Surveillance on meticillin-sensitive Staphylococcus aureus colonization and infection in a neonatal intensive care unit.

BACKGROUND: Meticillin-sensitive Staphylococcus aureus (MSSA) infection is a significant health concern in neonatal intensive care units (NICUs). Bacterial colonization increases the risk of subsequent infection, leading to morbidity and mortality. AIM: To report the findings of a retrospective cohort study on the surveillance of MSSA colonization and infection in NICU patients. METHODS: The weekly microbial surveillance results for MSSA colonization in the throat, nose, anus, and groin, as well as invasive and non-invasive MSSA infections, were analysed from November 2020 to June 2022. The MSSA infection and colonization risk were compared after adjustment for confounders by stepwise logistic regression analysis. FINDINGS: Three hundred and eighty-three neonates were screened; 42.8% (N=164) were MSSA colonized. Significant risk factors for MSSA colonization were length of stay, vaginal delivery and extreme low gestational age <28 weeks (ELGAN) (all P<0.05). The surveillance detected 38 (9.9%) mild MSSA infections and 11 (2.9%) invasive MSSA infections. Neonatal colonization with MSSA is a major risk factor for MSSA infection overall (29.3% in colonized/infected vs 70.7% colonized/not-infected and 0.5% in not-colonized/infected vs 99.5% in not-colonized/not-infected infants) and invasive MSSA infections (6.1% in colonized/infected vs 93.9% in colonized/not-infected and 0.5% in non-colonized/infected vs 99.5% not-colonized/not-infected infants). Also, extreme low birth weight (<1000 g), ELGAN and invasive ventilation were significant risk factors for MSSA infections (all, P<0.05). CONCLUSIONS: The link between postnatal MSSA colonization and subsequent MSSA infection offers possibilities for prevention. Additional research is needed to explore the association between vaginal birth and the pathogenesis of neonatal MSSA colonization.

[The association between religious coping styles and psychopathological symptomatology within a Christian population]. / De samenhang tussen religieuze coping­stijlen en psychische klachten in een christelijke bevolkingsgroep.

BACKGROUND: Religious coping can be seen as a method which applies religious resources, including prayer, and trust and appeals to God, in order to deal with stressful situations. AIM: To gain insight into the associations between religious coping styles and mental health and to investigate whether the use of the coping styles differs between mental health care clients and non-mental health care clients with a Christian background. METHOD: The sample consisted of 655 Dutch participants with a Christian worldview, aged 18 to 79 years (M = 42.6, SD = 14.2). 60.9% were female and 49.5% higher educated. Intra- and extramural clients in mental health care were involved. A cross-sectional, online survey was used, combined with an available client database. RESULTS: More use of the collaborative coping style was associated with less psychological complaints. More use of the (passive-)deferring and selfdirecting coping styles was associated with more psychological complaints. Christian mental health care clients used the collaborative and the deferring coping styles less often compared to Christian non-clients. CONCLUSION: The collaborative religious coping style is positively associated with mental health. Mental health care clients amongst them use this style less often compared to non-clients. Awareness of religious coping styles and appropriate support are indicated.

Reproducibility and relative validity of a food frequency questionnaire to estimate intake of dietary phylloquinone and menaquinones.

