Discussion of Carl Furr's presentation: Bartholin's gland carcinoma.
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Biomedical subjects
Publications and source records attributed to W Fowler.
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A pilot study was carried out in 50 patients with uncomplicated, untreated gonorrhoea to asses the effectiveness of mezlocillin, a new semi-synthetic penicillin. Patients received a single intravenous injection of 2 g mezlocillin and were followed-up for periods up to 101 days. Four patients defaulted immediately. Clinical and bacteriological findings showed that only 1 of the 46 patients followed-up had failed to respond to treatment, indicating a cure rate of 97.8%. Five (10.8%) male patients had developed post-gonococcal urethritis when seen 3 weeks or later in the follow-up period.
Cefuroxime, a new antibiotic derived from cephalosporin-C which is very stable in the presence of beta-lactamases produced by Gram-negative organisms, was used to treat 856 male patients and 340 female patients with uncomplicated gonorrhoea. In men the drug was used in three different doses, 1.5 g, 1 g, and 750 mg plus 1 g probenecid; in women 1 g and 750 mg cefuroxime plus 1 g probenecid was used. Cure rates ranged from 94.8% to 99.3%. The antibiotic was well tolerated and was free from side effects. Cefuroxime would be a valuable and efficient substitute for penicillin in the treatment of gonorrhoea due to beta-lactamase-producing strains of gonococci.
Few data are available regarding the effects of exercise training upon cardiac structure and performance in man. We evaluated the echograms of 24 normals before (PRE) and after (POST) 11 weeks of endurance exercise training. Conditioning consisted of a walk-jog-run protocol at 70% maximal heart rate for one hour four days per week. Training reduced heart rate and increased maximal duration and estimated oxygen consumption of treadmill exercise. Compared to PRE, the echogram in the POST training period revealed an increased left ventricular (LV) end-diastolic dimension (EdD), a decreased end-systolic dimension (EsD) and thus an increased stroke volume (EdD3-EsD3) and shortening fraction (EdD-EsD)/EdD). Cardiac output (CO) and peripheral vascular resistance (BP/CO X 80) were identical PRE and POST conditioning. Importantly, an increase in mean fiber shortening velocity was observed POST training as were increases in LV wall thickness, ECG voltage of S in V1 + R in V5, and LV mass. Thus endurance training was accompanied by increases in both LV dimension and mass as well as LV shortening fraction and contraction velocity as observed by echocardiogram.
Sigmoidovaginal fistulae are rare. They occur as a result of malignancy, irradiation, pelvic surgery, or diverticular disease, the latter being the principal cause. Numerous diagnostic techniques are available. Therapeutic modalities for these fistulae are discussed.
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The erythrocyte sedimentation rate was studied in 520 men and 202 women with syphilis. It was raised in 66-6 per cent. of sero-negative primary cases, 80 per cent. of sero-positive cases, 100 per cent. of secondary cases, 80 per cent. of early latent cases, and 73-9 per cent. of late latent cases. It was also raised in sixteen out of seventeen cases of neurosyphilis and in all eleven cases of cardiovascular syphilis. It was concluded that the ESR had little place in the management of syphilis in general, but could be helpful in the post-treatment follow-up of late syphilis.
Details are given of a double-blind trial involving 400 cases in which tetracycline 500 mg. four times a day for 7 days was compared with tetracycline 250 mg. four times a day for 14 days and also of the findings in 311 cases treated with Deteclo 300 mg. three times a day for 3 weeks. The treatment in the double-blind trial were equally effective and appeared to be as effective as the long-term Deteclo therapy. When the results of these treatments were compared with those obtained previously with tetracycline 250 mg. four times a day for 4 days and allowance was made for the time at which the latter results have been assessed, it was concluded that neither the treatment used in the double-blind trial nor Deteclo 300 mg. three times a day for 3 weeks offered any advantage over the customary treatment with tetracycline 250 mg, four times a day for 4 days.
Eighty-eight cases of Stage I and Stage II carcinoma of the cervix treated with radiotherapy at the University of North Carolina Memorial Hospital between April 1969 and July 1971 are reviewed. The question of whether the radiation time-dose-fraction relationship can be applied to the combination of external beam and intracavitary therapy used in the treatment of cervical carcinoma is studied. Formulas are outlined which enable one to calculate a total Rad Equivalent Therapy (RET) value, including the contribution from both the fractionated external beam and intracavitary therapy. Both the calculated RET value and the rad dose to Point A show good correlation with control of local disease in this retrospective analysis; however, the RET value may be more applicable when deviations from the standard time-dose-fraction relationship have occurred.
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