Richard B. Byrd

Treatment of Tuberculosis by the Nonpulmonary Physician

Because tuberculosis is currently being treated in many instances by the nonpulmonary physician, an evaluation of the skill with which he performs in this capacity was made. A group of 130 patients who had been treated by such physicians was analyzed, using generally accepted criteria for appropriate therapy. Seventy-three of the group were found to have been treated inappropriately. The use of isoniazid in those likely to be resistant to that drug, the use of a single drug in bacteriologically positive disease, and inadequate or excessive drug dosages were among the more common errors. Two thirds of the physicians caring for these patients were internal medicine specialists, half of them board certified. Increased education efforts in regard to this disease at all levels of training must be made.

Isoniazid Chemoprophylaxis: Association With Detection and Incidence of Liver Toxicity

The hepatotoxicity of isoniazid was studied in a double blind fashion in 120 adult patients receiving the drug for chemoprophylaxis. The incidence of abnormal SGOT values was significantly higher in those on the drug, 18.3% having elevated values as compared to 6.7% of those on placebo during the three-month study period. There was no statistical difference in the frequency of symptoms suggestive of liver diseases between the isoniazid and placebo groups. Furthermore, there was no significant relationship between symptoms and elevated SGOTs. Therefore, symptomatology would not appear to be a sensitive method for detecting early isoniazid liver toxicity. From available evidence, biochemical monitoring would appear to detect liver toxicity at an earlier and more reversible stage.

Mediastinal Histoplasmosis with Esophageal Abscess: Two case reports

Two patients were seen with Histoplasma capsulatum infection of mediastinal nodes which had eroded into the esophagus to produce dysphagia. Fungal serologies were of value in the diagnosis in one of the patients. Both patients responded well to amphotericin B therapy. A traction diverticulum was noted to follow healing in 1 patient.

The 30-year trend of bronchogenic carcinoma in Olmsted County, Minnesota, 1935–1964

Abstract The results of trend studies of bronchogenic carcinoma in the Olmsted County population are similar to those derived from mortality statistics and tumor registries assembled elsewhere, although the trends for other diseases in Olmsted County have not always conformed to the results from those other sources. Having available a unique data resource, centered about the records of the Mayo Clinic, which made it possible to avoid many of the methodologic shortcomings of retrospective population studies and permitted the identification of practically all cases of malignancy in the population of Olmsted County, we investigated the incidence and mortality of primary lung cancer in the population of Olmsted County, Minnesota, over the three decades 1935–1964, inclusive. Thus identified were 137 cases of bronchogenic carcinoma (112 male patients, 25 female) diagnosed among Olmsted residents during the years 1935–1964. Tissue specimens were located in 131 (95 per cent) of the cases, and 127 of these could be classified by specific cell type: 40 (31 per cent) adenocarcinoma and 37 (28 per cent) squamous-cell, 26 (20 per cent) small-cell, and 23 (18 per cent) large-cell carcinoma. There was a single case of adenocystic type. The average annual incidence per 100,000 population for males increased rapidly from 3 in the first decade to about 25 in the third, but for females the rate remained about 3 over the three decades. Since the same medical facilities and the same methods of record-keeping, indexing, and retrieval are available for females in the community as for males, the observed upward trend of bronchogenic carcinoma in males presumably is valid and not related to diagnostic procedures nor to any systematic artifact. The upward trend was more marked among urban males than among rural males; the reason for the difference is unknown. As of 1 January 1970, 130 (95 per cent) of the patients had died. The death certificates recorded bronchogenic carcinoma as the underlying cause of death in 116 (90 per cent) of these 130. This study reveals a marked increase over the last 30 years in the incidence rates for primary cancer of the lung and tends to refute the argument that proficiency in diagnosis has accounted for the rise. Such a dramatic upward trend through the same period has not been noted in Olmsted County for other diseases studied in a similar manner.