Electromyographic (EMG) study in thyrotoxic periodic paralysis. Thyrotoxic periodic paralysis (TPP) is produced by a different metabolic disorder than familial periodic paralysis. In the familial disorder, a myopathic cause is well known, but although electromyography can be used to demonstrate the site of the lesion in TPP, such studies are rare in the medical literature and the results are conflicting. In this report, EMG studies were carried out on eight Chinese patients with thyrotoxic periodic paralysis during the attack and the results compared with studies repeated during a remission. Most cases showed a myopathic pattern during an attack of paralysis which disappeared during remission. The myopathic changes noted were a decrease in duration of muscle action potentials, an increase in polyphasic potentials, a satisfactory interference pattern with reduced amplitude and a reduced amplitude of the evoked muscle action potential on nerve stimulation. Peripheral nerve function was normal in the cases studied. It is concluded that the weakness in TPP is myopathic and that the peripheral nerve function during paralysis is normal.


Demonstration of surgical portasystemic venous shunts by scintisplenoportography. Scintisplenoportography (SSP) was used to assess shunt patency in 15 patients with surgically created portasystemic venous shunts and proved to be a simple, safe and accurate technique for demonstrating the patency of both mesocaval "H" grafts and distal lienorenal shunts. SSP was as accurate as angiography in confirming shunt patency but was simpler to perform and resulted in less radiation exposure to the patient. The direction and distribution of blood flow within the splanchnic venous system was different to that obtained by angiography. It is postulated that SSP may well reflect portal haemodynamics more accurately than angiography. In patients with patent mesocaval "H" grafts SSP demonstrated the complete diversion of splanchnic venous blood through the shunt into the systemic venous circulation. This suggests that the mesocaval "H" graft is haemodynamically similar to other side to side portacaval shunts.


Jejuno-gastric intussusception---gastroscopic diagnosis. A case of actue jejuno-gastric intussusception diagnosed at gastroscopy is described. The patient had undergone a Polya gastrectomy eight years previously. Other reported cases have been discovered by radiology or at surgery. Endoscopy is the method of choice to diagnose this uncommon, but important condition.


Peripheral vascular disease as a mode of presentation of pseudoxanthoma elasticum. Two men presenting with premature peripheral vascular disease and minimal risk for atherosclerosis were found to have pseudoxanthoma elasticum (PXE). Fluorescein angiography was found to be of potential value in the early recognition of angioid streaks and pseudoxanthoma elasticum. There was evidence of disruption of arterial elastic tissue which may contribute to atherogenesis in PXE. Management is presently limited largely to minimizing risk factors for atherosclerotic vascular disease.


Drug-induced hepatic injury.

Drug-induced hepatic injury.


The president's new year message.

The president's new year message.


The effect of cavity depth on the pulpal response to restorative materials.


The effect of a povidone-iodine mouthwash upon thyroid function and plaque accumulation.


Bone and joint disease.

Bone and joint disease.


Competence in dental radiography.

Competence in dental radiography.


Teaching of anaesthesia to dentists.

Teaching of anaesthesia to dentists.


Adenomatoid odontogenic tumour (adenoameloblastoma). A case report.


Radiation protection. The administrative and legal framework in the United Kingdom.


A recommended career structure for clinical dental teachers. A central committee for university dental teachers and research workers report.


Microleakage of conventional and ternary amalgam restorations in vitro.


Mandibular dysfunction and incisor relationship. A theoretical explanation for the clicking joint.


Unplanned tooth movements during orthodontic treatment with removable appliances.


Tooth talk. An experiment in the use of theatre in dental health education.


F.D.I. recommendations on dental mercury hygiene.


A preventive scheme for infants.

A preventive scheme for infants.


Dental care of the child.

Dental care of the child.


The assessment of ventilator performance.


Teenage drinking in South-West Scotland.


Alcohol consumption and self-disclosure.


Short-term memory for hue in chronic alcoholics.


A specialised treatment service for young problem drinkers (16-30 years): treatment results obtained during the first six months of the treatment programme.


Alcoholics' perceptions of group therapy and Alcoholics Anonymous.


Treating the problem drinking driver: some notes on the time required to achieve impact.


Polydrug abuse or multidrug misuse: it's here to stay.


Common personality characteristics of male drug abusers in New Zealand.


Causal attributions, attitude similarity, and the punishment of drug offenders.


Deaths among users of dangerous drugs.

Deaths among users of dangerous drugs.


The significance of the Philadelphia chromosome in acute lymphoblastic leukaemia: a report of two cases. Two cases of Philadelphia chromosome (Ph1) positive acute lymphoblastic leukaemia are reported, both of which lost the Philadelphia chromosome during remission. In one patient remission of the acute lymphoblastic leukaemia continued but classical Ph1 positive chronic granulocytic leukaemia developed. In the other patient relapse of the acute lymphoblastic leukaemia occurred associated with the return of the Ph1 chromosome. The evidence suggests that the chromosome aberration occurred in a pluripotential stem cell, which in one case proliferated along both a lymphoid cell line and a myeloid cell line. Both cases responded well to conventional therapy for acute lymphoblastic leukaemia.


Terminal deoxyribonucleotidyl transferase from acute lymphoblastic leukemia cells and production of antisera.


Serum enzymes profile in human acute myeloblastic leukaemia: preliminary results. Serum enzymatic activities in 18 human acute myeloblastic leukaemias were tested using a semiquantitative micromethod: the activities of 5 enzymes were observed to be changed.


Monitoring normal and malignant human white blood cells by the use of linear programmed thermal degradation mass spectrometry. A new methodology has been applied to the analysis of human white blood cells obtained both from donors with normal white cells and from donors having one of several cytologically identified leukemias. The analytical process makes use of evolution patterns of molecular fragments generated during the well controlled degradation of the cells. The process has been shown to be effective both in grouping together malignant cells that originate from the same diseases and in distinguishing between malignant cells originating from different diseases. The reproducibility of the method has been demonstrated.


Intermittent combination chemotherapy with adriamycin for childhood acute lymphoblastic leukemia: clinical results. One hundred thirty-seven children with previously untreated acute lymphoblastic leukemia were entered into a new program that included intermittent combination chemotherapy featuring Adriamycin. Remission induction was initially randomized to vincristine and prednisone with or without an anthracycline. All children received asparaginase consolidation and central nervous system prophylaxis with cranial irradiation and intrathecal methotrexate. There were no primary failures of CNS prophylaxis. Complications were primarily infectious. Clinical evidence of cardiotoxicity and leukoencephalopathy were not observed. The time to enter complete remission and the presence of an anterior mediastinal mass at diagnosis were found to be statistically significant adverse prognostic factors, whereas presenting age and white blood count were not. With a median follow-up of 26 mo, and using life plot analysis, 65% of the children have remianed in continuous complete remission.


A symposium on the tetracyclines: a major appraisal. Introduction.


Conversion of polycythemia vera to refractory anemia with hyperplastic bone marrow. Clinical and morphologic findings in the conversion of treated polycythemia vera to pancytopenia with hyperplastic bone marrow (refractory anemia or pancytopenia with hyperplastic bone marrow) are described in light of our own observation. The nomenclature associated with this condition (pancytopenia, chronic erythroleukemia, preleukemia) is not uniform, whereas the morphologic findings are virtually identical. Some patients subsequently develop acute leukemia. The prognosis in cases of refractory anemia with hyperplastic bone marrow following polycythemia vera is, independent of the subsequent acute leukemia, invariably terminal.


Sinusitis, bronchitis, and mycoplasmal pneumonia.


Tetracyclines in abdominal trauma and abdominal infections.


Anaerobic lung infections treated with doxycycline.


Tetracyclines in gynecologic infections. The use of tetracyclines in salpingitis and in postsurgical gynecological infections is outlined.  Unless the patient is allergic, the drug of choice in gonococcal salpingitis is penicillin or a derivative.  However, a study of outpatients with gonococcal salpingitis showed that a majority of 197 women studied became asymptomatic 5 days after starting tetracycline treatment.  In nongonococcal acute salpingitis, evidence is good that both aerobic and anaerobic organisms are usually involved, especially Chlamydia and Bacteroides fragilis.  Penicillin must be infused intravenously in large doses to effect eradication, but the newer tetracycline analogs are effective in a majority of patients.  The following dose schedule for the analogs is recommended: intravenous doxycycline, a loading dose of 200 mg is administered slowly over several hours followed by 100 mg every 12 hours until the patient has been afebrile for 24-36 hours, then switch to oral forms.  For postoperative infections, doxycycline is effective in treatment.  In a comparative study of doxycycline and cephalothin, patients suffering intraabdominal contamination by gastrointestinal contents from perforation were divided in half; half were treated with the tetracycline analog and 74% responded; the other half were treated with the cephalothin and response was 57%.


Tetracyclines in the treatment of genitourinary tract infections.


Common sexually transmitted diseases and their treatment.


Tetracyclines in unusual infections.

Tetracyclines in unusual infections.


Tetracyclines in renal insufficiency: resolution of a therapeutic dilemma.


Hallucinogenic N-methylated indolealkylamines in the cerebrospinal fluid of psychiatric and control populations. The incidence and quantities of dimethyltryptamine and O-methylbufotenine were studied in the cerebrospinal fluid of patients suffering acute schizophrenic illnesses and in surgical and neurological control groups. Some schizophrenic patients have higher levels of both amines than do controls, though the differences in distribution did not reach statistical significance in the sample studied. The gas-chromatographic technique used is sensitive at the low picogram level.


The price of survival in childhood leukaemia.


Giant-cell pneumonia caused by measles and methotrexate in childhood leukaemia in remission. Four children who had acurate lymphoblastic leukaemia in remission and developed pneumonia were studied. Investigations including electron microscopy and immunofluorescence of lung biopsy material disclosed measles, although there was no clinical evidence of the disease. Despite an identical presentation, two types of illness developed: two children died of giant-cell pneumonia, while the other two developed pneumonia indistinguishable from that associated with methotrexate treatment, recovering when treated with steroids and gammaglobulin. Measles infection is easily overlooked in the absence of rash. The diagnosis may be suggested by clinical and radiological features and confirmed by specific immunofluorescence staining of lung biopsy tissue.


