Chronic atrial fibrillation: spontaneous conversion to sinus rhythm. Improvement in arrythmia may actually represent a worsening of the conduction system.


Primary aldosteronism-recognition and management.


Editorials: ER.

Editorials: ER.


Apudomas: a primer.

Apudomas: a primer.


Side effects of antihemophilic concentrates. Liver disease and thromboembolism are the most frequent and severe side effects associated with the use of clotting-factor concentrates in haemophiliacs. Knowledge and careful evaluation of the risk factors related to their development appear to be the most reasonable policy for prevention. themolysis due to significant isoantibody infusion and bleeding associated to abnormal platelet function occur more rarely during intensive replacement therapy with clotting factor concentrates. Finally, abnormalities of renal function have been observed in a number of patients, though they seem to be of minor clinical importance. These complications do not justify withdrawal or limitation of the very effective and life-changing use of concentrates. However, awareness of their occurrence and of their danger requires that specialized hemophilia centres carry out, at frequent intervals, clinical and laboratory testing of the target organs to allow an early detection.


Jaundice and hepatitis B surface antigen and antibody in Greek haemophiliacs. The incidence of hepatitis B surface antigen (HBsAg) and antibody (HBsAb) in 101 Greek multitransfused haemophiliacs with or without a previous history of jaundice was studied. Using the haemagglutination inhibition assay, HbsAg was detected in 9.9%, HBsAb in 61.3% and HBsAg plus Ab in 11.8% of the cases. The incidence of jaundice was 14.8%. Liver function was tested by means of Normotest, SGOT, SGPT and serum protein electrophoresis. Abnormal values of liver function tests were found in 47% of the patients. The abnormal findings were related to the presence of HBsAg or Ab and to the history of jaundice. There was no significant difference between the various groups of patients.


Modifications of factor VIII related antigen in hemophiliacs with acute hepatitis and sub-clinical liver disease. Modifications of Factor VIII related antigen (F, VIII R. A.) were investigated in three hemophilic patients during the course of post transfusion hepatitis. F. VIII R. A. was found to be elevated and correlated with the increase of the S.G.P.T. During the acute phase of the disease the Factor VIII related protein was tested for its ristocetin cofactor activity, its electrophoretic mobility on crossed antigen-antibody electrophoresis and its elution pattern on Sepharose 4B columns; all these properties proved to be abnormal. Liver function tests and F. VIII R. A. were measured in 36 multitransfused hemophiliacs. There was a significant increase of the F. VIII R. A. in the plasma of patients with abnormal liver function tests. Only a few of the multitransfused hemophiliacs had clinical symptoms of hepatitis, although 72% had elevated transaminase levels.


Chronic hepatitis in hemophilia.

Chronic hepatitis in hemophilia. The relationship of chronic hepatitis B and/or liver dysfunction to treatment in 113 hemophiliacs was evaluated by the enzyme tests, SGOT and SGPT, and by the presence of circulating hepatis B surface antigen (HbsAg) or antibody (anti-Hbs). The hemophiliacs were divided into three groups according to treatment pattern. Individuals who had received multiple doses of plasma fractions, derived from four or more commercial lots were placed in tgroup I "large Exposure". Group II "Small Exposure" had been treated with fractions from three or fewer lots and Group III "Cryo" had never received commercial fractions, but had been treated with cryoprecipitate. Abnormal liver function tests (LFT's) were found in 87% of Group I and 76% of Group II, but in only 16% of the "Cryo" group. Differences in LFT's were not great between treated VIII and IX deficient patients. All patients treated with 100,000 units or more showed either persistent or intermittent abnormalities. In the high exposure group, this history of past, overt hepatitis had no influence on observed LFT's. The sera of all patients in the high exposure and all, except one, in the low exposure groups were positive for HbsAg or anti-Hbs by RIA. Splenomegaly was found in 13% of fraction-treated patients. We conclude that there is biochemical evidence of liver disease following large exposure to commercial VIII or IX fractions, which should temper the physician's decision to start treatment with these fractions. On the other hand, evidence that their continued use produces mounting liver dysfunction is insufficient to withdraw this very effective and life-changing treatment from these individuals.


Alteration of primary hemostasis in hemophiliacs after treatment with lyophilized antihemophilic globulin. Seven patients with classic hemophilia A had alteration of primary hemostasis after treatment with lyophilized antihemophilic globulin (LAHG). The following test results, which were normal before treatment, became abnormal after treatment: bleeding time, bleeding intensity, and platelet adhesiveness. In two patients, the fibrin-fibrinogen-degradation products increased to more than 40 microgram/ml. In three patients, the bleeding symptoms became worse with LAHG therapy although no inhibitor against Factor VIII was demonstrated. In one of these patients, the bleedings symptoms disappeared when the use of LAHG was discontinued and prednisone was given; at the same time, the altered primary hemostasis returned to normal. In the remaining two patients, prednisone did not have any effect. In these two patients, however, the bleeding stopped, and the bleeding time became normal immediately after freshly prepared blood-group compatible cryoprecipitate was given.


Factor IX and thrombosis.

Factor IX and thrombosis. Fractionation technology has made Factor IX concentrates available. In addition to a very high incidence of hepatitis, thrombosis is being recognized as a consequence of their use. Contradictory reports exist in the literature as to the incidence of thrombotic events. A recent study of thrombohemorrhagic phenomena after infusion with Factor IX concentrates in patients with congenital Factor IX deficiency (hemophilia B) or liver disease, revealed an incidence of twenty episodes in 188 cases (11%). It is imperative to delineate the thrombogenic factors and find methods for their removal to insure the safety of Factor IX products.


Renal disorders in haemophilia A and B.

Renal disorders in haemophilia A and B. Although haematuria is a relatively common symptom of hemophilia A and B, renal disease seemed to be a rarity and it has usually been held that this symptom was benign in nature. However detailed studies of renal function in a series of such patients using radiological and biochemical tests of renal function show significant differences compared to normal. These abnormalities seem to be associated with recurrent haematuria but do not appear to be related directly to replacement therapy with plasma concentrate and do not occur more frequently in patients who have received long term fibrinolytic inhibitors. Other rare renal disorders associated with haemophilia include nephrotic syndrome, trauma, acute tubular necrosis, analgesic nephropathy and chronic pyelonephritis.


Isoimmunization in haemophiliacs.

Isoimmunization in haemophiliacs. Serum samples from 134 Greek haemophiliacs multitransfused with fresh frozen plasma and factor--VIII or factor--IX concentrates were investigated for the presence of blood group antibodies. All samples were tested against a panel of selected cells of known but differing genotype. The incidence of blood group antibodies was 12.7%. Anti-D was found in 6 out of the 17 immunized patients, i.e., 35.3% of D-negative haemophiliacs were sensitized. It is concluded that the high incidence of immunization is a serious complication of repeated plasma transfusions.


World use of blood products for hemophilia.


Home care for hemophilia: current state of the art. While home care treatment for hemophilia is not a panacea and does not supplant good comprehensive care, it does seem to offer improved medical care for those hemophiliacs enrolled in such a program. The results have been very encouraging in the programs of this type throughout the United States. Since most programs have been in existence for 5 years or less, long-term data have not accumulated. However, the evidence seems to suggest that crippling is less in children and that orthopedic deformities do not progress at the same rate in adults. Children have improved school attendance; young men may attend college and graduate schools without difficulty. Adults may hold a job without fear of absenteeism. There are fewer dollar costs of the disease for the patient and the psychiatric cost of this chronic illness is markedly less. The quality of life is improved and the patient may develop a new self-confidence which allows him to function as a productive member of society.


Liver dysfunction in patients with hemophilia. The incidence of post-transfusion hepatitis and liver dysfunction is presented in fifty-four patients with classical hemophilia who received episodic and/or prophylactic Factor VIII concentrate. 42.5% had persistent biochemical evidence of liver dysfunction with elevated SGOT and SGPT; 3.8% have persistent (HBs) antigenicity and 90% have (HBsAb) antibodies. The results are the same for those who were treated episodically and received an average of 753 units Factor VIII per week as those treated prophylactically who received an average of 686 Factor VIII units per week. The incidence of clinical and/or subclinical disease is unaffected by the transfusion regimen or the amount of concentrate used. The necessity for close follow is emphasized for determination of chronic liver disease and its further therapy.


Home care--psychological benefits and hazards.


The home therapy programme for haemophiliacs the situation in Egypt.


Home therapy in Argentina.

Home therapy in Argentina.


Home care of haemophilia in Italy.

Home care of haemophilia in Italy.


Home treatment in Great Britain.

Home treatment in Great Britain.


Critique of the application of the treatments of hemophilia.


Three years' experience in haemophilia home treatment.


A hemophilia home care program utilizing cryoprecipitate.


Projected estimation of factor VIII requirements for home treatment based on a pilot study of two haemophilic patients. An extensive programme of home administration of factor VIII replacement therapy has been proposed for the haemophiliacs of the Edinburgh Area following the successful training of self-administration therapy in the Haemophilia Centre. A study of 1 moderate and 1 severe haemophiliac, whose factor VIII requirements for the year 1974 were compared with factor VIII usage for "on demand" out-patient therapy at the Centre in 1973, showed these quantities to be 14,380 as compared with 38,725 factor VIII units in the severely affected patient. From these figures, and, knowing that the average number of factor VIII units used per patient per years was 8,116 for the moderate and 11,592 for the severe haemophiliacs, it has been calculated that home treatment would require 6,000-10,000 factor VIII units per patient per year for the latter class. The advantages and hazards of home treatment are discussed and evaluated in the light of the two patients studied and the self-administration programme of therapy at present in operation.


