JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
60
JANUARY, 1976
Current Status and Future Trends in Training Dental Practitioners and Dental Auxiliaries to Meet the Needs of the Black Community* JEANNE C. SINKFORD, D.D.S., PH.D., Dean, College of Dentistry, Howard University, Washington, D.C.
DENTAL education is no longer lockstep or rigid. The rapid changes in national health policies, social customs and mores, economic fluctuations and technological advances have all had their impact on those of us involved in the training of dental students and dental auxiliaries. In spite of our efforts to increase student enrollment, the status of dental manpower in the black community is far worse than the 1 to 5000 level used by the Public Health Service to categorize needy or shortage areas. The black dentist/population ratio is now approximately 1:12,500 as compared with 1:2,000 nationally!1 Thus, recruitment of qualified dental and dental auxiliary students must continue to be one of our major efforts in the future. The primary components of dental education in its broadest concept involve a tripod of essential facets: Education (didactics and curriculum-development, assessment and evaluation). Research (directed toward improvement of diagnostic and treatment capabilities). Service (delivery of Health Care and Systems of deliv-
ery).
This presentation will reflect on current trends and will consider future directions that are necessary for our survival. I say survival because one of the major questions that occurs to me as I make long range projections is: How long will dentistry be able to survive as a separate profession when we are constantly placed in the position of "begging" for support of our programs, "begging" for inclusion in health manpower legislation, "begging" for representation at the policy making level in all aspects of national and local health deliberations and in constant aggravation at being placed in a secondary role *Read before the Robert T. Freeman Dental D. C.
Society.
Inc. Feb.
18,
1975. Wash.,
to that of our medical colleagues. We work longer hours, for less compensation and die on the average at the age of 51 years.2 In spite of these facts, some of the major factors I consider to have had significant influences on the trends in dental education during the past decade include: 1) The Civil Rights Act of 1964 and the Education Amendments of 1972 laid the ground for increased minority enrollment in educational institutions receiving federal funds for support. It is interesting to note that the impact on enrollment trends in dentistry, however, were not seen until 1970.3 2) Health Manpower Legislation of the late 1960's and 1970's in the form of Basic Improvement, Special Project and now Capitation Grant awards to schools of Medicine, Dentistry and Osteopathy which provided direct payment to schools for increased enrollment and curriculum development. This legislation also included scholarships and loans to professional students, funds for construction and start-up grants for new schools. 3) The Carnegie Commission Report4 published in 1970 represented a study of the ills of health education and health care and called for: a) experimentation in curriculum with more flexibility; b) acceleration of medical and dental training; c) increased enrollment of students; and d) expansion of functions for health professions auxiliaries. 4) The Women's Liberation Movement which assured that all legislation directed toward equality would include: "women and other minorities". Today there are more women enrolled in U.S. dental schools than there are black dental students! The number of women enrolled has increased 412% during 1964-73, going from 163 in 1964 to 836 in 1973!
These propelling influences have existed in a country where: 1. There is no national health policy and the health strategies are like a political football being subject to the whims of changing administrations. 2) There is no national health insurance and no clear cut picture as to how health care will continue to be delivered or who will be responsible for financing health care. Current proposals do not define "adequate" health care and omit or significantly limit dental services to be included or funded. 3. Dental research and research training have suffered from competition with "Targeted" health research, e.g., the National Cancer Authority and the Heart, Lung and
Vol. 68, No. I
Trends in Dental Training
Hypertension Targets. Furthermore, dental research and delivery systems have been so bureaucratically separated that translation of a research discovery into the actual diagnostic and treatment system lags from 10 to 15 years. 4) The development of HMO's, PSRO's and other systems that include elements of quality control and peer review represent a call for increased accountability for funds received and treatment rendered. 5) Regionalization of major health services into "centers" e.g., Pain Control, Cardiovascular, Renal Units, etc., provide a threat to the comprehensive health care provided by the general dentist and physician within the concepts of a private practice.
