This study was undertaken to determine the vascular changes which occur following mucoperiosteal flap surgery where two different suturing techniques were employed. In four healthy adult mongrel dogs, buccal and lingual full-thickness envelope flaps were reflected in the mandibular quadrants following intravicular incisions from the first premolar to the first molar. The flaps were immediately readapted and primary closure was achieved by the horizontal mattress suturing technique in one quadrant and the direct interrupted suturing technique in the contralateral quadrant of each dog. A simple photographic system was developed for recording the in vivo gingival circulation depicted by fluorescein angiography just prior to surgery and then after surgery on days 1, 3, 7, 10, 14, and 21. The flaps were divided into three interproximal and two mid-buccal sites for analysis and the intracapillary and diffusion extent of dye fluorescence was accurately quantified by computerized planimetry. As healing progressed, longitudinal changes relative to presurgical baseline were analyzed by paired t-test. Cross-sectional comparisons utilizing Student t-test allowed for evaluating differences between the two suturing techniques as well as differences between interproximal versus mid-buccal sites at each postsurgical day. It was found that the simple act of raising a mucoperiosteal envelope flap initiates significant vascular trauma. Statistically significant reductions in flap circulation relative to presurgical baseline lasted for at least 3 days but persisted for 7 days at the interproximal sites. Flap diffusion (extravascular leakage) recovered sooner and extended over a significantly greater area of the flap than did intracapillary flap circulation during the early period of healing.(ABSTRACT TRUNCATED AT 250 WORDS)

This study evaluated the effects of citric acid demineralization and autologous fibronectin application in association with a modified Widman flap in the treatment of periodontitis. The study population comprised 29 patients under treatment for moderate to advanced periodontitis who reached the one-year posttherapy evaluation. After thorough scaling and root planing, a split mouth design was used in which two quadrants were treated by modified Widman flap alone, and the other two randomly assigned quadrants were treated by modified Widman flap combined with citric acid demineralization and autologous fibronectin application. Fibronectin, which had previously been isolated from the patient's own plasma, was applied with a tuberculin syringe on the citric acid demineralized root surfaces and the inner aspect of the flap. After suturing provided good flap adaptation, additional fibronectin was again applied under the flap and external pressure was applied. Patients were clinically evaluated at baseline and at one year. Statistical evaluation of the data using paired t test and Chi-square analysis indicated that both approaches, modified Widman flap alone or in combination with citric acid and fibronectin, significantly reduced probing pocket depth and increased clinical attachment. However, the changes achieved with citric acid and fibronectin were statistically greater than those obtained with the flap alone. Furthermore, the number of sites gaining 2 mm or more of clinical attachment were significantly increased. The results suggest that the use of citric acid and fibronectin holds promise in promoting reattachment after periodontal therapy.

No abstract

Visiting Physician to the Elizabeth General Hospital and Dispensary, Member of the Clinical Society of the General Hospital and Dispensary, the American Medical Association, and the District Medical Society of the County of Union, N. J. ELIZABETH, N. J.After an experience of twenty-five years, I desire to present some conclusions, the result of my own personal observations in pulmonary phthisis. I use the term advisedly, on account of its comprehensiveness, including as it does all that has been known and

action, causing in some cases acute suppression of urine, uremia and death. Chloroform, if administered during an operation or obstetrical case, as shown by Fraenkel, for a period of three hours or longer, may cause fatty degeneration of the renal cells and uremia. On the diseased kidney chloroform has a far milder action than ether, although occasionally a case of nephritis will be anesthetized with it and uremia follow, as in a case I observed a few weeks ago. Both, in cases of diabetes, will frequently increase enormously the sugar. Another dangerous after-effect which can be avoided is pneumonia following ether anesthesia. A careful examination of the lungs will quickly aid us to diagnose a bronchitis or emphysema. Such persons bear, ether poorly and should, if the heart permits, be anesthetized with chloroform. In regard to the latter organ, patients with heart trouble should be anesthetized either with ether or the A. C. E. mixture. In many hospitals abroad and in the East, the anesthetist is either a paid assistant, who remains for years, or is assigned to this task as an interne for many months. Slips are filled out for each anesthesia, stating the condition of the