Effectiveness of smear technique in detection of pulmonary and gastric cancer

In the initial use of cytologic examination of smears to detect pulmonary and gastric cancer at the Los Angeles County Hospital during the period April 1949 to June 1950, 350 patients with suspicion of pulmonary disease and 128 with gastric problems were studied. In the pulmonary group, 80 per cent of 51 malignant lesions were diagnosed by the smear technique. Sixty per cent of 15 neoplasms in the stomach were diagnosed by the method. The results are analyzed in terms of sensitivity, accuracy, reliability and "yield" for the method. Cytological criteria of the presence of malignant disease are given and illustrated by photomicrographs. The method is one of potentially great value as an aid to diagnosis. Use of it in examination of selected categories of patients seems warranted.     

Effect of antibiotics on the absorption of basic nutrients]

The impact of tetracycline, gentamicin, streptomycin, erythromycin, oxacillin, benzylpenicillin and sulfanilamides on the absorption function of the small intestine was studied in 79 patients with chronic bronchitis. The drugs were shown to mainly inhibit fat absorption: on the average, by 87 per cent in all the patients treated with tetracycline, on the average, by 89 and 36 per cent in 80-70 per cent of the patients treated with gentamicin and streptomycin, respectively, and, on the average by 26 and 16 per cent in 20-25 per cent of the patients treated with erythromycin and oxacillin, respectively. The absorption of protein decreased, on the average, by 23-74 per cent in all the patients treated with tetracycline, gentamicin and streptomycin. As for the other drugs, they had, on the average no significant effect on protein absorption. The absorption of carbohydrates (d-xylose) significantly decreased under the effect of these three drugs (by 21, 34 and 36 per cent, respectively). The analysis revealed a relation of absorption function to the presence and degree of intestinal dysbacteriosis.     

INTENSIVE X-RAY SURVEY FOR TUBERCULOSIS IN A RURAL COUNTY

In an intensive fast-tempo tuberculosis case-finding survey in a rural county 34,345 residents (73 per cent of all persons 15 years of age or over) had miniature x-ray films of the chest taken. In 256 instances, x-ray findings were consistent with pulmonary tuberculosis. Sixty-eight persons were ultimately reported as having active tuberculosis (one case of active tuberculosis for every 505 persons covered by the survey). Within one year, 57 of them had been hospitalized for treatment. Only four of the 68 cases had been known to the health department before the survey.The cost of the survey (80 cents per person surveyed and $444.58 per case of active tuberculosis) compares favorably with that of other surveys.     

Lung scintigraphy with [123I]IMP in patients with pulmonary tuberculosis

Lung scintigraphy using N-isopropyl-p-[¹²³I]iodoamphetamine (IMP) was performed on 26 patients with pulmonary tuberculosis. Early (5 min after injection) and late images (4 h after injection) were obtained with a large-field γ-camera equipped with a digital computer. Lung scintigraphy using [^99mTc]MAA (MAA) was also done. Although early IMP images showed the same findings as [^99mTc]MAA images, a discrepancy between delayed IMP images and [^99mTc]MAA images was seen in some patients. Increment of activities seen in late images was demonstrated in most patients whose chest x-ray findings included exudative inflammatory changes. Uptake and clearance of IMP was considered to be affected by the active phase of pulmonary tuberculosis.     

Ultrasonographic images of liver neoplasms--comparison with histopathological findings

Ultrasound pictures taken in 100 patients with histologically confirmed primary of metastatic neoplasms of the liver were analysed retrospectively. The most frequent were hyperechogenic foci (43%). Hypoechogenic foci were found in 33% of the patients whereas mixed changes in the liver scans (hyper- and hypoechogenic) in 22%. Thirty seven per cent of the hyperechogenic foci were attributable to metastatic process. Hypoechogenic disorders were most frequently due to the primary cancer of the liver (20%). Mixed lesions were mainly produced by the cancer of large intestine and liver (41% and 27%, respectively). Metastases into the liver produced all three types of ultrasound pictures. The obtained results confirm the opinion that ultrasound picture of metastatic liver tumours is not suitable for the diagnosis of the type and origin of the neoplasm.     

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.     

Do Spanish Hospital Professionals Educate Their Patients About Advance Directives?

