Radiological exposure evaluation through the computerised electronic records system as decisional support to X-ray examination justification in family medicine.

Background: In recent decades, patients' exposure to ionising radiation (IR) during diagnostic examinations has increased a great deal. X-ray requests do not always conform to the principle of 'justification', which emphasises the real utility and necessity of the examination. Databases maintained by general practitioners usually record all requests for radiological examinations of their patients and could be configured to assess the radiological risk for each patient.

Latency and the lung cancer epidemic among United States uranium miners.

The latency of occupational cancer was a key factor in the recent epidemic of lung cancer among U.S. uranium miners.

Permanent ventricular and dual chamber cardiac stimulation: role of pacing mode in relation to chronic atrial fibrillation risk and stroke development.

Ventricular single chamber permanent cardiac pacing undoubtedly eliminates symptoms related to extremely low cardiac rate, but also contributes to increased morbidity due to onset of permanent atrial fibrillation (PAF). Many studies have shown the superiority of atrial and dual chamber cardiac pacing in reducing atrial fibrillation risk and in preventing correlated embolic complications. It is not known, however, if this advantage is maintained in the elderly and in particular in the oldest old people.

Predicting lung cancer by detecting aberrant promoter methylation in sputum.

Despite the promise of using DNA markers for the early detection of cancer, none has proven universally applicable to the most common and lethal forms of human malignancy. Lung carcinoma, the leading cause of tumor-related death, is a key example of a cancer for which mortality could be greatly reduced through the development of sensitive molecular markers detectable at the earliest stages of disease. By increasing the sensitivity of a PCR approach to detect methylated DNA sequences, we now demonstrate that aberrant methylation of the p16 and/or O6-methyl-guanine-DNA methyltransferase promoters can be detected in DNA from sputum in 100% of patients with squamous cell lung carcinoma up to 3 years before clinical diagnosis.

Five year survival and later outcome of patients with X-ray occult lung cancer detected by sputum cytology.

Background: A cohort of 51 consecutive patients with roentgenographically occult lung cancer, identified by sputum cytology and confirmed by bronchoscopy was reported previously.

Methods: All patients have now been followed beyond 5 years and the causes of death ascertained.

Results: The actual 5-year survival of 27 patients who were resected for cure was 74% including death for all causes.

Radon progeny exposure and lung cancer risk among non-smoking uranium miners.

Studies of miners provide the basis for public health efforts to reduce residential radon progeny exposure. Because the preponderance of households do not have members who smoke indoors, studies of non-smoking miners contribute essential data for risk assessments for residential radon progeny exposure. We studied a cohort of 2,209 never-smokers who were underground uranium miners employed in the western U.

Clinical feasibility of low energy internal atrial cardioversion with a three-electrode configuration in patients with unsuccessful conventional configurations.

Low energy internal cardioversion is a safe and highly effective method for atrial fibrillation termination. We will describe 6 patients in whom the conventional 2-electrode systems with the defibrillation leads positioned in the right atrium and in the coronary sinus or left pulmonary artery failed to terminate the arrhythmia despite the use of maximal available energies. A 3-electrode configuration including right atrium, coronary sinus and left pulmonary artery was used in order to encompass as much atrial mass as possible between the cathode and the anode.

Paroxysmal supraventricular tachycardia caused by 1:2 atrioventricular conduction in the presence of dual atrioventricular nodal pathways.

One-to-two atrioventricular conduction, ie, the double response to a single sinus or atrial impulse, resulting in two QRS complexes for one P wave, is a rare manifestation of dual atrioventricular (AV) nodal pathways. This report describes the case of a 61-year-old woman with continuous episodes of supraventricular tachycardia caused by independent conduction to the ventricles of sinus impulses over both the fast and the slow AV nodal pathway, giving rise to a ventricular rate that was twice the sinus rate. A wide spectrum of electrocardiographic manifestations of 1:2 AV conduction was observed on the surface electrocardiogram.