Testicular disease in acute lymphoblastic leukaemia in childhood. Report on behalf of the Medical Research Council's Working Party on leukaemia in childhood. In three trials conducted by the Medical Research Council on acute lymphoblastic leukaemia in childhood the incidence of testicular infiltration in relation to presenting features and treatment was analysed. Initial severe thrombocytopenia was associated with an increased incidence. Testicular infiltration was occasionally found during treatment in patients with high blood leucocyte counts at diagnosis but the main incidence in patients with all types of disease occurred within one year of stopping treatment. The incidence may be increased when "second-line" drugs, especially cyclophosphamide, have been used. A reappraisal of the value of additional drugs in maintenance treatment of patients with good prognosis is needed.


Analysis of treatment in childhood leukemia. IV. The critical association between dose fractionation and immunosuppression induced by cranial irradiation. The degree of long term lymphopenia induced by cranial irradiation is shown to be dependent upon the number of fractions into which the standard cranial dose of 2400 rads is divided. The mean lymphocyte count of patients three months after receiving this dose in five fractions was 1.84 X 10(9)/1; in twelve fractions it was 1.12 X 10(9)/1 and in twenty fractions it was 0.64 X 10(9)/1. An explanation for this finding is offered which is based upon marked radiosensitivity of certain lymphocytes and the pattern of recirculation and redistribution of these cells.


Spontaneous respiration with the Bain breathing circuit.


Chromosomes and causation of human cancer and leukemia. XXIX. Further studies on karyotypic progression in CML. Fifty-seven Ph1-positive cases of chronic myelocytic leukemia (CML) were analyzed with chromosomal banding techniques and their karyotypic progression followed. These cases included 1 without evidence of a Ph1-translocation and 1 new patient with a complex Ph1-translocation involving chromosomes No. 9, No. 17 and No. 22. Of the 57 patients, 28 had the Ph1 as the only karyotypic anomaly, whereas the remaining 29 cases developed and/or were associated with chromosomal changes usually of a hyperdiploid nature, particularly in the blastic phase, in addition to the Ph1. Even though the additional karyotypic changes frequently included chromosomes No. 8, No. 17, No. 19 and No. 21, a large number of others was also involved, although less often. The series included 3 cases with different types of translocations unrelated to the Ph1. The cytogenetic observations have been correlated with some of the clinical parameters. The survival of the patients was evaluated in relation to the karyotypic findings, indicating that the chromosomal changes may not play as important a role in the prognostic and progressive aspects of Ph1-positive CML as that of other as yet undetermined factors.


Anaphylactoid type reactions in two patients receiving high dose intravenous methotrexate. Two patients recieving intravenous high dose methotrexate (MTX) and intracutaneous BCG injections as adjuvant treatment for osteogenic sarcoma suffered sudden cardiovascular collapse within minutes of infusion of MTX. These cases demonstrate that anaphylactic or idiosyncratic reactions to MTX and/or contaminants in these preparations do occur and that careful patient monitoring is required.


Isolation of novel glycoprotein HNC1beta from the urine of a patient with acute monocytic leukemia.


Biochemical and pharmacological basis for the lateral hypothalamic syndrome. The lateral hypothalamic (LH) syndrome characterized by impairment of the ability to regulate food and water intake has been reported to occur after injections of 6-hydroxydopamine (6-OHDA) into this region. In the present experiment the fluorescence histochemical technique was used to assess monoamine depletion of noradrenaline and dopamine containing neurons following intrahypothalamic injection of 6-OHDA. Results show that the intensity and area of monoamine accumulation in axons served by 6-OHDA is correlated with the severity of behavioral deficits but that actual catecholamine depletion of either the corpus striatum or the hypothalamus is unrelated to the syndrome. Possible mechanisms of action of this accumulation in producing behavioral deficits are discussed.


Clinical, biological, and biochemical effect of pyrazofurin.


Changes in DNA associated with induction of erythroid differentiation by dimethyl sulfoxide in murine erythroleukemia cells. The Friend virus-infected murine erythroleukemia cell can be induced to differentiate along erythroid cells in culture with various compounds, including dimethyl sulfoxide. DNA from murine erythroleukemia cells cultured with dimethyl sulfoxide shows a decrease in sedimentation rate in alkaline sucrose gradients after alkali lysis of the cells. These changes can be detected as early as 27 hr after the beginning of culture. Similar results are observed with DNA of the cells cultured with other inducers, butyric acid and dimethylacetamide, but not with DNA from a variant cell line resistant to induction with dimethyl sulfoxide. Ultraviolet irradiation, which is known to cause similar changes in the sedimentation rate of DNA in alkaline sucrose gradients, induces differentiation of the murine erythroleukemia cells. These studies suggest that alterations in DNA may be related to events involved in the induction of differentiation of murine erythroleukemia cells by dimethyl sulfoxide.


Levels of two plasma fucosyltransferases as an index of disease status in acute myelogenous leukemias.


N-trifluoroacetyladriamycin-14-valerate: additional mouse antitumor and toxicity studies.


Demonstration of dye-uptake as a potential aid in early diagnosis of incipient caries.


Supplemental fluoride recommendations for infant based on dietary fluoride intake.


Variation in caries prevalence related to combinations of dietary and oral hygiene habits and chewing fluoride tablets in 4-year-old children.


Objectives and criteria for the management of cleft lip and palate and the delivery of management services. This is a report of the proceedings of a conference convened for the purpose of identifying objectives of cleft lip and palate treatment and criteria for systems by which the treatment is delivered. A major feature of the report is the consideration of the interdisciplinary approach which is required for effective treatment of the problem.


Differences in the size of the palatal processes in mouse embryos with cleft palate induced in two critical periods. Using planimetric measurements of projections of the space between the palatal processes of ICR-Velaz mouse embryos, we indirectly demonstrated that the pre-horizontalization size of the palatal processes after the i.m. administration of 7.5 mg cortsone acetate on the 12th day of gestation was smaller than in the controls. After horizontalization, the inadequate palatal processes were unable to meet in the midline as they do in the majority of normal embryos. The administration of 0.5 mg 6-amino-nicotinamide on the 14th day of gestation did not significantly affect the size of the palatal processes.


An assessment of informative-counseling procedures for cleft palate children. 32 children with cleft palate and their mothers were interviewed for the purpose of learning what information they had about cleft and cleft management. Their responses were compared with standards specified by eight cleft palate specialists from four disciplines. The findings indicate that the specialists were somewhat inconsistent in what they expected the families to know about clefts and in their routine counseling procedures to provide the information. In general, the mothers had appropriate knowledge about clefts but predicted that their children knew more about clefts and cleft management than was actually the case. The children had less than adequate information about the general impact of a cleft, the etiology of clefts, the rationale for cleft management they had received, and future management of their problem. The results of the study indicate the need or more systematic procedures for providing information to the child with a cleft. The results also suggest the need for additional research about the general counseling process.


A lining vomer flap for palate pushback in unilateral cleft palate repair. A combinaation vomer mucoperiosteal flap and nasal floor mucoperiosteal flap is described which is used to achieve nasal coverage in unilateral cleft palate patients requiring pushbacks. A posteriorly based readily accessible vomer flap is raised on the cleft side and used as nasal lining for the palatal mucoperiosteal flap on the non-cleft side. On  the cleft side, a symmetrically sized nasal floor flap is easily elevated under direct vision and used to cover the nasal aspect of the corresponding mucoperiosteal palatal flap.


Lip adhesion and its effect on the maxillofacial complex in complete unilateral clefts of the lip and palate. The use of a lip adhesion as part of the treatment program for wide complete clefts of the lip and palate is gradually being accepted. Heretofore, little mention has been made as to its actual beneficial effects. Since the introduction of this procedure by our Group in 1966, it has been used routinely by us. Its effects on the maxillofacial complex is discussed in detail.


A rapid method of measuring the palatal surface area of cleft palate infants. A method is described for rapidly measuring the surface area of the palate by adapting a piece of soft plastic to a model of the upper jaw using a vacuum moulding technique. Tests with a hemisphere of known surface area showed the method to be consistent and to have a low degree of systematic error. When measuring models with unrepaired cleft palates, the error was found to be 2.1 per cent (compared with 3 per cent using stereophotogrammetry) but 7.1 percent when measuring intact palates. Because of the consistency of the method, the true palatal area could be calculated from the measured area by the use of a multiplying factor. These findings are described, and the application of the technique to the pretreatment assessment of cleft cases is illustrated by showing that, in a series of 30 cleft palate and 30 normal infants, a tissue deficiency of 16.8 per cent existed in the cleft subjects at birth.


A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome. This report describes a pattern of similarities among 12 patients which are felt to represent a newly recognized congenital malformation syndrome. The symptoms shown most consistently by the 12 patients were overt or submuscous clefts of the secondary palate, ventricular septal defects, typical facies, and learning disabilities. Other symptoms were noted with varying frequency. The occurrence of velopharyngeal insufficiency in all twelve patients reflected poor motion in the lateral pharyngeal walls, thus necessitating specific forms of treatment. Treatment was often dependent on the extent of cardiac lesions.


Videoendoscopic feedback in training velopharyngeal closure. Each of two adolescents with velopharyngeal closure deficits was taught to position him or herself on an endoscope attached to a television camera and to observe the velopharyngeal port during the production of syllables and other units. The videoendoscope was then used as a training apparatus, and each subject was given practice attempting to increase velopharyngeal closure while producing vowels and syllables. Videorecordings of each subject made without feedback before, during, and after the training period were played to panels of observers who were to rate closure during each utterance, and the data obtained indicated that the subjects more frequently approximated complete closure as the study progressed but improved performance was not established on an automatic level. Suggestions are made for the refinement and further investigation of videoendoscopic closure training.