It is unknown whether hospital-based medical professionals in Spain educate patients about advance directives (ADs). The objective of this research was to determine the frequency of hospital-based physicians’ and nurses’ engagement in AD discussions in the hospital and which patient populations merit such efforts. A short question-and-answer-based survey of physicians and nurses taking care of inpatients was conducted at a university hospital in Madrid, Spain. In total, 283 surveys were collected from medical professionals, of whom 71 per cent were female, with an average age of thirty-four years. Eighty-four per cent had never educated patients about ADs because of lack of perceived responsibility, time, or general knowledge of ADs. Patient populations that warranted AD discussions included those with terminal illnesses (77 per cent), chronic diseases (61 per cent), and elderly patients (43 per cent). Regarding degree of AD understanding in medical professionals: 57 per cent of medical professionals claimed sufficient general knowledge of ADs, 19 per cent understood particulars regarding AD document creation, and 16 per cent were aware of AD regulatory policies. Engagement in AD discussions was considered important by 83 per cent of medical professionals, with 79 per cent interested in participating in such discussions themselves. The majority of hospital physicians and nurses do not educate their patients about ADs, despite acknowledging their importance. Patient populations of highest priority included those with terminal diseases or chronic illness or who are of advanced age.     

Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.     

Antibiotic sensitivity and the characteristics of transmissive R plasmids in Shigella belonging to various species]

Sensitivity of 241 Shigella strains isolated from patients at various regions of the USSR in 1975--1978 was tested with respect to 14 antibiotics by the method of serial dilutions. 90.5 per cent of the isolates proved to be resistant to the antibacterial drugs and the greater part of 75.9 per cent of them had multiple resistance. The resistance of the Shigella was most pronounced and frequent with respect to tetracycline, streptomycin, levomycetin, as well as ampicillin and carbenicillin. Gentamicin, cephaloridin, polymyxin M, kanamycin, monomycin, neomycin and rifampicin were highly active against the Shigella. More than 50 per cent of the isolates were sensitive to levomycetin, ampicillin and carbenicillin. Differences in the frequency of the resistant strains and the spectrum of the antibiotic resistance of different Shigella subgroups (species) were observed. The study of 173 multiple resistant Shigella strains showed that about 67 per cent of the strains had a capacity for transduction of the resistance markers into the recipient cells of E. coli. The conjugative R-plasmids were most frequent in Sh. boydii and Sh. sonnei (95 and 95 per cent respectively), less frequent in Sh. flexneri and Sh. newcastle (68 and 53 per cent respectively) and least frequent in the mannitol negative Shigella (25 per cent). The capacity for transduction of R-plasmids in the strains carrying the determinants of resistance to 2 or 3 antibiotics was higher than in the strains carrying the determinant of resistance to one antibiotic. The clinical Shigella strains tested mainly had transmissive R-plasmids of fi--character (79 per cent).     

X-ray diagnosis of peripheral chondromatous hamartomas of the lungs]

A roentgenomorphographic picture was compared with gross specimens of the lungs in 104 operated on patients with peripheral harmatochondromas. Eighty three patients were followed-up roentgenologically for 2-18 years. The resultant three variants of an x-ray picture of hamartochondromas were revealed. CT investigation showed a benign process in a majority of patients, hamartochondrosarcoma was diagnosed in 36.5 per cent. Shadow size enlargement, calcifications and their increase are not signs of malignancy.     

Carcinoma of the cervix

Studies by eminent surgeons to reevaluate the place of radical operations in the treatment of carcinoma of the cervix-now that extensive procedures have become less hazardous-apparently have led to confusion in some minds as to choice between surgical and radiation therapy. Pending outcome of the studies, general employment of surgical treatment is unwarranted. Radiation is the treatment of choice in most cases, particularly if the lesion is in an early stage, although radical operation is indicated in certain rare early cases in which delivery of an effective dose of radiation to involved areas is technically difficult. Elsewise it appears at present that operation should be used only in cases of stages III or IV carcinoma-in which results by either means of treatment are poor.One hundred and seven patients were treated with a combination of x-ray and radium irradiation. X-ray was used first to reduce the hazard of implanting the radium. The "five-year arrest" rates were as follows: For 22 patients with stage I lesion, 70 per cent; for 31 with stage II, 55.7 per cent; 33 with stage III, 39.7 per cent; 21 with stage IV, 0. Eighteen patients with diagnosis of carcinoma of the cervix who had had subtotal hysterectomy were treated. The stage of the disease could not be determined. In this group the five-year arrest rate was 52 per cent.     

