Between 1966 and 1980, 72 patients with operable carcinoma of the lung were treated primarily with radiotherapy because coexisting, nontumor related medical problem, or patient refusal prevented thoracotomy. We compared results obtained in this group with results obtained by thoracotomy in 123 consecutive patients over the age of 70, who were assessed in a similar fashion, but who underwent thoracotomy. All patients in both groups had proven, nonsmall cell carcinoma of the lung without clinical, laboratory, or radiologic evidence of tumor spread. All patients in both groups had a negative staging mediastinoscopy, and bronchoscopic findings consistent with operability. Many of the patients treated with radiotherapy had less than a curative dose as their general medical condition prevented a course of radical radiotherapy. It is apparent, however, that the results of radiotherapy for patients with operable carcinoma of the lung may be disappointing and that for patients who are marginal in terms of operative risk, the benefits of surgical resection may warrant the risks involved.

A sputum cytology screening program was started for uranium miners in Elliot Lake to help in the early recognition of lung cancer in this high risk group. In order for a surveillance program to be successful a well-defined protocol is required. Because of the number of services required to support this program (coordination centre, laboratory, data centre, family physicians, consultants) the need for timely, accurate communications is extremely important and the data processing requirements are quite complex. This paper describes a computer system developed to help in the overall organization of the sputum cytology screening program and facilitate the complex network of communications. As of February, 1981, 491 participants had registered in the program and 1332 samples had been submitted. We believe it is a model for the occupational health programs required to monitor high risk workers.

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.3%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rare of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but wee generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.

Postspinal headache is not an uncommon complication of dural puncture. In 80% of cases, the headache resolves spontaneously within two weeks. Past treatment by empirical measures was not very successful. The epidural blood patch is a relatively new technique for treatment of postspinal headache. It has always been used within a few days of development of headache. In our patient the epidural blood patch was used successfully 11 weeks after the development of headache.