New perspectives in the management of severe cranio-facial deformity

It is postulated that craniosynostosis is due to a growth abnormality in all or part of the cranial capsule. Release of the stenosed part in the first months of life will re-establish the balance between the rapidly growing brain and eye, and the cranial capsule. Three periods for operative treatment are described: early, intermediate and late. Only in the early period can operative treatment restore normal growth dynamics; in the late period the aim is correction of an established deformity. The relationship between cranial clefts and frontonasal encephaloceles is explored. If the space-occupying encephalocele is removed early, the distorted facial bones adopt a more normal position, whereas cranial clefts do not respond to early operation by remoulding. The treatment of the acquired deformities of acute cranio-facial trauma have taken on new perspectives with the application of the multi-disciplinary approach and surgical techniques developed in the treatment of congenital deformities resulting in considerable reduction in the period of hospitalisation.

The stability and potency of vaccines prepared from inactivated foot-and-mouth disease virus concentrates

The stability of 146S particles in concentrates of foot-and-mouth disease virus stored at 4 degrees C was similar to that of 146S particles in a conventional virus preparation. Proteolytic degradation of VPl was not observed in the stored conventional virus preparation or inhibitor-supplemented concentrate but was observed in a supplement-free concentrate. The potencies of vaccines made from the conventional and concentrated preparations and stored in parallel at 4 degrees C appeared to decrease after 16 weeks. The vaccines made from the supplement-free concentrate and the Trasylol supplemented concentrate appeared to be at least as potent as the conventional vaccine and were clearly superior to vaccine made from ox serum supplemented concentrate.

Cephaloceles: treatment, outcome, and antenatal diagnosis

A series of 74 cephaloceles (17 cranial meningoceles and 57 meningoencephaloceles) is reported. Infants born with large meningoencephaloceles containing recognizable cerebral tissue usually did badly despite endeavors to conserve brain function by expanding the cranial capacity (5 cases) or decompressing hydrocephalic ventricles (9 cases). Infants with cranial meningoceles almost all did well, even when there was associated hydrocephalus. The etiological diversity of cephaloceles is emphasized. Frontoethmoidal meningoencephaloceles, which occur with noteworthy frequency in South and Southeast Asia, require separate consideration in both genetic counseling and treatment; the associated facial deformities (hypertelorism and orbital dystopia) can be corrected with a one-stage craniofacial reconstruction. Antenatal diagnosis by ultrasound is now often possible and was achieved in 4 cases; we suggest that neurosurgeons should participate in such antenatal evaluations.

Fronto-ethmoidal meningoencephaloceles: morphology and treatment

Twenty-five cases of fronto-ethmoidal meningoencephaloceles have been studied. The relationship to other sincipital meningoencephaloceles is explored. In all cases the exit holes from the anterior cranial fossa are at the site of the foramen caecum. The facial component of the defect determines the sub-classification: naso-frontal, naso-ethmoidal and naso-orbital. The cranio-facial deformity may consist of hypertelorism, orbital dystopia, elongation of the face and dental malocclusion. These reflect the distorting influence of the extruded intracranial contents on facial growth. Early removal of the meningoencephalocele by the cranio-facial route is recommended to allow normal growth forces to be re-established. In older patients with established deformities translocation of the orbits may be necessary.

Three-dimensional reconstruction of craniofacial deformity using computed tomography

The computed tomographic studies obtained routinely in the examination of patients with congenital or acquired defects of the skull and facial bones can be utilized as a substrate to provide an accurate three-dimensional representation of osseous abnormalities. The total dose of x-irradiation is reduced as other means of radiological examination are eliminated. Osseous structures are faithfully reproduced. Complete inspection of the reproduced structure can be made from any viewpoint, including internal inspection.

Chemotherapy of squamous cell cancer of the head and neck

Forty patients with advanced squamous cell cancer of the head and neck were treated with methotrexate, cisplatin, and bleomycin. Major regression of disease occurred in 69%; 30% of patients achieved complete remission. Fifteen patients received chemotherapy as the initial treatment, followed by either radiotherapy or surgery or both. Subsequent therapy was not prejudiced by this approach. The results demonstrate the marked sensitivity of these tumors to these three agents, and the need for further assessment of their use in optimal patient care.