BACKGROUND/OBJECTIVES: This study aims to investigate the reproducibility and relative validity of the Dutch food frequency questionnaire (FFQ), to estimate intake of dietary phylloquinone and menaquinones compared with 24-h dietary recalls (24HDRs) and plasma markers of vitamin K status. SUBJECTS/METHODS: In a cross-sectional study among 63 men and 58 women, the FFQ was completed three times over a 1-year period and the reproducibility was calculated over these measurements. Twelve-monthly 24HDR were collected to estimate relative validity. In addition, the relative validity of the FFQ, compared with plasma phylloquinone and desphospho-uncarboxylated matrix Gla protein (dpucMGP), was assessed cross-sectionally among 507 postmenopausal women. RESULTS: Intraclass correlations showed a good reproducibility, with correlations ranging from 0.65 to 0.83. The relative validity for phylloquinone intake compared with 24HDR was lower for women (rs=0.28) than men (rs=0.40). The relative validity, compared with 24HDR, for intake of short-chain menaquinones were ranging between 0.30 and 0.34. Long-chain menaquinones showed good relative validity (rs=0.60-0.69). Plasma phylloquinone concentrations were weakly correlated with phylloquinone intake (rs=0.16 (0.07-0.24). Plasma dpucMGP was negatively but weakly correlated with phylloquinone intake (rs=-0.09 (-0.18; -0.01)) and long-chain menaquinones (rs=-0.13 (-0.21; -0.04)), but not with short-chain menaquinones (rs=-0.04 (-0.13; 0.05)). CONCLUSIONS: The FFQ is reproducible to rank subjects for phylloquinone and menaquinone intake.The relative validity of our FFQ, compared with 24HDR, to estimate intake of phylloquinone and short-chain menaquinones was low, but the relative validity for long-chain menaquinones was good. The relative validity of our FFQ, compared with plasma phylloquinone and dpucMGP, was relatively low for both phylloquinone and menaquinone intake.

Limited differences in fish and benthic communities and possible cascading effects inside and outside a protected marine area in Sagres (SW Portugal).

Marine protected areas (MPAs) are a relatively recent fisheries management and conservation tool for conservation of marine ecosystems and serve as experimental grounds to assess trophic cascade effects in areas were fishing is restricted to some extent. A series of descriptive field studies were performed to assess fish and benthic communities between two areas within a newly established MPA in SW Portugal. We characterized benthic macroalgal composition and determined the size, density and biomass of the main benthic predatory and herbivorous fish species as well as the main benthic herbivorous invertebrates to assess indications of top-down control on the phytobenthic assemblages. Fish species were identical inside and outside the MPA, in both cases Sarpa salpa was the most abundant fish herbivore and Diplodus spp. accounted for the great majority of the benthic predators. However, size and biomass of D. spp. were higher inside than outside the MPA. The main herbivorous invertebrate was the sea urchin Paracentrotus lividus, which was smaller and predominantly showing a crevice-dwelling behaviour in the MPA. In addition, P. lividus size frequency distribution showed a unimodal pattern outside and a bimodal pattern inside the MPA. We found significant differences in the algal assemblages between inside and outside the MPA, with higher abundance of turf and foliose algae inside, and articulated calcareous and corticated macrophytes outside the MPA, but no differences in the invasive Asparagopsis spp. The obtained results show differences in predatory fish and benthic community structure, but not in species richness, inside and outside the MPA. We hypothesize these differences lead to variation in species interactions: directly through predation and indirectly via affecting sea urchins behavioural patterns, predators might drive changes in macroalgal assemblages via trophic cascade in the study area. However due to non-biological differences between the two areas it is difficult to suggest that the MPA causes increased biological parameters of targeted species and to assess predatory control and trophic cascade effects in areas where fishing pressure is reduced. It is therefor advisable to design MPAs so that their impacts can be scientifically evaluated in a proper fashion.

Fructose consumption in the Netherlands: the Dutch National Food Consumption Survey 2007-2010.

BACKGROUND/OBJECTIVES: Despite the worldwide scientific and media attention, the actual fructose consumption in many non-US populations is not clear. The aim of this study was to estimate the fructose consumption and its main food sources in a representative sample of the general Dutch population. SUBJECTS/METHODS: In all, 3817 children and adults aged 7-69 years from the Dutch National Food Consumption Survey 2007-2010 were studied. Values for fructose content of the products were assigned using several food composition tables. Diet was assessed with two nonconsecutive 24-h dietary recalls. The Multiple Source Method was used to take into account day-to-day variation and to estimate the habitual fructose consumption. RESULTS: Median habitual fructose intake was 46 g/day, with an interquartile range of 35-60 g/day. In boys, the highest median intake was observed among 14- to 18-year olds: 61 g/day. In girls, those aged 9-13 years reported the highest median intake: 56 g/day. Of total fructose intake, 67% was consumed in the form of sucrose and 33% was consumed as free fructose. Soft drinks constituted the main food source of total fructose (13-29% across age and sex categories), followed by juices (9-12%), fruit (9-18%), cake and cookies (9-11%) and dairy products (6-10%). CONCLUSIONS: Fructose comprised 9% of the mean daily energy intake in the general Dutch population aged 7-69 years. The fructose consumption was somewhat lower than most recent figures from the US. The main food sources of fructose were soft drinks, juices and fruit.