Craniofacial and dental characteristics of cartilage-hair hypoplasia. The cranio-facial and dental features were studied by means of roentgencephalometry and anthropometry in 24 patients with cartilage-hair-hypoplasia. Data pertaining to the cranial base were considered indicative of subnormal growth in some of the cranial synchondroses. The width of the neurocranium was slightly below the values of the controls, whereas neurocranial length and circumference appeared unaffected. Facial height was larger than in the controls and facial index values were high. The chin was receding, but the other values of facial depth were relatively large. No abnormalities were observed in tooth morphology, dental age, or dental occlusion. The neurocranial morphology in CHH and achondroplasia show some similarities; the skull base, however, is clearly less bent in the CHH-syndrome. This, together with the virtually normal face and dentition in CHH-patients, is, perhaps, of differential diagnostic value.


Cleft uvula: prevalence and genetics.

Cleft uvula: prevalence and genetics. The prevalence of cleft uvula (CU) was determined among 70,359 school children 6-18 years of age; 90 children having the condition were chosen as probands for a family study. Prevalence of CU was 0.44 per cent with no sex differences. The Non-Ashkenazi group had a higher prevalence than the other population groups. The prevalence of CU in parents and siblings was 7.7 per cent and 7.5 per cent respectively. The findings from the family study support the hypothesis of a polygenic mode of inheritance for CU. The prevalence of cleft palate and agenesis of upper lateral incisors in the families studied did not differ from that expected in the general population.


Posterior pillar webbing and palatopharyngeus displacement: possible causes of congenital palatal incompetence. Three cases of congenital palatal incompetence in the absence of the usual stigmata associated with hypernasality are presented. In two instances, mucosal webbing of the posterior pillars was noted and in one case the palatopharyngeus muscle was displaced. Hypernasal voice quality was apparent in each patient. A z-plasty on both sides of the posterior pillars is suggested as the treatment of choice when no other morphologic abnormalities are present.


Anencephaly and unilateral cleft lip and palate in conjoined twins.


Early septal surgery in a chimpanzee animal model. Early resection of the proximal one-third of the cartilagenous nasal septum was performed in a chimpanzee. Longitudinal data on facial growth was collected for fourteen months. Growth rates (from regression equations) were shown to be the same for operated and unoperated animals. Implications for cleft palate repair are discussed.


Mandibulofacial dysostosis.

Mandibulofacial dysostosis.


Anorexia, taste changes, and diet in cancer.


Overview of ethical aspects of clinical studies. Research in human subjects should be conducted only if the rights and welfare of the participants are protected. Prospective study subjects must be given adequate information about all aspects of a study so that they can make a rationally exercised decision about participation; coercive techniques to solicit participants should not be used. Research in humans may be classified in one of three categories: (1) research on treatment of existing conditions; (2) research on preventive measures; and (3) research other than for treatment or prevention. Different concerns and aspects of informed consent assume particular importance in each category. In research on the treatment of existing conditions, untreated or placebo-treated control groups are rarely justified if the condition is irreversible. In research on preventive methods prospective subjects should be informed of the likelihood of receiving an ineffective treatment, if one or more placebo groups are included. A randomized clinical trial is usually the best design for studies of preventive methods. Non-randomized designs, which are feasible and statistically valid, may be employed in order to avoid depriving some subjects from receiving effective preventive methods. In social or behavioral research, confidentiality of collected information and privacy of the subject are essential considerations.


Social sciences research: ethical and policy implications. Ethical issues are raised about the conduct of social research in the dental field particularly with respect to the use of survey methodology and aggregated data. Problems associated with respondent identifiers, open-ended and probing questioning, privacy of subject-matter, community contamination and burden, group stereotyping, knowledge of law violations, mis-use of data banks, re-use of data, effects of disclosure, and referral for treatment are discussed. The natural and the contrived social experiments are reviewed as well as the issue of needed research on the effects of regulation on science and on the protection of privacy.


Behavioral science research: ethical and policy implications. Problems centered about protection of human subjects in behavioral science research are discussed. Difficulties in obtaining truly informed consent are noted. It is concluded that the risks involved to subjects are minimal in this field of research. The use of deception in psychological research is discussed along with the necessity of appropriately debriefing the subject. The use of institutional committees to protect subjects' rights is contrasted with the bureaucratic review processes of the government. It is concluded that, in the absence of evidence to the contrary, the local institutional review process is likely to induce greater cooperation from investigators in protecting subjects' rights.


Community dentistry: developmental discussion approach. In 1960, Blackerby asked the question "Why not a department of social dentistry?". Since that time most of the dental schools in the United States have made some attempt at establishing such a department. Various names were given to these departments, but the one that appears to be in the forefront is the Department of Community Dentistry. Since that time each school with such a department has strived to develop various innovative methods of teaching community dentistry to its students. When the amount of time is taken into consideration, unlike the biological and clinical sciences, time allotted to community dentistry is minimal. However, at The University of Michigan students spend 232 hours in community dentistry, which necessitates development of creative teaching techniques to maintain their interest. This paper discusses one such technique which has proven to be successful over the past 3 years. Emphasis is placed on utilizing a modified method of the developmental discussion approach in teaching a course in community dentistry to 3rd-year dental students.


Betal chewing and caries experience in New Guinea. The prevalence of dental caries and variables relating to the betel-chewing habit were examined in a sample of 301 rural New Guineans aged 12--24 years. Consistent inverse associations were demonstrated between caries experience and the intensity of betel chewing for individuals and aggregates of subjects. The results indicate that betel chewing confers a degree of protection against caries.


Occurrence of dental caries and gingivitis in low, medium and high fluoride areas in Finland. The study was performed on a material of 365 Finnish schoolchildren aged 13--15 years. One-third of the children were from Jyväskylä, with 0.2 parts/10(6) fluoride in the drinking water, one-third from Kuopio, with an artificially corrected 1.0 parts/10(6) fluoride content since 1959, and one-third from Hamina, where the natural fluoride content of the drinking water varies between 2.5 and 5.0 parts/10(6). All the children were scored for the Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI) and for past caries experience (DFS). With increasing fluoride content of the drinking water the DFS scores were found to decrease significantly. No such difference was observed with regard to the VPI scores. The prevalence of gingival bleeding was found to be highest in Hamina (2.5 parts/10(6)). A highly significant positive correlation was found between individual VPI and GBI scores in all three towns. No corresponding correlations were found between the individual VPD and DFS scores. The latter finding is in desagreement with the generally accepted view that oral hygiene is an efficient caries-preventive measure.


An epidemiologic study of dental space anomalies in Icelandic schoolchildren. This study was performed mainly to determine the prevalence of space anomalies with regard to the various stages of dental development in Icelandic schoolchildren. The sample consisted of 1,641 randomly selected children (791 boys and 850 girls), making up 9.5% of the children attending all primary and secondary schools in Reykjavík during the school year 1972--73. In most of the frequencies of the different space anomalies boys showed a higher prevalence than girls. In both sexes there was often a significant difference from one stage of dental development to another. The results were compared with those reported for other ethnic groups.


Etiological factors in oral squamous cell carcinoma. A retrospective survey of 75 patients with oral squamous cell carcinoma (ICD Nos. 143, 144, 145) resident in the County Borough of Stoke-on-Trent, England, and 150 controls has been carried out by interview. The controls were matched for age, sex, occupation and place of residence. There was no difference in the prevalence or duration of denture wearing, although male controls had their dentures remade more frequently. Male patients practised oral hygiene procedures less frequently when they had their own teeth than controls. Habitual beer-drinking was more common and greater quantities were drunk by male patients than controls. Habitual cigarette smoking was less and pipe smoking greater among male patients than controls. Tobacco chewing, which was restricted to miners, was equally common (45%) in the two groups. Among miners, the combined habit of tobacco chewing and pipe smoking was more common among patients (1005) than among controls (25%).


Five years of community preventive dentistry and health education in the county of Sutherland, Scotland. Examination of 11-year-old Scots children who had participated in a 5-year, fortnightly dental health education and preventive dentistry programme showed that, compared with a similar age-matched group, the regimen produced mean DMF and DMFS reductions of 48.6% and 42.1%, respectively. In addition, the plaque and gingival indices differed significantly and 22.5% of test children were caries-free compared with only 7.6% of controls.


Enamel solubility reduction by acidulated phosphate-fluoride (APF) treatment. The enamel solubility reducing (ESR) potential of acidulated phosphate-fluoride (APF) solutions containing varying amounts of F was studied. Commercial APF (1.23% F, pH 3.0) reduced solubility by about 80%. Fivefold dilutions of this APF were made with either phosphoric acid or water without significant effect on ESR potential. Further dilution to 0.12% F significantly decreased effectiveness. Commercially available APF products (1.23%) can be diluted several-fold with distilled water in the dental office without significant loss of ability to reduce the solubility of enamel.


Effect of a field program based on systematic plaque control on caries and gingivitis in schoolchildren after 3 years. The effect of a field program, based on systematic plaque control, on caries and gingivitis was tested during a 3-year period on 1,100 schoolchildren. Once every 3rd week the children were given oral hygiene instructions, professional toothcleaning and fluorides topically delivered by specially trained dental nurses. The children of a control group of approximately the same number of pupils, participated in a preventive program consisting of mouthrinsings once every 2nd week with a 0.2% sodium fluoride solution. The children of the third and fourth grades were, at the start of the experiment, selected as reference groups and then continuously examined once every year. At the end of the trial the mean reduction of surfaces haboring plaque and units with gingival inflammation was 59% and 73%, respectively. The reduction in caries increment was 51%.


Release of fluoride from fluoride-containing chewing gum. The release of fluoride from fluoride-containing chewing gum and the fluoride concentration in whole saliva was measured at different intervals after the start of the chewing procedures. The residual fluoride contents were 78, 32, and 6% of the initial 0.25 mg in the gum after chewing for 2, 5, and 10 min, respectively. When chewing for 10 min, the salivary fluoride increased from 0.05 to 11.7 and 15.3 parts/10(6) after 2 and 5 min, respectively, followed by a fall to 3.9 parts/10(6) after 10 min. Concentrations exceeding the preintake level were still recorded 60 min after the start of the chewing.


