Middle ear pressure following tympanoplasty for various middle ear diseases. Pressure related to follow-up period and retractions. In 512 ears with various middle ear diseases, the middle ear pressure was measured a minimum of 2 years and a maximum of 10 years after tympanoplasty. The findings were related to the length of the follow-up period and to retractions of the drum and/or in the epitympanum. The tympanometric findings were best in sequelae to otitis with dry perforations, poorest in cholesteatomas and adhesive otitis. Tubal function had not further deteriorated 4 years after the operation. There was a highly significant correlation between the middle ear pressure and the frequency of retractions, which also does not essentially increase--except in the cholesteatoma cases.


Can an operation of deaf ear be dangerous for hearing? After a single or modified radical mastoidectomy the hearing of the contralateral ear was followed by pure tone audiometry in 55 patients. In 12 patients a sensorineural--mostly high tone--hearing loss of at least 20 dB was found in the contralateral ear. In six cases this was persistent. The number of patients with hearing loss increased with increasing operation time. The cause of this hearing loss must be the noise of the bone-cutting burr.


Hearing gain calculations after stapedectomy. A comparison of the postoperative air-bone gaps to pre- and postoperative bone condition (BC) was made in two groups of patients with otosclerosis, 18 cases with poor preoperative BC thresholds and 15 cases with good preop, thresholds. The gaps to the postoperative BC showed less variation than the gaps to the preop. BC threshold, the postop. BC may therefore serve as a more stable and natural reference when calculating a postoperative air--bone gap.


The most important allergens in allergic rhinitis. The distribution of allergens, found on thorough allergy work-up in a series of 770 patients with seasonal and perennial nasal symptoms, is reported. The percentages of positive reactions to grass, tree, and herb pollens were equally high (30--40%) but, clinically, pollens from grasses (Timothy, Alopecurus, Kentucky Blue and Meadow fescue), birch and mugwort (Artemisia) were the most important. In the Nordic countries house dust is evidently the commonest causative agent in perennial rhinitis but the heterogenous composition of house dust makes it difficult to determine potent allergenic factors. Sensitivity to house dust was present in 44% of the patients; a positive reaction to mite extract in only 10%. Animal danders were not found to be great importance in allergic rhinitis (13--18%). Reactions to moulds were observed in 9% of the patients.


Intra-arterial chemotherapy of malignant head and neck tumours with superselective angiographic technique. A technique is described for repeated superselective angiographic infusion of anticancer drugs into advanced malignant tumours of the head and neck region. The technique allows for a high concentration of the drug in the tumour and, furthermore, it is possible to ensure that the infused anticancer drug adequately reaches the tumour. Mitomycin C was given to 15 patients with advanced malignant tumours of the head and neck region. In 16 patients a partial remission was seen, and in another 5 patients a subjective improvement was reported. No complications were observed.


Irradiation-induced tumours of the head and neck. Though irradiation-induced tumours are uncommon they represent a well defined entity. At this Hospital, 14 "irradiation-induced" head and neck tumours were encountered in 11 patients over a 10-year period. The irradiation had been given for tuberculous lymph-adenitis in 6 of the patients, for lupus vulgaris in one, and thyrotoxicosis in another; the other 3 patients had received radiotherapy for malignant tumours. The interval between the treatment and the diagnosis of the tumour disease ranged from 9 to 48 years (mean 32). The induced tumours included 10 squamous cell carcinomas of the hypopharynx (4 tumours), the buccal mucosa (3), the skin (2), and the larynx (1), one poorly differented carcinoma of the parotid gland, 2 thyroid carcinomas and 1 fibrosarcoma of the stenocleidomastoid muscle. Three of the patients had multiple tumours. In view of the risk of cancer--albeit a small one--associated with radiological diagnosis and radiotherapy, these should be performed only on strict indications, especially in young patients.


Fibrinolytic activity in patients with sudden sensorineural hearing loss. Fibrinolytic activity and capacity were studied in a group of 18 patients with sudden sensorineural hearing loss of unknown etiology. The fibrinolytic activity and capacity were found reduced in 12 patients. No distinct changes in platelet aggregation in vitro could be demonstrated. Further, repeated studies in this category of patients should be performed.


Ear damage due to diving.

Ear damage due to diving. Diving injury may affect all parts of the ear during all types of diving. Divers are regularly exposed to noise and 120 dB(A) is measured during ventilation of a hyperbaric chamber. Ear canal squeeze, possibly with drum perforation, may give a transient conductive hearing loss. Middle ear squeeze, possibly with drum perforation, also gives a transient conductive loss. Inner ear barotrauma, possibly with perilymph fistula, most often results in transient vertigo and lasting sensorineural high tone loss, often resembling a noise-induced loss. Decompression sickness and gas embolism can also damage the inner ear. A change of breathing gas during deep diving has damaged the labyrinth, most likely due to counter diffusion. The authors have seen two cases of over window perilymph fistula resulting from diving. One of them also suffered a burst ear drum on the same side. His hearing returned to normal after surgical repair.


Hyposensitization in allergic rhinitis. Immunotherapy. Indications and contra-indications. Immunotherapy in allergic rhinitis should be initiated only when other efforts at elimination and treatment of symptoms prove ineffective. The indications become more convincing if symptoms of bronchial hyperreactivity and asthma are also present. General preconditions which must be fulfilled prior to treatment are the establishing of a precise diagnosis, and that the allergen planned for treatment must play a decisive part in the disease. The main contra-indications are other, concurrent immunological diseases, and pregnancy.


Impedance screening for middle ear disease. Pure tone audiometry has hitherto been employed as the sole means of indentifying ear pathology. During the last decade it has been demonstrated that even hearing which is normal according to pure tone sweep check screening audiometry (20 dB) can be associated with middle ear pathology. With the intention of identifying cochlear as well as middle ear pathology, a study was initiated in which pure tone testing was combined with impedance measurements as a screening test. The intention has been to determine a screening level at which pathology is identified and the number of false-positive is minimized. A combination of tympanometry (less than or equal to -150 mm H2O) and pure tone screening at 0.5 and 3 kHz is recommended as a screening procedure for the identification of cochlear as well as middle ear pathology.


Chronic secretory otitis media.

Chronic secretory otitis media. 212 of 242 patients (88%) treated for chronic secretory otitis media in 1972 were re-examined 5 years later. A total of 668 otological procedures has been performed, 99 patients being treated only once, while one patient received 12 procedures. The pure tone threshold was 20 dB or less in 88% of the ears in 1977, whilst only 57% had a type A tympanogram. Normal otoscopy was found in 40.5% of the ears, persisting secretory otitis in 11%, atelectasis in 2.8% and chronic suppurative otitis in 2.6%; the remaining 42.9% showed varying degrees of scarring and myringosclerosis.


The effect of adenoidectomy on secretory otitis media in children. 139 patients, 80 boys and 59 girls aged 1 1/4--13 1/2 years suffering from serous otitis media based on otoscopy and tympanometry had adenoidectomy performed and no other surgical measures taken. The efficiency of the treatment was assessed 2--4 months later. Intially flat tympanometry curves were found in 155 ears, negative middle ear pressure in 70 ears and low curves in 20 ears. 78% of all ears and 73% of the ears with flat curves were seen to normalize during the observation periods.


Middle ear mucosa in cleft palate children. A scanning electron microscopic study. Twenty-three promontory mucosal specimens from cleft palate children were studied by scanning electron microscope. Comparative studies were made, using light and transmission electron microscopy. The mucosal lining was pseudostratified columnar with microvilli, a few ciliated cells with secretory granules and numerous goblet cells. A few mucous glands, could be seen in certain areas. Microvilli with bulging tips and cilia with microknobs were common phenomena. The submucosa were inflamed, with leukocytes, macrophages, plasma cells and lymphocytes, indicating the presence of both cellular and humeral defence mechanisms.


Tonsillectomy and immune responses.

Tonsillectomy and immune responses. Immune response were examined in 10-year-old boys just before and one month after tonsillectomy, and in young male adults tonsillectomized 10 years earlier. All the parameters studied were found to be quite normal.


A universal way to evaluate the curve in rhinomanometry. A new way to evaluate the curve of nasal airway resistance has been developed. With polar coordinates, all curves can be described. Also, tightly closed or wide open noses can be compared with angles. The method is of value in clinical as well as in scientific work, especially when dealing with statistics.


Hyposensitization in allergic seasonal rhinitis as evaluated by rhinomanometry. Hyposensitization with Allpyral extracts was performed in 38 patients suffering from seasonal allergic rhinitis. An objective evaluation of the clinical course was obtained by rhinomanometry. After one year of hyposensitization therapy, 55% of the patients (21 out of 38) showed an improvement, and after the 3-year follow-up this figure had increased to 76% (19 out of 25 patients continuing with the treatment for this period). For the patients' subjective appraisal of the therapy the respective figures were 76 and 92%.


Peroral chromones. A new way to treat allergic rhinitis? Disodium chromoglycate (DSCG) is well documented in the topical treatment of allergic rhinitis. Its use does not lead to any major side effects. FPL 57579 is a new chromone compound which is well absorbed after oral administration. In a clinical trial, patients with allergic rhinitis underwent a nasal challenge before and after ingestion of FPL 57579. the effect on nasal airway resistance (NAR) was determined by rhinomanometry. In all cases there was a smaller increase in NAR after the intake of FPL 57579.


Parosmia.

Parosmia. Changes in the sense of smell may be quantitative. The latter are called parosmia. Various forms of central and peripheral parosmia are described. The treatment is mentioned.


Early, active diagnosis of acoustic neuromas. Since the introduction of the translabyrinthine approach in the treatment of acoustic neuromas in Denmark. 47 patients have been operated on, the series containing 2% small, 60% medium and 38% large tumours. This distribution differs significantly from previously published tumour series, where the large tumours dominated. The paper describes the various diagnostic procedures applied in the present active search for acoustic neuromas, and the reduction in tumour size is ascribed to information on the improved surgical results obtained by the translabyrinthine approach.


