CDC field triage criteria accurately predicts outcomes in high impact trauma

BACKGROUND

The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).

METHODS

This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.

RESULTS

With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category.

CONCLUSIONS

In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Surgical and non-surgical treatment of inguinal hernia during non-elective admissions in the Nationwide Readmissions Database

INTRODUCTION

Inguinal hernia repair is one of the most common surgical operations, yet the optimal treatment strategy remains undefined. Treatment of symptomatic inguinal hernias include both surgical and non-surgical approaches. The objective of this study was to determine differences in population, readmission rates, and costs between operative and non-operative approaches for patients admitted non-electively for an inguinal hernia in a national dataset. In addition, we sought to define the baseline characteristics of the two groups and identify potential predictive factors in the non-surgically managed subgroup who were readmitted and treated operatively within 90 days of their first visit.

METHODS

This study was a retrospective review of data from the Nationwide Readmissions Database (NRD) from 2010 to 2014. Patients above age 18 who were admitted non-electively for a primary diagnosis of inguinal hernia were included. Patients whose length of stay was < 1% or > 95% percentile or died during the initial visit were excluded. Readmissions within 90 days of the initial visit were flagged. Patients were classified according to initial management strategy: operative versus non-operative. Demographic, clinical, and organizational characteristics were compared between the two cohorts.

RESULTS

14,249 patients met inclusion criteria and were operative (n = 8996, 63.13%) and non-operative (n = 5255, 36.88%) cohorts. When comparing the two groups, readmission rate was lower (0.49% for surgical, 1.78% for non-surgical, p < 0.01), mean length of stay (LOS) longer (3.27 [SE = 0.05] days for surgical, 2.76 days [SE = 0.06] for non-surgical, p < 0.01), and mean total cost higher ($9597 for surgical, $7167 for non-surgical, p < 0.01) in surgically treated patients. The non-surgical population was on average older (63.05 years for surgical, 64.52 years for non-surgical, p < 0.01) with more chronic conditions (3.57 for surgical, 4.05 for non-surgical, p < 0.01). Of the patients initially managed non-surgically, 1.78% (n = 91) were readmitted, and of them, 62.63% (n = 57) were readmitted and managed surgically within 90 days of initial admission (i.e., crossed over from watchful waiting to surgical treatment). Average number of chronic conditions (3.79 versus 4.03, p = 0.74), average number of comorbidities (2.26 versus 2.18, p = 0.87), and average total number of ICD-9 discharge codes (7.44 versus 8.23 p = 0.54 did not differ significantly between the operative versus non-operative sample of the readmitted population. The total cost ($5562.38 versus $8737.28, p = 0.01) was greater in the operative versus non-operative sample.

CONCLUSION

Watchful-waiting strategy is the most common treatment approach in patients admitted non-electively for symptomatic inguinal hernia. Readmission after non-elective hospitalization for inguinal hernia is rare, but surgical intervention decreased the likelihood of readmission compared to non-operative management, while also increasing LOS and cost of care. Our data supports a patient centric approach to the management; non-surgical treatment is a viable temporary option even in symptomatic inguinal hernias, while surgical treatment may reduce the likelihood of future readmission.

Clinical Determinants of Long-Term Survival in Patients with Glioblastoma Multiforme

Repeated reports of more than ten years postoperative survival in patients with glioblastoma multiforme (GM) have appeared in the literature over the last decades. Authors have tried to identify the clinical, therapeutic and histological features determining long-term survival. We present two patients in whom, after radical removal of the tumor followed by conventional radiation, there has been no recurrence for at least ten years. The young age of the patients and the radical surgical approach were in accordance with previous reports of long-term survival. Nevertheless, one tumor originated from the thalamus, a location considered to be of unfavorable prognosis. We therefore further discuss the value of clinical signs as determinants in the prognosis of GM.