Mass surveys and selective case-finding; two tools for tuberculosis control

The productivity and effectiveness of the traditional mass x-ray survey method of tuberculosis case-finding were compared with those of a selective use of mobile miniature x-ray equipment. In Tulare County, California, two mobile miniature x-ray units were operated independently of each other. One unit conducted community-wide, pre-planned surveys, while the other unit operated a regular weekly schedule of mobile screening clinics in four cities in the county. THE MAIN FEATURES OF THE SELECTIVE SCREENING PROGRAM WERE: (1) Extensive use of the physician referral method; (2) utilization of the unit for contact contact investigation; (3) interpretation of the minifilm and mailing of film and report to the family physician one day after the screening clinic.RESULTS: Mass survey found one case of tuberculosis per 2,200 minifilms taken; cost per case found, $475. Selective screening program found one case per 292 minifilms taken; cost per case found, $111. Of all cases of tuberculosis reported in 1953, 8 per cent were found by mass survey and 18 per cent by selective screening.     

Radioisotopic Bone Scintigraphy with the Gamma Camera in the Investigation of Prostatic Cancer

Experience with x-rays, strontium-87m scintigraphy, and technetium-99m polyphosphate scintigraphy in the identification of bone metastases in 201 patients with prostatic cancer is reviewed. About 40% of the patients had demonstrable metastases in bone at the time of first presentation.Comparative studies of 247 x-ray and ^87mSr surveys indicated that x-rays failed to detect metastases in 10% of cases where they were identified by ^87mSr but that the isotopic survey similarly failed to detect radiologically evident deposits in 7% of cases.Similar studies comparing ^99mTc polyphosphate surveys with x-ray scans showed that x-rays missed isotopically detected metastases in 12% of cases, but in only one survey out of 67 did the isotope miss radiologically evident deposits. In a series of 32 patients investigated by both isotopic techniques ^99mTc polyphosphate did not fail to detect any metastases and identified deposits in one patient in whom they were missed by ^87mSr scintigraphy. About 15% of both x-ray and ^87mSr surveys gave equivocal results, but only 3% (2 out of 67) of ^99mTc polyphosphate surveys were equivocal.We concluded that ^99mTc polyphosphate bone scintigraphy with the gamma camera was the most reliable of the techniques used for the identification of bone metastases in patients with carcinoma of the prostate. The results of scintigraphy with ^87mSr suggested that serial surveys may provide early evidence of hormone resistance in prostatic cancer.     

Use of bleomycetin in malignant testicular tumors and the problem of studying bleomycin analogs

The efficacy of the chemotherapy of 16 patients with metastases of malignant tumors of the testicle was studied. The chemotherapy included vinblastine, platidiam and bleomycetin. The latter was used in a dose of 10 mg daily intramuscularly or as long-term intravenous infusions. As a result of the treatment complete and partial regression of the tumors was observed in 5 (31 per cent) and 4 (25 per cent) patients, respectively. Leukopenia was the main side effect. By present the total doses of bleomycetin had amounted to 250 mg for 4 patients and to 300-350 mg for 7 patients. No signs of pulmonary toxicity were observed with the use of these doses. The problem of clinical studies of bleomycin analogs is discussed.     

The dissections of craniocervical arteries

Dissection of craniocervical arteries internal carotid artery (ICA), or vertebral artery (VA) is an increasingly recognized entity and infrequent cause of stroke. We investigated 8 patients (4 women and 4 men) with dissections of the craniocervical arteries. Diagnostic procedures for detection of craniocervical dissection included: extracranial ultrasound-color Doppler flow imaging (CDFI) of carotid and vertebral arteries, transcranial Doppler sonography (TCD) and radiological computed tomography (CT) and digital subtractive angiography (DSA) examinations. Ultrasound findings (CDFI of carotid and vertebral arteries) were positive for vessel dissection in seven patients (or 87.5 per cent) and negative in one patient. DSA was consistent with dissection in five patients (or 62.5 per cent), negative in one, while in two patients the examination was not performed due to known allergy to contrast media. Five patients (62.5 per cent) were treated with anticoagulants, one with suppressors of platelet aggregation, and two patients were operated. Six patients (75 per cent) after the treatment showed partial recovery of neurological defects, and an improvement of ultrasound finding of dissected arteries. In one patient, following operation, stroke developed with deterioration of motor deficit, and one patient was readmitted three months later due to a newly developed stroke and soon died. The diagnosis should be suspected in any young or middle-age patient with new onset of otherwise unexplained unremitting headache or neck ache, especially in association with transient or permanent focal neurological deficits.     