Mottled permanent incisors in 15-year-old Lagos children. Mottled permanent incisors were studied in a stratified convenience sample of 206 Lagos schoolchildren aged 15 years. The mouth prevalence of this condition was 32%, and the right-left symmetry of the mottled incisors occurred very approximately in only a third of those persons with mottling. The distribution pattern was similar to that observed in similarly aged children in non-fluoride communities, and also that observed in optimally fluoridated Anglesey, England. The cause of this type of mottling in unknown, but its distribution suggests that endogenous (possibly genetic) factors may be involved.


Effect of professional toothcleansing every third week on gingivitis and dental caries in children. A previous paper reported on the 1-year effect on dental caries and gingivitis of biweekly professional toothcleansing. The purpose of this study was to evaluate the influence of a change from 2 to 3 weeks in the interval between the professional toothcleansings during the 2nd year. The DMFS increment during the 2nd year did not differe significantly between the experimental and control groups. The plaque and gingival indices, although  increased during the 2nd year, were still significantly lower in children subjected to the 3-weekly cleansing than in children in the control group.


Oral conditions and need for dental treatment in an elderly population in northern Norway. Oral conditions and dental treatment needs were investigated in a group of persons aged 65--79. A sample comprising 280 persons was drawn systematically to cover all persons in this age category living in the county of Troms in Norway. 241 persons attended, leaving a participation-rate of 86. The participants were examined mainly in their homes by dentists in graduate training. Sixteen percent of the group were in constant need of assistance or care due to a poor general state of health. In all, 80% were edentulous: 72% of the men and 87% of the women. Ninety-two percent wore removable dentures, 5% had natural teeth only, and 14% had natural teeth combined with a denture. Furthermore, 4% had neither teeth nor dentures, while dentures in both jaws were found in 66%. The "objective" treatment needs were extensive and had mainly accumulated due to neglectec care. Forty percent of the total group needed new complete dentures and 20% a more comprehensive correction of their dentures. By contrast only 30% intended to seek treatment in the near future. There seemd to be a definite need for a dental program to overcome or reduce the economic and other situational barriers.


Comparative effects of hallucinogenic drugs on behavior of the cat.


E-rosette dormation of fresh versus frozen-thawed lymphocytes from leukemic patients and normal individuals.


Chromosome structure and function. Future prospects.


Maintenance of parathyroid hormone response in clonal rat osteosarcoma lines.


Vacuolated lymphocytes in type II glycogenosis--a diagnostic approach? Using electron microscopy, glycogen-filled lysosomes were found in peripheral lymphocytes in 5 cases of the infantile form of glycogenosis type II. In two infants whose blood smears were available, the ultrastructural demonstration of this pathognomonic storage corresponded to well-delineated vacuoles detected by routine light microscopy. Detection of such vacuoles in peripheral lymphocytes by light microscopy and demonstration of glycogen-filled lysosomes by electron microscopy could be a simple and harmless tool for diagnosing the classical form of type II glycogenosis.


Measurement of erythropoietin in chloroleukemic rats. Erythropoietin (Ep) levels were measured in Shay chloroleukemic rats at various stages of anemia. Serum Ep was shown to increase logarithmically as the anemia became more severe. This increase in Ep levels was similar to that observed in normal rats subjected to acute blood loss. Significant levels of Ep were also demonstrated in ascitic fluid extracted from the peritoneal cavity of leukemic rats. These results indicate that the anemia of this disease is not due to a diminished production of Ep.


Murine myeloid leukemia: colony formation in vitro. Normal and myeloid leukemic spleen cells from RF mice were cultured in vitro in plasma clots. In situ histochemical staining and karyotypic analysis of the colonies formed in the clot revealed that the colonies produced by leukemic and normal progenitors were indistinguishable morphologically and cytochemically. Colonies of leukemic origin were identified by in situ karyotypic analysis, a method not previously utilized in studies of hematopoietic proliferation in semi-solid matrices.


The diagnosis of periorbital injuries.

The diagnosis of periorbital injuries.


Late reconstruction of the orbit.

Late reconstruction of the orbit.


Son-sire-regression based heritability estimates of chiasma frequency, using T70H mouse translocation heterozygotes, and the relation between univalence, chiasma frequency and sperm production. T(1;13)70H/+ translocation heretozygous mice were used for assessing heritability values for chiasma frequencies and the epididymal sperm count. The chiasma frequency estimates were based on 15 son-sire pairs, the translocation heterozygotes being maintained in a Swiss random-bred genetic background. The chiasma frequencies were scored separately for the T70H/+ derived multivalent, specific pairing segments within the multivalent and the remaining bivalents. Chiasma counts within these specified parts of the genome were positively correlated. The heritability estimates, significantly greater than zero, ranged from 0.78-0.98, depending on the chromosome segments included. These results indicate a strong genetic control on a cellular basis for the formation of chiasmata in the mouse. Despite significantly positive correlations and regressions between the various chiasma frequencies and the sperm count (for which 29 pairs of observations were available), no significant heritability estimate for the sperm count was obtained. The relation between the chiasma frequency and the sperm count was weakest when the chiasma count was confined to a region of the translocation-caused multivalent in which the absence of a chiasma almost always resulted in the production of an univalent. This indicates that in the translocation heterozygotes used, the overall chiasma frequency has a greater predictive value for the sperm count than autosomal univalence alone.


The population dynamics of genetically determined resistance to warfarin in Rattus norvegicus from mid Wales.


Alternative ways of estimating the number of genes in a polygenic system by genotype assay.


The power of the classical twin study.

The power of the classical twin study.


Musculoskeletal tumors in dogs.

Musculoskeletal tumors in dogs.


The incidence of dry socket following the use of an occlusive dressing.


A study of the viscosity of saliva at different shear rates in dentate and edentulous patients.


Composite resin restorations: a clinical assessment of two materials.


Unusual radiographic findings from orthopantomograms: 2 case reports.


Dentin permeation: comparison of diffusion with filtration. A comparison was made between the rate of iodide permeation of dentin by diffusion and by filtration. Before acid etching, filtration only doubled the rate of iodide permeation relative to that obtained by diffusion. After acid etching, filtration produced a 32-fold increase in permeation. Acid etching, by removing occluding debris, facilitates filtration more than diffusion.


Lead in enamel and saliva, dental caries and the use of enamel biopsies for measuring past exposure to lead. Enamel biopsies taken from schoolchildren in a community where exposure to lead was a health hazard were analyzed for lead and fluoride. The children with high enamel lead had significantly higher caries scores than the children with low enamel lead, in spite of the fact that the high lead group also was higher in enamel fluoride. There was no increase in enamel lead with age. The lead in saliva was only a fraction of that in blood. Infants with lead poisoning showed higher saliva lead than a normal infant. The use of the lead in enamel biopsies and in saliva for measuring exposure to lead is discussed.


Toxicity study of cytosine arabinoside and methotrexate in the maintenance therapy of childhood leukemia. A Southwest Oncology Group study. In a toxicity study to determine the feasibility of treating patients with acute lymphocytic leukemia (ALL) using an intravenous combination of cytosine arabinoside (Ara-C) and methotrexate (MTX), the drugs were given either simultaneously or sequentially every two weeks. Twenty-nine patients were studied, 17 treated simultaneously, 12 treated sequentially. The tolerated doses of Ara-C and MTX were 60 mg/m2 and 90 mg/m2, respectively, for the simultaneous treatment schedule and 90 mg/m2 and 150 mg/m2, respectively, for the sequential treatment schedule. The dose-limiting factor of the drug combination was gastrointestinal toxicity. The observed recurrent vomiting on both schedules rendered the treatment unsuitable for maintenance therapy.


Plaque accumulation in guinea pigs at reduced saliva flow with and without sucrose administration.


The effects of inorganic ions situated at the enamel surface on the adsorption and activity of acid phosphatase. This study has demonstrated, first, that the affinity of the enamel surface for a biologically active protein-in this case, acid phosphatase-may be modified by first impregnating the mineral with particular inorganic ions. Second, enzymic activity is altered as a function of the inorganic ion incorporated into the enamel surface. Third, strong inhibition of acid phosphatase is demonstrated by ions expected to be released during the carious process which contradicts the postulation that phosphatases are actively hydrolyzing enamel matrix-bound phosphate during the carious attack. Fourth, these results suggest that by incorporating a particular ion into the enamel mineral, a surface with assigned properties may be created which offers some degree of control over subsequent adsorption of organic matter. Thus, it is apparent that by proper selection of inorganic ions and organic macromolecules, both structural properties and biological activities at the enamel-oral fluid interface may be predictably modified.


Effect of SnF2 mouthrinse on initial bacterial colonization of tooth enamel. Microbiologic quantitative methods and scanning electron microscopy were used to observe the effect of stannous fluoride (100 ppm F-) mouthrinse on early plaque formation. An in vivo plaque model system was used on two individuals to test this experimental agent. Following SnF2 mouthrinsing, the total bacterial counts of two-day-old plaque on enamel cylinders were reduced up to 50.8 times or 98% and the streptococcal counts were decreased up to 48.4 times or 97.9%. Scanning electron microscopy confirmed a marked decrease of bacteria on enamel with use of SnF2 mouthrinse. It appears that, in addition to reducing enamel solubility and other properties, SnF2 may also alter bacterial accumulations on teeth.


The effects of fluoride on the percentage bacterial composition of dental plaque, on caries incidence, and on the in vitro growth of Streptococcus mutans, Actinomyces viscosus, and Actinobacillus sp. Administration of 250 mug/ml NaF in drinking water to rats reduced both caries incidence (P less than 0.001) and the percentage of S mutans (0.01 greater than P greater than 0.001) although the percentage of Actinobacillus sp. was increased (P less than 0.001). An Actinobacillus sp. and S mutans FA1 both proliferated in NaF broth only if the NaF greater than 10 mug/ml, which was associated with the inhibition of acid production.


Lingual tubercles and the maxillary incisor-canine field.


The effect of adsorption on the acid production of caries and noncaries-producing streptococci. Eighteen different Streptococcus strains including S mutans, sanguis, mitis, salivarius, bovis, and 2F2, were assayed for their relative adsorption to synthetic hydroxyapatite and for quantities of lactic acid produced while in the adsorbed state. The results indicated that all S mutans and some S sanguis have an enhanced metabolic activity while adsorbed to hydroxapatite as compared to control suspensions without hydroxyapatite.