Invasion of Sargassum muticum in intertidal rockpools: patterns along the Atlantic Iberian Peninsula.

Spatial patterns of non-indigenous species show scale-dependent properties. Sargassum muticum is an invasive macroalga widely distributed along the Atlantic Iberian Peninsula. Despite being quite abundant from Norway to South Portugal, there is little information about its patterns of distribution, particularly at a large spatial scale (i.e. thousands of kilometres). Here, we examined the spatial variation in the invasion success of S. muticum from rockpools at multiple spatial scales using a hierarchical design. In addition, we analysed how the richness of native assemblages was related to its invasion success and how this relationship changed over different scales. Most of the variation in the invasion success was found at the smallest scales of pool and plot. Furthermore, the invasibility of native macroalgal assemblages was related to the native species richness, but causes that determined invasion success could not be separated from the effects provoked by the invader. Results suggest that small-scale (centimetres to metres) processes contribute considerably to the heterogeneity of S. muticum invasion success.

Determination of phytase activity in feed by a colorimetric enzymatic method: collaborative interlaboratory study.

Fourteen laboratories participated in a collaborative study (coded fyt9404) and 13 laboratories participated in a study (coded fyt9410) to validate a colorimetric assay for determination of microbial phytase activity in feed. For each study, all laboratories received 6 laboratory samples provided by one commercial supplier (phytase activity levels within the range of 200-400 per kg) to be analyzed in duplicate. Method performance was calculated and statistical calculations were executed according to AOAC guidelines. Results from 3 laboratories for study fyt9404 and from one laboratory for study fyt9410 were excluded from statistical analysis because of invalid data determined during initial review by Youden pair, value versus laboratory. For study fyt9404, repeatability relative standard deviation (RSDr) values ranged from 6.2 to 8.6%, and reproducibility relative standard deviation (RSDR) values ranged from 14.1 to 27.6%. No outliers were identified. For study fyt9410, RSDr values ranged from 3.9 to 7.9%, and RSDR values ranged from 14.0 to 20.5%. With outliers excluded, RSDr values ranged from 2.5 to 7.9%, and RSDR values ranged from 14.0 to 20.5%.

[Endovascular stent implantation as a treatment for iliac artery disease]. / Endovasculaire stentplaatsing als behandeling bij iliacaal vaatlijden.

A stent is an endovascular prosthesis that may be used in the treatment of intermittent claudication caused by lesions of the A. iliaca communis and the A. iliaca externa in which earlier balloon dilatation has proved insufficiently effective. The expansion is caused by inflation of an angioplasty balloon (plastic remodelling: Palmaz stent) or by self-expansion due to elastic transformation as in the Wail stent or to thermic memory metal, as in the Memotherm stent. Evaluation of the literature shows that stent placement is a safe method of treatment. The proportion of initial technical success appears to be higher than that of balloon angioplasty, especially in the treatment of total occlusions. The haemodynamic situation immediately after treatment also appears to be better in case of stent placement. Long-term comparison of the clinical efficacy is not well possible because the published studies differ with regard to patient population, definition of indication and criteria of success.

Impact of different hemodynamic criteria for stent placement after suboptimal iliac angioplasty. Dutch Iliac Stent Trial Study Group.

PURPOSE: To investigate the consequences of different hemodynamic criteria as indications for stent placement after suboptimal iliac angioplasty. MATERIALS AND METHODS: One hundred thirty-six patients with intermittent claudication, on the basis of atherosclerotic disease of the iliac artery, underwent angioplasty. Intraarterial systolic and mean pressures were simultaneously recorded above and below the lesion, with and without vasodilation, and before and after percutaneous angioplasty. These data were used to estimate what proportion of the study population would be eligible for stent placement according to different criteria reported in the literature. Subsequently, the authors compared peak systolic velocity (PSV) ratios during follow-up in their patients, with and without indication for stent placement according to two different criteria. RESULTS: Applying the different thresholds reported in the literature to the patient group shows that stent placement would be indicated in anywhere from 4% to 87% of cases. No difference was observed when PSV ratios were compared in patients with a residual mean pressure gradient of > or = 5 and < or = 10 mm Hg with patients with a residual mean pressure gradient of less than 5 mm Hg. CONCLUSIONS: Application of the various published thresholds as indications for secondary stent placement leads to a wide range in proportion of cases requiring stent placement. Lesions with a residual mean pressure gradient of > 5 and < 10 mm Hg fare as well as lesions with a residual mean pressure gradient of less than 5 mm Hg. The optimal criterion is still not clear.