Economic valuation of environmental benefits of removing pharmaceutical and personal care products from WWTP effluents by ozonation

Continuous release of pharmaceutical and personal care products (PPCPs) present in effluents from wastewater treatment plants (WWTPs) is nowadays leading to the adoption of specific measures within the framework of the Directive 2000/60/EC (Water Framework Directive). The ozonation process, normally employed for drinking water production, has also proven its potential to eliminate PPCPs from secondary effluents in spite of their low concentrations. However, there is a significant drawback related with the costs associated with its implementation. This lack of studies is especially pronounced regarding the economic valuation of the environmental benefits associated to avoid the discharge of these pollutants into water bodies. For the first time the shadow prices of 5 PPCPs which are ethynilestradiol, sulfamethoxazole, diclofenac, tonalide and galaxolide from treated effluent using a pilot-scale ozonation reactor have been estimated. From non-sensitive areas their values are -73.73; -34.95; -42.20; -10.98; and -8.67 respectively and expressed in €/kg. They represent a proxy to the economic value of the environmental benefits arisen from undischarged pollutants. This paper contributes to value the environmental benefits of implementing post-treatment processes aimed to achieve the quality standards required by the Priority Substances Directive.

Assessment of wastewater treatment plant design for small communities: environmental and economic aspects

The preliminary design and economic assessment of small wastewater treatment plants (less than 2000 population equivalent) are issues of particular interest since wastewaters from most of these agglomerations are not covered yet. This work aims to assess nine different technologies set-up for the secondary treatment in such type of facilities embracing both economic and environmental parameters. The main novelty of this work is the combination of an innovative environmental decision support system (EDSS) with a pioneer approach based on the inclusion of the environmental benefits derived from wastewater treatment. The integration of methodologies based on cost-benefit analysis tools with the vast amount of knowledge from treatment technologies contained in the EDSS was applied in nine scenarios comprising different wastewater characteristics and reuse options. Hence, a useful economic feasibility indicator is obtained for each technology including internal and external costs and, for the first time, benefits associated with the environmental damage avoided. This new methodology proved to be crucial for supporting the decision process, contributing to improve the sustainability of new treatment facilities and allows the selection of the most feasible technologies of a wide set of possibilities.

A knowledge management methodology for the integrated assessment of WWTP configurations during conceptual design

The current complexity involved in wastewater management projects is arising as the XXI century sets new challenges leading towards a more integrated plant design. In this context, the growing number of innovative technologies, stricter legislation and the development of new methodological approaches make it difficult to design appropriate flow schemes for new wastewater projects. Thus, new tools are needed for the wastewater treatment plant (WWTP) conceptual design using integrated assessment methods in order to include different types of objectives at the same time i.e. environmental, economical, technical, and legal. Previous experiences used the decision support system (DSS) methodology to handle the specific issues related to wastewater management, for example, the design of treatment facilities for small communities. However, tools developed for addressing the whole treatment process independently of the plant size, capable of integrating knowledge from many different areas, including both conventional and innovative technologies are not available. Therefore, the aim of this paper is to present and describe an innovative knowledge-based methodology that handles the conceptual design of WWTP process flow-diagrams (PFDs), satisfying a vast number of different criteria. This global approach is based on a hierarchy of decisions that uses the information contained in knowledge bases (KBs) with the aim of automating the generation of suitable WWTP configurations for a specific scenario. Expert interviews, legislation, specialized literature and engineering experience have been integrated within the different KBs, which indeed constitute one of the main highlights of this work. Therefore, the methodology is presented as a valuable tool which provides customized PFD for each specific case, taking into account process unit interactions and the user specified requirements and objectives.

