective regional shunting of blood or increased stroke volume index occurs in marathoners subject to heat stress.


Medical examination and electrocardiographic analysis of elite distance runners.


Intramuscular substrate utilization during prolonged exercise. Large stores of intramuscular substrates are found in the different fiber types of human skeletal muscle, and with prolonged exercise both glycogen and triglyceride stores are utilized. The contribution from intramuscular glycogen stores is greatest at higher work intensities while triglyceride stores are utilized at moderate intensities. In man all fiber types have a similar glycogen content whereas the highest lipid content is found in the more oxidative fibers. The muscle metabolism is well adapted to the supply of substrate as well as to the demand for energy. Among several regulatory mechanisms, changes in citrate concentration seems to be an important factor in the interplay between carbohydrate and lipid metabolism.


Submaximal and maximal working capacity of elite distance runners. Part I: Cardiorespiratory aspects.


Submaximal and maximal working capacity of elite distance runners. Part II. Muscle fiber composition and enzyme activities. The present study confirms earlier observations that the musculature of elite distance runners is characterized by a high predominance of ST fibers. Although the percent ST fibers effectively discriminates between good and elite distance runners, fiber composition alone is a poor predictor of distance running success within the group of elite runners. Muscle enzyme measurements suggest that the 11 to 20 miles (17.7 to 32.2 km) of daily training performed by the elite runners produced a significantly greater increase in muscle SDH activity than was observed in the good distance runners, who were running 7 to 11 miles (11.3 to 17.7 km) per day, Although such endurance training enhances the oxidative capacity of the muscle, it apparently has little influence on the enzymes of glycogenolysis.


A biomechanical comparison of elite and good distance runners.


Body composition of elite class distance runners.


Pulmonary function of elite distance runners.


Psychologic characterization of the elite distance runner.


Adaptive responses in different types of muscle fibers to endurance exercise.


The effects of exercise-training on the development of fatigue.


Glucose turnover during exercise in man.


Characteristics of postcoronary marathon runners.


Metabolic adjustments to marathon running in coronary patients.


Limitations of marathon running in the rehabilitation of coronary patients: anatomic and physiologic determinants. Prescribed, supervised exercise training has proved valuable in the rehabilitation of selected coronary patients. However, long distance (marathon) running has limited cardiovascular value in the rehabilitation of patients for a majority of occupations, which involve predominantly upper extremity effort. The age of patients with coronary heart disease and the severity of the lesions preclude the wide application of marathon running to the general coronary heart disease population. Less than 6/1000 subjects with coronary heart disease have been estimated as potentially being able to achieve by high-level training a maximum Vo2 sufficient to complete a marathon race in 5 hours. The hazards of high-level-activity-induced cardiac arrest that is reversible mandates the availability of CPR equipment and personnel in the immediate vicinity of all coronary patients and most coronary-prone patients who are undertaking such heroic activity. Over-publicized marathon running by a few subjects has aroused unrealistic expectations for the majority of coronary heart disease subjects and probably similarly for a considerable number of coronary-prone subjects, many of whom have "silent" coronary disease.


Effects of exercise training on progression of documented coronary arteriosclerosis in men.


A physiological profile of a jogging class: young and old, male and female.


Amino acid metabolism in exercise.

Amino acid metabolism in exercise.


Marathon running and immunity to atherosclerosis. This is an interim report of an on-going study of deaths in 42-km men. The absence of fatal ASCVD in these athletes can not be construed as evidence for the protective role of exercise alone. The ability to run 42 km depends on many factors. Exercise is only one. Avoiding tobacco is another. Dietary factors also play a role. It has not been feasible to remove one of these factors while maintaining the ability to cover the 42 km distance. Some 42-km men claim that megadoses of ascorbic acid protect them from collagen injury. This is supported by animal studies that show increased collagen synthesis proportional to ascorbic acid intake up to dosage levels that would equal 10 grams per day for humans. Their self-selected macrobiotic diet contains a high ratio of peanuts:steak resulting in a high P/S ratio (polyunsaturates/saturates). Dietary manipulation quickly effects their ability to train. Smoking is so rare among these runners that it must be related to specific effects, such as a catalytic agent in tobacco smoke converting linoleic acid into a toxic lipid oxide. Noakes and Opie recently confirmed again (May, 1976) that no cases of "death due to coronary atherosclerosis" have been recorded in marathon finishers. If this holds true for the second 10-year period of this study, then marathon runners will have joined the longshoremen by earning life-long protection against ASCVD. These longshoremen burned 1,876 kcals on the job, equivalent to a 30-km run. Roberts and Straus suggest that many factors can cause atherosclerosis. Only time will tell whether the marathoner is protected from all of them.


Coronary heart disease in marathon runners. Six highly trained marathon runners developed myocardial infarction. One of the two cases of clinically diagnosed myocardial infarction was fatal, and there were four cases of angiographically-proven infarction. Two athletes had significant arterial disease of two major coronary arteries, a third had stenosis of the anterior descending and the fourth of the right coronary artery. All these athletes had warning symptoms. Three of them completed marathon races despite symptoms, one athlete running more than 20 miles after the onset of exertional discomfort to complete the 56 mile Comrades Marathon. In spite of developing chest pain, another athlete who died had continued training for three weeks, including a 40 mile run. Two other athletes also continued to train with chest pain. We conclude that the marathon runners studied were not immune to coronary heart disease, nor to coronary atherosclerosis and that high levels of physical fitness did not guarantee the absence of significant cardiovascular disease. In addition, the relationship of exercise and myocardial infarction was complex because two athletes developed myocardial infarction during marathon running in the absence of complete coronary artery occlusion. We stress that marathon runners, like other sportsmen, should be warned of the serious significance of the development of exertional symptoms. Our conclusions do not reflect on the possible value of exercise in the prevention of coronary heart disease. Rather we refute exaggerated claims that marathon running provides complete immunity from coronary heart disease.


Statistical analysis of deaths from coronary heart disease anticipated in a cohort of marathon runners.


A 4-year prospective study of the relationship of different habitual vocational physical activity to risk and incidence of ischemic heart disease in volunteer male federal employees. A prospective study of coronary heart disease (CHD) was done in 2,635 volunteer male federal employees of postal, health, aerospace, and other agencies, aged 35--59 years at intake. The present analysis is concerned with 2,065 initially well whites, of whom 65 suffered clinical CHD during a 4 years of annual follow-up. The subjects differed markedly in their levels of habitual vocational physical activity, which is classified (1) by division into sedentary, moderate, and heavy activity groups, (2) by blue collar or white collar type of occupation, and (3) by calculated annual caloric expenditure for both vocational and non-vocational physical activities. Intake variables that were studied in relation to physical activity and the CHD incidence include age, serum cholesterol, systolic blood pressure, relative body weight, ECG abnormality, and cigarette smoking. Socioeconomic status (SES) is assessed by levels of education and income and by a combined SES categorization based upon both. Estimated composite CHD risk scores are based upon Framingham equations. The CHD risk factors, singly, as well as in a derived composite risk score, are higher for men with heavy compared to sedentary or moderate habitual physical activity. However, this is a spurious association found to be induced by differences of SES. Thus, when physical activity and SES are studied in a concurrent analysis, a higher CHD risk is significantly associated with lower SES status but not with differences of vocational physical activity. The CHD incidence in this population is studied in relationship both to the risk factors and physical activity by multivariate analysis, using the multiple logistic risk model. The incidence of CHD is significantly associated with age, serum cholesterol, systolic blood pressure, and cigarette smoking. It is not found to be associated with the type of occupation (i.e., blue or white collar), the level of reported habitual vocational physical activity, or the calculated total vocational plus nonvocational caloric expenditure in physical activity.


The important role of fitness determination and stress testing in predicting coronary incidence. The question of whether there is some effect of status of cardiorespiratory fitness and exercise ECG abnormalities on occurrence of CHD other than their effect on the risk factors of serum cholesterol, blood pressure, glucose, and smoking seems to have been answered in the affirmative by this study. The relative prognostic importance of the measures considered here, the role of exercise, and the interrelationships between fitness, exercise, other risk factors, and CHD provide many interesting hypotheses for continued study. A future investigation will involve a large prospective study in which the risk function to be derived would include stress ECG and treadmill performance as predictor variables. The retrospective approach reported in this paper had certain limitations. It did, however, permit demonstration of new results because, essentially for the first time, all of the important risk factors are measured in the study population and can be evaluated simultaneously.


Endurance sports, longevity, and health.


The effects of continued training on the aging process.


Relative importance of physical activity for longevity.


A critique of several epidemiological studies of physical activity and its relationship to aging, health, and mortality.


Aerobic responses of female distance runners to submaximal and maximal exercise.


