Experiences with cryosurgery in the management of benign prostatic obstruction. Cryosurgery of the prostate gland has been used on mainly unfit patients for ten years as an alternative to open and endoscopic surgery in over 250 patients. With the use of a simple "rule of thumb" technique, blind cryosurgery can be recommended as causing few complications. Furthermore, the patient's early discharge from hospital can be achieved. Long-term functional results are satisfactory. More complicated techniques have been described and are mentioned, but as a result of experience simplicity of technique is recommended.


The surgical treatment of retrocaval ureter. Ureteric obstruction resulting from retrocaval ureter may be due to either compression of the ureter by the vena cava or stenosis of the postcaval segment. If obstruction is due to stenosis, the commonly described operation of division and anastomosis through the proximal dilated ureter or pelvis, after repositioning of the ureter, is likely to fail, as is division of the vena cava itself. Excision of the postcaval segment with anastomosis of the spatulated ureter over a Silastic splint is therefore recommended. Three case histories of patients with retrocaval ureter treated surgically are presented and support this view.


Carotid body tumours.

Carotid body tumours. Carotid body tumours are rare, but important. Their reputation for slow growth and virtual non-malignancy has had, in the light of experience, to be revised. Sudden spurts of growth are well known, and the tumour may become irremovable in a relatively short time. Aggressive local invasion and widespread metastasis are now well recognized. Histological features are no guide to malignancy. These tumors can nearly all be removed with an acceptable mortality and morbidity, without damage to the internal carotid artery. Ideally the diagnosis should be made by clinical acumen and confirmatory X-ray examination. Biopsy makes subsequent removal of the tumour much more difficult, and should be avoided if at all possible. Eleven personal cases of carotid body tumours are reported, and the technique of surgical excision is discussed in detail.


Radionuclide pancreatic scanning: a retrospective analysis. Records of 346 patients were studied to determine the reliability and diagnostic value of pancreatic scanning. In 157 the pancreatic diagnosis was established subsequent to scanning. The scan was abnormal in 28 of 34 patients (82%) with pancreatic neoplasm, and in 21 of 26 patients (81%) with chronic pancreatitis. Of 71 with normal scans, 56 (79%) had a normal pancreas, and 15 had pancreatic disease (a false negative rate of 21%). Of the 86 with abnormal scans, the pancreas was diseased in 56 (65%), and of the others, 14 had extrapancreatic conditions known to be associated with a high incidence of scan abnormalities. In obstructive jaundice all 21 patients with pancreatic carcinoma had abnormal scans (and the scan accurately diagnosed all four cases of bile duct carcinoma). A normal scan reliably indicated that the cause of jaundice was outside the pancreas. In chronic abdominal pain an abnormal scan was unreliable, but a normal scan excluded pancreatic disease with reasonable accuracy.


Arterial problems seen in a teaching hospital in Hong Kong. Over a 12-month period, 58 patients presented with arterial disease or other arterial problems to the University Surgical Unit, Queen Mary Hospital, Hong Kong. These patients accounted for only 0.6% of this Unit's annual admissions. In spite of the reported rarity of atherosclerotic arterial disease in this part of the world, this was the cause of the disease in nearly half of our patients. Abdominal aortic aneurysm was the single most common condition encountered. In at least one-third of patients with atheromatous disease of the aortoiliac segment, chronic peptic ulcers were demonstrated. It is concluded that peripheral arterial disease is rare, but atherosclerosis is the most common cause.


Migration of a ureteric calculus to the bladder via a ureterocolic and a vesicocolic fistula. Following a difficult nephrectomy for pyonephrosis, two large calculi in the left pelvic ureter were not removed. The upper of these two calculi finally found its way into the bladder after ulcerating into the sigmoid colon and thence into the bladder. The calculi and the residual ureter were removed and the fistulae closed, with a successful outcome.


Ileal replacement for gunshot injury of the ureter. A case of gunshot injury of the upper third of the ureter is reported. The injury was managed by ileal replacement with complete conservation of the kidney, after an attempt at primary repair had failed. A survey of the literature has not disclosed any previous report of a gunshot injury of ureter being treated by this method. However, we recommend it only in cases where the conventional procedure of end-to-end repair fails.


Isolated perforations of the ileum and jejunum in blunt abdominal trauma. A report of ten cases of perforations of the ileum and jejunum from blunt abdominal trauma is presented. The perforation was the only injury in eight patients, while in two there were other visceral injuries. The perforations were single in seven patients and double in three. Simple closure was used in seven cases and resection in three. Of the three patients who were operated upon late, one died.


Abdominal pain and gonorrhoea.

Abdominal pain and gonorrhoea. Two patients are described who presented with features of the Fitz-Hugh-Curtis syndrome. Recognition of this entity may prevent unnecessary investigation before diagnosis and treatment. As the incidence of gonorrhoea is increasing, complications such as this may be seen more frequently among patients presenting to surgical or gynaecological wards.


The simplification of a clinical data base: application to gallstone patients. In patients with gallstones, recommendations for cholecystectomy depend on evidence of abnormality in the cholecystogram. Symptoms and signs, usually related as a syndrome, are employed to identify patients who should have a cholecystogram. Triplet combinations of clinical data from gallstone patients and controls were examined to find which combination was the best discriminator between diseased and non-diseased, and between those who should be investigated radiologically and those who need not. The cholecystogram was confirmed as the best overall discriminator, but right costal margin pain by itself was as efficient as any triplet. The performance of a cholecystogram on all patients with right costal margin pain is as efficient a system for identifying patients with gallstones as the consideration of any quantity of clinical data.


The pathophysiology of renal hypertension. The increased understanding of the mechanisms leading to production of renal hypertension, and in particular the recognition of the renin-angiotensin-aldosterone axis as an integrated capacity-volume system for the control of arterial blood pressure, now allows a rational approach to the diagnosis and management of patients suffering from this disease. In this brief review some of the experimental evidence behind this rational approach is presented.


Treatment of acute myeloid leukaemia with a triple cytotoxic regime: DAT. Twenty patients with acute myeloid leukaemia (AML) were treated with a combination of chemotherapy which included daunorubicin, cytosine arabino-side and 6-thioguanine (DAT). The complete remission rate was 85% and was achieved, in responsive cases, after an average of 2 courses of therapy. Patients remained in hospital for an average of 37.5 days during remission-induction therapy and 3.7 days per month thereafter. The median remission period was 48 weeks and median survival was 70 weeks. A disappointing feature was the high relapse rate. This feature of the results re-affirms the need for a more effective form of remission therapy.


Spectral analysis of mouse EEG after the administration of N,N-dimethyltryptamine. Mice were implanted with permanent cortical electrodes. The EEG was recorded during the sleep-wake cycle and after the administration of N,N-dimethyltryptamine (DMT). Based upon spectral analysis the EEG was classified into three categories: awake, slow-wave sleep (SWS), and rapid eye movement sleep (REM). The dominant frequencies were located below 2 Hz in the case of SWS and between 6 and 9 Hz for REM. When DMT was administered intraperitoneally at 20 or 40 mg/kg, a dose-dependent hypersynchrony at 2.5-4.5 Hz was always observed lasting for up to 60 min. Hypersynchronous activity in the same range was occasionally observed during awake. In this range DMT induced a different but unique frequency for each animal. This individual frequency was closely reproduced by repeated administrations of DMT to the same animal.


Combination chemotherapy for acute lymphoblastic leukaemia in adults. Fifty-one adults with acute lymphoblastic leukaemia were entered into a trial of intense initial chemotherapy and early "prophylaxis" of the central nervous system (CNS). Initial treatment with OPAL (Oncovin (vincristine), prednisolone, adriamycin (doxorubicin), and L-asparaginase (colaspase)) followed by craniospinal or cranial irradiation and intrathecal methotrexate produced remission in 36 patients (71%). Seventeen of these patients relapsed three to 18 months after the start of remission; the remainder had been in remission for 12 to 52 months by the end of the study. The predicted median duration of complete remission was 18.5 months. None of the four patients who initially had clinical evidence of CNS disease, three of whom also had leukaemic cells identical to those found in Burkitt's lymphoma, achieved remission. Those patients who initially had hepatomegaly or splenomegaly had a shorter remission than those without. The predicted median survival was 27 months in those who achieved complete remission, one month in those who did not, and 21 months overall. The addition of colaspase and doxorubicin to vincristine and prednisolone and the use of early CNS treatment clearly improved the remission rate among adults with acute lymphoblastic leukaemia, though the presence and length of remission was affected by the extent of disease at presentation. Burkitt-like leukaemia, which had a poor prognosis, is probably a separate disease and may benefit from a different therapeutic approach.


Seven cases of Gilles de la tourette's syndrome: partial relief with clonazepam: a pilot study. The histories of seven consecutive cases of Gilles de la Tourette's syndrome are presented to exemplify the range of clinical manifestations in this disease and to collate preliminary results with the new benzodiazepine, clonazepam, as possible adjuvant therapy of this disorder. Controlled trials with clonazepam alone and in association with haloperidol are now justified. Five of our 7 patients had a positive family history of tics, and 2 a confirmed family history of gout. Because clonazepam improves myoclonia and tics and because its mechanism of action possibly involves serotonin, we thought it worthwhile to study simultaneously the relative roles of serotonin and dopamine metabolism in the production of tics, and their relationship to possible defects in purine metabolism in Gilles de la Tourette's syndrome.


Suppression of human myelosarcoma growth in athymic mice by a primate antiserum. A primate (Macaca speciosa) antiserum prepared against the human chronic myelogenous leukemia cell line K-562 suppressed the growth of the human myelosarcomas in nude mice. The ip administration of 0.5 ml of immune serum plus 0.5 ml of guinea pig complement, starting 7 days after sc tumor transplantation, resulted in a fourfold to fivefold decrease in tumor weight at 15 days when compared to nude mice given pre-immune serum plus complement or complement alone. Whereas the other two groups experienced an exponential increase in tumor volume at 7-9 days after tumor transplantation, the immune serum-treated mice remained in a "lag" phase of tumor growth during which the tumor volume neither increased nor decreased substantially. Histopathologic studies revealed various degrees of tumor alterations ranging form focal hydropic cellular degeneration to massive coagulation necrosis. The incorporation of tritiated thymidine into the tumors was also markedly diminished in the mice given immune serum.


