Craniotomy for brain metastases: a consecutive series of 316 patients.

OBJECTIVE: To assess the incidence of craniotomy for brain metastases, overall survival (OS), surgical mortality, and prognostic factors in a large, contemporary, consecutive series from a well-defined catchment area. MATERIAL AND METHODS: All patients ≥ 18 years who underwent craniotomies for intracranial metastases at Oslo University Hospital, Rikshospitalet and Ullevål, between 2005 and June 30, 2009 were included (n = 316). Patients were identified from our prospectively collected database and a thorough review of all charts to validate the entered data was performed. RESULTS: The annual incidence of first-time craniotomy for a brain metastasis was 2.6/100,000 inhabitants. Patient age ranged from 25 to 87 years (median 64 years). The 30-day mortality rate was 3.8%. Median OS was 9.2 months. Recursive partitioning analysis was class I in 19.6%, class II in 59.2%, and class III in 21.2% with median OS of 16.2, 8.9, and 5.6 months, respectively (P < 0.001). Lung cancer and melanoma were associated with a higher risk (>1% per year) of developing brain metastases. Significant negative prognostic factors were age ≥ 65, a poor performance score, unstable extracranial disease, presence of extracranial metastases, multiplicity, metastasis in eloquent area, and no post-operative radiotherapy. CONCLUSIONS: In this population study, the annual incidence of a first-time craniotomy for a brain metastasis was 2.6/100,000, the 30-day mortality rate was 3.8%, and median OS was 9.2 months. The well-known prognostic factors were confirmed.

Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme.

OBJECTIVES: To study overall survival (OS), prognostic factors, and repeated surgery in glioblastoma multiforme (GBM). MATERIAL AND METHODS: Retrospective study of 516 consecutive adult patients who underwent primary surgery for a GBM in year 2003-2008. RESULTS: Median age at primary surgery was 63.7 years (range 18.0-88.0). Median OS was 9.9 months. Age > 60 years, poor preoperative ECOG score, bilateral tumor, biopsy rather than resection, and no temozolomide chemoradiotherapy were negative risk factors. Repeat surgery was performed in 65 patients (13%). Median time between first and second surgery was 7 months. Indications for second surgery were increasing neurological deficits (35.4%), raised ICP (33.8%), asymptomatic but reoperated because of tumor progression verified on MRI (20.0%), and epileptic seizures (11%). Patients who underwent repeated surgery had longer OS; 18.4 months vs 8.6 months (P < 0.001). CONCLUSIONS: OS for adult GBM patients was 9.9 months. Negative prognostic factors were increasing age, poor neurological function, bilateral tumor involvement, biopsy instead of resection, and RT alone compared to temozolomide chemoradiotherapy. Our rate of repeated surgery for GBM was 13% and the main indications for second surgery were raised ICP and increasing neurological deficits. In a carefully selected group of patients, repeat surgery significantly prolongs OS.

Glutathione content in human bone marrow and circadian stage relation to DNA synthesis.

DNA synthesis and contents of reduced glutathione (GSH) and oxidized glutathione were determined every 4 hours during a 24-hour period in 70 human bone marrow samples from 10 healthy males. The mean GSH contents during the sampling periods were low, varying from 1.94 to 3.27 nmol/mg protein between the subjects; the mean values for all samples were 2.54 +/- 0.06 nmol/mg protein. The GSH content varied markedly within the individual according to circadian stage (31.0% to 90.2%; mean, 51.4%). Between individuals the mean percentage of cells in DNA synthesis varied from 10.6% to 14.5%, but there was an intraindividual circadian stage-dependent variation, ranging from 48.9% to 274.0% (mean, 126.6%), relative to the lowest value. After adjustment for a slight phase difference between GSH content and DNA synthesis observed for some of the subjects, a statistically significant correlation was found between the GSH content and the fraction of cells in DNA synthesis. The myelosuppressive effect of many chemotherapeutic agents assumed to be detoxified by GSH-dependent mechanism(s) should be considered in the light of the low GSH content in human bone marrow, the circadian variation of DNA synthesis, and the circadian stage-dependent relationship of the GSH content and DNA synthesis.

DNA synthesis and ploidy in non-Hodgkin's lymphomas demonstrate intrapatient variation depending on circadian stage of cell sampling.

