Evaluation of possible traumatic thoracic aortic injury using aortography and CT.

To identify and compare the methods of evaluation for suspected traumatic aortic rupture, 1,031 trauma charts from 1983-1989 were reviewed. Fifty-nine patients were evaluated for possible aortic injury. Patients who died before completion of the CT or aortogram were excluded. Widening of the mediastinum on chest x ray was the most frequent indication for follow-up studies. Twenty-five had a CT of the aortic arch alone. No study showed disruption. There were no false negative studies. Thirty patients had only aortography. Twenty-four were read as normal (one false negative). Six were read as positive (one false positive). In four, both studies were performed (CT/aortography--TP/TP, TN/TN, TP/FN, FP/FP). (FP = False Positive, TP = True Positive, FN = False Negative, TN = True Negative.) Six received surgical repair of the aortic injury (one death). In this experience, CT was used successfully as a screening tool for aortic disruption. It was highly sensitive in recognizing aortic injuries when present (100% vs. 75% for aortography) and in most cases did not require aortographic verification. False positive rates were comparable (CT = 3.8%, aortography = 7.7%). Specificity was also comparable (CT = 96%, aortography = 92%). Overall, four aortograms were inaccurate while only one CT was inaccurate. We recommend the use of CT for the evaluation of widened mediastinum in the stable patient.

Cancer family syndrome manifested in an extended kindred.

A large midwestern kindred exhibiting the CFS is described. In the branches of the family identified as "cancer-prone," malignant lesions of the colon, endometrium, ovary and skin have persisted through as many as five successive generations. In all, 29 family members have had 43 primary malignant growths of the CFS target organs. Eighty-three per cent of these lesions were colonic in origin. Cancers in these family members almost always occur at young ages (x = 40 years), and it is not uncommon for family members to have a second, third or even fourth primary malignant lesion develop. In branches determined "cancer-resistant," only isolated cancers have been diagnosed. Recommendations on the management of families, such as this one, are presented.

Report of a family with cancer family syndrome.

A report of the history and management of colonic cancer in two brothers with Cancer Family Syndrome is presented. An analysis is made of the prevalence of colonic and endometrial cancer in this family. The risk to the progeny of affected and unaffected individuals is discussed, and recommendations for screening for early signs of cancer are offered. [Key words: Cancer, colonic, familial; Cancer Family Syndrome.

Surgical manpower and practice patterns in a nonmetropolitan area. Nonmetropolitan surgical manpower.

Surgical practice in a nonmetropolitan area was studied with a field survey of 33 general surgeons and family practitioners. Instruments included a physician interview and questionnaire, a nurse-receptionist questionnaire, a sample of 3,733 office patient records, and a sample of hospital operating room logbooks. The general surgeons reported spending an average of 22 hours a week seeing an average of 74 patients in their office practices. Twenty-six percent of the presenting problems and 32% of the principal diagnoses identified in the sample of general surgeons' office patient records were defined as primary care problems. Twenty-two percent of the problems and diagnoses were defined as specialty surgical problems, such as urological problems. An indication of patient referral was found in 2% of the records. In hospital practice the surgeons estimated spending an average of 14 hours a week in the operating room, and performed an average of seven to eight procedures a week. The mean California relative value (CRV) for each procedure was 10.0 CRV. The family physicians managed patients with a broad range of problems, including surgical, in their office practices, and performed an average of three operative procedures each week in the hospital.