An osteosarcoma cell and matrix retained morphogen for normal bone formation. Histophysiology, ultrastructure, chemical analyses of transplants and implants of Dunn and Ridgway mouse osteosarcomas demonstrate that tumorigenesis is a manifestation of deranged morphogenesis in developing mesenchymal cell populations. The end product of development is defective, incompletely calcified, disorganized bone without any inclusions of bone marrow tissue. When Dunn osteosarcoma is freeze-dried and then implanted, the tumor is resorbed and replaced by deposits of normal cartilage, bone, and bone marrow. Freeze-dried Ridgway osteosarcoma is replaced only by a fibrous connective tissue scar. Disaggregated Dunn tumor osteoblasts synthesize a trypsin-labile collagenase-resistant cell surface localized bone morphogen. Tumor matrix stroma, prepared by sequential chemical extraction of soluble non-collagenous proteins also contains significant quantities of the same bone morphogen. Tumor tissue pulverized to particle size as small as 44 micrometer3 transmitted bone morphogen more rapidly than intact tumor tissue. The total tumor cell and stroma mediated bone morphogen produces three times more normal bone than normal cortical bone matrix. Our working hypothesis is that a normal bone morphogenetic polypeptide (BMP) is synthesized by Dunn osteosarcoma cells and retained by the tumor matrix stroma. Neither the mechanism of transmission nor the mesenchymal cell receptor sites of BMP are known.


Total femur and total knee replacement. A preliminary report. Osteogenic sarcoma, a highly malignant tumor of bone, is generally treated by amputation. This is a report of 19 cases of excision of the entire femur because of skip areas which are occasionally seen. The femur usually has the lowest cure rate according to site of involvement. In total femur replacement, the whole bone is removed while the limb is saved. The operation consists of isolating the neurovascular bundle and removing the knee joint and femur including some surrounding normal tissue for margin of safety. The femur and knee replacements are made entirely of metal. The resultant extremity is weak, but functional. The patients can walk without support, but their gait is better using a cane and/or an ischial weight bearing brace.


[Problems in the determination of the hinge axis in the partially edentulous arch]. The mandibular movements are well known to be complex because of the many muscles inserted at the most varied points and the anatomical peculiarities of the joints. This complicated course of movement is coordinated by a control system which is essentially influenced by the tactile sensitivity of the pressure receptors in the desmodont, but also by signals from the temporomandibular joints and the musculature itself.


[Lateral teleradiographic diagnosis of deep bite]. 113 lateral teleradiographs of students were analysed by A. M. Schwarz's method of X-ray analysis inorder to clarify whether the occlusal position of a patient can be determined from gnathometric data and data relating to soft parts in the lateral teleradiograph with sufficient certainty. The relatively high proportion of close bite cases (20%) enabled a comparison to be made of the measurements of anatomically correct occlusal position and close bite. The large scatter of the measurements for anatomically correct interlocking was striking. Of seven specific close bite characteristics, with anatomically correct occlusal position three at most could be identified whereas in cases of close bite, four to six occurred. So the diagnosis of "close bite" from the appearance of four or more close bite characteristics in the lateral teleradiograph seems to be confirmed.


[Abrasion in modeling materials].

[Abrasion in modeling materials]. Ten frequently used hard plasters (Types 3 and 4 in accordance with DIN 13911) and 5 current modelling plastics have been investigated. Abrasion with testing forces of 1, 2 and 5 N were determined on samples 2 mm broad and about 12 mm long. The amount of abrasion could be calculated from the loss in weight. Only Kol-Dur and the plastics Diemet, Impredur and Alpha-Die are sufficiently reliable not to become damaged by abrasion on wax modelling (abrasion less than 5 micrometer). Hard plasters are not hard enough to resist abrasion. Taking into account the bending strength and modulus of elasticity, only Kol-Dur and Diemet can be recommended. Because of the improved dimensional stability of the hard plasters, Alca Dental Stone, Begolith, Duralit, Tewstone or Ferrodur can be recommended if the bending properties and a possible slight abrasion are taken into consideration. With the hard plasters, damage of more than 10 micrometer is easily possible.


[Bending strength in modeling materials]. The bending strength and modulus of elasticity of 15 materials were measured. 9 of them were hard plasters. Five were plastics with filling material, one a hard plaster with copper. On the basis of modelling calculation a bending strength of 20 N/mm2 is necessary. It is exceeded by 12 of the materials and not quite attained by 3 of them.


[Correlation between dimensional changes of the casting investment and the accuracy of fit of schematic crown rings]. 90 pairs of measurements were evaluated to determine the correlation between the combined setting and thermal expansion of the investment Deguvest HFG and the width of the gap of the rings casted by Degulor M. The correlation is significant but not especially strict.


[Bending strength of UV hardening composites]. Mechanical firmness of 4 UV hardened composites was estimated by the bending test according to DIN 13922. Bending strength and breaking point lie between 70 and 120 MPA and 0.5 and 0.25 mm compared with 110 MPA and 0.13 mm for Adaptic. The results show that the combination of filling substance and UV irradiation is well balanced.


[Fluorescence of dental ceramics by means of non-radioactive materials]. In order to improve the aesthetics of dental ceramics under all lighting conditions, uranium and cerium are added as fluorescent additives. However, studies have shown that the fluorescent behavior of dental ceramics is still not identical to that of natural teeth in all cases. A further disadvantage of the use of uranium are its radioactive and poisonous properties. This study was undertaken in order to investigate the possibility of using elements of the rare earth family as fluorescent additives for dental ceramics. The rare earths were added to a potassium feldspar glass host and emission spectra were measured. As a result it is recommended that divalent europium and trivalent dysprosium be further investigated as possible fluorescent additives for dental ceramics, as they show intense blue-white and yellow fluorescence respectively.


[Laboratory technical problems of denture linings]. Inaccuracies after underpinning of total prosthesis must be the responsibility of the technical laboratory in the first place. Six procedures were compared. Böcker's apparatus for underpinning gave the best results.


[The mechanical effect of various types of tooth brushes on the alveolar mucosa and the gingiva (scanning electron microscopic studies)]. In animal experiments guinea pigs were subjected three times weekly for 4 weeks to cleaning with a plane multitufted or a toothed "space tufted" toothbrush for 20 seconds by a standardised method comparing opposing quadrants on each side. Scan electronmicroscopic evaluation of the tissue exfoliation from the area of attached gum before cleaning, after 2 and 4 weeks, shows that localised though different epithelial lesions occur with both tooth brushes. The lesions reach into the submucosa with the toothed type brush. Influence on the epithelium in the sense of normalising keratinisation after tooth brush massage could not be confirmed.


[The effect of brush stimulation on the keratinization of the gingival epithelium]. During a prolonged tooth-cleaning experiment extending over 6 weeks, using "multitufted" and "space-tufted" brushes on mini-pigs it was shown that significant thickening in all epithelial layers and in the total epithelium occurred in the area of the "attached" gingiva in comparison to the control side. These results were obtained by histological means, measuring the thickness of individual epithelial layers and total thickness with a semi-automatic picture analysing apparatus. Both brushes investigated showed no essential differences in the histological picture. Clinical evaluation however gives preference to the "multitufted" toothbrush over the "space-tufted" brush on the basis of better tissue tolerance.


[Cell culture of human gingival epithelium]. Gingival explants were taken from 8 volunteers in order to find a method to grow gingival epithelial cells. We succeeded in what we regarded as optimal conditions in achieving a monolayer cell thickness in the culture by means of BHK medium and foetal calf serum.


[Pretreatment in periodontal therapy].

[Pretreatment in periodontal therapy]. Initial treatment is of central importance in dental interventions for marginal periodontal lesions. The hygienic phase must be successfully concluded before further measures of periodontal surgery or bigger reconstructions of any kind are undertaken. In this way optimal prognosis is achieved for all phases of therapy.


[Measurements of the temperature during the use of dental ultrasonic devices]. This investigation worked at temperature measurements in cylindric pieces of copper for determination of surface temperatures and in root dentin of calves using ultrasonics by varying intensity, water flowing and pressure. In each experiment two different dental ultrasonic devices were used with two tips. The experiments with sufficient water flowing showed that the spray temperature which was determined separately in further experiments influenced the measurements mainly. On the other hand an insufficient water flowing resulted in remarkable findings showing for example temperatures in the pieces of copper higher than 195 degrees C and macroscopic changes on the root surface in form of carbonization and alterations of cementum and root dentin.


[Experimental gingivitis as a model for the testing of the pharmacological effect in anti-inflammatory treatment of the gingiva]. This is a report concerning the feasibility of using gingivitis caused by neglect of usual oral hygiene for testing the pharmacological effects of anti-inflammatory agents. An unexpected difficulty is presented by the inability to reproduce the height of increase of the SB-index during repetition of the experiment after interruption of oral hygiene for one week.


[Electron microscopic studies on pedicled grafts of alveolar mucosa and on newly formed periosteal epithelium]. 20 patients who had undergone a vestibuloplasty using the technique of Edlan and Mejchar were examined by histo-morphological studies of the transplanted alveolar mucosa and the epithelialised periosteal zone up to one year post-operatively. The following conclusions were reached: --the original characteristics of the transplanted tissue remain unaltered. --numerous abnormalities in the epithelium and connective tissue are explained by insufficient oxygen diffusion and marked inflammatory reaction in the connective tissue. --there is no keratin formation although the number of layers of the stratum superficiale increases after the 16th post-operative week. On the basis of these results the question of whether there is a possible change-over from uncornified to a cornified epithelium is answered in the negative.


