Cautionary considerations regarding N.O.T.E.S. in oncology

Over the last number of years, the emphasis in abdominal surgery has been to reduce invasiveness and to minimise trauma to the patient. This has led to the rapid development of laparoscopic techniques initially for the surgical management of benign disease and later for the successful management of malignant disease. Laparoscopy has now been shown to provide significant benefits to the cancer patient, in particular the reduction of wound infection, herniation and pain. More recently, benefits have been demonstrated in earlier discharge from hospital and return to normal activity. Laparoscopy has therefore been accepted as at least a valid alternative to open surgery for most types of abdominal cancer.With the objective of reducing invasiveness even more, the last few years has seen a rapid expansion in the development of Natural Orifice Translumenal Endoscopic Surgery (NOTES). Currently, NOTES is still in the early stages of evolution but its potential uses in the field of cancer surgery are already being proposed. To develop NOTES to the stage that it will be safe, effective and widely available for the management of cancer patients represents a huge challenge ranging from the development of equipment and techniques to the demonstration of safety and efficacy in clinical trials as well as training and competence issues. It is still not clear whether these challenges will be surmounted so that NOTES becomes mainstream therapy. A period of ‘watchful waiting’ seems appropriate therefore for the uncommitted general surgeon in order that NOTES may be given time to prove compelling and convincing before its general uptake into routine practice.     

Mammography Doses in N.S.W.

A statewide midline depth dose assessment of the mammography units in N.S.W. is presented the results compared with similar overseas data. Film/Screen units are shown to provide significantly less depth dose to the average patient when compared to the Xerox units in use in N.S.W. Twenty seven percent of the Film/Screen units were found to operate at a peak voltage below a level considered as adequate for proper image quality. A further twenty seven percent of Xerox units were found to operate at a peak voltage above that considered desirable for good contrast. In both cases this may lead to either needless exposure or missed microcalcifications and the need for modifications in either technique or equipment is considered essential.     

Chest X-Ray Changes in A.I.D.S.

Pulmonary complications are common in A.I.D.S. patients, and Pneumocystis pneumonia is the most frequent. The typical pattern is a fine perihilar infiltrate going on to a more pronounced reticulonodular and sometimes to an alveolar filling pattern. This latter pattern may herald respiratory failure. Pneumocystis can cause other unusual patterns, especially when the infection is chronic or is modified by simultaneous infection by other organisms. Other bacterial pulmonary infections have an aggressive course. Tuberculosis, even with a second or subsequent infection, has the radiological changes of a primary infection. Malignancies are most commonly non-Hodgkin's lymphoma and Kaposi's Sarcoma. They have no characteristic appearances. The occurrence of hilar lymphadenopathy in A.I.D.S. patients without Kaposi's Sarcoma, non-Hodgkin's lymphoma, TB or Pneumocystis requires further investigation as nodes are not a feature of A.I.D.S. per se. Although occasionally seen with Pneumocystis pneumonia, lymphadenopathy is more normally seen with Kaposi's Sarcoma, non-Hodgkin's lymphoma or tuberculosis. Because prompt and accurate treatment is essential in the immune compromised patient management of pulmonary infiltrates is based on a tissue diagnosis, either transbronchial or percutaneous biopsy.     

Co-trimoxazole in E.N.T. infections

Co-Trimoxazole (Septran) was used in the treatment of E.N.T. infections. The effectiveness of the drug was confirmed by bacteriological and clinical studies.     

Intraindividual variability in arsenic methylation in a U.S. population.

Several recent investigations have reported associations between a reduced capacity to fully methylate inorganic arsenic and increased susceptibility to arsenic-caused cancer. In these studies, methylation patterns were based on a single assessment of urinary arsenic metabolites collected at the time of cancer diagnosis. However, the latency of arsenic-caused cancer may be several decades, and the extent to which a recent measurement can be used to estimate a person's past methylation pattern is unknown. In this investigation, the distribution of urinary inorganic arsenic, monomethylarsonate, and dimethylarsinate was used to assess intraindividual variation in methylation capacity in 81 subjects with low to moderate arsenic exposures. Multiple urine samples were collected from each subject over a 1-year period. Duplicate analyses done on 27 samples were used to assess laboratory measurement imprecision. The intraclass correlation coefficients (ICC) for the proportion of urinary arsenic as inorganic arsenic, monomethylarsonate, and dimethylarsinate in samples taken an average of 258 days apart, were 0.45 [95% confidence interval (95% CI), 0.23-0.63] 0.46 (95% CI, 0.24-0.64), and 0.49 (95% CI, 0.28-0.66). In analyses of duplicate samples, ICCs for the concentration of arsenic species ranged from 0.87 to 0.93, whereas ICCs for species proportions ranged from 0.63 to 0.76. These data suggest that individual methylation patterns remain fairly stable over time, although variability due to measurement imprecision or intraindividual changes over time does occur. This variability could lead to misclassification of methylation patterns and could bias relative risk estimates in studies of methylation and cancer towards the null.     

Role of F.E.S.S. in chronic sinusitis

Functional endoscopic sinus surgery (FESS) is a new and exciting treatment for chronic sinus disease. A prospective study of 50 patients undergoing FESS was undertaken at the department of Otolaryngology, Dayanand Medical College & Hospital, Ludhiana. Parameters studied included patient symptoms, medical history, medical therapy, radiologic findings, complications and postoperative symptoms. 62% of our patients had sinonasal polypi (ethmoidal polypi 56%, antrochoanal polypi 6%) while 38% had chronic sinusitis. Osteomeatal complex involvement (88%) was the most common preoperative CT scan findings. All the cases were subsequently suhjected to functional endoscopic sinus surgery, studied for post-operative complications and 82% of the patients achieved improvement in preoperative symptoms. It was concluded that FESS is a highly successful treatment for chronic sinus disease.     

Cervical Myelopathy in C.P.P.D. Deposition Disease

Cervical Myelopathy is a rare manifestation of calcium pyrophosphate dihydrate (C.P.P.D.) deposition disease. A case is presented where radiographically non-calcified extradural masses containing C.P.P.D. crystals were present at the C7 level, producing cord compression and neurological symptoms. These masses are thought to represent para-articular deposits related to the adjacent facet joints.