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The 17th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Edmonton, Alberta, 11–12 September 2015. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of gastric cancer.

We report a case of phenytoin-associated Hodgkin's disease of lymphocyte predominance subtype, which developed after two years of phenytoin (Epanutin) treatment. Four other English cases of phenytoin-associated lmphoid malignancy are also reviewed.

UK sexual health services are shifting from hospital-based clinics into primary care, creating a need for high quality clinical sexual health training for non-specialists. Here we describe development, evaluation and costing of a new competency-based training programme, the Sexually Transmitted Infection (STI) Foundation Competency (STIF Competency) programme, based on the Department of Health's toolkit for delivering more specialized sexual health in primary care. We used an action research paradigm with two iterative cycles. Evaluation was to Kirkpatrick's third level with triangulation of results between trainers and trainees, and different methods, including portfolio evaluation, nominal group technique process, semi-structured interviews, Likert questionnaires and chlamydia testing rates. All 13 primary care clinicians completed the training successfully (median 20 hours) and rated STIF Competency highly. Trainers needed to reduce their clinical workload to accommodate the training. Average cost per trainee was £1125, reflecting the need for direct observation of competence across a wide range of clinical skills.

Liquid crystalline photoactuators typically bend toward the light source, driven by the isomerization of azobenzene. In samples with a relatively large thickness and high azobenzene loading such as LC photoactuators, intense optical beams are seen to be absorbed in spatially nonexponential ways. Here we show that the dynamics of the related mechanical behavior is also strongly nonlinear, where the actuator reaches a maximum bend before unbending again to its equilibrium deformed state. The effect is amplified when combined with actuators with an internal composition gradient, leading to a reversal of the bending direction away from the light source.

Cell-mediated tissue destruction, such as that occurring in allograft rejection, is thought to be mediated by Th1 cells and cytokines. We have recently shown that transgenic expression of the Th2 cytokine IL-4 by pancreatic beta cells completely protects nonobese diabetic (NOD) mice from autoimmune diabetes by inducing functional tolerance among autoreactive T cells. To investigate whether local IL-4 production could also induce functional tolerance among alloreactive T cells and thus prevent allograft rejection, we transplanted pancreata from transgenic neonatal mice and their nontransgenic littermates into allogeneic hosts. Within 2 wk, recipient mice had rejected their grafts regardless of the transgene's presence or absence. Considering that the vigorous immune response induced might have prevented any effect by IL-4, we injected recipient mice with anti-CD4 and anti-CD8 mAbs, thereby depleting them of T cells and thus providing the islets with an opportunity to mature and grow. This approach indeed delayed rejection of neonatal pancreata from nontransgenic mice by >1 wk. By that time, however, pancreata from transgenic mice had also been rejected. Our results indicate that the allograft rejection response under these conditions, in contrast to the autoimmune response in NOD mice, cannot be regulated by local IL-4 production, regardless of the cytokine's impact on Th1 cells.

There is controversy as to the value of the radiological or pathological estimation of surgical clearance of microcalcifying breast lesions. An important part of this issue has been addressed by coordinated three-dimensional radiographic and histological examination of a prospective consecutive series of 40 benign and malignant mammographically detected lesions in surgical breast biopsy specimens containing microcalcifications, including 20 cases of ductal carcinoma in situ. They were radiographed from four viewpoints by means of rotation in a radiolucent tetrahedral container. The planes of histological examination were then chosen to correspond to the radiographic view showing the minimum separation of the edge of the specimen and the outermost microcalcification. There was a close correlation (Spearman ranked) between the least tetrahedral radiographic distance and the corresponding histological distance separating the surgical margin of excision. There were, however, incompatible Wilcoxon signed ranking orders when comparing the least tetrahedral distance or the histological distance with all four single radiographic views, including the conventional specimen radiographic view. Two-dimensional specimen mammography and standardized histological examination are suboptimal and may thus have contributed to confusion as to the value of determining adequate surgical excision of ductal carcinoma in situ of the breast. Although labour-intensive, use of four-view radiography and choice of the appropriate plane of histological examination give a better correlation of the radiographic estimates of surgical clearance with histology than single-view specimen radiography and arbitrary histological sectioning.

