Fine-needle cytology of solid tumors: method, diagnostic accuracy, and role in management

Fine-needle cytology was obtained from 14 solid tumors in 12 children. Both aspiration and nonaspiration techniques were used and several staining methods were applied. May Grünwald Giemsa and Papanicolaou stains were preferred. The nonaspiration method yielded a superior quality cytology smear with less blood contamination. There were no complications recorded. Confirmation of the diagnosis with cytology allowed for planned management with preoperative cytotoxic chemotherapy and/or radiotherapy in 10 children, immediate surgery in one, and radiotherapy to a vertebral recurrence in one. Fine-needle cytology is considered a useful technique in the management of a selected group of children with solid tumors.     

'This isn't very typical I'm afraid': observing community care complaints procedures

The new complaints procedures which local authority social services departments have been required to introduce represent an important mechanism for managing the change of culture associated with recent community care reforms. They also represent a new genre in mechanisms of redress for welfare recipients. This paper reports the findings of a study which has observed considerable diversity in the ways in which local authorities are interpreting the nature and purposes of the new procedures and, in particular, the functions of review panels established under those procedures. Variations in the composition of panels, in the style of review panel proceedings, in perceptions of the panels' powers, and in the ways that complaints and complainants are constituted are all discussed. Attention is drawn to four competing interpretations of the review panels' role and to the need for these to be clarified and prioritised.     

The Inter-Regional Epidemiological Study of Childhood Cancer (IRESCC): past medical history in children with cancer.

The Inter-Regional Epidemiological Study of Childhood Cancer (IRESCC) collected interview and medical information relating to the child's past medical experiences from parents of 555 children diagnosed with cancer and parents of 1110 unaffected matched controls. No significant associations emerged overall for ante-natal care, place and mode of delivery, length of gestation, birth weight, condition at birth, special care, neonatal procedures or breast-feeding. Few risk factors relating to previous illnesses and medication were found, although increasing numbers of illnesses appeared to be associated with an increased risk of childhood cancer, particularly acute lymphoblastic leukaemia. A highly significant excess of case children had not been immunised (p = 0.005). In general, these results indicate that past medical experiences have little influence on the development of cancer in children.     

Canadian Association of General Surgeons Evidence Based Reviews in Surgery. 10. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial.

Question: Is there a difference in cancer-related survival between laparoscopic assisted colectomy (LAC) and open colectomy (OC)? Design: Randomized controlled trial. Setting: Single-centre trial, Barcelona, Spain. Patients: Two hundred and nineteen of 442 eligible patients with adenocarcinoma of the colon were included. Patients were excluded if the tumour was below 15 cm from the anal verge or was in the transverse colon; if there were distant metastases, adjacent organ involvement or obstruction; or the patient had previous colonic surgery. One hundred and eleven were randomized to the LAC group and 108 to the OC. Interventions: Randomization was done the day before surgery. Patients were stratified into 2 groups according to tumour location (right or left side with respect to the splenic flexure) and assigned to the LAC or OC group by means of sealed opaque envelopes containing computer-generated random numbers. Patients in both groups had surgery by a single gastrointestinal surgical team. Pre- and postoperative care was standardized for bowel prep and perioperative antibiotics. Patients received either LAC or OC using a no-touch technique and initial vascular ligation. Main outcome measure: Overall survival. Results: The Cox model showed that LAC was independently associated with reduced risk of tumour relapse (hazard ratio 0.39, 95% CI 0.19 – 0.82), death from any cause (0.48, 0.23 –1.01) and death from a cancer-related cause (0.38, 0.16– 0.91) compared with OC. This superiority of LAC was due to differences in patients with stage III tumours (freedom from recurrence p = 0.04, overall survival p = 0.02, and cancer- related survival p = 0.006). Conclusion: LAC is more effective than OC for treatment in terms of morbidity, hospital stay, tumour recurrence and cancer-related survival.     

Rural Radiology: Who is Producing Images and Who is Reading Them?

The purpose of this study is to identify the local availability and trends in local availability of imaging technology and interpretation services in rural hospitals in the northwestern United States during the period between 1991 to 1994. Another objective is to describe hospital and community factors associated with the diffusion of image production and interpretation services. The information for this study was gathered through telephone surveys of rural hospital administrators in eight northwestern states in 1991 and 1994. The availability of magnetic resonance imaging (MRI) equipment, computed tomography (CT) scanners, ultrasonography equipment, and dedicated mammography equipment increased between 1991 and 1994. The increases in MRI units were primarily in mobile equipment, while ultrasonography and mammography equipment increases were primarily fixed hospital-based units. In 1994, image interpretation in the rural hospitals was provided by both primary care and radiology physicians. Forty-six (11.5%) of the rural hospitals had no on-site radiology services and only 73 (18%) had daily radiology services. Between 1991 and 1994, 12 hospitals gained at least once-a-week radiology services, but 24 lost all radiology services. Teleradiology availability more than doubled during the three years. Radiology technology has diffused widely into rural communities in this region of the United States at differing rates for large and small hospitals. Radiologists are available to these hospitals only 46 percent of the days each year, with more days of availability in the larger hospitals and fewer days in the smaller hospitals. Teleradiology capability is increasing more rapidly in the larger hospitals that have radiologists more readily available.     

Effects of prostaglandins and the autonomic nervous system on the vasodilatory properties of nitroglycerin in conscious dogs.

This study was designed to assess the respective roles of prostaglandins and the autonomic nervous system in the responses to nitroglycerin (NTG) in conscious dogs. In vivo, NTG (1, 10, and 100 micrograms/kg i.v.) induced dose-dependent decreases in blood pressure and increases in heart rate and cardiac output. Coronary and carotid blood flows increased simultaneously, whereas responses in renal blood flow were biphasic, i.e., an initial decrease was followed by an increase above control at 10 and 100 micrograms/kg. NTG responses were not changed by indomethacin but were affected by chlorisondamine alone or in combination with indomethacin; tachycardia was abolished, and increases in cardiac output after 10 and 100 micrograms/kg were reduced by 26 and 32%, respectively, after ganglionic blockade and by 19 and 32%, respectively, after chlorisondamine plus indomethacin. In addition, increases in carotid blood flow in doses of 100 micrograms/kg were reduced by 88% after chlorisondamine and 83% after chlorisondamine plus indomethacin. Finally, in the presence of chlorisondamine plus indomethacin, NTG induced a more pronounced hypotension associated with a more pronounced renal vasodilation at the highest dose. Independent of indomethacin pretreatment, NTG in vitro induced a dose-dependent relaxation of the carotid, coronary, and renal arteries. Depending on the vascular bed, the reflex and local controls of circulation are affected differently by NTG.     

Epidural pethidine and bupivacaine in labour

A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.     

Urban and Rural Differences in Health Insurance and Access to Care

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub-samples of 400 group-insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies.
Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis.
Rural residents with group insurance have higher out-of-pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment-based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers.