Serum amyloid A (SAA) was determined in 160 patients with cancer. Active disease was associated with high titre compared with the titre in non-active condition (31.8 v 5.8 micrograms/ml, respectively; p = 0.0002). SAA value showed a direct correlation with the stage of the disease: it was lowest at stages 1 and 2 and highest at the metastatic stage 4 (stage 1 v 4, p = 0.001; stage 2 v 3, p = 0.05). Cancers of the lung and unknown primary site were characterised by highly increased SAA concentration. Initial SAA value had prognostic significance: a value below 10 micrograms/ml correlated with survival advantage, whereas a higher initial value indicated a greater likelihood of a poor outcome (actuarial survival analysis p less than 0.001). When stage was accounted for, initial SAA value had significant prognostic bearing on survival of patients with advanced disease (stages 3 and 4) but not on that of patients with limited disease (stages 1 and 2). Serial testing showed good concordance between changes in SAA titre and clinical course.

T HERE is no aspect of periodontal surgery that is in as great a state of confusion and flux as is that of mucogingival surgery. Since its inception a multiplicity of operations have been devised, modified and remodified; all with an eye to achieving maximum results with a minimum amount of trauma to the patient. The objectives of mucogingival surgery have been delineated clearly but the means of realizing these objectives have not been systematically devised. At this writing there remains the task of selecting the most effective of the techniques, standardizing them and laying down clear indications for their use.There are two basic approaches to mucogingival surgery when gingiva exists preoperatively. The surgeon either may retain this gingiva, alter it and utilize it by repositioning it apically; or he may remove it and depend on the healing process to create a new zone of gingiva. The terminology used in this paper for the first type of operation is the apically repositioned flap (previously called "Repositioning of the Attached Gingiva") ; for the second it is the apically displaced flap (originally known as the "pushback"). Modifications and variations of the displaced flap have been devised and each is designed to accomplish a specific purpose. However, they all have one principle in common: the excision and discarding of the existing gingiva and the dependency on a large granulating wound to obtain new gingiva. Historically, the apically displaced flap procedures ("pushback" and "pouch") were very important advances in the development of mucogingival surgery. 1 They provided the surgeon with the means of achieving objectives of treatment that pre-Associate Professor of Periodontology and Oral Pathology, School of Dentistry, University of Southern California. viously could not be attained. However, they are crude surgical procedures in which large areas of bone are left exposed postsurgically, often resulting in a great amount of postoperative pain, prolonged healing time, massive wounds that heal by second intention with all of the attendant problems such as exuberant granulation tissue and occasionally sequestration of bone, particularly in the mandibular posterior region. With the advent of more refined surgical procedures, the displaced flap operations, in the main, are obsolete and should be discarded.The term "Apically Repositioned Flap" as used in this paper is preferred to "Repositioning of the Attached Gingiva." The reason for this lies in the fact that more than the gingiva is repositioned. The entire complex of gingiva, alveolar mucosa and all of the structures and tissues within the flap are repositioned apically, as is the mucogingival junction. In addition, if a frenum is present, it will be repositioned apically or collapse entirely and a shallow vestibule will be deepened because the fornix too will be apical to its previous position. Such a vestibular deepening is precise and stable; it does not become shallower during the healing process as is the case with the several variations of the a...

In a consecutive series of 172 patients with Graves' disease treated by total thyroidectomy, 15 patients (9%) had an associated unsuspected carcinoma. There were 20 patients who had received prior treatment with radioactive iodine; 3 (15%) had carcinoma. The high incidence of thyroid carcinoma found in this series suggests that when surgery is elected as the treatment of choice in any given case of Graves' disease, nothing less than a total thyroidectomy should be performed. This high incidence would further indicate that surgery should be given even greater consideration in the selection of a modality for the management of any specific case of Graves' disease.

The positive effect of testosterone replacement therapy on psychosocial well-being in hypogonadal men has been demonstrated by various psychometric tests. However, there is no report available that objectively demonstrates the effect of testosterone on the function of the central nervous system in men. In this report we studied cerebral perfusion in seven hypogonadal men on testosterone replacement therapy. The blood perfusion to the central nervous system was assessed using single-photon emission-computed tomography. (99 m)Tc-hexamethyl-propylene-amine oxime crosses the blood brain barrier and localizes in brain tissue, depending on the intensity of the local blood flow. Psychosocial well-being was assessed with an Androgen Deficiency in Aging Men questionnaire. The study demonstrated that testosterone replacement enhanced cerebral perfusion in midbrain and superior frontal gyrus (Brodman area 8) at 3-5 wk of treatment. At 12-14 wk the study continued to show increased perfusion in midbrain in addition to the appearance of a new activated region in the midcingulate gyrus (Brodman area 24). The results of this study provide objective evidence that testosterone and /or its metabolites increased cerebral perfusion in addition to the improvement in cognitive function.