Quality of Life--a personal view.

Quality of Life encompasses many aspects of individual's life experience incorporating socioeconomic factors, housing, interpersonal relationships and job satisfaction. It is strongly affected by changes in health and ageing and the ability to adapt to these changes. Quality of Life may be measured by previously validated instruments, the outcomes of which may changes our clinical direction.

The management of subglottic stenosis in patients with Wegener's granulomatosis.

Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life-threatening.

Pathological features predictive of local recurrence after management by conservation of invasive breast cancer: importance of non-invasive carcinoma.

The pathological features of 236 clinical stage I and II invasive breast carcinomas treated by conservation were reviewed. On follow-up (minimum 2 years) 13 patients (6%) have developed breast relapse, 10 (4%) regional lymph node relapse and 26 (11%) distant metastases. Nineteen patients have died from breast carcinoma.

Stage IB cervical carcinoma: a clinical audit.

All patients with FIGO Stage IB cervical cancer registered with the Department of Clinical Oncology at the Western General Hospital, Edinburgh, during the 6 years from 1979 to 1984 have been reviewed, as part of a continuing programme of clinical audit. Of the 140 patients with Stage IB disease, 68 (49%) were treated by primary surgery of whom 44 (31%) also received adjuvant radiotherapy. Radical radiotherapy was the definitive treatment for 69 patients (49%).

The treatment of Wegener's granulomatosis with glucocorticoids and methotrexate.

Objective: To identify alternatives to daily low-dose cyclophosphamide (CYC) in the treatment of Wegener's granulomatosis (WG).

Methods: An open-label pilot study of weekly low-dose methotrexate (MTX) plus glucocorticoids (GC) for treatment of patients with WG was performed. Twenty-nine patients who did not have immediately life-threatening disease were included.

Sexual morbidity following radiotherapy for germ cell tumours of the testis.

An anonymous questionnaire study was designed to assess sexual function after orchidectomy and radiotherapy for testicular cancer. Questionnaires were sent to: (1) 237 patients treated with orchidectomy and abdominal radiotherapy in Edinburgh from 1974 to 1988; (2) 32 patients under "surveillance" following orchidectomy alone; (3) 402 "normal" age-matched controls. All were asked questions concerning sexual function over the preceding 6 months.

Short report: comparison of two doses of balsalazide in maintaining ulcerative colitis in remission over 12 months.

In a four-centre prospective double-blind trial, 108 patients with ulcerative colitis in remission were randomized to receive balsalazide in doses of 3 g or 6 g/day for 12 months. The patients were assessed at 3-monthly intervals clinically, sigmoidoscopically and with routine haematology and biochemistry. Remission rates of 77% (3 g/day) and 68% (6 g/day) at 12 months were not significantly different.

Primary radiotherapy for T4 breast cancer.

In Edinburgh in 1982, radiotherapy for patients with T4 breast cancer was modified by an increase in tumour absorbed dose from 42.5-45.0 Gy to 60-75 Gy by using tumour boosts and changing from alternate day to daily fractions.

The value of internal fixation and radiotherapy in the management of upper and lower limb bone metastases.

Fifty-four consecutive patients underwent 61 orthopaedic operations for metastatic bone disease affecting the upper and lower limbs. These patients were subsequently managed using a consistent postoperative radiotherapy (RT) policy. There were 27 prophylactic internal fixations and 34 internal fixations of pathological fractures.

Low dose preoperative radiotherapy for carcinoma of the oesophagus: results of a randomized clinical trial.

One-hundred-and-seventy-six patients with potentially operable squamous cell carcinoma or adenocarcinoma of the middle or lower thirds of the oesophagus were randomly assigned to preoperative radiotherapy or surgery alone. Patients assigned to the radiotherapy arm received 20 Gy in 10 treatments over 2 weeks, using parallel opposed 4 MV beams. The preoperative radiotherapy was not associated with any significant acute morbidity or any increase in operative complications.

Locally advanced breast cancer: report of phase II study and subsequent phase III trial.

Twenty-four evaluable patients with stage T4 breast cancer were entered into a phase II study and received chemotherapy comprising cyclophosphamide 1,000 mg m-2 i.v., doxorubicin 50 mg m-2 i.

Wegener granulomatosis: an analysis of 158 patients.

Objective: To prospectively study the clinical features, pathophysiology, treatment and prognosis of Wegener granulomatosis.

Design: Of the 180 patients with Wegener granulomatosis referred to the National Institute of Allergy and Infectious Diseases during the past 24 years, 158 have been followed for 6 months to 24 years (a total of 1229 patient-years).

