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


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


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


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


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


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


Loss of color from Jiffy tubes.

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


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


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


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


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


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


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


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


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


Ceramic augmentation of the lower jaw.

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


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


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


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


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


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


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


Idiopathic bone cavities.

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


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


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


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


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


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


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


Ameloblastic fibroma: report of case.

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


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


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


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


Thickness of facial gingiva.

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


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


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


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


Sophisticated radiology in otolaryngology. I. Diagnostic imaging: roentgenographic (x-ray) modalities. Conventional radiography is now complemented by a large range of newer radiologic diagnostic techniques, involving both roentgenographic and non-roentgenographic modalities. It is the purpose of this presentation to present these new roentgenographic modalities in graphic form, and demonstrate their application to otolaryngic diagnosis. The major roentgenographic modalities which will be stressed are: xeroradiography, angiography, and computerized tomographic scanning.


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


Simultaneous radiation and drug therapy: tumor response and toxicity. Three patients who received simultaneous radiation and chemotherapy are described. Increased tumor response and enhanced radiation reaction were observed. Simultaneous drug and radiation therapy may prove to be the treatment of choice for particular malignant tumors. More data concerning the magnitude of the toxic effects when 2 modalities are used in conjunction is needed. Dose adjustments will be required for each modality to allow for optimal damage to the tumor with minimal and acceptable adverse reaction in the normal tissue.


[Dental caries and the morbidity and mortality index in populations with endemic fluorosis]. Clinical and statistical research, conducted in collaboration with other workers in some instances, into the behaviour of dental decay and the morbidity and mortality indices in populations with dental fluorosis due to the ingestion of naturally fluorinated water in Calabria and Sicily showed that the fears expressed with respect to the toxic effect of fluorine on the organism can be considered excessive. It can also be asserted that fluorine is at present the only means available of ensuring a real reduction caries following its ingestion via various routes.


[Treatment of follicular cysts of the mandible with reduction cystostomy]. A surgical technique is described for the treatment of a voluminous mandibular cyst whereby the contrasting need to preserve the vitality of the teeth whose apex was near the cyst wall and that of preventing marsupialisation due to the difficulty of providing continuous and effective postoperative care were met by cystotomy with reduction of the primary cyst to a small, periapical cyst. The operation was planned to take place in two stages, the idea being to secure radical removal of the remains of the cyst at a later date. An exploratory inspection after 14 months showed that a bone cavity of negligible size and with no sign of a wall was left. Two objectives were thus achieved: maintenance of the vitality of the teeth around the cyst; improved and spontaneous alignment of the teeth to facilitate and simplify complementary orthodontic management.


[Frequency of malocclusion in 800 school children in the province of Pavia]. After a brief review of the literature on the subject, the results of a study of the frequency of malocclusions in 800 primary school children are reported. A very high percentage (80.3%) was observed, with a prevalence of males(83%) over females (77%). The relationships between malocclusions and age and between malocclusions an; caries are also examined.


[Histomorphological features of adamantinoma]. The histomorphological features of ameloblastoma and the literature classifications of this form are examined and a personal series of 19 cases involving the mandible and 2 involving the upper jaw is presented. Cord-like and plexiform pictures were followed by follicular, cystic, cylindromatous and stellate forms in order of frequency. Death occurred in two cases of cylindromatous ameloblastoma.


Cellular distribution of hemoglobin F in a clonal hemopoietic stem-cell disorder. Because all erythroid cells in chronic myelogenous leukemia are believed to arise from a common pluripotent stem cell, we studied the cellular distribution of fetal hemoglobin in patients with the disease to test whether cells with and without hemoglobin F have a common or separate pluripotent stem-cell origin. In a patient with chronic myelogenous leukemia and sickle/beta thalassemia, 17 per cent of the red cells during remission and 18 to 22 per cent during the blastic phase contained fetal hemoglobin. In 24 non-hemoglobinopathic leukemic patients 0.3 to 28 per cent of red cells contained hemoglobin F. Since the erythrocytes in chronic myelogenous leukemia are almost exclusively derived from the malignant clone, these data suggest that cells containing fetal hemoglobin originate from the same pluripotent stem-cell progenitor as those without hemoglobin F. The findings argue against a separate line of "partially switched" pluripotent stem cells as being responsible for maintenance of hemoglobin F production in the adult.


Mandible-like structure with teeth in an ovarian cystic teratoma. The findings of a tooth-bearing mandible-like structure within a large ovarian dermoid cyst is reported. Although the presence of assorted teeth and bone is not uncommon in teratomatous lesions, the formation of an apparent alveolar structure possessing multiple teeth is found less often.


An unusual triad: microdontia, taurodontia, and dens invaginatus. A 12 1/2-year-old white boy was examined and found to have permanent teeth that were smaller than those of the average adult. The microdontia was accompanied by taurodontia of the mandibular molars and several teeth with dens invaginatus. The patient was normal in appearance and had no other illness. The pedigree was compatible with X-linked recessive inheritance.


Antimicrobial effects of N2 in vitro.

Antimicrobial effects of N2 in vitro. The antimicrobial effect of the root canal filling material N2 has been studied in vitro. Pulverized as well as intact set N2 inhibited the growth of the mixed bacterial flora of saliva or pure cultures of S. mutants and A. viscosus on blood agar for at least 100 days. Intact set N2 transferred daily to blood agar inoculated with saliva lost its antimicrobial activity after nine transfers. The antimicrobial effect of N2 against S. mutants was found to be bactericidal. N2 also appeared to possess an antimicrobial "vapor effect".


Cell-mediated immune response to dog pulp tissue altered by N2 paste within the root canal. After pulpal extirpation of twenty teeth in each of four dogs, these animals were primarily immunized intramuscularly with the dogs' own pulp (three dogs) altered by N2 paste and saline solution with pulp (one dog). A fifth dog was used as a control for skin tests. Secondary immunizations were accomplished via the root canal every 7 days over a 28-day period. Cell-mediated skin tests reactions demonstrated less of a response to the N2 paste alone than when the dogs' pulp was altered with this material. In vitro analysis of cell-mediated immune response (lymphocyte proliferation) showed a marked response to the pulp altered by N2 paste as compared to the saline-treated pulp (P less than 0.002). Therefore, dogs' pulp tissue became antigenically altered by the N2 material, recognized by the host, and a specific cell-mediated lymphocyte proliferation resulted.


A microangiographic study of vascular changes in replanted and autotransplanted teeth of young dogs. The purpose of the present investigation was to study the revascularization process of the pulp of replanted and autotransplanted teeth with incomplete root development in dogs. A barium-sulfate injection method combined with contact microradiography was used. Ingrowth of apparently new vessels was seen during the first postoperative days. After 10 days, visible vessels were seen in the apical half of the pulp, and after 30 days, in the whole pulp. Branches and apparently also anastomoses between pulpal vessels were seen after 10 days but were especially numerous after 30 days. One hundred eighty days postoperatively, only one of fifteen teeth was devoid of visible vessels, indicating pulpal necrosis. Thirteen of the remaining fourteen teeth exhibited visible vessels throughout the entire length of the pulp. It seems, therefore, that replanted and autotransplanted teeth with open apices have a high potential for repair. The revascularization of the pulp appeared to occur mainly by ingrowth of new vessels. In some instances, however, anastomoses seemed to form to pre-existing vessels in the pulp.


Subacute pericoronitis from an unerupted supernumerary third molar. Report of a case. Any tooth may be affected by pericoronitis. A case of acute pericoronitis from an unerupted supernumerary third molar tooth is described. The importance of the patient's history and the clinical examination in reaching a diagnosis is stressed.


Thyroglossal-tract cyst.

