Whiplash and its effect on the visual system.

Whiplash or indirect injuries to the neck as a consequence of motor vehicle collisions are a common occurrence in which the frequency of ocular complications is largely unknown. Ophthalmic and oculomotor function was investigated in a longitudinal study of 39 cases who had their initial ophthalmological assessment within one week of the whiplash injury. Ten of 39 cases had ocular symptoms and signs which developed shortly after the accident. The principal abnormality in 6 of these was decreased convergence and accommodation, superior oblique muscle paresis in 2, decreased stereoacuity in 1 and bilateral vitreous detachments in 1 patient. All but 2 had complete resolution of their symptoms within 9 months. Four other patients were asymptomatic but had ophthalmic signs which resolved within 3 months. Oculomotor abnormalities following whiplash injuries are generally mild, have a good prognosis, and would appear from this study to be commoner than hitherto expected.

Disintegration of mercury disc cells in simulated gastric juice: implications for management of disc cell ingestion.

The disintegration of charged alkaline mercury button cells in simulated gastric fluid over a 24 h period has been studied. The integrity of the cells and the amount of mercury that can leak out of them were assessed. The cells raised the pH of the incubating solutions. Disruption was seen in five out of 18 cells tested in 0.1 mol/L hydrochloric acid and one out of nine in 0.9% saline. Five of the six disrupted cells were made by the same manufacturer. Major leakage of mercury only occurred after complete disintegration of the cells. The implications of these findings for the management of patients who have ingested mercury-containing button cells are discussed.

A controlled, prospective, randomised trial of adjuvant chemotherapy or radiotherapy in resectable gastric cancer: interim report. British Stomach Cancer Group.

A prospective, randomised controlled trial of surgery, surgery with adjuvant radiotherapy and surgery with adjuvant chemotherapy (5-fluorouracil, adriamycin and mitomycin C) in operable gastric cancer is described. Four hundred and thirty-six patients were randomly allocated to one of three treatment groups. With 12 months' minimum follow-up, 334 patients have died, 292 from recurrent cancer. The median survival for all patients was 15 months. Neither form of adjuvant therapy provides any survival advantage. Surgery remains the principal treatment for operable gastric cancer. Care should be taken to standardise surgical treatment and any adjuvant treatments must be compared within the confines of controlled, randomised trials.

Primary gastric lymphoma.

This is a population-based review of 153 cases of primary gastric lymphoma. Sixty-seven (43 per cent) were histologically reviewed using the Kiel classification. There were no significant differences between reviewed and unreviewed cases. Ninety-seven per cent of all cases were of the non-Hodgkin's type. The annual incidence was constant at 1.2 per cent of gastric malignancies. The mean age was 60 years and the male to female ratio 1:8. Presenting symptoms were similar to those of gastric cancer. Twenty-one per cent had a palpable mass but one-third of these were amenable to a potentially curative resection. Some 66 per cent were resectable and 58 per cent had a macroscopic clearance of tumour. TNM stage and absolute tumour size were significant prognostic factors (P less than 0.005 and P less than 0.05 respectively) but the Kiel classification was not. The overall 5 year survival was 24 per cent. Apart from 10 patients whose only anti-tumour treatment was radiotherapy (5 year survival 36.9 per cent) no patient who did not have curative surgery survived 5 years. The 5 year survival for curative resection was 34 per cent and for curative resection plus radiotherapy was 43.5 per cent (45 and 73.4 per cent for the node negative cases respectively). A laparotomy is essential; 'curative' surgery possibly with adjuvant radiotherapy offers the best hope for cure.

Gastric remnant recurrence--detection and implications for the management of gastric cancer.

The ability of endoscopy to detect remnant recurrence of gastric cancer has been evaluated in patients, either as a follow-up procedure (17 patients) or after symptomatic referral (7 patients). Overall 15 out of 24 (62.5%) patients developed some form of recurrence. Fourteen out of 15 (94%) had local disease either alone or in combination with distant metastases. Remnant recurrence was observed in 11 of these and after excluding those referred with symptoms, the true incidence of remnant recurrence was 41.2%. Patients in the follow-up group had 'early' remnant lesions which were diagnosed sooner after surgery than in the symptomatic group who had 'advanced' remnant recurrences. The detection of premalignant histology occurred earlier in those who developed remnant recurrence and this short time interval could be used to predict recurrence. Despite the early diagnosis of remnant recurrence, resection of the remnant at second laparotomy was only possible in one patient as the majority had other sites of extensive recurrence. The implications for the management of 'early' and 'advanced' gastric cancer are discussed.

Carcinoembryonic antigen (CEA) expression and heterogeneity in primary and autologous metastatic gastric tumours demonstrated by a monoclonal antibody.

The expression of carcinoembryonic antigen (CEA) in gastric malignancies has been assessed using a monoclonal antibody in an immunoperoxidase technique. Of 119 primary tumours examined, 92% reacted with the antibody. Metastases were available for 81 of the patients and 83% were CEA positive. A noteworthy observation was the detection of malignant cells in the lymph nodes of two patients, as a result of the presence of CEA, who were originally reported to be free of metastases. Of those patients whose primary tumours expressed CEA, 86% had at least one CEA positive metastasis. Two or more metastases were available from 60 of the patients and in 20% the secondaries were a mixture of positive and negative for CEA. Consequently, the CEA status of a single lesion does not enable confident prediction of expression in other metastases. In addition to variation between multiple lesions removed from the same patient phenotypic diversity of expression was observed between tumour cells of a given mass. Such distribution of the CEA detected by this monoclonal antibody may impose certain restrictions on its application. However, the high frequency of expression by gastric cancers indicate that it is a potentially useful antigen as a target for radiolocalisation or therapeutic agents.