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OBJECTIVE: In a selected low-risk population with spontaneous term labor we sought to determine whether there was a continuous effect of maternal age on uterine function. STUDY DESIGN: With our comprehensive computerized database and medical record system, we identified 8496 patients who were nulliparous and in spontaneous labor at term (> or =37 weeks' gestation) with singleton fetuses in vertex presentation. This group was then analyzed according to maternal age for measures of labor dysfunction and rates of operative delivery. Analysis of variance and chi(2) statistics were used. RESULTS: Use of oxytocin, duration of second stage of labor, cesarean delivery, cesarean delivery for failure to progress, and operative vaginal delivery rates were significantly increased with advancing maternal age (P <.0001). These increases appeared to be continuous functions beginning during the early 20s rather than new phenomena beginning after age 35 years. CONCLUSION: Among nulliparous patients with uncomplicated labor there is a continuously increasing risk of uterine dysfunction related to maternal age.

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Karyotypically normal fetuses with completely trisomic or mosaic placentae may be at increased risk for intrauterine growth restriction (IUGR). Molecular and cytogenetic analyses on nine pregnancies with confined placental mosaicism (CPM) for trisomy 2 were performed at two collaborating centres. Seven cases were identified through prenatal testing of chorionic villi (CVS). Two of these seven cases demonstrated complete trisomy 2 while the remaining five cases showed various levels of trisomy 2 (33 per cent-75 per cent cells). Two cases identified after IUGR was observed in newborn infants demonstrated 65 per cent and 100 per cent trisomy 2 in cultured villi from term placentae. In all nine cases, blood chromosome analysis (n = 4), chromosome analysis of amniotic fluid cultures (n = 4), and cultured amnion (n = 5) were normal, failing to demonstrate any trisomic cells in tissues of fetal origin. Molecular studies on the fetal or newborn tissues using dinucleotide repeat polymorphisms on chromosome 2 revealed normal biparental inheritance of chromosome 2 in all nine cases. The parental origin studies of the extra chromosome 2 in the placenta showed that three cases were maternal in origin, at least two of which were consistent with a maternal meiotic non-disjunction giving rise to the trisomy 2, while in one case a paternal origin of the extra chromosome 2 was established.

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Over the years there have been sporadic reports of unusual cystic lesions of the jaws, not readily classified under conventional headings but which have been variously diagnosed as median-mandibular, glandular, sialo-odontogenic or botryoid odontogenic cyst. We present five cases which do not fit into other categories of odontogenic cyst, two of which have recurred within a few years of conservative treatment. This paper aims to alert clinicians to the propensity for regrowth of these cysts, proposes the term polymorphous odontogenic cyst for these lesions, to encompass their varied histological appearances and discusses their distinction from other cyst types with mucous and papillary formations in epithelium.

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We have examined cells from amniotic fluid obtained at 17 and 21 weeks' gestation and fetal skin biopsy samples from a fetus at risk of harlequin ichthyosis by light and electron microscopy. Clumps of abnormally keratinized cells that had a large number of lipid droplets in the cytoplasm were seen within both the 17- and 21-week amniotic fluid cell pellets. The cells in these clumps were similar to the thick layers of keratinized cells observed in the skin biopsy and autopsy samples. Morphologic examination of the fetal skin biopsy samples obtained at 21 weeks gestation revealed the characteristic changes of harlequin ichthyosis. The intraepidermal portions of hair canals had an excessive number of layers of keratinized cells. Normal lamellar granules were absent but abundant membrane-bound vesicles of a similar size and a number of dense bodies were observed in the cells of the upper intermediate layers of the epidermis. Autopsy skin samples of the terminated fetus at the twenty-third week of gestation showed structural changes that corresponded to those of the amniotic fluid cells and the fetal skin biopsy samples, although the periderm was gone in all the regions. Our findings of amniotic fluid indicate that the characteristic epidermal abnormality of harlequin ichthyosis has been expressed at 17 weeks gestation in some parts of the body or structures of fetal skin (e.g., hair canals) that keratinize before interfollicular epidermis. Moreover, the results suggest that harlequin ichthyosis can be detected in utero by morphologic analysis of amniotic fluid cells obtained by amniocentesis.

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Behçet oral ulceration (BOU) is described as being indistinguishable from conventional recurrent oral ulceration (ROU). A clinical comparison between 38 Behçet patients and 38 control ROU cases was effected by completion of a standard questionnaire. Behçet patients reported an increased number of concurrent ulcers and involvement of the soft palate and oropharynx. No differences were detected with respect to duration, frequency, age of onset or family history. In addition, photographs of BOU in 15 patients revealed the concurrence of atypical aphthous and herpetiform varieties. Number, site and appearance of oral ulceration may therefore provide diagnostic features for the development of Behçet's disease.