Thyroglossal-tract cyst. Thyroglossal-tract cyst should be included in the differential diagnosis of any mass found in the anterior midline of the neck. A discussion and review of forty-two cases diagnosed between 1970 and 1976 at Wilford Hall USAF Medical Center are presented.


Frustration and temporomandibular joint pain. The significance of frustration as a cause of temporomandibular joint pain is investigated through the use of bilateral electromyographic recording. Interpretation of both parametric and nonparametric data indicates the lack of relationship. The need for careful controls and the problems of psychologizing are discussed.


Correlative study of pain perception and masticatory muscle reflexes in man. An attempt was made  to explore the possibility of using the masticatory muscle reflexes as pain indices in human subjects. It was found that the digastric reflex, so readily evoked by electrodental stimulation in experimental animals, could not be consistently elicited in man. The reflex silent period of the masseteric muscles, on the other hand, may be used as a pain index for evaluating dental analgesia, provided that analgesic interference is anticipated at points along the reflex arc.


Sialochemistry of patients with rheumatoid arthritis. Electrolytes, protein, and salivary IgA. Sialochemistry was undertaken to detect subclinical involvement of salivary glands in patients with rheumatoid arthritis (RA). The concentrations of salivary sodium and IgA were significantly elevated in 24 percent of the RA patients. Eighty per cent of the patients with elevated sodium and IgA concentrations had keratoconjunctivitis sicca as well. No correlation between serum and salivary IgA levels was found. The results indicate that salivary sodium and IgA levels can be used for detection of subclinical salivary gland involvement and for follow-up of RA patients.


Sialadenoma papilliferum of the oral cavity. Sialadenoma papilliferum is a rare tumor of salivary gland origin. A review of the English-language literature indicates that only four cases have been reported. This article describes the clinical and histologic characteristics of an additional case occurring on the left retromolar pad.


Intradermal nevus associated with epidermoid cyst in the mucous membrane of the cheek. A case of epidermoid cyst associated with an unusual amelanotic intradermal nevus, with structures identical to Meissner's tactile corpuscles, is reported. The possible relationship and the origin of both lesions are discussed.


Clinical and roentgenographic evaluation of thirty-seven autotransplanted impacted maxillary canines. Thirty-seven autotransplanted canines in thirty-one patients were observed for a period of 2 to 7 years. Transplants with less than 2 years follow-up were not included in this study. Although the surgical root canal, and fixation techniques were identical, the delayed pathophysiologic changes were different.


Intravascular papillary endothelial hyperplasia in the oral mucosa. An intraluminal reactive hyperplastic lesion from the lower labial mucosa of an adult male patient is described. It has been termed intravascular papillary endothelial hyperplasia and may have arisen in an organizing thrombosed vein. The importance of distinguishing it from a malignant vascular neoplasm is stressed, and the differential diagnosis is discussed.


Sialadenoma papilliferum.

Sialadenoma papilliferum. Two previously unreported cases of sialadenoma papilliferum are presented. This brings the total number of reported cases of this entity to five. A review of the literature and a discussion of the histopathologic characteristics and possible histogenesis of the sialadenoma papilliferum are included.


Osteoma cutis: cutaneous ossification with oral manifestations. Subcutaneous and mucosal calcifications are rare lesions which present problems in diagnosis. A large bony mass is presented, with dermal and mucosal findings. The literature is reviewed on this non-neoplastic bony lesion and differential diagnosis is discussed.


[The importance of an endexspiratory plateau in respirators (author's transl)]. A two-compartment lung model with a bronchial obstruction was ventilated with different respirators: Engström E 200, ER 300, ECS 2000, Bennett MA 1 B, Sandoz M 250 and Dräger Servoventilator 900 under same conditions. Redistribution of air, the socalled "pendelluft", was found in all respirators. The amount of "pendelluft" produced by E 200 and M 250 was much more lower than that produced by respirators with low internal compliance, ECS 2000 and Servo 900. Endinspiratory plateau means more even distribution of ventilation volume despite airway obstruction.


Pulsed nuclear magnetic resonance studies of human bone marrow. Pulsed nuclear magnetic resonance (NMR) studies of human bone marrow reveal that the proton spin-lattice relaxation times (T1) of acute myeloid leukemia (AML) and chronic myeloid leukemia (CML) are much greater than the T1 of normal bone marrow.


The management of extramedullary disease in acute leukemia with therapeutic radiations. The authors reviewed 181 patients who received local radiation therapy for the prevention or control of extramedullary disease resulting from acute leukemia. 126 had acute lymphocytic leukemia and 55 had acute granulocytic leukemia. They were treated over a 18-year period of time with different forms of chemotherapy. Most had not received prophylactic CNS radiation therapy. Patients were evaluated for local control until death or hematologic relapse intervened. More than 80% of patients with clinical ALL meningeal leukemia had a successful response to doses over 1000 rads. This same response was not apparent in AML. More than 80% of clinical non-CNS extra medullary leukemia was controlled with doses of 600 rads or greater. Only one patient with extra-medullary relapse is still alive. The authors feel that lower preventative doses of radiation to the CNS are compatible with similar control rates, based on their own data and other suggestive data.


Fluoride content of dental plaque before, during and after ingestion of sucrose modified with fluoride or bicarbonate-phosphate. Students ingested tablets daily during a period of 3 d growth of dental plaque and in connection with the collection of plaque specimens. The tablets varied in composition: sucrose (C), sucrose containing sodium bicarbonate-monopotassium orthophosphate and fluoride (BPF), and sucrose modified with fluoride (F). The daily fluoride dose in conjunction with the growth of plaque and the collection of specimens was 0.5 mg of total fluoride and 0.2 mg in the determination of ionized fluoride. The fluoride taken during the growth period did not significantly affect the total and ionized fluoride contents of the plaque. During the consumption of all the tablets, the total fluoride content of the plaque increased temporarily, after which a drop took place to close to the original value. In the case of the C- and the BPF-tablets, the increase was statistically significant (P-values less than 0.02 and less than 0.001, respectively). During the consumption of the BPF- and F-tablets, the ionized fluoride content dropped significantly (P-values less than 0.001 and less than 0.01, respectively). The investigation showed that a binding of the free fluoride ions in dental plaque takes place in connection with fermentation.


Adsorption of Streptococcus mutans lipoteichoic acid to hydroxyapatite. Lipoteichoic acid extracted from cells of S. mutans strain BHT exhibited a high affinity for hydroxyapatite. Phosphate ions, fluoride ions and to a lesser extent human saliva inhibited or reversed this adsorption. Extracellular lipoteichoic acid preparations obtained from the supernatant of cultures of the same bacteria exhibited similar properties. It is suggested that lipoteichoic acids could play a significant role in the colonization of teeth by Gram-positive bacteria and thereby contribute to the formation and pathogenicity of dental plaque.


Evaluation of histologic criteria applied for description of pulp reactions in replanted human premolars. To test the reproducibility of a scoring system prepared for the study of the tissue changes in replanted teeth, 30 teeth were allocated at random from a material comprising 70 replanted and control teeth. The scoring system elaborated was applied for description of the odontoblast layer, predentin, secondary dentin, circulatory alterations, resorption, Weil's zone, cellular infiltration and calcification. The registrations were performed twice with a time interval of approximately 2 months. The scores were subsequently compared. Generally speaking, the double determinations were in good agreement as only 4.7% of the pairs of registrations failed to correspond. The agreement was particularly good for secondary dentin, cellular infiltration, resorption, Weil's zone and calcification scores. These criteria are accessible for group comparisons when differences in pulp tissue characteristics are small. The remaining three criteria may prove not to be useful unless the tissue response is substantial.


