Pre-chemotherapy Era Research Articles

Otitic complications.

The prechemotherapy era still remains vivid in the memory of the older physicians, particularly the otologists. Acute infections of the ear with mastoiditis and otitic complications were frequent, dreadful, and often tragic in their outcome. The patient suspected of having a complication of a middle-ear infection was examined carefully and repeatedly, both locally in the region of the involved ear and systemically, in order to detect early signs of spread beyond the middle ear. The otologist was skilled in ophthalmoscopy and neurologic diagnosis and utilized this knowledage.¹Diagnostic measures, such as spinal taps, blood cultures,²Ottenberg differential blood cultures, cultures of ear discharge, and x-rays, were extensively used and their clinical implications clearly understood.^3,4Surgery was the accepted method of treatment and when properly performed was a lifesaving measure. The introduction of the sulfonamides in 1935 and the antibiotics in 1942 brought about a dramatic change in

Bronchiectatic Sequelae of Pulmonary Tuberculosis and Its Subsequent Complications

The following case is presented for the interesting sequelae of far advanced, bilateral pulmonary tuberculosis. In the pre-chemotherapy era, the patient to be discussed would probably have died rather promptly. At the present time, many of these formerly hopeless cases survive, but with extensive residual pulmonary destruction. Bronchiectasis is one form this destruction may assume. The following case report represents the sequelae of bronchiectasis and subsequent complications.

Indefinitely Prolonged Chemotherapy

Tuberculosis of the lungs is the most important and most insidious of the relapsing infections. Often without symptoms or signs of activity for years, it characteristically surprises patient and physician by exploding without warning from so-called stability into grossly progressive disease. It may then become quiescent again, only to repeat the cycle months or years later. Sometimes the process is repeated several times, to terminate fatally decades after the first episode. Thousands of patients have thus died of small improvements followed by fresh bronchogenic disseminations which could not be anticipated. It has always been true that some patients recover and remain well. This was the case prior to chemotherapy. The incidence of relapse, however, in the prechemotherapy era, ranged from 24% to 56% in treated cases.* It has become clear in the last several years that chemotherapy has an important role in the treatment of all cases of active tuberculosis.

Recurrent suppurative mediastinitis eighteen years after the ingestion of a foreign body.

INTRODUCTION For A PATIENT to survive a perforation of the esophagus and a subsequent suppurative mediastinitis in the prechemotherapy and preantibiotic era was a nearmiraculous happening. This is the tragic report of a girl who did just that, only to develop a recurrence of the mediastinal infection 18 years later. This time, in spite of all the modern antibiotic agents and surgical techniques, she never recovered from the complication. The case is presented in elaborate detail because of its many challenging facts, which at one time or another involved nearly every surgical specialty as well as internal medicine and psychiatry. Furthermore, the patient's sudden demise and the unexplainable gross anatomic findings at autopsy made this a most thought-provoking clinical problem. REPORT OF A CASE A 19-year-old white female college student had been in good health until one week prior to Oct. 3, 1952. At that time she was seen