Kala-azar of Unusual Duration, Associated with Agammaglobulinaemia
Authors: M. I. Wright
Journal: BMJ (1959)

~~~~~~~~~~~~~~~~~~~~~~~~~~MEDICAL JOUIRN41- reading, which has proved to be impracticable in con- ventional mobile mass radiography, would present relatively little difficulty at static units with 100-mm.cut films.It is obvious.thateven a large number of these static units would be unable to deal with the periodical routine x-ray examination of all men in the critical age groups, but general practitioners could help by sending for chest x-ray examination all men over 35, irrespective of the reasons for visiting their surgeries.In the meantime,.it would be wrong in our opinion to engage in any form of propaganda that suggests that at present routine mass radiography is a certain means of detecting " early cancer," and attention should not be deflected from the much more important preventive aspects of the present situation. SummaryA series of 238 cases of cancer of the lung in men found by mass radiography in the Midlands are reviewed.Comparisons are made between cases found by conventional routine mass radiography and patients referred to the units by general practitioners.The 12-months-survival rates irrespective of treatment and the resection rates were higher for routine survey cases than for general-practitioner referrals.A larger proportion of routine survey cases had a lobectomy than general-practitioner patients.Various aspects and reasons for these differences are discussed.Symptomatic cases were referred by general practitioners generally without undue delay, and the majority of resections were carried out within the first two months after x-ray examination.The very small number of truly asymptomatic cases and the absence of small peripheral shadows in this series are discussed in their relation to future mass radiography policy.The installation of more 100-mm.x-ray units to deal with a larger number of general-practitioner referrals, particularly of men in the critical age groups, is suggested.ADDENDUM: Second-year Survival Rates.-Since this paper was written a second-year follow-up report has been obtained on all but three patients (two general- practitioner referrals and one routine survey case) of the 238 in the series.Assuming all three had died, there were 38 general-practitioner referrals and 12 routine survey cases alive two years after the date of x-ray examination.Hence the second-year survival rates regardless of treatment for the two survey groups were respectively: G.P. referrals, 20% ; routine survey cases, 25%/,,.The rate for all patients was 21 %.Of the 57 general-practitioner cases and 21 routine survey patients resected, 25 and 8 respectively were alive two years after the date of operation.Hence the secondyear survival rates for the two groups of patients were respectively 44% and 38%, and for both groups combined 42%.We are indebted to the chest physicians and thoracic surgeons in the region for their full co-operation in provid- ing information of patients referred to them.We are grateful to Miss J. M. Levi, of the Birmingham Regional Cancer Registry, for obtaining follow-up details of our patients; to Mrs. M. Sheldon and Miss A. fioldsworth for clerical assistance, and to Miss J. Yates for help with processing of the material.