Exact method for clinical measurement of loss of periodontal attachment. The aim of the present investigation was to develop a clinical method for measuring loss of periodontal attachment, with a measuring unit of less than 1 mm, which did not require surgical intervention. The method was based upon impressions of the pocket area. Sixteen teeth on which the cementoenamel junction was situated below the gingival margin and which were scheduled for extraction for prosthetic reasons were used. Two impressions of the facial gingival pockets of each tooth were taken using steel strips dipped in Coe-flex and inserted at the bottom of the pocket. The loss of attachment in relation to the cementoenamel junction was measured in a stereomicroscope with a  measuring unit of 0.04 mm. After extraction, the teeth were stained for connective tissue attachment and the loss of attachment was measured. Duplicate measurements and pre- and post-extraction measurements of the same situation were compared. The results show that the accuracy and reproducibility of the method is high.


Microorganisms in recurrent aphthous ulcerations. Qualitative and quantitative examinations of the cultivable bacterial flora in biopsies from recurrent aphthous ulcerations (RAU), experimental oral ulcerations (EOU), and normal oral mucosa (NOM) were carried out under aerobic and continuous anaerobic conditions. An attempt was made to culture yeasts, mycoplasma, and virus from the biopsies of RAU, which were also tested for the presence of herpes virus antigen by the fluorescent antibody method. The predominant bacteria recovered in RAU were alpha-hemolytic streptococci, coagulase-negative staphylococci, and Neisseria. In EOU the main recoveries were alpha-hemolytic streptococci, Corynebacterium, Veillonella, Neisseria, and Haemophilus. In NOM alpha-hemolytic streptococci dominated the cultures. Yeasts were only cultured from one patient with RAU. No mycoplasmas or viruses were isolated, nor was herpes virus antigen demonstrated in any of the RAU specimens. The role of the microorganisms in the pathogenesis of RAU is discussed.


Clinical findings in temporomandibular joint osteoarthrosis. The clinical findings in 20 patients with TMJ-crepitation (E1-group) and 19 patients with TMJ palpatory tenderness (E2-group) have been compared with the findings in 29 other patients with mandibular dysfunction (R-group). The patients underwent a clinical examination of the masticatory system and of the second distal interphalangeal joints (DIP II joints). No statistically significant differences could be found between groups with respect to clinical signs, occlusal interferences, or dental attrition. Loss of molar support was found to be significantly more frequent in the E1-group than in the R-group. The frequency of tenderness to palpation or pain on movement of DIP II joints was significantly higher in the E2-group than in the R-group. Periarticular bony swelling of DIP II joints was significantly correlated with TMJ-crepitation. The patients with TMJ-crepitation were considered to have TMJ-osteoarthrosis. The results of the present study indicate that patients with TMJ-OZ have a similar clinical picture to other patients with mandibular dysfunction and that molar loss plays a role in the etiology of TMJ-OA.


Variations in bone mass within the cortices of the mandible. A study of intermandibular variations in bone mass in cortices between regions of the alveolar process and mandibular body and between buccal and lingual cortices in the same region has been carried out. The material consisted of 24 autopsy specimens of half mandibles from normal subjects. Microradiograms of ground sections from incisor, premolar, and molar regions were used. Quantitation of bone mass in percent within the cortices was done by an electronic point-counting system. The analysis indicates that bone mass may lie on nearly the same level all over in the entire lingual cortex. In buccal cortex, bone mass may vary from region to region, as a fall in bone mass from incisor to premolar to molar region in the buccal alveolar cortex, and a rise in bone mass from premolar to molar region in the mandibular body may occur. Bone mass in buccal incisor cortex of mandibular bodies shows great individual variations. Generally, bone mass may lie on a lower level in the buccal than in the lingual incisor and premolar cortec of the mandibular body while bone mass elsewhere lies on nearly the same level in the same part of the two cortices. Bone biopsies should be taken in either the premolar or the molar region of mandibular bodies.


Effect of acupuncture on myogenic headache. The purpose of the investigation was to study the effect of acupuncture on myogenic headache and to examine whether electromyographic recordings of jaw muscle activity would provide objective evidence of the effect of such treatment. In 21 dental students, 14 males and seven females, with a history of 2--10 years of headache, acupuncture was performed unilaterally in the foot between the 4th and 5th metatarsal bones (G 41). The needle was inserted to a depth of 10--15 mm and moved continuously by hand for 15--20 min. Electromyographic recordings of postural activity in the right and left anterior temporal and masseter muscles were obtained in the same sitting before, during and after acupuncture treatment. In clinical controls 24 h, 1 month and 4 months after the treatment, 12 subjects reported considerable improvement, two variable results, and seven no change. The electromyographic recordings showed an average decrease in postural activity during acupuncture, particularly of the temporalis muscles, and a further decrease after completed treatment. However, marked individual variations in muscular response were noted. The results indicate that acupuncture treatment can relieve headache, and that electromyographic recordings may provide objective evidence of the effect of acupuncture.


Galvanic series of some dental alloys.

Galvanic series of some dental alloys. Galvanic series for different metals in different electrolytes have been published, but never for dental alloys in artificial saline solution. The material classes studied are amalgam, gold alloy, nickel alloy, chromium cobalt casting alloy and temporary crown form. The electrogalvanic potentials were measured and determined in reference to a hydrogen electrode (H2/H+) arbitrarily defined as zero. A galvanic series of the tested materials was arranged in order of their potentials.


Creep of dental amalgam and its phases.

Creep of dental amalgam and its phases. The intention of the study was to evaluate creep as a function of temperature and stress, and to determine creep rate of compounds with a composition equivalent to the gamma, gamma1, and gamma2 phases in dental amalgam. The results were consistent with a creep model in which the deformation takes place in the gamma1 phase, and is dominated by glide pileups of dislocations in grain boundaries.


Correlation between strength and hardness of dental casting gold alloys. The yield strength, tensile strength, and hardness of Type IV dental casting gold alloys were measured. Regression lines and prediction intervals for the estimation of yield strength and tensile strength from hardness measurements were then determined. The 95% prediction intervals for the yield strength and tensile strength were found to be +/- 45 MN/m2 and +/- 105 MN/m2, respectively.


Fluoride release from a glass ionomer cement. The release of fluoride from a glass ionomer cement (ASPA) was compared with that from a silicate cement. Test specimens were shaken in a solution with hydroxyapatite for 7 weeks. The solution was changed every week and the fluoride taken up by the hydroxyapatite measured. The specimens released considerably more fluoride during each of the first 2 weeks than during each of the subsequent 5 weeks. The continued release did not decrease very much with time. Slightly more fluoride was released from the glass ionomer cement than from the silicate.


Acute myeloid leukaemia with the Philadelphia chromosome. A case report of serial chromosome studies on a 26-year-old male with acute myeloid leukaemia (AML) is presented. The classic Philadelphia chromosome (Ph1) translocation, t (9;22) was found in 77% of the metaphases at diagnosis and in 100% in relapse; during a 3-month remission period the cytogenetic picture was normal or the Ph1 was present in a minor cell population only. The clinical and morphologic features of this case indicated that it was really a case of AML and less likely chronic myeloid leukaemia (CML) presenting in blast crisis. It is suggested that the oncogen producing the 9;22-translocation and CML may also induce AML in rare instances.


The transcobalamins in polycythaemia vera. The unsaturated B12 binding capacity (UBBC) of the serum and the binding capacity of each of the 3 vitamin B12 binders--the transcobalamins (TC) I, II and III were determined in 21 patients with polycythaemia vera (PV) during the course of the disease and following treatment, using the recently described charged cellulose filter technique. High serum UBBC due to elevated serum TCIII was found in all patients. TCI was moderately elevated in patients who had leucocytosis with a shift to the left. The changes in serum TCIII and UBBC correlated with the activity of the disease. Chemotherapy resulted in a decrease in TCIII and UBBC. The decrease in TCIII and UBBC folowing chemotherapy may be observed before a decrease in the haematocrit and the leucocyte count occurs. Activation of the disease may be assessed by the elevation of TCIII and UBBC. The onset of acute myeloblastic crisis in 1 patient was associated with a decrease in TCIII and TCI levels and a rise in serum TCII. The determination of TCIII and UBBC may be helpful in differentiating true from secondary polycythaemia.