In our efforts to rise to the challenges of the Carnegie Commission and the Health Manpower Legislation, we have proved that we can vary the dental curriculum, that we can graduate dentists in three years and introduce specialty training at an earlier time. We have not shown that these are better dentists or that the current graduate will be able to deal with the demands of being a health practitioner. The suicide rate among dentists is already the highest among all professions-having moved ahead of psychiatry within the past two years. We are in a review and reflective period regarding the curriculum changes that have been instituted in the past seven or eight years. The Council on Dental Education has, as recently as December, 1974, set up a two year Dental Curriculum Review Study. I am almost certain that the results of this study will reverse the trend for accelerated curriculums in most dental schools where the educational objective is the training of competent general dental practitioners. Graduate education in dentistry continues to suffer from the lack of financial support except in hospital-based programs (non-dental institutional) where the student receives a stipend. Also, the federal restriction on training grant support (through the N.I.H. grants programs) has significantly curtailed the numbers of trainees at dental educational institutions. The data have just been released for 1973 which reports a 5.3% decrease in 1st year enrollment in advanced programs in dental schools with a 16% increase in nondental school institutions.5 If this trend continues, a significant imbalance could be created in the specialty training areas leaning heavily to hospital-based specialty areas,
61
e.g., oral surgery, pedodontics and general practice. Among the leading educational institutions involved in expanded function auxiliary training are: Forsythe, Alabama, Howard, Iowa and University of the Pacific. These schools represent a national effort to provide auxiliaries which could improve the system of delivery of dental services under the direct supervision of licensed dental practitioners. These auxiliaries have been called dental nurses, dental therapists and EDDA's. Most of these programs have been academic demonstration projects with an honest effort to improve the quality of health care and to relieve the dentist of mundane and timely tasks that could be performed by an individual with a lesser degree of training. When we consider that only 50% of the citizens of the U.S. in 1973 received any dental care6 and when one considers that pending health insurance programs are directed toward increasing the demand for services, the health planners must consider how and who will deliver these services. Also, the cost of educating a dentist has become prohibitive ($9,050 per year, ranging from $6,150 to $16,000).7 Half of the dental schools in the U.S. receive more than 50% of their operating funds from the Federal government and tuition costs cover 1/5 of the total cost per dental student. The more involved the federal government becomes with financing health education, the more pressures the practitioner will receive related to the delivery of health care. It is not inconceivable that the dental graduate of the future who has received funds for his or her training from the government will be told how many patients he must see per day and how many hours he must practice per day! These decisions will be determined by those in control of the nation's economy. Effective preventive programs and the use of expanded function auxiliaries are the two very feasible means of combating our pending disaster regarding dental health care delivery. It is late-but not too late for the dental practitioner to actively participate in defining, describing and identifying the types of expanded function auxiliaries that will
62
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
most effectively improve the quality of services that the dentist can provide. Some of the services currently included in our auxiliary training programs may not be those most needed by tomorrow's dental practitioner. We- must devise programs of continuing education that will help retrain the dentist to employ the expanded function auxiliary. Even if we were to start such programs today, no one has assumed the responsibility for training expanded function auxiliaries for the practitioner, e.g., if we use Howard as an example, we are training 25 therapists per year and we need 100 therapists to meet our clinical needs as long as we continue to admit 100 dental students per year. With an anticipated 50% anticipated attrition due to marriage, pregnancy, career mobility, pursuit of advanced study, other employment, etc., we can hardly meet our own manpower needs on a continuing basis. Therefore, without an increase in auxiliary enrollment (which we cannot do in the current facility), we could not significantly contribute to the manpower pool of expanded function auxiliaries. In the greater Washington area, most of this responsibility for auxiliary training would have to be met at the community college level but these determinations should be made with decisions and pressures coming from the local dental society and citizens groups who will be involved at the delivery-consumer level. Our medical colleagues are far ahead of us in auxiliary utilization and training. This has been true in the past with medical technology in general. The para medical personnel, e.g.,
physician's assistants,
nurse
practitioners,