Fate and removal of permethrin by conventional activated sludge treatment

The fate and removal of permethrin during conventional wastewater treatment were evaluated at pilot-plant scale at different concentrations of mixed liquor suspended solids (MLSS) and, hence, different solids retention times (SRT). At feed concentrations of 0.26-0.86 microg L(-1), the permethrin was removed by primary treatment at an efficiency rate of 37%, similar to previously reported data, and from 40% to 83% for secondary treatment, decreasing with decreasing SRT. Comparable ranges, from 37% up to 98%, have been reported for micropollutants with similar physicochemical properties to permethrin, such as galaxolide and tonalide. Little difference in removal was noted between the medium and low MLSS concentrations trials, the main difference in treated effluent permethrin concentration arising on changing from high to medium MLSS levels. This was attributed to the limited acclimatization period employed in these two trials, leading to higher levels of soluble organic matter in the treated water, with which the permethrin appeared to be associated.

Modifying Crystallographic Orientations of Polycrystalline Si Films Using Ion Channeling

Polycrystalline silicon films 4800 Å thick deposited via low pressure chemical vapor deposition on oxidized silicon wafers have been amorphized by silicon ion implantation and subsequently recrystallized at 700°C. Due to channeling of the ions through grains whose <110> axes were sufficiently parallel to the beam, these grains survived the implantation step and acted as seed crystals for the solid-phase epitaxial regrowth of the film. This work suggests the feasibility of combining ion implantation and furnace annealing to generate large-grain, uniformly oriented polycrystal1ine films on amorphous substrates. It is a potential low-temperature silicon-on-insulator technology.

Modifying Polycrystalline Films Through Ion Channelling

A novel low-temperature process to enhance the grain size of a polycrystalline film on an amorphous substrate has been previously reported. In this process, ion implantation is used to selectively anorphize the film, and undamaged grains act as seed crystals in a subsequent low-temperature anneal. In this work, a 120 nm polycrystalline silicon film was implanted from three angles with phosphorous at 150°K. The total dose was l.0×l015/cm2 . Transmission electron micrographs after a partial anneal (700°C for 30 minutes) indicate that some crystallites survived implantation due to ion channelling in the (111) plane. After a 60 minute anneal at 700°C, 7 μm grains were observed.

Comparison of PPCPs removal on a parallel-operated MBR and AS system and evaluation of effluent post-treatment on vertical flow reed beds

The presence in the aquatic environment of xenobiotics such as Pharmaceutical and Personal Care Products (PPCPs) has emerged as an issue of concern. Upgrading sewage treatment quality with modern technologies such as Membrane Bioreactors (MBRs) and/or implementing a further posttreatment might mitigate the release of xenobiotics into surface waters. The performance of two processes treating municipal sewage, a MBR and an Activated Sludge (AS) unit, have been compared in terms of PPCPs removal. Moreover, their effluents were treated using vertical flow reed beds. Both systems were operated under similar conditions, more specifically Hydraulic Retention Time (HRT), maintained at 8 hours, and Sludge Retention Time (SRT) set at 6 and 20 days. Pharmaceuticals belong to therapeutic groups such as antiepileptics (carbamazepine) and analgesics (ibuprofen, naproxen, diclofenac), whereas the personal care products are musk fragrances (galaxolide and tonalide). Xenobiotics removals achieved in the MBR showed better results, particularly for the acidic drugs ibuprofen (87% vs. 50%) and naproxen (56% vs. 6%) operating at low SRT. After filtration through vertical flow reed-beds, PPCPs content in effluents was decreased, below 1 ppb in most cases, improving the effluent quality and confirming reed-beds as an interesting low cost alternative in order to attenuate xenobiotics contamination.

Measurement of CP-violating asymmetries in B0 decays to CP eigenstates

We present measurements of time-dependent CP-violating asymmetries in neutral B decays to several CP eigenstates. The measurement uses a data sample of 23x10(6) Upsilon(4S)-->BbarB decays collected by the BABAR detector at the PEP-II asymmetric B Factory at SLAC. In this sample, we find events in which one neutral B meson is fully reconstructed in a CP eigenstate containing charmonium and the flavor of the other neutral B meson is determined from its decay products. The amplitude of the CP-violating asymmetry, which in the standard model is proportional to sin2beta, is derived from the decay time distributions in such events. The result is sin2beta = 0.34+/-0.20 (stat)+/-0.05 (syst).

