The influence of serum content in the medium on the survival of human bone marrow in suspension in vitro.

Samples of human bone marrow cells from patients with various diseases were cultivated in vitro by means of a simple stationary suspension method. Medium Eagle MEM with the addition of allogeneic serum and borosilicate glass were used. The cells survived significantly longer in samples with 50 per cent of serum than in samples with 30 per cent of serum only. Monocytes showed the longest survival (max. 95 days) in cultures with 50 per cent of serum. Myelocytes and segmented neutrophils as well as normoblasts survived till 45th day and plasmocytes till 66th day. Mitoses in monocytes were found till 50th day. Moreover so called "satellitosis" of plasmacytes around a macrophage was observed in cases with reactive plasmacytosis.     

SALIVARY GLAND TUMORS

In a review of a series of 248 salivary gland tumors, seen over a 28-year period, all pathologic material was brought up to date by reclassification according to more recent criteria and nomenclature. In parotid tumors, a probable lowered recurrence rate and a definite decrease in incidence of permanent facial nerve paralysis was found in the more recent cases in which the "Y" incision was used, with identification of the seventh nerve as it leaves the stylomastoid foramen. The five-year recurrence rate for primary mixed tumor was 8.3 per cent, and in recurrent cases it was found to be 18.1 per cent. Of 44 patients with malignant salivary gland tumors in all sites who were observed for five years or more, 32 or 72.7 per cent survived five years.     

Detection of cancer of the lung; results of a chest x-ray survey in Los Angeles

In a mass survey by x-ray minifilm in Los Angeles County, apparently suspicion of cancer of the lung was reported in more than 90 per cent of cases in which the condition existed. Of the patients who were appropriate for resection with intent to cure, 35.8 per cent had "three-year cures." This high cure rate indicates that if the condition is detected early by the survey method and "curative" operation is done, cure rate for lung cancer may be much higher than is usually thought.     

The prognosis in cataract operations; a correlation of preoperative appraisal with results

The preoperative and postoperative data on 500 cases in which cataracts were removed from the eyes were reviewed to correlate the results with the preoperative prognosis as determined by light identification and macular function tests. Another purpose was to consider the adequacy of various methods of preoperative appraisal. The vision was improved to better than 20/200 in 89.4 per cent of the cases. In 5.6 per cent (28 cases) vision was improved but was 20/200 or less. In 5 per cent (25 cases) the operation was a failure, for various causes. There was wide variation in methods used to determine the condition of the retina preoperatively by means of light identification and macular function tests, and there was no uniformity of terms used to describe degree of function.A standardized method of estimating retinal function in the presence of cataract was used in 60 cases. The equipment used is simple and inexpensive. From analysis of preoperative determination of prognosis and the operative results, it would appear that this simple inexpensive procedure is more reliable in arriving at a preoperative prognosis than some of the methods frequently employed.     

Prostatectomy in private practice; a review of 589 cases in a five-year period

Prostatectomy was done in 589 cases in a five-year period. The operation was done transurethrally in 530 cases of benign disease and in 50 cases of malignant lesions. In six cases of malignant disease and three of benign, open procedures were used. Results of transurethral prostatectomy were considered good or excellent in 94.4 per cent of the cases of benign hypertrophy and in 92 per cent of the cases of carcinoma. It was felt that radical perineal prostatectomy was advisable for early operable cases of carcinoma, but that the transurethral procedure was more suitable in almost all cases of benign hypertrophy.     

Treatment of itching; a preliminary report on results with a new oral antipruritic

A new antipruritic, trimeprazine, was used in the treatment of itching associated with a variety of dermatologic disorders in 215 patients.Good to excellent relief of itching was experienced by 71 per cent of the patients, fair relief by 15 per cent and poor relief by 14 per cent.Side effects included mild and transient drowsiness or dizziness that cleared spontaneously; six cases of drowsiness that necessitated discontinuance of the drug; three cases of drowsiness that was controlled by reduction of the dosage; and one case of generalized eruption that cleared upon discontinuance of the drug.     