med-X's, pediatric cardiology associates and pharmacology practitioners, all represent an effort to meet the anticipated demands for medical treatment. Also, I see increasing implications, re: the expanded function dentist which include, the dentist as a member of the emergency health team, the responsibility for pharyngeal, laryngeal and skin cancer detection, diagnosis and screening for hypertension, sickle cell screening, nutritional and genetic counseling, etc. Whether, we as dentists, accept or reject these additional profes-
JANUARY, 1976
sional responsibilities will be decisions of the future. If we do go this route in the U.S., then it is not inconceivable that one health professional degree would be adequate with clinical dental training being at the postgraduate level of training. There are those who consider this to be a real possibility. Before closing, I would like for you to consider some interesting data regarding dental student enrollment. In 1975, there were 12,569 applications to dental schools for 4,316 openings. It is interesting to note that during the past 10 years, dental student enrollment has increased by 39.6%. (13,876 in 1963 to 19,369 in 1973). There were no significant increases in minority student enrollment, however, until 1970. Minority student enrollment has increased 100.8% during the period 1970-1973 (1970-1,969, 1973-2,338). Though there appears to be a leveling off at the present time, there are only 872 black dental students or 4.5% and 283 of them are at Howard (33% of all black students). With regards to women, the 1974/75 enrollment total was 1,361 or 6.8%.9 Howard had 61 females enrolled in 1974-75 or 16% of its total dental students. We will probably level off at 20-25% females at Howard. The 1972 survey of recent dental graduates reports 95% of the dental graduates 1969-72 are in general practice and 5% are in specialty practice. Howard and Meharry continue to train 50% of the nation's black dentists. The graduates of these two institutions must, therefore, continue to be the monitors of the standards and systems of dental health care in the black community. The black community will suffer most as this country strives to achieve "'economic health' , rather than to continue its focus on the physical health and well being of its citizens. LITERATURE CITED
1. HENRY, J. L. Bridging the Gap. Jour. Amer.
College Dent., 37:317, 1970. 2. REED, 0. Perils of Being a Dentist. Vancouver, Feb. 8, 1975 (A.P.). (Concluded on page 8)
8
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
these cases,4 and present an obvious cause of respiratory embarrassment. Lieberman10 recently reported successful treatment of these complications with nitrogen mustard and diuretics. Although no satisfactory therapy exists for disseminated leiomyomas, local excision has been suggested for solitary nodules. 612 Occasionally, smooth muscle proliferation may occur in end stage pulmonary fibrosis to the extent that it has been called "muscular cirrhosis" of the lung. This type is also diffuse and may cause severe functional alterations and eventually death.14 A classification of pulmonary leiomyomas is suggested in Table 3. SUMMARY
Two unusual cases of pulmonary leiomyomatosis in women with miliary infiltrates by chest radiograph in whom "benign" uterine fibroids were found were presented. One patient was asymptomatic while the other was disabled, demonstrating the variability of disability that can occur in this disease. The asymptomatic patient had restrictive lung disease while uneven ventilation and defect in transfer of gases contributed to hypoxemia in the disabled patient. LITERATURE CITED
1. KRISCHE, G. Ein Fall von Fibromyomen des uterus mit Multiplen Metastasen bei einer Geisteskranken. Diss. Gottingen, W. F. Kastner, 1889. 2. LANGERHANS, R. Demonstration eines Prap arates von Myoma laevicellulare malignum. Berl. Klin. Wchnschr., 30:338-340, 1893.
JANUARY, 1976
3. MINKOWSKI, 0. Myommetasten in Lungen, Leber and Miskeln. Munchen. Med. Wchnschr., 48:1335, 1901. 4. VALENSI, Q. J. Pulmonary Lymphangiomyoma, A Probable Forme Frust of Tuberous Sclerosis: A Case Report and Survey of the Literature. Am. Rev. Resp. Dis., 108:1411-1415, 1973. 5. PIERCE, W. F. and R. L. ALZNAUR and C. ROLLE, Jr. Leiomyoma of the Lung: Report of a Case. AMA Arch. Path., 58:443-448, 1954. 6. ARIEL, I. M. and S. TRINIDAD. Pulmonary Metastasis from a Uterine Leiomyoma. Report of a Case: Evaluation of Differential Diagnosis and Treatment Policies. Am. J. Ob. Gyn., 94:110116, 1966. 7. DEL POZO, E. and I. R., MATTEI. Multiple Pulmonary Lieomyomatous Hamartomas. A Case Report. Am. Rev. Resp. Dis., 100:388-390, 1969. 8. STEINER, P. E. Metastasizing Fibroleiomyoma of the Uterus. Report of a Case and Review of the Literature. Am. J. Path., 15:89-109, 1939. 9. CASTLEMAN, B. and B. U. KIBBEE. Case Records of the Massachusetts General Hospital. N. Eng. J. Med., 268:550-557, 1963. 10. LIEBERMAN, J. and C. M. AGLIOZZO. Intrapleural Nitrogen Mustard for Treating Chylous Effusion of Pulmonary Lymphangioleiomatomatosis. Cancer, 33:1505-1511, 1974. 11. BEUCHNER, H. A. The Differential Diagnosis of Miliary Disease of the Lungs. Med. Clin. Nor. Amer. 43:89-112, 1959. 12. SPIRO, R. H. and C. J. MCPEAK. On the
So-Called Metastasing Leiomyoma. Cancer, 19:544-548, 1966. 13. KAPLAN. C. and A. KATOH, S. MIKIHIRO, E. ROGOW, J. H. SCOTT, W. CUSHING and J. COOPER. Multiple Leiomyomas of the Lung: Benign or Malignant. Am. Rev. Resp. Dis., 108:656-659, 1973. 14. RUBENSTEIN, L. and W. H. GUTSTEIN and H. LEPOW. Pulmonary Muscular Hyperplasia (Muscular Cirrhosis of the Lungs). Ann. Int. Med., 42:36-43, 1955.