DERMATITIS OF THE HANDS IN INDUSTRY

Three hundred and twenty-eight patients were referred for opinion as to whether a dermatologic condition was due to occupational causes. The answer was affirmative in two-thirds of the cases.Of 2,260 patients seen in ordinary private dermatological practice, about 9 per cent had lesions on the hands. Of 128 patients with contact dermatitis considered to be of industrial origin, 121, or 94.5 per cent, had lesions on the hands.Establishing industrial responsibility in cases of suspected occupational dermatitis of the hands is difficult, but in most cases a just conclusion can be reached by following certain guides.     

Evaluation of the usefulness of certain localization methods in diagnosis of pheochromocytoma]

Localization tests including TC-scans, scintigraphy with 131I-radiolabelled metaiodobenzylguanidine and ultrasound have been performed in 68 patients with diagnosed pheochromocytoma. Diagnosis was based on clinical symptoms and increased catecholamines and/or their metabolites excretion with the urine. Proper diagnosis with CT-scans was 97%, scintigraphy--92%, and ultrasound--93%; false negative results in scintigraphy amounted to 8% (3 patients) and 5% (3 patients) in case of ultrasound. CT-scans were free of such errors. False positive diagnosis was made in 2 (3%) patients with CT-scans and in 1 (2%) patient tested with ultrasound. These results suggest that pheochromocytoma may be precisely localized with non-invasive techniques, especially CT-scans.     

CARCINOMA OF THE CERVIX

Studies by eminent surgeons to reevaluate the place of radical operations in the treatment of carcinoma of the cervix—now that extensive procedures have become less hazardous—apparently have led to confusion in some minds as to choice between surgical and radiation therapy. Pending outcome of the studies, general employment of surgical treatment is unwarranted. Radiation is the treatment of choice in most cases, particularly if the lesion is in an early stage, although radical operation is indicated in certain rare early cases in which delivery of an effective dose of radiation to involved areas is technically difficult. Elsewise it appears at present that operation should be used only in cases of stages III or IV carcinoma—in which results by either means of treatment are poor.One hundred and seven patients were treated with a combination of x-ray and radium irradiation. X-ray was used first to reduce the hazard of implanting the radium. The “five-year arrest” rates were as follows: For 22 patients with stage I lesion, 70 per cent; for 31 with stage II, 55.7 per cent; 33 with stage III, 39.7 per cent; 21 with stage IV, 0. Eighteen patients with diagnosis of carcinoma of the cervix who had had subtotal hysterectomy were treated. The stage of the disease could not be determined. In this group the five-year arrest rate was 52 per cent.     

TUBERCULOSIS CONTROL IN CALIFORNIA MENTAL HOSPITALS

Diagnosis, the first step in tuberculosis control, is accomplished in the mental hospitals of California by x-ray examination of all patients annually and of new or returning patients on admission. This routine has been carried on since 1937.Tuberculous patients with active disease are segregated in one of three specially staffed and equipped units at the Patton, Sonoma and Napa hospitals. Those in whom disease is likely to recur are likewise segregated for special care and observation. Those in whom disease is inactive or not definitely diagnosed are not segregated but are observed by physicians of the Bureau of Tuberculosis Control of the California Department of Public Health in collaboration with the staffs of the institutions.Since the establishment of this program the proportion of new or previously unrecognized cases of tuberculosis has been reduced from 0.83 per cent, a year after the program was begun, to 0.37 per cent, while recurrence or progression of previously recognized disease has been reduced from 12.3 per cent at the first survey to 5 per cent at the most recent.Overcrowding in all hospitals has been the chief obstacle to the success of the program.     

Radiologic diagnosis of focal liver lesions

The paper is concerned with analysis of the results of combined investigation of 54 patients with focal liver lesions. USI, CT, angiography and radionuclide scintigraphy were performed. The diagnostic efficacy of USI and CT was 94.4 and 90.7%, respectively, that of scintigraphy was 68.5%, that of angiography was 55.5%. A scheme of the effective use of radiation methods in the diagnosis of sizable formations of the liver was worked out.