Measurements of the bulk, C-axis electromechanical coupling constant as a function of AlN film quality

Piezoelectric thin film AlN has great potential for on-chip devices such as thin-film resonator (TFR)-based bandpass filters. The AlN electromechanical coupling constant, K(2), is an important material parameter that determines the maximum possible bandwidth for bandpass filters. Using a previously published extraction technique, the bulk c-axis electromechanical coupling constant was measured as a function of the AlN X-ray diffraction rocking curve [full width at half maximum (FWHM)]. For FWHM values of less than approximately 4 degrees , K (2) saturates at approximately 6.5%, equivalent to the value for epitaxial AlN. For FWHM values >4 degrees , K(2) gradually decreases to approximately 2.5% at a FWHM of 7.5 degrees . These results indicate that the maximum possible bandwidth for TFR-based bandpass filters using polycrystalline AlN is approximately 80 MHz and that, for 60-MHz bandwidth PCS applications, an AlN film quality of >5.5 degrees FWHM is required.

[Immunomodulation of recurrent urinary tract infections with Urvakol vaccine]

The authors present the results of the URVAKOL vaccine use in clinical practice. The vaccine was administered in the treatment of recurrent cystitis, persistent lower urinary tract infection, chronic pyelonephritis and prostatovesiculitis. The clinical efficacy of the vaccine was assessed by detection of bacteria and leukocytes in the urine, subjective complaints, skin tests and the assessment of selected specific and nonspecific immunity parameters in the urine and saliva. Significantly positive clinical and laboratory responses were observed in patients with uncomplicated cystitis. In the group of persistent urinary tract infections excellent responses were detected in one half of the patients. The remainder half stated disappearance of subjective complaints, but with persistence of pyuria or bacteriuria. Similar results of "improvement" were observed in 10 patients with chronic pyelonephritis. There were no changes of the clinical state observed in patients with chronic prostatitis. (Tab. 5, Fig. 2, Ref. 7.)

[Surgical treatment of hydronephrosis]

The objective of the study was to find the most suitable method of surgery of primary hydronephrosis and congestive horseshoe kidney, based on the authors own experience. The result was the finding that plastic resection operations according to Anderson-Hynes and flap operations in long stenoses and horseshoe kidneys meet the demands which are the prerequisite of favourable therapeutic results.

Electromechanical coupling constant extraction of thin-film piezoelectric materials using a bulk acoustic wave resonator

Thin-film piezoelectric materials such as ZnO and AlN have great potential for on-chip devices such as filters, actuators and sensors. The electromechanical coupling constant is an important material parameter which determines the piezoelectric response of these films. This paper presents a technique based on the Butterworth Van-Dyke (BVD) model which, together with a simple one-mask over-moded resonator, can be used to extract the bulk, one-dimensional electromechanical coupling constant K(2) of any piezoelectrically active thin-film. The BVD model is used to explicitly define the series resonance, parallel resonance, and quality factor Q of any given resonating mode. Common methods of defining the series resonance, parallel resonance, and Q are shown to be inaccurate for low coupling, lossy resonators such as the over-moded resonator. Specifically, an electromechanical coupling constant K(2) of (2.6+/-0.1)% was measured for an (002) c-axis textured AlN film with an X-ray diffraction rocking curve of 7.5 degrees using the BVD based extraction technique.

