Preoperative arteriographic spasm and outcome from aneurysm operation

The timing of intracranial operation for the treatment of ruptured cerebral aneurysm remains controversial. To find objective parameters to guide us, we performed angiography 24 to 72 hours before contemplated operation in 35 Grade I patients in whom subarachnoid hemorrhage had occurred at least 1 week earlier. Operation in the presence of angiographic vasospasm in Grade I patients over 1 week after SAH was associated with increased morbidity and mortality rates. Only 1 of 28 patients in whom spasm was absent or mild at the time of operation had an unsatisfactory outcome from operation (P less than 0.003). There was no correlation between clinical grade and significant spasm; 17 patients who were clinically Grade I over 1 week after SAH had moderate or severe angiographic spasm. These data suggest that all patients should undergo angiography just before contemplated operation and that operation should be postponed if vasospasm is present.

Rationalising abdominal radiography in the accident and emergency department

A retrospective analysis is presented of 100 consecutive patients attending an accident department and referred for abdominal radiography. In general the reasons for requesting supine films appeared sound. Five per cent of referrals were for haematemesis which is not a valid reason for plain radiography. An erect abdominal film as a routine request is indicated only in suspected intestinal obstruction (4% in this series), but 83% of patients were referred for both erect and supine films. If haematemesis were excluded as a reason for X-ray referral, and if erect films were limited to suspected intestinal obstruction, 95% of the patients would still have been referred for radiography, but almost half the abdominal films would not have been required. This would have reduced film wastage, workload and more important, gonadal irradiation.

Arterial thrombosis in essential thrombocythemia

The course of essential thrombocythemia has been observed in ten patients, ages 46 to 83, of whom nine were followed for a period of 4 months to 9 years. In contrast to the experience with essential thrombocythemia recorded in the literature, manifestations of arterial thrombosis were far more common than hemorrhage. In six of the ten patients, the presenting complaints were ascribable to incipient gangrene of the toes and several of these patients additionally developed occlusion of tibial and larger arteries while under our observation. All patients with incipient gangrene showed marked clinical improvement accompanying busulfan-induced reduction and normalization of the platelet count. Relapses in five patients after 2 to 87 months responded well to retreatment with busulfan. No patient has shown evolution to another myeloproliferative disorder. Essential thrombocythemia should be considered in the differential diagnosis of occlusive arterial disease.

Histalog gastric analysis

A histalog gastric analysis was done in 20 patients with gastroduodenal disorders and 12 subjects with non-ulcer dyspepsia who were used as controls. Due to overlap of secretory responses its use as a diagnostic tool is limited. About 46% patients with duodenal ulcer exceeded the upper limit of acid secretion of control subjects. Values for stimulated secretion in controls and the patients with gastric ulcer were the same. Endoscopy if possible is the investigation of choice for the diagnosis of gastroduodenal disorders and the secretory studies should be limited to patients under-going surgery for peptic ulceration.

The radiology of nasal injuries: problems of interpretation and clinical relevance

Films of 50 normal patients and 50 dry skulls were examined to detect lines which might stimulate a nasal fracture. These were visible on the occipito-mental view but on the lateral view any line which reaches the anterior cortex must be regarded as a fracture. The results of an analysis of 100 patients with trauma to the nasal bone are also presented. It is concluded that radiography of the nasal bone is an unnecessary examination unless requested by the E.N.T. surgeon, and this will in any case occur infrequently.

Prophage inductive efficiency of alkylating agents and radiations

The prophage inducing efficiency in E. coli K-12 (lambda) of a number of agents--alkylating agents and radiations--has been compared at a high survival of bacteria. The inducing effectiveness (per alkylation in DNA) and efficiency (compared with mutation frequency in E. coli Sd-4) was found to decrease in the order 2-hydroxyethylating agents (2-hydroxyethyl methanesulphonate and ethylene oxide) greater than isopropyl methanesulphonate approximately equal to methyl methanesulphonate greater than ethylating agents (diethyl sulphate, ethyl methanesulphonate). The low inducing activity of the ethylating agents could not be explained with respect to their reactivity towards targets of differing nucleophilicity, nor could the effectiveness in mutagenicity or the ability to break the chromosomes in the presence of metal ions be invoked. The high inducing efficiency of hydroxyalkylating agents may be related to their ability to break DNA strands.

Treatment of metastatic malignant melanoma with a combination of 5-(3,3-dimethyl-1-triazeno) imidazole-4-carboxamide (NSC-45388), cyclophosphamide (NSC-26271), and vincristine (NSC-67574)

Courses of treatment with a combination of 5-(3,3-dimethyl-1-triazeno)-imidazole-4-carboxamide (NSC-45388) (850 mg/m2), cyclophosphamide (750 mg/m2), and vincristine (2.0 mg/m2) were given intravenously in single doses to patients with metastatic malignant melanoma. Treatment was repeated at 4-week intervals. Objective responses were observed in five of 20 patients (25%), indicating that treatment with this drug combination is at least as effective as treatment with NSC-45388 alone in either 5-day courses or intermittent, high-dose, single injections. The toxicity resulting from the combined treatment, although somewhat greater than that reported with the 5-day courses of NSC-45388, is acceptable and much less severe than that found with the single, high-dose schedule. Although the combination does not appear to increase the tumor response rate, it does maintain the advantage of a brief hospitalization for the patient.