Translabyrinthine surgery of acoustic neurinoma. In translabyrinthine and translabyrinthine-suboccipital removal of 47 acoustic tumours, the mortality rate was 2.1%; among 18 large tumours, 5.6%. The facial nerve was preserved in 89%, and 80% had normal facial nerve function. 98% of the tumours were removed in toto, including 17% where the tumour remnant was removed by the suboccipital approach one week after the translabyrinthine operation.


Recent expericience in the surgery of acoustic neurinomas. A translabyrinthine method was used in 49 and a suboccipital approach in 55 cases, for the removal of an acoustic neuroma. The translabyrinthine procedure is well suited in cases with no pontine compression, whereas in large tumours the wide opening in the suboccipital method gives added safety to the procedure. The mortality rate was 3% and the facial nerve function after translabyrinthie surgery showed permanent paralysis in 4 patients. A team approach using the suboccipital route has been started in an attempt to save hearing in small- and medium-sized tumours.


Vestibular neurectomy.

Vestibular neurectomy. Vestibular neurectomy technique used for the standard middle fossa approach and for a total translabyrithine VIII nerve section is described. The middle fossa approach has been used in 49 cases of mainly Meniere's disease and basically the same approach for nerve decompression has been used in 19 cases of facial paralysis, 15 being due to Bell's palsy, 2 to petrous pyramid cholesteatoma and 2 to facial nerve Schwannoma. In unilateral Meniere's disease with no further function in hearing, vestibular neurectomy gives good results in alleviating vertigo.


Comparison of the hearing threshold measured by pure-tone audiometry and by Békésy sweep audiometry. The hearing thresholds of 115 subjects, workers in a shipyard, were determined both by Békésy sweep audiometry and by conventional individual pure-tone audiometry at fixed audiometric frequencies. The Békésy method gave the lowest values for the hearing thresholds. It has been possible to find a useful linear relation between pure-tone and Békésy hearing thresholds. With the help of a retest experiment it has been established that the standard deviations of hearing thresholds, obtained under similar conditions in a pure-tone investigation, are about twice as large as those obtained in a Békésy investigation.


BSER-audiometry in difficult-to-test patients. The results of BSER audiometry in a group of 38 difficult-to-test patients are reported, and the response thresholds compared with previous assessments by conventional audiometric techniques. The frequently severe behavioural disorders of these patients necessitated the use of general anaesthesia. Myringotomy revealed middle ear fluid in 20% of the ears, whilst 26% had significant ocular pathology.


Chryotherapy in the treatment of subglottic hemangioma in infants. Congenital laryngeal hemangioma in infants is situated typically in the subglottic region and causes respiratory obstruction at the age of 1--6 months. Hitherto fewer than one hundred cases have been reported. The mortality has been high and the therapy problematic. As a primary measure, tracheotomy must be performed. In the treatment of the tumour itself, large doses of corticosteroids, sclerosing agents, radiotherapy and surgical removal have been used. The results have hardly been encouraging. In five cases we have utilized cryotherapy. The hemangioma disappeared after 3--6 sessions. No therapeutic or late complications were connected with this mode of therapy.


Diffuse sclerosing ostemyelitis of the mandible. Diffuse, sclerosing osteomyelitis of the mandible is a disease which requires a synthesis of clinical, radiographic and histologic findings for a correct diagnosis. The biopsy technique is important. 99mTc-scintigraphy and enzyme histochemistry can assist the diagnosis. Antibiotics and cortisone are the treatments of choice. Decortication should be reserved for recalcitrant cases.


Lateral fistulae and cysts of the neck. Heredity and diagnosis. A family with congenital fistulae from the second cleft or pouch over four generations is described. In order to obtain some idea of how often anomalies are found in relatives of patients with this type of malformation a material embracing 114 patients has been examined. The investigation demonstrates that patients with a complete lateral fistula of the neck from the second cleft or pouch showed a heredity of 35%, whilst patients with lateral neck cysts did not show any recognizable familial tendency. Views on differential diagnosis are presented, including the value of fine-needle biopsy, where in 92% of the cases a diagnosis of branchial cysts of the neck was obtained.


Abscess tonsillectomy à tiède.

Abscess tonsillectomy à tiède. During recent years, primary tonsillectomy, tonsillectomy à chaud, has again become popular as the standard therapy for the peritonsillar abscess, whereas the traditional tonsillectomy à froid, made 4--6 weeks after the incision, has been partially eclipsed. It seems, however, that the intermediate form between these two, tonsillectomy à tiède, an abscess tonsillectomy made 3--4 days after the incision, would be highly practical in many cases, compared with the other two mentioned above. The tonsillectomy à chaud requires such a high state of readiness for anaesthesia, even during the emergency hours, that it is not practical in all otolaryngological departments. Tonsillectomy à tiède needs a longer hospitalization, yet requires fewer days off work than does the classical tonsillectomy à froid method. Furthermore, a significant proportion of the patients fail to present themselves for tonsillectomy at the agreed time and consequently get a recurrence of the disease later on. Tonsillectomy à tiède is almost as easy an operation as the normal tonsillectomy, both for the surgeon as for the patient. During the years 1976--77, 153 cases of peritonsillar abscess were seen. 105 cases were treated with the tonsillectomy à tiède method. The average duration of treatment was 6 1/2 days. The only complications were 6 cases of light secondary bleeding. A tonsillectomy à chaud was performed on 9 children in the age group 3--9 years.


Results of the treatment of achalasia by pneumatic dilatation. Thirty-three patients treated at the Karolinska Hospital for achalasia of the esophagus during the period 1968--78 have been reexamined. Twenty-eight of these patients underwent pneumatic dilatation. Excellent and good results were obtained in 79% of cases; in 21% the result was considered poor. In 2 cases the esophagus was perforated during dilatation--a perforation rate of 5% of the total number of dilatations. In 6 cases the lower sphincteric pressure was calculated before and after dilatation. It was found to be higher than normal, preoperatively, but reduced to a near-normal value postoperatively.


Physiological aspects of the effects of sound on man and animals. A review of some short-term and long-term physiological effects of sound on non-auditory body functions is given. It is pointed out that the short-term effects depend closely on the acoustic properties of the sound. Habituation is rapid for steady signals but slow for interrupted ones. Irrelevant, meaningless sound, presented to rats over their life-time in such a way as to simulate an industrial acoustic environment, did not affect blood pressure, life-span or morbidity incidence. As far as the injurious effect of sound on the inner ear is concerned, it was shown that spontaneously hypertensive rats were considerably more susceptible to such impairment than were normotensive ones. Hence sound does not produce hypertension, but susceptibility to ear injury may be greater in hypertensive individuals. The protential role which individual variability in physiological properties of the sound conduction system might play for the observed individual variability in noise-induced hearing loss is also discussed.


Psychological effect of noise.

Psychological effect of noise. The most frequent harmful effect of noise is its irritating psychological influence on the individual. This influence has been measured in laboratory situations and in daily life by careful sociological interviews of the inhabitants in noisy and in quiet residential areas. Statistically significant differences were demonstrated between the two areas regarding consumption of soporifics, tranquilizers, isolation against noise, etc.


Noise-induced hearing loss and the comprehension of speech in noise. Subjects suffering from noise-induced hearing loss (NIHL) with or without hearing loss at 2 kHz were examined by speech audiometry with a three-digit test, bisyllabic and monosyllabic PB word lists in silence, and in USASI noise with a masking effect of 44 dB and 68 dB at 1 kHz. Subjects with up to 20 dB hearing loss at 2 kHz had almost the same speech comprehension in noise as normal hearing subjects. Subjects with hearing loss greater than 20 dB at 2 kHz had increasing discrimination loss at increasing noise levels. They also needed a signal-to-noise ratio better than normal-hearing persons would yield at the noise levels used. The evaluation of hearing disablement in occupational noise-included hearing loss should therefore be based for one-half on the results of speech audiometry in silence, and for the other half, in noise.


Military audiological aspects in noise-induced hearing losses. The sound pressure of a single shot ranges from about 165 up to 190 dB, depending on the type of weapon. In general, most shooting practice is carried out from a sheltered shooting gallery. Groupshooting and multiple reverberations from sheltered galleries maximize the acoustic strain. Clinically the acoustic trauma can be considered to be a combination of both acute and chronic noise injury, because very intense impulse noise, such as gunfire, can injure the inner ear both mechanically and by mean of disturbances in metabolism. When the ears are not protected, acoustic trauma develops in about 10% of military conscripts and 60% of regular army personnel.


Noise-induced hearing losses. Can they be explained by basilar membrane movement? The development of noise-induced hearing losses must in some way be related to the basilar membrane movement. Our analysis of this relationship is based on Mössbauer effect measurements of the basilar membrane movement in human temporal bone preparations. At a single basilar membrane position in each of seven preparations, the displacement frequency response was measured for a given sound pressure level at the ear drum. The measurements covered the place range 2.2--6.2 kHz. Despite the inadequacy of the experimental data, there seems to be no doubt that low frequency components contribute substantially to the displacement and mechanical strain of the hair cells near the 4 kHz location, where the hair cells are known to be most vulnerable to noise damage. In fact, the analysis performed indicates that these cells will suffer the greatest mechanical strain, almost irrespective of the spectrum shape of the stimulus noise.


Gilles de la Tourett's disease, a single case study: a discussion on aetiology and treatment. A case of Gille de la Tourett's syndrome is reported and discussed in the light of conflicting views on the aetiology of the condition. It is hypothesized that if Tourette's syndrome is to be considered as a sort of reaction against adaption to an unhealthy environment, this reaction and its continuity can be attributed to permanent CNS damage (Probably in the area of corpora striata) beginning in childhood. Treatment with haloperidol suggested as a most effective method of symptomatic treatment.


Osteomalacic new bone formation during chemotherapy of acute granulocytic leukemia. The development of a rapid rate of regeneration of osteomalacic bone in a patient treated for acute granulocytic leukemia has been demonstrated for the first time. This positive bone balance was most intense at the time of maximal depletion of leukemic tissue. The authors postulate that new formation of osteomalcic bone is due to inability to maintain the rate of calcification parallel to that of bone formation. A similar abnormality occurs in egg-laying birds, in rapidly growing children on a diet suboptimal in vitamin D who have rickets, and in some patients with osteoblastic metastases.


