Of 129 patients with small cell lung cancer (SCLC) who underwent bone marrow examination for staging, 39 (30%) had bone marrow involvement. Only three of 129 patients (2.3%) had bone marrow involvement as the only site of metastatic disease. When patients with bone marrow metastasis were compared with patients whose bone marrow was normal, there were significant differences in serum levels of lactate dehydrogenase (LDH), glutamic oxalacetic transaminase (SGOT), glutamic pyruvic transaminase (SGPT), alkaline phosphatase (AP), albumin, and sodium (Na). We found no clinically significant difference in survival between patients with extensive disease with or without bone marrow involvement. Serum Na, albumin, SGOT, and uric acid were important prognostic determinants of survival. Based on the results of this study, we do not recommend routine bone marrow examinations in the staging of SCLC.

Results of bone marrow biopsy were retrospectively evaluated in 120 previously untreated patients with Hodgkin's disease. The incidence of bone marrow involvement was 13%. All patients with marrow invasion had B symptoms and/or clinically advanced disease. When patients with bone marrow involvement were compared to those without there were significant differences in the incidence of B symptoms, the clinical stage, hemoglobin levels, leukocyte counts, platelet counts, and serum levels of lactate dehydrogenase and alkaline phosphatase. None of 59 patients with clinical stage IA and IIA had evidence of marrow invasion. This study demonstrates that trephine bone marrow biopsy is of value in detecting marrow involvement in specific subgroups of untreated patients with Hodgkin's disease, i.e., those patients with constitutional symptoms and/or clinical stage III or IV. However, bone marrow biopsy adds little to the initial staging of patients with clinical stage IA and IIA. Routine use of this procedure in such patients may be unnecessary.

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During the third-year medicine clerkship, students were instructed in online computer Physician Data Query (PDQ) searches. Each student completed computer searches in at least one of five tumor topics. Students assigned to selected tumor topics performed significantly better on test questions in their assigned topic as compared to the scores of students who were not assigned that topic. Although students were encouraged to use the PDQ ad libitum, within three months of completing the clerkship, only 22 students (20%) had conducted additional searches. We conclude that PDQ instruction may enhance students' knowledge about cancer. Student instruction can be effectively completed with minimal computer time. The results from our program evaluation and the limited student use following completion of the clerkship suggest that we should identify another user group, such as senior housestaff, to generate greater interest and more frequent use of the PDQ.

FLAKER GC, ET AL: Prognosis in patients with left ventricular dysfunction and ventricular tachycardia following programmed ventricular stimulation. We performed programmed ventricular stimula-