Chorioamnionitis caused by gram-negative bacteria as an etiologic factor in preterm birth

The role and microbiological causes of infection and inflammation of the chorioamnion were studied in 85 patients with spontaneous preterm deliveries (< 37 weeks) and in 85 control patients with full term deliveries. Microorganisms were isolated from the freshly separated chorioamnion in 55% of preterm and 26% of term deliveries (p < 0.001). Isolation rates of gram-negative enteric bacteria were significantly higher in preterm deliveries than in term deliveries (p < 0.001), whereas differences in the isolation of other bacterial species were not significant. Histological chorioamnionitis was noted in 49% of preterm and 14% of term deliveries (p < 0.001), and was strongly associated with a positive chorioamniotic culture in both groups (p < 0.001). Histological chorioamnionitis was noted in 94%, 54%, and 4% of membranes with gram-negative rods, other microbial species and negative cultures, respectively (p < 0.001). Preterm deliveries were also associated with significantly higher rates of bacterial vaginosis (38% vs. 14%) and isolation of vaginal pathogens (85% vs. 65%). In the case of the majority (88%) of chorioamniotic isolates the same species was isolated in the vagina. The findings suggest that gram-negative enteric rods are important placental pathogens responsible for sub-clinical chorioamnionitis and possibly preterm birth. The findings support the concept that microorganisms ascending from the lower genital tract produce local inflammation, which may result in preterm labour and delivery.

Neurotoxicity after spinal anaesthesia induced by serial intrathecal injections of magnesium sulphate. An experimental study in a rat model

We have previously demonstrated in a rat model that the lumbar intrathecal injection of 0.02 ml 6.3% magnesium sulphate, a concentration iso-osmolar with rat plasma, produces a state of spinal anaesthesia and general sedation which reversed completely after 6 h, without evidence of neurotoxicity, immediately or during the week thereafter. Using the same model and five groups of six animals in each, we administered the same volume and concentration of magnesium sulphate and compared its clinical effects with those of 0.02 ml 12.6% magnesium sulphate, 0.02 ml 2% lignocaine and 0.02 ml 0.9% sodium chloride solution, given as a series of 15 injections on alternate days for a period of 1 month. The animals were then killed and their spinal cords and meninges examined histologically. No significant differences were noted in the times of onset, durations of sensory and motor blockade and the times to full recovery throughout the entire period of 1 month's observation in the animals receiving intrathecal 6.3% magnesium sulphate. In the group receiving 12.6% magnesium sulphate, the time of onset of sensory and motor blockade was shorter and the duration of both parameters was significantly longer than in the former group. Full clinical recovery and resumption of normal eating and drinking took place in both groups throughout the entire series of 15 successive intrathecal injections. Identical, mild, uniform histopathological changes in the spinal cord were seen in all the five groups, including the group in which only the intrathecal catheter was implanted. The complete recovery and benign consequences of repeated intrathecal injections of iso-osmolar magnesium sulphate in a rat model indicate a lack of neurotoxicity and provide an impetus for further trials in larger animal species, before initial clinical trials of this substance, given intrathecally, in humans.

Gastric Mucosal Changes following Gastroplasty: A Comparative Study Between Vertical Banded Gastroplasty and Silastic Ring Vertical Gastroplasty

BACKGROUND: Long-term changes of gastric mucosa following surgery for morbid obesity have never been studied, to the best of our knowledge. As 31 patients in our series presented with various gastrointestinal complaints following surgery, we used this opportunity to study mucosal changes. METHODS: Thirty-seven gastroscopies were performed on 31 patients, 20 patients following Vertical Banded Gastroplasty (VBG) and 11 patients following Silastic Ring Vertical Gastroplasty (SRVG) with various gastrointestinal complaints. Macroscopic appearance of the gastric mucosa was examined and biopsies taken from the proximal gastric pouch, the transitional zone and distal stomach. RESULTS: In most patients, macroscopic appearance of the proximal and distal pouches was normal. Pathological findings were mainly located in the transitional zone and were found mainly in the VBG group. CONCLUSIONS: This study indicates that damage to the gastric mucosa is related to the surgical technique, and mainly to the strip of mesh used in the VBG patients. Since hyperplasia and metaplasia were among the microscopic findings, a question is raised about the possibility of malignant transformation. We suggest that routine post-operative gastroscopies be considered, especially following VBG.

