In summary I feel it can be said that the experiments confirm the following: That this is a Solitary Bone Cyst causing clinical expansion of the mandible. No epithelial lining is present, but some small vessels and a little loose connective tissue lines the bony walls. The hydrostatic intra-cystic pressure was exceptionally low, and comparable with capillary pressure, and quite unlike other cysts of the jaws. The osmotic tension of the cyst fluid was greater than that of the patient's blood, and this must constitute a small but definite expansile pressure. The measured osmotic pressure difference was lower than capillary pressure, and so this would allow the presence of capillaries inside the cyst wall, without collapsing them. The wall of this cyst acted in vivo as a semipermeable membrane, in spite of the absence of epithelial lining. The radioactive substance was not cleared rapidly into the lymphatics or blood system, and compared with other experiments, this indicated that the cavity formed no part of the patient's general circulation. There was no lymphatic access to the cyst cavity. Finally, it can be said that while certain points suggest strongly that this cyst was increasing in size by reason of an overall osmotic imbalance, the findings do not militate against the possible origin in an unresolved medullary haemorrhage, which, in a confined intra-bony space, could conceivably cause pressure effects which could isolate an area from normal lymphatic access and so a self-perpetuating area of osmotic imbalance could be set up. It certainly seems that our own artificially produced haemorrhage, with some subsequent haemolysis, into a prepared cyst fluid caused, at least temporarily, a steep rise in cyst pressure. Pressure-atrophy of the thin cyst wall would continue to supply substances to the cyst fluid which would tend to maintain a slightly hypertonic state, and in the absence of an epithelial lining the erosion of capillaries with intermittent small haemorrhages might periodically cause variations in osmotic tensions, and this may possibly be shown by the laminated appearance of the bony wall in this case and by bony appearances reported by other writers suggesting very slow and intermittent expansion. The term ‘haemorrhagic’ cyst of the mandible might well be accepted. The possible dose of radiation to the body in these investigations, both in regard to local and general doses, were carefully worked out by the Isotope Panel of the Medical Research Council, and the procedures were authorised as being well within the safety limits under the conditions which might be encountered.
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