Nerves of the thorax: atlas of normal and pathologic findings.

An anatomic and imaging atlas was created to provide detailed information about the six pairs of thoracic nerves (phrenic nerves, vagus nerves, recurrent laryngeal nerves, sympathetic trunks, costal nerves, long thoracic nerves). Serial axial computed tomographic (CT) scans of the normal thorax were obtained and included in the atlas, along with drawings showing the proper location of each nerve relative to adjacent anatomic structures. CT scans obtained in both symptomatic and asymptomatic patients with various thoracic diseases were paired with appropriate drawings and normal CT scans in the atlas. This format was designed to help determine the presence and severity of related disease, including injury from surgery, trauma, or penetrating injury, metastatic disease involvement, and, rarely, primary tumor. Although the nerves of the thorax are rarely identified at cross-sectional imaging, their location can be inferred by localizing easily identified anatomic landmarks. Familiarity with the functional anatomy and clinical significance of the nerves of the thorax is important for the correct interpretation of thoracic images.

Cervical cancer: changing trends in the Wellington region.

AIM: To identify changes in patient and tumour characteristics of women with carcinoma of the cervix treated through the Wellington Regional oncology unit between 1975-89. METHODS: The medical records of the patients treated between 1985-9 were reviewed. The age and stage of disease was noted in each case and results compared with the previous two 5-year cohorts. RESULTS: Over the 15 year period there was no obvious reduction in the incidence of cervical cancer. There was a significant trend towards women presenting with earlier stage disease. In the 1985-9 cohort, patients less than 40 years old were significantly more likely to present with earlier stage disease, and there was no detectable difference between the incidence of cervical cancer in Maori and nonMaori. CONCLUSIONS: The results indicate that cervical screening has not yet made an impact on the incidence of cervical cancer in the greater Wellington region, and possible reasons for this are discussed.

Results of treatment of cancer of the cervix in Wellington 1980-4.

A review was undertaken of all 115 women with invasive carcinoma of the cervix referred for treatment to the Wellington regional centre during the period 1980-4. In comparison with the previous five year period, there were 31 (37%) more patients, and a higher proportion of patients had stage I and II disease. The incidence of disease was significantly greater in Maori compared with nonMaori. Treatment was by various combinations of surgery and radiation according to agreed protocols. The actuarial survival at five years was 73% for the whole group, 89% for 64 stage I patients, 65% for 28 stage II patients and 45% for 19 stage III patients. The actuarial risk of a major treatment complication within the first five years was 8.8%. These results confirm that regional centres in New Zealand employing a multidisciplinary approach to patient assessment and treatment can achieve high cure rates with an acceptable incidence of treatment complications. However, prevention of the disease by effective cervical screening programmes should remain an objective of health services in New Zealand.

Results of treatment of cancer of the cervix in Wellington: 1975-9.

A review was undertaken of all patients treated for invasive carcinoma of the cervix in the Wellington region in the period 1975 to 1979. A total of 84 patients were assessed for the results and complications of treatment. Forty-one were stage I, 18 stage II, 18 stage III, and seven stage IV (FIGO staging). Treatment by different combinations of surgery and radiotherapy for each stage are described. Actuarial survival at five years is 54% for all stages. For stage I it is 86%, stage II 54%, and stage III 44%. There were only seven patients in stage IV. Seven patients (8.3%) suffered major complications, mainly gastrointestinal or genitourinary. Most complications occurred in patients treated with a combination of radical surgery followed by high dose external radiotherapy. This treatment should be reserved for selected patients who can be identified as having a very high risk of recurrence in the pelvis after surgery. Invasive cancer of the cervix is a highly treatable disease, with over half the patients surviving free of disease at five years, but screening programmes for early detection are essential.

The diagnostic possibilities of a modified hysteroscopic technique.

A small diameter laparoscope and 32% dextran solution was used to perform hysteroscopy on 158 patients with a variety of gynaecological problems. Greatest diagnostic value was in patients with irregular menstrual bleeding and lost IUCDS. The technique of hysteroscopy is easy to learn, safe, and complements the traditional dilatation and curettage as a diagnostic procedure.

Lymphocytolytic activity of glucocorticoids in vitro: 51Cr release under equilibrium conditions.

Cytolytic activity of glucocorticoids in vitro is assessed by measuring radiochromium release from steroid-treated thymic lymphocytes under the equilibrium conditions provided by a continuous-labeling technique. Isotope release is a glucocorticoid-specific effect produced at physiological concentrations and is virtually abolished by inhibitors of RNA and protein synthesis. The relative lytic potencies of the steroids tested are comparable to those reported for glucocorticoids as measured by other methods. This procedure not only possesses the advantages typical of isotopic techniques in general, but, in addition, circumvents the problem of "spontaneous" label release associated with the pulse-labeling method. It is a useful alternative to the morphologic examination of cells or the estimation of cell viability for determination of glucocorticoid cytolytic activity.

The partogram: a graphic guide to progress in labour.

The use of the partogram of Philpott, Studd, has proved to be a very valuable aid in the early detection of abnormal progress in labour. The graphic representation of all the relevant data of the labour on one sheet of paper has been received enthusiastically by the nursing and medical staff alike and has allowed the earlier detection of abnormal patterns of labour. It is considered that the partogram should become an essential part of the documentation of labour in all patients.