Experience on the treatment of chronic myelocytic leukaemia (CML) in blastic crisis. A group of 50 patients with chronic myelocytic leukaemia in blastic crisis were treated with different chemotherapeutic regimens. A total of 19 remissions (6 CR + 13 PR) were achieved with an overall and complete response rate of 38% and 12% respectively. Of the 4 patients presenting with a lymphoblast-like appearance of the blasts, the 3 treated with the combination of vincristine and prednisone all achieved remission (2 CR + 1 PR). Duration of survival was significantly longer in responding patients (median 11.5 versus 4.5 months). Either more effective therapeutic regimens or prevention by aggressively approaching the chronic phase are to be sought in order to improve the prognosis of blastic crisis of CML.


[The AS/BS occlusal angle, a replacement for the ANB angle]. In cephalometrics the ASBS/Occlusal angle and the "Wits" appraisal determine the sagittal discrepancy between the upper and lower jaw precisely. Standardizing procedures in locating points A, B and Mo are primarily introduced in order to reflect the anatomical situation without any distortion. The accuracy in reproducing the said cephalometric points, lines, angles and distances is proved and the behaviour of the ASBS/Occlusal angle, the "Wits" appraisal and the angle ANB is shown in ideal cases and in class II/1, II/2 And III malocclusions. It is recommended to use either the ASBS/Occlusal angle or the "Wits" appraisal as a cephalometric measurement of sagittal jaw relationship and to locate points AS, BS and Mo according to the standardizing procedures described.


[Electronic measuring and calculating devices for arcogrammetric model diagnosis and for the interpretation of teleradiographs]. A newly developed method to mesure different parameters from plaster models of the teeth, from dental radiographs and from cephalometric X-rays by means of a 4-K minicomputer and on-line linear transducers are described. Programs in connection to Arcogrammetrics [Herren] are presented. The electronic devices allow storage of these parameters in order to make drawings of the actual dental arches and of predicted arches, as well as to trace growth and/or progress in orthodontic treatment.


[The intraepithelial carcinoma of the mouth mucosa and its anatomo-clinical variants]. Contrary to common opinion the intraepithelial cancer of the buccal mucosa presents clinical symptoms, but they are discreet and different from those observed in an invasive carcinoma. Usually, there is leucoplakia with an erythema and an irregular keratosis or a punctuated one. There is an erythematous variation (Queyrat's erythroplasia) which is without keratinasation. Only histological evidence can confirm the diagnosis cancer. It should be differentiated against Bowen's disease and the light, intermediated and severe dysplasias.


[Relationship between caries resistance in permanent teeth of the Wrocław school children and the length of time of drinking-water fluoridation]. The age at which carious permanent teeth are equally distributed between upper and lower jaw depends upon the caries resistance of the individual. This age was called the "characteristic age" of the population. It was found that water fluoridation in Wrocław (1967) postponed this characteristic age by two years. In females, this age is earlier than in males. This method is useful in the appredication of the caries susceptibility of a population. The effect of water fluoridation upon this susceptibility was shown. Caries resistance was found to be higher in males.


Leukaemic involvement of the pleura. A case report. In chronic myelocytic leukaemia (CML), the pleura is a most uncommon site of extramedullary involvement. A 34-year-old man with CML presented with a massive pleural effusion. His peripheral blood contained few blast cells and the leucocyte alkaline phosphatase level was low. Cytological examination of the pleural fluid revealed cells with the morphological features of myeloblasts and monoblasts. The patient was treated with systemic chemotherapy, with no effect on the leukaemic pleural effusion.


Mucus in the healthy and diseased eye.

Mucus in the healthy and diseased eye. Mucous glycoproteins play an important role in maintaining the normal surface of the eye. Changes in the physical properties and chemical composition occur in disease with increased viscosity and a shift in the type of acid glycoprotein towards a predominance of sulphomucin causing some of the distinctive clinical features seen in dry eyes, superior limbic keratitis (SLK), vernal catarrh, and neuroparalytic keratitis.


Changes in the permeability of the lens capsule in senile cataract. When the water permeability of the lens capsule of a group containing all types of cataractous lenses is compared with a group of transparent lenses matched for age, there is no significant difference in permeability between the groups. If however, only those cataracts are selected which show changes in the cortex, namely, cuneiform opacities or 'water clefts', then the correlation between the water content of the cortex of these lenses and the permeability of their capsules is significant.


Effect of lid specula and superior rectus traction on intraocular pressure. The Pneumatonometer of Langham was used to record the effect upon intraocular pressure of a range of eyelid specula, lid sutures, and eyelid clamps. It was concluded that all methods tested produced a rise in intraocular pressure in most patients, and that the degree of rise was related to the degree to which the eyelids were separated. It was therefore recommended that a method of eyelid retraction which allows adjustment is to be preferred, and that specula which do not allow this, such as the Barraquer speculum, are not to be recommended. Traction upon the superior rectus suture was shown to lead to a considerable rise in intraocular pressure and this should therefore be avoided unless strictly necessary. The traction produced by two limbal sutures pulling tangentially downwards, rotates the eye downwards for intraocular surgery without inducing a rise in intraocular pressure. Measurement of intraocular pressure in the operating theatre is recommended in order to ascertain whether the method used to retract the eyelids or to rotate the eye to the field of surgery is having an adverse effect.


Anaesthesia for cataract surgery. A preliminary communication. It is well recognized that patients presenting for cataract surgery are usually old, with a high incidence of medical disease. This combination is said greatly to increase the risk of general anaesthesia. In an unselected series of patients undergoing cataract surgery, 53.5% had a significant medical problem and 50% were receiving some form of medical treatment. All but three of the patients were given a general anaesthetic. The series is discussed against the background of anaesthetic morbidity. The authors recommend that routine electrocardiograms should be carried out on all patients over 60 years of age.


Haemostasis in cataract surgery. The Down bipolar coagulator. The Downs bipolar coagulator is a precision microsurgical instrument for use in cataract surgery and other ophthalmic operations. Its chief advantages are robustness, ease of sterilization, mechanical reliability, and small size. The coagulation is delivered by a fine pair of forceps (designed for ophthalmic use). Precision can be achieved together with the advantage of being able to coagulate fine vessels under a wet film (as in the iris). The coagulation current can be varied and tissue shrinkage is lessened.


Corneal thickness after cataract surgery. An increase in corneal thickness occurs so regularly after cataract surgery as to be considered to be the rule. It reflects the state of endothelial activity and is therefore affected both by the preoperative condition of the endothelium and the degree of surgical manipulation. The question how quickly the endothelium can be expected to recover with consequent disappearance of corneal swelling is still open to discussion. The central corneal thickness of 55 eyes with normal slit-lamp endothelial appearance undergoing cataract surgery was measured preoperatively and on the 3rd, 7th, 14th, 21st, 28th, and 42nd postoperative days. The initial corneal thickness was 0.56 mm. The greatest corneal swelling, found on the third postoperative day, was 16%. Corneal thickness returned to preoperative values in four eyes within 7 days, in 19 eyes within 14 days, in 39 eyes within 21 days, in 50 eyes within 28 days, and in all 55 eyes within 42 days. Corneal swelling, as measured on the third postoperative day, was greatest (19%) when chromic catgut was used, less (13-16%) when black silk 7/0 was used, and least (9%) when virgin silk 8/0 was used.