[Comparative clinical and cytological studies on the local tissue toxicity of fluoride gels]. Local short term and long term topical applications of a sodium fluoride jelly and an aminofluoride jelly were tested in a comparative clinical and cytological study of the reaction of the alveolar mucosa and the attached gum. Neither after short term use (single application) nor after long term use (four times continuous daily application) of the fluoride jelly was any change detected in the oral mucosa or gingiva. No clinically manifest epithelial damage or changes in cytology were observed outside the range of normal variations.


[Comparative clinical studies on 2 toothbrushing methods--Roll and Bass technic]. The effectiveness of two tooth cleaning methods (Roll and Bass technique) was evaluated in 28 patients. Answers to the following questions were sought: 1. Which of the two methods results in greater reduction of plaque formation? 2. Are difficulties encountered in the learning and practice of each method? 3. Which method gives better results in the less accessible parts of the jaws? A significant difference in the cleaning effectiveness of the two methods could not be demonstrated.


[Evaluation of various radiographic technics for the diagnosis of periodontal diseases with special reference to the status X unilateral technic]. Various X-ray techniques (panorama views and intraoral plates) were contrasted and evaluated for diagnostic use in periodontal lesions. In addition the Status X-unilateral technique (Durner, Meyer) was compared to intraoral right angle roentgen states (Updergrave) in the examination of 20 patients.


[Comparative studies on panoramic radiographic (Panorex) and intra-oral radiographs]. 27 patients with periodontal lesions were examined by Panorex layered film and 14 intra-oral dental X-ray films (Updegrave's long tube right angle technique). The result of this enquiry shows that the two radiological methods do not compete with one another. Each has advantages over the other which derive from fundamentally different exposure techniques. The dental status films with right angle technique are superior in showing clear periodontal structures and hard dental tissue whilst the Panorex method gives X-ray surveillance over the whole mastication organ and neighbouring structures which cannot be visualised in its entirety by the intra-oral method.


[Critical thoughts on the periodontal status]. After 8 years' use of the periodontal status, recommendations for alterations to it are put forward for discussion, based on our own experience and on the evaluation of 218 analysed parodontal statuses. The headings "previous history", "function" and "diagnosis" are discussed in greater detail. Because of the significance of plaques as aetiological factors, it is recommended that a headling of plaque diagnosis should be added to the status.


[Plaque reduction by means of "multi-tuft" brushes connected to electric toothbrushes]. In 20 patients the plaque-removing properties of two toothbrushes were tested which work on the principle of an electric swing toothbrush. Brush A was of space-tufted type, brush B of multi-tufted type. The test ran for 14 days for each toothbrush. The study showed that the multi-tufted brush achieved a 30 to 50% better plaque reduction, measured on all tooth surfaces. When considering individual tooth surfaces it was shown that approximal surfaces were less well cleaned than the facial or oral surfaces. After a fortnight the cleaning power of both brushes was reduced. In spite of better plaque reduction by the multi-tufted type of brush the hand tooth brush by instructed patients is to be preferred.


[Free mucosal grafts: a technic for obtaining grafts with a newly developed mucotome]. "Free gingival grafts--a technique for obtaining grafts using the Mucotom": A new instrument with a mechanically oscillating blade for obtaining grafts from a palatal donor site was designed. The Mucotom can be attached to a dental unit. In 27 patients aged 18 to 46 the width of the attached gingiva in the mandibular anterior and bicuspid region was widened using for each case three independent grafts of ultrathin, thin and intermediate thickness. Each graft taken with the Mucotom was measured clinically in the center and at both ends using a Mitotoyo thickness measuring gauge. The average (+/- stand. dev.) thicknesses were in millimeters: 0.37 +/- 0.09 (M I), 0.55 +/- 0.12 (M II) and 0.75 +/- 0.14 (M II) respectively. Grafts obtained by manual scalpel preparation averaged 0.96 +/- 0.15 mm. Grafts of intermediate thickness (M III) showed excellent clinical healing of the donor and the recipient site. The precise cutting of the instrument and the direct visual control of the instrument's guidance produced grafts of uniform thicknesses and without microlacerations.


[Selfinduced gingival mutilations--a diagnostic and therapeutic problem]. A case of factitial gingival traumatism and trichotillomania in a hysteric 28-year-old female patient is reported. During a period of 31 months the patient presented with gingival necrosis which involved the lingual aspects of all four quadrants respectively. A wide range of diagnostical aids failed to enlighten the nature of the lesions until the patient developed an alopecia capitis which was typical for hysteric trichotillomania. The diagnostical and therapeutical aspects of selfmutilation in hysteria are discussed.


[Studies with the HSE-digital periodontometer on tooth mobility and for checking of clinical degrees of mobility]. The mobility of normal teeth and teeth with periodontal lesions could be measured by means of the newly constructed HSE-digital-periodontometer and specially developed measuring head. After obtaining norm values, measurements of pethological changes allowed us to determine to what degree the clinically increased mobility of teeth was subject to subjective influences (range of error 36.5 to 70.5%). These results suggest that the scale of clinical grades of tooth mobility be increased to 5 altogether and that practical objective measuring apparatus be developed especially for dental practice.


[Oral leukoplakia. II. Results of a year-long polyclinical pilot study]. A pilot study was carried out on close on 4000 uniformly examined and documented patients of the Erlanger maxillo-facial Policlinic. This resulted in the extensive collection of data useful as a basis for future follow-up studies on leucoplakia patients. Leucoplakia was found in 123 patients (3,1%) including 7 precancerous lesions and 6 mucosal carcinomata. Age and sex distribution of leucoplakia patients and various potential influential factors were statistically compared with a control group of an equal number of outpatients. For each of the factors examined, chronic smoking, chronic alcohol consumption, enoral habits, the connection with the occurrence of leucoplakia was highly significant (alpha less than 0,001).


Reagents specific for cell surface components. Mercury, diazonium ions and dyes which bind nucleic acids were covalently linked to dextrans using methods that resulted in non-hydrolyzable reagent-dextran bonds without impairing the binding abilities of the reagents, i.e. these dextran derivatives reacted with thiols, phenols/imidazoles and nucleic acids respectively. Since these dextran derivatives cannot penetrate into cells and since dextran itself does not bind to cells, these compounds represent reagents specific for the cell surface. They may be used both to evaluate cell surface constituents of intact cells and to affect viable cells via an interaction with those constituents. Mercury-dextran was found to bind to cells; the amount of mercury thus attached to the cells was about ten times smaller than when an equivalent concentration of free mercury ions was used. Mercury-dextran, bound to cells after a 30-min exposure at room temperature, was localized on the surface of these cells, as sodium borohydride reduced this complex giving rise to the intact cells, elementary mercury and free dextran which was released into medium. When cells were constantly exposed to the mercury-dextran, its toxic effects were comparable to that of free mercury ions. Diazonium-dextran, which also binds tightly to the cell surface, was also considerably toxic. Dextrans substituted with dyes which bind to nucleic acids were less toxic than the parent dyes themselves; it was shown that the attachment of such a dye to dextran decreased the binding of dye to cells under detection limits.


Effects of the spinal cord section and of subsequent denervation on the mechanical properties of fast and slow muscles. The Soleus muscle of the rat, 3--6 months old, becomes significantly faster than in the controls, if the spinal cord is cut at birth. Mechanical properties of Extensor Digitorum Longus (EDL) muscle are not altered by spinal cord section. In cordotomized animals Soleus muscle always remains slower than EDL muscle. Denervation, performed 3--6 months after birth, has the same slowing effects in the Soleus and EDL muscles, both in cordotomized and in the control animals.


Differential diagnosis of orofacial pain. No attempt has been made to deal with all of the various diseases that the dentist has to consider when diagnosing orofacial pain. One of the most important causes of facial pain--so-called temporomandibular joint or myofascial pain dysfunction (MPD) syndrome--has not been mentioned, yet it accounts for many of the patients attending facial pain clinics. There are several textbooks devoted to the MPD and the reader is referred to these for a full description of the condition. Whenever a patient presents for evaluation of orofacial pain the dentist must remember: (1) to take a detailed history of the characteristics of the pain; (2) to complete a full examination of not only the teeth and the oral cavity but also the face, head, and neck; (3) not to assume that the patient in his chair necessarily has a dental condition producing his pain; (4) that if he is unaware of the existence of certain diseases he will never diagnose them!; and (5) to have no hesitation in referring a patient for evaluation rather than perform irreversible dental procedures.


Selected pain states and the use of anesthesia in dentistry. Certain pain disorders may be difficult to diagnose because their presenting symptoms are confusing and difficult to classify, or because they occur so infrequently that they are not commonly considered. This article has presented a classification and discussion of selected pain states which the practitioner may find difficult to diagnose. When faced with a perplexing pain problem, the dentist is encouraged to perform a careful evaluation to determine whether the patient's pain is or is not of dental origin. Certain pain states require that the patient be referred for evaluation to other dental or medical specialists. The value of local anesthesia as a diagnostic aid in evaluating face and head pain has been presented.


A factor inducing differentiation of mouse myeloid leukemia cells in human amniotic fluid. The M1 line cells of mouse myeloid leukemia can be induced to differentiate in vitro into macrophages by a factor in human amniotic fluid. The macrophages showed phagocytosis and locomotic activity, and also gained Fc receptors on the cell surface. This factor in amniotic fluid capable of inducing differentiation of M1 cells was heat-labile, trypsin-sensitive, and non-dialysable. A growth-stimulating factor for the M1 cells was also found in the human amniotic fluid, and it was heat-stable and trypsin-resistant. The conditioned medium obtained from the amnion had the activity of differentiating the M1 cells.


A case of chronic myeloid leukemia with a translocation (12;22)(p13;q11). Chromosomal studies of the bone marrow and cultured peripheral blood cells in a 42-year-old female with the clinical and laboratory features typical for CML revealed a previously undescribed variant translocation involving chromosomes 12 and 22.


