The ALERT-B questionnaire: A screening tool for the detection of gastroenterological late effects after radiotherapy for prostate cancer.

There is an increasing need to measure treatment-related side effects in normal tissues following cancer therapy. The ALERT-B (Assessment of Late Effects of RadioTherapy - Bowel) questionnaire is a screening tool that is composed of four items related specifically to bowel symptoms. Those patients that respond with a "yes" to any of these items are referred on to gastroenterologist in order to improve the long-term consequences of these side effects of radiological treatment. Here we wish to test the ability of this questionnaire to identify these subsequent gastroenterological complications by tracking prostate cancer patients that were positive with respect to ALERT-B. We also carry out receiver-operator curve (ROC) analysis for baseline data for an overall ALERT-B questionnaire score with respect to subscale data for the Gastrointestinal Symptom Rating Scale (GSRS) and the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. 84.4% and 95.7% of patients identified by the ALERT-B questionnaire demonstrated complications diagnosed at 6 and 12 months post-treatment, respectively. ROC curve analysis of baseline data showed that ALERT-B detected clinically relevant levels of side effects established at baseline by the GSRS diarrhoea subscale (AUC = 0.867, 95% CI = 0.795 to 0.926) and at the minimally important level of side effects for the EPIC bowel subscale (AUC = 0.765, 95% CI = 0.617 to 0.913). These results show that ALERT-B provides a simple and effective screening tool for identifying gastroenterological complications after treatment for prostate cancer.

Measuring the unmet supportive care needs of cancer support persons: the development of the support person's unmet needs survey--short form.

Few rigorous measures of unmet needs have been developed for cancer support persons. This study describes the development of a short version of the Support Person's Unmet Needs Survey (SPUNS). Cancer survivors [n = 1589, 612 (52%) men, mean age of 62.5 years, SD 11.5] 1-5 years post diagnosis and recruited through three Canadian population-based cancer registries were asked to pass a survey package on to their principal support person. Surveys were returned by 1183 support persons. The survey included the long form of the SPUNS, which contains 78 items. Fifty-two items were deleted using a combination of expert opinion and statistical criteria. Analysis of the remaining items revealed a five-factor structure. The original factors were retained with the exception of a merging of the personal and emotional needs subscales. Cronbach's alpha co-efficients for all subscales were ≥ 0.87, and intraclass correlation of domain scores of the short and long versions of the SPUNS were high. The SPUNS short form was able to discriminate between support persons of survivors who had (n = 147), and those who had not received treatment in the past month (n = 969). At just 26 items, it is likely to have strong clinical and research applicability.

Prognostic value of laparoscopic ultrasound in patients with gastro-esophageal cancer.

Forty-four patients with gastro-esophageal tumors regarded as resectable by conventional staging underwent laparoscopic ultrasonography (LUS). Following LUS, seven were found to be irresectable and were managed by palliative therapies. Thirty-seven patients proceeded to surgical exploration and 36 were resected (R0 80%, R1 11%, and R2 9%). All patients were reviewed until death or for a minimum of 24 months. Patients undergoing resection had a 62% 1-year survival (median 17 months; confidence intervals, CI 6-28). LUS defined nodal status indicated a trend toward prolonged survival in the node-negative group, median 22 months (CI 5-39), compared with 13 months (CI 6-20) in the node-positive group. Disease-free survival was greater in LUS node-negative patients at 29 months (CI 23-35) compared with node-positive patients at 13 months (CI 5-21) P=0.0083. LUS staging allows prediction of the likelihood of recurrence of gastro-esophageal malignancies. This may prove useful for the appropriate allocation of patients to primary and adjuvant therapies.

Precipitous visual loss secondary to optic nerve toxoplasmosis as an unusual presentation of AIDS.

Life-threatening conditions requiring urgent medical treatment rarely present to the ophthalmologist. This case report describes a patient with precipitious visual loss as the primary complaint and which subsequently led to the diagnosis of Toxoplasmic papillitis and life-threatening cerebral involvement as an initial manifestation of AIDS.

