Biomedical subjects
Publications and source records attributed to H White.
Multiple fatal embolism following left heart catheterization is described in two patients. Postmortem examination showed friable atheromatous aortic plaques as the likely source of emboli that clinically involved the heart, peripheral blood vessels, brain, gastrointestinal system and solid organs. Histologic examination showed widespread arterial embolism by atheromatous material.
Altogether 117 patients with advanced breast cancer were treated with either tamoxifen 10 mg by mouth twice daily or aminoglutethimide 250 mg by mouth four times daily with hydrocortisone 20 mg twice daily in a randomised cross-over trial in which patients who failed to respond to the first treatment or relapsed while receiving it were switched to the other. Eighteen (30%) out of 60 patients initially treated with tamoxifen achieved an objective response and 11 (18%) showed stable disease. Seventeen (30%) out of 57 patients treated initially with aminoglutethimide achieved an objective response and 13 (23%) achieved stable disease. Objective responses in bone metastases were achieved more commonly with aminoglutethimide (11 patients (35%)) than with tamoxifen (five (17%)). The predicted median duration of response for tamoxifen was 15 months and for aminoglutethimide over 15 months (no significant difference). Five (15%) out of 34 patients who failed to respond to tamoxifen and four out of six patients who relapsed after responding to tamoxifen subsequently responded to aminoglutethimide. In contrast, only two (6%) out of 31 patients who failed to respond to aminoglutethimide and none out of four patients who relapsed while receiving aminoglutethimide subsequently responded to tamoxifen. The main side effects occurring in the 97 patients who received aminoglutethimide as first- or second-line treatment were lethargy and drowsiness (36 patients) and rash (29); seven patients had to stop treatment because of side effects. In contrast, side effects were rare and mild with tamoxifen and no patient had to stop treatment because of them. Both tamoxifen and aminoglutethimide appeared from this study to be equally effective in the medical endocrine treatment of advanced breast cancer.
Pulmonary fibrosis is a well-recognized complication of bleomycin therapy. Detection of bleomycin-induced pulmonary fibrosis by computed axial tomographic scanning (CT) has not been reported. We report on a patient in whom the development of lesions on chest CT scan following cessation of chemotherapy (including bleomycin) was interpreted as representing recurrent metastatic disease. At bilateral thoracotomy, only pulmonary fibrosis was found. In this patient, the CT scan appearance of bleomycin-induced pulmonary fibrosis mimicked recurrent disease.
A seminar for psychotherapy supervision of residents employed videotapes of interviews as the focus. When patients and therapists together reviewed the tapes, a number of therapeutically valuable results ensued including a) retelling of corrected histories and new commitment to the therapy; b) increased awareness of denied areas of experience and insight into transference, defense, hidden affects and so on; c) a variety of forms of confrontation. In addition, this report reviews indications, difficulties, problems, and failures encountered with this technique.
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A film reading exercise was developed to test the advisability and accuracy of using one "postinfusion" roentgenogram instead of a series of films for a complete antegrade urographic evaluation. The experience of the radiologist making the interpretations was also considered. In most cases a singly eight-minute postinfusion delayed film showed enough detail to rule out pathology when none existed and adequately revealed either specific abnormal findings or suggested an abnormality existed when such was indeed present. No false negative call was made by and of the radiologists, but experience did aid in detailing the pathology.
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Sixty consecutive patients with central bronchial carcinomas were studied by fibreoptic bronchoscopy. In all forceps biopsy and bronchial needle aspiration were performed, and in 54 bronchial brushings were obtained. The combination of bronchial brushings and forceps biopsy diagnosed bronchial carcinoma of a defined cell type in 80% of patients. Bronchial needle aspiration was the most effective single technique giving a cytological diagnosis in 80% of patients, and when all three techniques were combined the positive rate increased to 92%. No major complications occurred using bronchial needle aspiration. Needle aspiration was particularly helpful when sampling from lesions in the upper lobes where forceps biopsies were technically difficult, from tumours lying submucosally, and from abnormalities caused by extrinsic compression. We conclude that bronchial needle aspiration should be used routinely, together with other sampling techniques, in the diagnosis of central bronchial carcinoma with the fibreoptic bronchoscope.
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This paper reports a retrospective study of 477 patients with cutaneous malignant melanoma presenting in the south-east of Scotland (lat. 55 degrees-56 degrees N) between 1961 and 1976. The mean annual incidence during the period 1971 to 1976 was 4.6/100 000 with females affected almost twice as often as males. The incidence has probably increased in the last 10 years. The median age at presentation was in the sixth decade in both sexes and 88 per cent of patients had clinical Stage 1 disease when first seen. Primary lesions on the female lower leg accounted for a third of all tumours. Superficial spreading melanoma was the most common growth pattern. The overall five year survival rate was significantly less for males (48 per cent) compared with females (67 per cent). Other factors which had an independent effect on prognosis were the age of the patient, the site of the tumour, its thickness and mitotic rate. The thickness of the primary lesion was the best index of prognosis, with the five year survival rate ranging from 97 per cent for patients with tumours less than 0.5 mm deep to 38 per cent for those with tumours thicker than 3.5 mm. Although the relationship between tumour depth and duration of signs before treatment was not investigated, it seems likely that better survival figures will be achieved more by earlier diagnosis and treatment than by any change in management.
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This report describes a new method for preparing Häutchen monolayers for autoradiography with photographic emulsion contacting either the abluminal or luminal endothelial surface. Included is a means for monitoring completeness of the monolayer and retrieving cells which fail to adhere to it. Cell retrieval may be important in studies requiring autographic evaluation of endothelial cell populations. The procedure has been applied to endothelium containing newly reendothelialized aortic regions.
Five patients with normal thymus glands whose radiographs were mimicking mediastinal masses are presented; one in an infant with a compressed right upper lobe bronchus and two in adolescents with normal large lobes of the thymus. There were also two patients with regrowth of the thymus, one after severe infection and one after irradiation for secondary malignancies. We discuss the use of various techniques utilised to confirm the diagnosis and avert surgical procedures.
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An outbreak of Mycoplasma pneumoniae infection occurred in the summer of 1978 in a boys' camp in northern Wisconsin and affected 139 of 196 persons (71%); 115 (59%) had laboratory evidence of infection. In 77% of the cases, onset of disease occurred within three weeks after arrival at camp, in contrast to the usually indolent spread of the disease. Attack rates decreased with increasing age. The sensitivity of serology for detecting M pneumoniae disease may have been as low as 79%. There was shorter duration of cough in those treated with erythromycin within four days after onset of symptoms.
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Three young children with advanced cavitary pulmonary tuberculosis died between 1974 and 1978. Two of the patients had tuberculous meningitis as well. All diagnoses were verified at autopsy; however, all tuberculin skin tests were negative. These instances emphasize the difficulty of establishing the diagnosis of tuberculosis in young children. Tuberculosis should be considered in the differential diagnosis of cavitary chest disease in young children, even those with negative tuberculin skin tests.