The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital]

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.     

CEA, ZGM and EMA localization in cells of pleural and peritoneal effusion: a preliminary study

Carcinoembryonic antigen (CEA), the zinc glycinate marker (ZGM) and epithelial membrane antigen (EMA) have been described as epithelial or tumour markers of varying specificity. These antigens were studied by immunoperoxidase localization in selected cell blocks of 62 pleural or peritoneal effusions and compared to cytological findings and review of the clinical records. By cytological criteria, 25 of the cell blocks were positive for malignancy, 30 negative, and 7 inconclusive. CEA, ZGM, and EMA by immunoperoxidase staining were localized on the cell surface and often in the cytoplasm of malignant cells, in 11/25 (44 per cent), 17/25 (68 per cent) and 22/25 (88 per cent) of the positive cell blocks respectively. Ten (40 per cent) of these cases were positive for all three antigens, 7 (28 per cent) for two, and 6 (24 per cent) for one. Of the 7 cases which were inconclusive on routine cytological reporting, 5 were positive for at least one marker. In 3 of the 5 a diagnosis of malignancy was confirmed, and in the other two was strongly suspected as malignant on clinical grounds. Macrophages were sometimes positive for one or more markers (but showed cytoplasmic staining only) and mesothelial cells in some cases stained positively for EMA but were always negative for CEA and ZGM. Localization of the 3 antigens in cells of malignant effusions was compared with their localization in the primary tumours in 9 cases. Localization corresponded for CEA in 7 of 9 cases, for EMA in 8 of 8 an for ZGM in only 2 of 9. Effusion fluid levels for CEA were compared with the cytological and immunocytochemical findings in 30 cases. Mucin stains performed on the cell blocks were also compared with the immunoperoxidase findings.     

CHOLEDOCHOLITHIASIS-Correlation of Preoperative with Operative and Postoperative Data to Enhance Diagnostic Insight

One hundred cases of common bile duct explorations were reviewed in an attempt to obtain information that might give insight into the diagnosis and definitive treatment of choledocholithiasis. Fifty of the hundred patients had common duct stones. Correlations were made between the incidence of choledocholithiasis as proved at operation, and the following factors: Kind and number of choledochal exploratory criteria used, the clinical diagnosis of common duct stones, and the pathologic features of gallbladders removed. The incidence of stones was statistically related to aging. The most frequent choledochal exploratory criteria were common duct dilatation or thickening (63 cases) and history of jaundice (50 cases). The most reliable single criterion in "diagnosing" common duct stones was palpable common or hepatic duct stones, the diagnosis having been correct in 15 of 17 such cases. The most reliable combination of criteria was a history of jaundice, plus palpable stones, with correct diagnosis in all such cases. The clinical diagnosis of choledocholithiasis was correct in only 17 per cent of cases. The correlation of the incidence of common duct stones with the degree of gallbladder disease-that is, acute or chronic-did not provide information that might be helpful in diagnosing choledocholithiasis. The incidence of proven retained common duct stones was 3 per cent, the non-fatal postoperative complication rate was 21 per cent and operative mortality was 1 per cent.     

The Role of a Hospital Ethics Consultation Service in Decision-Making for Unrepresented Patients

Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment (LST) for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five (8.1 per cent) of which involved unrepresented patients. In thirteen (52.0 per cent) cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient’s best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST (72 per cent) or to change code status to Do Not Resuscitate/Do Not Intubate (12 per cent). Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision (50 per cent vs 6.3 per cent, p = 0.04). In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers.     