Tissue slices (500 to 1000 microns thick) of archival formalin-fixed, paraffin-embedded breast tissue were immunostained by a cytokeratin antibody (MNF116) using a streptavidin-biotin complex procedure. The technique requires prolonged exposure of tissue slices to the reagents. Use of the detergent Triton X-100 facilitated penetration of high molecular weight reagents through the tissue slices. Fifty of 58 slices 500 microns thick (86%) showed good to excellent immunostaining, and 13 of 20 slices 1000 microns thick (65%) showed similar staining. Omission of the primary antibody eliminated any immunostaining. Comparison with corresponding Haematoxylin staining of the thick slices (the conventional procedure for such breast tissue slices) showed that thick-slice cytokeratin immunostaining markedly improved visualization of the epithelial structure in normal lobules and invasive carcinomas. Although the immunohistochemical technique takes 33 days for completion, the quality of the epithelial images outweighs this disadvantage.

Six impalpable mucocoele-like lesions of the breast were detected by mammographic screening of 16000 women over a 15-month period in the Avon (Bristol) Breast Screening Programme as a result of suspicious clustered microcalcifications. The clusters measured between 5 mm and 50 mm. Five contained a small cluster between 5 mm and 15 mm, but one exhibited bizarre calcifications and soft-tissue densities over an area of 50 mm; two adjacent clusters displayed a crescentic (‘tea-cup’) morphology in some of the individual microcalcifications. Their mammographic appearances were pleomorphic. In this period calcified mucocoele-like lesions were detected both in a cohort of approximately 4500 women aged 50–52 years called for prevalent-round screening, and 11500 women involved in incident-round screening. However, not all mucocoele-like lesions are associated with mammographic microcalcification, and not all mucocoele-like lesions detected by microcalcification are associated with high-risk or frankly neoplastic lesions.

To image microstructures within tissue in detail using conventional light microscopy it is necessary to process the tissue and obtain thin (≈5 μm) physical sections by using destructive physical sectioning techniques. This article describes a microscopy technique, using near-infra-red light (700-1500 nm) as the source, which is able to image thin sections of thick-tissue specimens nondestructively. Images of contiguous two-dimensional thin sections obtained serially can be combined to generate a three-dimensional image of the structures being imaged.

AIM--To investigate overexpression of c-erbB2, expression of the p53 protein product and proliferation rates in benign breast lesions with specific reference to apocrine adenosis. METHODS--Twenty one cases of apocrine adenosis were stained with monoclonal antibodies to p185, the protein product of the c-erbB2 oncogene, the protein product of the p53 tumour suppressor gene and to the cell cycle related protein Ki67. Three cases were associated with concomitant ductal carcinoma in situ of large cell type and two were associated with invasive tubular or cribriform carcinoma. RESULTS--Twelve (57.1%) cases showed membrane staining for c-erbB2 oncoprotein of apocrine cells within sclerosing adenosis and six (28.6%) had occasional p53 protein positive cells. One case not associated with carcinoma showed extensive staining of apocrine metaplasia outside the area of apocrine adenosis. The proliferation rate, as measured by Ki67 staining, was increased in some of the lesions and all lesions showed at least some of the cells to be in the cell cycle. CONCLUSIONS--The expression of abnormal oncogene products and increased proliferation in some of these apocrine lesions questions the supposed degenerative nature of the atypia seen in such cases and suggests that there may be an association between these lesions and large cell ductal carcinoma in situ and hence invasive carcinoma.

The Naval Dockyards Society was formed in 1997. As well as placing a strong emphasis on research into the history of dockyards and the civil side of naval history worldwide, it has become involved in a number of important development issues, particularly in the UK. This paper traces the society’s involvement through a number of case studies (Gibraltar, Sheerness, Chatham, Deptford and Plymouth), assesses its successes and failures, and draws conclusions about the problems and opportunities presented by dockyard heritage.