Assessment of major intraocular and extraocular surgery performed as day cases. A review of 473 patients operated upon as day cases indicates that such surgery is safe, effective, and practicable. The surgical procedures included strabismus and ptosis correction in 265 children; major oculoplastic surgery for subtotal full-thickness eyelid reconstruction; and intraocular surgery in adults for trabeculectomy, cataract extractions with or without simultaneous intraocular implant introduction, and cataract extractions combined with trabeculectomy. No modification in surgical technique was required for strabismus and ptosis surgery. Slight modification was necessary for cataract surgery, and certain innovations were made in oculoplastic surgery.


Hard contact lenses. Medical aspects.

Hard contact lenses. Medical aspects. Hard lenses, corneal and scleral, are still useful in correcting ametropia. They offer better visual acuity and increased field of vision in high myopia, irregular astigmatism, and aphakia. Since their chemical and physical properties are reliable they are likely to be used for some time to come.


Management of keratoconus with hard corneal lenses. The lens lid attachment technique. Four modalities of corneal contact lens fitting in keratoconus have been considered: 1. The large alignment lens. 2. The large flat lens. 3. The small lens fitting flat on the apex of the cone. 4. The lens lid attachment technique. The lens lid attachment technique is considered in some detail and its particular merits discussed.


Soft contact lenses in keratoconus.

Soft contact lenses in keratoconus. In forming a special contact lens for use in cases of keratoconus, the centre the curves vary from 7.2 mm (47 dioptres) to 5.6 mm (60 dioptres), and at the periphery the curve is a constant 7.65 mm (44 dioptres) in all lenses. This special lens has the following advantages: (1) It protects the cornea: (2) It exerts a strong analgesic effect; (3) Vision is improved in 26% of cases from 0.03 to 0.6 and in 43% from 0.03 to 0.8. (4) Ophthalmometry gives equal values of about 69% and keratometry equal values of about 19%. The lenses may be made from PMMA, HEMA, CAB, and Polycon. The HEMA lenses did not correct the visual acuity, but those made with CAB and later with Polycon gave highly satisfactory results.


Protective corneal membranes in the treatment of eye disease. A protective corneal membrane (PCM) is a specific hydrophilic bandage lens made from Sauflon 85% hydrophilic material, chosen for its high oxygen transmission. The back curve or radius is 8.40 mm, the overall diameter 15.50 mm, and the centre thickness 0.15 mm. The PCM is made afocal, so that it will not alter whatever vision is present in the eye. This is particularly important when it is used for long-term treatment.


Contact lens in aphakia.

Contact lens in aphakia. Aphakia may be said to be the best reason for contact lenses. All types are used--(hard) corneal lenses, soft lenses both for daily and extended wear, and even (hard) scleral lenses in exce,tional cases. At present all have their problems so that, although on theoretical grounds an extended wear lens would be ideal, the corneal lens is probably still the lens of choice.


Continuous wear soft lenses in the treatment of alphakia. Continuous wear soft lenses made of Sauflon 85% were used in the treatment of 38 cases of uniocular aphakia. The patients were of all ages, but most of them were aged between 70 and 90 years. The success rate was greater than that achieved by hard contact lenses, especially after senile cataract extraction.


Management of cataracts in infancy and childhood. In recent years there has been a considerable improvement in our understanding of the mechanism of stimulus deprivation amblyopia and a continuous development of better surgical techniques for the removal of cataracts in very young patients. In spite of these advances and the fact that modern constant wear soft contact lenses are now a reliable proposition, there has not been a parallel improvement in the visual results achieved after cataract extraction and aphakia continues to present considerable problems of management in children. This study analyses over 100 cases treated at Moorfields Eye Hospital in recent years. As a result of our findings a Paediatric Aphakia Service has been established in order to integrate the surgical, contact lens, and orthoptic care of these patients.


Laboratory studies in the management of soft contact lens use. Laboratory procedures may be of great value in dealing with lens spoilation and in monitoring the state of the cornea during lens wear. Deposition of calcium-rich material remains the only defined non-mechanical process involved in spoilation although other forms of deposit and discolouration occur. Excess calcium levels in tear fluid are not a feature of contact lens wear, but changes in the sodium-potassium concentration ratio of tears are found. The basis for this effect is obscure but ratio changes may be useful empirical indices of corneal function.


"Minor" application of soft contact lenses. Some of the minor applications of soft contact lenses are believed to be more important than was hitherto thought. Soft contact lenses may be used to potentiate the therapeutic action of drugs, for the pleoptic treatment of ambylopic patients, for determining the visual field in aphakia and high myopia, and for the treatment of corneal wounds and descemetocoele.


Pilocarpine administration by contact lens. A previous investigation had indicated that pilocarpine delivered to the eye by means of a hydrophilic contact lens provided better control of the intraocular pressure over a longer period and with a smaller concentration of pilocarpine. To clarify the situation further, an animal experiment was undertaken with radioactive labelled pilocarpine. Three situations were compared: pilocarpine administered by a contact lens, by drops, and by subconjunctival injection. The results indicated that the contact lens gave a greater concentration of the pilocarpine in the iris and ciliary body than either the drops or the subconjunctival pilocarpine. A high concentration of pilocarpine was achieved in the conjunctiva with drop administration and was comparable to that of subconjunctival administration.


Autoregulation of the blood supply to the anterior optic nerve and lamina cribrosa. In the optic nerve an axial arterial system of peripheral origin is present; several intraneural collaterals of the central retinal artery are absent in the majority of cases while a rich pial network always exists. The question whether the central retinal artery should be considered as an important axial nutritional artery for the anterior optic nerve has to be answered in the negative. One or two large centrifugal collaterals running to the pial sheath-network probably play an autoregulatory role, protecting the laminar region from a temporary lack of blood supply during moderate rises in intraocular pressure.


Ocular manifestations of Wilson's disease in Iran. Within the last 5 years, 25 proved cases of hepato-lenticular degeneration (Wilson's disease) have been seen at the Children's Hospital Medical Center affiliated to Tehran University. The disease manifested abnormal copper metabolism in the following respects: (1) Hypoceruloplasminaemia was present: (2) 24-hr urinary copper excretion was low; (3) Tissue concentration of copper was high; (4) Treatment with penicillamine led to increased copper excretion in the urine and usually to relief of symptoms. The ophthalmologist cannot always assist the paediatrician in diagnosis, but fourteen of the 25 patients showed a Kayser-Fleischer ring and these were all in the older age groups. The following conclusions were drawn: (1) The incidence of Wilson's disease in Iran is high; (2) Penicillamine treatment may be successful; (3) Any young person with kidney, liver, or neurological disease of uncertain aetiology should have a detailed ophthalmological examination.


Meteorological triggering of acute glaucoma attacks. The files of all patients admitted to the Geneva and Lausanne University Eye Hospitals during 1972, 1973, and 1974 with the diagnosis of acute glaucoma were examined. Only those cases in which the exact date of onset and recorded, and in which the diagnosis of acute closed-angle glaucoma left no doubt, were retained. The dates corresponding to the first symptoms in the 34 remaining cases were submitted to meteorlogical and statistical study. Twenty of these cases (60%) occurred during the same meteorological condition: an advection of cold maritime air from the north-west at the rear side of a low-pressure system together with, or following, the passage of an active atmospheric disturbance. These conditions occurred only 57 times during the period of 1,096 days under study.


Value of prophylactic peripheral iridectomy on the second eye in angle-closure glaucoma. In a group of 250 patients with gonioscopically proved angle-closure glaucoma, 72 who did not have prophylactic peripheral iridectomy were reviewed and the adverse effects suffered by these patients were analysed. Comparison was made with 63 patients from the same group who did have peripheral iridectomy. All these patients were drawn from the Glaucoma Clinic, University Department of Ophthalmology, Manchester Royal Eye Hospital.


