W. Eugene Miller

Screening for lung cancer. A critique of the Mayo Lung Project.

The National Cancer Institute of the United States recently sponsored three large‐scale, randomized controlled trials of screening for early lung cancer. The trials were conducted at the Johns Hopkins Medical Institutions, the Memorial Sloan‐Kettering Cancer Center, and the Mayo Clinic. Participants were middle‐aged and older men who were chronic heavy cigarette smokers and thus at high risk of developing lung cancer. Screening procedures were chest radiography and sputum cytology, the only screening tests of established value for detecting early stage, asymptomatic lung cancer. In the Hopkins and Memorial trials the study population was offered yearly chest radiography plus sputum cytology every 4 months. The control population was offered yearly chest radiography only. In these trials the addition of sputum cytology appeared to confer no lung cancer mortality rate advantage. The Mayo Clinic trial compared offering chest radiography and sputum cytology every 4 months to offering advice that the two tests be obtained once a year. This trial demonstrated significantly increased lung cancer detection, resectability, and survivorship in the group offered screening every 4 months compared with the control group. However, there was no significant difference in lung cancer mortality rate between the two groups. The statistical power of these trials was somewhat limited. Nevertheless, results do not justify recommending large‐scale radiologic or cytologic screening for early lung cancer at this time.

The Fate of Patients with Methyl Methacrylate Cranioplasty

This report is the result of the interest created by the use of methyl methacrylate, an autopolymerizing acrylic resin, as the bone cement in the total replacement arthroplasty of the hip. For many years the use of this substance has been well established in neurosurgery. Its properties of being light, thermally non-conductive, transparent, and easy to mold make it a suitable material for covering skull defects. In 1 940, Zander first performed an acrylic cranioplasty in human patients, and since that time many reports have been published 111#{149} In the early days, the use of heat-cured acrylic made a two-stage procedure necessary in order to obtain a properly fitting plate; the advent of cold-cure, autopolymerizing acrylic simplified the technique to the one-stage procedure of today. The use of methyl methacrylate in cranioplasty differs from that in total hip arthroplasty. First, in the former, polymerization of the cement takes place outside the body; this mitigates the toxic effect of the free monomer, the amount of which is reduced by evaporation, and it also eliminates the effect on bone of the exotherniic reaction of polymerization. Second, in cranioplasty, the acrylic is not subjected to compressive (load) and shearing stresses as it is in total hip arthroplasty; these stresses could conceivably alter the material and modify the tissue reaction to it. And a third difference is that the area of contact of acrylic with bone is limited in the skull, whereas it is large in the pelvis and femur. A search of the literature did not yield any report of ill-effects of acrylic cranioplasties that could be related to the skull plate. We undertook this study to collect data on the long-term effect of methyl methacrylate in contact with bone under the conditions present after cran ioplasty.

The mayo lung project: Preliminary report of “early cancer detection” phase

The Mayo Lung Project has been established to assess the effectiveness of close surveillance in reducing the death rate from bronchogenic carcinoma. Candidates for study are high‐risk patients (men, aged 45 or older, smoking at least one pack of cigarettes daily) with life expectancy of at least 5 years. A lung‐health questionnaire, chest roentgenogram, and 3‐day pooled specimen of sputum provide the basic information. Candidates with positive test results receive appropriate treatment. Those whose initial data are negative are randomized into either a close‐surveillance (participant) group or a control group. Participants are restudied every 4 months. Controls receive whatever medical care they ordinarily would, but no regular restudy except annual follow‐up by letter. This routine will extend over 5 years or more, and tracing 5 to 10 years further. Lung‐cancer death rates in the two groups will be compared. Preliminarily, it appears such programs can be incorporated into private group practices.

Lung Biopsy: Transbronchoscopic, Percutaneous, Open

Transbronchoscopic lung biopsy is the method of choice for nonsuppurative parenchymal disease. In diffuse nodular disease, percutaneous aspiration biopsy is elected. Open lung biopsy is reserved for patients in whom the other methods have failed.

Pulmonary complications after total hip arthroplasty with Charnley prosthesis as revealed by chest roentgenograms.

This study was undertaken to detect roentgenographic evidence of pulmonary disease which could result from the use of acrylic cement in seating the Charnley prosthesis. During the period March 1 , 1 969, through February 28, 1 970, 333 total hip arthroplasties using the Charnley prosthesis were performed on 300 patients. In each case, two packets of powdered polymer and two vials of liquid monomer were used after the usual mixing, one batch in the acetabulum and one in the femur (North Hill Plastics barium-marked Simplex P). Preoperative and postoperative chest roentgenograms were available for 227 patients (242 total hip arthroplasties).

Nonoperative retrieval of an impacted long intestinal tube

SummaryA patient with recurrent intestinal obstruction and jejunocutaneous fistula was referred for treatment of the latter condition. Management with total parenteral nutrition was complicated by bacteremia. Subsequently, a double-lumen tube was passed via an existing gastrostomy for purposes of aspirating above the level of the fistula and infusing approapriate nutrients and fluids distally. A period of marked clinical improvement was followed by increased fistula output and evidence of intestinal obstruction secondary to gaseous distention of a sealed latex terminal balloon which was retrieved only after percutaneous puncture. The unusual complication of prolonged intestinal intubation is discussed with special reference to this nonsurgical method of managing the impacted balloon and tube. Factors affecting balloon distention are discussed and the necessity of venting intestinal balloons reemphasized.