Effects of an argon laser on the crystalline properties and rate of dissolution in acid of tooth enamel in the presence of sodium fluoride. Upon exposure to laser radiation, enamel powder mixed with NaF underwent an increase in crystallite size and/or perfection with a significant uptake of fluoride. Incisor teeth lased in the presence of NaF released significantly less calcium and phosphorus into sodium acetate (pH 4.0) compared with unlased controls, suggesting a possible role for the laser in caries prevention.


Dimensional communalities of the deciduous teeth.


Improving the fracture resistance of dental ceramic. A time-temperature sequence for optimally strengthening dental ceramic by ion exchange was investigated. Stress relaxation occurs at higher temperatures and/or longer times. Improved strenghts are obtained in a reasonable period of time that could be used for clinical application.


Dimensional correspondences between deciduous and permanent teeth.


Clinical study of dental cements. VI. A study of zinc phosphate, EBA-reinforced zinc oxide eugenol and polyacrylic acid cements as luting agents in fixed prostheses. A clinical trial for the final cementation of crowns and bridges with a reinforced zinc oxide and eugenol cement, a polyacrylic acid cement and a zinc phosphate cement was made over a 3-year period. The study involved 441 patients for whom 547 bridges and 162 single restorations were cemented. The patients were recalled at 6-month intervals for the duration of the study and the restorations were examined for looseness. Of the 547 bridges 520 remained firmly cemented to the abutment teeth. Of 1,082 bridge retainers, 1,049 remained in position; success and failure by types of retainer will be the subject of a subsequent paper. Of the 162 single restorations 159 remained in place.


Reduction in the modulus of elasticity in orthodontic wires. The modulus of elasticity of stainless steel orthodontic wires was found to be 20% below the normally assumed range of 19.3 to 20.0 x 10(4) MPa (28.0 to 29.0 x 10(6) psi). Use of the latter value can result in significant computational errors in orthodontic applicance mechanics. The lower modulus was attributed to severe cold drawing.


Collagen biochemistry of the two layers of carious dentin. The amino acid composition and intermolecular cross links of collagen fibers in the two layers of carious dentin, differentiated by a 0.5% basic fuchsin-propylene glycol-stain, were biochemically investigated. No difference in the pattern of amino acid composition of collagen fibers was found between the first and second layers of carious dentin and the sound dentin. However, obvious differences in the intermolecular cross links of collagen fibers were found between the three layers. Namely, compared with the sound dentin, the second layer of carious dentin had decreased cross links and increased precursors. This change is considered to be reversible. Contrastingly, in the first layer, both the cross links and the precursors remarkably decreased. In addition, the hexitollysines (protein-saccharide compounds probably related to bacterial metabolism) were found and several peaks of unknown materials appeared. This indicates irreversible destruction of cross-linkage in the first layer of carious dentin.


Electrochemical reduction of corrosion products on dental amalgam.


Properties and distribution of inorganic pyrophosphatase in rabbit dental pulp. Some properties and the intracellular distriubtion of inorganic pyrophosphatase in rabbit dental pulp were determined. This enzyme was sensitive to Mg2+, and not inhibited by imidazol and CN- which are inhibitors of alkaline phosphatase. Inorganic pyrophosphatase was found predominantly in the supernatant fraction.


Quantification of pulpal blood flow in developing teeth of dogs. Pulpal blood flow was determined in 32 dogs ranging in age from 6 weeks to 18 months by the isotope fractionation method incorporating diffusible and nondiffusible tracers. Dogs were placed into selected age groups by the developmental status of the canine teeth. For the teeth sampled, the maxillary first, second, and third incisors along with the canines and first molars, pulpal blood flow was determined to be not different in teeth at various developmental stages. For some dental pulps, alveolar mucosa, and bone, the tracers were not determining equivalent blood flows. Because of incomplete trapping of the 7- to 10 mu microspheres and the flow limitation of 86Rb, the 15 mu spheres would appear to be a reliable indicator of "total" blood flow to pulpal tissues. However, in alveolar mucosa and bone, and 15 mu microspheres may not be completely trapped and thus, may underestimate blood flow to these tissues. Within the age range of these dogs, tissue blood flow was not dependent upon the stages of oral development.


Implantation of new calcium phosphate glass-ceramics.


Association between HLA-antigens and periodontal disease. Patients with periodontitis juvenilis and patients with periodontitis were tissue typed. In the juvenile group, frequencies of tissue type specificities HLA-A9, HLA-A28, and HLA-BW15 were significantly increased as compared to the findings in the general population. In the periodontitis groups, no significant tissue type deviations were found.


SEM identification of zinc eugenolate crystals in postoperatively collected ZOE cements.


Phagocytosis of collagen by human gingival fibroblasts in vitro. Human gingival fibroblasts cultivated on collagen-coated cover slips had collagen fibrils in deep folds of the cell membranes after one hour and fully interiorized fibrils by 24 hours. In 5-day sections, fibrils were within dense bodies, some containing multiple dense granules (40 to 50 nm) aligned along the surface of the interiorized collagen fibrils.


The effect of diphenylhydantoin on fibroblasts in vitro. It was found that 0.02 mM was the higher concentration of drug which is not toxic and is compatible with normal cell morphology and growth over a period of a week. Using this concentration of drug there was no consistent stimulation of cell growth. A small increase in cell number was noted, however, in some cultures during the first 24 hours of culture. DpH at a concentration of 0.02 mM in the presence of ascorbic acid decreased collagen prolyl hydroxylation in "old" W1-38 cultures but a concentration of 0.1 mM was required to decrease the values to a similar extent in "young" cultures. A concentration of 0.02 mM DpH had no effect on hydroxylation in an "old" HGF culture. It is speculated that in a responsive individual a reduction of collagen prolyl hydroxylation may play a role in the etiology of DpH-induced gingival enlargement and congenital malformations.


A method for the in vitro toxicity testing of dental restorative materials. An vitro method of toxicity testing of dental restorative materials is described in which their clinical usage is closely simulated. The test material was separated from the cells by either a synthetic filter or dentine slice. Toxic effects were quantiated by determining changes in enzyme activity by scanning and integrating microdensitometry.


Graphic digitizer analysis of the myelinated axon spectrum in the inferior alveolar nerve of the cat. The diameter spectrum and other parameters indicating size and shape of myelinated axons were established in a cross-section of the inferior alveolar nerve obtained at the mandibular foramen. The spectrum is bimodal with approximately equal numbers of axons in the Aalpha and Adelta-range, in contrast to unimodal spectra of certain branches contributing to the inferior alveolar nerve.


Report of the president.

Report of the president.


Self worth is more important than net worth.


External factors leading to the loss of professional control of the delivery of oral health care.


Are we helpless?

Are we helpless?


President's inaugural address.

President's inaugural address.


Erosion rebuttal.

Erosion rebuttal.


Getting back on the track.

Getting back on the track.


Tooth sensitivity.

Tooth sensitivity.


Advertising dentistry.

Advertising dentistry.


Endocarditis and the irrigating device.

Endocarditis and the irrigating device.


Give up on prevention?

Give up on prevention?


Changing trends in endodontics.

Changing trends in endodontics.


Rationale and methods for crown lengthening. Surgical crown lengthening should not be attempted when tooth fractures extend into the middle third of the root. Excessive bone reduction on the fractured tooth and necessary blending of osseous contours over adjacent teeth may result in mobility or furcation involvement. In addition, the necessary osseous surgery may create precipitous changes in the bony architecture that will be bridged by soft tissues. This results in increased pocket depth and an unhealthy situation. If the tooth in question has a hopeless prognosis or the osseous surgical procedure would create a poor crown-root ratio, furcation involvement, mobility, or esthetic problems, crown lengthening should be avoided. In cases such as these, extraction may be indicated.


An evaluation of the clinical laboratory as an adjunct to dental practice. A study was completed at the University of Kentucky College of Dentistry in which 172 randomly selected adult dental patients were subjected to a battery of laboratory screening tests as a part of the initial examination procedure. The tests performed included rapid plasma reagin test, complete blood cell count, and determinations of serum glucose, blood urea nitrogen, and serum cholesterol values. Nearly 17% of the patients had at least one abnormal laboratory value. Thirty-three percent of the values were so abnormal that the patients required medical care. For the total group, the rate of detection of previously undiagnosed medical problems was 6.9%. Elevated serum glucose values were found most frequently.


Nitroblue tetrazolium and Limulus assays for bacteremia after dental extraction: effect of topical antiseptics. Bacteremia that occurs after dental extraction is common. This study assessed the effect of topical antisepsis on the incidence and magnitude of post-extraction bacteremia. On hundred patients scheduled for elective tooth extraction were randomized among four groups: contr-l, mouthrinsing with sodium-p-toluene sulfonchloramide (chloramine-T), toothbrushing with chloramine-T, and irrigation with Lugol's solution. The results showed that 84% of the control group and 59% of the treatment groups had positive blood cultures (290 organisms isolated) after dental extraction. The duration and magnitude of these bacteremias were diminutive as documented by the six serial blood cultures taken for each patient, colony counts per milliliter of blood, and nitroblue tetrazolium and Limulus assays. Brushing the teeth or rinsing the mouth with chloramine-T before dental extraction significantly reduced the incidence of bacteremia (P less than .025) and the number of different organisms recovered from each patient (P less than .05). Thus, topical treatment with chloramine-T is a simple and effective means of reducing the incidence of postextraction bacteremia.


Ethyl alcohol by the oral route as a sedative in dentistry. The history and social use and misuse of alcohol have been reviewed. Alcohol is an effective mild sedative drug for dental therapy when used in suggested dosage, and its use is encouraged. Guidelines and contraindications for administration have been suggested.


Chronic granulomatous disease: report of case and review of the literature. A man with chronic granulomatous disease had severe gingivitis and ulcerous lesions in the buccal mucosa and palatal plate. After the use of good hygiene procedures, his condition improved greatly. It is possible that oral symptoms reported in this disease are due in part to accumulations of plaque. A review of the literature on chronic granulomatous disease is included.