(Sinkford, from page 62) 3. Annual Report of Dental Education. 1973-74, SupEducation and Welfare, Public Health Service Replement 15; Trend Analysis 1964-1973. port. Health Resources Adm. 4. Carnegie Commission on Higher Education: Higher 7. Institute of Medicine Report of A Study: Cost of Education and the Nation's Health. New York, Education in the Health Professions, Washington, McGraw-Hill Book 1970. D. C.: National Academy of Sciences; Parts I and 5. Annual Report of Dental Education, 1973. EnrollII, Jan. 1974. Part III, April, 1974. ment in Advanced Education Programs. 8. Annual Report of Dental Education 1973-74, Sup6. Vital Health Statistics. Series 10-Number 95. Curplement 15; Trend Analysis 1964-1973. rent Estimates from the Health Interview Survey, 9. ADA Leadership Bulletin. Vol. 5/Number 4. Feb. United States, 1973. U.S. Department of Health, 17. 1975.
PAY YOUR NMA DUES NOW!!
60
JANUARY, 1976
Current Status and Future Trends in Training Dental Practitioners and Dental Auxiliaries to Meet the Needs of the Black Community* JEANNE C. SINKFORD, D.D.S., PH.D., Dean, College of Dentistry, Howard University, Washington, D.C.
DENTAL education is no longer lockstep or rigid. The rapid changes in national health policies, social customs and mores, economic fluctuations and technological advances have all had their impact on those of us involved in the training of dental students and dental auxiliaries. In spite of our efforts to increase student enrollment, the status of dental manpower in the black community is far worse than the 1 to 5000 level used by the Public Health Service to categorize needy or shortage areas. The black dentist/population ratio is now approximately 1:12,500 as compared with 1:2,000 nationally!1 Thus, recruitment of qualified dental and dental auxiliary students must continue to be one of our major efforts in the future. The primary components of dental education in its broadest concept involve a tripod of essential facets: Education (didactics and curriculum-development, assessment and evaluation). Research (directed toward improvement of diagnostic and treatment capabilities). Service (delivery of Health Care and Systems of deliv-
ery).
This presentation will reflect on current trends and will consider future directions that are necessary for our survival. I say survival because one of the major questions that occurs to me as I make long range projections is: How long will dentistry be able to survive as a separate profession when we are constantly placed in the position of "begging" for support of our programs, "begging" for inclusion in health manpower legislation, "begging" for representation at the policy making level in all aspects of national and local health deliberations and in constant aggravation at being placed in a secondary role *Read before the Robert T. Freeman Dental D. C.
Society.
Inc. Feb.