The aim of the scheme was to determine consistency of histopathological reporting in the United Kingdom National Breast Screening Programme. This external quality assessment scheme involved 51 sets of 12 slides which were circulated to 186–251 pathologists at intervals of 6 months for 3 years. Participants recorded their diagnoses on standard reporting forms, which were submitted to the U.K. National Cancer Screening Evaluation Unit for analysis. A high level of consistency was achieved in diagnosing major categories of breast disease including invasive carcinoma and the important borderline lesions, radial scar and ductal carcinoma in situ (DCIS), the latter exceeding a national target set prior to the onset of the scheme. Atypical hyperplasia (AH) was reported with much less consistency although, where it was the majority opinion, over 86% of diagnoses were of benign disorders and only 14% were of DCIS. Inconsistency was encountered in subtyping and measuring DCIS, the former apparently due to current uncertainties about classification and the latter to poor circumscription, variation in size in different sections and merging with zones of AH. Reporting prognostic features of invasive carcinomas was variable. Measurement of size was achieved with adequate consistency except in a small number of very poorly circumscribed tumours. Grading and subtyping were inconsistent although the latter was not specifically tested and will be the subject of future study. Members of the National Coordinating Group achieved greater uniformity than the remainder of the participants in all diagnostic categories, but both groups experienced similar types of problem. Our findings suggest that participation in the scheme improves diagnostic consistency. In conclusion, consistency in diagnosing invasive carcinoma and radial scar is excellent, and good in DCIS, but improvements are desirable in diagnosing atypical hyperplasia, classifying DCIS and reporting certain prognostic features of invasive rumours. Such improvements will require further research, the development of improved diagnostic criteria and the dissemination of clearer guidelines.

During the 1670s, the navy was the focus of increasingly critical scrutiny from parliament and the political nation. This article considers the causes and nature of this criticism, which had its roots in the perceived dominance of the catholic James, duke of York, in the field of naval appointments, and examines the political context of the various inquiries into the state of religious affection in the fleet. By so doing, the article identifies a dilemma which confronted the crown's opponents in the period 1678–81, namely the conflict between the requirement for a strong navy to oppose France and the risk that, because of York's influence over it, that same navy might in fact be an instrument of French and catholic designs. Finally, the response of the officers and men of the navy to the events of the popish plot, exclusion crisis and ‘tory reaction’ is examined, placing the navy in the mainstream, rather than on the periphery, of the political and religious history of the period.

Large volumes of water are utilised during the operation of complex integrated steelworks. This usually results in the discharge of liquid effluents containing low concentrations of metals in solution and also the need to dispose of metal-rich sludges resulting from the treatment of these effluents. This paper presents the current performance of the final effluent plant at a large steelworks in South Wales, UK, focusing on the discharge effluent quality. In order to better understand the metal removal mechanisms a series of laboratory studies have addressed the precipitation of single metals and the co-precipitation of Zn with a range of other metals, including Fe and Cu, using sodium hydroxide as the alkali. Experimental data is compared to the predicted values using the geochemical model, PHREEQCi 2. Large sludge volume reductions were found for effluent treatment using the so-called High Density Sludge (HDS) process, which was operated on a pilot scale. HDS was achieved by mixing recirculating sludge and the feed water prior to adding the alkali, creating a so-called two stage neutralisation process, where recirculated sludge acts as a seed for further metals precipitation. Careful performance monitoring of the HDS process pilot plant was carried out in order to ensure suitable conditions for the formation of HDS. By the end of the trial HDS with high initial settling characteristics was being formed.

During the first 2 years (July 1989 to July 1991) of the Avon Breast Screening Service, fine-wire localization biopsy was indicated in 213 impalpable breast lesions. A total of 144 lesions were benign and 69 malignant. Only four of 213 lesions (1.9 per cent) were not excised at the first localization. Factors influencing reoperation in the 69 patients with malignant impalpable lesions were examined. There was a significant association (P < 0.001) between parenchymal disturbances on mammography and invasive carcinoma, and between non-invasive carcinoma and microcalcification (P < 0.001). In 31 patients the localization biopsy was the only surgical procedure. Thirty-eight patients required further surgery: 12 underwent further local excision and 26 mastectomy. Reoperation was more frequent in patients with calcification than in those with parenchymal disturbance (P < 0.001). The most frequent indications for mastectomy were inadequate excision of widespread comedo ductal carcinoma in situ or invasive ductal carcinoma combined with extensive ductal carcinoma in situ. Fine-wire localization biopsy was a combined therapeutic and diagnostic procedure in 31 of 69 women with impalpable screen-detected lesions. The majority of patients required further surgery because radiological abnormalities underestimated the extent of disease.

These two books are published by the Maltese company BDL, one of several local publishers producing excellent maritime history books that deserve a much wider readership. Both cover superficially s...

(2004). Primary carcinoid tumours of the ovary. Journal of Obstetrics and Gynaecology: Vol. 24, No. 1, pp. 99-101.