World Health Organization initiative to estimate the global burden of foodborne diseases

Foodborne diseases are a multi-sectoral public health risk closely linked with the agricultural and animal health sectors. Many foodborne diseases are zoonotic in nature. The World Health Organization (WHO) seeks to measure for the first time the real impact of foodborne diseases through the advice of its independent expert body, the Foodborne Disease Burden Epidemiology Reference Group (FERG). Through the FERG, the WHO works on both assembling and appraising existing data as well as supporting countries in conducting their own studies into the national burden of foodborne disease. This is complemented by efforts to ensure thatthe findings are meaningful and useable to policy-makers and other research end-users to implement informed policy and interventions. For the Initiative to operate effectively and achieve its objectives, linkages and collaboration at all levels, especially at the human-animal interface, need to be fostered.

Treatment with coumarin to prevent or delay recurrence of malignant melanoma

Both coumarin (1,2-benzopyrone) and warfarin (4-hydroxycoumarin) have been shown to prevent the recurrence of malignant melanoma. Their action is macrophage-dependent and the dosage is critical. In 1984 a multicentre, prospective, randomised, double-blind trial of coumarin, given as a daily 50-mg dose for 2 years after surgery in patients with high-risk melanoma, was started. the patients had lesions greater than 1.70 mm thick and TNM stage IB or stage II disease. To date there are 4 recurrences in the coumarin-treated group of 13 patients, and 10 recurrences in the placebo-treated group of 14 patients (P < 0.01). There were no toxic effects.

Fine needle aspiration cytology of thyroid nodules: review of 36 months experience

Studies suggest that fine needle aspiration of thyroid nodules is a sensitive and specific tool for the detection of thyroid cancers thus preventing unnecessary operations. This technique was introduced in our institution in 1987 and performed where indicated under strictly defined criteria. We reviewed the aspirates performed over a 36 month period to critically evaluate the role of this procedure. Review was limited to F.N.A.s of nodules considered to be potentially malignant by conventional criteria and hence all the following criteria needed to be fulfilled: (1) solitary or dominant nodules in a multinodular goitre, (2) cold on isotope scanning, (3) solid or complex cystic nodule on ultrasonography. During the period May 1987 to May 1990 88 aspiration procedures were performed on 77 patients. 93% of the 77 patients had adequate aspirates and of these approximately 30% were considered suspicious or malignant. The overall resection rate was 23.4% which is approximately one third of the rate expected should suspicion have been based solely on conventional imaging criteria. The yield of neoplasia (adenoma and carcinoma) at resection was 89%. We found FNA to be a very useful adjunct in the management of nodular thyroid disease when used in conjunction with clinical laboratory and radiological evaluation. It is safe, inexpensive and provides useful additional information towards making appropriate decisions in an area beset with uncertainty.

Colorectal carcinoma over 30 years at one hospital: no evidence for a shift to the right

Many recent reports in the North American literature have documented an increase in the ratio of proximal to distal colorectal cancers with an increase in right-sided lesions. In order to assess trends in the distribution of large bowel carcinoma at our hospital we reviewed the files of 1553 patients who presented with primary colorectal carcinoma over a 30-year period. Thirty-nine percent of patients were over 70 years old and 51% were in the 50-69 year age group. Seventy five percent of the carcinomas were left-sided, 22% right-sided and caecal carcinomas accounted for 18%. This distribution varied only slightly over the study period. Left-sided lesions were more common in males (55%: p less than 0.005), and right-sided lesions were more common in females (57%: p less than 0.005). Caecal carcinoma was more common in patients over 69 years old than in younger patients (p less than 0.001). In elderly females (greater than 69 years) 30% of colorectal carcinomas occurred in the caecum. These findings may have important implications for the investigation of patients with suspected colorectal disease or for screening programmes.

Prevention of early recurrence of high risk malignant melanoma by coumarin. Irish Melanoma Group

Coumarin (1,2-benzopyrone) as a daily oral dose of 50 mg was evaluated in a multicentre prospectively randomized, double-blind, placebo-controlled trial to prevent early recurrence of malignant melanoma TNM Stage IB (Breslow thickness greater than 1.70 mm) and Stage II. Intake for the trial started in 1984 and was stopped prematurely, after review, in 1987. There were two recurrences in 13 treated patients and 10 in 14 controls which was significant (P 0.01). The sites of the metastases differed in each group, being local and in bone in the treated group, and in lymph nodes, skin and lung in the control group. There were no toxic effects associated with coumarin treatment and all patients without recurrence are now receiving coumarin.

Diagnostic and prognostic problems in early gastric cancer

Although common in Japan, early gastric cancer is rarely seen in Western countries and generally accounts for only 7 to 10 percent of all gastric malignancies. Eleven patients with early gastric cancer seen over a 10 year period have been reviewed for clinical and pathologic features, method of diagnosis, treatment, and prognosis. The symptoms usually consisted of vague epigastric pain or dyspepsia, but anorexia, weight loss, anemia, and hypoalbuminemia were not commonly seen. Barium meal examination was not helpful in the diagnosis in 50 percent of the patients. The diagnosis was made by endoscopic biopsy of abnormal areas of the stomach, although in 6 of 11 patients, there was no macroscopic suspicion of malignancy. All patients were treated by surgical resection. The tumor was confined to the mucosa in five patients and had infiltrated the submucosa in six patients. The lymph nodes were free of tumor in every patient. At last follow-up, seven patients had survived more than 5 years after operation and were well, although recurrent tumors developed in two patients 3 and 4 years postoperatively but were detected early by endoscopic surveillance. Early gastric cancer has a good prognosis after surgical resection, but the symptoms are vague and the diagnostic tests can be misleading. A vigorous approach to investigation, treatment, and follow-up is necessary to achieve satisfactory results.

Solitary familial desmoplastic trichoepithelioma. A study by conventional and electron microscopy

Solitary desmoplastic trichoepitheliomas from a mother and two daughters were studied by conventional and electron microscopy. Differential diagnosis by conventional microscopy is briefly discussed. The lesions consisted of cords and nests of basaloid cells set in fibrotic stroma and confined to the dermis. In addition, each lesion contained horn cysts and focal areas of calcification. Horn cysts were occasionally identified in continuity with infundibulae of normal hair follicles. Semithin sections showed cords and nests of cells in continuity with the horn cysts. Ultrastructurally, a continuous basal lamina surrounded the cords of basaloid cells and connected to horn cysts. Individual cells contained tonofilaments and were attached to adjacent cells by desmosomes. Hemidesmosomes were present at peripheral cell membranes bounded by basal lamina. There was no glandular differentiation. Our observations by electron and conventional microscopy support a conclusion that desmoplastic trichoepitheliomas are derived from hair appendages.