Increase of proliferative activity of leukaemic blast cells from human peripheral blood in liquid culture. The proliferative behaviour of leukaemic cells from the peripheral blood of 12 patients suffering from acute leukaemia was investigated in short term liquid culture. In 3 cases of AML an increase of the blast cell number was observed exceeding the initial value whereas in 9 other cases the cell number decreased more or less rapidly. In 9 of these patients the proliferation kinetics of the cultured leukaemic blast cells were studied with 3H-thymidine labelling. In all these cases the labelling index increased during the first days of culture, in 3 cases to values of 48%, 45% and 38% on day 3. Only in 5 cases, however, did an absolute increase of the blast cells incorporating 3H-thymidine occur. Here the doubling times of the proliferating leukaemic blast cells were estimated to be 12, 13, 14, 28 and 55 h. Since a doubling time of 12 to 14 h seems to be too short to be explained only by an exponential growth of the initially proliferating cells it is postulated that leukaemic blast cells in a G0- or long G1-phase were present in the peripheral blood of these patients and that these entered the cell cycle during liquid culture.


Hypotensive effects of sodium nitroprusside in intracranial surgery.


Treatment of dyskinesias.

Treatment of dyskinesias.


A solution to health manpower planning. A report from the Health Manpower Planning and Linkage Project, State Health Dept. Pierre, S.D.


Twenty-six year old woman with premature ventricular contractions and diagnostic auscultatory and echocardiographic findings.


Oscillation and chaos in physiological control systems. First-order nonlinear differential-delay equations describing physiological control systems are studied. The equations display a broad diversity of dynamical behavior including limit cycle oscillations, with a variety of wave forms, and apparently aperiodic or "chaotic" solutions. These results are discussed in relation to dynamical respiratory and hematopoietic diseases.


Inducibility of transferrin receptors on friend erythroleukemic cells. The ability of Friend erythroleukemic cells to bind transferrin and take up its iron increases substantially as a result of dimethyl sulfoxide-stimulated differentiation. Although transferrin-binding activity is also demonstrable in another mouse cell line of hematopoietic origin, the lymphoma cell, it does not increase on exposure to dimethyl sulfoxide. Gel filtration studies corroborate that the binding of transferrin to the erythroleukemic cells is due to the formation of a specific complex of transferrin and a membrane receptor. Thus, the specific interaction of transferrin with its receptor is another expression of dimethyl sulfoxide-induced differentiation in the Friend cell.


Host control of tumor growth.

Host control of tumor growth. A humoral factor (molecular weight less than 60,000) that was present in the ascitic fluid of mice bearing intraperitoneal tumors and in pleural effusions from human cancer patients was found to promote the growth of a murine tumor and to suppress cell-mediated tumor immunity. However, the hosts that had recovered from the immunosuppressive state produced a serum factor that could neutralize the immunosuppressive effect.


Osteogenic sarcoma in a patient with aplastic anemia. Osteogenic sarcoma developed in a 14-year-old boy 13 years after he had partially recovered from chloramphenicol-induced aplastic anemia. A possible relationship is considered between aplastic anemia, chloramphenicol, testosterone, prednisone, and osteogenic sarcoma. Leukemia has been reported following chloramphenicol-induced aplastic anemia and liver tumors have been associated with testosterone therapy. Certain chemicals have caused osteogenic sarcoma in animals. Thus, we believe there are sufficient a priori reasons to question an etiologic relationship between the cause or treatment of aplastic anemia and osteogenic sarcoma.


Chronic myelomonocytic leukaemia: a case report.


The dentist as a primary medical evaluator.


So, do we want to be doctors?

So, do we want to be doctors?


Dental students and the hospital clerkship program at Tufts-New England Medical Center.


Selective transcatheter embolization of a renal neoplasm: report of a case.


The effects of high efficiency air filtration system on nighttime asthma attacks.


Postpartum emotional disorders.

Postpartum emotional disorders.


Multiple myeloma management.

Multiple myeloma management.


Chemotherapy of N-nitrosobutylurea-induced W/Fu rat myeloid leukemias.


An autopsy case of aplastic anemia-PNH syndrome terminated in acute granulocytic leukemia.


Fetal erythropoesis in aplastic anemia and acute leukemia.


A rat myeloid leukemia model of the human disease. Hematological characteristics of N-nitrosobutylurea-induced W/Fu rat leukemia L1504 and L1005.


Variability in differentiation stages observed in a rat myeloid leukemia and its relation to human myeloid leukemia.


Diagnostic suction curettage without anesthesia. An investigation into the practical usefulness of the Vabra aspirator. The purpose of this work is: 1) to answer the question whether the procedure of the Vabra aspiration curettage without anesthesia is well tolerated by the patients; 2) to assess the reliability of the Vabra curettage and to compare it with the conventional curettage in the diagnosis of various endometrial disorder. 262 patients were submitted to the procedure of fractional suctioncurettage without anesthesia; the method succeeded in 261 cases. In 205 cases the histological diagnosis was compared to the diagnosis from a conventional curettage or from a hysterectomy specimen. The method gives histologically reliable results. The tolerance by the patients was good. There were no complications.


Fractures of the acetabulum. A clinical, radiological and experimental study.


A follow-up study of children with instability of the hip joint at birth. Clinical and radiological investigations with special reference to the anteversion of the femoral neck.


The oto neurologic examination.

The oto neurologic examination.


Precancerous lesions of the larynx. Round table symposium Trieste, Italy, 12 April, 1975.


Macro-microscopical findings and prognosis of hyperplastic aberrations of the laryngeal mucous membrane.


Precancerous lesions of the larynx.

Precancerous lesions of the larynx.


Observations of the pathologist on precancerous lesions of the larynx. Integrated with histological data and quantitative analysis of nuclear DNA content.


President's report.

President's report.


An introspective evaluation of expenditures of resources at the Baltimore College of Dental Surgery, Dental School, University of Maryland at Baltimore.


Vancouver: Fond memories.

Vancouver: Fond memories.


The base & the voice.

The base & the voice.


Intra/extra-oral photography.

Intra/extra-oral photography.


Group-centered leadership.

Group-centered leadership.


Several goals set.

Several goals set.


The high school in Israel: a challenging and fascinating learning experience for Alpha Omega children.


Human rights--how about us?

Human rights--how about us?


An open letter to President Jimmy Carter.


The transmural migration and release of blood cells in acute myelogenous leukemia. The transmural passage of malignant blood cells from the extravascular parenchyma into sinusoidal lumen has been studied in the bone marrow of rats with myelogenous leukemia. The Shay myelogenous leukemia was chosen as a model system because an increased bone marrow cellularity is, in this leukemia, usually accompanied by an increase in circulating myeloid cells. By means of light microscopy, transmission electron microscopy (TEM) and scanning electron microscopy (SEM) it was found that the sinusoidal endothelial lining of the bone marrow remains intact and continuous even in advanced stages of the disease. SEM shows that the malignant myeloblast-like cell enters the sinusoidal lumen by means of a temporary migration pore, which appears only during the transmural passage of the cell. Certain nondegenerative changes in the sinusoidal blood vessels are associated with the myelogenous leukemia. The normal radial alignment of sinusoids about the central sinusoid is changed into a tortuous pattern, and intraluminal cytoplasmic bridges which impede the blood flow are formed by the endothelial cells.


Nonspecific esterase activity in pernicious anemia and chronic erythremic myelosis: a cytochemical and electrophoretic study. Cytochemically, nonspecific esterase activity was detected in megaloblasts from three patients with severe untreated pernicious anemia, in megaloblastoid erythroblasts from five patients with chronic erythremic myelosis (DiGuglielmo syndrome), and in normoblasts from a patient with severe untreated iron-deficiency anemia. Nonspecific esterase activity in all of these erythroblasts was inhibited by sodium fluoride. Enzymatic activity could not be detected in normoblasts from normal marrows. Electrophoretically, three bands of nonspecific esterase activity could be visualized in marrow sonicates from the anemic patients and normal persons. All of these bands were inhibited by sodium fluoride. The results demonstrate that electrophoretically and in terms of fluoride inhibition, nonspecific esterases obtained primarily from erythroid precursors in various types of anemias are similar to nonspecific esterases found in normal marrows presumably containing a more heterogeneous population of cells.


A population-based study of referral, diagnostic and treatment patterns for childhood acute lymphocytic leukemia. In order to make decisions about cancer control programs, information is needed on the current management of cancer as actually practiced in the United States. A study to address this issue for acute lymphocytic leukemia in children (age 15 years and under) has been performed. The 101 patients represent all reported incident cases during 1972 in five regions which have population-based registries. Data on patient characteristics, referral patterns, treatment regimens, remission/relapse status, and survival are presented. It is concluded that the treatment strategies developed in leukemia research are reaching the general patient population. The present study can be considered a model for future studies of other forms of malignancy.


Erythroblastic transformation of chronic granulocytic leukemia. Erythroblastic transformation of chronic granulocytic leukemia was found in seven of 67 unselected patients with blast crisis. This morphologic picture of erythroblastic transformation was indistinguishable from that in erythroleukemia or Di Guglielmo's syndrome. The median survival of the patients with erythroblastic transformation was two months, considerably less than the four-month median survival in the entire series of 67 patients. Only two brief partial remissions were obtained with combination chemotherapy. The causes of death were primarily hemorrhage and infection, related to thrombocytopenia and neutropenia. In this regard, the patients with erythroblastic transformation resembled all the patients with blast crisis and patients with acute leukemia in general. The erythroblastic transformation seems to represent a morphologic variant of chronic granulocytic leukemia blast crisis, without apparent prognostic or therapeutic implications.


Chronic myelocytic leukemia: clonal origin in a stem cell common to the granulocyte, erythrocyte, platelet and monocyte/macrophage. Glucose-6-phosphate dehydrogenase (G-6-PD) isoenzymes types of granulocytes were determined in eight women with chronic myelocytic leukemia (CML). The patients were heterozygous at the X-linked G-6-PD locus for the common gene, GdB, and a variant, such as GdA, so that both B and A enzyme types were found in skin cells. In contrast to these normal cells, only one G-6-PD type was found in CML granulocytes. The fact that such single-enzyme phenotypes are found in CML granulocytes, but not in nonleukemic granulocytes, provides strong evidence that the disease has a clonal origin. Single-enzyme phenotypes were also found in erythrocytes, platelets and cultured blood macrophages indicating that these cells have a common stem cell which is the site of the abnormality in CML. In the one studied patient, no evidence was found for involvement of cultured marrow fibroblasts. Clonal origin of CML virtually excludes cell recruitment as a sole pathogenetic mechanism. Either the leukemia arises as a consequence of a rare initial event in a single cell, or a series of events occurs in a clone such that it evolves into CML, or both.


