Hemimandibulectomy without bone grafting: report of a case

Some patients require hemimandibulectomy who are poor candidates for reconstructive surgery or who do not want to subject themselves to multiple surgical episodes. With the use of an articulated external skeletal fixation appliance, near-normal esthetics and function can be achieved in these patients without bone grafting. A report of one such case is presented.

A high prevalence of diabetes in a rural village in Papua New Guinea

The prevalence of glucose intolerance was determined in a sample of 192 adults (34% of the adult population) from Wanigela in rural Central Province, Papua New Guinea. This centre was chosen to compare the high prevalence rates previously found in residents from this village who had become urbanized in Port Moresby. The age- and sex-standardised rates for abnormal glucose tolerance in Wanigela were significantly lower than those recorded in the urban community. However, the crude rates of 8.9% for diabetes and 5.7% for impaired glucose tolerance are among the highest reported for rural populations in the Pacific. These results strongly suggest that a genetic predisposition to glucose intolerance is present in this ethnic group, and argue for the early adoption of primary prevention programmes as the process of development encroaches rapidly upon the traditional lifestyles of previously isolated communities in Papua New Guinea.

Soft tissue sarcomas of the distal extremities

Multimodality therapy and limb salvage procedures constitute a significant advance in the treatment of soft tissue sarcoma of the extremity. The applicability of these procedures to soft tissue sarcoma of the distal extremities was evaluated in a retrospective study of 159 such cases treated during a 10-year period. Thirty-seven patients were treated by operation alone, 57 had operation and adjuvant chemotherapy, and 65 had multimodal therapy. The distal extremities are unusual sites for soft tissue sarcomas and accounted for only 20% of our patients with sarcoma. The majority of patients were younger than 50 years and the sex distribution was approximately equal. The major histologic types were synovial cell sarcoma (18.2%), fibrosarcoma (15%), liposarcoma (13.8%), and rhabdomyosarcoma (13.8%). The 5-year survival rate was 72% with multimodality therapy, 72% for operation and chemotherapy, and 51% for operation alone. The local recurrence rate was 13% with operation alone, 9% with operation and adjuvant chemotherapy, and 12% with multimodality therapy. Based on our review, wide local excision and adjuvant chemotherapy proved to be as effective as multimodal therapy.

An economic evaluation of "Health for All"

The World Health Organization's 'Global Strategy' is an ambitious vision, but to achieve its goals it must first be implemented. Implementation will require careful and detailed planning. This paper evaluates the possibilities of transforming the Global Strategy from a laudable policy initiative into an actual 'Plan for Health', from the point of view of a health economist. This economic evaluation assesses the probable costs of implementing various activities of the Strategy, and the likelihood that developing countries will be able to afford these costs, either on their own, or with the assistance of the developed countries. A final section considers the current global situation and presents trends over the last two decades. The numbers of countries that have already achieved the goals of the Strategy, that can be expected to achieve the goals of the Strategy by the year 2000, and that are unlikely to achieve these goals (on the basis of current trends) are shown. The WHO 'success indicator' based on numbers of countries is compared to a more epidemiological one based on deciles of the world's population. It is argued that, even several years after the initiation of the Global Strategy, insufficient information exists on the next logical step of transforming the Policy into a Plan. Unless adequate attention is paid to this vital step, implementation of the Strategy will inevitably be ad hoc and patchy. Further research on the costs of the activities proposed by the Global Strategy, and the probable effects on health of those activities, is desperately needed.

Tracheoesophageal fistula secondary to esophageal carcinoma presenting with aspiration pneumonia

Tracheoesophageal fistulas should be suspected in patients with recurring chronic aspiration pneumonitis. They are most often secondary to intrathoracic malignancies. A case report of a patient with this disorder is presented, along with a review of pertinent literature.