A revised coil for the external cooling of the kidney

The authors describe a coil they have developed for contact peroperative hypothermia of the kidney. This new type of coil eliminates the disadvantages of existing cooling coils, namely slow thermal transfer from kidney to cooling agent due to imperfect contact between the coil and the concave surface of the kidney, use of an inadequately conductive material and thermal losses from the outer surface of the coil. Special features of the coil described here include its construction to match the contours of the kidney, isolation of external shell to reduce thermal losses and continuous monitoring of renal tissue to reduce the danger of overcooling.

Kidney temperature measurement. Thermistors for temperature measurement

During a study of the protective effects of cold on kidney cells under conditions of interrupted blood circulation, it was found that attention must be paid to the temperature of kidney tissue in order to prevent cell damage caused by an excessively reduced temperature. The authors correspondingly developed an instrument for the measurement of kidney tissue temperature where thermal sensors located in a needle are able to measure deep temperature in live tissue under conditions of external hypothermia. Thermal sensors were also placed in a hypothermal coil for contact measurement of surface temperature of a cooled kidney and in a duct for supply of cooling medium into a coil. Construction of these devices is described and basic the characteristics of the thermistor and thermocouple sensors for temperature measurement are presented. After evaluation of advantages of the tested sensors, indications regarding their application are given.

Protection of kidney cell against ischaemic damage by decreased kidney temperature

At normal body temperature, kidney cells are highly sensitive to hypoxia. However, a bloodless operative field is advantageous in some interventions on the kidney. Kidney cells can be protected against the damage that might occur once blood flow has been interrupted pharmacologically or physically by reducing their temperature. The authors compare several methods for achieving renal hypothermia, including a method based on a device they developed themselves to eliminate defects found in existing equipment. The thermal curve obtained when the kidney is immersed in an oil bath cooled to 5 degrees C served as a model for other methods. Using the revised coil developed by the authors, renal hypothermia was achieved safely and efficiently. A combination of pharmacological and physiological methods is preferrable however in order to potentiate the effect of decreased temperature. This method was tested experimentally and then successfully applied in clinical practice.

Miliary Crohn's disease: early or different?

We describe what we take to be the eighth case of miliary Crohn's disease since 1967 with a view to the possibility that miliary Crohn's disease is a disease different from Crohn's disease, and not just an early stage. Miliary Crohn's disease might be a different disease because (a) miliary tubercles are seen so rarely on the serosal surface of the bowel, (b) the 100% chance of finding crowded, typical granulomas in the bowel wall, and (c) the anatomic distribution of the lesion.

[Gallbladder polyps]

There is a relatively high incidence of asymptomatic gallbladder polyps in the general population (1.5-9.5%). We present a 61-year-old woman who had a 22 x 37 mm polyp of the gallbladder.

[Presystolic increasing maximal flow velocity in the intracranial vessels in 3 children with heart failure]

The doppler-sonographic examination of flow velocities in intracerebral arteries is of central importance in the diagnostic evaluation of potential neurologic complications in intensive care patients. Furthermore pulsed Doppler-sonography can assess the hemodynamic consequences of several congenital heart defects (e.g. the ductus arteriosus Botalli). Characteristics of the normal flow profile in the intracranial arteries are the systolic and diastolic forward flow caused by the "Windkessel" function of the aorta. Well known pathologic flow profiles (systolically and diastolically increased flow velocities, diastolically decreased flow velocities and diastolic retrograde flow) occur in neurologic and cardiovascular diseases. We have investigated three children after cardiac surgery, who showed a presystolic increase in the flow velocities, which is clearly different from the flow profiles mentioned above. In our opinion, this abnormal flow pattern is due to a decreased ventricular output in combination with an elevated central venous pressure in these patients.

Intraosseous neurilemmoma of skull--single case report

Intraosseous neurilemmoma is a rare benign tumour of the bone with characteristic radiological and histological features. The most common places of this tumor are mandible, sacrum and vertebral bodies. A case of a not previously reported location of this tumor in the vault of the skull is presented.

