The indications for elective treatment of the neck in cancer of the major salivary glands.

To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982. Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors (P less than 0.00001). High-grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate-grade or low-grade tumors (P less than 0.00001). In view of the low frequency of occult metastases in the entire group, routine elective treatment of the neck is not recommended. High-grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group.     

Express-method of assessing the status of hypertension control

The authors describe a method for evaluating arterial hypertension control among the unorganized population visiting polyclinics and organized population taken care of at the medical centers. The method was tried in the city of Chelyabinsk as applicable to a randomized population sample of a medical territorial district and to a randomized sample (8%) of the workers from 9 shops of the steel plant. The method lies in the study of the population health status (arterial hypertension prevalence and knowledge, treatment coverage and efficacy) and of the documentation available at the treatment and prophylactic institutions concerning arterial hypertension control (coverage, registration, scope of examinations, and so forth). It is shown that the method is unsophisticated and feasible for examination of the population and documentation requires 5 days. It is suggested that the method should be used in the study of the situation concerning arterial hypertension control as well as in the study of the problems in the control of other non-infectious diseases.     

Expression of ɛBP, a β-galactoside-binding soluble lectin, in normal and neoplastic epidermis

Abstract The study of animal lectins and glycoconjugates has become an important area of research in biomedical sciences, as these molecules are believed to play important roles in a variety of biological processes. This report describes a study of the expression of an animal lectin, IgE-binding protein (?BP), also known as Mac-2 and CBP35, in human skin. We have analyzed cultured human keratinocytes as well as normal human skin and a number of epidermal neoplasms, by immunoblotting. immuno-fluorescence and immunohistochemistry. We showed that ?BP is expressed in human keratinocytes, hair follicles, sebaceous and sweat glands. We found that cBP expression retains in various epidermal neoplasms, including basal cell carcinoma, squamous cell carcinoma and keratoacan-thoma, although the level of expression appears to be reduced as compared to normal epidermis. The immunohistochemical analysis also suggests that the level of ?BP expression appears to be dependent on the degree of cellular differentiation of keratinocytes.     

Positive clinical impressions: II. Participants' evaluations

Nine months after the residential stage of Koach, participants were asked to evaluate the program's effectiveness. Most of the veterans reported improvement in the areas queried, and especially in social relations, and nearly all of them stated that they would recommend the program to other veterans. The commander-therapists became the major source of help for these veterans following the Koach project, and about half reported that they participated regularly in self-help groups. Most of the participants acquired coping techniques that continued to serve them 9 months after the end of the residential stage of Koach. One of the more important measures of Koach was thought to be the veterans' own evaluations of the project, their assessment of the project's success in achieving its aims, and their satisfaction with it. In this article we will present the subjects' evaluations of treatment effectiveness as expressed in behavioral and emotional changes that they attributed to the treatment.     

The problem of neck relapse in early stage supraglottic larynx cancer

We reviewed the records of 104 patients with Stage T1NO or Stage T2NO epidermoid carcinoma of the supraglottic larynx treated between 1965 and 1979. In 79 patients, surgery was the only type of initial treatment. These 79 patients are the subjects of this report. Forty-eight (61%) of these patients were treated by total laryngectomy, whereas 31 (39%) had a partial laryngectomy. An elective unilateral radical neck dissection was performed on 31 patients considered at high risk, but metastatic disease was found in the dissected side of the neck histologically in only 32% (ten of 31) of these patients. The minimum follow-up period was 5 years and the maximum was 20 years. Twenty-nine percent of the patients (23 of 79) experienced a neck relapse. The neck relapse rate was the same whether the patients did or did not have an elective radical neck dissection. Among the patients who experienced a neck relapse, 65% (15 of 32) have died of the cancer. Among those who did not experience a neck relapse, none (zero of 56) have died of the cancer (P less than 0.01). These results indicate that in surgically treated patients with early stage supraglottic larynx cancer, neck relapse was the major cause of failure associated with death from cancer. Strategies for decreasing the relapse rate are discussed.     

Causes of mitral valve re-stenosis and the ways of its prevention

The authors evaluated comparatively the results of surgical treatment of mitral stenosis in 203 patients after open mitral commissurotomy (OMC) (their personal experience) and the literature data concerning 168 patients who underwent closed mitral commissurotomy (CMC). The frequency of mitral stenosis recurrences with the use of both methods was determined. OMC was on a par with CMC in safety and exceeded it in efficacy. The frequency of mitral restenosis was considerably lower after OMC than after CMC (p less than 0.05). The authors claim that the main cause of mitral stenosis recurrences is residual stenosis developing in inadequate correction of the anomaly, while the principal preventive measure is OMC which makes it possible to separate the fused commissures completely, remove the subvalvar adhesions, and restore the mobility of the cusps.     

What is empathy and can it be taught?

Empathy is the "almost magical" emotion that persons or objects arouse in us as projections of our feelings. Empathy requires passion, more so than does equanimity, so long cherished by physicians. Medical students lose some of their empathy as they learn science and detachment, and hospital residents lose the remainder in the weariness of overwork and in the isolation of the intensive care units that modern hospitals have become. Conversations about experiences, discussions of patients and their human stories, more leisure and unstructured contemplation of the humanities help physicians to cherish empathy and to retain their passion. Physicians need rhetoric as much as knowledge, and they need stories as much as journals if they are to be more empathetic than computers.