Cleidocranial dysostosis: a multidisciplinary approach to treatment. To ensure eruption of the dentition in patients with cleidocranial dysostosis, close collatoration between the oral surgeon and the orthodontist is essential to determine the sequence of extraction, the teeth to be ligated, the preferred technique of ligation, and the approach for surgical exposure.


Prosthodontic therapy for cleidocranial dysostosis: report of case. Objectives of treatment of the oral manifestations of cleidocranial dysostosis should include restoring the vertical dimension of occlusion, building out the maxilla, establishing of functional occlusion, improving appearance and phonation, and improving the patient's mental well-being.


Cleidocranial dysostosis: report of case. In the treatment of oral problems of patients with cleidocranial dysostosis, the multidisciplinary approach should be considered. The collective abilities of the oral surgeon, the prosthodontist, and the orthodontist should be utilized to determine the most effective treatment.


Lists of products evaluated by the Council on Dental Materials and Devices and the Council on Dental Therapeutics.


Let the user beware.

Let the user beware.


You can change the patient.

You can change the patient.


Compliance with advertising policy.

Compliance with advertising policy.


Life, death and dollars.

Life, death and dollars.


The hucksters of dentistry.

The hucksters of dentistry.


Danger: fee control ahead.

Danger: fee control ahead.


Biopsy technique: the pathological considerations. As the dental profession moves toward additional emphasis in detection of disease and sophistication in diagnosis, biopsy is being used with increasing frequency as a diagnostic tool. This article states and elucidates simple ground rules that govern the rationale of surgical sampling of pathologic tissue. The three most common deficiencies that hamper interpretation (tissue artifact, inadequate clinical information, and inappropriate tissue sampling) are discussed, and the biopsy approach to various types of clinical lesions is reviewed.


Physical properties of dental silver-tin amalgams with high and low copper contents. Newly developed amalgams such as Tytin, Sybraloy, and Dispersalloy had low static creep, high compressive strength, and similar values for both diametral tensile strength and dimensional change in comparison with conventional amalgams such as Kerr Spheraloy, Caulk Spherical, Shofu Spherical, and Caulk 20th Century Micro Cut. The data for physical properties were evaluated statistically, and the amalgams were ranked according to the numerical position assigned to each property.


Dental fluorosis as related to the concentration of fluoride in teeth and bone. Rats (N = 58), given a diet low in fluoride, were stomach-fed solutions of NaF and (NH4)3AIF6 in amounts corresponding to 3.3, 8.3, and 16.5 microgram of fluoride per gram of body weight. After five weeks, the incisors were scored for fluorosis and samples of the incisors and mandibles were analyzed for fluoride. Less fluoride was deposited in teeth and bone from AIF6, than from NaF at all dosage levels. Less fluorosis also developed from AIF6, except at the lowest dosage level, which produced very little fluorosis in either group. Both incisor fluoride and fluorosis scores increased with increases in ingestion of fluoride. In a larger group of rats (N = 101) that had been on different fluoride regimens, the fluoride concentrations of the incisors were grouped according to the fluorosis scroes. There was a consistent trend of increase in fluoride with increase in fluorosis scores, but each score had a wide range and overlap in fluoride concentrations.


Clinical aspects of Candida infection in denture wearers. Candida-induced denture stomatitis usually does not reflect any deep-seated, systemic abnormality, the dentures being the primary predisposing condition. However, infection with C albicans should be recognized as an extremely common complication to the wearing of dentures. Most cases are treated relatively easily, but recurrences are frequent and the infection often spreads to other parts of the oral mucosa. Therefore, preventive measures should be taken against colonization by Candida of the palatal mucosa and the dentures. In healthy persons, Candida-induced denture stomatitis is not serious; however, it should be considered a possible spearhead of systemic yeast infections in seriously ill patients, especially in those subjected to prolonged treatment with antibiotics, corticosteroids, or immunosuppressive drugs.


A public education program in self-examination for orofacial cancer. Instruction in self-examination for early signs of orofacial cancer was given to over 450 persons attending a large county fair in western New York State. Participants received one-on-one instruction from dentists or specially trained dental hygienists according to a protocol designed to detect abnormalities of the oral cavity, cervical lymph nodes, and major salivary glands, as well as facial skin cancers. This method of personal instruction was judged feasible for large-scale application.


Recommendations in radiographic practices--March 1978. Council on Dental Materials and Devices.


Recommendations in dental mercury hygiene--March 1978. Council on Dental Materials and Devices.


Absorption kinetics of sublingually administered propranolol. The absorption of propranolol through the buccal cavity has been investigated in normal healthy male volunteers. Propranolol doses of 10 mg were retained in the mouth for varying lengths of time to investigate the absorption kinetics. Both plasma and oral contents were analyzed. Propranolol was found to be incompletely absorbed (about 40%) from the buccal cavity. The disappearance of propranolol from the oral cavity does not, however, reflect absorption of drug into the blood. Absorption onto or into the buccal mucosa followed first order kinetics with a half life of 1 to 17 minutes, variability being great between subjects. The appearance of drug into the blood was also first order characterized by a half life of 20 to 25 minutes. It was found that uptake from the oral cavity and appearance in the plasma are separate processes with transport into the plasma being the rate limiting step. This data is discussed in terms of previously presented models of buccal absorption.


Plasma cell leukemia: response to conventional myeloma therapy. A 76-year-old man with plasma cell leukemia was treated with L-phenylalanine mustard and prednisone (CLGB 7461). There was good partial remission of the plasma cell disease characterized by disappearance of the plasma cells in the peripheral blood, reduction of plasma cells in the marrow aspirates to less than 5% of the nucleated hematopoietic cells, a reduction in the serum monoclonal IgG from 7.6 to 2 gms/100 ml, and the disappearance of urinary monoclonal IgG, Bence-Jones protein and a complex of gamma-chain fragment and beta2-microglobulins. There was also a marked improvement in the renal function and a decrease in the proteinuria from 4+ to 1+. The patient relapsed after more than 8 months of response and failed to respond to subsequent treatment with cytoxan and cytosine arabinoside. However, the efficacy of standard myeloma therapy was clearly apparent in this case of plasma cell leukemia.


Metabolic changes induced by human growth hormone. In man purified human growth hormone shows anti-lipolytic effect and glycolysis is inhibited. The activity of lecithin-cholesterol-acyl-transferase is stimulated. The blood level of certain aminoacids fall.


Interferences and recovery of digitalis glycoside preparations using commercial radioimmunoassay kits for digoxin and digitoxin. The authors compare and discuss sensitivity and reproducibility of commercial RIA kits of digoxin and digitoxin commonly used in routine hospital laboratories and in emergency. Cross reactivity and recovery of these kits with different digitalis preparations currently prescribed in medical practice are studied with a view to practical application in patients receiving digitalis glycosides and derivatives.


Local anesthetics in surgical oral dentistry and in maxillofacial surgery their limits in regard to the cardiovascular system. The present study was undertaken to investigate the effects of vasopressor substances contained in local anesthetics in dentistry. The results obtained indicate substantial cardiac activity of these anaesthetics, as shown by electrocardiographic (EKG) tracings carried out on patients before and after anesthetization. The vasoconstrictors, adrenaline or noradrenaline, resulted at times in slight cardiac lesions which could not be observed clinically. Careful anamneses could avoid such situations.


The concept of the sagittal condylar guidance: biological fact or fallacy? The clinical concept of a sagittal condylar guidance pertaining to the human temporomandibular joint is discussed in the light of selected studies on the anatomy, radiography and cineradiography of this joint, and clinical attempts at recording a sagittal condylar guidance. It seems as if there is no single and well defined sagittal condylar guidance in vivo, and thus no single and well defined sagittal condylar guidance angle applicable to the adjustable articulator.


In vitro caries related to marginal leakage around composite resin restorations. The histology of caries-like lesions around composite resin restorations with and without marginal leakage has been studied. The lesions were generated from bacterial plaque growing in an in vitro system. Marginal leakage was prevented by an acid etch technique. Ground sections of the experimental teeth were studied by polarized light and microradiography. The caries lesions penetrated along conventional class V restorations with marginal leakage while restorations bonded to an acid etched enamel surface totally prevented this ingrowth.


Mast cells in masseter muscle in experimental bruxism in man. Three human subjects performed tooth grinding for 25 min, and after 20 h biopsies of the right and left masseter muscles were examined for their contents of mast cells. In comparison with specimens from a control group of three subjects, there was an increase of degranulating mast cells in muscles that had performed bruxism.


Gnathosonic monitoring of patients with gnathic dysfunctions. The progress of 23 adult patients during treatment for gnathic dysfunctions was monitored by gnathosonic techniques and graphs of the fluctuations in occlusal sound duration were studied. It was concluded that this method gave a useful insight into the progress of patients under treatment and aided the assessment of the effects of treatment.


The development of an artificial saliva for in vitro amalgam corrosion studies. Published data, consideration of chemical and physical properties and the requirements of amalgam corrosion testing were used to formulate an artificial saliva. A previously described method was used to determine the relevance of a number of human saliva constituents. Some results of those tests are described. Practical problems are discussed, and necessary further developments outlined. A number of other applications are suggested.


Some self-reported symptoms of temporomandibular joint dysfunction in a population in Northern Norway. The distribution of a number of self-reported symptoms of temporomandibular joint (TMJ) dysfunction, parafunctions and treatment behaviour was studied by means of a questionnaire answered by 94% of a population group of 358 persons aged 20-69 years in Northern Norway. Nine subjects reported pain from the temporomandibular joint (TMJ) when opening their mouth and/or when chewing, while twenty-one subjects had clicking sounds in the TMJ. Seventeen persons had been grinding their teeth during the previous week. Only seven individuals had ever sought medical or dental advice because of TMJ disorder. Tooth grinding and symptoms of TMJ dysfunction were most common in young people, in people with twenty teeth of more and/or in people from high social classes, whereas differences according to sex and income were small. The low frequency of subjective symptoms of TMJ dysfunction and parafunctions in this population was related to demographical, social, dental and methodological influences.


