Gestational trophoblastic disease - experience of the sheffield (United-kingdom) supraregional screening and treatment service

Abstract. The gestational trophoblastic diseases (GTD) are uncommon complications of pregnancy. The UK GTD registration scheme offers specialist facilities for screening and treatment. In Sheffield about 5% of all patients monitored require chemotherapy. The successful treatment - almost 100% cure - of these patients is a testament to the success of the registration scheme and undoubtedly this is one of the most cost efficient of all specialist medical treatments currently available.

Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial

High-dose chemotherapy and radiotherapy with autologous bone-marrow transplantation (ABMT) are increasingly used for the treatment of relapsed and resistant Hodgkin's disease, although there has been no randomised trial of this treatment. The British National Lymphoma Investigation therefore undertook a randomised comparison of high-dose chemotherapy (BEAM = carmustine, etoposide, cytarabine, and melphalan) plus ABMT with the same drugs at lower doses not requiring bone-marrow rescue (mini-BEAM) in patients with active Hodgkin's disease, for whom conventional therapy had failed. 20 patients were assigned treatment with BEAM plus ABMT and 20 mini-BEAM. All have been followed up for at least 12 months (median 34 months). 5 BEAM recipients have died (2 from causes related to ABMT and 3 from disease progression) compared with 9 mini-BEAM recipients (all disease progression). This difference was not significant (p = 0.318). However, both event-free survival and progression-free survival showed significant differences in favour of BEAM plus ABMT (p = 0.025 and p = 0.005, respectively). Recruitment to the trial became increasingly difficult because patients refused randomisation and requested ABMT. It was therefore closed early (40 patients rather than 66 intended). Nevertheless, we found a dose-response effect in these patients with relapsed and resistant Hodgkin's disease. High doses facilitated by ABMT can lead to better disease-free survival.

Community acquired pneumonia: aetiology and prognostic index evaluation

A 10 month prospective study of all adults admitted to Waikato Hospital with community acquired pneumonia was performed to assess aetiology, mortality, hospital stay, and the value of a prognostic index based on that obtained from a British Thoracic Society study. The 92 patients in the survey had a mean age of 56 (range 13-97) years. A microbiological diagnosis was established in 72%; Streptococcus pneumoniae (33%), Mycoplasma pneumoniae (18%), and influenza A virus (8%) were the most common microorganisms. Other causative organisms were Legionella pneumophila (4 cases), Staphylococcus aureus (3), Klebsiella pneumoniae (2), Haemophilus influenzae (2), Nocardia brasiliensis (1), and Acinetobacter calcoaceticus (1). Chlamydia sp, influenza B virus and adenovirus were each found in one case; all were cultured on nasopharygeal aspirates. Aspiration was considered to be the underlying cause in five patients, two with epilepsy and one with pseudobulbar palsy. Five of the six deaths that occurred were in patients over 75 years of age and the other was 69. In four of the six the established causative organisms were Chlamydia sp (1), K pneumoniae (1), and S aureus (2). Patients had a 16 fold increased risk of death if they had two or more of the following on admission: a respiratory rate of 30/minute or more, diastolic blood pressure of 60 mm Hg or less, and either confusion or a plasma urea concentration greater than 7.0 mmol/l.

New therapies for malignant melanoma

Once malignant melanoma has metastasised, conventional therapy is rarely curative. However, major technological advances have heralded the era of 'new' immunotherapy with agents such as the interferons and interleukin-2. These promising treatment options have not yet been fully evaluated.

Management of acute brachial artery occlusion due to trauma or emboli

Out of 37 patients requiring emergency surgery for upper limb ischaemia, 9 were due to spontaneous embolus, 7 to arterial laceration and 21 followed cardiac catheterization. Eleven of the initial operations (30 per cent) failed to relieve ischaemic symptoms though 6 were corrected by further operations. Success at the initial operation was associated with (i) repair with end-to-end anastomosis after resection, saphenous vein bypass or interposition graft, or generous vein patch, (ii) exposure of the radial/ulnar bifurcation, (iii) instillation of heparinized saline locally or (iv) restoration of the radial pulse at the end of the operation. In the cases studied in whom all the above recommendations were followed, the operation was entirely successful and all patients have a radial pulse and are currently symptom free.

Chemotherapy of metastatic carcinoma of the breast

Thirty-four patients with metastatic breast carcinoma were treated with the following combination: methotrexate 60 mg/m2 i.v. days 1 and 8,5-fluorouracil 500 mg/m2 i.v. days 1 and 8, cyclophosphamide 100 mg/m2 daily for 14 days, and prednisolone 25 mg b.d. by mouth daily for 14 days. In 21/34 (62%) patients regression of tumour was maintained for at least three months and in six (18%) this was complete. The median duration of response was 15 months (range 6--33) and there was a significant difference in survival between responders and non-responders (P<0.01). Toxicity was acceptable although dose reduction was necessary in eight patients and in three patients treatment had to be discontinued.

Malignant lymphoma of the cervix uteri: histology and ultrastructure

Two cases of primary lymphoma of the cervix uteri are described. Both responded to radiotherapy; both were composed at the ultrastructural level of mature macrophages and immature, apparently neoplastic lymphoreticular cells and are classified as reticulum cell lymphoma.