Leukapheresis: the process.

Leukapheresis: the process.


Deep overbite correction by intrusion.

Deep overbite correction by intrusion. Not all patients with deep overbite should be treated with the same mechanics. Some patients require intrusion of the anterior teeth, while others require primarily extrusion. This article has discussed the principles of incisor and canine intrusion and has demonstrated the use of intrusion springs that are capable of intruding incisors with minimal side effects on the posterior teeth. Six principles must be considered in incisor or canine intrusion: (1) the use of optimal magnitudes of force and the delivery of this force constantly with low-load-deflection springs; (2) the use of a single point contact in the anterior region; (3) the careful selection of the point of force application with respect to the center of resistance of the teeth to be intruded; (4) selective intrusion based on anterior tooth geometry; (5) control over the reactive units by formation of a posterior anchorage unit; and (6) inhibition of eruption of the posterior teeth and avoidance of undesirable eruptive mechanics.


Chin cup therapy for mandibular prognathism.


Palatal suture closure in man from 15 to 35 years of age.


Soft-tissue management of labially positioned unerupted teeth.


Monozygosity in twins: a detailed investigation. The twins presented in this article showed similarities in their physical make-up to a very high degree. Statistically, however, it is the blood picture which holds the "trump card" in this plethora of evidence supporting monozygous twinning, and it is an essential prerequisite in any presentation of this nature. It is perhaps noteworthy that, while only one of the twins sucked his thumb habitually, there was no difference in the degree of postnormality of the posterior teeth but merely a change in the interincisor relation and in the palatal height. It can clearly be seen from the study of these two twins that the differences between them were very small indeed and could quite easily be classed as individual variations within the same identical genetic pattern. Similarly, in any other identical twins, the way in which one differs from another must be to a similarly small degree or the cause of the difference must clearly be attributable to environmental or acquired influences. Differences which cannot be classed as other than genetic show us that the twins are fraternal or dizygous and, therefore, no more alike than would be two brothers of differing ages.


Occlusal and craniofacial growth changes during puberty.


Long Range Study Committee releases results of manpower survey.


Population predictions, fertility rates, and professional prospects.


Orthodontic patient possibilities.

Orthodontic patient possibilities.


A simple connector for transtracheal ventilation.


Neutrophilic leukemia and blastic crisis.


Retrospective study of intellectual development in children treated for acute lymphoblastic leukaemia. Nine younger children (mean age 6-3 years) and 6 older children (mean age 9-0 years), previously treated for acute lymphoblastic leukaemia by cranial irradiation and subsequently by 2 or 3 years of chemotherapy, were assessed in terms of intellectual development in relation to 15 controls, matched individually for age, sex, and social background. All children were functioning within a normal range. The older group of children performed as well as their matched controls in all tasks. However, the younger group tended to perform somewhat below their matched controls, and this applied especially to tasks measuring quantitative, memory, and motor skills, but not to language tasks. It is concluded that there is a continual need to monitor the development of children treated for leukaemia, especially when diagnosed in the 2- to 5- year age range.


Prognostic significance of radiological bone involvement in childhood acute lymphoblastic leukaemia. In 98 children with acute lymphoblastic leukaemia, aged 1 to 12 years, the prognostic significance of radiological bone involvement was studied. The mean duration of remission and of survival was much shorter in cases with multiple bone involvement (3 or more bones) than in those where bone involvement was absent. In those cases presenting with 1 or 2 bone lesions no statement of prognostic significance can be made at this stage. A radiological skeletal survey should be made in all children presenting with leukaemia to identify those (about 15%) having multiple bone lesions and therefore a poor prognosis, in order that they can be given more intensive therapy.


Peritonsillar abscess. A comparison of treatment by immediate tonsillectomy and interval tonsillectomy. The generally accepted therapeutic regimen for peritonsillar abscess consists of the administration of parenteral antibiotics with incision and drainage followed by interval tonsillectomy in four to six weeks. Treatment by immediate tonsillectomy, however, is practiced widely in Europe and has received recent attention in  the American literature. This report compares the clinical course of patients treated by interval tonsillectomy and immediate tonsillectomy. Patient morbidity was lessened by immediate tonsillectomy, since two separate surgical procedures were avoided, and the total period of hospitalization was reduced by nearly 50%. Advantages and disadvantages of both methods of therapy are discussed.


Trauma and accident prevention: the role of the College.


Osteogenic sarcoma of the maxilla.

Osteogenic sarcoma of the maxilla. Six cases of osteosarcoma of the maxilla are reported, including one case that was radiation-associated and one case that arose in Paget's disease. The literature on this entity is reviewed and the clinicopathologic features of this lesion in this unusual location are discussed.


The dimensions of the accident problem in Australia.


Oesophageal atresia: triumph and tragedy. An enormous amount has been written about oesophageal atresia during the last 30 years. This is not surprising because it is not so long ago that the condition was uniformly fatal, and even today, a generation after the first successful operations, many problems associated with its management have not been completely solved. This lecture discusses past and present management, past and present results and future prospects of infants suffering from this malformation.


The effects of seat belt legislation on road traffic injuries. The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one-third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attibutable to the wearing of seat belts.


Alcohol, road crash casualties, and countermeasures. Alcohol is a major contributing factor in over one-third of all road fatalities in this community. Almost half the fatalities occur in people aged less than 25 years of age. Results of recent compulsory blood test legislation in Australia and New Zealand are presented and provide incontrovertible evidence of the vast extent of the problem of alcohol on the road. The social and drinking profiles of road crash casualties with blood alcohol concentrations greater than .05 g/100 ml differ from those of other casualties. Countermeasures used in the control of this epidemic include legislation, improved community education, and greater awareness of the need to rehabilitate rather than to penalize.


Aspects of injury patterns in automobile accidents. During the period June 1971 to June 1973, the injuries of 34,378 persons involved in accidents attended by ambulance officers, and treated by hospitals, together with the injuries received by 1,699 victims investigated by coroners, were analysed. Clear-out injury patterns emerged for different types of road users. Pedestrians in general suffered injuries of greater severity than cyclists, who in turn had injuries of greater severity than vehicle occupants. The extent to which car occupant injury patterns are modified by seat belts is demonstrated. Injuries suffered by the wearers of seat belts occur less frequently, and are less severe, less likely to prove fatal, and less likely to cause long stays in hospitals.


Spinal cord injuries, 1976.

Spinal cord injuries, 1976.


Traumatic rupture of the thoracic aorta. Eleven patients with aortic rupture secondary to non-penetrating thoracic trauma, recent in four patients and of longer standing in seven, have been operated upon. Every patient with an acute injury had a widened mediastinum in the chest skiagram. The diagnosis of traumatic rupture was made by aortography in each case. The operative procedure involved cardiopulmonary bypass, left heart bypass or aorta to aorta bypass shunt. There was one postoperative death. It is recommended that in the acute stage a rupture of the aorta secondary to trauma should be repaired as soon as possible, while ruptures of long standing should be electively repaired.


The non-operative management of splenic trauma. Non-operative management of splenic trauma is not a widely accepted method of treatment. During the period 1964 to 1976, 39 children were treated in the Adelaide Children's Hospital for splenic trauma. Twenty-four were managed without operation, while 15 were treated by splenectomy. Recently, splenic scan has helped in the diagnosis and management of splenic injuries. From our observations, it appears that non-operative treatment of a proven splenic injury is safe and the ideal initial treatment in the paediatric age group, when the spleen is the only intraabdominal organ injured, and the vital signs are stable with the application of adequate resuscitative measures.


Severe chainsaw injuries.

Severe chainsaw injuries. A survey of 47 patients who sustained severe chainsaw injuries has been carried out. It shows that this machine, while an extremely useful one, is hazardous. Most of the patients were young, and over half of the injuries involved a hand. One fatality was recorded.


Osteomalacia in the elderly.

Osteomalacia in the elderly. Over recent years it has been demonstrated that there is a significant incidence of osteomalacia in elderly patients presenting with fractures of the femoral neck. The results of a survey carried out on all patients admitted to St Vincent's Hospital, Melbourne, with fractures of the upper end of the femur over a 12-month period are presented, and the condition of osteomalacia in the elderly is discussed. It is concluded that in this community osteomalacia does not present as a practical problem except in those patients who have the condition as a result of a definite predisposing factor.


A scanning electron microscopic study of wear in the plastic components of prosthetic knee and hip joints. The polyethylene surfaces of four metal on plastic prosthetic knee joints were compared with those of four hip joint replacements, by the use of scanning electron microscopy. The acetabular components of the hip joints showed concentric machining marks, but were generally smooth, and in some areas plastic deformation of the articular surface was evident after 24 months' use. In contrast, the tibial components of knee joints removed after 12 to 22 months showed deep scoring and pitting near the centre of their articular surfaces. This appeared to be due to abrasion by a third material, possibly fragments of cement, which sometimes became embedded in the joint surface. These results indicate that wear in prosthetic knee joints may be much more rapid than in hip joint replacements made from similar materials.


Craniofacial surgery: the team approach. Craniofacial surgery offers a new hope to some grossly deformed people. This complex surgery, which is based on a multidisciplinary team approach, needs to be carefully rationalized and regionalized to facilitate investigation, to improve planning, to reduce the number of complications, and to conserve financial resources. To date the Cranio-Facial Clinic at the Adelaide Children's Hospital and the Royal Adelaide Hospital has reviewed 37 cases and operated upon 13 of these. This work is presented together with a review of the team approach.


