Reliability of naevus counts in identifying individuals at high risk of malignant melanoma

Summary The majority of deaths from malignant melanoma could be prevented by regular screening of at-risk individuals. However, the feasibility of introducing active screening programmes depends on the reliability of criteria for identifying those individuals who are at increased risk. Several case-control studies indicate that one of the most important risk Factors is the number of benign pigmented naevi. This criterion might constitute a practical means of identifying individuals suitable for inclusion in an active screening programme. The aim of this study was to assess the reliability of using naevus counts as an indicator of risk. Two possible methods of assessment were compared: assessment by trained interviewers, and assessment by experienced dermatologists. The results suggest that this criterion may not be as practical or reliable as originally anticipated. Interviewer naevus counts correlated poorly with dermatologists' assessments (kappa =0·19). Counts by dermatologists of the number of naevi on the left arm differed by up to nine naevi, although most counts were within four naevi of each other. There was reasonable correlation between naevus counts on the left arm and those on the whole body ( r = 0·71). However, the relationship was not perfect. Selection of individuals for screening solely based on the number of naevi on the left arm may exclude many people with high total body counts but relatively low left arm counts.     

Intrathoracic Pressure as a Tourniquet Technic to Tamponade Bleeding Esophageal Varices

The authors' report observations on 79 cases of esophagovariceal bleeding in which ten cases were subjected to an intrathoracic tourniquet maneuver of increasing intrathoracic pressure. All esophagovariceal bleeding ceased following the maneuver. An established maneuver safety limit (holding mean transmural CVP to no higher than 4.0 cm H2O) insured cardiac output maintenance and guaranteed against maneuver-generated morbidity. The authors conclude the cessation of the bleeding from esophageal varices observed is the combined result of tourniquet-tamponade by direct venous air compression on the bleeding varices as well as general esophageal compression.     

Promoting screening for cervical cancer: realising the potential for recruitment by general practitioners

This paper explores the potential for general practitionersto promote screening for cervical cancer and describes one exampleof an effective general practitioner-based (GP-based) programmeto improve community screening rates. The GP-based programmewas designed to improve general practitioners' involvement inrecruiting women in their communities to have Pap smears. Theaim was to raise doctors' awareness of the fact that many womenare not adequately screened, to encourage them to consider whythese women are not being recruited, to assist them to developstrategies to overcome these problems, and to support them inthe use of these strategies by providing information and resources,feedback on performance, and peer support. The effectivenessof the GP-based programme was assessed as part of a multi-centretrial to compare the differential effectiveness of three community-basedstrategies to promote screening for cervical cancer: a televisioncampaign, a television campaign combined with personally addressedletters sent to all women in the community, and a televisioncampaign combined with the GP-based programme. Each interventionwas delivered to three postal regions in New South Wales, Australia,and time-series data on Pap smear rates were obtained. Threecontrol regions were included for comparison. Of all three strategies,the combined television campaign and GP-based programme hadthe most potential, with up to an additional 8% of previouslyunscreened women being screened during each quarter of the combinedtelevision campaign and GP-based programme. This compares withscreening of 2–4% of previously unscreened women in associationwith television combined with letters, and only 1–3% ofpreviously unscreened women when television was used alone.However, the impact of the GP-based programme was highly variable.This variation in effectiveness points to a need for furtherresearch to determine the general practitioner, community andprogramme factors associated with programme success.     

Effectiveness of two direct-mail strategies to encourage women to have cervical (Pap) smears

The aim of this study was to assess the acceptability, utilisazionand differential effectiveness of two direct-mail strategiesfor increasing community Papanicolaou (Pap) smear rates. Thetwo strategies were: a personally addressed letter containingsimple information about Pap smears and a personally addressedletter combined with a series of targeted behavioural promptsdesigned to address a number of aspects of screening which previousresearch had shown to be associated with poor screening rates.The two strategies were assessed in two geo graphically separatedpostal regions in Australia. Each region represented approximately10 women aged 18–70 wars. Outcome data on the change inregional Pap smear rates were obtained from government healthinsurance claims for cervical screening and from pathology servicerecords. Both interventions resulted in statistically significantincreases in attendances for screening over the post-interventionperiod. 42.2% in the region receiving the simple prompt and39.6% in the region receiving the multi-faceted approach Therewas no sigrujicant difference between the two intervention regions.The results indicate that direct-mail strategies can be effectivein prompting attendance for cervical cancer screening. Further,nore, it would appear that a simple informational strategy canbe at least as effective as a more elaborate package. Both interventionsresulted in similar increases in attendances of around 40%.     

THE EFFECT OF TRICHLOROETHYLENE-NITROUS OXIDE ANAESTHESIA ON ACID-BASE BALANCE IN MAN

Thirty-five patients undergoing major operations under trichloroethyleneand nitrous oxide anaesthesia with muscle relaxants and withaugumented respiration in a Magill System (Mapleson A) or non-rebreathingsystem were monitored with regard to acid-base balance and ventilation.A trend to acidosis occurred with the Mapleson A system, particularlyin those in the prone position. A mild respiratory alkalosisoccurred when the non-rebreathing system was used. Acid-basebalance reverted to the pre-operative state early in the recoveryperiod and blood pressure, pulse and cardiac rhythm remainedrelatively stable throughout. This study indicates that trichloroethylenecan be a suitable anaesthetic for major surgery provided thatthe criteria enumerated in this report are fulfilled.     

CHLORPROTHIXENE AND AMTTRIPTYLINEt: INTERACTION WITH THIOPENTONE, CIRCULATORY EFFECT AND ANTISIALOGOGUE EFFECT

Evaluation of the interaction of chlorprothixene and amitriptylinewith thiopentone, in dogs, showed that both of these have pharmacologicalproperties which cause delayed recovery from anaesthesia. Thiseffect is particularly strong with chlorprothixene. The effecton the circulatory response to tilt was measured with thesetwo drugs in young healthy male subjects, and both caused orthostatichypotension, which was rather severe in the case of chlorprothixene,and mild with amitriptyline. Tests of antisialogogue activitywith chlorprothixene, on the same subjects, showed that thisdrug was inactive in this respect, although it is reported toexert very strong anticholinergic effects on other organ systems. ^*Taractan; Tarasan. Laroxyl; Saroten; Tryptizol; Elavil.     

NEUROLEPTANALGESICS: A COMPARISON OF THE CARDIOVASCULAR, RESPIRATORY AND METABOLIC EFFECTS OF INNOVAN AND THIOPENTONE PLUS METHOTRIMEPRAZINE

Crossover experiments were carried out in dogs with a 50:1 mixtureof dehydrobenzperidol and phentanyl (Innovan) and a 40:1 mixtureof thiopentone and methotrimeprazine to determine their efficacyas anaesthetics, and their effect on blood pressure, heart rate,acid base balance, blood sugar, serum potassium, blood ureanitrogen and blood transaminases. Both mixtures, when used witha 2:1 nitrous oxide and oxygen mixture and hyperventilation,caused a moderate fall in blood pressure and a lowering of bodytemperature, a rise in blood sugar and a fall in the serum potassium.Odier measured parameters did not change appreciably. Smoothfull recovery from anaesthesia occurred within an hour of respondingto a painful stimulus. Respiratory depression was the only noteworthyeffect during recovery.