Effects of an endurance training regimen on assessment of work capacity in prepubertal children. The cardiovascular effects of a 12-week endurance training regimen were studied among normally active and healthy prepubertal children. Twenty-six 8- to 12-year-old children (20 boys and 6 girls) volunteered and 10 acted as control subjects. The training regimen consisted of distance running for progressively longer periods (from 10 to 35 min) 2 to 3 times per week, with 2 additional sessions per week devoted to running games. Those who were trained ran a cumulative average distance of 95.6 km (58.9 miles). Intensity of work was assessed from running pace and heart rate. The target workout intensity was 75% to 80% of aerobic capacity (Vo2 max). Growth and development accounted for increases in height, weight, body circumferences, and diameters, and fat-free body weight. Heart rate (HR) during submaximal workloads, both running and walking, decreased in the trained group (p less than 0.01) and (p less than 0.05). HRmax did not change, but Vo2 max increased significantly (average 7%) in the trained group but not in the controls. No significant change attributable to training was found for submaximal cardiac output, stroke volume, or arteriovenous oxygen difference. The Vo2 max value before conditioning was a relatively poor predictor of the magnitude of improvement in functional capacity, but those with higher initial Vo2 max logged more cumulative training mileage. It was concluded that prepubertal children respond to an endurance training regimen by improving their running capacity, which is, to a limited extent, associated with increased aerobic capacity.


Body physique and composition of the female distance runner.


Heat tolerance of female distance runners.


Biomechanical comparison of male and female distance runners.


The regulation of intracellular and extracellular fuel supply during sustained exercise.


An overview of overuse syndromes in distance runners.


Foot types and the influence of environment on the foot of the long distance runner.


A biomechanical approach to running injuries. I have introduced the concept of controlling overuse syndromes by controlling the etiology. The etiology of most overuse syndromes is biomechanical deformity of the lower extremity as well as nonadherence to sound principles of training and conditioning. It is important to realize these factors to provide for many years of injury-free athletic involvement.


Myoglobinuria in marathon runners: possible relationship to carbohydrate and lipid metabolism.


Effect of chronic exercise on the personality of adults.


Physiological defenses against hyperthermia of exercise.


President's message.

President's message.


Immediate vestibular extension with palatal grafting.


Desquamative gingivosis.

Desquamative gingivosis.


Forensic odontology--an overview.

Forensic odontology--an overview.


Role of infection in the death of children with acute lymphoblastic leukaemia. Twenty-four consecutive deaths from a total of 70 children receiving treatment for acute lymphoblastic leukaemia (ALL) have been reviewed. An attempt has been made to ascribe the cause of death to either infection, haemorrhage, the leukaemia itself, or a combination of these factors. No child was free of infection at death. Infection, with or without haemorrhage, was responsible for the deaths of all 15 children whose leukaemia had not relapsed. Although infection was present at death in all 9 children whose leukaemia had relapsed, the leukaemia process itself was also a major contributing factor. Viruses were associated with death in many of the children and may be emerging as important pathogens in children with ALL. Familiarity with a protocol may be an important factor in the prevention of fatal infections in such children. Centralization of treatment is necessary if this expertise is to be acquired.


Therapy of chronic granulocytic leukemia.


The value of a simple medical questionnaire in dentistry. A short specific medical questionnaire was given to 1125 new patients attending for their initial examination at the Perth Dental Hospital. A positive history was given by 398 patients. A wide variety of conditions was revealed and the dental significance is discussed. The extent of the information provided illustrates that the simple questionnaire is valuable in exposing conditions which may affect dental treatment.


An elementary study of deformation of molar teeth during amalgam restorative procedures. A technique using an optical comparator was employed to examine the dimensional changes resulting from cavity preparation, application of the matrix and packing with amalgam in three extracted molar teeth. The changes have been reported and the nature of the change discussed. A modification in the use of the matrix and amalgam packing technique is suggested.


A rapid spectrophotometric assay of amide type dental anaesthetic agents. A spectrophotometric procedure for the determination of lignocaine in ointments was investigated and standardized for general application to local anaesthetic solutions of the amide type commonly used for dental injection, namely, lignocaine, prilocaine, mepivacaine, pyrrocaine and tolycaine. The method is based on the controlled formation of a copper complex and the Beer-Lambert law was found to be obeyed over a useful range. Results indicated that the method would be accurate, convenient and rapid, saving substantial time over wet-way methods conventionally used. For confirmation of the identify of the anaesthetic agent, infrared spectroscopy was shown to be a rewarding technique.


A dentigerous cyst associated with an Angle Class II malocclusion.


Factors affecting the structure of a fissure sealant at the enamel/sealant interface. Scanning electron microscope study of a fissure sealant on enamel in vitro shows the effect of varying methods of application, viscosity, dryness and time of etching of enamel. The effective attachment of the sealant to enamel required that it be brushed into the dry etched enamel. Viscosity seemed unimportant.


The influence of some manipulative factors on creep. The effects of a number of factors on creep in dental amalgam was investigated. The factors studied were the delayed time between mixing and packing, the packing technique, the alloy system and the annealing or ageing of specimens at 37 degrees C for one and 190 days. The delayed time and the alloy system factors as well as an interaction between them had a significant influence on the one day annealed specimens. The alloy system in the 190 days annealed specimen was the only factor to affect creep.


Hazards of operative dentistry. Statement issued by the National Health and Medical Research Council at its 82nd Session, Canberra, October, 1976.


Immunological abnormalities in coeliac disease and their response to dietary restriction. I. Serum immunoglobulins, antibodies and complement. Twenty-three patients with coeliac disease were studied whilst on a normal diet and again after a mean period of 15 months on a gluten-free diet. Serum levels of IgG, IgA and IgM, total haemolytic complement, C3, serum autoantibodies and precipitins to dietary proteins were compared to those in age and sex matched control subjects. There was considerable individual variation, but as a group, patients on a normal diet had significantly raised IgA and low IgM and an increased prevalence of antibody to reticulin, smooth muscle and dietary protein. These abnormalities disappeared during the period of dietary restriction suggesting that they are disease epiphenomena rather than primary pathogenetic factors.


Immunological abnormalities in coeliac disease and their response to dietary restriction. II. Immunoglobulin containing cells, immunoglobulins and dietary antibodies in the small bowel. The numbers of immunoglobulin (Ig) containing cells in jejunal mucosa were determined in 29 patients with untreated coeliac disease and 28 control subjects. The patients had significantly increased numbers of IgM containing cells. Seven of the patients were studied again after 12 months on a gluten-free diet and showed a significant reduction in the number of IgM containing cells. The increase noted in untreated patients is therefore likely to be a manifestation of the disease rather than a primary abnormality of aetiological significance.


Factors influencing small bowel changes in dermatitis herpetiformis. Factors influencing small bowel morphology in dermatitis herpetiformis (DH) were investigated by comparing patients with DH and normal small bowel biopsies to patients with DH and abnormal small bowel biopsies. The mean age of 18 patients with morphological changes in small bowel (38 years) was significantly lower (P less than 0-001) than the mean age of nine patients with normal bowel mucosa (60 years). HLA typing confirmed the high frequency of HLA-B8 in DH (64%) but HLA-B8 was unrelated to the presence or severity of small bowel lesions. Four patients had diarrhoea with progressive weight loss or abdominal cramps subsequently responsive to gluten withdrawal. In this subgroup serum levels of IgG and IgM were significantly lower than in patients with normal small bowel mucosa. Small bowel involvement appeared to be independent of the duration and severity of skin disease, and the deposition of immunoglobulin and complement (C3) in the dermal papillae of skin adjacent to skin lesions.


A test of the ventilatory response to hypoxia and hypercapnia for clinical use.


Cancer and teratogenesis: infrequent occurrence after medical use of immunosuppressive drugs. This study examines long term "medical" immunosuppression with azathioprine or cyclophosphamide for immunopathic disease in relation to cancer and foetal malformation. The experience represent an aggregate of 241 years of treatment and 508 patient-years of follow-up in 133 non-transplant patients. For azathioprine the mean duration of treatment was 1-9 years and the mean duration of observation was 3-8 years, and for cyclophosphamide, the mean durations of treatment and observation were 0-7 and 4-6 years. A sample of 70 patients was shown by in vivo tests to have significantly suppressed cell-mediated immunity. In the period of review there were observed two cancers, both squamous cell carcinomas of skin, two benign neoplasms and six keratoses; after the period of review, three further cancers were recorded, one being in a subject with a known previous cancer. Nine pregnancies with azathioprine yielded no foetal malformations.


Do Australian Aborigines suffer from renal tract calculi? Analysis of intravenous pyelograms performed in the Darwin Hospital over the five-year period, 1970-1974, showed that 9% of the examinations carried out on non-Aboriginal patients demonstrated calculi in the renal tract. Although considerably fewer pyelograms had been performed on Aboriginal patients, only one showed a calculus. The result has been shown to be highly significant and is discussed in relation to racial and other differences between the Aboriginal and non-Aboriginal people of the Northern Territory.


Adverse reactions to drugs: a 12-month hospital survey. A formalised system of adverse drug reaction (ADR) reporting was instituted at the Royal Adelaide Hospital in August 1975. The present report reviews the results obtained from this system after a 12-month period of operation. A significant number of reports associated with the use of antibiotics and radiographic contrast media were received. The importance of "feed-back" of ADR information to prescribers is emphasised.