Role of the vertical muscles in horizontal deviations. This study was prompted by the observation that after horizontal muscle surgery a large number of cases of non-paralytic squint ended up with no binocular vision and an appreciable residual vertical deviation with a "V" or "A" pattern. It has become clear to us that the associated vertical deviation is usually present from the onset, and may play a major part in the mechanism of the squint. In less marked cases the vertical deviation is noticed only when the eye movements are fully examined, and is missed unless the extremes of elevation and depression are evoked. We have been largely influenced by the work and experience of Dr. M.H. Gobin (1964, 1968a, b, c), who feels that cyclotropia is an important factor in the aetiology of convergent squint. Gobin regards torsion as a third dimension in ocular motility, and thinks that for images to fall on corresponding retinal points it is reasonable to try to make the visual axes parallel horizontally and vertically, and that the retinal meridians should coincide.


Conservative management of central serous retinopathy. A study of 26 patients (thirty attacks) with central serous retinopathy was made in order to assess the results of conservative management, and the factors which might affect the incidence of residual symptoms. There were two groups, one given systemic steroids and one given no treatment. Comparison is made with two groups treated by laser coagulation and another given no treatment.


Day case surgery for strabismus in children. A consecutive series of 140 children was observed after strabismus surgery. All the postoperative problems are attributable to general anaesthesia, vomiting and drowsiness being the principal ones. Respiratory difficulties were unusual. There is no reason to keep a healthy child in hospital for longer than one night, and day case strabismus surgery appears to be safe if (1) an experienced doctor gives the anaesthetic, (2) there is adequate supervision for 3 to 4 hours after surgery, (3) the appropriate district nurse is forewarned that a child is returning home after general anaesthesia, and (4) facilities are available to retain a child in hospital if a problem arises before discharge. Signs of emotional trauma may be less in children treated as day cases than in those hospitalized for one or more nights.


Aetiological survey of visually handicapped children in Northern Ireland. A survey of visually h,ndicapped children in Northern Ireland identified 486 subjects aged 0 to 20 years on January 1, 1976, with a corrected visual acuity of 6/18 or less in the better eye. The prevalence of visual handicap was 81/100,000 of the population with an estimated ascertainment rate of 80%. Genetically determined diseases accounted for 51% of the cases. Birth hypoxia secondary to prenatal and perinatal complications was the second most important aetiological factor contributing towards visual handicap.


Retinal detachment surgery without cryotherapy. The traditional role of the cryotherapy adhesion in retinal detachment surgery is challenged by the successful treatment of 26 out of a series of 29 cases. The omission of cryotherapy has not interfered with the absorption of subretinal fluid and re-detachment has not occurred.


Retinal dialysis.

Retinal dialysis. The aetiology of retinal dialysis has traditionally been closely linked to blunt trauma to the eye, and experimental work in the past has tended to confirm this view. However, a close look at eyes that have suffered known concussional injury indicates that trauma is rarely associated with retinal dialysis. The aetiology of dialysis is discussed and a technique for treatment is proposed.


Encirclement versus 360 degrees buckling and prognostic factors in retinal separation surgery. In 554 consecutive primary cases, adverse prognostic factors for successful retinal detachment surgery were aphakic retinal detachment, severe vitreous traction creating retinal breaks, especially with lattice degeneration, long-standing retinal separations, choroidal or combined detachments, giant tears, Marfan's syndrome, and preoperative massive vitreous retraction (MVR). Vitreous haemorrhage was of secondary importance, and not a primary cause of MVR. The use of therapeutic encirclement is unnecessary and does not prevent the proliferative process of MVR. The few indications for cerclage, such as total retinal separation with no detectable breaks, total retinal separation with breaks in all quadrants, and MVR, are more effectively treated by 360 degrees scleral buckling. Encirclement should not be used as a constriction to obtain a buckle or to compensate for lost intraocular volume after drainage of subretinal fluid.


Lensectomy.

Lensectomy. Lensectomy is a new technique of lens extraction by which lens material is cut and aspirated through a fine-bore needle. The technique is simple and atraumatic. The small limbal incision, which does not require suturing, has the advantage of reducing the risk of vitreous loss and the amount of surgically-induced astigmatism to a minimum. Instruments designed primarily for vitreous surgery were used in the removal of cataracts from seventy eyes. This preliminary report shows that this new approach offers several advantages over conventional methods in selected cases. It appears to be of particular value in the management of cataracts secondary to chronic anterior uveitis. It is also a good alternative in the treatment of traumatic, presenile, and congenital or juvenile cataracts. Lensectomy is not a suitable technique for the removal of calcified lenses or those with hard nuclei. Possible complications include endothelial damage, loss of lens matter into the vitreous, and retinal detachment.


Traumatic cataract.

Traumatic cataract. In many cases of trauma it is presence of cataract which denies the patient a good final visual result. Cataract may be caused by blunt or perforating injury. Intraocular foreign bodies may be held within the lens or pass through it. Lens opacities may also be caused by chemical burns and remote forces such as electrical current and radiational injury. Frequently the cataract is unilateral, causing considerable impairment of vision of one eye while the function of the other eye is normal and expected to remain so. The aim of surgery must be to remove all lens protein from the pupillary area and as far as possible from behind the iris.


Kelman phaco-emulsification. Results and complications. The visual results and complications in an unselected group of 100 patients are reviewed. The implantation of a posterior chamber acrylic lens is described.


Iris-supported lens implantation v. simple cataract extraction. An analysis of data. In a study of a selected age (greater than 60) and ocularly matched population requiring cataract extraction, a perfectly executed intracapsular cataract extraction followed by the introduction of a Fyodorov Type II ("Sputnik") lens did not lead to irreversible anterior or posterior segment changes different from those seen in a group followed for from 5 to 9 years. It did lead to an incidence of implant support dislocation and to membrane formation in about 10% of cases, reducible to about 2% with correctly made lenses and the appropriate use of postoperative drugs. The incidence of corneal degeneration (0), retinal detachment (2%), and intraretinal cystic maculopathy (3%) was equal in each group. Visual acuity levels were also equal. In appropriate cases, if the surgery is carried out with sufficient skill, the reward to risk ratio of implantation not only justifies but indicates the use of such lenses.


Management of patients with intraocular lenses. Guidelines for those who do not perform this operation. Patients with intraocular lenses can be managed quite well by any experienced ophthalmologist. Every exmination must include the measurement of intraocular pressure and a slit-lamp examination, specifically noting: Corneal oedema, local or diffuse, Increasing corneal guttata, Touch of lens or iris suture to the cornea, AENS DISPLACEMENT, Iris suture problems, Pupil margin erosion, Secondary cataract, Vitreous face loss or thickening, Retrolenticular membrane formation, Vitreous cells. Lens implants should be removed only after very carefully consideration and consultation with an implant surgeon.


The safer operation for iris-clip lens implants. This short paper is not designed to show any new techniques and will not present any large scale statistical evidence. Rather it will, I hope, show a trend in the way intraocular implant surgery is progressing. I believe the problems are rarely due to the intraocular lens itself, but are more often due to a poor selection of cases and, all too often, an inadequately trained surgeon.


Manifestations of immunodeficiency diseases in ophthalmology. The clinical features in various types of immunodeficiency are presented in patients selected from a total of fifteen seen at the Bristol Eye Hospital. Immunodeficiency, either primary or secondary, can produce severe infective disease of the eye which is often bizarre in nature and slow to respond to therapy. It is important for the ophthalmologist to be aware of the various immunodeficiency syndromes in order that a realistic policy towards prognosis and treatment can be adopted.


Corneal oedema and endothelial cell loss after iris-clip lens implantation. Lens implantation as a form of replacement surgery has some clear advantages over other forms of aphakic correction. The most feared complication of this type of operation is bullous keratopathy. A short-term study was carried out in two comparable groups of patients to assess corneal oedema and endothelial cell loss after simple cataract extraction and after iris-clip lens implantation following intracapsular extraction as a primary procedure. All patients were randomly chosen to have one or other procedure. The results indicate that lens implantation causes greater postoperative corneal oedema and greater endothelial cell loss. It is therefore important for implant surgeons to bear in mind the possible harm they may be inflicting and the need both for stringent criteria of selection and for the adoption of techniques which will minimize endothelial trauma.