Determination of neutral lactase activity in industrial enzyme preparations by a colorimetric enzymatic method: collaborative study.

Thirteen laboratories participated in a collaborative study to validate a colorimetric assay for determining neutral lactase activity in industrial enzyme preparations. Each laboratory received 5 duplicate samples with activity levels of 2000 and 5000 neutral lactase units provided by 4 commercial suppliers. Two laboratories did not return results. Method performance was calculated according to AOAC guidelines. From the 11 remaining laboratories, 3 were excluded from statistical analysis because of invalid data determined during initial review by Youden pair, value versus laboratory. Repeatability relative standard deviation (RSDr) values ranged from 3.20 to 8.62%, and reproducibility relative standard deviation (RSDR) values ranged from 8.77 to 16.35%. With outliers excluded, RSDr values ranged from 2.94 to 5.01%, and RSDR values ranged from 7.50 to 13.84%. The colorimetric enzymatic method for determining neutral lactase activity in industrial enzyme preparations has been adopted first action by AOAC INTERNATIONAL.

Randomised comparison of primary stent placement versus primary angioplasty followed by selective stent placement in patients with iliac-artery occlusive disease. Dutch Iliac Stent Trial Study Group.

BACKGROUND: Percutaneous transluminal angioplasty (PTA) is a safe, simple, and successful treatment for intermittent claudication caused by iliac-artery occlusive disease. Primary stent placement has been proposed as more effective than PTA. We compared the technical results and clinical outcomes of two treatment strategies-primary placement of a stent across the stenotic segment of the iliac artery, or primary PTA followed by selective stent placement when haemodynamic results were inadequate. METHODS: We randomly assigned 279 patients with intermittent claudication, recruited from departments of vascular surgery, either to direct stent placement (group I, n=143) or primary angioplasty (group II, n=136), with subsequent stent placement in case of a residual mean pressure gradient greater than 10 mm Hg across the treated site. The main inclusion criterion was intermittent claudication on the basis of iliac-artery stenosis of more than 50%, proven by angiography. All patients had a clinical assessment before intervention and at 3, 12, and 24 months. Clinical success was defined as improvement of at least one clinical category. Secondary endpoints were initial technical results, procedural complications, cumulative patency as assessed by duplex ultrasonography, and quality of life. FINDINGS: In group II, selective stent placement was done in 59 (43%) of the 136 patients. The mean follow-up was 9.3 months (range 3-24). Initial haemodynamic success and complication rates were 119 (81%) of 149 limbs and 6 (4%) of 143 limbs (group I) versus 103 (82%) of 126 limbs and 10 (7%) of 136 limbs (group II), respectively. Clinical success rates at 2 years were 29 (78%) of 37 patients and 26 (77%) of 34 patients in groups I and II, respectively (p=0.6); however, 43% and 35% of the patients, respectively, still had symptoms. Quality of life improved significantly after intervention (p<0.05) but we found no difference between the groups during follow-up. 2-year cumulative patency rates were similar at 71% versus 70% (p=0.2), respectively, as were reintervention rates at 7% versus 4%, respectively (95% CI -2% to 9%). INTERPRETATION: There were no substantial differences in technical results and clinical outcomes of the two treatment strategies both at short-term and long-term follow-up. Since angioplasty followed by selective stent placement is less expensive than direct placement of a stent, the former seems to be the treatment of choice for lifestyle-limiting intermittent claudication caused by iliac artery occlusive disease.

Therapeutic consequences of variation in intraarterial pressure measurements after iliac angioplasty.