Acute lymphocytic leukemia manifesting as splenic rupture. Pathologic rupture of the spleen is a rare phenomenon in acute lymphocytic leukemia, and its mechanism is unknown. This complication has been seen almost exclusively in men, and at ages much older than those of the majority of patients who have this leukemia; these unusual features are also unexplained. A case of acute lymphoctyic leukemia with pathologic rupture of the spleen in which the pathologic findings suggest that the splenic rupture was due to infiltration and destruction of the splenic capsule by leukemic cells is reported.


Decreased ribosomal RNA content and in vitro RNA synthesis in purified bone marrow erythroblasts of patients with idiopathic ineffective erythropoiesis and DiGuglielmo disease. Ribsomal RNA content and in vitro 3H-uridine and 3H-thymidine incorporation with examined in purified marrow erythroblasts of patients with idiopathic ineffective erythropoiesis (IIE) and DiGuglielmo disease (DD) and compared with cells from normal marrows. Whereas 3H-thymidine incorporation rates were normal in all patients, 3H-uridine incorporation was 42%--75% of normal in cells from patients examined. Ribosomal RNA content was measured by spectrophotometric scanning of RNA electrophoresed on polyacrylamide gels and corrections made for contamination of the erythroblast preparations with ribosome bearing reticulocytes. In cells from every patient examined RNA content was decreased to 60--76% of normal. Uridine incorporation and rRNA content of patients with beta thalassemia minor and megaloblastic anemia were normal, suggesting that the defects observed in IIE and DD were not due to ineffective erythropoiesis per se. Since erythroblast ribosomes may be rate limiting in protein synthesis, we postulate that even a minor decrease in ribosome content might engender the ubiquitous abnormalities reported in erythroid cells in both IIE and DD.


New leukemia in the course of therapy of acute lymphoblastic leukemia. We have recently observed the development of second leukemia of a morphologically different type in three patients with acute lymphoblastic leukemia (ALL) while on therapy. The "second" leukemia occurred while on therapy at 23, 27, and 32 months of initial remission. All three were receiving systemic chemotherapy (CT) and prophylactic fractional irradiation to the central nervous system (CNS). The second leukemias in these three cases were one case of juvenile chronic myelogenous leukemia (JCML) and two cases of acute leukemia of the myeloblastic type by the usual morphologic criteria including the presence of Auer rods in one. In two cases a cytogenetically new clone was detected in the remission marrow 10 and 12 months preceding the overt change in clinical status. These three cases demonstrate that second leukemia occurs in patients with ALL and that some late "relapses" fall into this categpry. The possible etiologic role of modern intensive treatment regimens in the development of second leukemia is discussed.


Subacute myeloid leukemia: a clinical review. The data on 31 patients who fit into the clinical spectrum of subacute myeloid leukemia have been reviewed. The majority of patients were male with a median age of 61 years. The interval from onset of symptoms to actual diagnosis was extremely variable, with a mean of 16 months and a median of six months. Most patients presented with anemia and thrombocytopenia, although the white blood cell count varied from striking leukopenia to marked leukocytosis. Examination of the bone marrow invariably revealed abnormalities of all cell lines with megaloblastoid erythrogenesis and dysplastic megakaryocytopoiesis. Although the white cell line showed prominence of immature forms, there was more maturation than is seen in acute myeloid leukemia. Survival from diagnosis was variable, from less than one month to greater than 68 months, with a median of only six months. Anemia and hepatosplenomegaly were prognosticators of a poor outlook; patients with hepatosplenomegaly in association with either leukocytosis or thrombocytopenia had a particularly poor outlook, with a median survival of only one and a half months. Approximately half the patients received chemotherapy with no demonstrated effect on survival.


The inappropriateness of conventional cephalometrics. 1. Cephalometric conventions today may have little basis in either biology or biometrics. 2. There is no theory of cephalometrics, only conventions which involve landmarks and straight lines only. These fail to capture the curving of form and its changes, exclude proper measures of size for bent structures, and misrepresent growth, portraying it as vector displacement rather than a generalized distortion. 3. Conventional cephalometric procedures misinform by fabrication of misleading geometric quantities, by camouflage, particularly of remodeling, by confusion about what is happening (analysis of rotations, treating shape separately from size, and registering angles on landmarks as vertices), and by subtraction as a representation of growth. 4. We suggest that the present systems offer little real hope of improvement sufficient to meet our needs in craniofacial growth research. We call attention to three possible techniques to be included in future cephalometric conventions: (1) tangents and curvatures, (2) Blum's medial axis ("skeleton"), and (3) biorthogonal grids.


Distal displacement of the maxilla and the upper first molar. Data from a sample of 198 Class II cases treated with various appliances which deliver distally directed forces to the maxilla were examined to determine the frequency of absolute distal displacement of the upper first molar and of the maxilla. Analysis revealed that such distal displacement is possible and that it is, in fact, a frequent finding following treatment. Long-range stability of distal displacement was not assessed.


Craniofacial morphology: a principal component analysis. A series of 56 measurements was derived from lateral cephalometric radiographs of a large sample of subjects. These measurements were subjected to a principal-component analysis which resulted in a series of six components (factors). These factors, represented in general terms and in rank order of their percentage sample variability were as follows: Factor 1. Vertical facial characteristics Factor 2. Anteroposterior aspects of facial morphology Factor 3. Midfacial and dental protrusion Factor 4. Relationship of the mandible and dentition to the profile Factor 5. Horizontal base-line relationships (internal or deep) Factor 6. Maxillary incisor relationships These principal components and the variables contained within them were shown to have sex and age interactions. A longitudinal study of the principal component changes with age was then undertaken. Demonstrable age changes were verified for Factors 1, 2, and 3, and Factors 1 and 3 were observed to show patterns of change which were statistically different from each other and the remaining principal components. An orthodontically treated sample of patients was also assessed for factor changes. Factors 1 and 2 were found to show statistically reliable changes resulting from treatment and/or growth. The remaining four factors showed no statistically supportable alteration. The data-reduction method involving a principal-component analysis would seem to have potential research and clinical applications.


The use of muscle forces by simple orthodontic appliances. Orthodontic appliances of simple construction have been described. They are valuable in intercepting the deforming action of perioral muscle function or malfunction. The same muscles that have the deforming potential may be enlisted to correct dental malocclusions. Early interception often prevents a problem of considerably greater magnitude at a later date.


Morphologic evidence of muscle influence on dental arch width. Tests on hypotheses to explain changes in arch width during correction of distoclusion with the activator appliance used in this study showed that statistically significant increases occurred in both maxillary and mandibular arch widths during treatment. The increase was substantially larger in the maxilla than in the mandible. The arch width showed no statistically significant decrease after completion of treatment. The activator designed for this study affected orofacial muscle balance. The findings suggest that there were changes in the influence of tongue and cheek muscles on the maxilla. Available experimental as well as clinical data support the assumption that the tongue had taken a higher and more anterior position in the palatal area and that the tension of the cheek muscles was reduced relative to the posterior part of the maxillary dental arch.


An analysis of the relationship between posterior dental cross-bite and vertical palatal asymmetry. The relationship between unilateral posterior cross-bite and vertical proportions of the palatal vault observed in the frontal plane was studied in twenty cross-bite cases wtih asymmetric palates and twenty control cases. The contour of the palate was registered from study models at three different anteroposterior levels with an adjustable template. The tracings of the contours obtained from roentgenograms of the instrument were used to measure the asymmetry of the palate.


Photographic templates (the positive-negative technique). Uses of the positive-negative technique are as follows: 1. Study of soft-tissue changes in purely orthodontic cases. 2. In conjunction with a visual treatment objective plan as presented by Reed Holdaway. 3. In the posteroanterior cephalogram, to study changes in the lip form and the alar base changes which occur in surgical and purely orthodontic procedures done to the maxilla when the vertical dimension is reduced or increase. 4. In prosthetic dentistry, for determining proper lip position. 5. In rhinoplasty procedures, to determine the most desirable profile for the patient. 6. In consultation, for better conveying to the patient what can possibly be done to change his dental-facial contours and also give the patient a choice as to how he might like to look. 7. In research, to study soft-tissue changes and long-term case results. 8. In teaching students of cephalometrics the location of the hard-tissue skeleton and its relationship to the soft tissue of the maxillofacial complex.


Mesiodistal crown diameters of permanent teeth in male American Negroes. The mesiodistal crown diameters were measured in a group of fifty-six male American Negroes from the recruit population at the Great Lakes Naval Training Center and compared with previously reported data on Caucasians from the same population. The results indicate that tooth size is consistently larger in the Negro sample, averaging about 8.4 percent for the over-all maxillary and mandibular dentition, excluding third molars.


Loaiasis (Loa loa) in an African student in Indiana. Loaiasis was seen in an African student in Indiana, who had non-specific complaints, leukocyte count of 8,400/mm3, a 47% eosinophilia, and a high Loa loa microfilaremia. Successful treatment with diethylcarbamazine (Hetrazan) produced no allergic manifestations and no reactions to the adult parasites were evident.


Adult respiratory distress syndrome after venous air embolism. Venous air embolism is not commonly believed to produce the adult respiratory distress syndrome. We present a nonsurgical case of venous air embolism followed by the development of this syndrome. Other causes of adult respiratory distress syndrome were excluded. Physicians should be alerted to its possible occurrence and the need for appropriate therapy.


Human health effects from accidental release of tetrachlorodibenzo-p-dioxin (TCDD) at Seveso, Italy. This paper is a progress report of the epidemiologic work carried out under the supervision of the Lombardy Regional Authority during the two years elapsed from the accident in a TCP-producing factory (ICMESA) in Meda (Italy), which resulted in the contamination of several towns of a large, densely populated area called the Brianza di Seveso with a total population of 220,000 inhabitants. A wide follow-up program is in progress in the Seveso area; it includes a clinical screening of the population living in the contaminated area and longitudinal and systematic health control of different groups at risk; a long-term morbidity cohort study has been also undertaken. TCDD exposure following the ICMESA accident resulted in an increased chloracne frequency. Neurologic examinations showed both signs of idiopathic subclinical neurologic damage and cases of clinically detectable idiopathic polyneuropathy in adults. A limited percentage of idiopathic hepatomegaly was reported to be present on clinical investigation; no information, however, is given on the criteria by which the hepatomegaly was investigated. Some alterations were observed in some exposed people in one or more liver tests (mainly transaminases and gamma-GT). So far, immunologic investigations, cytogenetic examination and embryomorphology analysis on cases of therapeutical or spontaneous abortions have not given abnormal results.