18,
1975. Wash.,
to that of our medical colleagues. We work longer hours, for less compensation and die on the average at the age of 51 years.2 In spite of these facts, some of the major factors I consider to have had significant influences on the trends in dental education during the past decade include: 1) The Civil Rights Act of 1964 and the Education Amendments of 1972 laid the ground for increased minority enrollment in educational institutions receiving federal funds for support. It is interesting to note that the impact on enrollment trends in dentistry, however, were not seen until 1970.3 2) Health Manpower Legislation of the late 1960's and 1970's in the form of Basic Improvement, Special Project and now Capitation Grant awards to schools of Medicine, Dentistry and Osteopathy which provided direct payment to schools for increased enrollment and curriculum development. This legislation also included scholarships and loans to professional students, funds for construction and start-up grants for new schools. 3) The Carnegie Commission Report4 published in 1970 represented a study of the ills of health education and health care and called for: a) experimentation in curriculum with more flexibility; b) acceleration of medical and dental training; c) increased enrollment of students; and d) expansion of functions for health professions auxiliaries. 4) The Women's Liberation Movement which assured that all legislation directed toward equality would include: "women and other minorities". Today there are more women enrolled in U.S. dental schools than there are black dental students! The number of women enrolled has increased 412% during 1964-73, going from 163 in 1964 to 836 in 1973!
These propelling influences have existed in a country where: 1. There is no national health policy and the health strategies are like a political football being subject to the whims of changing administrations. 2) There is no national health insurance and no clear cut picture as to how health care will continue to be delivered or who will be responsible for financing health care. Current proposals do not define "adequate" health care and omit or significantly limit dental services to be included or funded. 3. Dental research and research training have suffered from competition with "Targeted" health research, e.g., the National Cancer Authority and the Heart, Lung and
Vol. 68, No. I
Trends in Dental Training
Hypertension Targets. Furthermore, dental research and delivery systems have been so bureaucratically separated that translation of a research discovery into the actual diagnostic and treatment system lags from 10 to 15 years. 4) The development of HMO's, PSRO's and other systems that include elements of quality control and peer review represent a call for increased accountability for funds received and treatment rendered. 5) Regionalization of major health services into "centers" e.g., Pain Control, Cardiovascular, Renal Units, etc., provide a threat to the comprehensive health care provided by the general dentist and physician within the concepts of a private practice.
In our efforts to rise to the challenges of the Carnegie Commission and the Health Manpower Legislation, we have proved that we can vary the dental curriculum, that we can graduate dentists in three years and introduce specialty training at an earlier time. We have not shown that these are better dentists or that the current graduate will be able to deal with the demands of being a health practitioner. The suicide rate among dentists is already the highest among all professions-having moved ahead of psychiatry within the past two years. We are in a review and reflective period regarding the curriculum changes that have been instituted in the past seven or eight years. The Council on Dental Education has, as recently as December, 1974, set up a two year Dental Curriculum Review Study. I am almost certain that the results of this study will reverse the trend for accelerated curriculums in most dental schools where the educational objective is the training of competent general dental practitioners. Graduate education in dentistry continues to suffer from the lack of financial support except in hospital-based programs (non-dental institutional) where the student receives a stipend. Also, the federal restriction on training grant support (through the N.I.H. grants programs) has significantly curtailed the numbers of trainees at dental educational institutions. The data have just been released for 1973 which reports a 5.3% decrease in 1st year enrollment in advanced programs in dental schools with a 16% increase in nondental school institutions.5 If this trend continues, a significant imbalance could be created in the specialty training areas leaning heavily to hospital-based specialty areas,
61
e.g., oral surgery, pedodontics and general practice. Among the leading educational institutions involved in expanded function auxiliary training are: Forsythe, Alabama, Howard, Iowa and University of the Pacific. These schools represent a national effort to provide auxiliaries which could improve the system of delivery of dental services under the direct supervision of licensed dental practitioners. These auxiliaries have been called dental nurses, dental therapists and EDDA's. Most of these programs have been academic demonstration projects with an honest effort to improve the quality of health care and to relieve the dentist of mundane and timely tasks that could be performed by an individual with a lesser degree of training. When we consider that only 50% of the citizens of the U.S. in 1973 received any dental care6 and when one considers that pending health insurance programs are directed toward increasing the demand for services, the health planners must consider how and who will deliver these services. Also, the cost of educating a dentist has become prohibitive ($9,050 per year, ranging from $6,150 to $16,000).7 Half of the dental schools in the U.S. receive more than 50% of their operating funds from the Federal government and tuition costs cover 1/5 of the total cost per dental student. The more involved the federal government becomes with financing health education, the more pressures the practitioner will receive related to the delivery of health care. It is not inconceivable that the dental graduate of the future who has received funds for his or her training from the government will be told how many patients he must see per day and how many hours he must practice per day! These decisions will be determined by those in control of the nation's economy. Effective preventive programs and the use of expanded function auxiliaries are the two very feasible means of combating our pending disaster regarding dental health care delivery. It is late-but not too late for the dental practitioner to actively participate in defining, describing and identifying the types of expanded function auxiliaries that will
