Adenocarcinoma of the cardia: A 10-year regional review

Adenocarcinoma of the gastric cardia has the worst prognosis of all sites, and treatment is often palliative. This study has reviewed 736 patients with carcinoma of the cardia registered with the Birmingham Cancer Registry during 1960–1969. Fifty-eight percent of the patients presented with advanced disease. Radical resection was accomplished in 265 (36%). The age adjusted 5-year survival for all patients was 4.5% and 9.8% for those undergoing radical resection. In patients with advanced disease, palliative resection was associated with a longer survival than for those treated by intubation (p < 0.001) and this difference was maintained even in the presence of liver or peritoneal metastases. There was no difference in the 30-day mortality rates for those undergoing palliative resection or intubation and it is suggested that resection be undertaken whenever possible.

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Resumen El adenocarcinoma del cardias gástrico tiene pésimo pronóstico y su tratamiento frecuentemente es sólo paliativo. El présente estudio revisa 736 casos de carcinoma del cardias del Registre de Cáncer de Birmingham entre 1960 y 1969. Cincuenta y ocho por ciento de los pacientes presentaba enfermedad avanzada. La resección radical fue realizada en 265 (36%). La supervivencia a 5 años ajustada por edad para la totalidad de los casos fue de 4.5% y para los sometidos a resección fue de 9.8%. En los pacientes con enfermedad avanzada la resección paliativa apareció asociada con una más prolongada supervivencia que la simple intubación (p < 0.001) y esta diferencia se mantuvo aún en presencia de metástasis hepáticas o peritoneales. No hubo diferencia en las tasas de mortalidad a 30 días para aquellos sometidos a resección paliativa o a intubación; se sugiere que se emprenda la resección los casos en que sea factible.

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Résumé L'adénocarcinome du cardia est d'un pronostic particulièrement sévère car le traitement n'est souvent que palliatif. L'étude présentée par les auteurs concerne 736 cas de cancer du cardia opérés de 1960 à 1969. Cinquante-huit pour cent des malades présentaient des lésions avancées. Dans trente-six pour cent des cas il fut procédé à une résection (265 cas). Le taux de la survie à 5 ans fut au total de 4.5% atteignant 9.8% après résection radicale. Chez les malades qui présentaient des lésions avancées la survie fut plus longue après résection qu'après intubation (p<0.001) alors même qu'étaient présentes des métastases péritonéales ou hépatiques. La mortalité postopératoire (30 jours) de la résection ne fut pas supérieure à la mortalité consécutive à l'intubation. Ce fait suggère que la résection doit toujours être entreprise quand elle est possible.

     

Pulmonary embolism after hip or knee replacement: postoperative changes on pulmonary scintigrams in asymptomatic patients

Serial pulmonary imaging has proved to be effective in the evaluation of patients undergoing total joint arthroplasty. A clinical dilemma arises in asymptomatic patients whose postoperative pulmonary images differ from the preoperative images. The authors prospectively evaluated 403 patients with serial imaging to determine the significance of changed postoperative images in asymptomatic patients undergoing total hip or knee arthroplasty. Twenty-two (5.5%) patients had significant changes on postoperative images. Seventeen were asymptomatic; all but one underwent pulmonary angiography. Documented pulmonary emboli were demonstrated in 100% of patients whose postoperative images changed to indicate a high probability of pulmonary embolism, 71% whose images changed to a moderate probability, and 0% whose images changed to indeterminate probability. Overall, pulmonary emboli occurred in 76% of all asymptomatic patients with significantly change postoperative images. Asymptomatic pulmonary embolism is a significant occurrence after total hip or knee repair, and a changed lung scan with appropriate clinical evaluation is an accurate indicator of pulmonary emboli in asymptomatic postarthroplasty patients.     

Cloning of cDNA coding for connective tissue activating peptide III from a human platelet-derived lambda gt11 expression library

We report here the cloning of the cDNA coding for platelet connective tissue-activating peptide-III (CTAP-III) from a lambda gt11 expression library prepared using messenger RNA (mRNA) isolated from human platelets. The open reading frame of the clone coded for a protein with 128 amino acid residues. Since the precursor of CTAP-III, platelet basic protein (PBP is 94 amino acids long, the 5'-translated region of the cDNA codes for a leader sequence 34 amino acids long. This leader sequence, like the sequence of mature CTAP-III, shows significant homology to the sequence of platelet factor 4 (PF4), the only other platelet specific alpha-granule protein cloned until now, from a human erythroleukemic (HEL) cell line-derived cDNA library. These leader sequences are probably critical for targeting such proteins to the alpha-granule. Northern blot hybridization with platelet and megakaryocyte mRNA shows a single species mRNA of approximately 0.8 kb, suggesting that the corresponding cDNA is full length. The cloning of platelet specific CTAP-III provides additional evidence for the platelet specificity of the cDNA library used.     

Sociodemographic Factors Associated with AIDS Knowledge in a Random Sample of University Students

A telephone survey was used to assess knowledge of the transmission, prevalence, and infectivity of acquired immunodeficiency syndrome (AIDS), and the safety of casual contact among 214 randomly selected university students. Males were more knowledgeable than females overall (odds ratio [OR], men/women = 4.8). Although most students understood the dangers of unprotected sex and intravenous needle sharing, up to 30% believed some kinds of casual contact (e.g., shared eating utensils) can transmit AIDS. Older students (greater than or equal to 23 yrs) were more knowledgeable than those 17 to 19 years old about the safety of casual contact (OR = 3.8). Students are in need of education programs that stress the ways AIDS is not transmitted. Since most students identified newspapers and television as their main sources of information, these may be effective vehicles for education efforts.     

An iterative requirements specification procedure for decision support systems

Requirements specification is a key element in a DSS development project because it not only determines what is to be done, it also drives the evolution process. A procedure for requirements elicitation is described that is based on the decomposition of the DSS design task into a number of functions, subfunctions, and operators. It is postulated that the procedure facilitates the building of a DSS that is complete and integrates MIS, modelling and expert system components. Some examples given are drawn from the health administration field.     

Intravenous digital subtraction renal angiography: use in screening for renovascular hypertension

Intravenous digital subtraction renal angiography (DSRA) has been compared with conventional angiography only in small, selected series of hypertensive patients. The authors prospectively examined with intravenous DSRA 94 patients at increased risk for renovascular hypertension and compared these studies with conventional angiography. A stenosis of at least one main renal artery was identified with intravenous DSRA in 22 patients and confirmed in 20 patients. No significant stenoses were seen with conventional angiography in any of the 64 patients in whom lesions were not seen with intravenous DSRA. Since inadequate DSRA studies were considered positive for renal artery stenosis, the sensitivity of intravenous DSRA was 100% (25 of 25); specificity, 93% (64 of 69); positive predictive value, 83% (25 of 30); and negative predictive value, 100% (64 of 64). The authors conclude that intravenous DSRA is a sensitive test for identifying stenosis of the main renal arteries and is appropriate to use as a screening test among patients at increased risk for renovascular hypertension.     

Why don't trainees pass the emergency medicine fellowship examination?

The pass rate in the Australasian College for Emergency Medicine Fellowship exams between 1996 and 2003 inclusive averaged 61%, substantially lower than that of other specialties with comparable training structures. The explanation for this pass rate, which many would judge as unacceptably low, is likely to be multi-factorial. Possible factors that should be considered include trainee selection, training programme structure, the impact of the Director of Emergency Medicine Training, examination preparation, examination validity and examination reliability. Each of these potential factors needs to be addressed in a systematic fashion in the context of inevitable and increasing internal and external scrutiny of the outcomes of our training programme.