Double-masked three-period crossover investigation of timolol in control of raised intraocular pressure.

Forty patients with an intraocular pressure (IOP) between 30 and 49 mmHg in either eye (57 eyes) were recruited into a trial of timolol 0.25% versus timolol 0.5%. Patients were randomised to receive the two concentrations of drug in the order ABA or BAB. The study period was 12 weeks for each patient, with changes in drug concentration at 4 and 8 weeks. IOPs were measured at the same time every 2 weeks. Mean IOP of both eyes was used, excluding any eyes with initial IOPs of less than 30 mmHg. There was no difference between the 2-week and 4-week pressure readings, which were therefore combined. There was no statistically significant difference in the initial IOPs of the two groups (0.5%, 33.45 mmHg; 0.25%, 32.63 mmHg) nor in the initial fall in IOP with either concentration (0.5%, 12.03 mmHg; 0.25%, 11.31 mmHg). Furthermore, changing from one concentration to the other had no significant effect on IOP. Mean IOPs over the whole study period averaged 21.12 mmHg for timolol 0.25% and 20.75 mmHg for timolol 0.5%. Again these differences were not statistically significant. The statistical power of the study was estimated to exceed 85%. The authors suggest that there is no justification for use of the 0.5% strength, which is more expensive and has no advantages.

A method for assessing the accuracy of surgical technique in the correction of astigmatism.

Surgical results can be assessed as a function of what was aimed for, what was done, and what was achieved. One of the aims of refractive surgery is to reduce astigmatism; the smaller the postoperative astigmatism the better the result. Determination of what was done--that is, the surgical effect, can be calculated from the preoperative and postoperative astigmatism. A simplified formulation is described which facilitates the calculation (magnitude and direction) of this surgical effect. In addition, an expression for surgical accuracy is described, as a function of what was aimed for and what was achieved.

Case report: renal excretion of gastrografin following rectal administration.

Renal excretion of water soluble iodinated contrast media following oral administration has often been described but no reports describing renal excretion following rectal administration of such contrast have previously been described. We describe a case of renal excretion of diatrizoate methylglucamine (Gastrografin, Schering) following a diagnostic 'gastrografin enema' in a woman with caecal carcinoma.

Pseudopapilloedema in the linear naevus syndrome.

This case report describes the ophthalmic findings in a child with the linear naevus syndrome. The patient was referred by the Department of Paediatric Neurology with 'unilateral papilloedema'. This was thought to be a form of pseudopapilloedema, a finding that has not been previously described in this syndrome.

Doubled-masked three-period crossover investigation of metipranolol in control of raised intraocular pressure.

Metipranolol is a non-cardioselective beta adrenergic blocking drug used in the treatment of glaucoma. 56 patients with intraocular pressure between 30-49 mm hg were randomised to one of six treatment regimens for a 12 week period. Each patient received each concentration for 4 weeks and intraocular pressures were checked every two weeks. Using a worst and an average eye approach, mean initial intra-ocular pressures were 35.8 and 35.0 mm hg respectively. The mean fall in intra-ocular pressure after 4 weeks treatment ranged from 12.8 (0.1%) to 14.1 mm hg (0.6%) for average eyes (n = 56), and from 13.4 to 16.7 mm hg for worst eyes. These differences were not statistically significant (p greater than 0.05-p greater than 0.5). Increasing the concentration had no significant effect on pressure. Reducing the concentration had no effect except in patients who changed from 0.6% to 0.1%, when there was a mean rise of approximately 2 mm hg, p less than 0.02. The incidence of stinging varied from 19% of attendances on 0.1%, to 63% on 0.6%. We recommend the use of the 0.1% strength since all three significantly lower intra-ocular pressure but the higher concentrations are more expensive, cause more stinging, and are no better at lowering intra-ocular pressure.