Treatment of cancer of the cervix with a high-dose-rate afterloading machine (the Cathetron)

Two hundred and ninety-one patients with invasive carcinoma of the cervix uteri were treated by a combination of external beam therapy (telecobalt or 4 Mv Linear accelerator) and a high dose-rate afterloading intracavitary apparatus (the Cathetron). All patients have been followed for a minimum of 3 1/2 years. The five year survival rates are: all patients 55%; Stage I, 81%; Stage IIA, 74%; Stage IIB, 40%; Stage III, 27%. Death was directly attributed to treatment in five patients. We found a serious complication rate of 3% for all patients treated, the major problem being radiation ileitis. It is concluded that high dose-rate treatment offers comparable results to conventional radium therapy; the choice between high and lose dose-rate afterloading systems depends on the number of patients needing treatment and associated economic factors rather than any intrinsic radiobiological advantage of either system.

Diphenhydramine in insomniac family practice patients: a double-blind study

One hundred eleven mildly to moderately insomniac patients participated in a double-blind, placebo-controlled study to establish the efficacy of diphenhydramine as an over-the-counter (OTC) sleep aid. A two-week crossover design was employed in which all patients received both diphenhydramine and placebo for one week each. The daily diphenhydramine dose was 50 mg at bedtime. Results obtained indicate that diphenhydramine improved various sleep parameters, including sleep latency, to a significantly higher degree than did placebo. In addition, patients on diphenhydramine reported feeling more restful the following morning and patients preferred the diphenhydramine drug to placebo despite experiencing more side effects. This study thus supports the use of 50 mg diphenhydramine as an OTC sleep aid in the treatment of temporary mild to moderate insomnia.

Ilio-psoas abscess in Crohn's disease

We encountered 12 patients with psoas abscess in a two-year period. Of these, four were due to Crohn's disease making this the most important single cause of such abscesses in our series. Psoas abscess may be the presenting complaint in Crohn's disease and it should be considered as a possible cause of any psoas abscess from which enteric organisms are cultured.

Reproduction in rabbits after excision of the oviductal isthmus, ampullary-isthmic junction, and uteroisthmic junction

The effect of total deletion of the isthmus, including the ampullary-isthmic junction and the uteroisthmic junction, upon reproduction was determined in 21 rabbits. None became pregnant on the side lacking isthmus, whereas all became pregnant on the intact control side. Eight does were studied using in vivo and in vitro techniques at 18 to 20, 64 to 65, and 136 to 137 hours after mating. Spermatozoa fertilized the ova, with evidence of polyspermy. However, the modified oviduct did not transport fertilized ova into the uterus at the normal time. Furthermore, degeneration was noted from the morula stage onwards. We conclude that the rabbit ova can neither develop normally past the morula stage nor enter the uterus at the normal time in a recognizable form in the total absence of isthmus, and infertility results.

Psychiatric illness in family practice

One hundred twenty patients from each of 6 family practices were surveyed to determine the prevalence of symptom-based psychiatric illness (emotional distress) in family practice. Assessments of presence or absence of emotional distress and the severity of this distress were made using ratings made by the treating physician and by the patient. Nineteen percent of the surveyed patients were designated by their physicians as having "high distress," and 21% by the patient-completed abbreviated Hopkins Symptom Checklist (HSCL-25). High concordance (86.7%) existed between the "case" assessment by the physician and the patient's own rating of distress. For the majority of "high distress" patients, pharmacotherapy was considered the treatment of choice by physicians.

Prolapsing urethral polyp in child with hypospadias

This report details the first published case of a urethral polyp presenting as a prolapse through the proximally displaced meatus of a child with hypospadias. Urethral obstruction, a symptom common to other reported urethral polyps, was absent. The congenital nature suggests a benign neoplastic process as the etiologic factor.

Treatment of locally recurrent carcinoma of the nasopharynx

Forty-two patients with recurrent nasopharyngeal carcinoma in the primary site and/or neck nodes were treated at the University of California, San Francisco, between 1940 and 1974. Sixty-nine per cent of the recurrences appeared within 3 years and 83% within 5 years after initial treatment. Retreatment included external radiotherapy and/or intercavitary radium or cobalt beads in the majority of cases. The actuarial survival rate was 41% at 5 years after first recurrence. Survival rates increased proportionally with increasing time between initial treatment and recurrence. There was no statistically significant difference in survival rates with respect to age, sex, race, or histology. Local soft-tissue or bone necrosis developed in 9 patients, but both conditions were tolerated well.

Behavioral Effects of Reducing the Daily Frequency of Phenothiazine Administration

After an 11-day base line of behavioral observations, 24 chronic female schizophrenics were assigned to two groups matched for alertness. In the first treatment phase, the administration of phenothiazine medication of one group was switched from a multiple-dose schedule (three to four times per day) to a single daily administration, while the total dosage per day was held constant. The second group continued on a multiple administration schedule for 11 days and then was switched to a single daily dosage. A multivariate analysis of variance showed that there was no overall effect (positive or negative) due to the schedule change; however, preplanned t tests showed transitory decreases in nonfunctional behavior. The results are discussed in terms of implications for the administration of phenothiazines and the experimental analysis of drug effects.