Is the risk of cancer increased in Asians living in the UK?

The pattern of cancer in white and Asian (Indian, Pakistani, and Bangladeshi) children living in the West Midlands Health Authority Region was investigated using age standardised incidence rates. Two sets of rates were calculated, a 10 year rate (1982-91) using survey based estimates of the ethnic population and a four year rate (1989-92) using the ethnic population counts from the 1991 census. The 10 year rates showed a significantly higher annual incidence of cancer in Asian (159.1/million/year) than in white (130.8) children. The pattern of cancers in Asian children was different, with an excess of lymphomas and germ cell tumours, and a deficit of rhabdomyosarcomas. These findings were confirmed by the four year rates. Although underestimation of the Asian population probably contributes to the apparent excess, there remains cause for concern that UK Asian children may be at higher risk of cancer. Accurate ethnic population figures and confirmatory studies are urgently required.     

Abnormal elastic tissue in cartilage-hair hypoplasia

A 29-year-old white woman had short limbs, hyperextendable joints, fine skin and body hair, anergy to common skin test antigens, subnormal lymphocyte response to phytohemagglutinin, and increased numbers of natural killer cells, characteristic of cartilage-hair hypoplasia, an autosomal, recessively inherited disorder found in America mainly among the old-order Amish. Her forearm skin was hyperextendable and numerous verrucae were present on the digits of her hands. A skin biopsy from hyperextendable skin showed ovoid, 10- to 20-micron bodies in the papillary dermis. Ultrastructurally, the bodies were interpreted as abnormal elastic fibers.     

CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra-abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra-abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre-anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.     

Interventions to promote optimal health outcomes in children with Type 1 diabetes—are they effective?

The incidence of Type 1 diabetes is increasing worldwide, imposing enormous public health costs, as well as profoundly affecting individual quality of life. There is evidence that psychological problems are increased in children with diabetes and this morbidity is often associated with poor metabolic control. Specific risk factors for this dual morbidity are emerging from empirical studies. The next challenge is to identify effective interventions for use with children at risk for adverse mental and physical health outcomes. The intervention literature is reviewed. It is noted that most studies have used diabetes-specific, unstandardized interventions in groups of adolescents, with few interventions trialled with younger children. No study has targeted a specific psychological disorder such as behaviour problems or depression, both of which are known to be increased in children with diabetes and for which effective standardized interventions are available. Attention is drawn to methodological limitations in many of the studies conducted to date and suggestions made to reduce these in future interventions attempting to reduce the burden of illness in children with diabetes.