Pre-treatment white blood cell subtypes as prognostic indicators in ovarian cancer.

OBJECTIVE: Inflammatory cells can both suppress and stimulate tumour growth and their influence on clinical outcome in cancer patients has been studied in various cancer types. Here we have investigated their influence on outcome in primary epithelial ovarian cancer. STUDY DESIGN: Serum white blood cell numbers according to subtype were recorded prior to treatment in 136 patients with primary epithelial ovarian cancer. Their correlation with overall survival and disease-free survival was analysed using both univariate and multivariate analysis adjusting for the known prognostic factors (age, stage and debulking status). RESULTS: Multivariate analysis demonstrated that a lower lymphocyte fraction of total white blood cells was significantly associated with mortality (p<0.01). On univariate analysis (p=0.0027, HR=1.15), and multivariate analysis of those patients who were optimally debulked (p=0.036, HR=1.17), a higher monocyte count was significantly associated with recurrence. On multivariate analysis amongst those who were suboptimally debulked, a higher eosinophil count was predictive of both recurrence (p=0.0037, HR=1.77) and mortality (p=0.033, HR=1.73). CONCLUSION: High monocyte counts amongst those who were optimally debulked independently predict adverse outcome in primary epithelial ovarian cancer.

Clinically relevant fatigue in cancer outpatients: the Edinburgh Cancer Centre symptom study.

BACKGROUND: Fatigue is associated with cancer and its treatment but we know little about how many and which patients suffer fatigue of clinical severity. We aimed to determine the prevalence of clinically relevant fatigue (CRF) and its associations in outpatients with various cancer diagnoses. PATIENTS AND METHODS: A survey of outpatients with colorectal, breast, gynaecological, genitourinary, sarcoma, melanoma and miscellaneous tumours at a regional cancer centre. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) fatigue subscale and the Hospital Anxiety and Depression Scale (HADS). These self-report data were linked to demographic and clinical variables. Data were available on 2867 outpatients. RESULTS: The prevalence of CRF (EORTC fatigue subscale > or =40) was 32% (95% confidence interval 31-34%). The variables independently associated with CRF were primary cancer site, having disease present, type of cancer treatment and emotional distress (total HADS score > or =15). Emotional distress had the strongest association with fatigue but half the cases of CRF were not distressed. CONCLUSION: CRF is common in cancer outpatients and is associated with type of disease and treatment, as well as with emotional distress. The association between CRF and emotional distress is strong but they are not equivalent conditions.

Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study.

To: (1) estimate the prevalence of clinically significant emotional distress in patients attending a cancer outpatient department and (2) determine the associations between distress and demographic and clinical variables, we conducted a survey of outpatients attending selected clinics of a regional cancer centre in Edinburgh, UK. Patients completed the Hospital Anxiety and Depression Scale (HADS) on touch-screen computers and the scores were linked to clinical variables on the hospital database. Nearly one quarter of the cancer outpatients 674 out of 3071 (22%; 95% confidence interval (CI) 20-23%) met our criterion for clinically significant emotional distress (total HADS score 15 or more). Univariate analysis identified the following statistically significant associations: age<65, female gender, cancer type and extent of disease. Multivariate analysis indicated that age<65 (odds ratio 1.41; 95% CI 1.18-1.69), female gender (odds ratio 1.58; 95% CI 1.31-1.92) and active disease (odds ratio 1.72; 95% CI 1.43-2.05) but not cancer diagnosis, were the independent predictors of clinically significant emotional distress. Services to treat distress in cancer patients should be organised to target patients by characteristics other than their cancer diagnosis.

Automated microwave digestion of certifiable color additives for determination of mercury by cold vapor atomic absorption spectrometry.

A procedure using an automated microwave flow digestion technique was developed and validated for the digestion of samples of certifiable color additives before mercury determination by cold vapor atomic absorption spectrometry. Recovery studies were performed by spiking most of the color additives subject to batch certification by the U.S. Food and Drug Administration with inorganic mercury (HgNO3) and with organic mercury (CH3HgCl). Successful recoveries of 72-113% Hg added at the 1 microg/g level were obtained. A method detection limit of 0.2 microg Hg/g was estimated from a Hg-spiked FD&C Yellow No. 6 sample. At the specification level of 1 ppm Hg (1 microg Hg/g), the 95% confidence interval was +/- 0.2 ppm (0.2 microg Hg/g).

Medullary femoral nailing of pathological fractures using the Derby nail--a preliminary report of 22 cases.

A new medullary femoral nail is reported. The device provides dynamic compression, producing rigid stabilization with resistance to rotational stresses. We present 22 cases of pathological fractures of the femur treated by the Derby nail. Rigid fixation was achieved with no sepsis, loosening or implant failure at the latest follow-up or death. The mean time spent in hospital was 20 days and patients took full weight, on average, by the 9th postoperative day.

Bucket-handle tear of the medial meniscus. A case for conservative surgery.

To compare the results of two methods of treatment for bucket-handle tears of the medial meniscus eighty-seven knees were studied, thirty-seven treated by excision of the bucket-handle tear alone and fifty by total meniscectomy. A postoperative history suggestive of locking was given by one patient in each treatment group. Anteroposterior laxity was found in 72% of knees treated by excision of the bucket-handle tear alone as compared with 68% of the knees treated by total meniscectomy, but in all other respects the results showed a marginal preference in favor of the simpler operation. Although the numbers are too small to prove that results are better following excision of the bucket-handle tear alone, it is suggested, in the absence of evidence that total meniscectomy is more advantageous, that the simpler operation of excision of just the bucket-handle tear is the treatment of choice in bucket-handle tears of the medial meniscus.

The long-term effect on the tibiofemoral compartment of the knee joint of comminuted fractures of the patella.

We have studied the long-term effect of comminuted fractures of the patella with particular reference to the development of degenerative changes in the tibiofemoral joint. Degenerative changes which could convincingly be ascribed to the original injury were found in only one case, but we stress that the numbers are small, and that carefull search sould be made at operation for damage to the femoral condyles.