Nonrandom chromosome rearrangements in 27 cases of human myeloid leukemia. The R-banding pattern of the chromosomes of 31 patients hospitalized in the Hematologic Clinic for myeloid leukemia were studied before chemotherapy. This analysis permitted identification of one unusual 3-chromosome rearrangement t(3;9;22) in addition to 25 classic forms of (22q-;9q+) translocation accompanied by the specific Ph' chromosome in chronic granulocytic leukemia patients, independent of the blastic course of the disease. During blastic crisis observed in 6 patients, extra 8 and 10 chromosomes, monosomy for chromosome 17, isochromosomes 17q, translocation (12q;13q), and additional Ph' were noted. The nonrandomness of these findings is determined from results published by other authors. Their significance for the cellular phenotype is presently unknown.


[Immunological diagnosis of filariosis in persons returning from tropical countries and in European and indigenous inhabitants of endemic areas (author's transl)]. Serum samples from persons who lived in areas where onchocerciasis occurred or who had filariasis were examined with the complement fixation test and the indirect hemagglutination test for the presence of antibodies against crude extracts from Dirofilaria immitis, Onchocerca volvulus, Dipetalonema viteae, and Ascaris suum. The results could be interpreted as follows: 1. The indirect hemagglutination test was more sensitive than the complement fixation test for the demonstration of antibodies in sera from European and indigenous inhabitants of endemic areas. 2. There were no differences between the responses to the four crude worm extracts among the groups of 21 patients with Loa loa, 12 patients with Onchocerca volvulus, 11 patients with Dipetalonema perstans, and 22 patients with clinical filariasis in whom no microfilaria had been found. It was concluded that the examination with crude extracts cannot give any information about the antigens that had caused the stimulation of antibodies.


The plaque-inhibiting effect of copper amalgam. In order to assess whether copper amalgam accumulates less bacterial plaque than silver amalgam, 14 copper amalgam cervical restorations were placed in 10 patients. Control silver amalgam fillings were placed in homologous teeth of the same jaw. To evaluate the amount of plaque, the stained areas on the amalgams were analyzed from photographs with a planimetric method. Further quantitative analyses of plaque growth on copper amalgam were carried out with microbiological methods, for which a new group of 10 patients was selected. Cervical cavities were prepared on both sides of the jaw. Specimens of copper amalgam and silver amalgam restorations were placed on opposite sides. The plaque was collected after 2 and 3 days and cultivated under aerobic and anaerobic conditions on blood agar plates and on Mitis Salivarius Agar. The results of both methods show a very significant inhibition of plaque growth on copper amalgam. These results were confirmed by scanning electron micrographs which showed that copper amalgam only had plaque on small areas. The plaque appeared in band formations arranged irregularly on the surface. Higher magnifications revealed a filamentous structure with predominating coccoid organisms. Scanning electron micrographs also showed that pellicle formation, which is considered to be necessary for bacterial adherence to the surface, took place on both amalgams.


Calculus removal and loss of tooth substance in response to different periodontal instruments. A scanning electron microscope study. The efficiency of calculus removal and the amount of lost tooth substance resulting from the use of hand curette, ultrasonic curette and rotating diamond and Roto-Pro points were examined by scanning electron microscopy (SEM). Root surfaces of mandibular incisors placed in a jaw model were cleaned of adhering deposits, photographed by SEM and evaluated at a standard magnification by three examiners. Scores were given for remaining calculus (RCI) and loss of tooth substance (LTSI) according to defined index criteria. The results revealed that calculus removal was most complete following diamond instrumentation, whereas the ultrasonic curette was least efficient in this respect. Hand curette, ultrasonic curette and Roto-Pro removed about the same amount of tooth substance whereas the diamond removed considerably more than the others. The diamond regularly removed all the cementum and left deep instrumental marks in the dentin; it seems advisable to avoid the use of such instruments in periodontal depuration.


Periodontal treatment needs of 35-year-old citizens in Oslo. The periodontal condition was evaluated according to the PI and the Periodontal Treatment Need System (PTNS) in a random sample of 35-year-old citizens of Oslo. The study demonstrated that periodontal disease was a major dental health problem despite the fact that 88.9% of the subjects visited a dentist regularly. No statistically significant differences were found in PI, PTNS and OHI-S values among the different sexes and educational groups. Although the majority of the subjects (77.8%) brushed their teeth more than once a day, the oral hygiene status was not satisfactory (mean OHI-S 1.56). The frequency of toothbrushing did not influence the mean PI scores. Dental hard and soft tissue lesions related to toothbrushing were found in 30.0 and 6.8% of the subjects respectively, and more often among persons brushing more than once a day than among persons brushing less frequently.


Juvenile periodontitis: skeletal bone mineral content. No analysis of the skeletal bone mineral content in patients with juvenile periodontitis seems to be available. The purpose of the present analysis, therefore, was to determine, on the basis of estimation of the skeletal bone mineral content (BMC), if an osteopenia is present in patients with juvenile periodontitis. The material consisted of 30 subjects without known systemic diseases: one group of 15 patients with juvenile periodontitis and a control group of 15 subjects with normal periodontal conditions. Test- and control subjects were paired according to sex, age, height, and weight. Each group comprised four men and 11 women aged 18-31 years. The bone mineral content (BMC) was estimated by gamma-ray photon absorptiometry of both forearms, expressed (in arbitrary units) as the mean value of 6 scans of each forearm. No significant differences were found between the total average of the 6 scans from right and left forearms or between the total and mean value for BMC in the test- and in the control group. Conclusively, the analysis shows that the BMC values lie within normal limits in patients with juvenile periodontitis. Therefore, a generalized osteopenia does not seem to be a contributory factor in this disease.


Mental health and dental education.

Mental health and dental education. The relationship between mental health and the educational process in dental school has rarely been explored. In the author's experience as the mental health consultant at the USC School of Dentistry, several focal points of conflict do influence academic effectiveness. These problem areas are often marked by a variety of physical or psychological symptoms such as anxiety--sometimes of panic proportions--gastrointestinal disturbances, and the like. These are frequently related to fear of failure, being exposed as being intellectually inept and fraudulent, neurotic competitive needs, real and unreal paranoid attitudes toward instructors, the student's expectations as to what his or her "silent partners" require to him or her, and the effect dental education has on marriage.


Mastery learning strategy applied to a preclinical course in endodontics. Student learning is the primary aim of the educational process. Learning is facilitated by designing courses that remove many of the inhibitory factors inherent in conventional lecture/demonstration methods. The development of resource material, testing methods and the changed role of the teacher in Mastery Learning techniques are discussed.


Sample size needed for student ratings of instruction. The number of evaluation forms students are asked to complete is multiplying. To reduce that number, the present study determines the minimum sample size needed for accurate student ratings of instruction. Typical questionnaire items using four- and seven-category ratings scales were studied. Data for four class sizes (40, 60, 100, 140) were sampled in graduated sizes, and a standard error of the mean was computed for each sample size. A permissible error index was computed to estimate the accuracy of ratings obtained from any sample size needed for the four different class sizes. Figures are presented from which minimum sample sizes necessary for accurate student evaluation of instruction can be computed. The figures show that sampling only one-third of classes of 100-140 students is sufficient to obtain accurate evaluations.


Dental research priorities and availability of research opportunities for dental students. The American Student Dental Association surveyed 69 dental deans representing schools in the United States, Canada, and Puerto Rico to assess the priority of research and the role of dental students in research activity. Student interest, curricular requirements, potential funding, and opportunities available, as related to dental research, were topics included on the questionnaire. The results indicate that although the percentage of dental students seeking research involvement is small, opportunities and financial support for research are available in most dental schools as part of the regular curriculum.


Preclinical laboratory course in dental behavioral science: changing human behavior. Dental health professionals are frequently frustrated when they present preventive or therapeutic regimens to patients. This paper describes an approach to the teaching of behavioral science designed to familiarize the dental student with applying behavioral change techniques to dental problems. Ninety-nine second-year dental students participated in the two-credit course. Students were taught in six groups, each led by a clinician-behavioral scientist team. The behavioral science materials were presented in five slide-tape programs developed by the authors. The key to the course was a behavior change project in which each student identified a problem, designed an intervention strategy, and attempted to manage the problem using the behavioral techniques presented.


Relative discernment of lesions by intraoral and panoramic radiography. Panoramic and intraoral periapical radiographs were compared for their demonstration of pathologic conditions in patients seeking general dental care. Panoramic views allowed additional detection of noteworthy lesions that were not detected by intraoral survey in 5.3% of the cases reviewed, with only 0.1% or one patient in 1,000 possibly requiring treatment. The paucity and lack of urgency of the pathologic conditions discovered solely by panoramic radiography suggest that the expectation of a high incidence of detection of such conditions cannot be used as the sole rationale for the routine use of this procedure as an adjunct to the intraoral survey.


Placebos in dentistry: their profound potential effects. The placebo effect may influence the treatment of patients with postextraction pain, localized osteitis, and myofascial pain dysfunction syndrome, to name a few. The patient, the doctor, and the situation all influence the placebo effect. This phenomenon is still not understood, and further research is needed. The practitioner should learn to utilize the placebo effect for its potential benefits.


Supracrestal fiberotomy.

Supracrestal fiberotomy. Details of a surgical technique to divide the free gingival and transseptal fibers around rotated teeth that have been corrected orthodontically are outlined. The rationale of the procedure, its applications, indications, and contraindications are discussed. Supracrestal fiberotomy is not a substitute but an adjunct to normal retention procedures.


Retention and effectiveness of a single application of an adhesive sealant in preventing occlusal caries: final report after five years of a study in Kalispell, Montana. The single application of a BIS-GMA adhesive sealant in Kalispell on a paired half-moouth basis and the annual monitoring of the sealed sites for five years is not a recommended preventive regimen. The study does proved information on the potential long-term in vivo retention of the sealant and its ability to prevent dental caries. The findings of this study clearly show that when this pit and fissure sealant is retained, its is effective in preventing caries in sealed tooth surfaces. Moreover, on occlusal surfaces, the usual susceptibility to decay is not altered by having been treated with a sealant that is not retained.