62
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
most effectively improve the quality of services that the dentist can provide. Some of the services currently included in our auxiliary training programs may not be those most needed by tomorrow's dental practitioner. We- must devise programs of continuing education that will help retrain the dentist to employ the expanded function auxiliary. Even if we were to start such programs today, no one has assumed the responsibility for training expanded function auxiliaries for the practitioner, e.g., if we use Howard as an example, we are training 25 therapists per year and we need 100 therapists to meet our clinical needs as long as we continue to admit 100 dental students per year. With an anticipated 50% anticipated attrition due to marriage, pregnancy, career mobility, pursuit of advanced study, other employment, etc., we can hardly meet our own manpower needs on a continuing basis. Therefore, without an increase in auxiliary enrollment (which we cannot do in the current facility), we could not significantly contribute to the manpower pool of expanded function auxiliaries. In the greater Washington area, most of this responsibility for auxiliary training would have to be met at the community college level but these determinations should be made with decisions and pressures coming from the local dental society and citizens groups who will be involved at the delivery-consumer level. Our medical colleagues are far ahead of us in auxiliary utilization and training. This has been true in the past with medical technology in general. The para medical personnel, e.g.,
physician's assistants,
nurse
practitioners,
med-X's, pediatric cardiology associates and pharmacology practitioners, all represent an effort to meet the anticipated demands for medical treatment. Also, I see increasing implications, re: the expanded function dentist which include, the dentist as a member of the emergency health team, the responsibility for pharyngeal, laryngeal and skin cancer detection, diagnosis and screening for hypertension, sickle cell screening, nutritional and genetic counseling, etc. Whether, we as dentists, accept or reject these additional profes-
JANUARY, 1976
sional responsibilities will be decisions of the future. If we do go this route in the U.S., then it is not inconceivable that one health professional degree would be adequate with clinical dental training being at the postgraduate level of training. There are those who consider this to be a real possibility. Before closing, I would like for you to consider some interesting data regarding dental student enrollment. In 1975, there were 12,569 applications to dental schools for 4,316 openings. It is interesting to note that during the past 10 years, dental student enrollment has increased by 39.6%. (13,876 in 1963 to 19,369 in 1973). There were no significant increases in minority student enrollment, however, until 1970. Minority student enrollment has increased 100.8% during the period 1970-1973 (1970-1,969, 1973-2,338). Though there appears to be a leveling off at the present time, there are only 872 black dental students or 4.5% and 283 of them are at Howard (33% of all black students). With regards to women, the 1974/75 enrollment total was 1,361 or 6.8%.9 Howard had 61 females enrolled in 1974-75 or 16% of its total dental students. We will probably level off at 20-25% females at Howard. The 1972 survey of recent dental graduates reports 95% of the dental graduates 1969-72 are in general practice and 5% are in specialty practice. Howard and Meharry continue to train 50% of the nation's black dentists. The graduates of these two institutions must, therefore, continue to be the monitors of the standards and systems of dental health care in the black community. The black community will suffer most as this country strives to achieve "'economic health' , rather than to continue its focus on the physical health and well being of its citizens. LITERATURE CITED
1. HENRY, J. L. Bridging the Gap. Jour. Amer.
College Dent., 37:317, 1970. 2. REED, 0. Perils of Being a Dentist. Vancouver, Feb. 8, 1975 (A.P.). (Concluded on page 8)
8
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
these cases,4 and present an obvious cause of respiratory embarrassment. Lieberman10 recently reported successful treatment of these complications with nitrogen mustard and diuretics. Although no satisfactory therapy exists for disseminated leiomyomas, local excision has been suggested for solitary nodules. 612 Occasionally, smooth muscle proliferation may occur in end stage pulmonary fibrosis to the extent that it has been called "muscular cirrhosis" of the lung. This type is also diffuse and may cause severe functional alterations and eventually death.14 A classification of pulmonary leiomyomas is suggested in Table 3. SUMMARY
Two unusual cases of pulmonary leiomyomatosis in women with miliary infiltrates by chest radiograph in whom "benign" uterine fibroids were found were presented. One patient was asymptomatic while the other was disabled, demonstrating the variability of disability that can occur in this disease. The asymptomatic patient had restrictive lung disease while uneven ventilation and defect in transfer of gases contributed to hypoxemia in the disabled patient. LITERATURE CITED
1. KRISCHE, G. Ein Fall von Fibromyomen des uterus mit Multiplen Metastasen bei einer Geisteskranken. Diss. Gottingen, W. F. Kastner, 1889. 2. LANGERHANS, R. Demonstration eines Prap arates von Myoma laevicellulare malignum. Berl. Klin. Wchnschr., 30:338-340, 1893.