In vitro studies of fluoridated amalgam. Four types of fluoridated amalgam were assessed in vitro in terms of fluoride release, corrosion behaviour and compressive strength, and compared with amalgams prepared from the corresponding non-fluoridated alloys. Although corrosion susceptibility was found to be increased, steady release of the fluoride ion was demonstrated over a 16-week period, indicating that fluoridated amalgams might be prophylactically employed in clinical dentistry as a means of overcoming the problem of secondary caries associated with amalgam restorations.


Does a temperature gradient exist across the mucogingival junction? On the assumption that the colour difference between attached gingiva and alveolar mucosa is accompanied by a temperature difference, twenty subjects with a high standard of oral health were studied. Five points on either side of the mucogingival junction were examined by means of a thermocouple probe. A mean difference amounting to about 2/3 degrees C was found between the surface temperatures of the two structures.


Viscoelastic properties of elastomeric impression materials. I. A method of measuring shear modulus and rigidity during setting. A method of measuring torsional shear modulus and rigidity of elastomeric impression materials has been developed and is described. In addition, the changes in viscoelastic properties of these materials during setting are discussed.


Horizontal stabilization of upper and lower borders of the comfortable zone. Using a screw jack device the upper and lower borders of the comfortable zone were recorded in a two step procedure designed to counteract bias inherent in previous measurements. In these measurements, successively increasing and decreasing values of zonal borders were recorded corresponding to a fully closed or fully opened starting position of the screw. Both of these positions are outside the comfortable zone. The two step procedure used a starting position which was supposed to lie inside the comfortable zone. However, the procedure did not achieve its aim fully. It succeeded only in stabilizing the lower border values. In the discussion hypothetical considerations are made concerning the neurophysiological mechanism underlying recordings of the borders of the comfortable zone, which might explain the differential behaviour of the zonal borders.


Role of mucin and albumin in saline polarization of dental amalgam. Studies into the electrochemical nature and corrosion behaviour of dental amalgam have indicated the need for an artificial saliva formula that will accurately simulate the electrochemical properties of natural saliva. Existing formulae have been based on inorganic saliva constituent concentrations, without accurate representation of organic constituents. Albumin and mucin were added to several dilutions of saline solution. The resulting solutions were used as electrolyte at 4 degrees and 37 degrees C for the potentiostatic anodic polarization of conventional amalgam. The presence of albumin and mucin did not appear to alter the major characteristics of corrosion profile. Examination of the current-time transient curves indicated, however, that the kinetics of the electrochemical reactions were delayed. Also, the open circuit potential was observed to shift to more active values with the addition of organic constituents, thereby creating a low current density region in the initial segment of the polarization profile.


An appraisal of the British National Health Service.


Conscious sedation with intravenous drugs: a study of amnesia. A comparison of amnesia that is produced by two intravenous sedation techniques commonly used to reduce anxiety in ambulatory oral surgery patients showed that both techniques induce high levels of safe, predictable amnesia. More than 200 patients undergoing surgical extraction of third molars were asked to verbally identify visual and cutaneous-tactile stimuli intraoperatively. The patients responded via written questionnaires at the postoperative interview sessions. No retrograde amnesia was observed. Complete amnesia was attained for the local anesthetic injections. Amnesia for visual stimuli was significantly lower than for cutaneous-tactile stimuli. No significant differences in amnesia were observed between the two drug combinations studied.


Reversible skeletal muscle damage after administration of local anesthetics with and without epinephrine. Local anesthetic preparations with and without epinephrine, which are in common clinical use, produced reversible skeletal muscle damage in the rat after a single local administration. In addition, epinephrine alone, in concentrations of more than 1:200,000, caused similar but less extensive damage.


Microfibrillar collagen (Avitene) as a hemostatic agent in experimental oral wounds. In dogs with experimentally created oral wounds, Avitene proved to be superior to Gelfoam or Surgicel as a topical hemostatic agent. No postoperative problems were encountered. All sites healed equally well and there was no discernible histological difference between results with Avitene and with the other agents.


Case 22, part 1.

Case 22, part 1.


Surgical correction of macroglossia in Beckwith-Wiedemann syndrome. Two cases of Beckwith-Wiedemann syndrome have been reported. The children were large at birth and had an umbilical defect and macroglossia. After considering several alternatives, the elliptical (modified Butlin-Handley), U-shaped excision was used in case 1 for the following reasons: symmetry and minimal disturbance of muscle attachment, reduction of thickness without reduction of width, and reduction in length of the tongue. Use of the V-shaped excision proved most advantageous in the second case where length, rather than thickness, was the only problem. It was hoped that partial glossectomy at an early age might help circumvent the attendant sequelae of macroglossia in patients with Beckwith-Wiedemann syndrome.


Combined surgical and orthodontic management of anterior open bite using corticotomy. Two cases of dentoalveolar abnormality have been presented that were treated successfully in a relatively short time by using the combined efforts of the oral surgeon and orthodontist. Although corticotomy has limited applications, it has a place in the armamentarium of the orthognathic surgeon.


Resorption of the zygomatic arch after elevation of a depressed fracture and subsequent osteomyelitis: report of case. A case of osteomyelitis of the zygomatic arch with complete resorption has been presented. The cause of osteomyelitis of the facial bones was discussed. Infection of the soft tissue after intraoral elevation of fractured zygomas does occur, but rarely leads to osteomyelitis and subsequent bony resorption of the underlying bone. Antibiotics have reduced the incidence of osteomyelitic infections in the past 20 years; however, a vigorous regimen of preoperative and postoperative attention to aseptic technique, proper antibiotics, and close follow-up is required to control these problems.


Malignant lymphoma and salivary obstruction. Salivary obstruction may result from growth of a malignant tumor in the vicinity of the salivary gland, as well as result from sialolithiasis. Lymphomas of all types, including Hodgkin disease, lymphosarcoma, and reticulum cell sarcoma frequently are diagnosed in the region of the head and neck. The biopsy of a suspected tumor should be done by multiple needle biopsies. Open biopsies should be avoided to prevent seeding and spreading. When the diagnosis of malignant lymphoma is made, the tumor must be classified histologically and the extent of disease must be determined and staged for proper treatment. Treatment should consist of radiation and chemotherapy. Surgery is of little value. Malignant lymphomas usually are disseminated widely and end fatally.


Chondrosarcoma of the mandible: report of case. A case of chondrosarcoma of the mandible in a 69-year-old man has been reported. The patient was treated by radical surgery (hemimandibulectomy) and he was alive 54 months postoperatively.


A new oscillating saw blade for areas of limited access in orthognathic surgery.


Orbital decompression and infraorbital augmentation for correction of exophthalmos secondary to Cruzon disease. Facial deformity secondary to Crouzon disease may include exophthalmos and midfacial hypoplasia. If there is no dental malocclusion, treatment may consist of transantral orbital decompression and infraorbital augmentation with custom-made Silastic implants.


Dentists' perceptions of their patients relation to quality of care. This study investigates dentists' perceptions of their patients and the relation of these perceptions to measures of actual quality of restorative treatment. The results indicate that 1) though the dentists see their patients as "cooperative," they perceived a substantial number of "problems," i.e., willingness to pay for optimal care or follow professional recommendations; and 2) there are significant associations between dentists' perceptions of patients and measures of the quality of restorative treatments; higher quality scores were associated with perceptions of a more cooperative patient.


The jabberwocky parade.

The jabberwocky parade.


Prevalence of hepatitis B surface antigen in a dental school patient population. A sample of 300 adult patients accepted for initial treatment between January 5th and 24th, 1977 at the Louisiana State University School of Dentistry had blood samples drawn and analyzed by radioimmunoassay+ for the presence of hepatitis B surface antigen (HBSAg). Two patients were positive for HBSAg (a prevalence of .67 percent. Medical questionnaire information obtained from each participant indicated that 11 patients had had hepatitis; seven were confirmed by the patients' private physicians. Both patients positive for HBSAg gave confirmed histories of having had hepatitis. The information gathered tends to indicate that dental patients who give a history of hepatitis should have a blood sample drawn and analyzed by radioimmunoassay for HBSAg to determine whether they are carriers of HBSAg. This analysis should precede any dental treatment. Further studies are planned to obtain information from another sample population.


Evaluation of dental health education in a school dental care program.


From President ADA to President USA.

From President ADA to President USA.


Presidential address of Richard F. Murphy. American Association of Public Health Dentists. October 8, 1977.


Behavioral objectives for dental public health. Department of Continuing Education. School of Public Health. The University of North Carolina at Chapel Hill.


Destruction of circulating leukemia cells by phagocytosis in rats with myelogenous leukemia. Acute myelogenous leukemia was induced in outbred Long-Evans rats by iv injections of leukemia cells from a subcutaneous tumor of Shay myelogenous leukemia. In rats with this leukemia the peripheral white blood cell (WBC) counts varied from 2.4 to 700 X 10(9)/liter. No differences were found in the bone marrow of the rats with the high WBC counts and that of rats with low WBC counts. This observation could explain the large variations in the number of circulating leukemia cells caused by differences in cell proliferation or delivery of cells into the circulation. Massive phagocytosis of leukemia cells occurred in animals with low WBC counts (less than 12 X 10(9)/liter) but not in animals with high WBC counts (greater than 150 X 10(9)/liter). This phagocytosis was directed against circulating leukemia cells. The main phagocytes were Kupffer's cells of the liver and macrophages of the spleen parenchyma. In addition, phagocytosis occurred in the spleens and bone marrow by intravascular macrophages, which were derived from extravascular sites. The endothelium of the postcapillary venules of the lymph nodes participated in the phagocytosis of circulating leukemia cells while continuing to be the locus of lymphocytic return from circulation to lymphatic parenchyma. The factors underlying the differences in macrophage activity between the rats with high and low WBC counts were unknown.


Characteristics in youth predictive of adult-onset malignant lymphomas, melanomas, and leukemias: brief communication.