Oral manifestations of acute leukemia in children. Seventy-seven children with acute leukemia were examined. A wide spectrum of oral findings was observed as the consequence of direct leukemic infiltration of tissue, infection resulting from bone marrow and immunosuppression, impaired healing responses, and poor oral hygiene. Guidelines for dental treatment are provided.


Osteochondromatous exostosis of the condyle. Osteochondromatous exostosis of the condyle is rare. When these exotoses become large, they can cause temporomandibular pain and clicking with mandibular movements. Treatment consists of surgical removal of the mass. Adjunctive care may include use of intermaxillary fixation, training elastics, and jaw exercises.


Patient susceptibility limits to the effectiveness of preventive oral health education. A preventive oral health care regimen will not succeed for every dental patient. Instruction probably will not be effective unless the patient has a good general attitude toward all his health habits. Dentists who have developed a preventive program should individualize the treatment to obtain maximum patient susceptibility.


Rhinocerebral mucormycosis.

Rhinocerebral mucormycosis. Rhinocerebral mucormycosis is a fungal diseases that has a 50% mortality. Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that mya compromise the immunologic defenses of the host or alter the normal flora. The earliest signs, ulceration and pain, may appear in the mouth. In the patient described in this report, the autopsy showed that mucormycosis had entered the brain cells.


Post-tetanic mechanical tension and evoked action potentials in McArdle's disease. The tension produced by the cramp evoked in the adductor pollicis muscle by repetitive stimuli to the nerve (20/s for 50 s) and by full voluntary effort in the brachial biceps was measured in a patient with McArdle's disease. The contracture was 17% of the peaktetanic tension, and was not associated with action potentials. Twitches superimposed on the contracture were at most diminished to half, as were their action potentials. Both slow and fast muscle fibres participated in the contracture. The contraction time of the twitches elicited after the tetanus was prolonged more in the patient than in a normal subject of the same age. There was evidence of delayed firing, first observed 90 seconds after the peak of the contracture. The patient had electromyographic and histological signs of myopathy.


The art of history taking.

The art of history taking. The art of history taking involves the ability to recognize the interrelationship between the details of the medical history and the patient's personal history. For the oral surgeon, this provides important insights into how the patient has reacted to illness in the past as well as how he is most likely to react to current treatment. Specific problems have been reviewed as well as suggested interview techniques to guide the oral surgeon in his management of his patient's reactions. No one expects the doctor to be an iconoclast. He cannot be all things to all patients. He should recognize a problem, acknowledge it as a problem, and be flexible enough to deal with it or refer the patient to someone who can. This kind of understanding will enable the oral surgeon to fulfill his role with appreciation from his patients and an inner sense of professional and personal achievement.


Hyperbaric oxygen in the adjunctive treatment of chronic osteomyelitis of the mandible: report of case. A case of chronic osteomyelitis has been presented to show the effectiveness of hyperbaric oxygen in treatment of this disease. Surgical intervention is needed, as are adequate cultures, even though the cultures may be difficult to obtain and identify. Because the antibiotic therapy may need to be changed during the course of the disease, the selection of antibiotics should be dictated by positive cultures as well as the clinical course. Antibiotic therapy is needed for four to six weeks after abatement of symptoms.


Mandibular-piriform aperture wiring for fractures in infants: report of case. A case was presented of bilateral subcondylar and parasymphyseal fractures of the mandible in a 16-month-old boy. The case was treated by mandibular-piriform fixation. The advantages of this procedure are described.


Tuberculous osteomyelitis of the mandible with pathologic fracture. A case of disseminated miliary tuberculosis with a lesion of the left side of the mandible leading to pathologic fracture has been presented. The primary medications and the basic principles of treatment have been reviewed.


Inverted-L osteotomy for correction of mandibular prognathism after relapse. As more orthognathic surgery is performed, more case of relapse can be expected. A case of re-operation of a recurrent prognathism has been reported. An alternative surgical approach was used because the planned operation could not be accomplished. However, the implications of the use of the technique are broader than the single example given in this report. The inverted-L technique, because of its similarity to the combined oblique osteotomy and coronoidectomy for correction of extreme prognathism, provides an alternative procedure that leaves a greater proportion of the masticatory musculature in its natural position. In addition, with the development of techniques and instrumentation for intraoral approaches to oblique osteotomy of the ramus, the feasibility of an intraoral inverted-L osteotomy becomes apparent and the approach merits further consideration.


Brown tumors associated with secondary hyperparathyroidism of chronic renal failure. Two cases of brown tumors associated with secondary hyperparathyroidism and chronic renal failure are reported. Both patients underwent excision of the tumor because of mechanical interference. Subsequent parathyroidectomy has substantially improved the general status of the patients.


Prevalence, location, and patency of accessory canals in the furcation region of permanent molars. One hundred and two extracted permanent molars were debrided in 3% H2O2, sealed at the apex, and placed in a vacuum chamber. Safranin dye was introduced into the teeth that were placed in a vacuum of 525 mm of Hg. Observations were made of the external root surface to determine any staining due to patent accessory canals. Accessory canals were demonstrated in the "furcation region" in 28.4% of the total sample; 29.4% in mandibular molars, and 27.4% in maxillary molars. Of the total sample 25.5% exhibited canals in the "furcation" only, while 10.2% exhibited canals on the lateral root surface. Communication between the pulp chamber and the external surface was noted via dentinal tubules, especially when the cementum was denuded. The salient biologic and pathologic ramification of these aberrant canals were discussed along with the need to establish a differential diagnosis in order to determine the proper sequence of treatment should pulpal-periodontal disease exist.


The effects of root shape and biology on bone growth. A statistical study was carried out on the influence of root surfaces on adjacent cellular activity. This activity is indeed affected by both the shape and the biology of those surfaces. Flat surfaces tend to inhibit, nicked surfaces tend to stimulate bone formation in a bone-growing environment. A biologic effect is exerted by the matrix of diseases roots. They contain an inhibitory principle which is not present in healthy roots. This factor is masked by the apatite structure and is destroyed by heat.


Quantitation of retention of endosseous dental blade implants in dogs. This research was initiated in order to study the extraction forces associated with solid, single-vented and multi-vented blade dental implants placed in mandibles of dog for 2 months. An extraction device was used to measure the extraction forces on five of the implants and a histological study was carried out around the sixth multi-vented implant. The main finding was that the extraction forces for the multi-vented blade implants were 6 to 12 times those of the single-vented and solid blades. Other findings in this study were: none of the implants exhibited mobility; sulci ranged from 2 to 3 mm at the implant neck; bone covered the implant shoulder. There was gross and histologic evidence of bone growth in the vents of the multi-vented blade; close adaptation of the bone, connective tissue capsule and implant; and no gross, histologic, clinical or radiographic evidence of bone pathology.


A simple shield for radiographic film.

A simple shield for radiographic film. The fabrication and use of a simple shield to protect radiographic film during exposure of a full series has been described.


A simplified technique for fabricating a lightweight obturator. Polyurethane foam was used as a core material in the fabrication of a lightweight obturator. This is a time-saving method of achieving a meaningful reduction in the total weight of a prosthesis while increasing strength and facilitating repair.


Observations on the use of the Denar pantograph and articulator. An investigation was undertaken to determine the reproducibility of articular settings from graphic records of simulated mandibular movement using the Denar pantograph and the Denar D4-A articulator. The results of the study showed that most of the articulator adjustments were reproducible with a reasonable degree of accuracy, although not quite to the extent one would hope for. The rear-wall and top-wall adjustments are of questionable value in reproducing mandibular movements with this technique, since the results for these adjustments in the present study were unreliable. However, familiarity with the technique gave better results, as shown in the third experiment. It would, therefore, seem that much of the basis for adverse reports depended upon results obtained by operators with insufficient experience in the technique.


Hyperbaric oxygenation: prosthodontic responsibilities. This article discussed the use of hyperbaric oxygen in the treatment of chronic osteomyelitis, osteoradionecrosis, and nonhealing wounds. The fabrication of custom-fitted oxygen applicators is presented, and specific recommendations are made for their use. The prosthodontist serves as a valuable member of the hyperbaric treatment team. His professional knowledge and technical expertise allow him to construct treatment applicators which are professionally sound and provide comfort for the patient.


Influence of immediate dentures on oral motor skill and speech. An investigation was designed to test whether the precision of finely coordinated orofacial movements is influenced by the transition from natural to artificial dentition. The oral motor skill of 16 patients was tested before extraction and within 2 weeks of wearing immediate dentures. Speech recordings were employed to detect changes in voice quality and speech sound production. Results showed that the loss of natural teeth and the wearing of immediate dentures did not alter sensorimotor pathways significant to the precision of oral motor skills. It was also determined that physical characteristics of dentures are significant factors in the production of acceptable speech.


Histochemical and histopathologic studies of alveolar mucosa under complete dentures. An investigation was made of the enzymatic, histochemical, and histopathologic characteristics of clinically healthy edentulous mucosae of non-denture wearers. The effects of dentures on the oral mucosa were examined and related to the length of time that dentures were worn. Succinodehydrogenase, acid phosphatase, and alkaline phosphatase enzymes were used along with periodic acid Schiff's stain. Hematoxylin and eosin stain was used for the histopathologic study. The results indicated that a denture stimulates the underlying mucosa for the first 3 years. A healthy mucosa results, showing slight hyperkeratinization and increased enzymatic activity. After 3 years there are atrophic changes which can lead to inflammatory changes. There is also a reduction in enzyme activity associated with wearing dentures for more than 3 years. Remaking the dentures after 3 years increases the enzymatic activity of the alveolar mucosa.


