SUMMARY The accuracy of diagnosis in 656 patients with the four common histopathological types of primary lung cancer has been assessed by comparing the cell type diagnosis made on cytological and histological investigation with that determined by examination of the surgically resected or necropsy specimen. The accuracy of diagnosis achieved by cytological examination of sputum and bronchial aspirate, and by bronchial biopsy histology was over 85%. The least accurate diagnostic procedure was percutaneous needle biopsy (62%). Squamous and small cell tumours were accurately diagnosed by all four investigations but errors were made in the diagnosis of large cell and adenocarcinomas. Nearly half the number of patients (43%) with large cell carcinoma were later reclassified as having squamous carcinoma and of the patients with adenocarcinoma 32% had been predicted to be squamous and 18% large cell carcinoma. We consider such quality control of pretreatment diagnosis mandatory in management of individual patients and before enrolment in clinical trials.In 1979 a study was reported from Papworth Hospital, Cambridge which examined the accuracy of diagnosis of cell type in patients with primary lung cancer.' The presumptive cell type as predicted by cytology and biopsy techniques was compared with the true histological cell type as determined by histological examination of tumour tissue obtained at surgical resection or necropsy. The results indicated that the true cell type was most accurately predicted by sputum cytology (88 Y.), closely followed by bronchial aspiration (84%) and bronchial biopsy (80 %). The least accurate procedure was percutaneous needle biopsy (48 %). Diagnostic accuracy was highest in patients with squamous cell carcinoma while particular difficulty was experienced in diagnosis of patients with adenocarcinoma.Inevitably, with such a study limited to a four-year period in a single hospital, the number of patients in each histological group was relatively small. We have therefore undertaken a larger study of 673 patients with confirmed lung cancer seen at two centres, Papworth Hospital, Cambridge and Brompton Hospital, London and this includes the results of the original work from Papworth.

The clinical presentation and management of 30 consecutive patients with tuberculous peritonitis are reviewed. Seventy per cent of the patients were aged 40 years or less and 80 per cent were immigrants. The main clinical features of abdominal pain, loss of weight, vomiting and sweating at night had been present in a large number of patients for several months before presentation to hospital. The clinical diagnosis of tuberculous peritonitis was difficult in the absence of extraperitoneal tuberculosis. Laboratory investigations were of little value in establishing the diagnosis. An elevated ESR was found in 80 per cent of patients. At laparotomy omental biopsy was performed and was diagnostic in all cases. Laparotomy was a safe and fast method of obtaining tissue for confirmation of the diagnosis in suspected cases, particularly when presenting acutely. Ascitic fluid cultures and guinea-pig inoculations were positive in only 6 out of the 15 patients in whom they were performed. Only 1 patient died.

With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well.

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