Significant circadian cell cycle variations with a maximal number of cells in S-phase during the night have been found in a series of 24 patients (18 men and 6 women) with histologically established non-Hodgkin's lymphomas. Pathological lymph nodes of a total of 26 patients were punctured and aspirated by fine needle technique every 4 h during a single 24-h time span. Twenty-four patients (92.3%) had Stage III or IV disease. Twelve patients (46.1%) had low grade, 10 patients (38.5%) had intermediate grade, and 4 patients (15.4%) had high grade lymphomas according to the Working Formulation. The samples were analyzed by flow cytometry, and DNA synthesis (S-phase) and ploidy were determined according to circadian stage. The individual mean 24-h S-phase varied from 2.2 +/- 1.2% (mean +/- SD) to 24.0 +/- 3.3%. Within the group of patients with low grade lymphomas, a wide range in mean S-phase from 2.4 +/- 1.2% to 9.2 +/- 2.8% was observed. The percentage variation within each patient between the lowest and highest S-phase as compared to the lowest value (range of change) during the 24-h time span varied from 21 to 353%, with a mean range of change of 128 +/- 19%. When each individual S-phase series was converted to percent of mean and combined for analysis by one-way analysis of variance to test for time-effect across 2 12-h time spans (8 p.m.-8 a.m. versus 8 a.m.-8 p.m.), S-phase variation according to circadian stage was found to be statistically significant (P < 0.004), with higher values found in the 8 p.m.-8 a.m. time span. By single cosinor analysis, S-phase yielded a near significant P value of 0.069 for the least-squares fit of a 24-h cosine to all data as percent of mean, with the acrophase found to be near midnight (0.05 h). For those patients with low and intermediate grade lymphomas and with mean S-phase values < 10.0%, we found that mean S-phase was higher during winter (5.8 +/- 0.4%) than during spring (3.8 +/- 0.3%) or during fall (3.6 +/- 0.3%) (P < 0.001, analysis of variance). Twenty-one of the 26 patients (80.8%) had an aneuploid, hypodiploid, or near diploid population in one or several of the repeated samples. For the whole series, the DNA indices for the aneuploid populations varied from 1.09 to 1.96, the median DNA index being 1.20.(ABSTRACT TRUNCATED AT 400 WORDS)

Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients.

PURPOSE: We report survival, prognostic factors, and treatment efficacy in low-grade glioma. PATIENTS AND METHODS: A total of 379 patients with histologic intracranial low-grade glioma received post-operative radiotherapy (n = 361) and intraarterial carmustine (BCNU) chemotherapy (n = 153). Overall survival and prognostic factors were evaluated with the SPSS statistical program (SPSS Inc, Chicago, IL). RESULTS: Median survival (all patients) was 100 months (95% confidence interval [CI], B7 to 113); in age group 0 to 19 years (n = 41), 226 months; in age group 20 to 49 years (n = 263), 106 months; in age group 50 to 59 years (n = 49), 76 months; and for older patients (n = 26), 39 months. Projected survival at 10 and 15 years was 42% and 29%, respectively. Patient age, World Health Organization (WHO) performance status, tumor computed tomography (CT) contrast enhancement, mental changes, or initial corticosteroid dependency were significant independent prognostic factors (p < .05), while histologic subgroup, focal deficits, presence of seizures, prediagnostic symptom duration, tumor category, and tumor stage were not. Patients aged 20 to 49 years with no independent negative prognostic factors (n = 132) had a median survival time of 139 months versus 41 months in patients with two or more factors (n = 33). Patients who presented with symptoms of expansion (n = 97) survived longer when resected (P < .03); otherwise no survival benefit was associated with initial tumor resection compared with biopsy. Intraarterial chemotherapy and radiation doses more than 55 Gy were not associated with prolonged survival. Among 66 reoperated patients, 45% progressed to high-grade histology within 25 months. CONCLUSION: Prognosis in low-grade glioma following postoperative radiotherapy seems largely determined by the inherent biology of the glioma and patient age at diagnosis.

A retrospective study of the value of chemotherapy as adjuvant therapy to surgery and radiotherapy in grade 3 and 4 gliomas.

