No abstract

No abstract

Of 2,545 in-patients with primary lung cancer, pathological proof of the diagnosis was obtained by sputum cytology in 48%, by bronchoscopy in 32%, by biopsy from miscellaneous sites in 12%, and at thoracotomy or necropsy only in 19%. The diagnosis was made solely on clinical and radiological evidence in 8%.One or more satisfactory specimens of sputum from 2,035 patients gave a positivity rate of 59%. When three specimens of sputum were tested the positivity rate was 69% and when four or more were tested, 85%. The maximum false positivity rate was 0-7%. Agreement between the types of malignant cells found in the sputum and in resected or necropsy specimens occurred in 84%. The pathological diagnosis was based solely on sputum cytology in 40% of the patients in whom malignant cells were found in the sputum.The total work of the sputum laboratories was analysed for one year (1967); sputum was examined from 1,598 patients, of whom 266 (17%) had positive results.Of 1,518 patients who had a bronchoscopy, the positivity rate was 53%, and of 524 patients with biopsies from miscellaneous sites the rate was 64%.Sputum cytology, as practised at present, is a very valuable method of diagnosis, but its demands on time and expertise make it unsuitable for general application outside large medical centres. Bartholomew's Hospital and 29 from Brompton Hospital could not be traced.Notes from a total of 2,545 patients were available for study, 913 from St. Bartholomew's and 1,632 from Brompton. There were 2,176 males and 369 (14%) females. One or more specimens of sputum were submitted for cytological investigation from 2,035 (80%) of the patients, bronchoscopy was performed in 1,518 (60%), and biopsies were taken from other sites in 524 (21%). Lung resection was performed in 1,002 (39%) and a further 199 (8%) (1-1%)The miscellaneous group included 10 bronchiolo-623 on 9 May 2018 by guest. Protected by copyright.

Breathlessness and Anxiety-Oswald et al. BRITISHoversewing of the ulcer) was employed in a minority of cases. As time went by vagotomy plus drainage came to be used more and more, and this procedure was performed in 75% of the emergency operations in which one of these three procedures was used.Vagotomy plus drainage has emerged as more successful than a partial gastrectomy. Among patients aged less than 60 the fatality rate was low and there was no great difference between vagotomy and partial gastrectomy; but among patien-ts aged 60 and over the surgical fatality rate was considerable and the results with vagotomy were decisively better than with either type of partial gastrectomy.As medical treatment remained essentially unaltered throughout the period studied, and as surgical practice showed a clear advance due to the increasing use of vagotomy plus drainage, it is at first sight paradoxical tha-t In this connexion it is highly pertinent that in the present series four out of every five patients who died did so after they had been in hospital more than two days. So far as those dying without surgery are concerned the figure was three out of every four. If bleeding oesophageal varices are excluded, because these are likely to be dangerous however they are treated, four out of every five medical deaths occurred more than two days after admission. Among patients with gastric or duodenal ulcer no fewer than seven out of every eight medical deaths occurred more than two days after admission. It is plain that there was ample time for emergency surgery to be carried out on most of the patients who died without being treated surgically.While these conclusions are based solely on the experiences of -the Radcliffe Infinnary, we consider -that nany of our findings are applicable to many other hospitals employing traditional methods in -the treatment of acute upper gastrointestinal bleeding. The problem is a large and important one. As the Radcliffe Infirmary deals with a population of 300,000, an annual admission rate of 140 patients with haematemesis or melaena implies that there are. about 28,000 emergency admissions each year for the whole country. If our fatality rate of 8-9% is taken as representative, this means that there are about 2,500 deaths in hospital each year from this cause. In a large proportion the underlying cause is a benign focal lesion. In view of the great efforts that are being made to reduce the fatality rate in other common and dangerous conditions, such as myocardial infarction, it seems strange that comparatively little attention is paid to improving the methods of managing severe haematemesis and melaena.

The aim of this study was to establish the incidence and prevalence of polymyalgia rheumatica/giant cell arteritis in general practice. Patients with this disorder, whether previously diagnosed or not, were ascertained by using a questionnaire administered by interview, and all received full clinical and laboratory assessment. A total of 579 patients aged 65 and over was seen, and 19 (33/1000) had been diagnosed or developed symptoms within the previous eight years. Thus the calculated annual incidence in those aged 65 and over was about 4/1000. The figures from this first large scale study of polymyalgia rheumatica/giant cell arteritis in general practice are much higher than those from studies carried out in hospital. The questionnaire was effective in both identifying known cases of polymyalgia rheumatica/giant cell arteritis and detecting new cases. As this is a treatable disorder, it is important that doctors become aware of how common it is in elderly people.