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We present a method for the development of consensus documents describing the components of genetic evaluation and genetic counseling for various diagnoses. These documents were developed to encourage consistency among genetic professionals in Washington State. Other possible uses of these documents are to provide information regarding genetic evaluations for health care practitioners and payers, and to assist in quality assurance and genetic training programs. A working group of six genetic professionals developed two templates for the "critical elements of genetic evaluation and genetic counseling," for clinical (nonprenatal) and prenatal patients. The working group then completed prototype templates for several specific genetic disorders. The templates and prototypes were sent to interested genetic professionals and perinatologists who submitted a total of 76 draft "critical elements" (CE's) to the working group. At two statewide meetings, participating practitioners modified and unanimously approved the CE templates, then unanimously approved the 21 draft CEs that had been finalized in small group discussions. Approved CE's were distributed to genetic professionals and perinatologists within the state.

This paper describes the acute and chronic causes of short clinical crowns and their management. Fracture or trauma are common causes of acute failures whilst toothwear is the most common cause for chronic causes. There are many methods of restoring teeth using conventional indirect techniques, which may alter the existing occlusal vertical dimension (such as orthodontic Dahl appliances), or conserving the vertical dimension by increasing the length of the teeth. These methods are described and illustrated to assist the practitioner choose the most appropriate restoration.

This is the second of a short series of articles detailing the steps that a general dental practitioner should take in order to produce an effective treatment plan for each patient. In this article the various aspects of managing the patient and the examination are discussed.

Careful treatment planning is vital if examination and treatment of even the most routine cases is to proceed smoothly. This is the first of a short series of articles in which the authors detail the steps that a general dental practitioner should take in order to produce an effective treatment plan for each patient. In this, the first paper, the steps necessary to accurately record the information required in formulation of the plan are outlined. A second article will deal with matters concerning patient management and the examination.

The effect of heat inactivation and freezing on fatty acid composition of plasma and red blood cells was investigated. Analysis was completed at baseline; after freezing; after incubation; after incubation and subsequent freezing; after incubation, freezing and a second incubation; and after freezing and subsequent incubation. There were changes in fatty acid levels observed in all groups with the phospholipid fractions showing the greatest changes. Those bloods that had been incubated, frozen and incubated again, and those which had been frozen initially followed by incubation showed the greatest change when compared to baseline samples. Even though there were changes in fatty acid levels seen in all groups, the changes were small except in those two groups. Treatment of blood with either of those two treatment regimens changes the fatty acid values so that they do not accurately reflect the composition of fatty acids in the blood.

A woman underwent cesarean delivery for premature labor, breech presentation, and ruptured membranes. Placenta accreta associated with uterine atony and severe hemorrhage was diagnosed. Prostaglandin E1 instead of prostaglandin F2 alpha was inadvertently administered in an effort to control the hemorrhage. The resulting complications included profound hypotension, disseminated intravascular coagulation, and ventricular tachycardia.

Human cultural needs are not easily categorized, studied, or taught to others outside the group. Generalizations about groups are made to increase the awareness of differences and commonalities. It is hoped that this increased sensitivity will serve as a catalyst for the individual to develop a greater awareness of the importance of culture in delivery of genetic services.

Internal bleaching can be a simple, economic and effective method for improving the appearance of discoloured non-vital teeth. The authors give a step-by-step guide to the 'walking bleach' technique, and describe how to avoid the most common potential complications of bleaching.

A subcommittee of The Social Issues Committee of The American Society of Human Genetics (ASHG), aware of the growing interest in the implications of inheritance and adoption, in 1987 began surveying the 50 states' and Washington DC's public adoption agencies regarding this issue, and it completed the survey in 1988. In 1987, two surveys obtained data on each state's legal requirements for obtaining genetic information and on what each public adoption agency collected as genetic history. These results were presented in a poster at the 1987 ASHG annual meeting in San Diego. In 1988, a questionnaire was sent to the same agencies to elicit opinions as to whether adoption agencies should systematically collect genetic information to share with the adoptive family and adoptee, whether legislation should be mandated to collect such information, and whether genetic education programs should be developed and implemented for adoption-agency staff. On the basis of responses to the 1988 questionnaire, it was concluded that there is an interest in developing a uniform set of genetic information which should be part of a child's adoption record and that there is a need for genetic education programs for adoption workers. Responses to the desirability of mandating legislation for this purpose were less consistent.

Hyperthermia as a human teratogen has been implicated as one cause for neurulation defects. To determine whether there is an association between early maternal hyperthermia (20 to 28 days' gestation) and isolated occipital encephalocele, record reviews were conducted for the period 1969 through 1979 in three major medical centers in the Pacific Northwest. Control patients consisted of children with Down's syndrome matched for year of birth, sex, and race. Of the 17 patients ascertained with an isolated posterior encephalocele, four (24%) of the mothers gave a history of hyperthermia, due to prolonged fever of at least 1.5 C above normal thermal levels early in gestation. In the control patients and siblings of affected children, no history of maternal hyperthermia was elicited. These data are compatible with the concept that early maternal hyperthermia is one cause in the genesis of isolated occipital encephalocele.

Amniotic fluid alpha-fetoprotein (AF-AFP) determinations were performed on 1,215 women who were at low risk for fetal neural tube defects and who were undergoing mid-trimester amniocentesis for cytogenetic indications, primarily age-related aneuploidy. Maternal sera obtained before amniocentesis and amniotic fluids were assayed in duplicate for alpha-fetoprotein by radioimmunoassay. Of the 1,215 low-risk women, eight (0.7%) had significant elevations of AF-AFP (greater than or equal to +5 SD). In none of the cases was the elevation associated with a fetal neural tube defect. Two cases with elevated AF-AFP were associated with chromosome aberrations; one with impending fetal demise; one with fetal blood contamination; and one case was due to a laboratory error. In one case, no source for the elevated AFP was found, and a normal infant was delivered at term. In the final two cases, the cause of the elevated AF-AFP was a fetal abdominal wall defect (one gastroschisis and one omphalocele). The predictive value of an elevated AFP varies with the population screened, and is reduced by routine ultrasonography before amniocentesis, which at least identifies anencephaly. In a low-risk population, an elevated AF-AFP is most often not associated with a fetal neural tube defect. Because of the low predictive value and the nonspecificity of AF-AFP, genetic counselors should reconsider the recommendation of routine AF-AFP in low-risk maternal populations.