Ultrasonic echography in the diagnosis of abdominal disease. The place of two-dimensional ultrasonic echography in the diagnosis of surgical diseases of the abdomen is outlined, and illustrative cases are described. The method is safe and can be repeated as often as required. It does not replace radiological or radionuclide examinations, but complements those techniques.


Acute pancreatitis: the Queensland scene. One hundred patients suffering from acute pancreatitis and studied in two large teaching hospitals in Brisbane between 1959 and 1973 were reviewed. Gallstones were present in 43 patients (of whom 31 were female), and a history of alcoholic excess were elicited in 23. Sixty-three patients were aged over 50 years. Characteristic clinical features included spreading epigastric pain with radiation to either of the upper quadrants of the abdomen. Left-sided upper abdominal peritonitis associated with severe repetitive vomiting was suggestive of the diagnosis. The serum level in most cases fell below the arbitrary diagnostic level of 500 Somogyi units/100 ml within 72 hours of the onset of the pain. Acute haemorrhagic necrosis of the pancreas was positively diagnosed in 15 patients, six of whom died. The overall mortality rate in the series was 9%.


Benign non-parasitic cysts of the liver: a review of 18 cases. Benign non-parasitic cysts of the liver are a clinical and pathological curiosity except when they cause symptoms or are incorrectly diagnosed as metastases in patients with abdominal malignancy. It is difficult to make a correct diagnosis of benign liver cysts in spite of the armamentarium of modern diagnostic aids available, and on many occasions the diagnosis is made at laparotomy. This is a report of 18 patients with benign cysts of the liver, two of whom suffered complications which we believe have not previously been reported.


Xanthogranulomatous pyelonephritis in Malaysians. Eight cases of xanthogranulomatous pyelonephritis occurring in an oriental population are reported. The patients were mostly middle-aged, and there was a female preponderence. Nephrectomy controlled the disease in all cases. Diagnosis on clinical and radiological grounds is difficult, and it is often only made on pathological examination of the kidney after nephrectomy. The nature of the disease remains obscure.


Left hepatic lobectomy and resection of a carcinoma involving the confluence of the right, left, and common hepatic ducts. This is a report of a single case of carcinoma involving the confluence of the right, left, and common hepatic ducts, treated by left hepatic lobectomy and resection of the tumour. The clinical onset of symptoms with pruritus and steadily deepening jaundice was typical of the condition, as was the difficulty in establishing a diagnosis. Radical treatment for this tumour, which is frequently slow to metastasize, is advocated. The importance of complete filling of the billiary tree during operative choledochography is highlighted.


Idiopathic chondrolysis of the hip: case report with a review of the literature. The first case of idiopathic chondrolysis of the hip from South-East Asia is reported, with a review of the literature. The problems of differential diagnosis are discussed. As the condition is rare, it is likely to be misdiagnosed and may well be over-treated. The rarity of the condition and its natural history terminating in spontaneous fusion make it mandatory that a correct preoperative diagnosis be established in order to avoid needless radical surgery. Some of the significant clinicopathological findings are highlighted.


Surgical repair of a large incomplete cleft sternum. Congenital deformities of the chest are not uncommon, are frequently symptomatic, and are readily correctable. This applies particularly to malfusion of the manubrium and upper sternum, which results in a bony deficiency together with divarication of the sternomastoid muscles and the sternoclavicular joints. Such defects of the sternum are best corrected as soon after birth as possible. Two patients are reported who had such a defect, and the technique for a satisfactory repair is described.


Ureteroureterostomy for ureteric duplication with one pathological renal segment. An operation for the management of ureteric duplication with one pathological renal segment is described. A report of 13 cases with 15 duplex systems is presented, showing the merits of ureteroureterostomy as measured against the established procedures.


On the form and function of the abductor pollicis brevis muscle. The abductor pollicis brevis muscle acts in conjunction with the palmaris longus and the abductor pollicis longus to abduct the first metacarpal in the sagittal plane. Segments of the abductor pollicis brevis which arise from the tendons of the palmaris longus and/or the abductor pollicis longus and are inserted into the extensor expansion are the lumbricals of the thumb. The lateral border of the abductor pollicis brevis presents an important muscular (in four cases out of ten neurovascular) hilum. The tendinous slip to the abductor pollicis brevis from the palmaris longus presents near its origin an orifice which the palmar branch of the median nerve traverses to become superficial.


Injury control: a state-of-the-art review. There is a growing body of new knowledge suggesting that trauma should no longer be conceptualized as a behavioural phenomenon with the associated connotations of chance, unexpectedness and blame worthiness. Instead, it should be regarded as a public health problem amenable to scientific, research-based strategies of the type that have been successfully introduced in the fight to conquer infectious disease. If progress is to be made in reducing the toll of accidental mortality and morbidity, the current need is for the increased allocation of resources to develop, extend and disseminate this new knowledge.


Basic training and the part I examination.


The Gordon Craig Library, Royal Australasian College of Surgeons.


Antenatal cardiotocography in patients with persistently subnormal urinary oestriol excretion.


Prognostic value of plasma oestradiol-17beta human placental lactogen in high-risk pregnancies.


Oral prostaglandins E2 and F2alpha in the induction of labour.


Health maintenance for the industrial worker: a rural health experiment in Puerto Rico.


Drug therapy, cardiac pacing and cardiac surgery in the Wolff-Parkinson-White syndrome. Report of two cases treated with cardiac pacemakers.


Coronary artery disease: natural history, risk factors and management.


Mercury vapour hazards from hot air sterilisers in dental practice.


The leukaemias.

The leukaemias.


Disseminated histoplasmosis. A case report.


Thirteenth memorandum to the Review Body. Presented by the British Dental Association, December 1976.


Ask me another.

Ask me another.


International relations.

International relations.


Fluoridation in Newcastle and Northumberland. A clinical study of 5-year-old children.


Dental surgery assistant's mobile cabinet. An experimental design.


Model of cell kinetics with applications to the acute myeloblastic leukemic state in man.


Change.

Change.


Our image.

Our image.


N'N-dimethyltryptamine lowers rat brain acetylcholine and dopamine.


Raised brain GABA levels, motor activity and exploration in the rat.


Multiple-drug chemotherapy for acute leukemia The TRAMPCOL regimen: results in 86 patients. A combination of eight cytotoxic drugs, administered simultaneously, has been used in 86 cases of acute leukemia. The regimen, designated TRAMPCOL, incorporated thioguanine, rubidomycin, (daunorubicin), cytosine arabinoside, methotrexate, prednisolone, cyclophosphamide, vincristine, and usually L-asparaginase. Treatment was administered in five-day pulses with treatment-free intervals varying from nine to 23 days. Subjective and objective toxic effects were not more severe than those seen with two- and four-drug regimens previously employed. Substantial clinical and hematologic improvement occurred in 8/19 patients with chronic granulocytic leukemia (CGL) in acute transformation. Complete clinical and hematologic remission (CR) was achieved in 3/7 patients with untreated acute myeloid leukemia (AML), 5/19 patients with AML who had failed to achieve CR with other therapy, and 4/18 patients with AML in relapse after CR obtained with regimens other than TRAMPCOL. CR occurred in 15/17 patients with acute lymphocytic leukemia (ALL), most of whom had had multiple previous relapses. CR was not achieved in four patients with AML superimposed on pre-existing myeloproliferative disorders. The TRAMPCOL regimen merits further evaluation in CGL after acute transformation, as a primary treatment for AML, and as therapy for ALL 1) in relapse, 2) in adults, 3) in children with adverse prognostic features, and 4) in T-cell ALL.


Tuberculosis in a general hospital.

Tuberculosis in a general hospital.


Five-year survivors among children with acute leukemia in Japan. This Japanese nation-wide survey was carried out on long-term survivors among children with leukemia, i.e. those who had survived more than 5 years by October of 1974. Eighty-three children were surveyed. This was about 2.5 times as many as the 31 children surveyed in the first Japanese nation-wide survey in 1971. Clinical and laboratory data were also analyzed statistically and compared to that of the first survey. Most of the children had received inductive therapy according to the old protocol, but 10 children were treated with a combination of VCR and steroids. Nine of these 10 were still in a state of remission. CNS involvement occurred in 15.3% of the cases and a late onset of this complication implied a prognostic significance: among the 9 children whose complication had occurred 3.5 years after onset of the disease, 6 died. The relapse rate decreased between the 4th and 5th year after initiation of maintenance therapy. The percentage of the risk of death became zero after the 9th year.


Tuberculosis, now and the future: short-term therapy, preventive therapy, and bacillus Calmette-Guérin.


Complete remodeling of the vertebrae in a child successfully treated for acute lymphocytic leukemia (ALL). This report describes a 10-year-old white boy who presented with acute lymphocytic leukemia (ALL) and several collapsed thoracolumbar vertebrae in 1965. His ALL was successfully treated, and he has been disease-free for over 10 years. He has now completely remodeled all of the collapsed vertebrae.


Pulmonary heart disease: relation of pulmonary hypertension to abnormal lung structure and function.


Rationale for combined therapy.

Rationale for combined therapy. The presence of micrometastatic disease at the time of diagnosis is the major cause of failure in the treatment of cancer. The mechanisms, biology, and biochemistry of tumor metastases at an experimental level are being effectively studied. Potential control points and therapeutic implications are emerging. These are being employed in the construction of clinical trials involving adjuvant chemotherapy. This is part of combined modality treatment in which the best of treatment design to achieve local control (surgery and/or x-ray) is combined with systemic treatment (chemotherapy and/or immunotherapy) designed to irradicate microscopic metastases. The evolution of such studies in patients with breast cancer and osteogenic sarcoma over the past five years is presented. Disease-free survival has improved as a result of adjuvant chemotherapy for both of these diseases. While a longer follow-up will be required to determine more precisely the impact of multi-disciplinary treatment on these and other diseases, the short-time results are promising.


Diagnostic aspects of pleural effusion.

Diagnostic aspects of pleural effusion.