A histologic evaluation of tissue response to three currently used temporary acrylic resin crowns. The subgingival placement of any one of the three types of temporary crowns placed on 28 posterior teeth of seven subjects caused no detectable change in the gingiva over a 3 week period. There is a need for further study of the influence of temporary crowns on the different types of gingival tissue.


Articulator adjustments using the transfer vise. The transfer vise, a new instrument that is used for the adjustment of articulators, is described. Its application to one articulator, the Simulator, is presented in detail. The technique using the transfer vise is compared to other existing techniques, and its advantages and limitations are discussed. The transfer vise and its technique are recommended for the routine treatment of fixed and removable prosthodontic patients.


Evaluation of the use of a face-bow in complete denture occlusion. A study was conducted that compared three arbitrarily located axes to the true hinge axis location on ten subjects. Of the 60 different arbitrary axis locations registered, 55% were within 6 mm of the true hinge axis. The results of this study revealed very small differences between a hinge axis face-bow. Hanau 132-SM face-bow, and the Whip-Mix ear face-bow. A linear deviation range of 0.116 to 0.268 mm is of doubtful clinical significance to complete denture construction. If an articulator like the New Simplex is used without a face-bow and with a 3 mm interocclusal wax record, it can be anticipated that there will be a 1 mm deviation in the anterior direction in centric occlusion. This discrepancy, incorporated with errors due to processing, can be eliminated by remounting the finished complete dentures with a new centric relation record for occlusal correction.


A safe crown-removal technique.

A safe crown-removal technique. A method has been described that may help the dentist in removing ceramic-metal restorations that resist easy removal from the teeth during the fitting procedure and after temporary or final cementation.


Tear strength of elastomeric impression materials. 1. Under simulated clinical conditions the maximum tear strength of those materials tested was reached in 10 to 15 minutes. 2. The polysulfide materials showed three to six times the tear strength of the silicones. 3. The polyether material displayed a tear resistance slightly higher than that of the silicones but one third to one fifth as high as that of the polysulfides. 4. The clinical significance of the differences in tear strength was undetermined since other factors (such as adhesion) were not considered.


Using pantographic tracings to detect TMJ and muscle dysfunctions. Forty-six subjects were examined using the HDI and a PRI. Two sets of pantographic tracings were used to determine if subjects experiencing dysfunction could differentiate between degrees of dysfunction. Subjects were divided into groups according to their clinical symptoms: none (D0), sligh (D1), and moderate dysfunction (D5). Each subject was further classified into one of two groups according to his state of occlusion/articulation. The PRI detected differences between the group with moderate dysfunction and those groups with no dysfunction and slight dysfunction on the basis of differences between the first and second sets of tracings; no difference was found between the groups with slight and moderate dysfunction. Subjects with poor occlusions had higher PRI scores. The diagnosis of TMJ dysfunction may require the use of several modalities such as subjective responses, clinical examination, radiographs, and pantographic tracings.


The anatomy of a smile.

The anatomy of a smile. The anatomy of the smile is an integral part of dentistry. Its understanding involves close scrutiny of all elements of the oral region. It is not enough to establish the size of teeth based on the high and low lip lines, size of the mouth, and a shade to blend with the age and complexion. To create a harmonious smile the dentist must maintain or create the normal curvature of the lips, proper exposure of the red zone of the lips, an undistorted philtrum, and undisturbed nasolabial grooves. These entities, maintained in harmony with the exposed teeth, constitute the anatomy of a smile. In order that patients may be served properly, the smile must be understood, recorded, and analyzed so that desirable aspects may be preserved and graceless components returned to attractiveness.


Procedural problems in using the Denar pantograph as a transfer-bow. A method has been described for using zinc-oxide/eugenol paste as an interclutch support when the Denar pantograph is used as a transfer-bow. Using this technique a stable centric relation position can be maintained during the maxillary cast mounting procedure and the subsequent setting of the articulator to the pantographic recordings.


Practical considerations in iontophoresis of fluoride for desensitizing dentin. A review of the literature on treatment of dentin hypersensitivity by use of fluorides and fluoride iontophoresis was presented. It was concluded that topical applications of fluoride are modestly effective for treatment of dentin hypersensitivity, but the most rapid and effective relief follows fluoride iontophoresis. This technique has a broad application in dental practice since fluoride iontophoresis was shown to be an effective desenitizer in cavity preparation, before cementation of restorations, and in cases of occlusal wear and enamel hypoplasia. The report also presents a new and effective method for the iontophoresis of fluoride for dentin desensitization.


Polyurethane elastomers for facial prostheses. A review of the polyurethane elastomers used for facial prostheses has been presented. A description of the casting technique was given. The materials require accuracy and care in handling to insure the successful casting of a prosthesis. They seem to simulate the characteristics of the facial tissues and are more durable and comfortable than previously used materials. Over 300 patients have been exposed to or treated with these materials without evidencing significant adverse tissue reaction. In spite of the improvements that these materials present over previous ones (PVC and silicones), much work is still required to understand their behavior and their physical and mechanical characteristics and to compensate for the metameric phenomenon.


Vinyl chloride concentrations in maxillofacial prosthetics laboratories. Air sampling was conducted in three maxillofacial laboratories to determine whether vinyl chloride, a carcinogen, was released during the formulation of polyvinylchloride facial prostheses. Results show that time-weighted average exposures of technicians were less than 0.1 ppm, a concentration meeting current U.S. Department of Labor standards.


Cytodifferentiation in the acute myeloblastic leukemias of man. Correlation analysis of numbers of colony-forming progenitor cells was used as an approach to the quantitation of human pluripotent stem cells. Marrow specimens were obtained from 24 patients with untreated acute myeloblastic leukemia, 22 patients under treatment, and 29 patients with no hematologic malignant disease. Three classes of progenitor cells were assayed: burst-forming units dependent on erythropoietin (BFU-E), colony-forming units dependent on erythropoietin (CFU-E), and granulopoietic progenitors (CFU-C). Significant positive correlations between numbers of BFU-E, CFU-E, and CFU-C were found in all 3 groups of patients. In contrast, no such positive correlations were seen between marrow blasts and any of the classes of colony-forming progenitors. These results were compatible with a shared relationship of the colony-forming progenitors to a pluripotent cell of origin and raised the possibility that the immediate progenitors of the blasts may not be any of the myelopoietic progenitor cells monitored in these studies.


[Acute hemorrhagic meningoencephalitis due to rubella-infection in acute lymphatic leukemia (author's transl)]. We observed a fatal meningoencephalitis in a patient who suffered from acute lymphatic leukemia. The infection occurred after complete bone marrow remission. As the cause of this complication we discovered a rubella-infection, whose beginning had been several weeks ago. Relations to several forms of rubella-encephalitis in otherwise healthy patients are discussed and pathogenetical conclusions are made.


[Influence of remission induction therapy on the further outcome of acute lymphoblastic leukemia in children (author's transl)]. An analysis of 66 children with ALL treated during the last 10 years shows an increase in medium survival time from 27.1 +/- 17.8 months to so far 39.3 +/- 15.1 months after the introduction of preventive CNS therapy. In the group with preventive CNS therapy both CNS relapses and hematological relapses are markedly reduced. Furthermore, in the group with preventive CNS therapy, patients initially treated with 3 drugs obviously survive longer than patients initially treated with only 2 drugs. Thus our study shows the importance of the quality of first remission for the further outcome of a patient with leukemia.


[Correlation of the cytochemical classification of acute leukemia in children with the course of their disease (author's transl)]. Acute leukemia in 93 children was cytochemically classified into three groups: 1. the PAS-Typ (acute undifferenciated leukemia) paramyeloblastic leukemia, 2. the AML, and 3. the Acid Phosphatase Typ (SP-Typ). Therapy for the first group differed from that for AML. The acid-Phosphatase-Typ was found in only a few cases, where the acid Phosphatase is good to see in the paranuclear region of the cell. These cases have a bad prognosis. It is proposed to publish even single cases of the acid Phosphatasetype leukemia in order to find the optimal therapy.


Neurologic complications of acute myelomonoblastic leukemia of four years' duration. An adult with acute nonlymphoblastic leukemia involving the central nervous system is presented. Unusual features included: (1) Focal signs and radiographic evidence of sagittal sinus occlusion early in the course of disease; (2) progressive meningeal, cranial nerve, and spinal nerve involvement despite a 4-year bone marrow remission; (3) intracerebral tumor formation, and (4) retrobulbar optic neuritis associated with microscopic findings of herpeslike viral particles. The incidence of clinically overt neurologic disease in adults with acute nonlymphoblastic leukemia seems to have increased in tandem with improved chemotherapy. The prophylactic treatment of the central nervous system during prolonged remission of adult acute nonlymphoblastic leukemia may prove of benefit to these patients.


[Etiopathogenetical, clinical and therapeutic considerations on meningo-encephalic localizations in acute lymphatic leukemias: personal contribution]. The aetiology, pathogenesis, clinical forms and therapeutic attempts carried out in connection with the central nervous system localizations in acute lymphoblastic leukaemia, on the basis of an extensive review of the literature and of personal experience are examined. The particular role which central nervous system leukaemia plays on the subsequent clinical course of the disease is stressed and the efforts made, both prophylactically and therapeutically, in order to decrease the incidence of this complication, which invariably has a deteriorating influence of the progress of the disease are described.


Contraceptive use and pregnancy planning in the Hutt Valley. This survey, carried out in an area where there are good family planning services, demonstrates that such surveys can be successfully carried out in New Zealand where so far there is little data on contraceptive practice and pregnancy planning. This article compares failure rates of several contraceptive methods and shows that most women in the survey sample had had some experience in contraception during the previous three years. Pregnancy planning overall is seen as poor, with 29.9 percent of all pregnancies being unwanted at the time of conception.


Social characteristics of patients attending a private early pregnancy termination service in Auckland. During a two-year period, 5143 of 6303 patients referred, had a therapeutic abortion at a private service in Auckland. The basic social characteristics of these patients and the workings of this service are presented. Reasons for denial of abortion requests in 18.4 percent of patients are discussed.