The theoretical ideal for an artificial lens implant to correct aphakia. In considering the theoretical ideal for an artificial intraocular lens implant to be used in the correction of aphakia it has always been taken for granted that Nature's bioconvex lens is best. But there is some evidence that other configurations may be an improvement. We also have to decide how large it should be and whether it should be placed in front of the iris or behind it. Moreover we have to consider the management of eyes which are already aphakic when first seen and cataractous eyes requiring lens extraction before the pseudophakos can be inserted.


Binocular effects of intraocular lens insertion. Observation of fifty patients submitted to primary Binkhorst intraocular lens insertion for uniocular cataract has shown that 88% regained 6/12 or better visual acuity in the operated eye. All but three patients with healthy fellow eyes and a good visual result from surgery regained orthotropia and some binocular functions promptly without squint surgery, but formal tests of stereoacuity were poorly performed. The best clinical guide to binocular performance for near vision was found to be Lang's pen test.


[Cellular immunity indices in osteogenic sarcoma]. Prior to the treatment 39 patients with osteogenic sarcoma were examined for some cell immunity indices by the skin-allergic reaction of delayed hypersensitivity (RDH) and the reaction of suppression of leucocytes migration (RSLM). As an antigen a polysaccharide fraction of osteogenic sarcoma was employed, for the control--normal bone polysaccharide fraction. In 25 patients the course of the disease was followed up for 8--14 months after the primary examination. Both RDH and RSLM were found to show no essential difference in the reactions for polysaccharide antigens isolated from osteogenic sarcoma and normal bone. In patients with a rapid growth of the primary tumor negative RSLM was noted, while RDH indices failed to show such differences. In patients without any signs of the progressing disease during 8--14 months since the moment of the examination, as a rule, positive RSLM and RDH are noted. In patients with a precipitous course of the disease 1--8 months prior to the treatment negative RSLM and RDH are more frequently observed.


Undetectable ABO isoagglutinin in a patient with chronic myelocytic leukemia. An instance of undetectable anti(A+B) was described in a patient, group O, in acute crisis of chronic myelocytic leukemia. The finding was not parallel to the level of gamma globulin in the patient and a possibility of functional abnormality of the related antibody was discussed.


[Comparative study of nuclear RNA in leukocytes of normal individuals and patients with leukemia by the method of molecular DNA-RNA hybridization]. Spectra of nuclear RNA were studied in leukocytes in healthy donors and in patients with leukoses by DNA-RNA hybridization. Cross competitive hybridization showed that in chronic lymphoid leukosis and acute myeloblastosis new forms of nuclear RNA were observed, which were not found in normal state; in myeloleukosis the nuclear RNA spectra were similar to those of normal granulocytes. The results obtained suggest that universal type of impairments appears to be absent in regulation of transcription in leukoses; it may be related not only to leukosis transformation but depends on variations in cell content of leukocyte populations studied.


[Anaemia with medullary myeloblastosis (author's transl)]. A case of refractory anaemia with medullary myeloblastosis (RAMM) is described. RAMM is a very rare disease and its relationship to aplastic anaemia and smouldering leukaemia is not clearly established. The diagnosis is confirmed by evaluation of the bone-marrow aspirate and ferrokinetic studies which demonstrate ineffective erythropoiesis. The disease is combined with leucopenia, thrombocytopenia and a hyperplastic bone-marrow. Our patient was monitored for 18 months, during which time her haematological findings remained stable. Since transformation into acute leukaemia occurs in about 25% of the cases, a bone-marrow culture study was performed in order to determine such a leukaemic transformation which is not detectable on examination by the light microscope. Culture studies are discussed along with some prognostic, therapeutic and pathophysiological problems of RAMM.


Childhood pertussis and pneumonia admissions in the highlands of Papua New Guinea. During a pertussis epidemic, the majority of children admitted with respiratory disease were under one year old and had pneumonia, with or without pertussis syndrome; heart failure was common. A greater proportion of those with 'pneumonia alone' were slightly older, were malnourished, were admitted earlier and recovered slightly faster than those who had 'pertussis with pneumonia'. Differential white cell count was of little help in diagnosis and chest X-ray findings seldom altered management. Eight percent of the pertussis and 3 percent of the pneumonia groups died: all had pneumonia and additional complications, and 71 percent of those who died were under one year of age. Results suggest that two or more infections of triple antigen may protect some children from an attack of pertussis so severe that hospital care would be needed.


Recent advances in gastro-enteritis.

Recent advances in gastro-enteritis. This paper briefly reviews new knowledge about the causes, consequences and control of gastro-enteritis. Various recently discovered viral and bacterial causes of gastro-enteritis are discussed and the possible role of prolonged gut infection in causing malabsorption and thus malnutrition, considered. The revival of interest in prevention by improved water supplies is discussed and the need to critically evaluate the relative importance of the quality and quantity of a water supply stressed. Some newer regimes for treating acute and chronic infections are also discussed.


Patterns of tumoral calcinosis in Nigeria and Papua New Guinea. An analysis was made of 7 cases of tumoral calcinosis diagnosed during a period of 6 years at a central laboratory serving the Igbos of Nigeria, West Africa. As in Papua New Guinea, the hip is the region of predilection and adults are usually affected, especially females. In both populations , most cases show discrete, solitary, hard, subcutaneous lesions which measure from 1 cm to 8 cm across.


Effect of a Ca(OH)2 solution and a chlorhexidine based detergent on the microbial activity of human carious teeth. Occlusar carious lesions from human molars, preserved in continuous humidity after extraction, were removed using conventional clinical techniques. Bacteriological samples were taken after rinsing the cavity with water only, after experimentally infecting the cavity and after treating uninfected cavities either with a saturated Ca(OH)2 solution or with a chlorhexidine based detergent. The samples were cultivated on blood agar plates aerobically and anaerobically. Cavities rinsed with water only showed very sparce bacterial growth. After experimental infection the growth was significant, but decreased radically after treatment with the test materials. In order to describe the effect of the two test materials on the microbial enzyme activity in infected dentin, cryostat sections of 10 micrometer were prepared from undermineralized carious dentin fragments excavated from freshly extracted human teeth. Conventional histochemical techniques were applied to demonstrate the aminopeptidase activity in the sections using N-L-leucyl-2-naphthylamide as a substrate. The aminopeptidase activity of carious dentin was inhibited totally with the Ca(OH)2 solution, whereas the chlorhexidine based detergent had no effect on the enzyme activity.


Bite force and state of dentition.

Bite force and state of dentition. The maximal bite force and the strength of the finger-thumb grip of 125 Skolt Lapps, aged 15 to 65, was measured with a specially devised apparatus. The bite force was measured with the biting fork placed between the first molars and between the incisors, respectively. The finger-thumb grip was measured by letting the subject press the prongs of the fork between the thumb and forefinger of each hand as hard as possible. The range of inter-individual variation of the maximal bite force and finger-thumb grip was great. The mean values were higher for the males than for the females. In the males the maximal bite force thus measured in the molar region was 39 kg (382 N) and 18 kg (176 N) in the incisor region. The corresponding values for the females were 22 kg (216 N) and 11 kg (108 N). The finger-thumb grip strength for males was, on the average, 10 kg (98 N); that of the females, 7 KG (69 N). The average difference in bite force between the men and the women was larger in the group with natural teeth than in the one with complete dentures. The values found for the bite force decreased with increasing age, especially for the females. Most of this reduction with increasing age was probably due to the age-dependent deterioration of the dentition. In both sexes the bite force was notably smaller among the denture wearers than among the dentate persons. The number of natural teeth varied closely with the bite force, i.e. the greater number of natural teeth the greater the bite force.


