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The sagittal split osteotomy of the mandibular ramus is a common procedure used in the correction of mandibular deformities. Modifications of the procedure will be presented for advancement and setback of the mandible. Major advantages of this technique include controlled splitting of the segments and predictable positional control of the proximal segment. The advantages and disadvantages of rigid skeletal stabilization are discussed, as well as application to the modified mandibular ramus sagittal split osteotomy.

The hospital mortality of acute myocardial infarction amongst 285 known diabetics treated in the last decade was 39.7 per cent at one month and had increased to 51 per cent at 12 months. Treatment in a coronary care unit during the acute stage had little effect on the mortality amongst patients on insulin, but was beneficial for patients whose diabetes had been controlled by oral hypoglycaemic drugs. Female patients on oral hypoglycaemic drugs had the highest mortality. When considering age, duration of diabetes and presence of retinopathy, acute myocardial infarction in diabetics controlled on oral therapy appeared to have a worse outcome than in patients on insulin. Independently of whether patients were on insulin or on oral hypoglycaemic drugs 12 months after the acute episode, only about half of them were still alive.

A post-mortem study of the heart was performed in 20 patients dying of cardiogenic shock. The extent of infarcted myocardium was defined by using a mitochondrial dehydrogenase stain nitro-BT which allowed macroscopical recognition of tissue death as early as 12 hours. Extensive myocardial injury was found to accompany cardiogenic shock predominantly affecting the left ventricle and the interventricular septum. Severe atheromatous involvement of the coronary arteries was noted.

Transvenous intracardiac pacing was carried out on nine patients with recurrent ventricular tachyarrhythmia after drug treatment had failed. In eight patients recurrent Ventricular ectopic activity was suppressed by pacing at a rate above the sinus rate. With this technique the need for D.C. shock and repeated antiarrhythmic drugs can be avoided.

Four cases of cyanide self-poisoning were admitted to one hospital over a period of two years. Two of the patients died. The diagnosis in the unconscious patient may be suggested by the finding of bradycardia and the absence of cyanosis (despite inadequate ventilation). The diagnosis can be confirmed in 5 to 10 minutes by a simple test on gastric aspirate, performed by the casualty officer. Cardiac pacing was used in two patients and may have a place in the supportive management of severe cases.