Construction and recovery of viable retroviral genomes carrying a bacterial suppressor transfer RNA gene

The integration of retroviral genomes into cellular DNA can induce mutations by altering the expression of nearby cellular genes and can serve to identify the gene affected. The construction of a retrovirus that stably carries a suppressor transfer RNA gene from Escherichia coli has allowed facile recovery of the viral genome in vectors marked with amber mutations. This virus can be used for rapid isolation of cellular sequences at the site of proviral insertion.

Trial of relaxation in reducing coronary risk: four year follow up

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.

An unusual angiographic appearance of aorto-iliac disease presenting as the Leriche syndrome

An unusual angiographic presentation of Leriche syndrome is described that demonstrates short segment occlusions of iliac arteries with bilaterally symmetrical post-stenotic dilatations.

Reliability of cardiotocography in predicting baby's condition at birth

A prospective study of 6825 labours was undertaken to determine the relation between the Apgar scores of the babies at one minute and the cardiotocograph tracing in labour. The sensitivity of an abnormal tracing was 35.2% for babies who needed intermittent positive pressure ventilation and 20.0% for babies who did not but who had Apgar scores of less than 7. The sensitivity of an abnormal tracing for all babies with an Apgar score of less than 7 was 23.2%. The positive predictive value of an abnormal tracing was 8.7% for babies who needed intermittent positive pressure ventilation and 18.7% for babies who did not but who had an Apgar score of less than 7. The positive predictive value of an abnormal tracing was 27.4% for all babies with an Apgar score of less than 7. The specificity of the tracing was 93.4% for babies with an Apgar score of 7 or over. The relatively high incidence of false positive predictions might be explained on the grounds that abnormalities in the cardiotocograph tracing are a more sensitive indicator of hypoxia than the Apgar score. False negative predictions might have been due to adverse factors other than hypoxia--for example, fetal trauma, compression of the head, infection, and analgesia in labour. These findings suggest that the current overdependence on fetal monitoring by cardiotocography alone should be examined and that other reliable indicators for non-hypoxic fetal distress should be sought.

Epidermoid carcinoma subsequent to a gunshot wound of the face

Reported is a case of epidermoid carcinoma of the face following a gunshot wound. A review of the pertinent literature is included.

Dermal grafts to bony defects in irradiated and nonirradiated tissues

Coverage of intraoral ablative defects presents many different problems. Free dermal grafts have been used to cover exposed mandibular bone in dogs. Grafts were placed in animals both before and after irradiation. Grafts were uniformly successful in animals not previously irradiated but failed when placed after irradiation.

A novel phenazine antifungal antibiotic, 1,6-dihydroxy-2-chlorophenazine. Fermentation, isolation, structure and biological properties

A novel, solvent extractable, antibiotic complex has been purified from the fermentation broth of an unusual member of the genus Streptosporangium. Two of the major components were isolated from the complex by alumina column chromatography. One of the components was identified as a previously reported compound, 1,6-dihydroxyphenazine. The other component was a novel chlorine containing phenazine, 1,6-dihydroxy-2-chlorophenazine, which exhibited broad spectrum antifungal activity in vitro against dermatophytes and Candida.

Type 2 (non-insulin-dependent) diabetes mellitus and HLA antigens in Papua New Guinea

HLA phenotypes were studied in 57 Type 2 (non-insulin-dependent) diabetic Papuan patients and the results compared with control subjects of the same Austronesian origin. An association was found between disease and BW62, a split antigen of B15, with corrected probability significant at the 5% level. The frequencies of B13 and BW22 were also increased in diabetic patients but the differences were not statistically significant. Although it has been postulated that Melanesian communities have protection against diabetes, they have a high frequency of BW62, which would imply, from the association found in this study, that susceptibility to Type 2 diabetes has yet to become manifest in them.