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In this cohort study, uterine contractions were recorded in 81 low-risk pregnant women who wore ambulatory tocodynamometers continuously during three 72-hour periods at advancing gestational ages. During these periods, they also recorded their daily activities in a diary. Examination of the data, in general, revealed no association between uterine contraction frequency and habits such as smoking, alcohol consumption, or drinking caffeinated beverages. Physical activities, such as prolonged standing, heavy housework, lifting, or organized exercise also did not appear to affect uterine contraction rates. Only climbing stairs and walking were associated with increased contraction frequencies, but this effect, although statistically significant, was relatively small in magnitude and was present only during the last gestational age period monitored (30 to 33 weeks).

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Although there is a 21% recurrence risk for PPROM, little research has been directed to the obstetric management of women with prior PPROM. This article reviews indirect information regarding risk assessment, diet, lifestyle factors, and infections. A management plan is suggested.

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A dilution technique, with fluoride as a marker, has been developed to measure the volume of saliva and other fluids in the mouth. Immediately after swallowing, a small amount of fluoride solution is placed in the mouth, mixed with the oral fluids, and expelled from the mouth. The fluoride concentration of the expelled oral fluid is measured and the volume of fluid in the mouth at the time of spitting calculated from the fluoride dilution. Mean values of 0.75 +/- (SD) 0.28 ml for males and 0.72 +/- (SD) 0.16 ml for females were recorded. The accuracy of the volume determination is about +/- 0.10 ml in vivo. This technique has provided a convenient and rapid means of determining saliva volumes. It could also be used to determine rates of secretion and may prove useful in the clinic for assessing a patient's salivary competence.

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Eighty-nine black women without major medical risks for preterm labor participated in this longitudinal, prospective study for the evaluation of usual prelabor uterine activity and for the assessment of how gestational age, time of day, maternal weight, age, and parity affected contraction frequency. Participants wore an ambulatory tocodynamometer for 72 consecutive hours at three points in gestation during the second and early third trimesters while engaged in usual home and work activity. Data obtained from the 81 women with uncomplicated term pregnancies demonstrated a significant increase in contraction frequency with advancing gestational age between 22 and 33 weeks. After 26 weeks, significantly more uterine activity occurred at night. Perhaps because of detection difficulties, contraction frequency was inversely related to maternal weight in women weighing greater than 112% ideal weight. Maternal age and parity did not affect contraction frequency. Contraction characteristics of eight women experiencing preterm labor or medically indicated preterm delivery are described.

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This paper reviews the clinical presentation and many causes of burning mouth condition. A diagnostic approach and some management procedures that include eliminating all oral irritants, correcting predisposing systemic disease, and most important of all, allaying anxiety that induces parafunctional mouth habits. The term "burning mouth condition" (BMC) is considered more appropriate than the word "syndrome" for this common and troublesome complaint.

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Preterm premature rupture of the membranes (PPROM) is a significant cause of prematurity, accounting for approximately one third of preterm births in the United States. PPROM occurs in approximately 0.7-2% of all pregnancies nationally, and has a reported recurrence rate of 21%. The elucidation of potential risk factors for PPROM could contribute to a better understanding of its etiology. To study the contributions of 20 potential risk factors, we undertook a case-control study in our clinic population, which has a 5-6% incidence of PPROM. One hundred and thirty-three patients experiencing PPROM were matched for race, age, parity and gestational age with undelivered patients. Studies performed included ultrasonographic examinations, blood levels of ascorbic acid and zinc, microbiologic assays, patient questionnaires, and chart reviews. After stratification of both groups into subgroups based on matching criteria, summary tests of significance and Mantel-Haenszel tests of odds ratios were performed. On univariate analysis the following factors achieved significance at the p less than 0.05 level with 95% confidence intervals: 1) previous history of PPROM 2) smoking (dose related) 3) fundal location of the placenta in the present pregnancy. 4) a prior history of cerclage. After regression analysis, we concluded that smoking and history of previous PPROM were found to be risk factors for PPROM in our inner city black population.

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To enhance the value of exfoliative cytology for the study of the oral mucosa, a simple apparatus was developed to permit adequate sampling of a specific site so that samples collected on different occasions could be compared. The device essentially consists of a collecting cup connected to a blood collection evacuation system. The collecting cup is a modified female half of a stainless-steel filter holder supporting a 13-mm-diameter cellulose filter of 0.05-microns pore size. Suction pressure is applied by means of a 10-mL glass tube of premeasured vacuum. After positioning the collecting cup on the selected site on the buccal mucosa, the vacuum (440 mm Hg) is applied for five seconds. The mucosa is drawn in against the filter, producing a monolayered imprint of cells. This sample may be disengaged from the filter by agitation into a solution; this allows quantitative cytologic studies, such as the measurement of cell numbers by an electronic counter or the estimation of the areas of cells and nuclei by computer-aided image analysis of Cytospin preparations. Five separate samplings from each of three test subjects produced a harvest of 3,000 to 7,000 epithelial cells per sample; the cellular areas ranged from 784 to 1,052 sq microns while the nuclear areas ranged from 18.4 to 21.8 sq microns.