Salivary antipyrine kinetics in hepatic and renal disease and in patients on anticonvulsant therapy. The effects in man of liver disease, renal failure and hepatic microsomal enzyme induction on the elimination kinetics of antipyrine in saliva have been examined. Antipyrine (10 mg/kg) was given orally and assayed in saliva by gas-liquid chromatography. The mean antipyrine half-life from saliva in nine epileptic subjects receiving long term anticonvulsant drug therapy (6 hr +/- 0-9 SEM) was significantly shorter than in twenty normal healthy volunteers (10-7 +/- 0-6). Therapy included phenytoin and phenobarbitone, two drugs known to induce hepatic microsomal enzymes. Five subjects with chronic renal failure exhibited no significant difference in salivary anti-pyrine half-life (11-7 +/- 1-9) compared to the control group, whereas six subjects with chronic liver disease and impaired hepatic function had significantly increased half-life values (42-4 +/- 10). The results suggest that differences in the activity of hepatic microsomal enzymes are reflected by changes in salivary antipyrine elimination kinetics. Chronic renal failure appeared to have no effect on the function of these enzymes.


Left main coronary artery obstruction: early surgical experience with forty-two patients. Direct coronary artery surgery was performed on 42 patients with high grade obstruction of the left main coronary artery (LMCA), with a perioperative infarction rate of 7% and a hospital mortality of 9-6%. There was no significant difference in presentation of patients with LMCA lesions and no prediction of this lesion could be made by preangiographic assessment. Significant obstructive lesions in other coronary vessels were noted in most patients, triple vessel disease occurring in 27 patients (64-3%), double vessel in 14 patients (33-3%) and the LMCA lesion was an isolated lesion in only one patient (2-4%). Right coronary lesions occurred in 35 patients (83%), left anterior descending artery artery lesions in 38 patients (90%) and left circumflex system lesions in 34 patients (81%). The surgical procedures are discussed.


Hepatitis B antigen--a survey in a major metropolitan hospital. The prevalence of hepatitis B antigen in blood donors in the Wellington Hospital region is 0-27%. A retrospective survey of 66 persons found by the Wellington Hospital Laboratory to be hepatitis B antigen positive between September, 1971 and August, 1975, showed that over this period there has been a consistent decline in the number of new antigen positive cases found per year. This appears to be due to a decline in the numbers originating in the renal unit. A liver biopsy was taken in only one case and this showed chronic persisting hepatitis. Apart from the renal unit, high risk patients and staff are not tested regularly for hepatitis B antigen. Regular testing of laboratory staff and patients and staff of the cardiothoracic and haematology departments is recommended.


Hepatic venous occlusion from carcinoma of bile duct in ulcerative colitis. The illness is described of a 25-year-old man with an 18-year history of ulcerative colitis, who presented with obstructive jaundice due to a carcinoma of the bile duct. Terminally, he developed acute symptomatic hepatic venous occlusion due to extrinsic compression of the ostia of the hepatic veins. This was caused by a large mass of intrahepatic metastatic tumour.


Herpes simplex encephalitis.

Herpes simplex encephalitis. In this paper seven cases of severe viral encephalitis seen over a four year period at the Princes Alexandria Hospital, Brisbane, are presented. Four of these cases were proven cases of Herpes simplex encephalitis on the basis of viral culture, and three were probable cases of Herpes simplex encephalitis on the basis of rising serum antibody titres. A summary of the clinical aspects and laboratory investigations of the cases is followed by a brief discussion of the diagnostic and therapeutic problems of this condition.


Use of a microprocessor in the control of malignant hypertension with sodium nitroprusside. In a malignant hypertensive, steady control of blood pressure at a pre-determined level has been achieved with the continuous intravenous infusion of sodium nitroprusside. A microprocessor was programmed to assess the patient's blood pressure and adjust the rate of nitroprusside infusion so that a mean pressure of 106 mmHg was achieved. Brief interruption of the nitroprusside infusion allowed the effectiveness of changes in oral therapy to be evaluated. Thiocyanate concentrations were measured throughout as an index of potential nitroprusside toxicity. After six days, blood pressure control was maintained with oral therapy alone and papilloedema had almost resolved.


Bilateral ptosis and proximal myopathy--muscular manifestations of hypothyroidism. The case report of a 28-year-old hypothyroid female is presented. She demonstrated several muscular disorders of hypothyroidism including proximal myopathy and the previously unreported occurrence of severe bilateral ptosis.


Primary hyperparathyroidism presenting as a proximal myopathy. A 46-year-old female presented with a three year history of progressive weakness. Asymptomatic apart from proximal myopathy, multi channel screening and radiological features indicated primary hyperparathyroidism with severe metabolic bone disease. Removal of a parathyroid adenoma led to improvement of muscle strength and regression of bony and metabolic changes.


Recurrent venous thrombosis with a "lupus" coagulation inhibitor in the absence of systemic lupus. A young man presenting with recurrent deep venous thrombosis was found to have a lupus type coagulation inhibitor. He showed neither clinical nor serological evidence of systemic lupus. The value of the Russell viper venom coagulation time in the detection of the inhibitor is demonstrated. Anticoagulant therapy has not caused any bleeding complication despite the presence of the inhibitor.


Primary amyloidosis with cardiac involvement diagnosed by left ventricular endomyocardial biopsy. A case of primary amyloidosis is described. The patient presented with the nephrotic syndrome and later developed heart failure. Left ventricular endomyocardial biopsy was performed and haemodynamic data were recorded. The findings were those of a 'restrictive' cardiomyopathy. Histology of the biopsy was pathognomonic of amyloid involvement of the heart. The patient was started on chemotherapy consisting of prednisone, penicillamine, melphalan and fluoxymesterone. This case demonstrates the ability of endomyocardial biopsy in arriving at a definitive diagnosis in this patient.


Slow but sure.

Slow but sure.


The upper mid-line space and its relation to the labial fraenum in children and in adults. A statistical evaluation.


Clinical testing of a mouthrinse and a dentifrice containing fluoride. A two-year supervised study in school children.


Alcohol and drug abuse.

Alcohol and drug abuse.


Scanning electron microscopy of instrumented, irrigated and filled root canals.


Exposure to scattered radiation in the vicinity of dental x-ray sets.


Postgraduate experience with general anaesthetics. Survey of dental graduates of Manchester.


Viscosity of setting anterior restorative materials.


An unusual pattern of dental erosion. A case report.


The bleeding disorders.

The bleeding disorders.


Incidence of bone sarcoma in SW England, 1946-74, in relation to age, sex, tumour site and histology. A study is presented of all cases of primary sarcoma of bone registered during the period 1946 to 1974 for a specified population resident in south-western England. Ninety-six per cent of the 365 cases were histologically and radiologically verified and are separated into 8 categories of sarcoma. The number of tumours presenting during each hemi-decade did not markedly diverge from the 5-year mean for the period, nor was any significant change found in tumour incidence during the last 20 years of the survey. The age, sex and site distributions correspond with those reported elsewhere. Age-specific incidence rates are compared with those published for Sweden. For osteosarcoma and Ewing's tumour, both commoner in young people, the two series agree closely up to age 55 years, after which the Swedish incidence rates rise and are not exceeded when, for the present cases, Paget's osteosarcomas are included. Whilst Paget's disease may change the age incidence of some types of bone sarcoma, it is uncertain whether it increases the total number which occur. Differences in tumour incidence between males and females, whether for a specific type or for all bone sarcomas, are seldom statistically significant, but the patterns appear to be consistent.


Direct and serial transplantation of a Ph + ve human myeloblastoid tumour into nude mice.


The immunotherapy of acute myelogenous leukaemia using intravenous BCG.


Refractory anaemia with excess of myeloblasts in the bone marrow: a clinical trial of androgens in 90 patients. In a cooperative trial, 90 patients with refractory anaemia with an excess of blast cells in the marrow were evaluated and treated with androgens. The clinical presentation was very similar to previously published observations: features of medullary insufficiency were less marked than in primary aplastic anaemia; bone marrow blastic infiltration varied from case to case, and remained stable until death or until an acute leukaemic change. All the patients were treated with high doses of androgens as for aplastic anaemia. The efficacy of this therapy was poor. The average life expectancy was 13 months, 64% of deaths being associated with a change to acute myeloid leukaemia. A severe bone marrow deficiency foreshadowed early death, but myeloblastic transformation was observed whatever the initial degree of blastic infiltration of the bone marrow. A comparison with the literature suggests that androgen therapy may accelerate the change to acute leukaemia.


Morphanalysis of craniofacial dysharmony. The first stage in the morphanalysis of craniofacial dysharmony involves induction. In this process, individual analytic morphograms are combined to form analytic histograms, which in turn are connected to form analytic histomorphograms, which provide three-dimensional statements about the variation in craniofacial structures in a population. The second stage involves deduction, in which the analytic morphograms of a particular patient are compared with appropriate analytic histomorphograms, so that a diagnosis of the three-dimensional nature of the dysharmony can be made. Craniofacial morphanalysis is performed manually in small scale enquiries but the methods have been converted to computer-graphic technology for large-scale studies. A clinical morphanalysis service is currently conducted and a standard reference atlas is being prepared.