Daycare Pomeroy sterilisation by the vaginal route. One hundred consecutive Pomeroy sterilisations were performed via the posterior vaginal fornix. In 50 cases the patient went home on the day of operation and was visited by a district nurse at home. The other 50 cases remained in hospital as inpatients for a minimum of 36 hours. The morbidity in the two groups was the same. The advantages of the daycare approach are discussed.


Health and mortality status of the West Coast population 1969-72. Findings presented confirm and extend earlier evidence that people living on the West Coast of the South Island are disadvantaged in terms of mortality status. This is so of total mortality, of most ages, of neonatal but not post-neonatal or total infant mortality, and of the several major causes of death. In addition the frequency of dying is found to be higher among the unmarried compared with the married, and greater among blue rather than white collar workers.


Non-medical drug use in students.

Non-medical drug use in students. A questionnaire was used with tertiary education students. This obtained information regarding the use of, and attitudes towards, various illicit drugs, tobacco and alcohol. The results demonstrate the almost universal acceptance among the samples of regular alcohol use. Tobacco and cannabis are the next most popular social drugs, used by about one-third of those surveyed. Respondents' reasons for regular use suggest wide acceptance of these drugs to alleviate psychological discomfort. Use of other illicit drugs remains minimal.


Accidental poisoning in children: a psychosocial study. Fifty pre-school children thought to have ingested potentially poisonous substances were studied, together with 50 controls. An interview of each child and mother was undertaken in the home situation. Seven at-risk factors make a child more likely to ingest a toxic substance. These are: greater accommodation changes by the family, father having had a large number of jobs, paternal past history of accidents, child's exploring ability, child's past history of poisonings, an abnormal appetite in children older than two years old and lower stimulation indices in 2-5 year-olds. Attention is drawn to the similarity between many of these factors and childhood abuse and neglect.


Accident and emergency services at Auckland hospital. This is an investigation of the role that the accident and emergency department of the Auckland Hospital plays in the provision of medical care in the Auckland area. It is demonstrated that a significant part of the work that is done in that department could equally well be performed by general practitioners and that there is a need for further education of the public concerning the delivery of health care.


The content of some trace elements in infant milk foods and supplements available in New Zealand. The concentrations of iron, copper, zinc, manganese, nickel, cadmium and lead are reported for milk foods and supplements offered to infants before the introduction of mixed feeding. Levels of most of the trace elements in samples of breast milk and homogenised cows' milk were within the ranges reported overseas. Most of the milk products should supply adequate amounts of iron, copper, manganese and nickel to the young infant although zinc intakes may be marginal. Concentrations of cadmium and lead were well below the maximum values permitted by law.


Hepatitis B surface antigen and antibody among Samoans living in Christchurch. Ninety-six Western Samoan volunteers were examined for the presence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). Seventy-two volunteers were full blooded Samoans and four were found to be asymptomatic carriers of HBsAg. No mixed blood volunteers had detectable HBsAg by either haemagglutination or radioimmunoassay techniques. Fifty of the 72 full blooded Samoans had anti-HBs detectable by radioimmunoassay. Eight of these reactions were only weakly positive. Seventeen of the 24 mixed blood volunteers had detectable anti-Hbs. All were Samoan born. This study suggests that Samoan born Somoans should provide a valuable source of anti-HBs if New Zealand preparation of this antibody is contemplated.


Recreational drug use among Auckland high school students. The first large scale questionnaire survey of Auckland high school students demonstrated widespread use of alcohol, a slight drop in tobacco use relative to an earlier survey and almost one-third of the students prepared to take marihuana if the opportunity arose. The reasons given by the students for their regular use or abstention from various drugs are discussed in the context of pervasive drug use throughout New Zealand society and the drug information currently available to high school students.


After hours availability of general practitioners in Canterbury/Westland: a survey. The results of a postal questionnaire to 185 general practitioners in the Canterbury-Westland agea are discussed. The intention was to describe the after hours provision for patients made by general practitioners. The study indicates that about one half of doctors are on call on weekdays evenings and about a third on weekends. Only a handful of doctors provide no cover. The kind of cover provided is discussed and the patient load during such hours is analysed. Figures are presented which suggest that Canterbury practitioners are marginally younger than the national average; that most doctors (100 out of 106 responding) have formal cover arrangements; that 82% are on duty no more than one weekend a month (less often for group practitioners); that about two-thirds have a regular half-day free during the week; that about two-thirds of after hours call are judged to be justified.


Correlates of impulsive suicidal behaviour. Up to two-thirds of reported suicidal acts are impulsive in nature. In a series of patients presenting at a general hospital as a result of suicidal behaviour, it was concluded that over half the acts were impulsive in nature. A number of variables were found to be related to the occurrence of impulsive suicidal behaviour and they included the following: a past history of suicidal behaviour, the tablets being in the same room when the decision to engage in the act was reached, the ingestion of more than half the available tablets, and finally, the tablets tending to be bottled rather than foil packaged. Findings were discussed in terms of the aetiology and prevention of impulsive suicidal behaviour.


Current health problems in the South and Central Pacific. Tabulation of monthly reports of infectious diseases from 19 countries and territories in the South and Central Pacific for the years 1973 through 1975 indicated that influenza-like illness, dengue, dysentery, measles, and gonorrhoea were the greatest problems. Reports of the leading causes of hospitalisation from 11 areas indicated that infectious respiratory disease, gastroenteritis and accidents were the most common problems requiring hospitalisation in most Pacific countries. The leading causes of death showed a different pattern with striking differences between traditional and modernised areas. It appeared that the major causes of death were changing from infectious diseases in the traditional areas to chronic diseases such as cardiovascular disease and cancer in the modernised areas.


Hryntschak prostatectomy: a review of 900 patients. A personal series of 900 consecutive Hyrntschak prostatectomy operations is reported. Haemostasis with this method is excellent and post-operative haemorrhage has been much less of a problem than in the past. In this series there were 24 hospital deaths (2.6%) 19 of these being in bad-risk patients, the other five being due to pulmonary embolism in good-risk cases. The average post-operative hospital stay in the survivors was 10.6 days. In the last 300 cases there were six deaths (2%)--five bad-risk cases, one pulmonary embolus--and an average hospital stay of 9.2 days.


Tropical fish tank granuloma.

Tropical fish tank granuloma. A case of tropical fish tank granuloma due to mycobacterium marinum is presented. The source, epidemiology, diagnosis and treatment are discussed.


Psychotherapeutic prescribing patterns in general practice. An analysis of more than 25 000 prescription items dispensed between January and May 1976 in a rural town (Ashburton) and a city (Dunedin) has indicated that one item out of every eight written in general practice is for a psychiatric symptom, and that of these psychotherapeutic agents, almost three out of every four are written for adult women. In addition it has been shown that the consumption of psychotherapeutic agents in the urban environment of Dunedin city is significantly higher than that in the rural town of Ashburton.


A clinical trial of cyproterone acetate for sexual deviancy. Cyproterone acetate was used in the treatment of ten patients presenting with problems of sexual deviancy. Of these six completed the course of treatment over a period of one year and psychological, medical and endocrinological measures were recorded.


Generalised amyloidosis with involvement of the parathyroids: case report. A case of generalised amyloidosis is described. Attention is drawn to the involvement of the parathyroids, an uncommon site of amyloid deposition. The histology and ultrastructure are illustrated and the relevant literature reviewed.


Viral hepatitis among practising dentists. A survey among Auckland dentists has shown a high experience of viral hepatitis occuring during practising years. The prevalence of dentists affected is higher than for similar groups of American dentists, and the incidence of viral hepatitis among dentists practising in Auckland appears to be rising. This study supports the view that infection with viral hepatitis should be regarded as a occupational health risk for practising dentists.


Towards an accurate measurement of dietary fibre. A method of acid and neutral detergent extraction of food has been used to measure the cellulose, hemicellulose and lignin content of a number of New Zealand foods. Foods can be classified as those high or relatively high in hemicellulose and those high or relatively high in cellulose and lignin. The accurate determination of this fibre content is of importance in understanding the physical, chemical and bacteriological effects of various fibre components in preventing or causing disease.


Patients denied abortion at a private early pregnancy termination service in Auckland. Follow-up of patients who were denied abortion at a private early pregnancy termination service shows at least half of the sample eventually had an abortion elsewhere.


Scombroid poisoning--recapitulation on the role of histamine. The histamine content and the total vagal stimulating activities in various fish samples involved in an outbreak of food poisoning were compared. There was a close correlation between the two levels and there was lack of potentiation between histamine and other non-active fractions. The role of histamine in scombroid poisoning is discussed in the light of these results.


An audit of weight reduction in a diabetic clinic. A group of long-term attenders at a diabetic outpatient clinic were compared with new patients who were referred for the first time by their own general practitioners. There was some evidence that first attenders, especially women, appear to lose weight significantly over the subsequent three years, such weight loss being more marked when the diet therapy is also combined with a re-organisation of their attendances over a month, to provide education both to the patients and to the relatives. This preliminary information suggests that the development of patient self-sufficiency programmes in diabetes in the New Zealand setting appears to have economic justification.


Neuroblastoma: a twenty year review.

Neuroblastoma: a twenty year review. A retrospective study was made of children with neuroblastoma presenting to Princess Mary Hospital over the past twenty years and to Green Lane Hospital over the past fifteen years. There was an increase in the numbers of children presenting over the years. The majority of patients were under five years of age and half of them were under two years. The majority of cases had an abdominal tumour, and abdominal mass was the commonest mode of presentation. In general, those children under one year of age and early stage and/or a primary tumour outside the abdomen, had a far better prognosis. A particularly good prognosis was noted in those children under one year of age with metastases confined to the liver skin and bone marrow (stage IVS).