[Faulty origin of the right subclavian artery from the pulmonary artery: a rare cause of subclavian steal syndrome in childhood]

A congenital subclavian steal syndrome may be caused by coarctation or interruption of the aortic isthmus or by isolation of a subclavian artery. We describe a patient with D-transposition of the great arteries, a left aortic arch, and isolation of the right subclavian artery which originated from the right pulmonary artery via a right ductus arteriosus. A subclavian steal syndrome was demonstrated noninvasively by echocardiography and doppler sonography of the cerebral arteries. We recommend routine cerebral doppler sonography for all infants with congenital heart disease and unilaterally weak brachial pulses. Since the long term outcome of the congenital subclavian steal syndrome is uncertain the aberrant subclavian artery should be reimplanted at the time of corrective cardiac surgery.

[Personal experience with the treatment of priapism]

The authors discuss the aetiology and therapy of priapism. They deal in detail with different therapeutic approaches and analyze the results with regard to new pathophysiological findings in a group of 23 patients. They mention possible complications and emphasize the necessity of an urgent approach to the solution of this disease. They decide on treatment after assessment of the type of priapism; as to surgical methods they use puncture fenestration according to Winter, if this does not prove satisfactory then they operate according to Al-Ghorab's method.

[Liposarcoma]

During a 12-year period, 10 men and 5 women ranging in age from 22-76 (mean 53 years), were treated for liposarcoma. In 7 the tumor was located in the retroperitoneum, in 5 in the lower extremity and in 1 each, in the back, shoulder and groin. The best results were given by wide excision of the tumor followed by chemo or radiotherapy.

Fine needle aspiration cytology of the pancreas

Fine needle aspiration cytology has been increasingly used in recent years to diagnose pancreatic lesions. During a 6 year period, we performed 33 aspiration cytologies of the pancreas. Twenty-one were performed during exploratory laparotomy, seven under the guidance of computed tomography and five guided by ultrasonography. In seven cases inflammatory lesions were found, while 26 cases were of malignant tumors. Out of these patients, 10 underwent additional tissue biopsy. The correlation between cytology and histology was 100%. We suggest that fine needle cytology of pancreatic and other intraabdominal lesions can be considered an accurate diagnostic procedure.

Cytodiagnosis of soft tissue tumors

The only acceptable definitive diagnosis of a soft tissue mass is histologic or cytologic examination. In recent years, fine-needle aspiration cytology is used in more and more centers for diagnosis of soft tissue masses. We studied 196 aspiration cytologies performed on soft tissue lesions. Out of these, in 48 cases a definitive surgical procedure or open biopsy for histology and further evaluation were performed. There were 25 sarcomas and 23 benign tumors. There was one false negative cytologic result in this group; no false positive cytologies were detected. It seems that cytodiagnosis of soft tissue masses performed by an experienced pathologist is the method of choice, permitting a good diagnostic evaluation, with almost none of the traumatic and oncologic disadvantages of the other methods of biopsy.

Diagnosis of carcinoma of the breast by fine needle aspiration cytology

During a six year period, 1,953 fine needle aspiration cytologies (FNAC) were performed for lumps of the breast. Of these, 355 were diagnosed as carcinoma of the breast. The FNAC was performed on an outpatient basis and the pathologic interpretation was available within 30 to 60 minutes. The treatment strategy was always guided by the clinical impression of the physician. If the results of a suspected mass were negative on FNAC, biopsy was performed and histologic study gave the final diagnosis. There were no false-positive results and only 6 per cent were false-negative findings diagnosed later by open biopsy. The over-all accuracy rate was 90 per cent plus 4 per cent diagnosed on cytologic examination as "suspicious" and which proved to be malignant. Based upon our accumulated results, simplicity of performing the test, its low cost, the extremely low morbidity, the immediate response and, above all, an over-all high accuracy rate, we conclude that FNAC is a highly recommended method for the diagnosis of carcinoma of the breast.