Antimetaboliths in the prophylaxis and treatment of central nervous system leukemia. The results of the administration of two antimetabolites, methotrexate (MTX) and cytosine arabinoside (Ara-C), for the prevention and treatment of established central nervous system (CNS) disease in children with acute lymphoblastic leukemia are discussed. Two protocols (L-2 and L-10) for the management of patients with acute lymphoblastic leukemia have been developed. In the L-2 protocol, prophylaxis consists of repeated intralumbar injections of MTX alone, and in the L-10 regimen, both MTX and Ara-C are administered; for the patients with an initial leukocyte count of greater than or equal to 25,000/mm3, the two drugs are given intraventricularly instead of by the usual intralumbar route. In the treatment of established CNS leukemia, intralumbar MTX and Ara-C in addition to CNS irradiation are employed; for maintenance, periodic intraventricular MTX injections are given. Of the 70 children receiving the L-2 protocol, four developed CNS leukemia and in a fifth patient, CNS and bone marrow relapse were concurrent. Among the 31 children receiving the L-10 regimen, CNS disease has been observed in only one child. Of the five children treated for the established CNS leukemia, recurrence was observed in two at 19 and 29 months after remission; the other three remain in remission for 2, 15, and 39 months, respectively.


The New York City nurse - epidemiology program.


The health manpower situation in occupational medicine.


Natural resistance to methotrexate in human acute nonlymphocytic leukemia.


Potential advances in the clinical use of arabinosyl cytosine.


High-dose methotrexate in acute lymphocytic leukemia. A pharmacokinetic study of methotrexate (MTX) was performed in 60 patients who received high-dose MTX at 500 mg/m2 infused over 24 hours. MTX levels reached 1.2 X 10(-7) M in the cerebrospinal fluid (CSF) within 10 minutes and remained constant at that level for 24 hours. Forty of these 60 patients were children with acute lymphocytic leukemia. In these 40 patients, simultaneous intrathecal MTX was given along with high-dose MTX. The resultant CSF levels (lumbar area) were higher than those obtained with either high-dose MTX alone or simultaneous intrathecal MTX alone. To date, there have been one systemic and one central nervous system relapse in these 40 children, and the treatment program appears safe to administer.


Antagonistic substances produced by streptococci from human dental plaque and their significance in plaque ecology.


Antibacterial activity of lactoperoxidase adsorbed by human salivary sediment and hydroxyapatite.


Effects of strontium and fluoride uptakes on the solubility of powdered enamel.


Polarizing microscopy of sound enamel. Combined polarized light, microradiographic and scanning electron microscopic investigation.


Cyclic alteration of electrophoretic property associated with growth circle in HeLa S3 cells. Changes of electrical cell-surface charge associated with cell cycle were examined electrophoretically in the synchronous culture of HeLa S3 cells. The electrophoretic mobility of the cells increased abruptly in the mitotic phase as high as 45% compared with that of cells in the S phase. This difference of mobility was obtained by comparing pure population of mitotic cells and S-phase cells. Mitotic cells were also found to be more susceptible to neuraminidase than S-phase cells in term of electrophoretic mobility, a greater amount of sialic acid being correspondingly released from the former. The mechanism of the electrokinetic change associated with the processes of cell cycle is discussed, with special reference to the distribution of electric charge in the cell surface membrane.


Postoperative scars and cleavage lines.

Postoperative scars and cleavage lines. We elucidated the pattern of skin cleavage lines of the neck of Japanese cadavers and studied the scarring in 42 cases of radical neck dissection for the removal of metastatic nodules from the malignant tumors of the oral region, in the operation of which one incision was made parallel to, and another perpendicular to, the cleavage lines. From this study we came to the following conclusions: 1) The cleavage lines run parallel in ring-form around the neck, with the exception of the back and the lowermost part of the base of the neck. Seen from the side, the lines run horizontally across the neck.  2) Raised and widened scars were few at the site of the incision parallel to the cleavage lines but there were seen often at the site of the perpendicular incision. 3) There were no raised postoperative scars in the patients who had received radiotherapy prior to the time of observation.


A comparison of plaque removal by different toothbrushes and toothbrushing methods. Six toothbrushing methods were evaluated using several kinds of toothbrushes. Two kinds of electric toothbrushes were tested also. Forty-two adults who had normal dentition and clinically healthy peridontal tissue, aged 20 to 34, 36 males and 6 females, volunteered for this study. The plaque score was calculated by the modified Volpe's method on which Suzuki et al. reported before. The scoring of the plaque was restricted to the six teeth (formula: see text) The average percentage of plaque removal from the total (labial and lingual) tooth surface by different toothbrushing methods was as follows: (1) 75.2 +/- 9.9% by the Fones method with a hard brush, (2) 71.7 +/- 11.1% by the Scrub method with a hard brush, (3) 67.4 +/- 12.5% by the modified Stillman's method with a hard brush, (4) 64.7 +/- 13.7% by the National electric toothbrush with a soft brush, (5) 62.9 +/- 13.6% by the Roll method with a hard brush (6) 58.1 +/- 16.3% by the Charters method with a brush of a medium hardness, (7) 55.2 +/- 10.2% by the Bass method with a brush of a medium harness. A similar tendency was obtained independently on the labial, lingual and papillary tooth surface. The hard brush was the most effective for the plaque removal by all kinds of brushing methods.


Anthropometry of the face in lateral facial dysplasia: the unilateral form. The skull, face and ears of 46 patients with the unilateral form of lateral facial dysplasia were examined at the Hospital for Sick Children, Toronto, using anthropometric methods for the purpose of contributing to the morphology of this syndrome. The classical picture of unilateral facial asymmetry with microtia was found in 13 cases (28.3%). The study showed bilaterally defective mandibular arc measurements in 28 per cent of the cases. The facial damage was associated in 15 per cent with ears normal in size but defective in location, level, and shape. The anthropometric examination revealed a great variety of defects on both sides of the face, often barely detectable by routine inspection. It was also found that great deficiencies in the surface measurements were accompanied by great bone deficiencies.


Performance of normal six- and seven-year-old males on oral manometer tasks. An assessment was made of oral manometric performance of normal speaking six- and seven-year-old boys. Readings of maximum, sustained, positive and negative pressure with bleed and nostrils occluded and open were obtained from each of forty subjects. It was found that the majority of normal speaking six- and seven-year-old boys had considerable difficulty generating and maintaining stable, maximal positive and negative pressure upon repeated trials of each of four manometric tasks. The findings of this project support the general hypothesis that oral manometric ratio data may be of questionable diagnostic value in predicting velopharyngeal adequacy for speech, particularly if ratio data must be interpreted dichotomously. The observations made were interpreted to support the view that there may be substantial differences even within the normal population in the ability to perform manometric tasks. The present results suggest that operational procedures commonly used during manometric testing merit rigorous scrutiny, re-examination and analysis.


The role of the mandible in mouse palatal development revisited. Growth changes associated with formation of the secondary palate were studied in H-Velaz mouse embryos by morphometric measurement of medial sagittal sections of the heads between days 13 and 15 of embryonic development. Horizontalization of the palatine processes depends primarily on the length of the mandible and is effected by a shift of palatine process material into the supralingual space. The administration of 7.5 mg cortisone acetate im to the female on day 12, of 0.5 mg 6-aminonicotinamide im on day 14, or amniocentesis on day 14 significantly retards growth of the embryo in general and of the mandible in particular without significantly affecting deflexion of the skull base. The different spatial conditions created by disproportion between deflexion of the base and the length of the mandible cause irregularities in the course of horizontalization which lead, as a rule, to cleft palate.


Dermatoglyphic analysis of primary and secondary cleft palate patients. No significant differences are found among the different groups. Some of the observed minor differences between the cleft and the control groups may be the result of sampling error. Our findings are not surprising because our cleft patients have no other congenital anomalies. Indeed aberrant dermatoglyphic patterns are found mainly in generalized dysmorphogenesis, such as in chromosomal syndromes, rather than in isolated congenital malformations, exception being made of course for congenital malformations of the hand itself.


Prevalence of cleft uvula among 2,732 Danes. A total of 2,732 patients at the Royal Dental College, Copenhagen, were studied for occurrence of cleft uvula. The prevalence was 1.13%, and the ratio of partial to total clefts was 30:1. From a comparison with results of previous studies, it is concluded that the prevalence of cleft uvula in the Danish population appears to be in the same range as in other white populations which have been studied.


Cleft palate in two syndromes.

Cleft palate in two syndromes. Patients with cleft palates with or without cleft lip need more special attention at birth when the cleft is associated with other malformations. For example, the Pierre-Robin and the Klippel-Feil Syndromes are both well known for the special problems they present. Reported here are three cases, with Crouzon's and two with Franceschetti Syndromes, all of whom have palatal clefts.


A case of detached prolabium in a cleft lip.


A new feature in the Cleft Palate Journal. Clinical conference.


Partial trisomy 13 associated with cleft lip and cleft palate.


Cleft palate and multiple anomalies in one of two siblings with partial 13 trisomy. Siblings with multiple congenital anomalies secondary to familial partial trisomy of chromosome number 13 are described. In addition to other findings, the younger child exhibited a cleft of the soft palate. The mechanism of transmission of the chromosomal abnormalities, the relationship of the physical abnormalities and the chromosome findings, and the significance of these findings in the consideration of recurrence risks in future pregnancies are discussed.


Photomicrographs in the article entitled "The morphology of musculus uvulae".


Effects of maxillary advancement on the speech of a submucosal cleft palate patient.


Properties of the alpha-glucosidase from various human tissues in relation to glycogenosis type II (Pompe's disease). The physico-chemical and electrophoretical properties of alpha-glucosidases from various human tissues and urine have been studied. There were some differences among Peak I enzymes (neutral alpha-glucosidases) obtained from liver, heart, muscle, kidney and urine. These differences are based on different effects of tris(hydroxymethyl)aminomethane and various thermostabilities of the Peak I enzymes. Electrophoretically, the Peak I enzyme activity at pH 6.5 from control tissues displayed a two-banded pattern except in kidney and urine. In the patient with the adult form of Pompe's disease the faster band of the Peak I enzyme from heart and muscle was not found and the slower band of the Peak I enzyme from liver was more cathodic. The results are discussed in relation to glycogenosis type II (Pompe's disease).