Suspected link between exposure to hexachlorophene and malformed infants. Retrospective studies, performed in 6 hospitals in Sweden, demonstrated that severe congenital malformations occurred more frequently in neonates born to mothers who used hexachlorophene soaps, 10--60 times a day by handwashing and hand-creams during at least the first trimester of pregnancy (25 severe malformations in 460 neonates), when compared to neonates born to similarly employed mothers who did not use hexachlorophene soaps (0 severe malformations in 233 neonates). Minor congenital anomalies were also more commonly noted in the hexachlorophene-exposed group when contrasted with controls. Other known adverse influences, such as age, infections during pregnancy, other drug usage, or smoking habits did not appear different in the two groups.


Laboratory studies on the immune effects of halogenated aromatics. The effects of TCDD exposure on the developing immune system were investigated in Wistar/Fischer hybrid or Fischer rats. Fetal and neonatal rats were exposed to TCDD through maternal dosing (5 muk/kg) on day 18 of gestation and on days 0, 7, and 14 of postnatal life (group 1). Another group of neonatal rats was exposed to TCDD through maternal dosing on days 0, 7, and 14 of postnatal life only (group 2). Variable but significant effects on body weights and thymus/body weight ratios were found up to 133 days of age. Cell mediated immune functions were depressed up to 133 days of age in both groups but less severely in animals exposed only postnatally. Furthermore, TCDD suppressed cell-mediated immune functions without affecting humoral immune function. Adoptive cell transfer studies indicated suppression of T-cell functions was selective in that "helper" cell function was not suppressed. In other studies, the effects on lymphocyte function following brief exposure of spleens from B6C3F1 mice to TCDD in dimethylsulfoxide (DMSO) were investigated. DNA, RNA and protein synthesis were inhibited at concentrations less than 2 X 10(-7) M TCDD in DMSO. This concentration accounted for approximately 0.2 ng TCDD uptake per spleen. The structurally related chemicals 3,4,3',4'-tetrachlorobiphenyl and 1-amino, 3,7,8-trichlorodibenzop-p-dioxin did not show significant lymphocyte effects even at two-fold higher concentrations. The ability of lymphocyte mitogens to bind to their cell surface receptors was not affected by TCDD treatment. TCDD was slightly cytolytic to lymphocytes after 48 hours of culture. DMSO treatment alone was also slightly toxic to lymphoid cells as indicated by a 10--20% loss of cell viability, although this occurred within 4 hours after DMSO exposure. Studies were performed to investigate the effects of 2,3,7,8-tetrachlorodibenzofuran (TCDF) on immune function in adult Hartley guinea pigs. Animals received 6 weekly doses of either 0, 0.05, 0.17, 0.5 or 1.0 microgram TCDF/kg body weight. TCDF slightly depressed cell-mediated immune functions, particularly at the higher dose levels as indicated by decreased lymphocyte blastogenesis, delayed hypersensitivity reactions, and production of macrophage inhibitor factor. Additionally, thymus-to-body-weight ratios were slightly reduced in the 0.5 and 1.0 microgram dosage groups. Serum IgG levels and antibody titer to BGG did not differ from controls. These results indicate that TCDF-induced immunosuppression is similar to that of TCDD.


Effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on splenic lymphocyte transformation in mice after single and repeated exposures. Male CD-1 mice were orally treated with 0.01, 0.1, 1 and 10 micrograms TCDD/kg body wt./week for up to 8 weeks. Randomly selected animals were sacrificed at 2, 4, and 8 weeks of exposure. An additional group was given orally 10 micrograms TCDD/kg and the animals similarly sacrificed. Splenic lymphocytes from these animals were cultured in vitro with or without the presence of phytomitogens, phytohemagglutinin, and pokeweed mitogen. The incorporation of 3H-thymidine was measured as an indication of relative blast formation. Exposure of animals to TCDD, even at the lowest level (0.01 microgram/kg/wk for 2 weeks) caused a marked increase in the thymidine uptake by cultured lymphocytes. The blastogenic response of mitogens was reduced at high levels of TCDD exposure, indicating an immunosuppressive effect. Following a single treatment with 10 micrograms TCDD/kg, the increase in the blast formation was noted at 2 weeks, the effect reduced at 4 weeks, and no difference noticed in treated vs. control cultures 8 weeks after the treatment. Small doses of TCDD stimulate the splenic lymphocyte transformation and this effect, although somewhat dose-related, can be reversed in a relatively short period of time.


Immunologic effects of vinyl chloride in mice. Male CD-1 mice were exposed to 10, 100 or 1000 ppm vinyl chloride (VC) for 2--8 weeks at 6 hr/day, 5 days/week. A slight increase in the spleen weight of mice was noted at the highest exposure level. Spleens were obtained from these animals (4 mice/group after 2, 4, and 8 weeks of exposure) and their lymphocytes cultured in vitro with or without the presence of phytomitogens, phytohemagglutinin (PHA) and pokeweed mitogen (PWM). Relative blast formation and the DNA synthesis was measured by the incorporation of 3H-thymidine in the cultured cells. The response of splenic lymphocytes to the phytomitogens was increased several-fold by VC exposure. The effects were apparent at 1000 ppm VC after 2 weeks of exposure and at all levels of VC exposure after 4--8 weeks. The effects were generally more pronounced at 100 ppm VC exposure than those at 1000 ppm. In vitro culture of splenic lymphocytes from control or VC-exposed mice in the VC atmosphere did not show an enhancement of blast formation. Alteration of VC metabolism during the VC exposure in vivo yielded results that indicated that metabolites of VC may be responsible for the stimulation of lymphocyte transformation observed in splenic cultures.


Investigations on the effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on parameters of various immune functions. The effects of TCDD exposure on parameters of immune function during the developmental period were investigated. Exposures were performed in Fischer/Wistar rats. Fetal and neonatal rats were exposed to TCDD through maternal dosing (5 micrograms/Kg) on day 18 of gestation and on days 0, 7, and 14 of postnatal life (group 1). Another group of neonatal rats were exposed to TCDD through maternal dosing on days 0, 7, and 14 of postnatal life only (group 2). Body weights and relative thymus weights were found to be suppressed up to 135 days of age in group 1 but only up to 35 days of age in group 2. Parameters of cell-mediated and humoral immune function were investigated. TCDD suppressed cell-mediated immune function without affecting humoral immune function. TCDD-exposed animals had recovered normal cell-mediated immune function by 270 days of age. A group of inbred Fischer rats was exposed to TCDD as described for group 1 above. At 45 days of age these animals were utilized in lymphocyte homing studies. It was found that TCDD exposure alters homing patterns of lymphocytes from exposed animals when adoptively transferred to untreated animals. In addition, lymphocytes from nonexposed animals did not home normally when injected into TCDD-exposed recipients.


Carcinoma of the superior pulmonary sulcus. From January, 1971, to January, 1977, 26 patients underwent surgical resection of a carcinoma of the superior pulmonary sulcus. They ranged from 33 to 77 years old. All but 1 had symptoms characteristic of Pancoast's syndrome. The site of involvement was the right superior sulcus in 17 patients and the left superior sulcus in 9. All patients were treated by lobectomy and extended en bloc resection. Twenty-five patients survived operation. There was 1 early postoperative death. Twenty-two patients had been followed for at least 3 years, and 8 had survived for 5 years, at the time of writing. Nine patients died of recurrent disease from five months to 3 years after operation. Important considerations in postoperative care include routine use of continuous positive airway pressure and intermittent mandatory ventilation.


Cytogenetic studies in basophilic chronic myelocytic leukemia. Basophilia is found in association with many diseases and is commonly seen in patients with chronic myelocytic leukemia (CML). Substantial basophilia development during the course of CML has been considered to be a poor prognostic sign. Prominent basophilia occasionally has been seen in patients at the time of the original diagnosis. These cases have been classified as "basophilic leukemia." A patient with a basophil count of 24,080/cu mm and myeloid immaturity in his peripheral blood had typical Ph1 chromosome in his bone marrow. G-banding studies showed typical 22q-;t(9q+;22q-) of CML. Since seven of the nine basophilic leukemias so far studied cytogenetically have Ph1 chromosomes and since Ph1 chromosomes are absent in the majority of eosinophilic leukemias, we believe it more appropriate to call basophilic leukemia basophilic CML.


Chronic granulocytic leukemia occurring in blast crisis. Cytogenetic studies of marrow using chromosomal banding techniques revealed the presence of the Philadelphia (PH1) chromosome in two patients with clinical and hematologic findings of acute myelogenous leukemia (AML). A review of the literature since the use of chromosomal banding techniques revealed about 15 patients with Ph1)-positive acute leukemia that we consider to be chronic granulocytic leukemia (CGL) occurring in blast crisis. We describe two additional patients, one of whom we believe is unique in that the initial blast crisis contained Auer's rod-positive cells.


Mycotic wound infections. A new challenge of the surgeon. Fungal wound infections have become more common because of the increased use of immunosuppressive and antineoplastic agents, prosthetic devices and grafts, broad-spectrum antibiotics, and hyperalimentation. Severe burns, renal failure, and other debilitating conditions also predispose to invasive mycoses. An aggressive diagnostic approach is particularly important, and tissue biopsy specimens are often necessary to establish a diagnosis. Meticulous surgical technique and minimization of the predisposing factors are crucial in the prevention of these infections, and prophylactic antimycotic agents may be of value in selected high-risk patients. Some mycotic wound infections can be managed effectively without systemic therapy; but when systemic agents are needed, combination antifungal therapy may provide improved results without increased drug toxicity.


