Miliary tuberculosis: A complication of intravesical BCG treatment

A case of miliary tuberculosis following intravesical bacillus Calmette-Guerin (BCG) treatment is described.     

Lead poisoning from retained missiles. An experimental study.

The problem of lead poisoning from bullets has been investigated by surgically implanting discs of lead, each enriched in a different natural isotope, into the tissue of two mongrel dogs and monitoring by mass spectrometry the release of the lead into each animal's blood over the course of 3 years. Lead placed in the knee underwent vigorous attack by the synovial fluid, far in excess of what would be expected from corrosion theory, and reached a maximum concentration in blood 4-6 months after operation. Thereafter, lead concentration exponentially declined as the remaining fragments became encapsulated. The disc placed in muscle was sparingly soluble immediately following implantation. It is concluded that the greatest danger of lead poisoning from an injury involving many fragments having collectively a large surface area will occur within a month, and that the cases of lead poisoning resulting from bullets in joints that occur 5 or more years after injury are caused by continual wear of metal on a joint surface, storage of lead so released in the skeleton, and its subsequent resorption during a change in osteocyte activity.     

Utilization of screening mammography: comparison of different physician specialties

Data obtained on 426 consecutive patients referred to a breast center by 122 physicians, including family practitioners, general surgeons, and other specialists, showed that the obstetricians-gynecologists referred the greatest average number of patients per physician, with more than 50% of these referrals for screening mammography. Internists referred fewer patients by nearly a factor of ten, with only one-third of these patients referred for screening mammography. Internists may be the weakest link in the utilization of screening mammography.     

Acute and chronic effects of oral physostigmine and lecithin in Alzheimer's disease

Alzheimer patients were treated with lecithin and gradually increasing doses of oral physostigmine during a drug trial to determine if these compounds would improve memory. Memory was measured using a selective reminding task. Of 16 patients, 10 showed improvement in total recall, retrieval from long-term storage and a decrease in intrusions. The optimal dose was 2.0 mg or 2.5 mg of physostigmine per dose for most patients. During a replication study, all 10 patients again responded. During long-term (4 to 20 months) treatment of five patients, most demonstrated continued drug response initially but then lost responsiveness to physostigmine and their dementia progressed. Physostigmine treatment appeared to improve memory with or without concomitant lecithin therapy. However, progressive dementia ensued despite physostigmine therapy. The degree of memory improvement correlated with increasing cerebrospinal fluid cholinesterase inhibition suggesting that memory improvement is associated with entry of physostigmine into the brain.     

Significance of omental evisceration in abdominal stab wounds

Over a 4 year period, 115 patients presented to Parkland Memorial Hospital with omental evisceration after a stab wound to the abdomen. All patients underwent exploratory celiotomy. Serious abdominal injuries were found in 86 patients (75 percent), and half of these had two or more organs injured. The injury rate in patients with omental herniation was three times that of patients with simple stab wounds. No preoperative evaluation technique was reliable in identifying patients without injury. There were no deaths and only a 7 percent incidence of minor complications in patients who underwent negative exploration. Our data suggest that omental evisceration in a patient with an abdominal stab wound portends potentially serious injury and supports the policy of expeditious celiotomy.