Radical resection for osteogenic sarcoma of fibula with preservation of the limb. This is a report of a 15 year old girl with osteogenic sarcoma of the proximal fibula treated by en bloc radical excision without amputation of the limb. The anatomical individuality of the fibula, vascularization of the leg and effective adjuvant chemotherapy determined the feasibility of the procedure. There is no evidence of tumor recurrence 27 months after surgery.


Adult-onset acid maltase deficiency. Case report of an adult with severe respiratory difficulty. Pompe's disease (acid maltase deficiency) classically affects infants and children, with a few sporadic cases occurring in adults. An adult patient initially have progressive muscular weakness, exertional dyspnea, diaphragmatic paralysis, and objective evidence of restrictive respiratory disease. Muscle biopsy established the diagnosis of acid maltase deficiency. The patient's brother had died at the age of 44 years, after 23 years of a "progressive muscular dystrophy." Acid maltase deficiency should be considered in the differential diagnosis of progressive respiratory insufficiency associated with weakness.


Studies of malformation syndromes of man XLVII: disappearance of spermatogonia in the Fanconi anemia syndrome. A 15 year old boy with the Fanconi malformation-aplastic anemia syndrome developed erythroleukemia and died of multiple arterial thromboses and hemorrhage. He was one of 10 siblings including 3 affected sisters. He was short of stature and had hypoplastic thumbs; his testes were small and secondary sexual characteristics were inadequately developed. At autopsy he was found to have very few spermatogonia, i.e., a histological picture compatible with the "Sertoli-cell-only" defect. Male hypogonadism in other chromosome breakage syndromes (the Bloom syndrome and ataxia telangiectasia) may have a similar pathogenesis.


Radiographs and third-party carriers.

Radiographs and third-party carriers.


A comparison of panorex and intraoral surveys for routine dental radiography.


Paralleling radiographic technique without the long cone.


Measures of management: your fees.

Measures of management: your fees.


Enter the professional office manager.

Enter the professional office manager.


The road to marathon.

The road to marathon.


The rotten apples in dentistry: can peer review cull them out?


Tickled by your unpaid insurance claims?


Read faster--get home earlier.

Read faster--get home earlier.


On control.

On control.


Murder by suffocation.

Murder by suffocation.


Dentist-staff interpersonal relationships. The growing demand for dental services has resulted in an expanded utilization of auxiliary personnel in an effort to increase productivity. Enlarged dental teams which have evolved from this effort have also magnified the potential for interpersonal conflicts in the office. Although such conflicts are sometimes unavoidable, they can be reduced through effective preventive management. Careful selection of personnel, well designed training programs, and attention to those factors which assist retention of qualified staff members are important in this process. Finally, the entire team must have common goals and work in a coordinated fashion to achieve ultimate success. The dentist of today must possess the skills of an effective manager as well as those of a competent clinician.


Sharing leadership influence: a life-cycle model. We have described the effective leader in terms of several concepts: (1) leadership style as a means of sharing the influence of leadership with a ready group; (2) the readiness of a group to successfully exert influence on the practice; (3) the matching of leadership styles with group readiness; and (4) the impact of the environment on the readiness of a group. We have described how all of these elements combine to determine a leader's effectiveness. All elements interact and present the leader with a situation for which he must adopt an appropriate leadership style (Table 1). Several elements combine to change the readiness of a group through four phases - unready, ready, mature, and professional. The leader then matches leadership styles I through IV to these levels of readiness. We believe a dentist will be effective as a leader in proportion to his success in matching an appropriate leadership style to the readiness of his group to perform in its particular environment.


Management by objectives for the dental office. Management by objectives is a better way to run a dental practice. The required planning will take additional time in the initial stages but can save a great deal of time in the long run. The major requirement is the establishment of specific measurable objectives over a defined period of time. Encouraging your staff to participate whenever possible will result in better objectives, more commitment, and greater motivation. By stating where you want to go and developing plans to reach this destination, you will be able to work smarter and not harder.


Behavioral assessment. An appraisal of beliefs and behaviors relating to treatment.


Effect of patient behavior and personality on treatment planning. Several models are described that show the interrelationship between the patient and his behavior/personality, the dentist, and the proposed plan of treatment for each patient. The patient assessment model is introduced, which asks neither the patient nor dentist to change, but through identification of personality characteristics of the patient, modifies the plan of treatment to fit the individual's need. To accomplish the aspect of personality assessment, the locus of control is employed. This instrument distinguishes between two distinct types of individuals, "internal" and "external." Through this classification of patients, the dentist can more clearly define the necessary treatment plan that fits the needs and wants of dissimilar patients.


Effective case presentation.

Effective case presentation.


Effective utilization of forms for efficient office communication. The efficient use of forms can increase the effectiveness of communication with the office, staff, and with the patient. An effective form meets a specific need, does so in the simplest possible way, and is flexible in its use. The use of the modified buck slip with the pegboard system directs the treatment schedule for the receptionist, gives the patient more detailed financial information, and postpones the ledger card and journal entry until a more convenient time. It also permits you to communicate with the office staff in a clear manner. At the very least it eliminates second guessing. The use of the modified truth-in-lending form increases the effectiveness of the communication with the patient as to the procedures to be performed and reinforces the diagnosis and the payment arrangements. The use of a patient treatment follow-up slip provides a simple system for communication between the postoperative patient and doctor. Such forms increase the efficiency of the total practice.


The dental patient's cultural response to the need for dental care.


Psychological, physiological, and pharmacological management of pain. It has been the intent of the authors to impress upon the clinician the multifaceted nature of the human pain experience. We have sought to create an understanding of the emotional nature of pain. The treatment of pain as a pure sensation without directing attention to its behavioral and psychological aspects will generally lead to failure in understanding and ultimately in treating this ubiquitous problem in our profession. The use of drugs alone will have only a minor effect on the treatment of pain. Knowledge of environmental control and an understanding and empathetic approach to the patient in pain or in stress will carry the dentist a long way toward his goal of dental treatment without pain or emotional upset.


The child and the adolescent: new rights for an "old" minority. The use of the learning model is a necessary prerequisite for rendering dental care to the child or adolescent. The awareness of the emotional needs of the child and adolescent and the ability of the doctor to handle them is a requirement for an individual to treat these persons. The treatment plan and methods of treatment are essential factors in the behavioral management of the child or adolescent. There is a normal range for grwoth, development, and maturation in which sequences, timing, and rates of changes are critical. A cross-sectional approach in rendering care is not appropriate in learning to work with children and adolescents. The doctor who renders the care for this age group should be well versed in certain aspects of behavior, as this will affect the treatment plan and methodology, but that doctor must also have the technical abilities to do the spectrum of services to which the patient is entitled. One without the other is a definite compromise for the patient. If the doctor does not further pursue additional assistance from his colleagues, the rights of the child or adolescent have been violated.


Behavioral management of the mentally retarded.


The geriatric patient.

The geriatric patient.


The hospitalized and homebound patient.

The hospitalized and homebound patient.


Variation in the Philadelphia chromosome. Cytogenetic study of 17 cases of chronic myeloid leukaemia has shown that the Philadelphia chromosome is a variable entity, differing in size and banding pattern between individuals.


Evaluation of plasma lactate dehydrogenase (LDH) isoenzymes in cancer patients. I: qualitative and quantitative assessment in patients with chronic myeloid leukaemia and acute lymphatic leukemia.


Evaluation of plasma lactate dehydrogenase (LDH) isozymes in cancer patients. II: qualitative and quantitative assessment in patients with oral cancers and osteosarcoma.


A study of leukemia.

A study of leukemia.


Central nervous system leukemia.

Central nervous system leukemia.


Patient evaluation.

Patient evaluation. Failure to diagnose periodontal disease is a frequent and unnecessary error. A new periodontal screening examination has been proposed that will accurately detect periodontal disease in approximately five minutes and can be incorporated into a routine dental examination. Simplified treatment planning based on the findings of the periodontal screening examination has also been proposed. Its use could significantly improve the quality of periodontal care for most dental patients.


Juvenile periodontitis (periodontosis).

Juvenile periodontitis (periodontosis). Juvenile periodontitis, characterized by early age of onset, rapid rate of periodontal tissue destruction and selective tooth involvement in the absence of commensurate aetiological factors, is recognized as a distinct clinical entity. The present paper describes the clinical findings and some immunological characteristics in a group of thirty-four patients under the age of thirty. Clinical aspects studied included the influence of sex, race, family history and general health. Immunological findings relating to the level of immunoglobulins in serum and saliva, lymphocyte transformation in response to veillonella, bacteroides, fusobacterium and actinomyces species and to ultrasonicated plaque, and the inhibition of macrophage migration by these antigens. Differences were shown to exist between those patients below the age of 22 years and the group aged 23-29 years.


Cancer and the environment.

Cancer and the environment. The environment is becoming an increasingly important factor in the aetiology of cancer. In addition to physical carcinogenic substances, chemical agents, in particular, are identified in ever increasing numbers as being oncongenic. This has been experimentally shown in the case of more than 1000 substances, of which 30 are also regarded as carcinogenic in humans. To be effective, aetiological research should lead to the elimination of the substances which are identified as harmful. In the present state of our knowledge, this will be a considerable contribution to prophylaxis.


Clinical signs for the early recognition of cancer of the oral cavity. The dentist bears a particularly great responsibility with regard to the early detection of cancer of the oral cavity, since only early detection provides the greatest prospect of a cure. A description is therefore given of the features of the oral mucous membrane on which the differential diagnosis of 'carcinoma of the oral cavity' must in particular be made. The author then sets out an examination procedure which every dentist should follow before any treatment is given; this will also make it possible to detect those carcinomas of which the patient himself is not yet aware.