Efficacy of two sputum collection techniques in patients with air flow obstruction.

Objective: To compare the efficacy of two sputum collection techniques in patients with chronic obstructive pulmonary disease (COPD) in order to diagnose dysplasia or neoplasia.

Study Design: This was a crossover study design comparing induced sputum with sputum collected at home. One hundred seven patients with COPD were enrolled.

Aberrant methylation of p16(INK4a) is an early event in lung cancer and a potential biomarker for early diagnosis.

The p16(INK4a) (p16) tumor suppressor gene can be inactivated by promoter region hypermethylation in many tumor types including lung cancer, the leading cause of cancer-related deaths in the U.S. We have determined the timing of this event in an animal model of lung carcinogenesis and in human squamous cell carcinomas (SCCs).

Saccomanno smear slides and Megafunnel slides for sputum specimens. A comparison.

Objective: To compare Megafunnel slides to standard Saccomanno smear slides of sputum specimens and evaluate the use of Megafunnel slides for retrospective studies.

Study Design: Papanicolaou-stained Saccomanno smear and Megafunnel slides (Shandon Lipshaw, Inc., Shandon Inc.

Concurrent fluorescence in situ hybridization and immunocytochemistry for the detection of chromosome aberrations in exfoliated bronchial epithelial cells.

Objective: A procedure was developed to allow concurrent detection of chromosome aberrations and identification of bronchial epithelial cells.

Study Design: Fluorescence in situ hybridization for chromosome 7 and immunocytochemistry for cytokeratin were performed on exfoliated bronchial epithelial cells in a sputum sample from a cancer patient.

Results: The Spectrum Orange-labeled alpha satellite probe for chromosome 7 produced red fluorescence, nuclei were counterstained with 4,6-diamidino-2-phenylindole (blue), and cytokeratin was visualized using a fluorescein isothiocyanate (FITC)-conjugated secondary antibody (green).

Identification of a novel region of homozygous deletion on chromosome 9p in squamous cell carcinoma of the lung: the location of a putative tumor suppressor gene.

Cytogenetic and molecular studies have implied the presence of tumor suppressor genes (TSGs) on chromosome 9p that are critical in the development of lung and other cancers. The p16/CDKN2 gene, a cyclin dependent kinase inhibitor, is a well-defined TSG on 9p21. Although the frequency of mutations in the p16/CDKN2 gene has been detected in approximately 30% of non-small cell lung cancer, loss of heterozygosity on 9p has been observed in greater than 70% of non-small cell lung cancers.

Dual chamber pacing in the treatment of congestive heart failure.

The present work reviews current literature and the authors' experience of dual chamber pacing in the treatment of patients with congestive heart failure (CHF). In these patients, the atrial contribution to ventricular filling may be less than optimal, especially in the presence of first degree atrioventricular block or mitral insufficiency, both of which are common in the elderly subject with CHF. Dual chamber pacing with short atrioventricular delays has proved effective in enhancing ventricular filling and, in selected cases, cardiac output, with improvement in clinical and instrumental parameters of heart failure.

Cytopathological analysis of sputum in patients with airflow obstruction and significant smoking histories.

Advances in the understanding of lung cancer biology have led to observations that specific genetic changes occur in premalignant dysplasia. These observations have occurred predominantly in molecular studies of resected lung tumors and consequently, they may not be fully representative of those biological abnormalities characterizing premalignant lesions in individuals without overt lung cancer. Studies of premalignant epithelial cell biology and chemoprevention are needed in this patient subgroup.

Automated sputum screening with PAPNET system: a study of 122 cases.

The use of interactive, computerized PAPNET system (Neuromedical Systems, Inc, Suffern, NY) for screening of cervicovaginal smears has been favorably evaluated in several studies. In this article, the authors report on the performance of this apparatus on smears of sputum. One hundred twenty-two randomly selected, single slides of sputum specimens from an equal number of patients were subjected to PAPNET scanning.