PURPOSE: To assess the accuracy of intraarterial measurement of transstenotic pressure gradients for the detection of hemodynamically suboptimal iliac angioplasty. METHODS: In 14 patients, referred for diagnostic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Additional iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the mean difference plus standard deviation (MD +/- SD) and repeatability coefficient (2 x SD). These results were extrapolated to 137 iliac angioplasty procedures with secondary stenting where there was a residual pressure gradient > 10 mmHg. RESULTS: MD +/- SD for repeated measurements at rest and during flow augmentation were 0 +/- 2 mmHg and 1 +/- 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty were 8 +/- 7 mmHg at rest and 17 +/- 5 mmHg following vasodilatation. Inaccurate pressure recordings may have led to inappropriate stent placement in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. CONCLUSION: Variability of intraarterial pressure measurements has little consequence in the detection of hemodynamically significant stenosis after angioplasty.

Radiation-induced brachial plexopathy: MR imaging.

OBJECTIVE: To describe the MR imaging appearance of radiation-induced brachial plexopathy. DESIGN: MR imaging was performed in two patients with the clinical diagnosis of radiation-induced brachial plexopathy and in one with surgically proven radiation fibrosis of the brachial plexus. PATIENTS: Three patients who had had radiation therapy to the axilla and supraclavicular region (two with breast carcinoma and one with Hodgkin's lymphoma) presented with symptoms in the arm and hand. To exclude metastases or tumor recurrence MR imaging was performed. RESULTS AND CONCLUSION: In one patient, fibrosis showing low signal intensity was found, while in two patients high signal intensity fibrosis surrounding the brachial plexus was found on the T2-weighted images. In one case gadolinium enhancement of the fibrosis was seen 21 years after radiation therapy. It is concluded that radiation-induced brachial plexopathy can have different MR imaging appearances. We found that radiation fibrosis can have both low or high signal intensities on T2-weighted images, and that fibrosis can enhance even 21 years after radiation therapy.

Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions. Dutch Iliac Stent Trial Study Group.

PURPOSE: To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. METHODS: We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n = 107) or primary PTA (n = 106), with subsequent stenting in the case of a residual mean pressure gradient of > 10 mmHg (n = 45). Eligibility criteria included angiographic iliac artery stenosis (> 50% diameter reduction) and/or a peak systolic velocity ratio > 2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also during vasodilatation in the case of a resting gradient < or = 10 mmHg. RESULTS: Pressure gradients in the primary stent group were 14.9 +/- 10.4 mmHg before and 2.9 +/- 3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3 +/- 11.3 mmHg pre-PTA, 4.2 +/- 5.4 mmHg post-PTA, and 2.5 +/- 2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. CONCLUSION: Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.

Stent placement after iliac angioplasty: comparison of hemodynamic and angiographic criteria. Dutch Iliac Stent Trial Study Group.

PURPOSE: To assess the diagnostic value of angiography as a guideline for selective stent placement after percutaneous transluminal angioplasty (PTA) of the iliac artery. MATERIALS AND METHODS: Seventy-nine patients (100 iliac artery lesions) with intermittent claudication were treated with PTA and stent placement if they had a residual intraarterial mean pressure gradient of more than 10 mm Hg across the PTA site. Pre- and post-PTA angiograms were used to determine if stent placement was necessary for improvement of the initial result of PTA. Interobserver agreement was determined by using kappa statistics. Pearson correlation coefficients for the percentage of residual stenosis and the pressure gradient after angioplasty were calculated. Sensitivity and specificity of angiography with regard to secondary stent placement were calculated. RESULTS: Observer agreement on stenosis grade before angioplasty was good (mean kappa, 0.65). Agreement on angioplasty results was fair (mean kappa, 0.45). Agreement on selective stent placement on the basis of angiographic criteria was poor to fair (kappa = 0.21-0.62). Correlation between percentage stenosis and pressure gradient was low (Pearson coefficient, 0.01-0.17). The sensitivity and specificity of angiography were 45% and 63%, respectively. CONCLUSION: Angiography is inadequate for determination of a suboptimal angioplasty result. The decision to perform selective stent placement should be made on the basis of hemodynamic measurements.