The assessment of available manganese and aluminium status in acid soils under subterranean clover pastures of various ages

Three methods of estimating available manganese and aluminium status in acid soils were compared on three groups of soils from the Pejar district near Goulburn, New South Wales in which differences in pH had been brought about by different periods under subterranean clover pasture. Managanese extracted by 0.01 M calcium chloride gave the best correlation with the manganese concentration in rape and subterranean clover grown in pot culture, and provided the best index of available manganese. Soil solution manganese was inferior to CaCl2-extractable manganese and was more difficult to determine. Extraction with neutral ammonium acetate was unsatisfactory because this reagent overestimated available forms of manganese in soils containing high levels of reactive manganese. Aluminium extracted by 0.01 M CaCl2 was well correlated with exchangeable aluminium and with percentage aluminium saturation of the effective cation exchange capacity. None of the three measures of aluminium status alone was an effective index for predicting lime response by rape on these soils because both manganese and aluminium status were involved in this response. These three parameters were equally effective in multiple regressions for yield responses of rape to lime. Because of its relative ease of determination, CaCl2 extraction is preferred as a practical measure of aluminium status. Aluminium interacted with and increased the toxic effects of manganese in rape. Thus CaCl2-extractable manganese alone only provided a satisfactory index of a 'critical' value for manganese toxicity in rape for soils low in available aluminium. Subterranean clover was only slightly affected by aluminium and manganese levels in these soils, and manganese toxicity symptoms were only observed on soils containing 50 ppm or more CaCl2-extractable manganese. Nodulation failure in pots occurred in all soils with pH below 5.2 (water) or below 4.3 in CaCl2, whereas nodulation was normal when these soils were treated with CaCO3 to raise the pH to 5.8-6.0 (water). With one exception nodulation appeared adequate at field sites from which soils showing nodulation failure in the glasshouse had been collected.

Change in soil pH, manganese and aluminium under subterranean clover pasture

Changes in soil pH, manganese and aluminium as a result of long periods under subterranean clover pasture were examined in soils formed on granite, basalt and sedimentary rocks near Goulburn, New South Wales. Decreases in the pH of yellow duplex soils formed on granite, sedimentary rocks and basalt had occurred to depths of 60, 40 and 30 cm, respectively. The smaller depth of acidification in the latter two soils is considered to be due to their shallower A horizons over well buffered, clay B horizons. Under the oldest pastures (55 years) the decreases exceeded one pH unit throughout the entire sampled depth (60 cm). In some soils, under old improved pastures, calcium chloride-extractable manganese had increased to more than 20 ppm throughout the 60 cm profile and to greater than 50 ppm in the surface 10 cm. These levels are considered toxic to sensitive plant species and the highest levels may be toxic to subterranean clover. The amounts of extractable manganese in soils appear to be determined by both pH and the amounts of reactive manganese. In general, the amounts of total and reactive manganese were appreciably higher in the soils of basaltic origin. Substantial increases in extractable and exchangeable aluminium had also accompanied the decrease in pH and, in the surface 10 cm, were greatest in the soils formed on sedimentary parent materials. In many of the soils under old improved pastures, exchangeable aluminium, as a percentage of the effective cation exchange capacity, now exceeds 12%, especially in the 5-10 cm layer, and is probably harmful to sensitive species. Increases in exchangeable aluminium also occurred below the surface 10 cm and, in the granitic soils under the oldest pastures, exchangeable aluminium accounted for 30-50% of the effective cation exchange capacity throughout the 5-50 cm soil depth. The adverse changes in pH, manganese and aluminium observed in this study can be expected to continue under many improved pastures and to generate soil conditions unsuitable for many agricultural plants. The use of lime to arrest or reverse these changes seems inevitable.

Nasendoscopy: significant refinements of a direct-viewing technique of the velopharyngeal sphincter

The need for a three-dimensional record of velopharyngeal sphincter function in patients with craniofacial anomalies and speech problems is discussed. A refined split-screen video technique using color nasendoscope image, lateral video-fluoroscopy, and synchronous speech recording with the patient awake and in supine position is described. A special signal processor is used to position the color nasendoscopy image. The examination is recorded on 1-in. videotape. The technique allows three-dimensional appraisal of sphincter function with direct viewing and enables assessment of a range of abnormalities, assessment of the effectiveness of pharyngoplasties, and prediction of speech deformities and their management following midface craniofacial surgery.

Severe cranio-facial deformities and their management

Historical attitudes to cranio-facial deformities are discussed. A simple nosology of cranio-facial deformities is given, the main groups being craniosynostosis syndromes, facial clefts, tumours, trauma, facial microsomias, and midface hypoplasias. Each group is briefly discussed, with emphasis on the craniosynostosis syndromes and facial clefts. Cases from these two groups are illustrated before and after surgery, showing the dramatic improvement offered by cranio-facial techniques. The basic principles of cranio-facial surgery are briefly discussed, and the complications discussed. The South Australian Cranio-Facial Unit experience with complications is discussed, especially blindness and persistent C S F leaks. The necessity for only a few cranio-facial units each with a high workload is reiterated, and new directions for cranio-facial surgery discussed, including the use of microvascular techniques and early surgery to minimise later deformity, particularly in cases with plagiocephaly.

