Oesophageal cancer mortality in Europe: paradoxical time trend in relation to smoking and drinking.

The main risk factors for oesophageal cancer previously identified in western Europe are tobacco smoking and alcohol drinking. However, a study of the time trend from 1951 to 1985 of the mortality from oesophageal cancer in 17 European countries shows that, except among the younger age groups in men, oesophageal cancer had either decreased or increased only slightly in most countries. This trend differed from that of lung cancer, cirrhosis and alcohol consumption which had in general increased substantially during the period. The results strongly suggest that population-wide changes in certain undetermined risk/protective factor(s), one possibility of which is the consumption of fruit, had overridden the effect of tobacco and alcohol and resulted in a reduction of oesophageal cancer risk. Apart from further efforts to reduce smoking and drinking, studies to identify the factor(s) will be of great public health importance to the prevention of oesophageal cancer.     

The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

Atrial myxoma: a tumour in search of its origins.

OBJECTIVE--To determine whether atrial myxomas express antigens suggesting a neural origin. DESIGN--A retrospective analysis based on immunohistochemical examination of myxoma tissue. SETTING--Atrial myxomas excised by two tertiary referral cardiothoracic surgical units. SUBJECTS--24 excised atrial myxomas. Three were from known cases of familial myxoma syndrome. METHODS--Immunohistochemical identifications of three neuroendocrine markers (protein gene product (PGP) 9.5, neurone specific enolase (NSE), synaptophysin) and S100 antigen; CD34 and von Willebrand factor; and chi smooth muscle actin to identify possible Schwann cell differentiation, endothelial cells, and smooth muscle cells respectively. RESULTS--The myxoma cells were PGP 9.5 positive in 18, S100 positive in 16, and NSE positive in 12. Of the 12 NSE positive myxomas seven were synaptophysin positive. All tumours that were NSE positive were also S100 and PGP 9.5 positive. The tumour surface was partially covered by myxoma cells, partly by endothelial cells. CONCLUSION--The histological appearances of myxomas with stellate cells embedded within a loose connective tissue stroma, abundant basophil cell infiltration, and the presence of pericellular type IV collagen are similar to nerve sheath tumours (neurofibromas) at other sites. A significant proportion of myxomas also express Schwann cell and neuroendocrine differentiation markers. These features cannot prove the origin of myxomas because tumours may develop aberrant phenotype expression but they do accord with the view that myxomas originate from endocardial sensory nerve tissue.     

The Detection of Metastatic Disease of the Spine in Oncology Patients Using MRI

The value of MRI in the diagnosis and management of patients with primary bone tumours has already been established.The use of MRI in the detection of metastatic spinal disease is discussed in this paper.     

Lung cancer cell type and mining exposure

It is frequently stated that the most common primary lung cancer cell type in asbestos-exposed persons is adenocarcinoma. Recently a contrary opinion has been expressed. This study compares the cell types recorded among deceased South African miners whose lungs were examined at the National Centre for Occupational Health. It supports the opinion that adenocarcinoma is not associated with asbestos exposure. From the large database available, there is no evidence of a consistent association between any particular cell type and specific mining exposure.