The aim of this retrospective study was to evaluate the effect of adjuvant chemotherapy among patients < 55 years of age with anaplastic gliomas (historical grade 3, n = 85) with four cycles 4 weeks apart of 160 mg carmustine (BCNU) infused into the internal carotid artery, combined with vincristine 2 mg and procarbazine 50 mg x 3 for 1 week (i.a.BCNU-PV) versus no adjuvant chemotherapy. In glioblastomas (histological grade 4, n = 257) the same chemotherapy was evaluated versus two cycles 4 weeks apart of 160 mg lomustine (CCNU) orally instead of BCNU, combined with vincristine and procarbazine (PCV) versus no chemotherapy. All patients in both groups received radiotherapy. Among glioblastoma patients < 55 years of age there was a significant (P = 0.03), but moderately increased survival in the i.a.BCNU-PV group versus the two other arms that did not differ from each other. This difference could be explained by an uneven distribution of prognostic factors, especially age group (< 50 years versus 50-54 years) in favour of the i.a.BCNU-PV group. In anaplastic gliomas, the median survival in the i.a.BCNU-PV group was 80 months versus 25 months for the no chemotherapy arm (P = 0.004). No significant differences in the distribution of prognostic factors were found between the two therapy arms. We suggest that the role of adjuvant chemotherapy in glioblastomas is unclear, while i.a.BCNU-PV as adjuvant chemotherapy among patients < 55 years of age and with anaplastic gliomas increased survival markedly.

Cause of death and long-term survival in patients with neuro-epithelial brain tumours: a population-based study.

Long-term survivors of neuro-epithelial brain tumours have a higher death rate compared with the general population and the aims of this study were to investigate the causes of death and analyse long-term survival using population-based material. A total of 6209 patients were registered in the period of 1970-1993 with a primary intracranial neuro-epithelial tumour in the The Norwegian Cancer Registry. In a pilot study, a high level of agreement with regard to the cause of death was found between clinical data and the registered cause of death. Underlying causes of death in the whole population were therefore analysed. Most deaths were caused by the primary neuro-epithelial brain tumour within 10 years of diagnosis. Although the numbers were small, the proportion of patients dying from other cancers, vascular disease, infections and accidents continued to rise with time. Survival was computed using the Kaplan-Meier method. For children, survival at 5, 10 and 15 years significantly improved from the time period of 1970-1981 to 1982-1993 (47.9, 43.6 and 43.3% versus 63.8, 59.8 and 59.8%, respectively, P <0.0001). Similar improvements in survival at 5, 10 and 15 years were observed for young adults aged 15-49 years (32.7, 21.3 and 16.5% versus 50.1, 37.5 and 33.1%, for the same time periods, P<0.0001). No such improvement for those aged 50 years and over was observed (corresponding figures of 6.6, 3.8 and 2.8% versus 7.7, 4.8 and 3.4%). Prognosis for those with childhood medulloblastomas improved significantly, as did the prognosis of younger adults with low-grade gliomas and unbiopsied/ unclassifiable grade gliomas.

Prognostic factors in 140 adult patients with non-Hodgkin's lymphoma with systemic central nervous system (CNS) involvement. A single centre analysis.

We examined retrospectively the outcome of patients with non-Hodgkin's lymphoma (NHL) with systemic involvement of the central nervous system (CNS) registered at The Norwegian Radium Hospital (NRH) from 1980 to 1996, in order to evaluate our treatment strategy for these patients. 170 of 2561 patients (6.6%) had CNS involvement, 140 (5.5%) systemic CNS lymphoma (SCNSL) and 30 (1.2%) primary CNS lymphoma (PCNSL). Description of the patients, time of SCNSL diagnosis, symptoms at CNS diagnosis, treatment and survival were registered. The overall median survival for the 140 patients with SCNSL was 2.6 months (95% confidence interval (CI) 2.1-3.2), only 12 patients are alive in complete remission (CR). Patients with CNS involvement at diagnosis, relapse or progression during treatment for NHL had a median survival of 5.4 months (95% CI: 0.3-10.6), 3.8 months (95% CI: 0.0-9.1), and 1.8 months (95% CI: 1.0-2. 7), respectively (P=0.001). 5 of the 8 patients consolidated with high-dose therapy (HDT) are in CR. Paresis was the only symptom that predicted survival for SCNSL. Patients above 60 years of age with CNS involvement at progression or relapse and those with paresis at the time of CNS diagnosis have a dismal prognosis. For these patients supportive therapy only should be considered. For patients under 60 years of age with chemosensitive disease, the trend was toward better prospects, and they should be offered intensive chemo-radiotherapy including HDT with autologous stem cell support.

Prevalence and prognostic significance of epilepsy in patients with gliomas.