[Pathomorphology of the lymph nodes and the genesis of myeloid infiltrates in them in acute granulocyte-type leukemia]. Five hundred lymph nodes taken from various parts of the body in 89 patients who had died of acute granulocytic leukemia at the age of 3 to 71 years were examined. The degree of involvement of lymph nodes of the same patient was different and depended of their site: more frequent and pronounced changes were found in submaxillary, cervical, and retroperitoneal lymph nodes, less marked in inguinal and mesenterial nodes. The earliest infiltrates of oxidase-positive cells appeared in hilus fat around small arteries, then in the medullary part and, finally, in the cortex. In sinuses, the oxidase-positive cells accumulated later than in the medullary part, were more mature and sometimes were phagocytized by histocytes. A direct correlation between the degree of myeloid infiltration in the lymph nodes and the number of leukocytes in the peripheral blood was observed. These results and data of the literature suggest a metastatic genesis of myeloid infiltrates.


Treatment of osteogenic sarcoma of the mandible. Osteogenic sarcoma of the mandible is a rare tumor, comprising less than 0.5% of all head and neck tumors, and, even in large institutions, the experience in management of such tumors is limited. Current therapy for osteogenic sarcoma of the long bones is based on a more extensive experience in large centers and includes a major role for chemotherapy. We report two cases of osteogenic sarcoma of the mandible that were treated by combined chemotherapy, radiation therapy, and surgery. The expected disease-free survival of patients with this disease, treated by surgery alone, would have been less then 50% in the first year. The survival of these two consecutive patients for more than one year, free of disease, is significant and encourages further use of this type of treatment.


The leukaemias.

The leukaemias. The leukaemias comprise a group of blood disorders which differ widely in regard to prognosis, the need for treatment and the intensity of treatment. A detailed understanding of them is necessary to decide which cases require treatment, and where the treatment is to be carried out. Such an understanding is also needed in counselling and advising patients, proper communication being a very important part of management. Acute leukaemia (with some exceptions) requires intensive and difficult treatment appropriate only in properly staffed hospital units. Chances of control range from reasonable to very good, especially in children, and significant prolongation of survival is seen in those who achieve remission. Future prospects for cure are promising. Chronic lymphatic leukaemia may be a very benign disease, though risk of infection increases as time passes. Chronic myeloid leukaemia, though initially benign, is less chronic than is generally believed and commonly the disease transforms to an acute pattern which cannot for long be controlled.


The management of primary hyperparathyroidism. With the advent of serum parathyroid hormone assays the diagnosis of hyperparathyroidism has become relatively straightforward. Current unresolved problems comprise the selection of patients for surgery, the pre-operative localization of lesions and the medical management of patients who, for one reason or another, are unsuitable for surgery.


Treatment of Paget's disease with the calcitonins. Calcitonin has been used in the treatment of Paget's Disease of bone because of its ability to inhibit osteoclastic bone resorption. This results in a return of bone turnover towards normal, as reflected by urinary hydroxyproline and serum alkaline phosphatase. A plateau is reached with these parameters, at about 50% of the pre-treatment level. The cause of this plateau is unknown, but does not indicate resistance to treatment, since it occurs with all forms of calcitonin. Most treated patients experience pain relief, and there is radiological and histological evidence of arrested progression of Paget's Disease in patients treated with calcitonin. Both primary and secondary resistance to calcitonin occur with all calcitonins, including homologous hormone. Antibodies develop commonly in patients treated with pig or salmon calcitonin, but antibody-based clinical resistance has been demonstrated only in a few patients. Methods of selection of patients for treatment and of assessment of response are discussed, and treatment schedules summarized.


Atheromatous coronary artery ectasia.

Atheromatous coronary artery ectasia. Of 431 consecutive patients who underwent coronary arteriography during the twelve month period ending December 1976, 23 (5%) had angiographically documented coronary artery ectasia. Of these only five had "pure" or isolated ectasia, whilst 18 had ectatic disease combined with coronary artery stenoses. Clinical findings that are significantly associated with ectasia are male predominance (96%), abnormal lipid patterns (64%), a positive family history of coronary artery disease (57%) and previous hypertension (50%). Anatomically, ectasia most often involved the right coronary artery (96%), then the circumflex artery (75%) and the left anterior descending artery (57%). Only seven (five with severe proximal stenoses) of the 28 patients had coronary artery bypass grafts. Care should be taken not to overdiagnose narrow segments between ectatic, dilated segments as being obstructions. Failure to appreciate this resulted in two patients with isolated coronary artery ectasia having bypass grafts performed with little relief of their symptoms.


Haemoglobin A1 in diabetes mellitus.

Haemoglobin A1 in diabetes mellitus. HbA1 was measured by a rapid method in a routine hospital laboratory. The normal range of 5.0--8.5% compares favourably with other studies. Patients with uncontrolled diabetes had levels of HbA1 of up to 20.5% while well controlled patients had levels of HbA1 in the normal range. The level of HbA1 is relatively stable in normal subjects and does not correlate with age, sex or weight. There was a correlation (p less than 0.001) with a 1-2 hour post-prandial, post-insulin blood sugar in insulin dependent diabetics. There was a relationship between type of therapy and HbA1 level at presentation. From the study of two ketoacidotic patients, it is apparent that the level of HbA1 decreases about six weeks after the decrease in blood sugar. It is concluded that the measurement of HbA1 is a useful adjunct in the assessment of diabetic control.


An outbreak of acute methyl alcohol intoxication. An outbreak of acute methyl alcohol intoxication occurred in Port Moresby, Papua New Guinea, in March 1977. Twenty-eight young men attended a drinking party and drank methyl alcohol. The amount consumed by each individual ranged from an equivalent of 60--600 ml of pure methanol. Three had prior ethanol ingestion. All 28 became ill 8--36 hours after drinking and were hospitalized. The most commonly observed clinical syndromes were: acute metabolic acidosis, severe visual impairment and acute pancreatitis. Four died within 72 hours after admission to the hospital. All had severe metabolic acidosis and visual impairment and three pancreatitis. Of 24 who recovered, 16 showed no residual complications, six had bi-lateral visual impairment and two had difficulty in speech as well as visual impairment. A three month follow-up examination showed no change in the findings. Coma, seizures and prolonged acidosis were poor prognostic signs. The estimated amount of consumed methanol and the rapidity of the appearance of signs of toxicity following methanol ingestion did not seem to influence the outcome of poisoning. The treatment of acute methyl alcohol intoxication in centres where dialysis is not available is discussed.


Abdominal pain following intravenous benzyl penicillin administration. The occurrence of abdominal pain (in three patients) and lower chest pain (in one patient) either during or immediately after the intravenous administration of high doses of benzyl penicillin is reported. All four patients were diagnosed as having bacterial endocarditis and had been receiving between 8 and 18 mega units of the drug per day for 2--3 weeks, when the symptoms were first noticed. A skin rash also appeared in each case, at this time. Both the rash and abdominal pain disappeared when an alternative antibiotic was substituted for the penicillin.


Acute non-lymphocytic leukaemia in the third trimester of pregnancy. A 28-year-old woman with acute myeloblastic leukaemia was effectively treated with cytosine arabinoside and 6-thioguanine during the third trimester of pregnancy and a complete remission achieved. A normal infant was delivered at term. The patient survived for 27 months and the baby is now 2 1/2 years old with normal physical and mental development. The literature on management of acute non-lymphocytic leukaemia during the second and third trimester of pregnancy is reviewed and it is concluded that effective combination chemotherapy improves fetal survival.


Angiostrongyliasis cantonensis.

Angiostrongyliasis cantonensis. A case of Angiostrongyliasis cantonensis with eosinophilic meningoencephalitis, presenting in a Caucasian resident of Rabaul, Papua New Guinea, is described. Diagnosis was supported by serological studies. This appears to be the first report of a case from New Britain.


Ocular side effects with 5-fluorouracil. The concentrations of 5-fluorouracil in tears and plasma were studied in eight patients receiving the drug for carcinoma of the colon. The drug was measured by a gas liquid chromatographic method and found to be present only in the tears of patients with excessive lacrimation. In three patients with watery eyes the peak concentration in tears (16-23.8 micrograms/ml) occurred 15 minutes after IV administration and this corresponded with the end of the distribution (alpha) phase in the plasma when the plasma levels ranged from 18-26 micrograms/ml. In five patients without eye symptoms the drug was undetectable in the lacrimal fluid even though they had similar plasma levels (15-25 micrograms/ml) of 5-fluorouracil. The volumes of distribution and plasma clearance rates were similar in the two groups [being 0.2-0.52 (mean = 0.33) 1/kg and 612-978 (mean = 850) ml/min respectively in patients with excessive lacrimation and 0.13-0.79 (mean = 0.36) 1/kg and 435-1138 (mean = 831) ml/min respectively in the five patients without symptoms.]. It appears that 5-fluorouracil produces irritation of the lacrimal apparatus in about 30% of patients on the drug and in association with this appears in the tears where it may be responsible for the reported irritation and fibrosis of the tear duct.


Crohn's disease: a review of 122 cases.

Crohn's disease: a review of 122 cases. One-hundred-and-twenty-two patients with Crohn's disease were admitted to Royal Prince Alfred Hospital from 1966 to 1977. Thirty-seven had disease confined to small bowel, 37 to colon and 48 had combined small and large bowel involvement. The disease was twice as common in females as in males. Pain was the major symptom in patients with small bowel disease and was associated with diarrhoea if both small and large bowel were involved. Disease confined to the colon most commonly produced diarrhoea with bleeding. Perianal disease occurred more often in patients with colonic disease. Systemic complications were also more frequent in the group with disease confined to colon, and these complications were often multiple. Medical treatment with corticosteroids, salazopyrine or azathioprine, was generally unsuccessful. One in two patients required surgery, usually in the form of resection. Following resection, recurrence occurrred in more than one half of the patients but was less frequent in those with colonic disease. Three-quarters of patients with a recurrence required a further resection, emphasising the unsatisfactory long-term results of surgery in this disease.


Release of secretin--plasma levels reproduced by exogenous infusion. Infusion of 0.1 M HCl (0.5 mmol/kg/hr over 20 minutes) into the duodenum of each of seven normal subjects led to a significant rise (P less than 0.05) in mean plasma secretion levels from 3.0 +/- 2.2 (SE) to 15 +/- 4.0 pmol/l. Intravenous infusion of secretin at a rate of 6.6 pmol/kg/hr (0.08 clinical units/kg/hr) reproduced the peak plasma levels of secretin observed during duodenal acidification. However, there was no detectable (2.5 pmol/l) change in plasma secretin after oral protein or glucose.