Bilateral mandibular condylysis-a morphanalytic diagnosis. Four cases of bilateral mandibular condylysis are presented. The condition does not appear to be included in current teaching or existing nomenclature and consists of an acquired absence of the mandibular condyles, unassociated with temporomandibular ankylosis or aural/facial anomalies. In the literature of condylar maldevelopment four published cases appear to justify reclassification as bilateral mandibular condylysis, bringing the recorded total to eight. Whereas previous writers have regarded the condition as a prenatal condylar aplasia or hypoplasia, morphanalysis studies of the four current cases have shown that the probable aetiology is postnatal local disturbance in the condylar region. The term condylysis has been chosen to emphasise the locally destructive (or lytic) mechanism which appears to be involved. Mandibular condylysis is distinguished from condylar aplasia by its non-association with aural/facial anomalies and because normal development appears to proceed until the lytic event occurs. It is further distinguished from primary and secondary condylar hypoplasia because the condyle is absent rather than small, because normal development appears to proceed until the lytic event occurs and because of its non-association with aural/facial anomalies or temporomandibular ankylosis.


An alternative method of reducing the vertical height of the ramus of the mandible.


Jaw lymphoma in Middle East children.

Jaw lymphoma in Middle East children. Six cases of jaw lymphoma occurring in Middle East children between 1971-1976 are reported. While the histological and radiological appearances of the tumours were suggestive of a diagnosis of Burkitt's tumour, the Middle East tumour failed to respond clinically to treatment which is effective against Burkitt's lymphoma. It is believed that these tumours may constitute a separate clinical entity. The identification of the initiating agent should be a matter of urgency, for treatment at present is invariably unsuccessful.


Clinical statistics of odontogenic cysts in West Malaysia. A study was made of the clinical statistics of odontogenic cysts treated at two hospitals in West Malaysia over a 6-year period. The general incidence of the individual cyst-types is similar to that reported in previous studies. A marked difference in the age distribution of radicular cysts emerged and 80% of the residual cysts in the survey occurred amongst the Chinese population. Reasons for the distribution variation are discussed.


Multiple cystic adenomas of labial salivary glands. A case of multiple cystic adenomas is described and their histological characteristics discussed. Review of the literature showed no previous publication of multiple tumours from labial salivary glands.


The radiographic appearance of the inferior dental canal: an additional variation.


A study of medically qualified dental graduates.


Current principles of morphanalysis and their implications in oral surgical practice. This survey of morphanalysis in an oral surgical context summarises current conventions concerning the fixed relations theory, the analytic morphograph and craniofacial morphography. The oral surgical implications are then discussed in preparation for subsequent papers on the morphanalysis of craniofacial dysharmony and mandibular condylysis.


Method for enrichment of proliferating myeloid cells from normal and leukemic human bone marrow.


Vibration analysis in experimental models of atherosclerosis.


The motor unit: revisited.

The motor unit: revisited.


Many psychotherapies and what they have in common.


Data for local health-planning decisions.


The National Center for Health Statistics and the data needed for national health insurance.


Lymphoid blast crisis in chronic myeloid leukaemia.


Measurements of endosteal surface areas in human long bones: relationship to sites of occurrence of osteosarcoma. Using techniques of bone scanning and ashing, the areas of the endosteal surfaces in cortical and trabecular bone have been determined for the proximal, mid and distal thirds of each of the six long bones of an adult human subject. The relative frequency of occurrence of bone sarcomas, scored as to site, has been analysed in relation to these measured areas. Data on tumour occurrence have been drawn from three sources: radium-case data from Rowland and Keane (33 cases), naturally-occurring cases from series by Sissons (139 cases) and by Dahlin (473 cases). A strong correlation is demonstrated between tumour frequency and trabecular area, but correlation with cortical area is poor. By comparing the tumour frequency in the mid thirds of the bones with the total recorded it has been possible to show that the probability of tumour occurrence per unit area of cortical bone, relative to that of trabecular bone, is 0.16 +/- 0.06. Analysis of the available dose data for the radium cases shows that in this instance dose has not contributed to the observed correlations. The results lend support to the thesis that tumour occurrence depends on surface area, i.e. on the number of cells at risk.


Meningeal leukaemia in lymphoid blast crisis of chronic myeloid leukaemia.


Chronic myeloid leukaemia of adult type in 5-month-old infant.


Methotrexate-induced malabsorption in children with acute lymphoblastic leukaemia. A one-hour D-xylose absorption test was performed on 18 children with acute lymphoblastic leukaemia. Xylose absorption was normal in children who had not received methotrexate, but there was a significant degree of malabsorption in those who had taken methotrexate within the previous seven days. There was a progressive and significant increase in malabsorption related to the cumulative dose of methotrexate. These findings provide further evidence that regular methotrexate treatment every seven days is more toxic than if it is more widely spaced. The spacing of treatment is currently under investigation.


Classification of bone tumours.

Classification of bone tumours. Primary tumours of bone can be classified conveniently into distinct groups based on the appearance of the tumour cell, or its product, or both. Almost all the groups have benign and malignant counterparts. However, malignant bone tumours usually do not arise from benign tumours. Although the cell of origin in many tumours is unknown, the classification described in this paper refers to well-defined clinicopathologic entities, so that the behaviour of a given tumour can be anticipated. This classification is accepted the world over and provides a "common language" for those who treat patients with bone tumours.


En bloc resection for osteogenic sarcoma. Preservation of a limb without sacrifice of the principles of cancer surgery is desirable in young people with osteogenic sarcoma. At present amputation is generally regarded as the only well-established curative treatment for this condition. To determine whether en bloc resection with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy, 43 patients who underwent en bloc resection for osteogenic sarcoma of the distal femur (20 patients), proximal tibia (11 patients), shoulder girdle (11 patients) and fibula (1 patient) were studied. After tumour resection, chemotherapy and pulmonary resection 32 (74%) of the 43 patients are alive and 20 (67%) have no evidence of distant disease. Of the 38 patients without metastatic disease at the time of admission (5 were admitted with pulmonary metastases) 24 (63%) are alive without evidence of disease and without having had postoperative metastases.


Radiation treatment of Ewing's sarcoma and osteogenic sarcoma. At the Princess Margaret Hospital, Toronto, during the period 1960 to 1975, radiation therapy was given to 59 patients with Ewing's sarcoma without overt metastases. Over this period treatment was modified to include, as well as irradiation to the primary tumour, total body irradiation (TBI) and chemotherapy according to various regiments. The 5-year survival rate of 38% in 26% patients who received TBI suggests that this may be of value. In patients with osteogenic sarcoma preoperative irradiation was not found to be of value. Recently the resection of pulmonary metastases combined with chemotherapy has increased the survival rate. When the primary site makes resection impracticable, the response to irradiation and chemotherapy is encouraging. Three cases so treated are described.


Paraparesis following intrathecal cytosine arabinoside: a case report with neuropathologic findings. A 65-year-old white male with acute myelogenous leukemia received whole brain irradiation (2550 rads) and intrathecal cytosine arabinoside for CNS prophylaxis. Bone marrow remission had been previously achieved with systemic chemotherapy (vincristine, Adriamycin, prednisone, and cytosine arabinoside). Two weeks following the last intrathecal cytosine arabinoside treatment, the patient developed a spastic paraparesis requiring the use of a walker. A gas myelogram was normal and CSF examination revealed a protein of 50 mg/100 ml but was otherwise unremarkable. Five months later, the patient had improved in that he could stand on his own. A relapse of his leukemia subsequently occurred and the patient died the following month. Striking degenerative changes were found in the spinal cord at postmortem examination. These included microvacuolization, axonal swellings, and loss of myelin with scattered macrophages laden with fat.


Metastatic osteosarcoma to lung: a clinicopathologic study of surgical biopsies and resections. Metastatic tumor to the lungs is one of the most important factors in the poor prognosis of primary osteosarcoma of bone. Until recently, pulmonary resection alone was the only therapeutic method available to salvage these patients. Previous investigators have reviewed a number of clinical and pathologic parameters which may possibly relate to the prognosis of osteosarcoma and the occurrence of pulmonary metastases. The pathologic features of these latter lesions have received little attention other than to state that they generally are less differentiated than the primary tumor. A review of multiple pulmonary nodules resected from 15 patients has demonstrated that 66% of all lesions were essentially identical to the primary tumor. The 5-year survival from the original amputation was 33% in this series; however, it was not possible to prognosticate a favorable outcome from the metastasis, a similar type of observation which has been made by others in relation to the primary osteosarcoma.


Extraosseous osteogenic sarcoma following an intramuscular injection. A 29-year-old white male with an extraosseous osteogenic sarcoma is reported. He first noted a nodule at the site of eventual tumor development some eight years previously, following an intramuscular penicillin injection. Treatment consisted of wide surgical excision and radiation therapy, and he remains healthy some 8 months later. To our knowledge this represents the first case of extraosseous osteogenic sarcoma occurring at the site of a previous intramuscular injection.


