Biomedical subjects
Publications and source records attributed to T Schaub.
Radionuclide imaging (99mTc bone scans, 99mTc S colloid scans, 99mTc brain scans and 67gallium scans) and bone radiographs were done in 54 children with histiocytosis X. The results are discussed, compared with the literature and indications for the different nuclear medicine studies are given.
In a 43 year old man with an inguinal abscess a paravertebral soft tissue swelling suggested a gravitation abscess. On CT only a retrocrural fat accumulation was identified.
Tumours originating from the ceruminous glands can be classified into five types: adenomas, adenocarcinomas, adenoid-cystic carcinomas, pleomorphic adenomas and mucoepidermoid carcinomas. The diagnosis is based on histological findings and can be quite difficult if the tumour status has to be determined. Classification into one of the five types of tumours may be facilitated at times by studying the clinical pattern. Three case reports are quoted as examples to illustrate that neoplasias originating from the ceruminous glands can assume considerable proportions and must be considered in differential diagnosis when assessing space-occupying growths in the soft tissue of the neck. Whereas prognosis of adenomas and pleomorphic adenomas can be considered to be good, it must be regarded as likely to be infaust in the case of adenocarcinomas, adenoid-cystic carcinomas and mucoepidermoid carcinomas. The use of cytostatics resulted in a marked reduction of the tumour in one of the described cases of adenocarcinoma.
The difficulties arising in diagnosing osteoidosteoma are demonstrated by means of 30 surgically treated cases and the results are compared with those available from the literature. The value of bone scintigraphy and of tomography within the framework of a diagnostic concept is underlined. Diagnosis is confirmed and treatment is effected by the successful surgical removal of the nidus.
The unfavourable prognosis of malignant synoviomas makes it essential to arrive at an early diagnosis. The early clinical symptoms and radiological appearances may be minimal and sometimes absent. It is therefore advisable to obtain bone scintigrams with perfusion and early images as well as the radiographs. The local extent of the tumour can be evaluated by ultrasound and CT. Angiography is required only if the relationship to the vessels cannot otherwise be ascertained, or if intra-arterial therapy is being considered. The final diagnosis depends on a biopsy. For subsequent observation, both scintigrams and radiographs should be obtained. It is essential to perform a three-phase scintigram. This improves the recognition of recurrences and of soft tissue or bone metastases. Most bone metastases are visible on scintigraphy, but a normal scintigram in the presence of an osteolytic lesion on a radiograph may be obtained. Pulmonary metastases can only be demonstrated radiologically.
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Spinal Ewing's sarcomas are rare and cause problems in differential diagnosis. The radiologic, nuclear medicine and CT findings in two children with histologically proven Ewing's sarcoma are presented and problems in differential diagnosis discussed. Biopsy should be done early.
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Digital subtraction angiography was compared to computerized tomography and histopathological findings for staging renal cell carcinoma in 24 patients. Injection of contrast material through a 16 gauge angiocatheter into the femoral vein provided digital subtraction cavography, digital subtraction arteriography and excretory urography during 1 investigation. Computerized tomography established the diagnosis in all patients, while digital subtraction angiography showed all angiographic signs of renal cell carcinoma in 14 (58 per cent). T staging was correct on computerized tomography in 18 patients and on digital subtraction angiography in 16. Absence or presence of venous involvement was indicated correctly by computerized tomography in 20 patients and by digital subtraction angiography in 21. In small tumors the combination of ultrasonography, digital subtraction angiography and excretory urography is sufficient for an operation. In all other tumors digital subtraction angiography cannot replace computerized tomography but adds useful information about arterial distribution, possible venous tumor thrombus and the anatomical relationship of vessels.
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Smoking has become a major issue for public health policy in recent years. This paper deals with the economic aspects of smoking. First, we outline the basic concepts of welfare economics which subsequently are used as the normative framework of the analysis. In particular, we stress the role of efficiency as a criterion for economic policy evaluation. Second, we demonstrate that smoking is associated with several market failures, notably externalities and dependency/addiction (non-rational behavior). Third, costs and benefits of smoking are considered. We argue that the benefits of smoking are the satisfaction (utility) which the consumers derive from it rather than the employment effect of producing tobacco products or the revenues of the excise tax on these products. A general model for estimating the costs of smoking is developed and various cost concepts are discussed. Empirical cost estimates are presented for Switzerland. In 1976, estimated social (economic) costs of smoking were between 560 and 800 million Swiss francs while the external costs were between 140 and 260 million francs. Contrary to a widely held belief, smoking hardly influenced health care costs because the higher medical care costs of smokers during their lifetime are offset by their reduced life expectancy. The last section deals with intervention strategies to reduce smoking: anti-smoking publicity, advertising restrictions, and taxation. We discuss these three instruments on a conceptual level and summarize previous empirical studies. The main results are: (1) Both publicity and taxation offer a considerable potential as deterrents of cigarette demand. (2) The results for Switzerland imply that publicity campaigns are likely to be efficient in the sense that expected campaign benefits outweigh its costs.
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The quantitative impact of smoking on mortality and longevity in Switzerland is investigated. The calculations are based on mortality ratios between smokers and nonsmokers reported in prospective epidemiologic studies, the prevalence of smoking in Switzerland, cause-specific mortality rates and the lifetable. The results imply that in 1976 roughly 3800 premature deaths were attributable to smoking, more than 90% involving males. Thus, smoking appears to be the leading preventable cause of death in Switzerland. The results of lifetable methods used to estimate the impact of smoking on longevity imply that smoking reduces male life expectancy by 12 to 16 months, and that eradication of smoking would increase life expectancy accordingly. Combining the above results suggests that, in 1976, between 52 000 and 54 000 life years were lost as a consequence of the smokers' premature mortality.
For the purposes of an analysis of the hospital capacities of the canton of Basel-Stadt, a one-day census was conducted on April 20, 1983. On that day, the physicians in charge identified every fifth patient out of 2920 hospitalized patients as misplaced. "Misplaced" means that, from a medical point of view, mostly elderly patients could be treated and cared for as well (and cheaper) in other institutions (e.g., nursing homes) or in community settings if adequate home care services were available.
The impact of smoking on medical care expenditure is analyzed, challenging the widespread belief that smoking imposes a large cost burden on health services systems. The results imply that lifetime expenditure is higher for nonsmokers than for smokers because smokers' higher annual utilization rates are overcompensated for by nonsmokers' higher life expectancy. Population simulation, taking into account the effects of past smoking on present population size and composition, suggests that 1976 expenditure would have been the same if no male born since 1876 had ever smoked. The male population would have been larger, particularly at older ages, increasing medical care expenditure, but this increase would have been offset by lower annual medical care utilization rates. Thus the results imply that smoking does not increase medical care expenditure and, therefore, reducing smoking is unlikely to decrease it.
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