EUROCAT: an update on its functions and activities

This paper provides an outline of the development and growth of EUROCAT, the European network of congenital anomaly registers. In recent years the network has been through a period of transition and change. The Central Register of data has transferred from the Ulster University to the EU Joint-Research-Centre, Ispra, Italy.The benefits of combining data from across Europe, from different populations and countries are described by the uses to which these data can be put. These uses include:. surveillance of anomalies at a local, regional or pan-European level. pharmacovigilance. registration of rare diseasesNew studies and projects are underway, including EUROlinkCAT (a Horizon 2020 funded data-linkage project), promising a fruitful future in further research of congenital anomalies.

Evaluation of cognitive assessment and cognitive intervention for people with multiple sclerosis

OBJECTIVES

Cognitive problems in multiple sclerosis are common but any possible benefits of treatment remain uncertain. The aim of the study was to evaluate the benefits of providing a psychology service, including cognitive assessment and intervention, to patients with multiple sclerosis.

METHOD

The study was a single blind randomised controlled trial. A total of 240 patients with clinically definite, laboratory supported, or clinically probable multiple sclerosis were recruited from an multiple sclerosis management clinic and assessed on a brief screening battery. They were randomised into three groups. The control group received no further intervention. The assessment group received a detailed cognitive assessment, the result of which was fed back to staff involved in the patients' care. The treatment group received the same detailed cognitive assessment and a treatment programme designed to help reduce the impact of their cognitive problems. Patients were followed up 4 and 8 months later on the general health questionnaire (GHQ-28), extended activities of daily living scale, SF-36, everyday memory questionnaire, dysexecutive syndrome questionnaire, and memory aids questionnaire.

RESULTS

The three groups were compared on the outcome measures at 4 and 8 months after recruitment. There were few significant differences between the groups and those that occurred favoured the control group. Overall, the results showed no effect of the interventions on mood, quality of life, subjective cognitive impairment or independence.

CONCLUSIONS

The study failed to detect any significant effects of cognitive assessment or cognitive intervention in this cohort of people with multiple sclerosis.

The effect of reminder calls in reducing non-attendance rates at care of the elderly clinics

BACKGROUND

DNA ("did not attend") at outpatient clinics is an important problem costing the NHS an estimated pound266 million annually. The national DNA rate for 1996-1997 for all clinics was 12%. The DNA rate at Hammersmith Hospital for the same year in the care of the elderly specialty was 21%. The aim of this study was to establish why this was so, and to test the efficacy of a reminder call in increasing attendance rates at care of the elderly clinics.

METHODS

23 DNAs from seven clinics were contacted to ascertain the reasons for non-attendance (group I). For seven further clinics, 84 patients were contacted in advance to reconfirm their appointment (group II).

RESULTS

From group II 12 patients were identified who were unaware of their appointment (14%), six of whom agreed to attend; thus six potential DNAs were prevented. Eleven vacant appointments were identified in advance. The unexpected DNA rate was reduced to 5% from a potential 21% as a result of this exercise. The DNA rate for all patients with dementia (both groups) was 44%, whereas the DNA rate for all patients without this diagnosis (both groups) was 16% (p < 0.001).

CONCLUSIONS

A preclinic phone call reminder to elderly patients is feasible, increases attendance rates, and identifies vacant appointments. Patients with dementia are more likely to miss clinic appointments; therefore they and their carers need specific reminders about appointment dates.

Measurement of 90Sr in bone ash

Bone is a critical organ for the accumulation of many radionuclides, including 90Sr. A bone ash has been prepared by NIST to become a standard reference material and the assaying of the 90Sr activity concentration is reported. A radiochemical procedure, based on extraction chromatography using a crown ether, has been developed to separate Sr from the bone ash. The natural Sr content of the bone ash has been determined by isotope dilution inductively coupled plasma mass spectrometry. The 90Sr activity concentration has been measured by low-level liquid scintillation counting.

Radioiodinated N-(alkylaminoalkyl)-substituted 4-methoxy-, 4-hydroxy-, and 4-aminobenzamides: biological investigations for the improvement of melanoma-imaging agents

The syntheses and radiolabelling of 27 new N-(alkylaminoalkyl)-4-methoxy-, -4-hydroxy-, and -4-aminobenzamides are described and evaluated in C57B1/6 mice with subcutaneously transplanted B16 melanoma in order to screen the optimal chemical structure for melanoma scintigraphy. Using T1(TFA)3 for 131I- labelling, a series of radioiodinated 4-methoxy benzamide derivatives proved to exhibit superior melanoma uptake with outstanding melanoma/non-target-tissue ratios. From the benzamide derivatives tested, N-(2-(1'-piperidinyl)ethyl-3-[131I]iodo-4-methoxybenzamide and N-(2-diethylaminoethyl)-3-[131I]iodo-4-methoxybenzamide demonstrated best results. The introduction of 4-hydroxy and 4-amino groups led to less favourable benzamides. While the former compounds showed little melanoma uptake, the latter revealed unfavourable melanoma/non-target-tissue ratios. Additionally, it could be shown that an amino group was inevitably necessary for melanoma uptake, and that dialkylation of the amide nitrogen and replacing CONH by CH2NH revealed less advantageous results.

Pharmacokinetics of iodine-123-IMBA for melanoma imaging

The development of an effective radiopharmaceutical with affinity for malignant melanoma has been a research goal for some time. The early detection of melanoma metastases would greatly improve the therapy outcome for this disease. This article describes the synthesis of radioiodinated IMBA, N-(2-diethylaminoethyl)-3-[123I/131I]iodo-4-methoxybenzamide 8, its organ distribution, its comparison with BZA and other benzamides, and demonstrates the scintigraphic efficacy of the title compound with three melanoma patients.

METHODS

The syntheses and radioiodination of eight benzamide derivatives are described. After intravenous injection into C57B16-mice subcutaneously transplanted with B16 melanoma, the organ distribution of the respective benzamides were investigated at 1 and 6 hr. n-octanol/phosphate buffer partition coefficients. The wholebody retention, erythrocyte and serum protein bound fractions of radioiodinated benzamides were measured.

RESULTS

While structural changes in the amide substituents of N-(2-dialkylaminoalkyl)-4-iodobenzamides 2-7 resulted in no improvement in organ distribution compared with BZA, the 3-iodo-4-methoxyphenyl form of IMBA showed high melanoma uptake with significantly higher melanoma/nontarget tissue ratios. Compared with BZA the average ratio improved after 1 hr by a factor of eight and was still four times better after 6 hr. BZA and IMBA exhibit almost identical n-octanol/ phosphate buffer partition coefficients, however, IMBA has a faster urinary excretion facilitated by a lower affinity to erythrocytes and serum proteins; this could explain the improved tissue partinioning observed. Scintigraphy of patients with melanoma metastases confirmed the promising characteristics derived from the animal studies.

CONCLUSION

Due to rapid background clearance and high melanoma affinity, IMBA showed high tumor contrast already at 4 hr after injection which makes it a promising new radiopharmaceutical for the scintigraphic detection of melanoma metastases.