Carcinocythemia (carcinoma cell leukemia) due to metastatic carcinoma of the breast: report of a case. A patient with a 17-year course of metastatic lobular carcinoma of the breast is described who developed large numbers of circulating carcinoma cells which were easily detectable in several routine peripheral blood smears shortly before death. This rare complication of carcinoma has been called "carcinocythemia." Carcinocythemia is probably due to widespread infiltration of many bone marrow sites and may also be related to splenectomy, which may impair reticuloendothelial clearance of circulating tumor cells. The differential diagnosis of carcinocythemia from superimposed acute myelogenous leukemia, which can complicate radiotherapy and chemotherapy for the primary tumor, is discussed. Cytomorphology, histochemistry, and electron microscopy of abnormal circulating cells should aid in the distinction of these two processes.


A factor in human saliva that induces differentiation of mouse myeloid leukemia cells. The differentiated functions of phagocytosis, locomotion, and morphological changes into cells resembling granulocytes and macrophages were induced in cultured mouse myeloid leukemic cells, M1 clone 34, by treatment with human saliva. The rates of induction of these differentiated phenotypes were proportional to the concentration of saliva added and the period of treatment. The factor inducing differentiation was nondialyzable and heat labile. This factor was purified 70-fold by fractionation with Diaflo membranes and DE52 column chromatography. The activities inducing the three differentiated characters examined were purified together, suggesting that they were all due to the same factor.


Transplantable granulocytic leukemia in strain 13 guinea pigs. The occurrence of a granulocytic leukemia in 1 of 40 female strain 13/N guinea pigs given N-nitroso-N-butylurea continuously in their drinking water for 21 weeks is reported here. This leukemia has been successfully transplanted in this guinea pig strain for 13 transplant generations by i.p. inoculation of leukemic blood or marrow cells. Macroscopically and microscopically, this leukemia resembles the chronic myelogenous form in humans. Histochemical studies showed, however, that unlike the human leukemic cells those in the leukemic guinea pigs are alkaline phosphatase positive. Electron microscopic studies of the guinea pig leukemic cells revealed the presence of numerous intracisternal A-type particles that are not found in corresponding normal leukocytes.


Guanosine diphosphate-L-fucose plasma: N-acetylglucosaminide fucosyltransferase as in index of bone marrow hyperplasia after chemotherapy. We have measured the plasma level of a fucosyltransferase in patients with acute myelogenous leukemia and non-Hodgkin's lymphoma at various stages of the disease and in normal controls. This enzyme transfers the sugar fucose from a guanosine diphosphate-L-fucose donor to high-molecular-weight acceptors with a terminal N-acetyl-glucosamine residue. The enzyme levels of fucosyltransferase in individuals free from disease and in patients with untreated leukemia or lymphoma were comparable. A substantial increase in plasma enzyme level was measured during drug-induced remissions, three weeks after drug therapy. The enzyme level fell to the normal range during unmaintained remissions inpatients with lymphomas; comparable information for the leukemia is not available since all remissions were drug maintained. These data, together with microscopic examination of marrow samples, indicate that the level of this fucosyltransferase is correlated with regeneration of a normal marrow population after chemotherapy. The enzyme assay may prove useful in defining normal bone marrow recovery and in timing cyclic combination chemotherapy in patients with neoplastic disease.


Murine myeloid leukemia: I. Pathophysiology and drug sensitivity. The pathophysiology of serially passaged myeloid leukemia of the RFM mouse was studied. The disease was characterized by progressive splenomegaly and infiltration of both marrow and spleen by myeloblasts. The animals became anemic and there was an associated erythroid hyperplasia in the spleen. Leukemic spleen cells obtained from animals early in the course of the leukemia were less malignant than those obtained from preterminal mice. The leukemia is most sensitive to alkylating agents but is also responsive to antimetabolites.


Treatment of refractory acute leukemia with high-dose chemotherapy.


Time relationship between last dose of daunorubicin and congestive heart failure.


Studies on flies in Korea II. Taxonomical studies on sarcophagid flies (Diptera). Thirty-eight species belonging to 15 genera of the family Sarcophagidae were found so far in Korea. The description, locality in Korea, distribution and bionomics of these species are given in this paper. The fifth sternite, forceps and genitalia of these male flies are illustrated. The key to the species of sarcophagid flies in Korea are also presented.


Correlation between hypomethylation of DNA and expression of globin genes in Friend erythroleukemia cells. This report identifies L-ethionine as an inducer of differentiation in murine erythroleukemia cells. When Friend erythroleukemia cells are grown in the presence of 4mM L-ethionine, globin mRNA accumulates and in 4-5 days, 25-30% of the cells in the culture contain hemoglobin. Incubation of the cells with bromodeoxyuridine prevents both ethionine-induced accumulation of globin mRNA and erythroide differentiation. At the concentration where L-ethionine acts as an inducer of FL cell differentiation it inhibits methylation of DNA and tRNA in vivo but does not prevent macromolecular synthesis or cell division. To establish whether a link existed between inhibition of a specific methyltransferase and activation of globin synthesis in FL cells, we examined the degree of hypomethylation of DNA and tRNA from FL cells induced to differentiate with dimethylsulfoxide and butyrate. In contrast to the tRNA from ethionine-treated cells, tRNA from cells induced by butyrate or Me2SO cannot be methylated in vitro using homologous enzymes. DNA isolated from cells exposed to any of the three inducers, however, was significantly hypomethylated when compared with DNA from uninduced cells. These data suggest that methylation of DNA may play a role in the regulation of gene expression.


A method for the quantitative detection of human acute lymphatic leukemia.


Interactions of partial LSD analogs with behavioral disrupting effects of LSD and DMT in the rat. Adult male Holtzman rats were trained to barpress on a schedule whereby every fourth press earned a reward of 0.01 ml of sugar-sweetened milk (FR4). After an i.p. injection of LSD (0.1 mg/kg) or DMT (3.2 or 10 mg/kg) such barpressing is abolished completely and resumed, usually within an hour, at a rate near the preinjection control rate of pressing. It continues at a steady, uninterrupted pace until the animals are removed from the operant chamber one-half hour later. A series of N,N-diethylnipecotamide derivatives were synthesized and tested for their ability to modify the disruptive effect of these hallucinogens. N,N-diethylbutyramide (DBA) and 1-methyl-1,2,5,6-tetrahydropyridine-3-(N,N-diethylcarboxamide) (THPC) were also tested. Pretreatment with a single i.p. injection of any of these compounds (5--40 mg/kg) either had no effect on or else prolonged the duration of hallucinogen-induced cessation of barpressing.


Decreased deoxy-D-glucose transport in Friend cells during exposure to inducers of erythroid differentiation.


Comparison of the sensorimotor dysfunctions produced by damage to lateral hypothalamus or superior colliculus in the rat.


Can Peer Review be made to work?

Can Peer Review be made to work?


Resolving the doctor's dilemma.

Resolving the doctor's dilemma.


Hear! Hear!

Hear! Hear!


The sum total of money.

The sum total of money.


Jaws and the dentist.

Jaws and the dentist.


Being black.

Being black.


"Should I put my wife on the reception desk?".


Be alert for symptoms of malignant hyperthermia.


ADA's chief executive welcomes you to the profession.


First, decide your philosophy of practice, then pick your equipment.


How to create good patients.

How to create good patients.


Notebook is a simple way to gather important papers and documents.


How many patients are enough?

How many patients are enough?


Careful system sets up recall routine.

Careful system sets up recall routine.


Is pressure the only way to provide dental care for shortage areas?


Forms meet credit-law requirements.

Forms meet credit-law requirements.


The lactobacillus test: keystone of oral health evaluation.


Death from improper mastication.

Death from improper mastication.


Soft stainless steel crown as an intermediate restoration: observations in clinical practice.


Patterns of alveolar bone loss in Nigerian Yorubas. Unusual patterns of alveolar bone loss in 33 Nigerian Yorubas with severe periodontal disease are described. The subjects, aged 15-50 yr represented 1.4% of a population of dental patients in Western Nigeria. Periodontal pocketing and alveolar bone loss in the incisor and first molar regions, far in advance of other mouth areas, were the criteria for inclusion in this report. Intra-oral radiographs showed advanced horizontal or crescentic bone resorption in incisor regions, and vertical or arc-like bone defects around first molars. Incisors and first molars were frequently missing as a result of periodontal disease. Surveys of tooth mortality and periodontal pocketing in Western Nigeria, and immunological findings elsewhere, suggest these cases represent a severe form of plaque-induced inflammatory periodontal disease. The role of protein-calorie malnutrition as an aetiological factor is discussed.


Periodontosis: a treatment approach for the general practitioner (a case report).


Potential for clinical cooperation between dentistry and speech pathology. Clinical management of articulation dysfunctions is one area in which the joint efforts of dentistry and speech pathology are particularly beneficial. Those articulation deviations discussed result from: (1) deformities in the upper lip, teeth, mandible and the hard and soft palates; (2) introduction of dentures; (3) difficulties in adjusting to esophageal speech; and (4) special problems associated with cleft palate/cleft prepalate. Team management of the individual with cleft palate and/or cleft prepalate was also reviewed. While orthodontists and prosthodontists provide the technology for correct speech production, speech pathologists furnish therapy for cultivating speech or modifying defective articulation patterns. Speech pathologists also serve as liaisons with respect to patients and other professionals. The authors believe that, ideally, clinicians from all disciplines should assume a holistic attitude in treating organic and functional human pathologies. Such interdisciplinary clinical cooperation is especially effective between dentistry and speech pathology. The concept of team management of cleft palate/cleft prepalate is an excellent example of how concomitant treatment effects total patient care. However, joint research and educational ventures also contribute to this objective and should continue to be encouraged.