Spleen immunomorphologic behaviour in primary and secondary acute bronchopulmonary inflammations of children. Comparative analysis of the lung and hilar-tracheobronchial lymph nodes' reactions

The spleens sampled at necropsy of 221 children with acute primary and secondary bronchopulmonary inflammations were characterized by the hyperplasia of lymphoid follicles and plasma cells in 37 per cent of the cases, only a few of them with a multilayered organization of follicles, and by lymphoid depletion in 19 per cent of the cases. The remainder presented small unorganized lymphoid follicles of the primary type, some cases being remarkable by their nodules with a "core" of "epithelioid pattern". The pyroninophilic reactions of high intensity were preponderant in bronchopneumonia of the primary type, but unlike the lung and hilar-tracheobronchial lymph nodes, in spleen there were no differences concerning the two value groups of reactions between the primary pneumonia cases with or without associated extrapulmonary inflammations. Immunofluorescence evidenced, in decreasing order, all the three classes of immunoglobulins: IgM, IgG and IgA.     

MYELOGRAPHY—Diagnostic Value in Lesions of the Lumbar Intervertebral Discs with a Variation in Technique

Myelography using pantopaque in greater than usual amount with a variation in technique, which is described, is believed to provide increased accuracy in differential diagnosis and precise localization of lesions in the lumbar spine. The need for multiple space exploration is eliminated and more detailed information concerning the size and shape of lesions is provided as compared to that secured by the use of 3 or 6 cc. of opaque medium and fluoroscopic examination alone. In 53 cases in which lumbar myelography was performed and the diagnosis verified or disproved at operation, there was a 5 per cent diagnostic error in 41 instances in which the method outlined was used, as compared with 17 per cent error in 12 cases in which only 3 or 6 cc. of radiopaque material and fluoroscopy alone were used. The accuracy of the procedure would appear to warrant its use in the evaluation of patients suspected of having abnormalities of the lumbar discs associated with nerve root compression.     

Epidemiological survey of rhinosporidiosis in Kanyakumari district of Tamil Nadu

One hundred and twelve nasal polyps received along with full history from three different hospitals of Kanyakumari district of Tamil Nadu during the period 1983–1987 were found positive for rhinosporidiosis on histopathological examination. Among the four taluks (countries) the majority of the cases (41.1 per cent) came from Agastheeswaram, followed by Kalkulam (28.6 per cent), Thovalai (17.0 per cent) and Vilavancode (13.3 per cent). The 11–20 years age group found to be highly susceptible (60 per cent). There was no sex prepondence in contracting the disease as the cases were evenly distributed between both sexes. These findings exhibited the endemic nature of the disease in Kanyakumari district.Unreported cases to an extent of 9 to 40 per cent were encountered during the ENT disease diagnostic camps conducted in nine high incidence villages. Further 8 more cases were detected in addition to cases attended in the hospitals and ENT camps when a complete enumeration of cases was undertaken in Pallam village. Thus the actual number of cases found in the district need a stratified random sampling.     

TREATMENT OF ITCHING—A Preliminary Report on Results with a New Oral Antipruritic

A new antipruritic, trimeprazine, was used in the treatment of itching associated with a variety of dermatologic disorders in 215 patients.Good to excellent relief of itching was experienced by 71 per cent of the patients, fair relief by 15 per cent and poor relief by 14 per cent.Side effects included mild and transient drowsiness or dizziness that cleared spontaneously; six cases of drowsiness that necessitated discontinuance of the drug; three cases of drowsiness that was controlled by reduction of the dosage; and one case of generalized eruption that cleared upon discontinuance of the drug.     

Use of antibiotics for the prevention of postoperative suppurative complications in planned surgery

Two methods for antibiotic prophylaxis in scheduled surgical treatment were studied comparatively. In the main group antibiotic prophylaxis with respect to 621 operations was started simultaneously with premedication, the duration of the course being defined by the operation type. With respect to 252 pure operations antibiotics were not used in 69.8 per cent of the cases or used for 2-3 days in 27.8 per cent of the cases. With respect to 253 conditionally pure operations shorter courses of antibiotic prophylaxis, i.e. for 2-3 days were used in 50.2 per cent of the cases. In the control group the antibiotics were used after operations in mean therapeutic doses, the duration of the course being defined by the clinical findings. The number of purulent complications in the main group decreased, while the amounts of the antibiotics used were much lower.     