Antitumor activity of interferon against murine osteogenic sarcoma cells in vitro. Murine interferon inhibited the growth of a continuous line of osteogenic sarcoma (OGS) cells in tissue culture. Inhibition of tumor cell growth by interferon was demonstrated by: a) decreased colony formation in soft agar, b) suppression of clone formation in liquid medium, and c) reduction of tumor cell counts in monolayer cultures. This inhibition of cell growth was further documented by suppression of [3H]thymidine uptake by OGS cells exposed to interferon, which suggested inhibition of DNA synthesis of tumor cells. Exposure of tumor cells for 4 hours, 24 hours, and 2,3,4,6, and 8 days demonstrated greater activity with prolonged exposure to interferon. Inhibition of cell growth was significantly greater for OGS cells than for normal mouse embryo fibroblasts. Finally, the antitumor activity of the interferon preparation could be reversed by anti-interferon antibody.


Benzene toxicity: a critical evaluation: introduction.


Experimental benzene intoxication.

Experimental benzene intoxication.


Atypical pyoderma gangrenosum with leukemia. Pyoderma gangrenosum (PG) has been increasingly reported in association with myeloproliferative disorders. Monoclonal gammaopathy, myeloma, myeloid metaplasia, and polycythemia have all been found in association with PG. Recently, seven cases of PG in association with leukemia have been described: three cases with acute myeloblastic leukemia, two cases with chronic myelogenous leukemia, one case with acute lymphoblastic leukemia, and one case with acute leukemia of either plasma cell or myeloblast origin. To these we add two cases of PG with acute myeloblastic leukemia. These patients often have an atypical clinical presentation for PG, with bullae and relatively superficial involvement obscuring the correct diagnosis.


Deamination of 5-methoxytryptamine, serotonin and phenylethylamine by rat MAO in vitro and in vivo.


Preselective sex determination.

Preselective sex determination. Preselective sex determination in ten consecutive pregnancies has been achieved by means of strict control over timing and technique of coitus which was combined with acidic or alkaline douching. Eight female and two male babies were born.


Preliminary results of three protocols for the treatment of acute lymphoid leukaemia of children: distinction of two groups of patients according to predictable prognosis.


Therapeutic leukopheresis of acute myelo-monocytic leukemia in pregnancy. Cytopheresis techniques have proven useful in the provision of platelets and granulocytes for transfusion to the pancytopenic patient. Mechanical cell removal has been applied to the treatment of chronic myelocytic and lymphocytic leukemias and the Sezary syndrome. We have treated a 16-year-old pregnant acute myelomonocytic leukemia (AMML) patient for 12 weeks solely with the use of intensive leukopheresis utilizing batch processing centrifugation and packed red cell transfusions. The patient presented with a white blood cell count of 54,000/mm3 with 64% myelomonoblasts, a platelet count of 45,000/mm3, marked gingival hyperplasia, and splenomegaly. Patient had a normal spontaneous delivery of a 2.5-kg male infant without complications. At the time of delivery, 12 weeks later, the white blood count had fallen to 4,9000/mm3 with 8% blasts and the platelet count had risen to over 100,000/mm3. Gingival hyperplasia decreased and the patient felt well. We have treated an additional small group of patients with acute myelogenous leukemia (AML) with high white counts with short term intensive leukopheresis followed by chemotherapy with promising results.


Letter to the editor.

Letter to the editor.


Tonsils and adenoids: in or out?

Tonsils and adenoids: in or out?


Partial deficiency of muscle carnitine palmitoyltransferase with normal ketone production.


Allylisopropylacetamide restricts expression of beta minor globin gene in Friend cells.


Psychiatric sequelae of therapeutic abortions.


Maternal mortality in North Carolina. 1971-1975.


Gilles de la Tourette syndrome: clinical and genetic studies in a midwestern city. Clinical and genetic observations of Gilles de la Tourette syndrome were carried out on members of 14 families from the Minneapolis area. An unusual number of the families were of Jewish and other Eastern European ancestry, and in all but one of these families multiple members were affected. These observations parallel our earlier findings based on 21 families from the New York City area. Together with recent evidence indicating relative instability of a specific enzyme in some patients, these observations suggest that there is a genetically determined form of Gilles de la Tourette syndrome.


Antitrust implications of physician walkouts.


Malpractice. Physician successfully countersues plaintiff and attorneys.


Emotional disturbances. Use of medication.


Discogenic radiculopathy. Use of electromyography in multidisciplinary management.


Vision care. Seeing eye to eye.

Vision care. Seeing eye to eye.


Newborn screening for sicle-cell disease. Benefits and burdens.


Voluntary methadone treatment clinic. Two-year study.


Essential malignant hypertension. Clinicopathologic correlations.


Guidelines concerning euthanasia. Dying patient.


Amyloidosis in juvenile rheumatoid arthritis.


Unusual gunshot wound of abdomen.

Unusual gunshot wound of abdomen.


Thymoma in childhood.

Thymoma in childhood.


Pelvic lipomatosis.

Pelvic lipomatosis.


Safety of oxazepam.

Safety of oxazepam.


Complication of temporary endocardial pacing. Knotting of catheter.


On innovation--scientific research. Luxury or necessity?


How accessible are physicians? Some findings and implications of the changing distribution of general practitioners in three New Zealand cities. An understanding of the changing distribution of general practitioners within urban areas is considered necessary as a first step towards understanding the problems of developing primary care services. Both the distribution of general practitioners and the pattern of change 1966 to 1974 are analysed for three urban centres: Auckland, Wellington-Hutt and Christchurch. Results indicate that newer suburbs are less well served than either established neighbourhoods or areas of high socio-economic status. In addition, non-European areas were found to be disadvantaged. It is suggested that two particular strategies are required to promote change: (a) the development of an information system for primary care, and (b) some organisational framework within which primary care services can develop.


Accidental paraquat poisonings.

Accidental paraquat poisonings. Three accidental deaths due to ingestion of paraquat are described. There is as yet no proven effective treatment once significant absorption has taken place. A short review of clinical features and recommended treatment is presented.


Skin infections in Kaimai Rail Tunnel construction workers. Skin lesions in Kaimai Rail Tunnel workers were noted to respond poorly to treatment and investigations revealed that this was because the lesions were either gram-negative infections or Trichophyton rubrum infections.


Hereditary angio-oedema.

Hereditary angio-oedema. A family with three affected but only two symptomatic members with angio-oedema is described. One had potentially life threatening dental treatment at presentation while the other had inexplicable gastro-intestinal disease.


Prolactin: rediscovery of a clinically important hormone.


Rehabilitation services and responsibilities.


Isotopes in general practice.

Isotopes in general practice.


Doctors may grow on trees!

Doctors may grow on trees!


Asymptomatic gonorrhoea in males.

Asymptomatic gonorrhoea in males. Over a 21 month period at Cook Hospital nine patients, or 10% of diagnosed cases of gonorrhoea in men were asymptomatic. The importance of this group in maintaining a reservoir of infection is noted. About half of these patients have been treated inadequately for gonorrhoea and the importance of post-treatment cultures and urine checks is stressed. Penicillin by injection is still the best method of treatment.


Cholestyramine in the treatment of antibiotic associated pseudomembranous colitis: a case report. A patient with antibiotic associated pseudomembranous colitis (A-PMC) is described in whom there was a dramatic response to the administration of cholestyramine. Although it is not clear why cholestyramine should be beneficial, its use should be considered whenever the diagnosis of pseudomembranous colitis is entertained.


Reaction of patients to hospital care.

Reaction of patients to hospital care.


Pacemakers and cremation.

Pacemakers and cremation.


Health of children.

Health of children.


A model to integrate hospital board and health office functions at district level. Proposals to integrate the administrative responsibilities of a hospital board and a district health office, are described. Relevant literature advocating the combination of some of the operational functions of these two agencies is reviewed, as is the situation in the Gisborne district as it was at the time that the proposals were formulated. Possible constraints that may obstruct the implementation of the proposals are also discussed, and the need for empowering legislation to allow further development to proceed is emphasised.


People, medicine and the state, which way? Part 2: Organisation in the future.


Family medicine training scheme.

Family medicine training scheme.


Report from the Ombudsman.

Report from the Ombudsman.


Routine chest x-rays.

Routine chest x-rays.


New Zealand Committee on Adverse Drug Reactions: Twelfth Annual Report 1977.


Good medicine: the place of pathology.

Good medicine: the place of pathology.


Why educate the diabetic?

Why educate the diabetic? There is a need for better education of diabetics. This leads to better quality care by the patient, and better quality of care by health professionals. Economic advantages of patient education are discussed.


The needs of the intellectually handicapped. There are about 10 000 intellectually handicapped people in New Zealand. Most are fit, healthy, mobile adults with individual needs and the same rights as other citizens. Most can be trained to live semi-independent lives, living within the community in family-type homes, flats or small hostels, provided properly organised and efficient community based support services are developed. A minority present major problems in behaviour, or lack mobility, or are multi-handicapped and require permanent institutional care. Such institutions should be small and located in the community that they serve. There is a need for action, not words, in developing the provisions for the intellectually handicapped in our community.


Education for general practice.

Education for general practice.


The irritable bowel syndrome.

The irritable bowel syndrome.


Rape and abortion.

Rape and abortion. A 1977 study of rape in New Zealand indicated that only about 20% of all rapes are reported to police.  The Royal Commission on Contraception, Sterilisation and Abortion which rejected rape as a ground for legal abortion did so after inadequate consideration of the issue. The Commission Report suggests postrape insertion of an IUD or administration of a morning-after pill within 72 hours of the incident.  These suggestions are inadequate.


Child health revisited.

Child health revisited. Much discussion has taken place over the recently published mortality statistics for infants and young children. These statistics are critically examined and conclusions reached. Suggestions with regard to the improving of Child Health Services are made.


Echovirus 19 outbreak in Auckland 1975-76. An epidemic of echovirus 19 infection in Auckland, New Zealand, during the summer of 1975-76 is reported. Echovirus 19 was recovered from 33 patients, 70 percent of whom had upper respiratory tract involvement, 55 percent presented with meningitis and 33 percent exhibited a rash. Gastroenteritis was diagnosed in 9 percent. Various clinical syndrome combinations were common. The overall male to female ratio was one. Infants younger than six months were more seriously affected than older patients.