A new view of the endodontic radiograph.


Pin-retained restorations: literature evaluation and clinical considerations.


Management of patients with angular cheilitis.


Tumor-associated humoral cytotoxicity in patients with acute myelogenous leukemia before and after chemotherapy. Sera of eight unselected adult patients with acute myelogenous leukemia obtained before and after chemotherapy were repeatedly tested for specific complement-dependent cytotoxicity against autochthonous peripheral white blood cells from the acute leukemia stage and from the remission stage, respectively. Complement-dependent cytotas demonstrated in all of the eight patients, while none of three patients' sera were reactive against white blood cells from the remission stage tested in parallel. The cytotoxicity was increased after chemotherapy, also in those patients in whom remission was not achieved.


A technique of management of the unerupted maxillary incisor.


Further evidence for a non-random chromosomal abnormality in acute promyelocytic leukemia. We have previously reported on two patients with acute promyelocytic leukemia (APL) who had what appeared to be a deletion of chromosome No. 17. We now describe a third patient with APL. All three patients had a structural rearrangement involving No. 15 and No. 17. Our current interpretation of the chromosomal abnormality is that it is a reciprocal translocation, t (15;17) (q22; q21). Evidence that this is a consistent rearrangement associated with APL comes not only from our three patients, but also from two other published cases of APL, studied with banding, who also had an identical abnormality.


Inhibition of RNA and protein syntheses makes non-differentiating mouse myeloid leukemia cells sensitive to a factor(s) stimulating differentiation. Treatment with ascitic fluid from animals bearing various tumors, can induce mouse myeloid leukemia line cells, M1, to differentiate in vitro into macrophages and granulocytes. Cells were isolated that were resistant to the ascitic fluid factor(s) stimulating differentiation (D-factor). The resistant cells became sensitive to the D-factor and differentiated after treatment with various inhibitors of RNA synthesis (actinomycin D, nogalamycin, chromomycin A3 or cordycepin) or protein synthesis (puromycin or cycloheximide). The cells could not be induced to differentiate by treatment with the inhibitors alone. The effective doses of the inhibitors of protein synthesis were toxic to the cells. Among these inhibitors actinomycin D (5 ng/ml) was the most effective for sensitizing the resistant cells. Inhibitors of DNA synthesis did not sensitize the resistant cells. Added actinomcyin D was mainly recovered in the nuclear fraction of the cells. The sensitizing effect of actinomycin D on the cells was roughly parallel to the extent of its inhibition of RNA synthesis in the cells. The effective concentration of actinomycin D (5 ng/ml) mainly inhibited it also inhibited alpha-amanitin-resistant RNA synthesis to some extent. These results suggest that alpha-amanitin-sensitive RNA synthesis may be involved in sensitization of the resistant cells to the D-factor.


Sexual excitement and response by imagery production.


Emotion in motion.

Emotion in motion.


Notes on "spontaneous" regression of cancer.


Cancer of the mouth.

Cancer of the mouth.


Man in a trance.

Man in a trance.


Special set-up and treatment techniques for the radiotherapy of pediatric malignancies.


Glucocorticoid binding and mechanism of resistance in some clones of mouse myeloid leukemic cells resistant to induction of differentiation by dexamethasone. Several clones of dexamethasone-resistant cells, which could not differentiate even in a high concentration of dexamethasone, were isolated from glucocorticoid-sensitive myeloid leukemic cells. Some of them were shown to be deficient in steroid binding to specific cytoplasmic receptors, while the others contained glucocorticoid-specific cytoplasmic receptors that might be the same as those in sensitive cells. One of the resistant clones was found to be almost completely deficient in nuclear acceptor sites for cytoplasmic steroid-receptor complexes. The remaining clones were also characterized by significantly reduced amounts of nuclear-bound glucocorticoid. These results suggest that resistibility to glucocorticoids in the resistant clones of myeloid leukemic cells is due mainly to a defect in some steps of intracellular transfer of the steroid. Dexamethasone-sensitive cells, which could differentiate in the presence of dexamethasone, could be also induced to differentiate by protein factor(s) in ascitic fluid. Although all the resistant cells showed a low response to ascitic fluid, some of them showed 10-fold enhancement of phagocytic activity which is a typical character of differentiated cells. These results suggest that response to steroids is not directly correlated with that to protein inducer(s).


Research in dental education: the paradox of integrity.


The Colorado tuition policy: progress, problems, and opinions.


Pharmacology national board examinations: factors that may influence performance. Data from a survey of pharmacology courses in 60 dental schools were used to determine whether certain teaching variables affect performance in pharmacology National Board examinations. In addition, three-year class-averaged pharmacology scores and, rarely, one-year averaged scores were correlated with several admissions variables. While correlations between some admissions variables and pharmacology scores were quite good, the averaged pharmacology scores were not powerfully affected by course length, placement of the course in the curriculum, length of the curriculum, or the presence of a dentally trained pharmacologist in the department. It is suggested that other factors, related to the student and his capabilities, influence performance on National Boards. Dental pharmacology courses should be designed to given students the best possible exposure to an important basic science, not to make them perform well on National Boards, because student performance on National Boards may be independent of the nature of the didactic courses.


The professional role of the dental hygienist as viewed by accreditation commissioners and consultants. Members of the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs and of its associated Committee D (Committee on Dental Hygiene) were asked a series of questions designed to elicit their positions on (1) the occupational status of dental hygiene in society at large and in the social prestige hierarchy of the dental profession, (2) reference groups for dental hygienists, (3) ethical norms for the hygienist role, (4) revivalism movements within dental hygiene, and (5) images of the "ideal dental hygienist." Results indicate that commissioners and consultants see dental hygienists as (1) ranking 7.1 on a ten-point scale of professional status in the community-at-large, (2) somewhat lower than dentists but higher than other auxiliaries in the social hierarchy of the dental profession, (3) socially referenced to dentists rather than hygienists, (4) primarily oral health educators with strong clinical skills, (5) better educated and more skilled now than they have ever been before, (6) bound to essentially the same ethics as dentists, except for self-regulation, and (7) much too aggressive at the national level for their own good. The ideal dental hygienist was seen as a behavioral change specialist with (1) clinical skills, (2) an attitude of service to patients (3) a willingness to work with dentists to increase the scope of dental hygiene duties in the preventive and periodontal areas, and (4) a willingness to leave the decisions regarding the profession of dental hygiene to dentists.


Development of a behavioral dentistry course: a follow-up report.


Interest survey for continuing education courses in endodontics.


The dental and dental auxiliary education profile system: a report to the membership.


Endodontic problems resulting from surgical fistulation: report of two cases. The use of surgical fistulation after endodontic therapy caused clinical problems for two patients. Only one patient was treated successfully for restoration of a molar; for the second, surgery was not advised. Analgesics and antibiotics may be better initial therapy than use of fistulation.


An autogenous tooth transplant: report of case.


Restoration of a fractured anterior tooth. A fragment of tooth missing for three years was found in the patients' lower lip. The fragment was surgically removed and cleaned. It was restored to its original position on the maxillary left incisor with an acid etch resin technique. After three months, the restoration was satisfactory.


Prevention of skin fistulas of odontogenic origin.


Good bites, bad bites, and malpractice suits.


Cement failure in bridges.

Cement failure in bridges.


Bacterial endocarditis.

Bacterial endocarditis.


A cephalometric study of patients with cystic fibrosis. Children with cystic fibrosis have skeletal maturation and epiphyseal anomalies similar to those in children with nutritional problems. However, these patients have been found to have normal somatic development if treatment is begun early. In a group of children with cystic fibrosis undergoing medical treatment, cephalometric measurements compared favorably with those established by normal standards.


The case of the disappearing third molar. A mandibular third molar moved into the lower border during a period of several years. When the patient experienced discomfort, an incisional biopsy and marsupialization were performed. Eight months later, adequate bone had regenerated and the molar and remaining cyst structure were removed. Full-mouth and panoramic radiographs would have allowed the dentist to locate the missing molar before surgery was necessary.


Loss of color from Jiffy tubes.

Loss of color from Jiffy tubes. Colored, disposable applicator tubes have been said to lose color to their contents during use. Since they are used to contol the placement of a variety of accessory materials important to clinical dentistry, a selection of restorative materials and solvents was evaluated to determine which had a color-leaching potential. Neither aqueous system nor alcohol, chloroform, eugenol, xylene, or ether caused a loss of color that was clinically significant. Acetone and amyl acetate caused a visibly apparent loss of color and softening of the tube matrix. Methyl methacrylate completely dissolved specimens of celluloid tubes. Unfilled resins containing methyl methacrylate in their liquid catalysts leached sufficient red color form the test specimens to stain the restorative noticeably pink; the composite resins and cements that were evaluated did not.


