Report on treatment of cancer of the ovary.

A malignant ovarian tumour has been diagnosed in 373 patients referred to the R.R.T.I. from January 1966 to Jun 1972. Serious ovarian carcinoma was the commonest type and occurred in 254 patients. The results in these patients are studied in detail after staging according to F.I.G.O. recommendations. Following surgery and postoperative radiotherapy, chemotherapy was started immediately in all patients with progressive disease and after randomization also in 50 per cent of the others. The three-year survival rate in Stage II patients tended to be more favourable following irridation ofthe pelvis and lumboaortic nodes (55 per cent ) than following radiotherapy restricted to the pelvic area (40 per cent). The dose should be 5-6 krad. The five-year survival was 68 per cent for Stage I, 26 per cent for Stage II and nearly zero for Stages III and IV, as well as for patients referred for treatment of a recurrence. In spite of whole-abdomen irradiation 50 per cent of the patients in the latter three groups were deceased within eight months; therefore chemotherapy should be preferred. The main problem in ovarian cancer is late diagnosis. Evaluation of results is difficult because numerous variable factors concerning pathology and treatment make it necessary to sub-divide the patients into groups too small for statistically reliable conclusions. Each treatment factor should be studied by a group of hospitals.     

Thermography of the female breast: a five-year study in relation to the detection and prognosis of cancer.

More than 12,000 women have been examined thermographically in the Breast Unit of the Royal Marsden Hospital, London. Of these women 1,464 had biopsy and histology; 363(25 per cent) were found to have carcinoma and of these 68 per cent had abnormal thermograms, 13 per cent has some thermal asymmetry of doubtful significance and 19 per cent had normal thermal patterns. Fifty-seven per cent and 62 per cent of patients with Stage I and Stage II cancer, respectively, had abnormal thermograms whereas 83 per cent of patients with Stage III cancer had abnormal thermograms. Of 1,101 women who had benign lesions, 63 per cent had normal thermal patterns, 15 per cent had thermal asymmetry of doubtful significance and 22 per cent had abnormal thermograms. The subsequent histories of 172 cancer patients examined thermographically have been analysed and three-year survival rates have been correlated with thermography report, the clinical stage of the disease and the histotogical grade (Bloom, 1950) of the excised tumour. The mean three-year survival rates for patients with Stage II or Stage III cancer are 84 per cent for those with normal and 61 per cent for those with abnormal thermograms.     

Alpine skiing injuries.

Alpine skiing accidents admitted to the Trondheim Regional and University Hospital during one year were recorded. Of the 339 injured, 67 per cent were male and 33 per cent were female. Eighty-seven per cent were outpatients, and 13 per cent were hospitalized. Falling accidents (67 per cent), followed by collision accidents (17 per cent), were the most common cause of injury. The injuries in the lower extremities were caused by falling and the head injuries were mostly caused by collisions. Knee ligament strains were the most common injuries, and 17 per cent of these were hospitalized and required operative treatment. Of the minor knee strains, all 44 per cent were not fully recovered after two and a half years. Seventeen patients sustained tibial fractures, eleven of them spiral fractures and six transverse fractures. The patients with spiral fractures were younger than the patients with transverse fractures. Head injuries were the most severe injuries, with eleven concussions and two epidural haematomas.     

车祸所致的颅脑损伤（附426例分析）

本文报告由车祸引起的颅脑损伤426例，并与同期非车祸所致的496例进行对比分析。分析表明，车祸所致颅脑损伤多较严重。且多为合并份，并发症亦多。随着交通事业的发展其发生率有逐渐增高的趋势，文章对其损伤的机理，临床特点以及诊断处理等问题进行了讨论。     

实时超声引导下肾脏活检的临床意义

目的探讨实时超声引导下肾脏穿刺活检技术在肾脏疾病诊断中的实际临床意义。方法对362例临床高度怀疑肾脏实质病变的患者进行经皮超声引导下肾脏穿刺活检,对活检定位的准确性和并发症进行分析。结果362例全部取材成功,均获得满意的病理结果,用时最长30min,最短10min。并发症血尿61例,肾周血肿2例。结论经皮超声引导下肾脏穿刺活检的操作简单,患者痛苦小,操作时间短,准确性好,安全。运用该技术穿刺肾脏有助于肾脏疾病的鉴别诊断,为临床治疗提供依据。     

Effect of local irradiation on the acute rejection process in transplanted kidneys.