Measurements: Characteristics of clinical presentation, surgical pathology, course of illness, laboratory and radiographic findings, and the results of medical and surgical treatment have been recorded in a computer-based information retrieval system.

Radical radiotherapy with salvage surgery for invasive bladder cancer: results following a reduction in radiation dose.

The management of invasive bladder cancer in Edinburgh, as in many other centres in the UK, has been by radical radiotherapy, with cystectomy reserved for local treatment failure or relapse. A review of the results of this policy in 1987 highlighted what was felt to be an unacceptably severe morbidity rate of 15%. The dose of radiation was therefore reduced from 55 Gy in 20 daily fractions to 52.

Combined radiotherapy and surgery: local control and complications in early carcinoma of the uterine cervix--the Villejuif experience, 1975-1984.

From January 1975 to December 1984, 441 patients were treated by combined radiotherapy and surgery at the Institut Gustave Roussy (IGR) for Stage IB (288) and II (proximal) (103) carcinoma of the uterine cervix. Standard treatment consisted of pre-operative utero-vaginal brachytherapy (60 Gy) using a mould technique followed by a colpo-hysterectomy and external iliac lymphadenectomy. Overall 5 year actuarial survival for the whole population was 87% and disease-free survival 85%.

Effect of potassium on ventilation in the rhesus monkey.

Increasing the concentration of arterial plasma K+ to 6-8 mM increased ventilation in two sedated analgesic-treated rhesus monkeys who had their end-tidal CO2 held constant during euoxia (arterial oxygen pressure, Pa,O2, ca 100 Torr) and hypoxia (Pa,O2, ca 40 Torr). During euoxia and hypoxia, hyperkalaemia increased ventilation up to 40 and 250%, respectively. This effect was reduced in euoxia and virtually abolished in hypoxia following an abrupt switch to 100% oxygen.

The effect of electromagnetic stimulation of the posterior parietal cortex on eye movements.

The posterior parietal cortex probably plays a central role in the sensorimotor transformations needed to make an accurate saccadic eye movement to a visual target. In an attempt to disrupt the normal programming of saccades, we magnetically stimulated the posterior parietal cortex in human volunteers, 80 ms after a small target moved 5 degrees horizontally from the centre of a VDU screen. Saccadic eye movements were recorded and experimental trials were compared with control, unstimulated trials.

Intractable vasculitis, resorptive osteolysis, and immunity to type I collagen in type VIII Ehlers-Danlos syndrome.

A unique patient with type VIII Ehlers-Danlos syndrome and cutaneous vasculitis, resorptive osteolysis, and cardiac valvular disease is described. Collagen analyses identified morphologic and physical abnormalities of type I collagen. The patient's T lymphocytes could be propagated in vitro with type I collagen and produced a 60-kd lymphokine that bound this protein.

Surveillance of methicillin-resistant Staphylococcus aureus in England and Wales, 1986-1990.

The incidence of methicillin-resistant Staphylococcus aureus in England and Wales was monitored by a weekly reporting scheme from early 1986 to March 1990. Potential coverage was approximately two-thirds of hospital beds. Reporting centres fell from a peak of 210 in 1986 to a low of 101 centres early in 1989 with later recovery.

The value of follow-up in stage II carcinoma of the cervix.

The optimal frequency of clinic follow-up after radical radiotherapy to early cervical cancer is not well established. A retrospective analysis was carried out of 392 patients with FIGO Stage IIA and IIB carcinoma of the cervix treated by radical radiotherapy who attended a radiotherapy clinic for follow-up. A total of 38 (43%) of the 87 locoregional and 25 (38%) of the 66 metastatic relapses were detected at routine clinic visits.

Torsade de pointes associated with perhexiline maleate therapy.

Multiform ventricular tachycardia (torsade de pointes) is a recognised proarrhythmic effect of drugs which prolong the QT interval. A case is now described for the first time where torsade de pointes occurred with the administration of the anti-anginal agent perhexiline maleate.

Source inventory limits.

A new set of values has been developed for exempting sealed sources of radioactive materials from inventory. The criteria for exemption are: (a) the annual occupational dose from external radiation at 1 m from the source is approximately 100 microSv (10 mrem) or less; and (b) the source activity is approximately equal to the annual limit on intake by inhalation or less than 4 X 10(7) Bq (1000 microCi). These criteria were selected to correspond to an annual occupational dose of approximately 50 to 500 microSv (5 to 50 mrem) and a small potential annual risk of approximately 1 X 10(-6) to 1 X 10(-5) fatal cancers or less.