JANUARY, 1976
3. MINKOWSKI, 0. Myommetasten in Lungen, Leber and Miskeln. Munchen. Med. Wchnschr., 48:1335, 1901. 4. VALENSI, Q. J. Pulmonary Lymphangiomyoma, A Probable Forme Frust of Tuberous Sclerosis: A Case Report and Survey of the Literature. Am. Rev. Resp. Dis., 108:1411-1415, 1973. 5. PIERCE, W. F. and R. L. ALZNAUR and C. ROLLE, Jr. Leiomyoma of the Lung: Report of a Case. AMA Arch. Path., 58:443-448, 1954. 6. ARIEL, I. M. and S. TRINIDAD. Pulmonary Metastasis from a Uterine Leiomyoma. Report of a Case: Evaluation of Differential Diagnosis and Treatment Policies. Am. J. Ob. Gyn., 94:110116, 1966. 7. DEL POZO, E. and I. R., MATTEI. Multiple Pulmonary Lieomyomatous Hamartomas. A Case Report. Am. Rev. Resp. Dis., 100:388-390, 1969. 8. STEINER, P. E. Metastasizing Fibroleiomyoma of the Uterus. Report of a Case and Review of the Literature. Am. J. Path., 15:89-109, 1939. 9. CASTLEMAN, B. and B. U. KIBBEE. Case Records of the Massachusetts General Hospital. N. Eng. J. Med., 268:550-557, 1963. 10. LIEBERMAN, J. and C. M. AGLIOZZO. Intrapleural Nitrogen Mustard for Treating Chylous Effusion of Pulmonary Lymphangioleiomatomatosis. Cancer, 33:1505-1511, 1974. 11. BEUCHNER, H. A. The Differential Diagnosis of Miliary Disease of the Lungs. Med. Clin. Nor. Amer. 43:89-112, 1959. 12. SPIRO, R. H. and C. J. MCPEAK. On the
So-Called Metastasing Leiomyoma. Cancer, 19:544-548, 1966. 13. KAPLAN. C. and A. KATOH, S. MIKIHIRO, E. ROGOW, J. H. SCOTT, W. CUSHING and J. COOPER. Multiple Leiomyomas of the Lung: Benign or Malignant. Am. Rev. Resp. Dis., 108:656-659, 1973. 14. RUBENSTEIN, L. and W. H. GUTSTEIN and H. LEPOW. Pulmonary Muscular Hyperplasia (Muscular Cirrhosis of the Lungs). Ann. Int. Med., 42:36-43, 1955.
(Sinkford, from page 62) 3. Annual Report of Dental Education. 1973-74, SupEducation and Welfare, Public Health Service Replement 15; Trend Analysis 1964-1973. port. Health Resources Adm. 4. Carnegie Commission on Higher Education: Higher 7. Institute of Medicine Report of A Study: Cost of Education and the Nation's Health. New York, Education in the Health Professions, Washington, McGraw-Hill Book 1970. D. C.: National Academy of Sciences; Parts I and 5. Annual Report of Dental Education, 1973. EnrollII, Jan. 1974. Part III, April, 1974. ment in Advanced Education Programs. 8. Annual Report of Dental Education 1973-74, Sup6. Vital Health Statistics. Series 10-Number 95. Curplement 15; Trend Analysis 1964-1973. rent Estimates from the Health Interview Survey, 9. ADA Leadership Bulletin. Vol. 5/Number 4. Feb. United States, 1973. U.S. Department of Health, 17. 1975.
PAY YOUR NMA DUES NOW!!
