The secret health care system: guatemala 1988.

There is currently widespread use of health care by undemocratic governments in an effort to control elements of their populations. A number of recently published articles have dealt with this problem. What has not been widely reported is the peoples' response to this situation. This article relates the response of the people of Guatemala and addresses those conditions in Guatemala that reflect the health needs of the people and the government's measures to meet and use these needs for political and military ends. The peoples' response, namely the creation of a clandestine health care system based on the secret training and practice of village health workers is presented. The data were obtained by personal observations, interviews and accounts from recently published periodicals.

Whole lung tomography in metastatic disease.

Because pulmonary metastases in patients with primary neoplasms have both therapeutic prognostic implications, a review was undertaken of 100 patients with primary neoplasms in whom whole lung tomography and chest roentgenography had been performed. Eight (20%) of 28 patients with solitary metastases on conventional films had more than one lesion on tomography. Due to the tomographic findings, therapy was altered in six of those eight. Two (3%) of 72 patients with normal chest roentgenograms had metastases visible on their tomograms. The data indicate the high value of whole lung tomography in determining therapy whenever a solitary metastasis is visible on conventional chest roentgenograms. The 3% pickup rate of metastases in patients with normal chest roentgenograms is less clear-cut but does suggest the contribution tomography can make in patients with potentially curable lesions.

Migration of epicardial pacemaker leads.

The implantation of permanent pacemakers often gives rise to complications. Migration of leads, an unusual complication, occurred in two of our patients with epicardial pacemakers. In one case lead fracture and sussequent displacement due to heart action occurred after an automobile accident. In the second case looping and migration of the wire occurred within a day after implantation although the lead continued to function properly for six months. The probable cause of migration in this patient was excess slack.

Disagreements in chest roentgen interpretation.

Each of 100 chest radiographs selected randomly from a hospital population were read by five experienced radiologists. The films were rich in abnormal findings. Disagreement analysis was performed considering the entire content of the interpretation. The disagreements were graded by a panel as to type (false negative, false positive, and indeterminate) and significance. The overall repeatability of the panel's performance was 75 percent. Forty-one percent of the reports contained potentially significant errors and 56 percent indeterminate disagreements. Among all errors 78 percent were false negatives and 22 percent were false positives. The error rate varied among readers. An average of 25 percent of important findings were omitted by an individual reader. An association between specific abnormalities and the types of disagreement was found.