Neurocognitive function after (chemo)-radiotherapy for head and neck cancer.

Radical radiotherapy has a pivotal role in the treatment of head and neck cancer (HNC) and cures a significant proportion of patients while simultaneously sparing critical normal organs. Some patients treated with radical radiotherapy for HNC receive significant radiation doses to large volumes of brain tissue. In fact, intensity-modulated radiotherapy techniques for HNC have been associated with a net increase in irradiated brain volumes. The increasing use of chemoradiotherapy for HNC has additionally exposed this patient population to potential neurotoxicity due to cytotoxic drugs. Patients with HNC may be particularly at risk for adverse late brain effects after (chemo)-radiotherapy, such as impaired neurocognitive function (NCF), as risk factors for the development of HNC, such as smoking, excess alcohol consumption and poor diet, are also associated with impaired NCF. The relatively good survival rates with modern treatment for HNC, and exposure to multiple potentially neurotoxic factors, means that it is important to understand the impact of (chemo)-radiotherapy for HNC on NCF, and to consider what measures can be taken to minimise treatment-related neurotoxicity. Here, we review evidence relating to the late neurotoxicity of radical (chemo)-radiotherapy for HNC, with a focus on studies of NCF in this patient population.

A report generator package for routine laboratory tests in a hospital cardiology department.

A simple report generating package is described. The package is designed for hospital computing personnel who wish to develop fast, easy access, easy-to-use report generating programs for use by non-computer specialists. Use of the system is illustrated by examples from three sections within a hospital cardiology department: nuclear cardiology, M-mode echocardiography and reporting of 24-hour ambulatory electrocardiogram tapes.

Cardiac electrophysiological studies: computer analysis using a digitiser and interactive visual display unit.

Recording of localised intracardiac electrical potentials provides useful and important information on conduction disease in man. Analysis of intracardiac recordings involves measurement of large numbers of timing intervals representing the sequence of activation of the various part of the cardiac conduction system. In this paper we describe a semi-automatic computer based analysis system tailored to the specific requirements of cardiac electrophysiological measurement. A digitising tablet is used in conjunction with a visual display oriented data handling package to input data directly to computer memory for sorting and further analysis. Particular attention is paid to providing the user with a system that is simple to learn yet is robust and flexible in use. The computer software is written entirely in the high level FORTRAN language. It is modular in design and is therefore easily adapted for the changing needs of a research oriented department.

Surgical audit: Comparison of the work load and results of two hospitals in the same district.

Surgical audit is being undertaken to monitor and compare (by computer) the type of patient, work load, and results of two similar surgical units. Both units are in the City and Hackney District of London, one at St Bartholomew's Hospital and the other at Hackney Hospital. During 1978, 736 patients were admitted by the unit at St Bartholomew's Hospital and 902 by the unit at Hackney. At St Bartholomew's 70% of admissions were elective compared with 49% at Hackney, where 86% of patients lived within the district compared with only 36% at St Bartholomew's. The wound was the commonest site for complications, infection affecting 9% of those at Hackney and 6% at St Bartholomew's, despite identical antibiotic policies. There were six post-operative deaths at St Bartholomew's and 32 at Hackney. In both hospitals the length of stay was similar, 50% of patients being discharged within one week and 80% within two weeks. As a result of the audit a vigorous venous thrombosis prophylactic regimen has been instituted, and at Hackney the anaesthetic department has been strengthened and a new intensive care unit opened.