Discoloration of dental pellicle by tannic acid. The ability of tannic acid to discolor pellicle was studied in vitro and in vivo. Freshly extracted teeth were submerget in solutions of tannic acid, and in the clinical study individuals rinsed three times daily with 0.1% or 0.2% tannic acid. It was fount that 0.2% tannic acid caused brownish discolorations within 10-12 days both in vitro and in vivo. Discolored pellicle material collected from the in vivo test group was shown to contain furaldehyde after hydrolysis. The origin of the furaldehyde is not ascertained, but could be due to the presence of dietary deposits, transformation of pellicle pentoses, or from reactions between reducing sugars and amino compounds.


14C vitamin A in developing rat teeth and bone. A whole body-autoradiographic study. The distribution of vitamin A in developing young rats has been studied. Low doses of 14C-retinol were administered intraperiotoneally and the uptake analyzed autoradiographically. The vitamin was found to accumulate mainly in the intestines, liver, kidney, adrenal and brown fat. No uptake could be detected in hard tissue forming cells nor in any hard tissue, except in the secretory ameloblasts of the incisors.


Development of chronic myelocytic leukemia during the course of acute lymphocytic leukemia in an adult. A 59-year-old patient is described who presented with acute lymphocytic leukemia. Complete remission was induced rapidly with vincristine and prednisone. Nine months later he acquired the clinical and hematological picture of a myeloproliferative disease, and bone marrow cytogenetic studies demonstrated the presence of the Philadelphia chromosome. Within 4 months he again developed overt acute lymphocytic leukemia and died. Several lines of evidence have recently indicated a relationship between myeloproliferative and lymphoproliferative disorders, particularly chronic myelocytic and acute lymphocytic leukemia. This patient's course is another example of that association.


The adult orthodontic patient.

The adult orthodontic patient. Adults now make up an increasing portion of the orthodontist's patient load. Though most seek esthetic correction, requests for multidiscipline treatment are expanding. The etiology of adult malocclusion, unlike that of malocclusion in the young, presents us with psychological and physiologic factors that specifically affect treatment and dictate special diagnostic, planning, and mechanical procedures. The adult patient offers the orthodontist a new challenge and the stimulus to develop successful treatment approaches peculiar to the nongrowing patient. Careful diagnosis and treatment planning on a multidiscipline basis will result in satisfactory resolution of most adult malocclusions, and there is no requirement for esoteric appliances or mechanics. An evaluation of treated cases indicates that all corrective dental movements are possible and that the health, function, and esthetics of the dental apparatus can be markedly improved. The cases presented demonstrate that adults are amenable to treatment over the full orthodontic spectrum. Treating the adult patient can be very satisfying. The patient is invariably pleased with his effort (and your help), once the "braces" are off. Since the original need was great in the patient's mind, success in its satisfaction is especially rewarding and it overflows on everyone involved.


Early class II mixed-dentition treatment with the universal appliance. I have attempted to describe Dr. Nagamoto's rationale and a method of treating early-mixed-dentition cases. This particular adaption of a two-phase approach to this type of case was formulated by him in the early 1950's and has since been used in his office and mine. The steps, mechanics, and arch wires necessary for treatment have been outlined. It is thought that, by approaching these cases at an early age, the potential is increased for development so as to avoid the extraction of premolars and to prevent possible irreparable damage to the procumbent maxillary anterior teeth in the event of an accident. It has been shown that these young patients can be treated successfully with an efficient, gentle appliance that, in my own clinical experience, has proved to be most valuable.


A modified technique for ligating impacted canines. This article describes a combined surgical-orthodontic method to manage impacted teeth, primarily maxillary canines. The method uses a modified type of ligation chain that enables the oral surgeon to lasso the tooth with ease and affords the orthodontist large, successively placed eyelets to which he can easily tie elastic thread in order to keep continuous heavy force pulling the tooth toward the oral cavity.


Tensile properties of orthodontic wire.

Tensile properties of orthodontic wire. 1. Wires with a range of tensile properties are available for construction of a Stage 1 arch wire in the Begg orthodontic appliance. 2. Over a period of 3 days, a detectable amount of stress relaxation occurs in some orthodontic wires loaded initially to 20 kg.


The use of regression constants in estimating tooth size in a Negro population. A study of a sample of 105 Negro children and adolescents, residents of Connecticut, was undertaken to determine the degree of correlation between mandibular tooth size and the size of the canines and premolars. The correlation between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary or mandibular canine and first and second premolars was found to be 0.63 and 0.71, respectively. Further, regression constants were determined in an attempt to estimate the buccal segments from the mandibular incisors.


[Crux medicorum: Ondine's curse (author's transl)]. All known cases of the Ondine's curse syndrome with lifethreatening complications in consequence of narcosis, sedatives or oxygen-administration are reported. The avoidance of accidents requires blood gas analysis and more attention to the less well-known phenomenon--possibly a cause of the sudden-death-syndrome.


Effect of a pneumatic breathing aid on the minute ventilation of patients with chronic obstructive lung disease and bronchial asthma. A pneumatic breathing aid is described in which air pressure is used to compress the thorax and abdomen of patients with bronchial asthma and chronic obstructive lung disease. Pressures of 40 to 44 mm Hg were applied during the latter half of expiration. A mean decrease in minute ventilation of 14% was recorded 10 minutes after thoracic-abdominal compression in 18 tests. The mean decrease in expiratory volume was 218 in 10 cases. The use of this new pneumatic breathing aid is a preliminary report with the suggestion that similar studies be utilized to increase the ventilatory function of patients who present suggestive evidence of air trapping and alveolar over-distention.


Anterior cervical arachnoid cyst simulating syringomyelia: a case with preceding posterior arachnoid cysts. An arachnoid cyst lying anterior to the cervical cord at level C6-7 was found in a 28-year-old woman believed to have syringomyelia. This diagnosis was based both on previous findings at laminectomy and on computerized tomography. The diagnosis of arachnoid cyst was suspected because of clinical features atypical for classical syringomyelia and a history of arachnoid cysts found during childhood. Air myelography demonstrated an extramedullary intradural mass anteriorly that proved to be an arachnoid cyst. Drainage and subtotal resection resulted in marked clinical improvement. This case illustrates the need for reevaluation when a patient with "known" syringomyelia presents an atypical clinical picture. Anterior cervical arachnoid cyst, which may accompany or succeed posterior arachnoid cysts, should be considered.


Renal angiography and the management of severe closed renal trauma. The purpose of this study was to determine the place of selective renal angiography in the assessment of major renal trauma. Thirty-one cases of renal injury assessed by urography and angiography were reviewed, and the radiological features correlated with the subsequent clinical course. Based on the angiographic findings, a classification of these more severe injuries is proposed, and the prognostic significance of renal ischaemia demonstrated. Because conservative treatment in those cases with significant ischaemia is likely to fail, early elective surgery is recommended. In this selected group, viable renal tissue can be preserved, and the necessity for subsequent nephrectomy due to secondary haemorrhage, or continuing urine leakage, is avoided.


Surgical and external ureteric trauma.

Surgical and external ureteric trauma. This paper details the aetiology, presentation, diagnosis, prophylaxis, treatment, and results, of 84 surgical and external ureteric injuries. Although the incidence of surgical ureteric trauma was found to be low it was related to both the particular operation performed and certain faults in surgical technique. The series emphasizes the importance of prophylaxis, early diagnosis, and specific therapy. There were 94 operations carried out on the 84 ureters, resulting in 22 nephrectomies and 63 open repair procedures, of which 55 were regarded as successful and 8 as failures.