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Ninety-three odontogenic cysts, 42 of inflammatory and 51 of developmental origin, were grown in vitro from explants and/or cell suspensions. There was little difference in the success rate of culturing epithelium from explants of dentigerous cysts (N = 28) or odontogenic keratocysts (N = 23) (approximately 75% and 87%, respectively) and the dentigerous cyst grew particularly well from suspensions (N = 11) (91%) compared with the keratocyst (N = 19) (58%). Epithelium from developmental odontogenic cysts grew much better in vitro than did cysts of inflammatory origin (56 to 58% from explants and 19 to 25% from suspension). From this work there is little evidence to support previous statements that the dentigerous cyst cannot be grown from explants, or that the odontogenic keratocyst has 'aggressive' growth characteristics.

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Patient education regarding the signs and symptoms of preterm labor combined with frequent clinical evaluations has been advocated as a means to reduce preterm births. Over a 3.5-year period, the risk for preterm labor was determined in 943 indigent black inner-city women using the Papiernik-Creasy scoring system. High-risk women were allocated randomly to a Preterm Labor Detection Clinic or to serve as high-risk controls. Women with lower risk scores served as low-risk controls. Women from both control groups were not informed of their risk status, and both groups received prenatal care in standard obstetric clinics. Women accepting the Preterm Labor Detection Clinic Program received comprehensive patient education and were seen weekly starting at 22 weeks' gestation. Despite this extensive outpatient program, there were no significant differences between the high-risk groups with respect to mean gestational age at delivery, mean birth weight, or percentage delivering before term as a result of preterm labor or premature rupture of membranes (PROM). Evaluations of inpatient charges revealed no significant differences due to participation in this program, although outpatient clinic utilization and charges were increased significantly for Preterm Labor Detection Clinic patients. Failure of this program to reduce preterm birth may relate to the relatively low overall rate of women presenting in preterm labor with advanced cervical dilation. In contrast, high rates of PROM and fetal death occurred in all three study groups.

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To test the hypothesis that follicular (dentigerous) cyst enlargement arises from impeded tooth eruption, data from standardized Orthopantomographs of 30 uninfected, wholly intracortical cysts associated with mandibular third molar teeth were analysed. Cyst areas were measured with a computer-aided image analyser (Magiscan 2, Joyce Loebl, Gateshead, UK). Two size categories, small and large, each comprising 15 cases, were distinguished. These were correlated with the radiographic variables of cyst relationships to tooth crown, and angulation and nature of impaction of associated tooth. Cyst enlargement is most active in the third and fourth decades of life. Smaller cysts were associated with teeth impacted against adjacent tooth or bone, whereas larger cysts developed predominantly from horizontally angulated teeth intruded endosteally. These findings lend support to the haemodynamic concept of follicular cyst enlargement linked with dysfunctional eruptive forces.

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The clinical data of 102 patients referred to Leeds Dental Hospital from 1978 to 1987 with acute herpetic stomatitis confirmed by laboratory investigations were analysed. No gender difference was found. Differences in age distribution were marked. Only 5% of patients were aged less than 11 years, whereas the majority of cases (51%) occurred during the third decade. Statistical analysis confirmed a general trend for the mean age of patients to have increased progressively over the 10-year period.

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To assess the predictive value of uterine activity as a marker for subsequent preterm labor, 139 black, inner city women were monitored at least three times for 1 hour between 28-32 weeks' gestation using a portable tocodynamometer. All had singleton gestations and gave no previous history of preterm labor or delivery. They were monitored between 8 and 10 AM while sitting in the clinic waiting area. Uterine activity records, numbered randomly, were transmitted by telephone to a site remote from the hospital. No one having any clinical contact with the participants saw or received feedback regarding the contraction data. Tocodynamometry records were then mailed to another center where they were read by one investigator blinded to all clinical information. The mean contraction frequency during the single hour of weekly testing was significantly greater for the 16 women who developed preterm labor than for women who delivered at term at each point between weeks 28-32. Using greater than six contractions per hour on at least one occasion between 28-32 weeks' gestation as a predictor would have identified 12 of 16 women (sensitivity 75%) who subsequently developed preterm labor. This contraction frequency was noted in 26 of 123 women (21%) who labored at term (specificity 79%; P = .0003).

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