Clubbed fingers: indicators of serious disease. Clubbed fingers were noted by a dentist in a woman patient having respiratory symptoms. He referred her to a physician to be examined for pulmonary disease. Bronchogenic carcinoma was diagnosed.


Management of the fractured incisor.

Management of the fractured incisor.


Age and treatment response in acute nonlymphoblastic leukemia. Treatment of older acute leukemia patients has been the subject of recent debate. We treated 101 acute leukemia patients in a prospective randomized trial. Fifty-seven per cent of the population was over 50. Half were treated with a mild induction program (VAMP) and half with a vigorous program (CAT). The older patients who received vigorous treatment did better than those who received mild treatment. We suggest that patients over 50 should be regarded as a separate category in design of treatment protocols in order to further maximize the benefits of therapy.


Oral cancer: the behaviour and response to treatment of 194 cases. During the 16 year period 1960-1975, 350 cases of Oral Cancer were seen in the Department of Oral and Maxillo-Facial Surgery at the London Hospital. Detailed records were available for 250 patients. After excluding tumours of the salivary glands, sarcomata and tumours of the reticulo-endothelial system 194 cases remained and these were subjected to a computer analysis. The overall 5 year survival figure, not corrected for age and sex was, 32.8%. The local recurrence rate for all sites was 44%, 90% of these recurred within 2 years of diagnosis. The overall uncorrected 5 year survival figure for females was 42.1% and that for males was 22.9%. Analysis of the material has not provided a satisfactory explanation for this; lesions do not present at an earlier stage in females neither do they occur in younger patients. The distribution of the lesions by site and histology was the same for both sexes. Survival rates analysed by clinical staging at presentation confirm that the prognosis for early stage lesions is very much better than for late stage lesions, the 5 year survival for Stage I being 50% whereas that for Stage IV is only 20%.


Haemangiomas of the parotid gland in children. The authors present the case histories of 40 intraparotid haemangiomas, in 11 of which they achieved healing after radical surgical treatment (parotidectomy). Since 1971, the authors have adopted a conservative approach (not surgical), seeing that most of the cases involute spontaneously up to complete healing. None of the 29 cases treated conservatively has undergone exacerbations of the process, after the age of 6-9 months. No emergency surgical operations were required.


Secondary lip correction in unilateral cleft lips. Between 1973 and 1976, we performed 121 secondary corrections of the lip in cleft lip and palate cases; 75 of them were unilateral. Most of the cases were originally operated upon in another unit, usually by the same surgeon using a straight line closure according to Veau (1931). The result was always a short lip at the site of operation. In addition, the typical deformity of the aperture of the nose, with flatness of the ala cartilage, has been frequently observed. Various techniques have been used to correct the secondary deformities of the lip; some were modified by the author. In most cases, the Tennison (1952) technique was used with modification of the Trauner (1966) flap. The results of this technique were compared with those of Millard (1964). Other methods were used in a few cases. The results demonstrate, that by using the rotation advancement technique, better improvement of the nasal aperture will be obtained and the Z-plasty of the lip has the advantage of forming a cupid's bow. The method of lip correction chosen depends upon the nature of the lip deformity.


A rationale for the surgical treatment of exophthalmos and exorbitism. Exophthalmos and exorbitism, although both manifesting protrusion of the eye, differ in their aetiology and treatment. Illustrative cases are presented from both catagories, with a short experimental section illustrating on the degree of orbital expansion obtained with various procedures. Methods for accurately measuring orbital volume clinically still require development.


A spectrum of application of autogenous costochondral grafts. Autogenous costochondral grafts have found application in 26 variegated cases of congenital dysplasia, ankylosis, neoplastic disease, osteoarthritis, and post-traumatic dysfunction. The authors' experience with the grafting procedure has been generally favourable, but various difficulties have also arisen. There is a cursory discussion on the physiological superiority of rib cartilage grafts over those of other autogenous joints in reconstruction of the temporomandibular articulation.


Results of osteotomies of the facial skeleton in adolescence.


Cephalometric observations in premature craniosynostosis. Forty patients with premature craniosynostosis of variable extent and severity were subjected to cephalometry. The majority of the children and adolescents involved had undergone bilateral cranial fenestration at age 6 months to 11 years. Lateral cephalometric radiographs were used for analysis. The measurements obtained were compared with normal values of comparable age groups. In two thirds of the patients examined facial skull growth was found to be impaired, the clinical appearance ranging from pronounced faciostenosis to abortive forms. In some cases the clinical appearance was normal. One of the conclusions derived from the cephalometric data is that inhibited growth primarily affects the anterior portions of the skull base, which are found to be shorter than normal. The defect appears to involve the spheno-ethmoidal, intersphenoidal and sphenofrontal synochondroses.


Ceramic augmentation of the lower jaw.

Ceramic augmentation of the lower jaw. Atrophy of the lower jaw is essentially a manifestation of vertical bone resorption and must be treated in a compensatory manner. Animal experiments have shown the value of the bioactive glass ceramic Ceravital as a bone replacement material. After box-shaped or step-shaped osteotomies, we perform interpositional plastic operations with glass ceramic in order to augment the atrophied human lower jaw. Results, advantages and dangers of the method are shown in 12 patients.


The incidence of masticatory dysfunction and its relation to the masticatory myalgia syndrome. 840 people were included in this study. 29.2% of them were found to have at least two dysfunctional signs, either in combination with pain (7.2%) or without pain (22%). The former group represents cases of the masticatory myalgia syndrome, while the later (the non-painful masticatory dysfunction group) may be considered as representing a pre-clinical stage of the masticatory myalgia syndrome.


Production of a nasoantral window with an Ar+-laser. In vitro experiments on perforating and cutting 14 human nasoantral walls using an argon laser are described. The drilling velocity is proportional to the power density up to 100 W/mm2. The cutting velocity is measured using focussed spots of 40 micrometer diameter and powers from 5 to 40 W. Histological studies were performed at the edges of the lesion. The experiments show that the technical problem for producing a window in the nasoantral wall using a laser can be solved.


Sodium, potassium, renin and aldosterone relationship in normal persons.


A statistical analysis on mortality of malignant neoplasms in Taiwan.


Alkylphthalides isolated from Ligusticum wallichii Franch and their in vitro inhibitory effect on rat uterine contraction induced by prostaglandin F2alpha.


Antigenic reactivities of synthetic polymers. (I) Hemagglutination of polymers to red blood cells of various species and hemagglutination inhibition of guinea pig antisera.


Comparison of the fine structure of basal cell carcinomas in ordinary patients and patients with chronic arsenicalism.


Maximal stress test performance while wearing a self-contained breathing apparatus. Fifteen adult male volunteers (mean age = 31.0 years; eight non-smokers and seven smokers) carried out a Bruce protocol maximal treadmill stress test under four separate conditions. These four conditions were (1) without Scott Air Pak (SAP) respirator; (2) with SAP respirator apparatus but not wearing face mask; (3) with SAP apparatus, wearing face mask in "demand" breathing mode; and (4) with SAP respirator apparatus, wearing face mask in "pressure-demand" breathing mode. The data indicate that the overriding factor in the approximately 20% decrement in work performance during conditions 2, 3, and 4 was related to the weight of the SAP respirator (15.8 kg), P less than 0.05. Only during condition 3 did eight of 15 subjects report lack of air as one reason for termination. Conditions 3 and 4 resulted in a significant decrease in TFore (2.5 degrees C) and was primarily related to the decreased Tinsp which reached a maximum decrement of 9.7 degrees C. Under all conditions the smokers' work time was significantly less than nonsmokers, P less than 0.05.


The oral surgeon's role in preventive aspects of health care.


Synovial chondromatosis of the temporomandibular joint. Synovial chondromatosis is a benign, chronic, progressive synovial metaplasia that will not resolve spontaneously. Although it is non-neoplastic, the condition can be easily mistaken histologically as malignant. Seven patients with synovial chondromatosis involving the temporomandibular joint have been seen at the Mayo Clinic; two of these have been described previously. Of the remaining five, four have had the lesions evaluated histologically. The fifth patient, recently treated at the Mayo Clinic, has had no recurrence of symptoms a year after surgery.


Orbital tripod osteotomy for facial asymmetry. An attempt has been made to provide an additional alternative to the treatment of zygomatic deformities. It is an approach that was used on a series of four patients but one that has met with success and satisfactory results in restoring more normal form and function. When performed correctly, the orbital tripod osteotomy is a physiologically and esthetically sound approach to the correction of the deformed or deficient cheek as a result of trauma or congenital malformation.


Management of ambulatory oral surgical patients with hemophilia.


Interpositional bone graft augmentation of the atrophic mandible: a preliminary report. The mandible is sectioned in an oblique direction and an iliac crest graft is placed between the fragments for augmentation of an atrophied mandible. The technique was used in 12 patients; follow-up examinations included serial panoramic radiographs and recording of changes in mandibular height. A 10% to 27% loss of the height gained occurred between three and 12 months postoperatively.