The effects of dietary fibre on glucose tolerance in healthy males. Previous studies have shown that the addition of non-absorbable carbohydrate (NAC) to test meals decreases the glucose and and insulin response both in normal and diabetic subjects. However, these  studies appear to have used brain in the basic test meal without a knowledge of the effect of bran itself or of the added NAC alone. In the present investigation bran alone, pectin alone, guar alone and pectin with guar have been studied. Guar alone added to the test meal significantly lowered blood glucose at 90 minutes. Pectin alone did not have a significant effect. Pectin and guar together resulted in a blood glucose lower at 30 minutes and greater at 120 minutes. No significant changes in insulin response were noted to our study. It appears that NAC alters the glucose response to a given meal, but the extent to which this occurred in the present study was less than in previous studies. The differences may reflect synergism between bran and other NAC's to lower blood glucose response after a meal.


Distribution and interrelations of coronary risk factors in a community sample of Auckland men. Distributions and interrelations of blood pressure, serum cholesterol, triglycerides, urate and glucose, cigarette and alcohol consumption and ECG characteristics were assessed in a community sample of 524 Auckland men aged 30-55. The distributions of these variables were generally similar to those found in other New Zealand samples, indicating that New Zealand levels of coronary risk factors lie in the upper reaches of the US and European range. Notable amongst the interrelations found were the pattern of relationships between serum cholesterol, triglycerides and urate, and the association of both body mass and alcohol intake urate level.


Exercise testing in congenital aortic stenosis. Treadmill exercise testing was performed on 23 patients with isolated congenital aortic stenosis. It was found that eight patients, with a negative exercise test and a normal rise in systolic blood pressure on exercise, had gradients less than 45 mmHg. Fifteen patients with gradients greater than 50 mmHg had positive exercise tests and their systolic blood pressure did not rise normally. It is suggested that the left heart studies to measure aortic valve gradients can safely be postponed if an exercise test is negative. Serial exercise testing of such patients will give an indication when left heart catheterization should be considered.


Patent ductus arteriosus in Malaysia.

Patent ductus arteriosus in Malaysia. Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty-two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty-two per cent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.


The association of haemopoietic dysplasia (pre-leukaemia) and abnormal cell clone with connective tissue disease. A 68-year-old man with haemotological features consistent with haemopoietic dysplasia (pre-leukaemia) and an abnormal cell clone in the marrow, 46, XY, -18, +t(13;18) (q11;123), developed acute connective tissue disease characterised by vasculitis, dermal changes, marked muscular weakness and serological features suggesting an auto-immune disturbance. Although four other cases of haemopoietic dysplasia ("pre-leukaemia") with unusual connective tissue disease had been reported since the recognition of haemopoietic dysplasia as a distinct entity, a definite association between these two disease states still awaits confirmation by further reports and investigations.


A case of paroxysmal nocturnal haemoglobinuria terminating in a myeloproliferative syndrome. This report discusses the case of a 60-year-old man who presented in 1969 with thrombocytopenia and mild marrow hypoplasia. A diagnosis of paroxysmal nocturnal haemoglobinuria (PNH), was established. The subsequent course included episodes of overt intravascular haemolysis. Thrombocytopenia reverted on several occasions during Oxymetholone therapy. The terminal phase of the illness was marked by the development of a leukocytosis and densely hypercellular bone marrow with splenomegaly. The features were those of a myeloproliferative disorder, although frank leukaemia did not develop.


Progressive polyradiculoneuropathy: treatment with Azathioprine. A case is presented of a 64-year-old male with chronic inflammatory polyradiculoneuropathy (CIP) relentlessly progressing (despite steroids) to virtually complete quadriplegia over seven months. Once commenced on Azathioprine he dramatically improved over a six week period. The truly progressive form of CIP is rare. It is, however, immunologically similar to relapsing CIP and to the more common acute inflammatory polyradiculoneuropathy (AIP). Although the place of steroid therapy is still in doubt it would seem that cytotoxic immunosuppressives have something definite to offer in these conditions where there is progression beyond 4-5 weeks. In the largest series of CIP available (where the patients were untreated, or treated with steroids alone) the mortality rate was 11%, and the "complete recovery" rate only 5%. Although only isolated case reports are available, it would seem that if more aggressive immunosuppressive therapy was used more frequently, the prognosis might be considerably improved.


Tracheobronchopathia osteochondroplastica. The clinical, pathological and physiological features of two patients suffering from tracheobronchopathia osteochondroplastica (TO) are described. Unequivocal evidence of extrapulmonary airways obstruction was not able to be obtained by lung function testing, despite extensive central airway involvement in both patients. TO is a rare condition of which there is only one other clinical report from this country. As the bronchoscopic appearance may closely resemble that of endobronchial neoplasms, TO should be remembered in the differential diagnosis of patients with haemoptysis.


Juvenile Reiter's syndrome.

Juvenile Reiter's syndrome. A case of Reiter's syndrome occurring in an 11-year-old, pre-pubertal boy is described. The boy was a heterozygote for the histocompatibility antigen B27 and other arthritic members of his family included his mother with colitic arthritis and an aunt with ankylosing spondylitis. His HLA-B27 negative sibs have remained well. Shigella Salmonella and Yersinia organisms have been previously incriminated as precipitating factors in some patients with Reiter's syndrome but no evidence of recent infection with any of these agents was found in this patient. The case is reported because of the rarity of the condition at this age.


A chemotactic inhibitor produced by blast cells and present in the serum of a patient with acute lymphoblastic leukemia. A chemotactic factor inhibitor (CFI) was found in the serum of a patient with acute lymphoblastic leukemia. The factor was characterized as heat-labile, with activity against complement-dependent chemotactic factors and against the chemotactic factor produced by Escherichia coli. Normal sera and sera from other patients with acute leukemia also demonstrate heat-labile inhibitory activity against complement-dependent chemotactic factors but not against the E. coli-derived chemotactic factor. Supernatants from cultured lymphoblasts of the patient also possessed CFI activity similar in character to that found in his serum. It is suggested that in vivo the lymphoblasts were responsible for the chemotactic defect observed in his serum, presumably by manufacturing and releasing a chemotactic factor inactivator.


Selective sensitivity of chronic myelogenous leukemia cell populations to alkyl-lysophospholipids. In order to evaluate the specificity of alkyl-lysophospholipid-induced cell destruction, peripheral blood leukocytes from chronic myelogenous leukemia (CML) patients in chronic phase of the disease as well as in blastic crisis have been separated by density centrifugation. These subpopulations, enriched for the different maturation stages, were tested for their sensitivity to alkyl-lysophospholipids. It is shown that myelocytes in chronic phase CML are resistant, but blast cells from both clinical stages as well as maturational defective myelocytes from blastic crisis CML are highly sensitive to these antimetabolites. In contrast to chronic phase CML myelocytes, these sensitive cells show a high lysophospholipid adsorption rate and lack an O-alkyl-cleavage enzyme.


Two cases of carcinoma of the lung characterized by a bone marrow agar culture pattern resembling acute myeloid leukemia. In vitro agar culture patterns of bone marrow cells in acute myeloid leukemia may show several growth patterns, including cultures where no colonies or clusters develop, cultures with varying numbers of clusters and no colonies, or colony and cluster formation with an extremely high ratio of clusters to colonies. Twelve cases of carcinoma of the lung are described, of which two show an in vitro growth pattern of cluster formation alone, characteristic of that seen in acute myeloid leukemia. The remaining ten patients showed slightly reduced colony numbers compared to normal.


Prognostic significance of alkaline phosphatase measurements in patients with osteogenic sarcoma receiving chemotherapy. During the period January 1975 to August 1977, alkaline phosphatase levels in 30 patients with osteogenic sarcoma were closely followed in an attempt to determine if these measurements had clinical value in predicting the course of patients with this disease. Of 17 patients with elevated preoperative alkaline phosphatase levels, 12 recurred. Of 13 patients with normal preoperative alkaline phosphatase levels, only 4 recurred (p less than .05). Thus, alkaline phosphatase levels that were elevated preoperatively were correlated with poor prognosis. A similar correlation between postoperative alkaline phosphatase levels and prognosis could not be made.


Eosinophilia, chloromas and a chromosome abnormality in a patient with a myeloproliferative syndrome. The existence of eosinophilic leukemia remains controversial since many authors challenge the existence of this entity. We present a patient with a hypereosinophilic syndrome whose findings were consistent with a leukemic process. The patient's course was marked my signs and symptoms of myeloblastoma formation and his illness terminated in an acute blastic crisis. chromosome studies on peripheral blood leucocytes demonstrated aneuploidy and an abnormal number four chromosome with additional material on its long arm. This case appears to be an unusual example of a hypereosinophilic syndrome with both myeloblastoma formation and an abnormal leucocyte karyotype.


Acute nonlymphoblastic leukemia in childhood. Cytogenetic studies have been done on a group of childhood patients over a period of 3 1/2 years in which time Giemsa trypsin banding was applied to all specimens. Fifteen of the 107 patients (14%) were diagnosed as having acute nonlymphoblastic leukemia (ANLL). Twelve of the 15 had chromosomal abnormalities. The most common was an involvement of the No. 7 chromosome which occurred in five patients. Three patients had trisomy 19. No correlation could be found between the disease subgroup and the karyotypic aberration in patients with anomalies involving a common chromosome.


Cytogenetic studies of chronic myelocytic leukemia in children and adolescents. In a 3 1/2 year cytogenetic study of 107 leukemia patients diagnosed in childhood and adloescence, 8 presented with chronic myelogenous leukemia (CML). Seven of the 8 had chromosomal abnormalities. Six had the Ph1 chromosome; 5 had the usual 9;22 translocation. Two patients had involvement with chromosome 15; one had a 9;15 translocation in Ph1 positive cells during remission while a second had a 1;15 translocation during blastic crisis. The 2 patients who did not have a Ph1 chromosome survived 13 and 30 months, respectively, considerably less time than the 4+ year survival in most of those with Ph1 positive CML.