The graft in 178 renal transplant patients was irradiated in an effort to halt acute rejection phenomena. Of the patients, 61 per cent received their transplant from either a sibling, parent or child and 38 per cent received cadaveric kidneys. Of the irradiated kidneys 61 per cent were functioning at 6 months, 58 per cent at 12 months and 49 per cent at 18 months. The rational for irradiation of transplanted kidneys with acute rejection is discussed.     

Lymphography and abdominal computed tomography in the staging of non-Hodgkin lymphoma. With an analysis of discrepancies

Ninety-one patients with non-Hodgkin lymphoma (NHL) were subjected to computed tomography (CT) and lymphography. Both examinations agreed in 74 patients (81%) with regard to the infradiaphragmatic lymph nodes. In patients undergoing CT prior to lymphography, the concordance amounted to 75 per cent. When lymphography was the initial examination, the concordance amounted to 86 per cent. Lymphography was abnormal in 30 per cent of the patients with a normal CT scan and in 93 per cent of those with an abnormal CT scan as the first examination. CT was abnormal in 4 per cent of patients with a normal lymphogram and in 84 per cent of those with an abnormal lymphogram as the first examination. CT did not detect mesenteric or retrocrural lymph node enlargement in the absence of retroperitoneal lymph node involvement. Eleven patients had extranodal manifestations of the disease (excluding liver and spleen), and 3 were detected primarily with CT. Lymphography is the most complete examination for the infradiaphragmatic lymph nodes for staging purposes. Although CT outlined the disease better, it changed the lymphographic diagnosis in only 2 per cent of the patients. Lymphography modified the CT stage in 15 per cent of the patients. When abdominal CT is performed first, in staging patients with NHL, lymphography will only yield additional information when CT is normal or equivocal.     

Diagnostic value of stress radiography in lesions of the lateral ligaments of the ankle

The diagnostic accuracy of inversion and anterior stress radiography in rupture of the lateral ligaments of the ankle joint was assessed in 56 patients undergoing surgery. In inversion stress radiography, 58 per cent of the patients with confirmed rupture of the lateral ligaments of the ankle had a talar tilt of 10 degrees or more, allowing a predictive value of a positive test of 94 per cent. In anterior stress radiography, 53 per cent of the patients had a posterior tibiotalar distance of 9 mm or more, allowing a predictive value of a positive test of 81 per cent. In measurements of talar tilt and anterior displacement of the talus values higher than normal in the injured ankle may be a sign of a rupture of the lateral ligament.     

Malignant tumours of the nasopharynx.

A series of 115 patients with malignant tumours of the nasopharynx were primarily irradiated. All the cases of carcinoma were TNM classified in retrospect. 60Co irradiation appeared to afford a somewhat better prognosis than conventional irradiation previously used. The 5-year crude survival rate for the patients with lymphoma and with carcinoma was 40.0 per cent and 23.8 per cent respectively. A distinctly better prognosis was found for women than for men and the prognosis was independent of whether or not lymph node metastases were present. There seems to be no indication for maintaining lympho-epithelial carcinoma as a special group of tumour. Surgical procedures are rarely indicated in the treatment of malignant nasopharyngeal tumours.     

Radiographic diagnosis of bile duct cysts. Retrospective analysis of thirteen cases

Twelve patients and a foetus with congenital bile duct cysts suggested in the majority of cases at routine upper abdominal sonography were examined by two or more of the following investigations: ultrasonography (10 patients), computed tomography (5 patients), CT-cholangiography (2 patients), oral cholecystography (7 patients), intravenous cholangiography (4 patients), endoscopic retrograde cholangiopancreatography (ERCP) (6 patients) and cholescintigraphy (2 patients). The sensitivity of each investigation for the diagnosis of bile duct cysts was: ultrasound 40 per cent, computed tomography 20 per cent, CT-cholangiography 100 per cent, oral cholecystography 17 per cent, intravenous cholangiography 75 per cent, ERCP 83 per cent and cholescintigraphy 50 per cent. When a bile duct cyst has been suggested by ultrasonography or other examinations, without a conclusive diagnosis being made, CT-cholangiography is recommended as the next examination. In patients with impaired biliary excretion of contrast medium, ERCP may be required to achieve the diagnosis.     