Partial purification and properties of rat liver glutaminase

The mitochondrial enzyme phosphate-dependent glutaminase was partially purified from rat liver. The enzyme had Mr 290 000 as judged by chromatography on Sephacryl S-300. After sodium dodecyl sulphate/polyacrylamide-gel electrophoresis of the preparation, glutaminase was tentatively identified with a peptide of Mr 73 500. The concentration-dependence on glutamine was highly sigmoidal, with half-maximum velocity at 22 mM-glutamine. Half-maximum activity was obtained with 5 mM-phosphate. The enzyme required ammonia as an obligatory activator, in agreement with previous reports on intact and sonicated mitochondria. These findings further differentiate liver glutaminase from the phosphate-dependent glutaminase present in kidney and several other tissues.

Extremely high levels of natural killer cells in angioimmunoblastic lymphadenopathy

Analysis of peripheral blood leukocytes from a patient with angioimmunoblastic lymphadenopathy using monoclonal antibodies and the fluorescence-activated cell sorter showed an unusually high proportion of cells that were OKT10+OKM1+63D3-. Since a large proportion of the large granular lymphocytes associated with natural killing in humans bears this surface phenotype, both blood and lymph node cells were subsequently tested for cell-mediated cytotoxicity in natural killer (NK)-cell assays. Following chemotherapy, both cells bearing the NK surface phenotype and the NK cytotoxicity disappeared and a population of cells, bearing none of the typical lymphocyte or monocyte markers, became dominant. At this point the patient was diagnosed as having immunoblastic sarcoma and shortly thereafter succumbed to his disease. In the few cases where extremely high levels of NK activity have been reported, the tumor cells themselves have been responsible for cell-mediated cytotoxicity. In this case, the final tumor population had no NK activity. Thus either a subpopulation of cytotoxic tumor cells was destroyed by chemotherapy or the patient had expanded numbers of NK cells reacting against his tumor prior to therapy.

The hazimicins, a new class of antibiotics. Taxonomy, fermentation, isolation, characterization and biological properties

The hazimicins, a new class of broad spectrum antibiotics with at least 2 active components (5 and 6), were isolated from the fermentation of Micromonospora echinospora var challisensis SCC 1411. The complex was separated from the broth by a solvent extraction procedure, and the individual components were separated by column chromatography. The two primary active components are isomers, with unique structures shown to be di-tyrosine analogs containing two isonitrile groups. The antibiotic has in vitro activity against Gram-positive and Gram-negative bacteria, and in vitro activity against yeasts and dermatophytes.

Use of x-ray microanalysis to monitor diffusion of Zn from a cement into human dentin

Energy dispersive x-ray spectrometry (EDAX system), with scanning electron microscopy was used to detect diffusion of Zn from a source in human dentin and the system was tested for sensitivity and reproducibility. Sections of human teeth in which a ZnO-eugenol cement had been placed in a cavity in the dentin in vivo were prepared and x-ray microanalytical measurements carried out. We found that values of counts for Zn, Ca and P in the same field were linear up to a total counting time of 60 sec. We further found that reproducibility of values between repeat examinations of the same specimens on different days was excellent. The concentration of Zn in the dentin decreased exponentially with distance from source within the distance tested. We conclude that the system can be used to detect trace concentrations of Zn, and that accordingly the diffusion behavior of a variety of ions in dentin could be monitored.

Dislocation of the carpometacarpal joint of the thumb. A report of four cases

In four cases of complete carpometacarpal dislocation of the thumb, closed reduction, although easily performed, usually had unstable results. Open reduction and internal fixation with Kirschner wires were used in two cases. The third case was stable after open reduction. The fourth patient was treated by closed reduction and percutaneous Kirschner wire fixation. The joints were immobilized in spica casts for six weeks. At follow-up examinations, two patients had asymptomatic dorsal subluxation. At two years' follow-up examinations, two of the four patients had dorsal subluxations. Open reduction and internal fixation alone were not adequate for this type of injury. The dorsal capsule and ligament should be explored during surgery and reconstructed by free tendon grafts.