Epidemiological studies of oral cancer.

Epidemiological studies of oral cancer. The FDI has shown considerable interest in the oral cancer and has in recent years arranged three symposia on the subject. The incidence of oral cancer shows marked geographic differences mostly depending upon environmental factors. In the present paper the epidemiology of oral cancer is illustrated by the relative frequency to total number of cancers and incidence rates from a number of countries. Canada has the highest rate of cancer of the vermilion border, which is extremely rare among dark-skinned people. Even within one country differences may be found, a fact which is illustrated by findings from Czechoslovakia and India. In most of the studies dealing with the etiology of oral cancer tobacco usage in its various forms is shown to be the outstanding factor.


Dental education in Sénégal.

Dental education in Sénégal. At the present time Senegal has two types of dental education: a full university training for dentists and a training programme for operating dental auxiliaries. The teaching objectives of the Institute of Dentistry and Stomatology were defined in such a way that these two grades work together in a public health team trained in accordance with the general principles of a common education in preventive and social dentistry. This dental education system which has received the full support of WHO and is backed by the educational and hess in all the African countries which send students for training in Dakar. This success is undoubtedly due to the fact that the system is designed to train personnel adapted to the special problems found in Africa, with a realistic approach to local conditions, and capable of providing effective help for the African communities whose dental health needs have for too long been neglected.


President's message.

President's message.


A simple and efficient method for measuring the uptake of radiolabelled compounds by leukocytes in whole blood.


I.J.O. Diagnostrix.

I.J.O. Diagnostrix.


Influence of inhaled Ca-DTPA on the long-term effects of inhaled Pu nitrate.


Osteogenic sarcoma at the site of a chronic nonunion fracture and internal fixation device in a dog.


Dr. Nancy J. Reynolds March 14, 1977.

Dr. Nancy J. Reynolds March 14, 1977.


American Association of Dental Schools. Constitution and bylaws.


Dress and grooming in dental schools.

Dress and grooming in dental schools.


Teaching clinical judgment in periodontics. Clinical judgment is a complex process that is difficult to develop. It is the essence of the health professional, yet most dental curricula do not emphasize the learning of the judgmental process. In this paper the judgmental process is analyzed into three components: input, mediation, and output. Following the analysis, suggestions for using these components are presented in four instructional phases: the introductory phase, the initial guidance phase, the application phase, and the feedback phase. While the illustrations used are drawn from periodontics, the principles are generalizable to the teaching of all clinical disciplines.


Misery loves baloney.

Misery loves baloney.


The three-year curriculum at the New York University College of Dentistry: analysis and implications.


The oral-facial geneticist: his training and role in dentistry. There is a great need today for clinical geneticists who can diagnose hereditary malformation complexes and counsel afflicted patients and their families. The vast majority of these heritable syndromes have significant expression in the oral-craniofacial complex. This paper describes the minimal qualifications and training needed by postgraduate dentists to function as oral-facial geneticists. The oral-facial geneticist is defined as a human geneticist who has special interest and training in diseases of the oral-facial complex. In addition to patient care and consultation, persons with such training may make important contributions to teaching and research in cranio-facial growth and development.


A survey of human genetics in the dental school curriculum. A survey of American dental schools was conducted to determine the extent to which genetics is currently taught. Results indicate that there is a stronger emphasis at the postdoctoral level than at the predoctoral level and that the approach to teaching genetics tends to multidisciplinary. Some dental schools have already given organizational status to genetics and have instituted clinical activities in orofacial or craniofacial genetics. Considerable interest was shown in audiovisual materials and autotutorial programs in genetics. A greater emphasis on the teaching of genetics at the predoctoral, postdoctoral, and continuing education level is recommended. More trained orofacial geneticists are needed to support didactic and clinical activities within the dental schools.


Genetics in the postdoctoral dental curriculum. Over the past decade, genetics has played an increasingly important role in both predoctoral and postdoctoral dental programs. In an effort to define the scope of genetics education at the postdoctoral level, this paper outlines desired learning objectives and presents a curriculum model which has proven effective in meeting these objectives.


Correlation between preclinical and clinical grades. This study indicated that grades for preclinical performance in the restorative laboratory were seldom predictive of the same student's performance in the clinic and should be used very carefully by promotions committees in evaluating a student's potential for success.


Postgraduation assessments of a dental school TEAM program experience.


Eye hazards among a dental school population.


Emphasis and quality of a dental education: a survey of graduates.


Teaching physical evaluation and physical diagnosis in a hospital setting. The inclusion of physical evaluation as a predoctoral course emphasizes the physical and emotional needs of the patient to the dental student. The dental graduate who enters a general practice residency program will have better preparation for his hospital training and he will have more time to develop diagnostic skills if his predoctoral training includes physical evaluation.


Dental aspects of patients with cystic fibrosis: a preliminary clinical study. The oral conditions of 42 patients being treated for cystic fibrosis were evaluated. The patients were grouped by age and, in some aspects, were compared with a small control group of their siblings. The patient group had a lowered incidence of plaque and less gingival disease than did the control group in which every person had some amount of plaque or gingival disease. Calculus formation was minimal. The reasons for the finding of minimal plaque in the patient group could be related to several factors, including the life-long use of various antibiotic agents, the chewing of digestive enzyme supplements, the effect of medical management on tooth hardness, and the effect of stained teeth (possible tetracycline deposition) on the plaque microorganisms. It appears that the therapy for cystic fibrosis was beneficial to the periodontal health of these patients. Much further study is needed to understand the interrelationship between an altered oral environment (salivary changes in cystic fibrosis), altered microbial flora (by antibiotics, enzymes) and even altered tooth surfaces (possible tetracycline deposition). Most patients were found to have one or more oral habits. Tooth mobility was associated with tension habits. Patients who had clubbed fingers (indicating pulmonary compromise) and possibly a severe disease process, did not appear to have either stained teeth or the severity of the gingivitis associated with this. The relationship of tetracycline to tooth staining could not be pinpointed.


1977 National Children's Dental Health Week. Bureau of Dental Health Education.


Accredited dental schools. Commission on Accreditation, Council on Dental Education.


Status report on polyether impression materials. Council on Dental Materials and Devices.


Assuring quality--the profession's opportunity.


Future physical facilities should be planned well in advance.


Use rubber dam.

Use rubber dam.


Wheelchair transfer.

Wheelchair transfer.


Comments on basic science editorial.

Comments on basic science editorial.


Rebuttal to a JAMA editorial: hepatitis B--traffic in the dentist's office.


Apparent viscosity of materials used for making edentulous impressions. The viscosity of commercially available impression materials used for making edentulous impressions was determined as a function of time and rotational speed. The impression materials studied showed large differences in viscosity and could be ranked into three groups. The values for one group--Plastogum, Ackerman cement (1:1 powder-to-liquid ratio), and light-bodied Permlastic--ranged from 23,800 cp to 57,200 cp. The viscosity values for a second group--Unilastic, syringe Elasticon, Luralite, and Coe-Flo--ranged from 92,200 cp to 107,000 cp. For a third group--Omniflex, Jeltrate, and Ackerman cement (2:1 powder-to-liquid ratio)--the viscosity values ranged from 239,000 cp to 257,000 cp. Light-bodied Permlastic, Ackerman cement (1:1 powder-to-liquid ratio), Jeltrate, and syringe Elasticon functioned as Newtonian liquids immediately after mixing. All other materials were non-Newtonian in behavior. The viscosity of most impression materials increased dramatically with time; the only exceptions were the zinc oxide-eugenol impression materials.


Citric acid consumption and the human dentition. The habitual and abusive use of fruits and foods containing citric acid can cause serious dissolution effects on human tooth enamel. Because these effects can occur so easily, this paper suggests that foods and fruits containing citric acid, as well as other acids, could be definite contributors to the many other forms of idiopathic erosion so often observed by the dentist. There is a need for continued research and study in this area.


Character and frequency of discomfort immediately following restorative procedures. Within 24 hours after dental treatment, discomfort was experienced by 78% of the patients questioned. Sensitivity to cold was the most frequent type of discomfort experienced (reported by 50% of the patients). Postoperative discomfort resulting from cold stimulus was most often mild (in 78%), occasionally moderate (in 22%), and never severe. The duration of postoperative discomfort resulting from cold stimulus was most often fleeting (reported by 94%) and seldom prolonged (reported by 6%). The second most frequent type of postoperative discomfort reported was associated with the administration of the local anesthetic. Sensitivity to sweets does not seem to be a source of postoperative discomfort following routine operative dental procedures.


Endodontic perforations: their prognosis and treatment. Causes of tooth perforation include resorption, caries, and operator performance. The prognosis for a tooth with a perforation is related to the location of the perforation, negotiability of the canal, contamination, and treatment. Alternative treatment approaches include routine endodontic treatment, correction via the chamber, surgical correction, and stimulation of calcification. In most instances, a perforation can be treated so that satisfactory healing will occur.


Black teeth: a primitive method of caries prevention in Southeast Asia.


Blood pressure measurement: problems and solutions.


Attempts to infect jirds (Meriones unguiculatus) with Wuchereria bancrofti, Onchocerca volvulus, Loa loa loa and Mansonella ozzardi.


Failure of hand disinfection with frequent hand washing: a need for prolonged field studies. In a prolonged field trial a 4% chlorhexidine digluconate detergent scrub (Hibiscrub(R)), that had earlier proved to be an effective hand disinfectant, was studied in hospital wards. Finger tips were found to harbour more bacteria than the hand dorsum and the samples collected from them yielded more information on the bacteriological and dermatological effects of hand disinfectants in practice.In wards with a relatively low hand-washing frequency (less than 20 times in 8 hours) the bacteriological results resembled those obtained by in-use tests with volunteers. In the neonatal unit where the hand washing frequency was remarkably high, even occasionally over 100 times/8 h shift, an increase in the bacterial colony counts of the majority of the staff was recorded both before and after hand washing already after using the preparation for 1 week. Age, occupation and hand-washing frequency all correlated with the bacteriological results. Twenty-seven out of 37 persons complained of side effects such as wounds of finger tips and redness or heavy drying of the skin. Wounds, particularly on finger tips, resulted in the failure of disinfection. An increase in bacterial counts was sometimes noted without any dermatological or subjective changes. Drying of the skin was complained of less often when no increase in skin bacteria occurred.After the changeover of washing practice to a detergent followed by a rinse with spirit solution containing chlorhexidine and glycerol a decrease was recorded in the bacterial counts. It is concluded that more attention should be paid to long-term testing of hand washing and disinfection methods to ensure optimum final results in practice. It is obvious that the knowledge obtained from short time in-use testing cannot be applied to all conditions of use.