The aim of this study was to evaluate the prevalence and prognostic significance of epilepsy in 1028 patients diagnosed in the computer tomography (CT) era with histological low- or high-grade intracranial gliomas. Survival analysis included Kaplan-Meier plots, log-rank tests, logistic regression and Cox's analysis as implemented in the SPSS statistical package. Epilepsy was a positive univariate (P < 0.0001) and multivariate, (P < 0.03) prognostic factor for survival in the total patient group (n = 1028, relative risk of death 0.83, 95% confidence interval (CI) 0.70-0.98) as well as in the high-grade patient group (n = 649, relative risk of death 0.80, 95% CI 0.66-0.96), but not in the group of low-grade glioma patients (P > 0.2). The prevalence of epilepsy in glioblastoma patients was 251/512 (49%), 95/137 (69%) in anaplastic gliomas, and 322/379 (85%) in patients with low-grade gliomas, with 97 of the 102 T1 low-grade subgroup (95%) having epilepsy, indicating that the presence of epilepsy may select patients for early radiological diagnosis. The frequency of epilepsy at presentation decreased with age in high-grade glioma patients, and increased with age in low-grade glioma patients to a plateau in the fourth decade of life (P < 0.01). The prevalence of epilepsy in patients with histological intracranial gliomas varied with patient age and tumour histology, with low-grade patients having the highest prevalence. Epilepsy was a significant positive prognostic factor except in patients with low-grade gliomas, and may select low-grade patients for early diagnosis.

Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis.

PURPOSE: Three databases were pooled and analyzed to determine which groupings of prognostic factors best predicted overall survival for patients with low-grade gliomas treated with surgery and immediate or delayed radiotherapy. METHODS AND MATERIALS: Databases of patients with low-grade gliomas compiled at the London Regional Cancer Centre (LRCC), the Norwegian Radium Hospital (NRH), and the University of California, San Francisco (UCSF) were merged. Inclusion criteria for the pooled analysis included: age > or =18 years and histologically confirmed low-grade (World Health Organization Grade II) supratentorial fibrillary astrocytoma, oligodendroglioma or mixed oligoastrocytoma. Factors analyzed for prognostic significance included: age at diagnosis, gender, seizures at presentation, presence of enhancement on computed tomography (CT) or magnetic resonance imaging (MRI), Karnofsky Performance Status (KPS) at diagnosis, histology, extent of surgical resection, timing of radiotherapy, and treating institution. Univariate and multivariate analysis of overall survival for these factors was performed. Recursive partitioning was performed to generate prognostic groups using these factors. RESULTS: From the combined databases, 401 patients were eligible for analysis. Median survival for the entire group was 95 months/7.9 years. On univariate analysis age 18-40, presence of seizures at presentation, KPS > or =70, treating institution, and absence of contrast enhancement were associated with improved overall survival. On multivariate analysis, these factors remained independent predictors of improved overall survival. Recursive partitioning analysis yielded four prognostic groups with statistically different median survivals (MS): Group I (n = 41: KPS <70, age >40) MS 12 months; Group II (n = 34: KPS > or =70, age >40, enhancement present) MS 46 months; Group III (n = 138: KPS <70, age 18-40 or KPS > or =70 age >40, no enhancement) MS 87 months; Group IV (n = 188: KPS > or =70, age 18-40) MS 128 months. CONCLUSION: Clusters of pretreatment prognostic factors described subgroups of low-grade glioma patients with divergent overall survivals. Consideration of these prognostic subgroups may be important when considering timing of interventions for these patients and in the stratification of patients for clinical trials.

Triglyceride lipase activity and human platelets.

The activity of triglyceride lipases in human postheparin plasma is significantly higher in platelet rich than platelet poor plasma. This holds for total activity, lipoprotein lipase (LPL) activity, and hepatic triglyceride lipase (H-TGL) activity. Gel filtration of platelet rich postheparin plasma on Sepharose 2 B will separate platelets from triglyceride lipase activity. The very small triglyceride lipase activity of isolated platelets is inhibited by 1.0 M NaCl, slightly inhibited by specific antibody to hepatic lipase, and not influenced by specific antibody to lipoprotein lipase.

The effects of a combined alpha- and beta-blocking drug, labetalol, on some aspects of platelet function.

The effects of the combined alpha- and beta-adrenoreceptor blocking agent labetalol on human blood platelets as estimated by platelet aggregation, platelet count, bleeding time and platelet factor 3 activity were studied in 5 patients. The drug reduced adrenaline-induced platelet aggregation in vitro. However, it did not influence the above platelet function test in therapeutic plasma concentrations in vivo.

