Computed tomography (CT) has been compared to plain radiographs and bronchial washings as a screening tool for lung cancer. In comparison with other screening modalities, CT allows detection of lung lesions at an earlier cancer stage. Technologic improvements have decreased imaging costs, thus making chest CT a more feasible option as a screening tool in the community hospital. In this study, smokers over the age of 45 years with a greater than 20 pack-year smoking history were referred for screening chest CT. Noncalcified nodules larger than 10 mm underwent CT-guided biopsy, and smaller nodules underwent follow-up CT in 3 months. Currently, patients have been followed for 4 years. The prevalence, stage, and histology of lung cancer were compared to study results from academic centers. Eighty-seven patients underwent screening chest CT. The study population was 51 per cent male with a mean age of 64 ± 9 years. Four (3 female and 1 male) patients were biopsied and found to have lung cancer giving a prevalence of 5 per cent. Stage IA disease was found in three patients and stage IIIA disease was found in one patient. Adenocarcinoma was present in two patients, adeno-squamous carcinoma in one patient, and squamous cell carcinoma in one patient. The stage and histology of lung carcinomas in this study were comparable to studies performed at larger institutions. However, the disease prevalence was almost double the highest prevalence found in other studies. This discrepancy could be related to study size, as the patient populations were similar. Clearly, screening chest CT in the community setting is equally efficacious in the diagnosis of lung cancer at earlier stages. Following these patients beyond the 5-year mark will give some insight on the effect of screening chest CT on the mortality of lung cancer.
SHOCK may be defined as a state of tissue underperfusion and cellular hypoxia. Usually the hypoxic state is secondary to circulatory inadequacy, but it is evident that other factors, secondary to shock itself, play an important role in tissue anaerobism. From our studies of patients in shock it became apparent that arterial blood oxygen tensions frequently were less than theoretically expected. Further, oxygen therapy did not improve this abnormality to the degree theoretically possible. These findings suggest that in shock, either shunting occurs through anatomic pulmonary arterial-venous fistulae or that ventilation perfusion abnormalities are present or that both conditions exist. The following studies were undertaken to define these and other phenomena. Methods and Materials Phase I. Concerns 57 patients in shock from various causes treated and studied at the University of Maryland Shock Trauma Unit (Table 1). The patients were grouped according to shock diagnosis, survival rates and whether or not there was pulmonary disease. Pulmonary disease was defined as evidence by history of respiratory symptoms (cough, sputum production, etc.) or
In the experiments reported here we have used amphibian metamorphosis (in the larvae of Ambystoma tig&zunz) as a physiological sign of the effects of the thyroid hormone, pilocarpin and adrena h as stimulators of the parasympathetic and sympathetic nervous system respectively, and injections of thyreoactivator from the anterior lobe of the beef hypophy~is'~ as an activator of the thyroid function.When pilocarpin or adrenalin alone is injected intraperitoneally, no visible effect on metamorphosis is obtained. It will be shown here that the injection of either of these drugs together with thyreoactivator increases the sensitivity of the larvae to the metamorphic action of the thyreoactivator.In one representative experiment (CCCLVI, 1933) a number of the larvae of the tiger salamander were divided into 4 groups : Group "a", controls injected with Ringer solution; Gruup "b, c and d" received triweekly intraperitoneal injections of thyreoactivator extracted from approximately 30 mg. dried anterior lobe, per animal and injection ; group "c" received in addition triweekly injections of 2 mg. pilocarpin-hydrochloride ( Merck) per animal and injection ; group "d" received in addition triweekly injections of 0.05 mg. adrenalin-chloride, 1 :lo00 (Parke, Davis Company), per animal and injection.
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