Tetanus in California; epidemiology and a review of 232 cases

A study was made of records of the 232 reported cases of tetanus in California, from 1953 through 1958. Cases occurred in 30 of California's 58 counties. Two-thirds of the patients lived in suburban and urban areas. Two-thirds of the cases occurred in persons over the age of 20 years. The incidence was twice as high in males as in females. Forty-seven per cent of the patients died, with the highest death rates being in persons over the age of 40 years.Sixty-three per cent of the injuries associated with these 232 cases occurred in the home environment and 17 per cent at the place of employment.Ninety-one per cent of the patients had never been immunized with tetanus toxoid, or if they had been immunized, had not received the booster injections necessary to maintain effective immunity. Nine per cent gave a history of having had one or more injections of tetanus toxoid within five years.     

Carminomycin study in breast cancer]

Karminomycin was used for the treatment of cases with disseminated cancer of the mammary gland in doses of 5 mg/m2 of the body surface intravenously every day for 5 days (15 patients) or 6 mg/m2 twice a week for 2-3 weeks (30 patients). Partial remission or diminution of the tumor size at least by 50 per cent was observed in 26 and 17 per cent of the patients respectively. The remission duration was from 2 to 6 months. With the use of the shortperiod scheme the frequency of the direct side reactions increased. Leucopenia as a side effect was registered in 100 and 40 per cent of the patients and thrombocytopenia was registered in 18 and 3 per cent of the cases respectively.     

The prevalence of islet-cell antibodies and complement-fixing islet-cell antibodies in Japanese diabetics

The presence of complement-fixing islet-cell antibodies (CF-ICA) and islet-cell antibodies (ICA) was examined in 355 patients with different types of diabetes mellitus in the Japanese population by an indirect immunofluorescence test (IFT). The overall prevalence of ICA, which were stained as a homogenous cytoplasmic fluorescence in islet cells, was 7 per cent (5/67) in insulin-dependent (Type I) diabetics, 4 per cent (6/137) in noninsulin-dependent (Type II) diabetics treated with insulin and 2 per cent (1/58) in Type II diabetics treated with oral hypoglycemic agents. None of 84 Type II diabetics receiving diet alone and 9 diabetics associated with chronic pancreatitis had ICA. CF-ICA, which were stained as a "ring-shaped" fluorescence in a part of the cytoplasma, were demonstrated in 5 out of 12 cases (42%) whose sera possessed ICA. The lower prevalence and remarkably shorter persistence of ICA and CF-ICA in Japanese diabetics than those observed in Caucasian diabetics may be explained by the heterogenous immunological response in different races or possible heterogeneity of Type I diabetics.     

Ofloxacin and ciprofloxacin in the treatment of sexually-transmitted diseases]

A complex clinico-laboratory++ examination and treatment were made of 76 women with inflammatory processes in the urogenital tract. Gonorrhea, trichomoniasis, chlamydiosis and Ureaplasma infection were detected in 60, 31.4, 41 and 14 per cent of the cases, respectively. There were affections of the rectum by gonococci, chlamydia, ureaplasmas and Trichomonas in 55, 32, 10.6 and 6.6 per cent of the cases, respectively. The frequency of chlamydia in the oropharynx amounted to 30 per cent whereas gonococci and ureaplasma were less frequent i.e. 9 and 1.2 per cent, respectively. The combination of the above pathogens in the rectum were the following: gonococci and chlamydia (15 per cent of the cases), gonococci, chlamydia and Trichomonas (7.3 per cent), gonococci and ureaplasma (7.3 per cent), ureaplasma and chlamydia (7.8 per cent). In the throat the association of gonococci and chlamydia was detected in 3.7 per cent of the cases. It should be indicated that the signs of sex-transmitted diseases were few, which required careful clinico-laboratory examination of the extragenital foci in the patients with inflammatory urogenital diseases. Ofloxacin showed a high efficacy in the treatment of patients with gonorrhea and ureaplasmosis. Its use in treatment of chlamydiosis proved inexpedient while ciprofloxacin was effective in the treatment of the infection.