Anticipatory nausea and vomiting in cancer patients.

The present study reports on a mediating mechanism for anticipatory nausea and vomiting (ANV) in cancer chemotherapy. ANV is usually explained as a classically conditioned response. However, conditioning models have failed to explain individual variation in ANV susceptibility. On the basis of the positive correlation between degree of autonomic reactivity (AR) and conditionability, it is proposed that individual AR is predictive of ANV development. Of the 31 patients who participated in the study, 74% experienced postinfusion nausea and vomiting (PNV). Of the 23 patients who experienced PNV, 52% developed ANV. AR was recorded in a habituation paradigm before chemotherapy treatment was initiated. The patients in the ANV group showed significantly increased sympathetic reactivity as compared with the no-ANV group, implying that AR is a mediator of ANV development.

Circadian phase relationships between peripheral blood variables and bone marrow proliferative activity in clinical health.

Potential life-threatening drug induced side effects to the bone marrow (BM) may be reduced by the proper timing of chemotherapy (chronotherapy) according to circadian stage. Blood and BM samples were obtained concomitantly every 4h for 24h from 16 healthy men (19 series total) to compare circadian patterns in peripheral blood (PB) as reference rhythms for BM DNA. Circadian rhythm characteristics from population mean cosinor summary follow (phi = acrophase): in PB: cortisol, p = 0.014, phi = 13:04h; leukocytes (/mm3), p = 0.001, phi = 00:16h; neutrophils (%WBC), p = 0.001, phi = 15:36h; neutrophils (/mm3), p = 0.101, phi = 22:36h; lymphocytes (%WBC), p = 0.009, phi = 03:24h; lymphocytes (/mm3), p = 0.001, phi = 0.1:40h; in BM:DNA, p = 0.014, phi = 13:04h; and CFU-GM, p = 0.041, phi = 13:12h. When all DNA synthesis (S-phase) values were correlated with PB values by repeatedly advancing the DNA values by 4h, significant correlations with cortisol were found by advancing S-phase by 8h (r = 0.19, p = 0.050). Lymphocytes correlated best with S-phase when shifted by 12h (r = 0.37, p < 0.001), while neutrophils as % of leukocytes (but not absolute counts) correlated significantly when S-phase was delayed by 4h (r = 0.35, p < 0.001). These correlations confirm the phase relationships determined for the circadian rhythms. These findings suggest that the proper timing of an optimized anticancer cytotoxic chronotherapy can be confirmed and guided via sampling of marker rhythms (such as lymphocytes) in peripheral blood which have been found to demonstrate a relatively fixed relation to the circadian stage-dependent variation in unaffected BM proliferative activity.

Prevalence of Norwegian patients diagnosed with childhood cancer, their working ability and need of health insurance benefits.

The object of this study was in a population-based material to investigate the prevalence of patients diagnosed with childhood cancer, and compared to the general population to assess working ability, yearly income and need for health insurance benefits in patients surviving at least five years after treatment for childhood CNS tumours or hematological malignancies. During the period January 1, 1970 to December 31, 2002 the prevalence in the Norwegian population of patients diagnosed with any childhood cancer increased from 12.2 (473/3 888 305) to 65.1 (2944/4 524 066) per 100 000 population. The proportion of survivors in need of any health insurance benefit was for CNS tumours 47.1% and for hematological malignancies 21.0%. The proportion in the age group 16-67 receiving disability pension for CNS tumours was 94/454 (20.7%) compared to 21/575 (3.7%) for patients treated for hematological malignancies (p < 0.001). Of patients given radiotherapy 25/70 (35.7%) received disability pension, compared to 90/959 (9.4%) in unirradiated patients, p < 0.001. Yearly income and working ability was particularly low for CNS tumour survivors. This study illustrates loss of working capability associated with pediatric cancer and treatment and long-term requirement of health insurance benefits.

Impact of intraoperative MRI on the surgical results for high-grade gliomas.