Management outcome and follow-up of fetal tachycardia.

OBJECTIVES: The aim of this study was to evaluate fetal tachycardia and the efficacy of maternally administered antiarrhythmic agents and the effect of this therapy on delivery and postpartum management. BACKGROUND: Sustained fetal tachycardia is a potentially life-threatening condition in which pharmacologic therapy is reported to be effective. There is ongoing discussion about optimal management. METHODS: A group of 51 patients with M-mode echocardiographically documented fetal tachycardia was studied retrospectively. RESULTS: Thirty-three fetuses had supraventricular tachycardia; 15 had atrial flutter; 1 had two episodes of both; and 2 had ventricular tachycardia. Fetal hydrops was seen in 22 patients. Thirty-four fetuses received maternal therapy with either digoxin or flecainide as the first administered drug (additional drugs were given in 12). Drug treatment was successful in establishing acceptable rhythm control in 82% (84% without, 80% with hydrops). In the latter group the median number of drugs and number of days to conversion were higher. Three patients with fetal hydrops died. In 50% of cases, tachycardia reappeared at delivery: 9 neonates presented with atrial flutter, 14 with supraventricular tachycardia and 1 with ventricular tachycardia. Seventy-eight percent of the group had pharmacologic therapy by 1 month of age and 14% by 3 years. CONCLUSIONS: Fetal tachycardia can be treated adequately in the majority of patients, even in the presence of hydrops, and therefore emergency delivery might not be indicated. Digoxin and flecainide were drugs of first choice and produced no serious adverse effects in this series of patients. The majority of patients do not require prolonged therapy.

Simple and rapid determination of phytase activity.

A simple and rapid method is described for determining the enzymatic activity of microbial phytase. The method is based on the determination of inorganic orthophosphate released on hydrolysis of sodium phytate at pH 5.5.

Fetal arrhythmias.

The increased awareness of fetal arrhythmias by obstetricians and the development of sophisticated fetal echocardiography have established the basis for identification and treatment of these arrhythmias. The development of fetal hydrops is a recognized link to the severity of the arrhythmia. Fetal tachycardias have been diagnosed relatively early in gestation. They may be differentiated into sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, and ventricular tachycardia. The need for prenatal treatment is widely accepted and various modes of therapy are advocated. Oral maternal antiarrhythmic medication is often used, is considered convenient and safe, and provides adequate conversion. The drugs of choice at various centers have included digoxin, flecainide, amiodarone, and a host of combinations, as well as sotalol, which is gaining popularity. At birth, reentry mechanisms are often documented, with frequent relapses of tachycardia, warranting postpartum continuation of treatment. Fetal bradycardias consist of sinus bradycardia (generally related to obstetric pathology) and atrioventricular block. Atrioventricular block may occur secondary to severe congenital heart disease in the fetus or as an isolated phenomenon. The development of isolated total atrioventricular block has been seen to occur from a gestational age of 18 weeks up to term. It is invariably accompanied by the presence of SS-A and SS-B autoantibodies in the mother. Passage of these antibodies across the placenta causes inflammatory disease of fetal atrioventricular node tissue, resulting in fibrosis and atrioventricular block.(ABSTRACT TRUNCATED AT 250 WORDS)

Yearly chest radiography in the early detection of lung cancer following laryngeal cancer.

In a retrospective study of 556 patients (505 men, 51 women) with laryngeal cancer the incidence and prognosis of lung malignancies was studied in patients who were examined yearly by chest radiography. In 69 patients (12.4%) a lung malignancy was diagnosed, with 28 having a histologically confirmed second primary malignancy. All of these 69 patients were men. The incidence of radiologically detected lung malignancies, both second primary and metastatic cancer, is higher and more prolonged following supraglottic carcinoma than following glottic carcinoma. In 47 patients (68%) without symptoms, the lung malignancy was detected by routine annual chest radiography. The survival rate in patients with lung cancer detected by the yearly radiography was significantly higher than in patients diagnosed after symptoms (median survival 10 and 4 months, respectively). However, taking into account the lead time between early radiologic diagnosis and the time a tumor would have been diagnosed following symptoms, the observed survival benefit of yearly radiography was much lower, or even nil.