Bacterial contamination in a modern operating suite. 1. Effect of ventilation on airborne bacteria and transfer of airborne particles. The effect of ventilation on airborne contamination was studied in a new operating suite containing operating rooms with conventional ventilation (17-20 turnovers/h) and operating rooms with zonal ventilation, where the turnover in the central part of the room was approximately 80/h. The efficacy of the ventilation was first examined with gas tracer experiments and found satisfactory. Experiments using potassium iodide particles showed the transfer between adjacent rooms in the suite to be less than 10(-3)% with closed doors and from 1% to 2.5 x 10(-2)% when the doors were opened once a minute. The transfer between two adjacent operating rooms was calculated to be approximately 10(-4)%. There is thus little risk of spread of airborne infection between operating rooms.Experiments with potassium iodide particles showed that in operating rooms with zonal ventilation the particle concentration in the centre of the room was about one-tenth that in the periphery; in conventionally ventilated operating rooms the concentration was about one-half. With bacteria-carrying particles generated by human activity the concentration in the centre of operating rooms with zonal ventilation was about half that in the periphery both during experimental activity and operations; in conventionally ventilated operating rooms it was about equal in both cases. Bacterial counts at the periphery were found to be lower in rooms with zonal ventilation ( approximately 50 c.f.u./m(3)) than in conventionally ventilated ( approximately 70 c.f.u./m(3)).


Bacterial contamination control mats: a comparative study. The ability of six different types of contamination control mats currently in use at the entrances to theatre suites and other clean areas to remove bacteria-carrying particles from theatre trolley wheeels was compared. Marked differences in the effectiveness of this property were obtained; and all mats showed some disadvantages. Modification of one of the mats has resulted in improved efficiency under working conditions.


Air exchange through doorways. The effect of temperature difference, turbulence and ventilation flow. Analytical expressions have been derived for the exchange of air across doorways or similar apertures, in terms of the temperature difference between the spaces on both sides of the opening and the net volume of air flowing through this as a result of unbalanced air supply or extract. A simple allowance for turbulence which gives reasonable correspondence with observation is included. The formulae, which assume complete air mixing on both sides of the doorway up to the plane of the aperture, predict outflows from the warmer side, when there is an excess air supply to this side, which are progressively smaller than those observed as the temperature difference rises above 2-3 degrees C and the volume of excess air supply increases to produce an averaged outflow velocity greater than 0-1-0-15 m/s. This seems to be due to lack of mixing of the warm outflowing air with the cooler air mass. A correction factor for this can be deduced as a function of the pressure difference due to the excess air supply. The limiting magnitude and general form of this function are compatible with a simple theoretical model of the air flow patterns involved.


Age-sex incidence in symptomatic allergies: an excess of females in the child-bearing years. Eight-hundred and one patients amongst 1912 referred for skin testing because of suspected allergies were found suffering from asthma due to the house-dust mite or from grass pollenosis. They were analysed in terms of sex, age of referral and age of onset of symptoms. Amongst children referred below the age of 10 with house-dust mite asthma the ratio of males to females was 3:1; with grass pollenosis 2-1:1, as expected. The sex ratio gradually became reversed with increasing age of referral, females overtaking males in the third decade. Female-male ratios increased to a mean of 1-8:1 in the fourth and fifth decades. Reliable ages of onset of symptoms were obtained in 388 males and 323 females. Of these, 280 males and 162 females experienced their first symptoms before the age of 10 whereas 96 males and 148 females first developed symptoms between 10 and 29 years of age. The remaining 12 males and 13 females showed their first symptoms after the age of 29.


Virulence factors of Francisella tularensis. The mechanism causing viable Francisella tularensis to lose virulence in aerosols has been investigated. Fully virulent organisms were found to be encapsulated and avirulent organisms from aged aerosols, decapsulated. Capsules were also removed by suspension of F. tularensis in hypertonic sodium chloride. The resulting naked, but viable, organisms were predominantly avirulent for guinea-pigs challenged intraperitoneally. Capsular material and cell walls were found to contain large amounts of lipid, about 50 and 70% (w/w) respectively, and to differ in lipid and sugar composition. Isolated capsular material was not found to contain a lethal toxin for mice or guinea-pigs, or to induce an immunological response in these animals to fully virulent F. tularensis.


Salmonella serotypes, Salmonella typhi phage types, and anti-microbial resistance at the University Hospital of the West Indies, Jamaica. Bacteriologically proved cases of salmonellosis presenting at the University Hospital have increased nearly threefold since 1957. The most striking change has been a considerable increase in the incidence of Salmonella heidelberg and Salmonella derby in the last 5 years, probably resulting from hospital acquired infection. About 80 cases of typhoid fever are reported each year in Jamaica. There has been little change in the prevalence of different phage types of Salmonella typhi since 1961. Paratyphoid fever is rare. Standardized antimicrobial disk-sensitivity testing was performed on selected surviving salmonella strains since 1964. S. typhi has remained fully sensitive to all the agents tested except streptomycin. Other salmonellas, however have shown a significant increase in antimicrobial resistance since 1970. Most of this increase was due to multiple resistance in S. heidelberg and S. derby, and the survival and dissemination of these strains in the hospital environment may be related to antibiotic usage.


Travellers' diarrhoea: does it occur in the United Kingdom? Of 485 persons who replied to a questionnaire after attending a European Congress in September 1974, diarrhoea was experienced by 4 of 143 British residents and 2 of 342 visitors to the United Kingdom. This extremely low incidence of travellers' diarrhoea contrasts with the high incidence reported in travellers from countries with cool climates and north European standards of hygiene to countries where these conditions do not hold.


The laboratory surveillance of influenza epidemics in the United Kingdom 1968-1976. The extensive laboratory investigations of respiratory disease in the U.K. over many years have demonstrated the frequency with which influenza viruses, both A and B, are found each winter. Only rarely are none isolated. These findings correlate well with other indicators of influenza such as increases in sickness benefit claims and in deaths attributed to influenza and pneumonia. However, outside these demonstrable peaks of incidence influenza viruses have been found to circulate over considerably longer periods often first appearing as early as November and continuing through to April or even May. But there has been no regular or predictable pattern determined. The period of 1968-76 has seen a series of differently developing influenza winter epidemics caused by a series of the H3N2 virus. The contributions of virus isolation and serology to influenza surveillance is discussed.


Predetermination and alternative course of treatment cost control or cost switching with increased cost to patient.


Dental admissions report no2.

Dental admissions report no2.


Dental erosion: an operative dentistry problem.


Trouble-free placement of rubber dam using the Young-type frame.


State board appointments.

State board appointments.


Plead not guilty.

Plead not guilty.


A suit you can't wear.

A suit you can't wear.


President's message.

President's message.


Dentists are suicidal.

Dentists are suicidal.


Resilient denture linings.

Resilient denture linings.


The cellular transport of chloramphenicol and thiamphenicol. The transport of chloramphenicol (CAP) and thiamphenicol (TAP) was examined in several mammalian cell systems. Chloramphenicol was concentrated by all cells by a factor of 2 to 4 (cellular/extracellular concentration [CE] ratio). Both the uptake and efflux were rapid and temperature independent. In contrast, the influx and efflux of TAP progressed slowly at 37 degrees C over a period exceeding 30 min, the maximal C/E ratios in most instances being slightly greater than 1. Thiamphenicol was virtually excluded from cells at 0 degrees C. Cells preloaded with TAP at 37 degrees C lost little or no drug at 0 degrees C. The uptake of labeled CAP and TAP was uninfluenced by metabolic inhibitors, and was only slightly reduced by the presence of relatively large concentrations of unlabeled drug. This transport pattern is most consistent with a mechanism of simple diffusion based on partitioning of CAP in cellular compartments. It is postulated that the greater polarity of the methylsulfonyl moiety of TAP renders this drug less soluble in membrane lipids and hence more slowly diffusible. The possible significance of these findings in relation to hematologic toxicity from CAP is discussed.


Postgraduation plans reported by the University of Louisville's 1976 graduates.


Last opportunity.

Last opportunity.


Dental insurance.

Dental insurance.


Effective temporization in crown and bridge therapy.


Results of standardized lip repair after tumour resection. Modifying and extending Bernard's method Fries (1971) developed a universal technique for reconstructive surgery of the lip after tumour resection. So far this technique has been employed in 80 cases, 50 of which were available for follow-up studies. Cosmetic results were invariably found to be optimal. Functional deficits were predominantly associated with whistling and pouting, while eating, speaking and laughing were unimpaired.


Kaposi sarcoma on the base of the tongue. Case report. A 76-years-old female (housewife) with a Kaposi sarcoma presenting as a single, isolated pedunculated tumour on the base of the tongue, is described. No skin or alimentary tract involvements were found, and  there were no signs of recurrence locally or generally with the exception of one nodule on the neck 3 years after a local removal.


Multiple recurrent central giant cell granulomas of the jaws. Case report. A case of a 31-year-old Caucasian female with multiple recurrent central giant cell granulomas of the maxilla and mandible is presented. The patient's mother was also treated for an extensive giant cell granuloma of the maxilla. Hyperparathyroidism was excluded.


Sail flap excision for the iguana neck deformity. A method of recontouring the lax submental tissues of the sagging neck is discussed.