OBJECTIVE: The impact of intraoperative MRI (iMRI) on the surgical procedure, patient outcome and median survival for a series of patients harbouring high-grade gliomas forms the basis of this study. Their outcome has been compared to a matched cohort of patients operated in a conventional manner to determine if the use of intraoperative MRI can be shown to improve the results of surgery and prognosis for this type of patient. MATERIALS AND METHODS: 32 microsurgical open craniotomies, performed in the intraoperative iMRI scanner for grade IV supratentorial gliomas, with follow-up periods of more than 2 months, were analyzed for this study. A group of 32 primary high-grade glioma patients (no recurrent tumors) were matched for age, preoperative clinical grade, gender and histology and operated during a corresponding time interval in a conventional manner acted as controls. RESULTS: All 64 patients were examined and analyzed for the occurrence of postoperative increased neurological morbidity or death. No complications directly related to the intraoperative scanning procedures were observed and no intraoperative death occurred in either group. The average operating time in the intraoperative scanner was 5.1 hours and was significantly longer than in the conventional OR (3.4 hours). The mean overall survival time for the 32 patients in the study group was 14.5 months (95 % confidence interval 12.0 - 16.6) compared to 12.1 months (95 % confidence interval 10.2 - 14.1) for the matched control group. CONCLUSION: Although iMRI is an effective way of imaging residual tumor, this study could not demonstrate an increased efficacy of surgery utilizing this technique for patients harbouring grade IV gliomas compared to more conventional methods. No statistical significance was noted between the two groups (p = 0.14). The complication rate was within the range reported for other series, in both control as well as the study group.

Hypoxic radioprotection by temporary intestinal ischemia: degradable starch microsphere embolization in the cat.

Temporary small intestinal ischemia was induced by mesenteric arteriolar embolization of degradable starch microspheres in cats. During ischemia, the small intestine received a surface dose of 7 Gy 200 kV x-ray irradiation. One group of animals also had received 7 Gy to the intact abdomen 72 hr earlier. The risk of thrombosis in small intestinal vessels during or after starch microsphere-induced ischemia combined with irradiation was evaluated by monitoring superior mesenteric arterial blood flow, by determination of blood platelets, fibrinogen, and factor VIII consumed across the mesenteric vascular bed, and by histologic examination of small intestinal vessels. Vascular integrity was inferred from intact response to isoproterenol and vasopressin after the combined trauma of ischemia and irradiation. No signs of thrombosis were detected in small intestinal vessels after temporary ischemia and irradiation. Hypoxic radioprotection of the small intestine in the cat can thus be achieved by mesenteric arterial microembolization of degradable starch spheres without evidence of thrombotic complications of significant vascular damage.

Temporary ischaemia induced by degradable starch microspheres. Possible thrombogenic effects in vivo and in vitro.

Possible thrombogenic effects of degradable starch microspheres were investigated. Controlled temporary small intestinal ischaemia ws induced by injection into the superior mesenteric artery in cats. Arterial flow consistently recovered after ischaemia. No consumption of blood platelets, fibrinogen, or Factor VIII was observed. Aggregation of human platelets was not influenced by microsphere exposure, and platelet retention in starch microsphere columns was minimal. No thrombosis was detected in feline small intestinal vessels in vivo nor did starch surfaces induce adhesion or aggregation of human platelets in vitro. Thus, no evidence of thrombotic hazards was found by inducing temporary intestinal ischaemia by starch microspheres.

[Press coverage of medical issues]. / Pressedekning av medisinske emner.

We assessed the coverage of medical issues in six Norwegian newspapers during the period January - March 1995. A majority of the articles and a minority of the letters presented neutral information about the national health system. 13% of the articles and 61% of the letters were, in our opinion, critical. Only 2% and 5%, respectively, conveyed unequivocally positive attitudes. In at least three out of 11 incidents, the journalists violated the ethical rules commonly accepted by members of the press for criticism of named health workers. In 503 major articles overall correctness of the medical information, as judged by the authors, was 85% and varied between newspapers (top 98%, bottom 70%). We conclude that health workers are more likely to be criticised than praised. The credibility of the medical information varied from one newspaper to another.

Temporary intestinal ischaemia induced by proximal mesenteric artery occlusion.

The severity and distribution of small intestinal ischaemia caused by temporary proximal occlusion of the superior mesenteric artery in cats were evaluated by electromagnetic flowmetry and carbonized microspheres. Average mucosal blood flow was reduced from 0.94 to 0.40 ml/min/g. Mucosal flow in the proximal jejunum and distal ileum was even less affected. Ischaemia induced by proximal occlusion of the superior mesenteric artery in cats was not severe enough to provide optimum conditions for intestinal hypoxic radiation protection, nor was such ischaemia evenly distributed along the gut.