Idiopathic bone cavities.

Idiopathic bone cavities. Nine cases of idiopathic bone cavities, also described as traumatic bone cysts, were discovered within a 15-month period. These lesions are obviously more prevalent than indicated by a perusal of the literature.


Clinicopathological conference. Case 21, part 2. Diffuse undifferentiated lymphocytic lymphoma.


Cleidocranial dysostosis: review of the literature and report of case. A case report is presented in which the management of impacted teeth and cystic lesions is described in a patient with cleidocranial dysostosis. A review of the literature with emphasis on the incidence, clinical features, etiology, diagnosis, and treatment is also discussed.


Early recognition and treatment of the traumatically transected parotid duct: report of case. The immediate treatment of a transected parotid duct has been presented along with a brief review of the literature. The importance of exploration of wounds in the facial area cannot be overemphasized, as early repair of a severed duct is of utmost importance for establishing its patency.


Atrophy of mandibular condyles after sagittal ramus split osteotomy: report of case. Bilateral atrophy of the mandibular condyles after a SRSO with advancement is reported. Although a definite cause could not be established, a biomechanical phenomenon based on increased muscle tension was the most likely causative mechanism.


Pulmonary metastasis to the submandibular gland.


A large mandibular tumor with a distinct radiological "sun-ray effect" as the primary manifestation of multiple myeloma. The significant feature of the reported case was that of a sinister-looking mandibular tumor highly suggestive of a metastatic lesion or of osteogenic sarcoma. A biopsy specimen and results of a thorough medical work-up showed the lesion to be multiple myeloma. The myeloma cells apparently have the capability to stimulate osteoblastic activity and new bone formation. This capability should be kept in mind when making the differential diagnosis of osteoblastic bony lesions of the jaws.


Bilateral solitary bone cysts: report of case.


Osteocartilaginous choristoma of the tongue: clinical and histopathologic considerations. To the 25 previously reported cases, we have added an additional example of an osteocartilaginous choristoma of the tongue that occurred as an asymptomatic mass on the ventral surface of the tongue in a 57-year-old white woman.


Leiomyosarcoma of the maxilla: report of two cases. Two cases of leiomyosarcoma of the maxilla have been reported. These lesions occurred in 67- and 24-year-old men. One was treated by hemimaxillectomy, and the other by radical local excision.


Ameloblastic fibroma: report of case.

Ameloblastic fibroma: report of case. A case of ameloblastic fibroma of the mandible in a 7-year-old girl is presented. The case is of interest because of the unusually large size of the lesion. The lesion was treated with conservative surgical enucleation. There has been no evidence of recurrence of the lesion during the 14-mongh postoperative period. The views expressed herein are those of the authors and do not necessarily reflect the view of the United States Air Force or the Department of Defense.


A procedure for stabilization of the proximal segment after vertical osteotomy of the mandibular ramus for apertognathia and micrognathia. A supplemental technique has been presented for stabilization of the proximal segments after bilateral oblique osteotomies of the mandibular rami for the treatment of micrognathia and apertognathia. This procedure stabilizes the condylar segments in all planes. Since the medial plate of bone is not violated in creating the depression, it acts as a medial stop while the rest of it prevents the condyle from moving inferiorly and anteriorly. The wire prevents movement of the condyle laterally and posteriorly.


Coccidioidomycosis involving the mandible: report of case. We have presented a case of disseminated coccidioidomycosis involving the mandible in a 47-year-old white man. A review of the literature has shown that coccidioidomycosis involving the jaws is an unusual, if not rare, entity. The pathogenicity of the disease and accepted treatment were discussed.


Responsibility for the history and physical examination.


Thoracotomy as adjuvant to chemotherapy in metastatic osteogenic sarcoma. This is a review of the experience at Memorial Hospital using chemotherapy combined with surgical excision for control of pulmonary metastases in osteogenic sarcoma. Effective multiple drug chemotherapy was able to control small deposits of osteogenic sarcoma in the lung, making surgical resection of residual visible nodules worthwhile. Surgical resection was most successful for solitary nodules or where multiple nodules were shrunk or at least prevented from growing by chemotherapy. Eight percent of these patients with pulmonary metastases initially or subsequently showed bilateral lung disease. When two or more nodules were found at th oracotomy, they were never confined to one lobe. For these reasons, wedge resections or segmental resections were the most commonly indicated procedures. Results justify an aggressive surgical approach to these lesions including multiple wedge resections of all lesions found at thoracotomy, chest wall resection and multiple bilateral thoracotomies. Chemotherapy alone cannot be expected to cure metastatic osteogenic sarcoma of the lung, but combined with surgical resection of residual disease the results are encouraging.


Healing potential in periodontal lesions. The interdental crater.


Thickness of facial gingiva.

Thickness of facial gingiva. Gingival thickness was measured in 10 subjects with healthy gingiva on the facial aspect of selected maxillary and mandibular teeth at the depth of the gingival sulcus and midway between the sulcus depth and mucogingival line. Measurement instrumentation, consisting of a differential transformer coupled to an oscillator and digital voltmeter was sensitive to the travel of a probe from the gingival surface to tooth surface or alveolar bone. The probe assembly was accurate to 0.01 mm and the average range of differences in replicate measurements under a variety of conditions never exceeded 0.15 mm. 1. Free gingival thickness averaged 1.56 mm + 0.39, attached gingival thickness averaged 1.25 mm + 0.42 and the total mean thickness for all areas measured was 1.41 mm. 2. Thickness in mandibular free and attached gingiva and maxillary free gingiva increased from anterior to posterior. Thickness in maxillary attached gingiva remained fairly constant. 3. Thickness measured at the depth of the sulcus was directly proportional to the free gingival width. 4. Thickness measured midway between sulcus depth and mucogingival junction was inversely proportional to attached gingival width.


Relationship of occlusion and periodontal disease. Part X. Relation of cross-bite to periodontal status.


Subcutaneous emphysema during periodontal surgery: report of a case. Subcutaneous emphysema (S.E.) of the facial region is an uncommon complication of dental procedures. A case is presented which details the development of S.E. following use of an air-water syringe during periodontal surgery. Differential diagnosis of the condition depends upon accurate historical data and the finding of crepitus on palpation of the involved tissues. Treatment is supportive in nature, although prophylactic antibiotic coverage is suggested. The etiology of S.E. is discussed and judicious use of compressed air or gas-producing medicaments during dental treatment is stressed.


Depression and appetite.

Depression and appetite.


Intra-aortic balloon counterpulsation in community hospital: interface with open-heart centers and description of patient transport system.


Subcutaneous mastectomy: perspectives and problems.


Assessment of statistical significance of clinical data.


Incidence of acute myocardial infarction among Blacks in an urban community.


Methylphenidate (Ritalin) abuse.

Methylphenidate (Ritalin) abuse.


Tear of right atrial appendage following blunt chest wall trauma.


Simultaneous bilateral and complete rupture of the quadriceps extensor mechanism.


Bioethics: health care questions for a new age.


Anovulation: etiology, investigation and treatment.


Immunologic hematologic diseases in infancy.


Patients, families, and health professionals. Deciding the use of heroic life-sustaining measures.


Case reports: Pylephlebitis and multiple liver abscesses due to bacteroides. Successful treatment with clindamycin.


Transurethral resection of the bladder neck in neurogenic bladder secondary to myelomeningocele.


Mucocutaneous lymph node syndrome with vesicles.


The sanctity of life.

The sanctity of life.


The evolution of diagnostic radiology of the temporal bone.


The radiologic diagnosis of pneumocele of the maxillary sinus. Pneumocele of the maxillary sinus is a recently described disease, first noted in 1974. Three subsequent cases have been encountered. Pneumocele refers to an expansile cystic air-containing mass, occupying the entire maxillary sinus, and lined by the original attenuated mucous membrane. It is analogous to mucocele, but containing air rather than fluid content. Radiologic signs are diagnostic, and it is the purpose of this presentation to enumerate these radiologic findings.


The radiologic findings in synovial chondromatosis (chondrometaplasia) of the temporomandibular joint. Synovial chondromatosis or chondrometaplasia is a rare disease in which foci of cartilage may develop in the synovial membrane, usually of the large diarthroidal joints. However, the temporomandibular joint may be affected, with less than 15 such cases documented. It is the purpose of this presentation to define the radiologic findings in synovial chondromatosis of the temporomandibular joint, not previously recorded, which allow for definitive diagnosis. These radiologic findings are: 1) widening of the joint space; 2) limitation of motion; 3) irregularity of joint surfaces; 4) presence of calcified loos bodies (cartilage); and 5) sclerosis of the glenoid fossa and mandibular condyle.


Sophisticated radiology in otolaryngology. II. Diagnostic imaging: non-roentgenographic (non x-ray) modalities (ultrasound, nuclear medicine, thermography). Newer forms of radiologic diagnostic imaging now include non-roentgenographic modalities such as ultrasound, nuclear medicin, and thermography, all of which can be applied to otolaryngology. It is the purpose of this presentation to demonstrate these modalities, and indicate their clinical application, yet in its earliest stages, to otolaryngology.