Systemic lupus erythematosus and avascular bone necrosis. Two cases of systemic lupus erythematosus (SLE) developing avascular bone necrosis are described. One case had eight separate areas involved (shouldres, hips, knees and both distal tibiae), which is the largest number in a single case of SLE yet reported. In both cases, at the onset of symptoms of necrosis in a new area, the antinuclear factor increased markedly compared to the preceding level. This indicates that the onset of the pathological process leading to necrosis is due to increased activity of the SLE rather than the steroid treatment.


Cervical spondylotic myelopathy in wide canals. The anteroposterior diameters of the cervical spinal canal in 21 patients with cervical spondylotic myelopathy were measured. In more than one-third (eight) of these it was found that this diameter of the canal was more than 14 mm, despite a widely held belief that this myelopathy is unlikely if the cervical spinal canal is wider than 14 mm in the AP diameter.


Classification of glomerulonephritis.

Classification of glomerulonephritis. A classification of glomerulonephritis which is being used as a basis for the New Zealand National Study of Glomerulonephritis is presented, together with comments about the salient pathological features of each type of glomerular disease.


Auckland hospital ethical committee: the first three years. A committee responsible for the ethical surveillance of research involving human subjects has been in existence at the Auckland Hospital for over three years. Guidelines for clinical investigators have been published and a form of application for approval of research projects designed. Major problems grappled with in 121 research projects are outlined. The need for such ethical surveillance appears to have been established beyond reasonable doubt.


Models for hospital care.

Models for hospital care. Analyses of hospital functioning are frequently reported with patient outcomes as the independent variable. However, the main focus in this paper is the length of stay in hospital not just in terms of "short stay" or "long stay", but ranked in tenths so that ten-point distributions of patient use of hospital resources are available for study. From the analysis of these distributions three patterns emerge: (a) a "standard procedure" model with best fitting "curves" given by a linear function, eg routine surgery; (b) a "finite disease" model (exponential series) eg internal medicine and, (c) a "person in hospital care" model (power series) eg psychiatry.


Endometrioma of the rectum: case report. A case of endometrioma of the rectum is reported. This was clinically indistinguishable from a carcinoma. The difficulties of diagnosis and management are emphasised.


Phospholipid monolayers and systemic lupus erythematosus. A hypothesis is presented of the fundamental cause of the systemic lupus erythematosus. From a study of the molecular interaction of procainamide with phospholipid monolayers, it is proposed that the drug causes phospholipid loss from the cell membrane. Chronic phospholipid loss would lead to cell lysis and antinuclear antibody production.


Follow-up of past tuberculosis, its value and limitations. Recently the policy of life-long follow-up of tuberculous patients has been questioned, particularly for those who have taken adequate chemotherapy. To assess the value of follow-up at a chest clinic, the relapse rate of approximately 3000 male patients was examined and found to be 0.51 percent annually during the last eight years. It was 0.46 percent amongst those treated prior to the introduction of prolonged chemotherapy, 0.55 percent anually amongst those prescribed at least 18 months chemotherapy. No relapses would have been missed if all the patients had been followed for five years after ceasing chemotherapy and only selected groups subsequently. The selected groups included, those not prescribed adequate chemotherapy in the past, those suspected of irregularity of drug intake, alcoholics and those with atypical or resistant organisms. It was concluded that patients adequately treated with chemotherapy need not be followed up after five years.


Renal biopsy pathology in Auckland, 1969-1976. The pathology of 1058 samples of kidney tissue studied during the past seven years as part of the renal biopsy service in Auckland is reviewed. About half of the samples were examples of glomerulonephritis, with diffuse proliferative and exudative glomerulonephritis being the most common finding. In the group of focal glomerular disease, lupus nephropathy and Goodpasture's Syndrome were frequently diagnosed.


Serum digoxin levels in neonates, infants and children with heart disease. Serum digoxin levels were measured in 53 neonates and infants receiving 18-22 microgram/kg/day (high dose) oral maintenance digoxin, and 44 neonates, infants and children receiving less than 18 microgram/kg/day (low dose) oral maintenance digoxin. In both groups, patients under four months of age had significantly higher serum digoxin levels than older patients, in the high dose group 2.6 ng/ml compared with 1.4 ng/ml and in the low dose group 2.2 ng/ml compared with 1.0 ng/ml. Correlation between digoxin dosage and serum level was weak and unaffected by blood urea level. Only two patients in the entire series showed toxic manifestations. Sixteen patients had serum digoxin levels measured before and after corrective cardiac surgery while receiving comparable dosages of digoxin. Despite lower serum digoxin levels postoperatively pulse rates fell significantly, illustrating the influence of changing haemodynamic status on the inter-relationships of digoxin dosage, serum levels and clinical response. Recommended dosage regimens are outlined.


Death certification in Dunedin hospitals. An analysis is presented of death certification in Dunedin Hospitals. The study involved a comparison of death certificates with post-mortem findings in 643 deaths which occurred in Dunedin hospitals between 1 October 1971 and 30 September 1973. The cases were categorised according to diseases in the various body systems. The study also involved consideration of the format of the current death certificate and of attitudes towards death certification. Serious defects have been revealed in all areas of the study which are considered to be representative of the national scene. Errors of epidemiological significance were found in 64.7 percent of the certificates, and in 57.5 percent of individual diagnoses. Responsibility for the defects lies with the certification itself and not with the statisticians who diligently compile mortality data from the information supplied to them.


Endocrinology of normal pregnancy and premature labour. Peripheral plasma levels of the biologically important hormones of pregnancy--plasma oestradiol 17 beta, plasma oestriol, plasma progesterone, human placental lactogen (hPL) and human chorionic gonadotrophin (hCG) have been measured serially in a control group of 10 normal women who delivered at term +/- three days. A second group of patients were similarly studied when admitted in premature labour and the levels compared with the control group. The levels of all hormones except human chorionic gonadotrophin increased till 37 weeks. After the 30th week, the increase of oestriol was steeper than oestradiol and hPL. The hormone profile of the maternal plasma is a good index of feto-placental function. The hPL levels which heralded the increase in endocrine function of the feto-placental unit were also elevated in premature labour, suggesting a casual relationship of significance. Levels of plasma oestradiol in premature labour were considerably higher than in the control study and suggests an endocrine basis for premature labour of hitherto unknown aetiology.


Seat belt injury of the colon.

Seat belt injury of the colon. Two cases of seat belt injury of the colon are presented. In each case a gangrenous tube of mucosa remained while the muscle layers and adjacent mesentery were divided. The delay before the severity of the injury is appreciated is emphasised.


The susceptibility of New Zealand isolates of leptospira to three antibiotics. The susceptibilities of 14 recent isolates of Leptospira to benzyl penicillin, tetracycline and minocycline, were tested. All strains were highly susceptible to penicillin. The minimum inhibitory concentrations (MIC) of the two tetracyclines were generally low, and no significant difference was found between them.


Haemostasis in traumatic injury to the portal vein. A case of penetrating thoraco-abdominal injury involving portal vein in the free margin of lesser omentum is reported; light traction on a tape sling or a tape tourniquet around the hepato-duodenal ligament applied just above the level of duodenum is an effective method of achieving haemostasis and space necessary for repair of portal venous injury at this site.


A simple method for the prevention of postoperative thrombo-embolism. A simple appliance for the prevention of postoperative thrombo-embolic disease is described and a plea is made for its use in a multicentre trial. A modified device should be placed in the beds of all high risk medical, surgical and obstetric patients.


A random blood sugar diabetes detection survey. In a co-operative study undertaken between various groups in the community, 3212 persons were screened at the Agricultural and Pastoral Summer Show in Christchurch. The mean glucose value was 88.4 mg/dl (4.9mmol/l) which roughly equates to 91 mg/dl (5.1mmol/l) plasma value. There was a standard deviation of 19.5mg/dl (1.08mmol/l) the 22.5 percentile was 63mg (3.5mmol/l), the 97.5 percentile was 125 (6.5mmol/l). One hundred and twenty persons of the total of 3212 were advised to contact their family doctors as a result of higher than normal blood sugar levels on the day. Twenty-five probable diabetics were diagnosed.


Serum levels of immunoglobulins A, G and M in New Zealand and Tokelauan children. Serum levels of immunoglobulins A, G and M are described in a group of New Zealand (NZ) children of European descent. These findings are used as reference standards for three groups of Tokelauan children, atoll residents, migrants in NZ, and NZ-born Tokelauan children. All three Tokelauan groups had high levels of IgA, IgG, and IgM. Breast feeding was diminished and morbidity was higher in the NZ-born group. The IgG level was negatively correlated with duration of breast feeding in this group. In the atoll group IgG was related to present illness but no other consistent relationships were found between present illness status and the immunoglobulin levels. It remains unclear whether the high Tokelauan immunoglobulin levels are genetically or environmentally determined.


Drug prescribing in rheumatoid arthritis in Otago. The drug therapy prescribed for a group of 50 patients with rheumatoid arthritis in Otago prior to specialist referral was examined. Thirty-two patients were receiving some first-line anti-inflammatory drugs and six were receiving no therapy at the time of their first hospital clinic visit. Salicylates had been prescribed first in only 16 of the 50 patients while this drug had been withdrawn because of side effects in about one-third of the patients who had been treated with it prior to specialist referral. Seven patients had received phenylbutazone and six corticosteroids as the first treatment for their rheumatoid arthritis. About one-third of the patients were receiving more than one anti-inflammatory drug at the time of their initial clinic visit.


Drugs which interfere with alcohol metabolism. A review is made of compounds which produce antagonism to alcohol. Some of these drugs are used purposefully in alcoholism therapy to curtail drinking; others, which are administered for quite unrelated reasons in the treatment of different medical conditions, may also cause unpleasant symptoms if alcohol is subsequently ingested.


Hand reconstruction using a damaged index finger. Improvement in the function and appearance of hand brought about by using tissue from a damaged index finger is presented. The damaged index finger could have been retained as a stiff digit or thrown away in the bucket.