A comparison between the localization of lung tumors in uranium miners and in nonminers from 1947 to 1991.

Background: Lung cancer was noted to be increased in cigarette smoking miners and nonminers. Carcinogen particulates deposit differentially in the central, middle, and peripheral zones of the bronchial tree depending on the size of the particle. The object of this study was to evaluate the incidence of tumors; their cell types; and the relationship of particulate size to their position in the bronchial tree.

Examination of p53 alterations and cytokeratin expression in sputa collected from patients prior to histological diagnosis of squamous cell carcinoma.

Mutations in the p53 gene are detected in greater than 50% of squamous cell carcinomas of the lung and to a lesser extent in adenocarcinomas. The p53 protein is also overexpressed in a relatively high percentage of preinvasive lesions of the bronchial epithelium. However, unlike tumor tissue, immunoreactivity does not necessarily imply that cells in preinvasive lesions carry a mutant p53 allele.

[Prognostic value of ECG changes detected by Holter monitoring in silent ischemic heart disease in the aged].

Ischemic Cardiomiopathy (IC) is the main cause of morbidity and mortality in the elderly and its incidence increases progressively with age. Holter monitoring (HM) is used to study IC which reveals asymptomatic ischemic episodes identifiable with the depression of the ST tract. It has been demonstrated that these electric manifestations have the same unfavourable diagnostic value as those accompanied by pain.

[Femoro-popliteal bypass with reversed saphenous vein. Experience in a General Surgery Department].

Femoro popliteal bypass with reversed saphenous vein are "the gold standard" for revascularization of lower extremities with femoro popliteal occlusion. This form of therapy is usually performed in a Vascular Surgery Department. We report the experience of a General Surgery Department, with patency of 90% at two years.

p53 and K-ras in radon-associated lung adenocarcinoma.

Mutations in the p53 tumor suppressor gene and the K-ras proto-oncogene are common genetic defects in lung cancer. Analysis of the patterns of damage in these genes may provide important insights into the mechanisms by which environmental mutagens initiate cancer. Previously, our laboratory found that a rare p53 codon 249 mutation (AGG(ARG) to ATG(MET) transversion) was present in 31% of a series of 52 large and squamous cell lung cancers from uranium miners, suggesting that this mutation might be a marker for radon exposure.

Permanent cardiac pacing and thromboembolic risk in elderly patients.

In patients undergoing permanent cardiac pacing, the maintenance of atrial contractility is important to ensure adequate ventricular filling and to guarantee an optimal ventricular ejection capacity. The appropriate pacing mode, assuring a suitable mechanical atrioventricular coupling, prevents the onset of atrial fibrillation and contributes to reduction of the risk of subsequent systemic and pulmonary thromboembolic episodes. We examined 461 patients (266 males and 195 females, aged between 52 and 97 years, average age 76.

Outcome of 51 patients with roentgenographically occult lung cancer detected by sputum cytologic testing: a community hospital program.

Background: Lung cancer is the most common fatal malignant neoplasm of both men and women. It is usually caused by tobacco smoke. However, at present there is no systematic approach to early diagnosis.

Reproducibility of major diagnoses in a binational study of lung cancer in uranium miners and atomic bomb survivors.

A binational panel of four Japanese and four American pathologists examined 208 pulmonary neoplasms, according to the World Health Organization (WHO) recommendations, second edition, for the histologic typing of lung tumors. The study design included independent evaluations by pathologists working alone, followed by group reviews. The individual evaluations, and their implications for reproducibility of the WHO recommendations, are reported.

p53 mutation hotspot in radon-associated lung cancer.

Mutations in gene p53 are the most common defects in lung cancer and may be a pathway through which environmental carcinogens initiate cancer. We investigated p53 mutations in lung cancers from uranium miners with high radon exposure. 16 (31%) of 52 large-cell and squamous-cell cancers from miners contained the same AGG to ATG transversion at codon 249, including cancers from 3 or 5 miners who had never smoked.