Staging of squamous cell carcinoma of the tongue: extrinsic lingual muscles and the 8th editions of the American Joint Committee on Cancer/Union for International Cancer Control staging manuals.

Our aim was to find out first whether the extrinsic muscles of the tongue are histologically identifiable, and secondly to what degree the use of the new criteria in the 8th editions of the American Joint Committee on Cancer(AJCC)/Union for International Cancer Control (UICC) manuals (which have recognised the importance of depth of invasion of tumour, rather than invasion of the extrinsic muscles of the tongue and extranodal extension), will alter staging of lingual squamous cell carcinoma (SCC). The histological sections from 165 patients who had had primary resection of lingual SCC were reviewed, and one or more extrinsic muscles of the tongue was identified in 100 patients (61%), with the genioglossus seen the most often (in 96). By contrast, the hyoglossus was identified in only eight patients, the styloglossus in two, and the palatoglossus in none. Identification was straightforward only in extensive resections. Applying the criteria from the 8th edition increased the number of pT3 SCC with a simultaneous reduction in pT4a tumours. The number of pN2b SCC was also reduced, but the new category of pN3b meant that overall 53% of tumours were upstaged. The kappa scores for agreement between the two sets of criteria were 0.221 (weighted 0.410) for the pT values, 0.508 (0.713) for pN values (but 0.227, weighted 0.386, if the pN0 values were removed before calculation), and 0.243 (0.514) for overall stage, indicating poor to fair agreement. We conclude that the removal of invasion of extrinsic muscles of the tongue as a criterion for a pT4a SCC is justified, and that many SCC of the tongue will be upstaged as a result of implementation of the 8th editions.

Compliance of referral and hospital documentation with National Institute of Health and Care Excellence guidelines for the extraction of third molars: a comparative analysis of two NHS Trusts.

To find out whether documentation for the extraction of wisdom teeth complies with National Institute of Health and Care Excellence (NICE) guidelines, we reviewed the referral letters and hospital notes of patients treated at the maxillofacial unit of two NHS Trusts (A: 314 records and B: 280) over 12 months (1 September 2012 to 31 August 2013). Compliance was assessed as unsatisfactory ("indication for extraction not mentioned", "incorrect indication", "indication unclear") or satisfactory ("correct indication implied", "correct indication explicit"). The grade of the clinician who examined the patient was also recorded. A total of 194/314 (62%) referral letters in Trust A and 126/280 (45%) in Trust B were unsatisfactory (p<0.001). Hospital notes were unsatisfactory in 168/323 (52%) and 87/297 (29%) of cases, respectively (p<0.001). In Trust A, middle grades saw 23% (75/323) of the patients, as compared with 53% (157/297) in Trust B. In both, junior staff produced the highest percentage of satisfactory documentation, but in Trust A they were also responsible for most of the unsatisfactory examples. However, senior house officers saw 60% (195/323) of the patients in Trust A, and only 28% (83/297) in Trust B. Consultants were responsible for significantly more unsatisfactory documentation (p<0.001). One referral letter (0.2%) and seven hospital records (1%) explicitly and accurately complied with the guidelines. We conclude that compliance of documentation with the current NICE guidelines is poor and inconsistent.

THE PERFORMANCE OF AGROSTIS CAPILLARIS L. GENOTYPES, DIFFERING IN COPPER TOLERANCE, IN RYEGRASS SWARDS ON NORMAL SOIL.

Sample sub-populations, each of six plants, were chosen for high, mid and low tolerance of copper from each of two naturally-occurring copper tolerant populations and from tolerant individuals selected from a cultivar of Agrostis capillaris L. The naturally-occurring ecotypes came from a closed sward community at Drws y Coed, and from an open community at Parys Mountain, both copper mines in North Wales. Clonal replicates of all plants were introduced into swards of perennial ryegrass cvs. S23 or S24, growing on normal soil at the University of Liverpool Botanic Gardens. S23 plots were cut eight times between June 1977 and July 1978, whilst S24 plots were cut 3 times during the same period. Half the experimental plots received N, P, K, fertilizer; the rest received none. Plants selected from the cultivar (selected) produced most dry matter, and with infrequent defoliation flowered freely in competition with ryegrass. Those taken from Parys Mountain mine spoil produced least dry matter and no inflorescences. Drws y Coed plants were intermediate in dry matter and inflorescence production. These results may reflect differences in population density in the habitats from which the populations were sampled. Sub-populations chosen for high, mid or low copper tolerance within the selected and Drws y Coed populations did not differ significantly in dry matter yield. By contrast under certain circumstances Parys Mountain plants with low tolerance outyielded other more tolerant plants. These results are considered with respect to growth strategies adopted by plants growing on and off copper mine sites.

RELATIONSHIPS BETWEEN TOLERANCE TO HEAVY METALS IN AGROSTIS CAPILLARIS L. (A. TENUIS SIBTH.).

Heavy-metal tolerance was investigated in Agrostis capillaris L. (A. tenuis Sibth.) using a standard rooting test on plants originating from a copper-contaminated site (Parys Mountain) and a lead-contaminated site (Goginan). Six F1 families obtained by interpopulation hybridization and F2 and backcross generations derived from one of them were screened. Estimates of the genetic and environmental components of phenotypic correlation were obtained in terms of both root length and tolerance index. Results are discussed in relation to problems of interpretation of evidence for multiple- or co-tolerance based on tolerance indices and phenotypic correlations.