Radiologic diagnosis of liver metastases in colo-rectal carcinoma. Prospective evaluation of the accuracy of angiography, ultrasonography, computed tomography and computed tomographic angiography

To evaluate the accuracy of radiologic methods in liver metastases from colo-rectal carcinoma, a prospective investigation of 71 patients was performed. These patients were examined by angiography, ultrasound (US), computed tomography (CT) and computed tomographic angiography (CTA). The primary aim of the investigation was to determine the accuracy of CTA. The results of these examinations were then compared with the results from inspection and palpation of the liver at laparotomy. An analysis of liver tumor distribution, as well as a lesion-by-lesion analysis, was performed. In 20 patients, tumor growth was found in the liver in 36 lobes/segments at laparotomy. Three patients called false positives (angiography 2, US, CT and CTA 3 patients) turned out to be true positives since the lesions were overlooked at operation. The changes in sensitivity obtained when these patients are considered are given in parentheses. Of the lobes/segments affected by tumor growth at surgery, angiography revealed 47 (48) per cent, US 69 (71) per cent, CT 80 (82) per cent and CTA 83 (84) per cent. At a lesion-by-lesion analysis, angiography showed 33 per cent, US 69 per cent, CT 61 per cent and CTA 76 per cent of the lesions. Because of a larger number of false positives recorded with CTA compared with CT the former examination is not suitable as a single method for evaluating resectability of liver metastases.     

The impact of the intifada on the health of a nation

This article describes the nature and extent of non-fatal injuries sustained by Palestinians during the first three months of the second intifada in late 2000 by looking at two sets of data. 10,279 cases were obtained from the records of the Red Crescent Organization, which provides first level emergency care via ambulance crews in the West Bank and Gaza Strip. For 6,071 cases in the West Bank, additional information was available from the Ministry of Health, which keeps records of first and second emergency level care provided at hospitals and health points. The Ministry of Health cases were classified by type of weapon, site of injury and level of treatment provided. Fifty-eight per cent of injuries occurred in young men 18-34 years, but 25 per cent occurred in school children, ten per cent in people over 50 years and five per cent in females. Fifty-nine per cent of the injuries were caused by bullets and 76 per cent of these affected the upper part of the body; 13.4 per cent of the injuries were severe, with major implication for disability and the need for long-term care and support.     

Lymphography in carcinoma of the uterine cervix.

Lymphography was carried out in a series of 158 patients with carcinoma of the uterine cervix. The diagnostic accuracy rate of 85 per cent compares favourably with the results of a similar investigation made ten years ago. Positive lymphography does not alter the survival rate in clinical stages I and II, probably due to the more accurate and selective therapeutic approach induced by lymphography. In stage III the 2-year survival rate of patients with negative findings is 58 per cent compared to only 17 per cent in case of positive lymphographic findings.     

Medulloblastoma. Treatment results.

A series of 44 patients with medulloblastoma is presented. The treatment was primary operation followed by irradiation of the entire CNS. The 3-year and 5-year survival rates for children and adults together were 36 and 33 per cent, respectively, and for children alone 37 amd 33 per cent, respectively. No certain difference in the prognosis for boys and girls was found.     

