Adjuvant therapy for colorectal cancer--is there a place for a Northern Ireland study?

Survival from colorectal cancer has not improved over the last four decades despite advances in surgery and anaesthesia. The answer to the question whether adjuvant chemotherapy and radiotherapy will improve survival from the disease can only come from randomised, controlled trails. In the future, immunotherapy and gene therapy may be of benefit but these are still many years from the clinical arena. We believe that current evidence suggests that patients with Dukes B and C colorectal cancer should be entered into trials of adjuvant therapy. This evidence is reviewed below among with estimates of the impact that adjuvant therapy would have on the outcome from this disease in Northern Ireland.     

Ectoparasites of a population of urban gray squirrels in northern Florida

Ectoparasites infesting a population of urban gray squirrels (Sciurus carolinensis Gmelin) in northern Florida were collected monthly during 1974. Eleven species were identified: one flea (Orchopeas howardi (Baker], three suckling lice (Enderleinellus longiceps Kellogg & Ferris, Hoplopleura sciuricola Ferris, and Neohaematopinus sciuri Jancke), one tick (Dermacentor variabilis Say), two mesostigmatid (gamasid) mites (Androlaelaps casalis (Berlese) and A. fahrenholzi (Berlese], and four chiggers (Eutrombicula alfreddugesi (Oudemans), E. splendens (Ewing), Leptotrombidium peromysci Vercammen-Grandjean & Langston, and Parasecia gurneyi (Ewing]. The flea and three suckling lice represent core species of ectoparasites for the gray squirrel; the remainder are probably satellite species. Only E. longiceps varied significantly in prevalence or intensity of infestation among host age groups; subadult squirrels had higher intensities than adults. Peak prevalence of O. howardi occurred in January and attained maximum intensity in March, whereas both prevalance and intensity were minimum in August. Prevalence of H. sciuricola was maximum in November and remained at similar levels through June. It then declined significantly to its minimum in September-October. Intensity of infestation, however, was greatest in August, September, and January. Maximum prevalence of N. sciuri occurred from January to March and was minimum in September; intensity of infestation reached maxima in January, June, and August.     

Cytoprotection by iloprost against paracetamol-induced toxicity in hamster isolated hepatocytes.

1 The ability of iloprost (ZK36374) to protect hamster isolated hepatocytes from the toxic effects of paracetamol and its reactive metabolite N-acetyl-p-benzoquinoneimine (NABQI) was investigated. The cytoprotection provided by iloprost was compared with that of N-acetyl-L-cysteine. 2 Treatment of hepatocytes with either NABQI (0.4 mM) or paracetamol (2 mM) alone resulted in a considerable loss of cell viability, as assessed by trypan blue exclusion or leakage of lactate dehydrogenase, accompanied by an increase in the percentage of viable cells that were blebbed. N-acetyl-L-cysteine (1.25 mM) pretreatment diminished the loss of cell viability and the percentage of blebbed cells resulting from exposure to NABQI or paracetamol, whereas iloprost (10(-16) M to 10(-10) M) pretreatment reduced only the loss of cell viability, not the percentage of viable cells exhibiting blebbing. Pretreatment with N-acetyl-L-cysteine significantly attenuated the depletion by paracetamol of glutathione and decreased the covalent binding of [14C]-paracetamol to cellular proteins, whereas iloprost was without any such effects. 3 The effects of iloprost and N-acetyl-L-cysteine were also investigated by use of a model of paracetamol toxicity in which it is possible to study the biochemical events leading to cell injury separate from the generation of toxic metabolites. Hamster hepatocytes were incubated with paracetamol (4 mM) for 90 min at 37 degrees C during which metabolism of paracetamol occurs with minimal loss of cell viability.(ABSTRACT TRUNCATED AT 250 WORDS)     

Milk nasendoscopy in the assessment of dysphagia.

The bedside assessment of dysphagia may be difficult, due to the inability to witness the act of swallowing directly. The milk test described in this paper gives a good assessment of swallowing, is cheap and easily portable and allows an instant decision to be made without recourse to special investigations.     

Pancreaticojejunostomy for chronic pancreatitis.

The treatment of chronic pancreatitis commonly yields disappointing results. Patients with chronic pancreatitis and a dilated pancreatic duct can be treated by longitudinal pancreaticojejunostomy. In order to evaluate the procedure, 20 patients undergoing pancreaticojejunostomy were followed for a median time of more than 5 years. Their clinical characteristics and outcomes have been compared with a group of 43 patients with chronic pancreatitis and small pancreatic ducts. There were no differences between the two groups in the major epidemiological parameters, except that calcification in the gland was more frequently noted in those with large ducts. The operation of longitudinal pancreaticojejunostomy could be accomplished with an acceptable morbidity. There was one death in the postoperative period. Seventy-six per cent of patients were found to have benefited clinically at five years, compared with 48% of those with small duct disease. This difference was statistically significant. Patients who benefited were defined by four factors; they were carrying out their usual occupation at the time of surgery, they were not narcotic dependent at the time of surgery, they had a pancreatic duct width greater than 7 mm and, they had totally abstained from alcohol from before the operation to the time of follow-up. Longitudinal pancreaticojejunostomy probably remains the best surgical treatment for suitable patients with chronic pancreatitis. The operation should only be performed when the pancreatic duct is greater than 7 mm in width. In such patients the operation produces considerable improvement of pain with minimal metabolic disturbance.     

Elevated levels of acute phase plasma proteins in major depression.

Levels of acute phase and other plasma proteins were measured in 21 men with major depression, 28 men with alcohol dependence, and 12 men who acted as controls. The depressed men had significantly elevated levels of the acute phase proteins, haptoglobin and alpha-1-antichymotrypsin, and of immunoglobulin G. The elevations in haptoglobin and alpha-1-antichymotrypsin were highly correlated with each other, and were correlated with the severity of depression and negatively correlated with the thyroid stimulating hormone response to thyrotropin. The alcoholic men had elevated haptoglobin levels, but significantly decreased levels of immunoglobulin G. These findings provide further evidence for an inflammatory response during depression.     

Executive cognitive deficits in primary dystonia.

Primary dystonia is a disorder of movement for which no consistent pathophysiology has been identified; in the absence of evidence to the contrary, it is assumed to be cognitively benign. We have studied a clinically heterogeneous group of 14 patients with primary dystonia on a battery of neuropsychological tests. Despite well-preserved speed of information processing, language, spatial, memory and general intellectual skills relative to normal controls, we have identified a constellation of attentional-executive cognitive deficits on the Cambridge Neuropsychological Test Automated Battery (CANTAB). Specifically, patients demonstrated significant difficulties negotiating the extra-dimensional set-shifting phase of the IED task. The implications of these findings for the pathophysiology of primary dystonia are discussed. This is, to the best of our knowledge, the first report of a significant cognitive deficit in patients with primary dystonia.     

Fracture of the femoral stem of the Ring TCH hip prosthesis.

We report the clinical and operative details of seven cases of fracture of the femoral stem of the Ring TiMESH cementless hip prosthesis (two were cemented and five uncemented). Six fractures occurred in the proximal one-third of the stem and one at mid-stem. The failures are attributed mainly to two defects in stem design, the narrowness of the anteroposterior dimensions and the depth of the recess for the titanium mesh pads. Great difficulty was experienced in removing the osseo-integrated distal fragments of the broken stems.