Relations between plant aluminium content and the growth of lucerne and subterranean clover: their usefulness in the detection of aluminium toxicities

ln an experiment with lucerne (Medicago sativa) and subterranean clover (Trifolium subterraneum), grown in solution cultures at two levels of phosphorus, each at five aluminium levels and pH 4, growth and aluminium transport to the leaves were comparable in both species up to the fourth aluminium level (40�M All. The highest aluminium level (200 �M Al) caused a much greater growth depression in lucerne than in subterranean clover. In lucerne, aluminium concentrations in leaf dry matter peaked at the fourth aluminium level. Concentrations below this peak could indicate non-toxic as well as toxic supplies of aluminium. Leaf analysis, therefore, appears to be of little value in the detection of aluminium problems in lucerne. In subterranean clover leaves, aluminium concentrations increased to values in excess of 1 70 ppm of the dry matter at the highest aluminium level. In a second experiment, in which subterranean clover plants were grown in pots in two acid soils at two phosphorus x five aluminium levels, close, inverse, linear relations were found between relative yield (Al/no Al x 100) and leaf aluminium concentrations. These relations differed between soils, harvests and phosphorus levels, and would therefore be of little help in providing quantitative estimates of yield depressions in subterranean clover caused by aluminium. However, the lines all converged within the range of 100-1 50 ppm aluminium in leaf dry matter of plants in the no aluminium treatment, suggesting that this range represented a 'threshold' above which yield reductions due to aluminium occurred.

Microvascular surgery in maxillo-facial reconstruction

The recent advances in microvascular surgery have been applied to maxillo-facial reconstruction in the area of the lower jaw and soft tissue of the face. Five cases are presented, demonstrating some of the techniques and results in patients suffering from congenital, post-traumatic and post-cancer resection deformities.

The acute toxicity of ethanol: dosage and kinetic nomograms

We are concerned with the frequency of potentially lethal ethanol intoxications (about 1 pint of hard liquor) in teenagers. We present 2 illustrative cases, discuss the acute toxicity of ethanol, and present 2 simple calculating charts for dosage and kinetics. The widespread use and economic impact of ethanol have kept this potent sedative-hypnotic free of the same federal regulations that control the availability of other drugs with a similar potency and margin of safety.

Selection in Lupinus albus L. for lower seed manganese concentration

Seeds of 49 Mediterranean white lupin accessions and of 36 F5 families derived from 13 of them were analysed for manganese concentration. High concentrations in the range 1770–4640 µg g-1 dry matter were found in material grown near Canberra and lower ones (1060-2750 µg g-l) at Wagga Wagga, N.S.W. A small number of L. angustifolius L. lines grown under comparable conditions at both sites had 7- to 70-fold lower concentrations of manganese in their seeds than L. albus. The means for accessions and families of L. albus varied widely and continuously about the site means. High alkaloid lines had approximately two-thirds the manganese concentration of low alkaloid lines. Seeds from primary inflorescences had 6% lower manganese concentrations than those from higher order inflorescences. About one-quarter of the variation within the low alkaloid class was associated with seed yield variation, there being a negative correlation between these traits. There was no line x site interaction. Broad sense heritabilities at Canberra and Wagga Wagga were moderately high, so that selection for lower concentrations should be effective. The results suggest that selection for higher yield could be almost as effective as direct selection in reducing seed manganese concentration. The reduction should be sufficient to enable white lupin seeds, grown on soils no higher in available manganese than those used in this study at Canberra, to be safely used as a high protein supplement in pig and poultry rations. Selection for lower seed manganese should not affect seed calcium, phosphorus or protein concentrations, but would tend to increase seed yield and plant height at maturity.

A de-epithelialized free groin flap for facial contour restoration

The transfer of de-epithelialized free groin flaps to restore facial contour after tumour resection and in hemifacial microsomia is described. The flap can be transferred in one stage and remodelled at a later minor operation. This provides an acceptable alternative to the other more difficult and often less successful methods of restoring soft tissue deficiencies of the face.

Psychosocial aspects of head and neck cancer surgery

Thirty-six patients who underwent major surgical excision and reconstruction for head and neck cancer were subjected to a psychosocial assessment in hospital and, later, in their home environments. The information gained from the survey is discussed, with particular reference to those factors which can be used by the head and neck surgical team to improve the quality of the patients' existence.

Use of an innervated deltopectoral flap for intraoral reconstruction

The technique for the transfer of sensitive skin into the mouth for intraoral reconstruction is described. This procedure may be performed at one or two operative stages. Supraclavicular nerves supply sensation to the tip of the standard deltopectoral flap--which may be swung up with the nerves left in continuity, or the nerves may be divided and anastomosed to an appropriate sensory nerve in the mouth.