Treatment of the superior vena cava syndrome

The author describes the results of therapy in three groups of patients (128 patients altogether) with the superior vena cava syndrome caused by a tumorous disease. All the patients were treated by radiotherapy as a main method of therapy. (200 kV, filtration 2 mm Cu) in a daily fractionation 300 r on the surface by one field, in the second period (1974-1978) 55 patients were irradiated by 60Co cobalt from two opposite fields by daily fractionation of 170-180 rad into the focus and in the third period (1984-1986) 25 patients were irradiated by 60Co cobalt from two opposite fields in 3-4 introductory daily fractions 3.0 Gy into the focus and then in normal fractionation up to the total dose planned. Immediate results of the treatment--complete disappearance of the syndrome symptoms--were the best in the 3rd group, where a complete disappearance of the symptoms was observed in 84% of patients and a partial relief in 8%. In the first period a complete disappearance of symptoms was in 54% and a partial relief in 10% of patients. The corresponding values in the second period were 74% and 11% respectively. In evaluating the survival of patients, no significant differences were found. In the first period, 50% of patients survived 12 weeks, in the second period 16 weeks and in the third one 20 weeks. One-year survival was reached by two per cent of patients in the first period, four per cent in the second period and eight per cent in the third period. The paper discusses other therapeutic possibilities and approaches in the treatment of the superior vena cava syndrome.     

Double contrast examination of the stomach compared with endoscopy

The results of the double examination of the stomach in a series of 102 patients were compared with the findings at endoscopy. Nasogastric intubation was used to introduce the air into the stomach. Hypotonia was achieved mainly with glucagon. The radiologic error rate was 10 per cent, consisting of 7 per cent false negative and 3 per cent false positive findings. The diagnostic advantages of the double contrast technique over those of the conventional barium examination are discussed.     

Computed tomography in pre- and postoperative evaluation of aortic dissection

Thirty-seven patients with angiographically or operatively confirmed acute, chronic or postoperative aortic dissection were examined by means of dynamic CT and the results compared with those obtained by angiography and ultrasonography (US). The diagnostic accuracy was 87 per cent for CT, 97 per cent for angiography, and 76 per cent for US, although US was only available in less than half of the cases. The highest accuracy (95%) of CT was achieved in the pre-operative group, which is comparable with the 97 per cent accuracy achieved using angiography. Three patients in the postoperative group had false negative CTs, resulting in an overall accuracy of 82 per cent as compared with 100 per cent for angiography. Despite its diagnostic capacity, CT could not define the complete extent of dissection in four patients. The descending thoracic aorta was the area most difficult for CT examinations because of frequent artifacts in the images.     

Cancer chemotherapy in advanced malignant disease. A cost benefit analysis.

A cost benefit analysis of chemotherapy in unselected patients with advanced malignant disease originating in a defined population (250 000 inhabitants) demonstrated that the use of this therapy as the main treatment in hospitalised patients increased from a few per cent during 1973 to 60 per cent during 1977, corresponding to an increase in the cost of drugs from 10 000 to 200 000 dollars. At the same time the capacity for hospital care of patients with advanced malignancies increased from 317 to 488 patients without any enlargement of other resources. As more than 90 per cent of the medical budget consists of expenditures for salaries and localities, a cheaper medical care was obtained, but, above all, the survival rate and the quality of life for many patients was improved.     

Radiographic changes in the condyle of the temporomandibular joint in psoriatic arthritis

One hundred and ten patients with psoriatic arthritis (PA) and 100 matched control patients were examined by using orthopantomography to discover radiographic changes in the condyle of the temporomandibular joint (TMJ). Thirty-one per cent of the PA patients and 13 per cent of the control patients had radiographic changes in the condyle of the TMJ. The most common radiographic finding in PA patients was unilateral erosion of the condyle. Of the radiographic changes in the PA group, cortical erosions correlated negatively with age, whereas osteophytes correlated positively with the duration of PA.     

影响弱视早期发现的相关因素调查

目的　调查本地区影响儿童弱视早期发现的相关因素。方法　对 2 2 0名弱视儿童的发病情况作走访问卷式调查 ,采用SPSS软件进行统计分析。结果　 2 2 0名患者中 ,<6岁的只占 14 5 % ,而大部分于 6岁以后才被发现 ,而且以 8～10岁最多 ,占 2 7 7% ;平时卫生用眼教育及视力检查和保护措施做得不好者占 6 1 4%。调查 2 2 0名患儿弱视的发现方式 ,由儿童自己表述发现者 ,所占比例 14 5 % ,家长或教师无意中发现者最多 ,占 38 6 % ,家长及教师对弱视的基本知识认识不足者占到 6 6 8%。结论　多数家长及教师对儿童弱视的基本知识及常用的儿童视力的主客观检查方法了解不足 ,是导致儿童弱视不能早期发现的一个重要原因。