An audit of postoperative radiotherapy after non-curative resection for cancer of the oesophagus.

AIMS: The role of postoperative radiotherapy (PORT) after non-curative resections for cancer oesophagus is not well defined. A policy of offering PORT after non-curative resections for cancer oesophagus has been followed at our institution, and we report an audit of our experience. MATERIAL AND METHODS: Between March 1990 and September 2002, 139 patients underwent resections for cancer oesophagus. Of these, 86 patients received PORT to a dose of 45-50.4 Gy/25-28 fractions. Eleven of these patients also received concurrent and adjuvant 5-fluorouracil (5-FU). Disease-free survival and overall survival were computed from the day of surgery using the Kaplan-Meier method. RESULTS: Seventy-six per cent (65/86) of patients had squamous cell carcinoma and 69% (59/86) of patients had tumours in the lower-third of the oesophagus. The median interval between surgery and PORT was 41 days, and 93% of patients received doses as planned. Strictures at the anastomotic site and ulcerations in the stomach mucosa were seen in 17% and 5% of patients, respectively. The median and 5-year disease-free survival was 12 months (95% CI 9.9-14.1) and 14%; whereas the median and 5-year overall survival was 17 months (95% CI 12.4-21.6) and 17%, respectively. Local and distant failures were seen in 29% and 45% of patients, respectively. CONCLUSIONS: PORT, after a non-curative resection of cancer oesophagus, is well tolerated with acceptable morbidity and survival.

Transurethral resection of the prostate as catheter-free day-care surgery.

OBJECTIVE: To evaluate the feasibility of transurethral resection of the prostate (TURP) as catheter-free day-care surgery. PATIENTS AND METHODS: The study comprised 64 patients (mean age 62.4 years) with a mean (range) American Urological Association symptom score of 21.4 (9-31) and prostate volume (by ultrasonography) of 32.8 (17-50) mL, and with no significant comorbidity. The patients were admitted on the morning of the surgery and, under brief spinal anaesthesia, underwent standard TURP. After surgery the urethral catheter was removed as soon as the effluent was clear. The patients were discharged after they could pass urine freely and with a good stream. RESULTS: The mean duration of catheterization after TURP was 7.15 h; 59 patients (92%) had their catheter removed within 10 h (mean duration 6.42 h). There were no major complications during or after TURP. After removing the catheter, no patients required its reinsertion for failure to void or for clot retention. The mean hospital stay after TURP was 10.7 h and 98% of patients were discharged within 23 h of surgery. CONCLUSION: TURP can be conducted safely in a day surgery setting in patients with mild to moderate benign prostatic enlargement and no coexisting medical illness.

Absence of an effect of naloxone, an opioid antagonist, on luteinizing hormone release in vivo and luteinizing hormone-releasing hormone I release in vitro in intact, castrated, and food restricted cockerels.

The possibility that the tonic secretion of luteinizing hormone (LH) and chicken luteinizing hormone-releasing hormone I (LHRH-I) is regulated by an inhibitory action of endogenous opioid peptides was investigated in cockerels using the opiate receptor antagonist, naloxone. Baseline concentrations of plasma LH in the experimental cockerels were increased by surgical castration or reduced by limiting food intake. Baseline and K(+)-induced releases of LHRH-I from perifused mediobasal-preoptic hypothalami from castrated cockerels were higher than those from hypothalami from intact cockerels. Similarly, baseline and K(+)-induced releases of LHRH-I from perifused mediobasal hypothalami from fully fed cockerels were higher than those from the hypothalami from fasting cockerels. Intravenous injections of 0.1, 1, or 10 mg naloxone/kg body weight failed to increase the concentration of plasma LH in castrated, intact, fully fed, or fasted cockerels. Perifusion of mediobasal-preoptic hypothalami from castrated or intact cockerels with 200 microM naloxone or mediobasal hypothalami from fully fed or fasted cockerels with 10 microM naloxone failed to stimulate the release of LHRH-I. These observations suggest in the cockerel that endogenous opioid peptides may not play an obligatory role in the inhibitory control of the tonic secretion of luteinizing hormone.

Epidemic dropsy in New Delhi.

Forty-five cases of epidemic dropsy were studied from an epidemic in New Delhi. Argemone oil contamination was found in the mustard oil used for cooking. Sanguinarine was detected in the eight urine samples collected within 2-3 weeks of onset of dropsy and its concentration ranged from 0.4 to 3.6 mug/100 ml. Three of the 18 sera were positive for sanguinarine, the concentration being 1.2, 1.6 and 3.6 mug/100 ml. The clinical manifestations and epidemiological factors were studied. Edema of the legs was the most consistent clinical finding, and was present in all the patients. In contrast to the earlier epidemics, three striking features were pigmentation in 33%, hair loss in 77.7% and nontender hepatomegaly in 24.4% of cases. A follow-up of 10 months showed almost complete recovery in all.