Respiratory distress of hyperleukocytic granulocytic leukemias. The rapid appearance of acute respiratory distress during the course of 25 hyperleukocytic leukemias was associated with the rapid increase of the leukocytosis. The regression of the tachypnea was spectacular when treating hyperleukocytosis by exchange transfusion and chemotherapy. Blood gas studies, although blurred to some extent by in vitro blast consumption of oxygen, showed a hypoxemia with a hypo-or normocapnia. The symptoms seem to be related to the leukostasis by the mechanical obstruction of the pulmonary capillaries. This leukostasis was shown to be responsible for a septal and alveolar oedema. The high frequency of this syndrome during the course of AGL and of acute phase of CGL seems to be linked to the low deformability of the myeloblasts. In CGL at its chronic phase, CLL or even in ALL, the absence of this syndrome could be explained by the greater deformability of the circulating cells. The hyperleukocytic AGL patients which do not have this syndrome are all characterized by a stable or slowly increasing leukocytosis. Thus, this syndrome seems to characterized by hyperleukocytic granulocytic leukemias with a rapid blood leukocyte doubling rate. Treatment in such cases is an emergency.


Effects of partially thiolated polycytidylic acid on the clonogenicity of murine leukemic stem cells. The effect of partially thiolated polycytidylic acid (MPC) on the colony-forming ability of the progenitor cells (CFUC) of RF/Un leukemic mice was investigated using the plasma clot method in order to study the mode of action of the modified polynucleotide. The results showed that MPC inhibited the CFUC in a dose-dependent and time-dependent manner. Once a maximum level of inhibition of CFUC (approximately 40%) was observed, no further inhibition occurred whether the concentration of MPC was increased or whether the duration of incubation was lengthened. High-specific-activity [3H]thymidine, an S-phase-specific agent, showed a similar inhibition profile on the CFUC as did MPC. When MPC and high-specific-activity [3H]thymidine were incubated together with the bone marrow cells, there was no additive or synergistic inhibitory effect on the CFUC. Thus, it appears that MPC is an S-phase-specific agent. When injected i.v. into the mice, MPC decreased the number of CFUC of both the bone marrow and the spleen significantly.


Prolongation of survival time of mice inoculated with myeloid leukemia cells by inducers of normal differentiation. Studies were made on the effects of inducers on the leukemogenicity of sensitive mouse myeloid leukemia cells (M1) that could be induced to undergo cell differentiation into mature granulocytes and macrophages in vitro by incubation with inducers (certain proteins, bacterial lipopolysaccharides, or glucocorticoids) and of resistant M1 cells that could not be induced to differentiate into mature cells. Inducers of cell differentiation significantly enhanced the survival times of mice inoculated with sensitive cells but scarcely affected the survival times of mice inoculated with resistant cells. Some mice inoculated with the sensitive cells and treated with lipopolysaccharide did not develop leukemia. The sensitive and resistant clone cells contained similar common tumor-related surface antigens. Treatment with lipopolysaccharide was also effective in athymic nude mice inoculated with the sensitive M1 cells. Lipopolysaccharide or glucocorticoid significantly stimulated differentiation of the sensitive cells cultured in a diffusion chamber in vivo but had little effect on differentiation of resistant cells. These results suggest the possibility of treating, with partial success, leukemia in vivo with differentiation inducers.


Treatment of osteogenic sarcoma. II. Aggressive resection of pulmonary metastases. Thirty-nine patients with osteogenic sarcoma were treated in a prospective protocol involving the use of adjuvant high-dose methotrexate, frequent screening for pulmonary metastases, and aggressive resection of all metastatic disease whenever possible. Twenty-two of these 39 patients have had recurrence and in 20 patients evidence of metastatic disease was confined to the lungs. Eighteen of the patients had thoracotomy, and in 11 patients all known disease was resected. Although four of these patients have required further thoracotomies, all 11 patients have no evidence of disease. Thus, of the original 39 patients, 30 (76.9%) are now alive and 28 (71.8%) have no evidence of disease, with a median followup of 27 months. Survival is significantly improved compared to historical control patients (P less than 0.001; one-sided Kruskal-Wallis test).


Biochemical parameters of growth inhibition of human leukemia cells by antitumor anthracycline agents. Ten antitumor anthracycline derivatives used in this study inhibit growth of a human leukemia cell line over a range of potencies exceeding four orders of magnitude. The agents vary from each other at C-4 and C-13, with stereochemical differences at C-4' and substitutions at C-14 and N. Drug retention, DNA damage, and inhibition of DNA synthesia are parameters used to express potency of the agents in a mathematic model. Estimates of DNA damage are sufficient, however, to describe growth inhibition by a single agent (4-demethoxydaunorubicin). It may be possible now to attempt to extend the model to predict therapeutic responses to a number of anthracyclines, thereby enhancing the clinical utility of this important class of agents.


Clinical studies with daunorubicin-DNA and adriamycin-DNA complexes: a review. The clinical results presently available on the use of daunorubicin (DNR)-DNA and Adriamycin (ADR)-DNA are reviewed in light of the most recent experimental data regarding the anthracycline-DNA complexes. Three randomized trials indicate that ADR-DNA is superior to DNR-DNA in combination therapy for acute lymphoblastic leukemia, that DNR-DNA equals DNR in the treatment of acute nonlymphoblastic leukemia, and that ADR-DNA might be equal to ADR in the chemotherapy for anaplastic bronchogenic carcinoma. Increasing evidence suggests that the anthracycline-DNA complexes are less cardiotoxic than the corresponding free drugs.


Clinical studies with rubidazone.

Clinical studies with rubidazone. One hundred and thirty-three patients, 94 with acute luekemia and 39 with solid tumors, received rubidazone, alone or in combination, at M. D. Anderson Hospital. The initial study, a phase I--II study carried out in 39 patients with acute leukemia, revealed substantial antileukemic activity with optimal results at a dose level of 450 mg/m2. Toxic manifestations included an acute reaction suggestive of histamine release with dose-limiting mucositis at a dose of 600 mg/m2. Forty-seven patients with acute leukemia were treated at phase II dose levels. Thirteen of 32 patients (42%) with acute myelogenous leukemia and seven of ten patients (70%) with acute lymphocytic leukemia achieved complete remission. Twenty-seven previously untreated patients with acute leukemia who were greater than 50 years old were treated with rubidazone in combination with cytosine arabinoside, vincristine, and prednisone. Fifteen patients (50%) achieved complete remission including 12 of 15 patients (73%) who were treated at a dose of 200 mg/m2 of rubidazone on Day 1 and a dose of 70 mg/m2/day X 7 days of cytosine arabinoside (continuous infusion). For patients with solid tumors, the dose-limiting toxic effect was myelosuppression at a dose of 200 mg/m2. Other toxicity at that dose level was minimal. The best responses were seen in patients with carcinoma of the period with two of four evaluable patients showing objective tumor regression. Of six previously untreated patients with thyroid carcinoma none responded, and in a phase II study of patients with breast cancer there were no partial remissions among 13 patients. Cardiac toxicity, manifested by congestive heart failure, occurred in seven patients at cumulative doses of 1050--2600 mg/m2 of rubidazone; all patients had had prior anthracycline therapy at low doses. Rubidazone has been shown to be an active antileukemic agent, but appears to be less active than Adriamycin in our studies of patients with solid tumors.


Deficient heme synthesis as the cause of noninducibility of hemoglobin synthesis in a Friend erythroleukemia cell line. Friend cells of the line Fw are not induced to accumulate substantial amounts of hemoglobin and to become benzidine-positive when treated with butyric acid or other inducers, except in the presence of exogenous hemin. The cells are shown to have a deficiency in heme synthesis since they require exogenous hemin during the period of maximal hemoglobin synthesis; since endogenous heme synthesis cannot be induced to the level found in normal inducible Friend cells, even after hemoglobin synthesis has been induced by hemin and butyric acid and the hemin has then been withdrawn; since they are not inducible for ferrochelatase (heme synthetase) activity; and since they accumulate free globin chains after stimulation with butyric acid in the absence of hemlin. Comparison of globin synthesis and globin mRNA content of the cells shows that globin synthesis is not controlled by the hemin-controlled repressor of protein synthesis (HCR) nor by any specific translational control of globin synthesis by hemlin.


[Myelosarcoma as the 1st manifestation of myelosis]. Myelosarcoma of the nodes, middle ear, rib, and spinal epidural space was observed in five cases as preceding the diagnosis of myelosis. In two cases involving epidural localization malignant lymphoma was misdiagnosed and reclassification only at the time of postmortem. Myelosarcoma is best distinguished from other types of tumour by means of the histochemical proof of naphthol-AS-D-chloracetatesterase.


Phase-II trial with vindesine for regression induction in patients with leukemias and hematosarcomas. Vindesine (VDS) has been submitted to a phase-II trial, the results of which were assessed in terms of regression induction. VDS was given weekly IV in doses of 2 mg/m2 on two consecutive days to 59 patients, 55 of whom were evaluable. A high proportion of complete (36%) and over 50% partial regressions were obtained in acute lymphoid leukemias (ALL) (overall response 63%) whatever the perceptible phase, in blastic crisis of chronic myeloid luekemia (55%), and some responses were recorded in lymphosarcoma (40%). No effect has so far been seen in acute myeloid keukemia or in Hodgkin's disease. Malignant neoplasms of the immunoblastic type seem to be particularly sensitive to VDS. Continuous 48 h IV infusion can induce a remission where an IV push administration of the same dose has failed. One remarkable characteristic of VDS is the apparent absence of cross-resistance with VCR: in acute leukemic forms, 55% of patients who failed to obtain remission induction after three weekly injections of VCR (used in combination chemotherapy) achieved a complete or partial remission with VDS. The toxicity was mainly neurologic (paralytic ileus, constipation, paresthesias, loss of reflexes) and hematologic (leukopenia and thrombopenia), and was not more significant than with the other agents: four patients died of infection or hemorrhage.


An initial report of a phase-III trial comparing vindesine and vincristine for acute lymphocytic leukemia of childhood. The initial results from the Children's Cancer Study Group (CCSG) study on vindesine are the subject of this report. Vindesine was shown to be active in the treatment of acute lymphocytic leukemia (ALL) in children in a phase-II clinical trial conducted by the CCSG. A phase-II trial is now in progress. The aim of this is to compare the use of vincristine and of vindesine with reference to induction rate, toxicity, and cross-resistance.


Urinary excretion of thymine and uracil in a two-year-old child with a malignant tumor of the brain. A two-year-old boy with a malignant tumor of the brain (medulloblastoma) excreted large amounts of thymine and uracil in his urine. The excretion was related to progress and regress of the disease, and reached a maximum of 3.0 mol of thymine per mole of creatinine and 2.6 mol of uracil per mole of creatinine. The excretion by 20 apparently normal children was less than 0.01 mol/mol of creatinine for each of the two pyrimidines. Three children with brain tumors, two with leukemias, and one with neuroblastoma were also studied; two of them had a moderate increase in urinary pyrimidine excretion, but only up to 0.07 mol/mol of creatinine. The activity of dihydrouracil dehydrogenase (NADP+) (EC 1.3.1.2) in cultured fibroblasts from the patient was somewhat lower than in control fibroblasts. The tumor was considered to be the likely cause of the increased excretion of pyrimidines, but an impaired degradation of pyrimidines in the liver could not be ruled out.


An anatomical study of the columella and the protruding premaxillae in a bilateral cleft lip and palate infant. An anatomical reconstruction of the protruded premaxillary segment of an infant with bilateral cleft of the primary palate was made from serial histological sections and described in comparison with reconstruction columella, alar cartilages, nasal septum, and premaxillae of a neonatal control specimen. Most of the bilateral cleft abnormality was seen in the premaxillary bones which were advanced on the nasal septum and whose alveolar process protuded anteriorly into the columellar area. The medial crura of the alar cartilages and the nasal septum in the cleft specimen showed an essentially normal structure. Underdevelopment of the columbella was considered as primarily failure in the development of columellar skin caused by the invasive obstruction by the premaxillary bones.


Patterns of articulation abilities in speakers with cleft palate. The purpose of this study was to report the articulation scores of 351 subjects with cleft palate from the ages of 2-6 to 18-0. Analysis of the data indicate that, as a group, subjects with cleft palate are retarded in articulation skills. However, they continue to improve in this regard past the age at which normal speakers have achieved articulation maturation. This information should be compared with that acquired from other centers in order to determine how typical these findings are.


Perceptual preferences between compensatory articulation and nasal escape of air in children with velopharyngeal incompetence. Three groups of children (eight with adequate velopharyngeal closure and normal speech, eight with velopharyngeal imcompetence and compensatory articulation patterns, and eight with velopharyngeal incompetence and compensatory articulation patterns, and eight with velopharyngeal incompetence and nasal escape of air) listened to 12 pairs of tape-recorded words. One word of each pair was produced with compensatory articulation, and the other was produced with audible nasal escape of air. Each subject indicated which word in each pair sounded better. The normal group and the group with velopharyngeal incompetence and nasal escape of air considered single words produced with compensatory articulation to be better than the same words produced with nasal escape of air. The group with velopharyngeal imcompetence associated with compensatory articulation patterns did not consider such productions to be better perceptual approximations of standard phonemes than the alternative distortion from nasal escape of air.


A roentgen stereophotogrammetric study of implant stability and movement of segments in the maxilla of infants with cleft lip and palate. Three implants (tantalum pins 1.5 x 0.5 mm) were inserted in each lateral segment of the cleft maxilla of ten infants aged three to 33 months. To check the stability of the implants in the bone the distances between the three implants within each segment were measured by means of roentgen stereophotogrammetry (accuracy 0.05 mm) at intervals of 7, 35, 63, 147, and 287 days after initial examination and at varying intervals thereafter (maximal observation time 833 days). No implants were lost and 18 of 60 measured distances were stable (final changes less than 0.2 mm). The three implants were regarded as a rigid-body model which represented the segment in the calculations of motion. In all infants with complete clefts, transverse narrowing occurred immediately after primary closure of the lip, or primary palate repair, while subsequent movement followed individual patterns.


Perci: a method for rating palatal efficiency. This paper describes a new, simple technique for instantaneously rating velopharyngeal competency during speech. The instrument, designed on the basis of data obtained from aerodynamic studies, provides an index of palatopharyngeal closure. Results from model studies and 75 cleft palate subjects demonstrate how the instrument is used to differentiate between problems related to velopharyngeal closure and those resulting from other variables which often influence the performance of speakers with cleft palate.


The craniofacial complex in cleft lip and palate: an update review of anatomy and function. This report has been prepared for the purpose of updating the previous State-of-the-Art reports on the status of research on the anatomy and physiology of cleft lip and palate (Dickson, et al,. 1974, 1975; Maude-Dickson, 1977). It covers the literature from August, 1976 to August, 1978, on middle ear musculature, the auditory tube, the velopharyngeal mechanism, the lip, mandible, tongue, nose, and larynx. It also includes a review of the literature from August, 1972, through August, 1978, on the growth and development of the craniofacial skeleton. Significant advances have been made in our understanding of the velopharyngeal mechanism and auditory tube. Further investigation is needed on the innervation and blood supply to the velopharyngeal mechanism and on the effects of age, race, and sex on the development of the craniofacial skeleton in both normal and cleft-palate individuals. There is a continued need for interdisciplinary research.


Patient dental values and their relationship to oral health status, dentist perceptions and quality of care. In this study, 1287 patients completed a questionnaire assessing knowledge of home care procedures, adherence to home care instructions, obstacles presented to the dentist in delivering care, and ability to pay for optimal care. Ninety-seven dentists that provided treatment for these patients completed a parallel questionnaire. Measures of oral health and the quality of restorative care were based on clinical examinations. It was found that though patient values and dental perceptions were associated, dentist perceptions did not closely match patient dental values. Analysis of variance indicated that patient dental values were related positively to both oral health measures and the quality of restorations. Patient-reported compliance with home care recommendations showed the strongest relationship to both oral health and quality of restorations.


A two-wave interview study of frequency of dental visits and dental complaints. A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.


A longitudinal study of multiple approaches to dental health education. An evaluation was made of the separate effects on oral hygiene of token reward treatments, discovery (project) learning, and plaque staining feedback demonstrations with children in the first through fifth grades. Both short- and long-term effects were assessed in an open classroom setting. Twenty classrooms were non-randomly assigned to treatment and control groups. Plaque scores were recorded according to the Podshadley Patient Hygiene Performance Index (PHP) at time T0, before initiation of any of the educational interventions; and again at times T1, T2, and T3; 7 days, 74 days and 255 days, respectively, following cessation of the educational interventions. The combination of dental health interventions at this school had short-range effects at every grade level, and those effects persisted for 9 months among the third and fourth graders. It was not possible to identify which of the various treatments produced the observed differences, although the project learning method was generally less effective. A linear regression analysis was used to evaluate the shifts in oral hygiene behavior, a method not previously used in studies of this type.


Intraindividual effect of daily supervised flossing on caries in schoolchildren. The aim was to study the effect of flossing on proximal caries in children grouped according to different combinations of dietary and oral hygiene habits. 140 12--13-year-old children flossed the right or the left lateral region of the mouth once every school-day for 2 years by pulling a waxed floss once up and down through the proximal contacts. Proximal caries was recorded on bitewing films, taken at the baseline and at the 2-year registration. Diet history was obtained four times during the period. Oral hygiene was classified according to the number of bleeding points registered with a feather-loaded probe at the final examination. Caries increments on the control side during the experimental period were calculated for groups with the same habits. A logical border with respect to the amount of new caries was then established between suitable and unsuitable dietary habits as well as between sufficient and insufficient oral hygiene. No statistically significant difference was found between the control and experimental subgroups in the different combinations of dietary and oral hygiene habits, neither with respect to the whole material nor comparable contralateral surfaces. The numerical differences were so small that the technique of flossing studied here cannot be recommended.


Two years' effect on the primary dentition of mouthrinsing with a 0.2% neutral NaF solution. The benefits to the primary teeth from a school-based fluoride mouthrinsing program are presented. Children in grades 1--4, residents of a fluoride-deficient community in New York, rinsed an average of 49 times during 2 school years using a 0.2% neutral NaF solution. Rinsing was done under the supervision of homeroom teachers. Differences in caries prevalence of 20.0% (dfs/child) or 23.8% (dfs/100s) were found in children who participated in the rinsing program for 2 years compared with baseline caries scores of children who never rinsed. Surface specific differences in caries prevalence after 2 years were: 27.5% for proximal surfaces, 24.1% for buccolingual surfaces, and 12.4% for occlusal surfaces.


Evaluation of a pit- and fissure-sealing program in a public dental health service after 2 years. The aim of the present study was to test the caries-preventive effect of a bis-GMA type fissure sealant (Concise Enamel Bond System) in a public dental health service for children. The study compared one group of children, in which all sound permanent teeth were sealed, and a control group in which no sealants were placed. During the study period all children received systematic restorative care, while sealing was performed on the basis of diagnoses made at subsequent examinations by one of the authors. After 2 years a total of 187 children were available for re-examination. Sealant retention was comparable to that obtained in previous studies, but no statistically significant reduction in overall caries increment could be demonstrated. Further analysis showed that only 223 sites had been sealed, while the majority of all erupting sites (394) were either carious or filled before they were screened for the purpose of sealing. It is therefore assumed that only teeth less susceptible to occlusal decay were sealed, thereby explaining the lack of benefit derived from the sealing program.


Dental caries in susceptible fissures after prolonged fluoride application. A prolonged fluoride application (PFA) method was used to treat susceptible fissures in 210 permanent first molar teeth in 79 children living in a fluoridated community. The development of caries in these fissures was followed for periods ranging from 2 to 4 years. At the final examination, 82.8% of occlusal surfaces in the 2-year group and 8090% of those in the 3-year group were free of detectable lesions. The corresponding value for the 4-year group was 78.9%. The mean number of treatments of these surfaces with the PFA method ranged from 1.6 for the 2-year group to 2.9 for the 4-year group.


A new method of direct computer entry for dental epidemiological data using an X-Y digitiser. A method has been devised for obtaining a rapid and accurate transfer of dental epidemiological data directly from survey sheets or dental charts to computer records by using an X-Y digitiser. The technique involves modification of the conventional 'menu' approach to data entry via a digitiser.