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Rationale Mandibular advancement devices (MADs) are used to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS) but evidence is lacking regarding their clinical and cost-effectiveness in less severe disease. Objectives To compare clinical- and cost-effectiveness of a range of MADs against no treatment in mild to moderate OSAHS. Measurements and methods This open-label, randomised, controlled, crossover trial was undertaken at a UK sleep centre. Adults with Apnoea-Hypopnoea Index (AHI) 5-<30/h and Epworth Sleepiness Scale (ESS) score =9 underwent 6 weeks of treatment with three nonadjustable MADs: self-moulded (SleepPro 1; SP1); semi-bespoke (SleepPro 2; SP2); fully-bespoke MAD (bMAD); and 4 weeks no treatment. Primary outcome was AHI scored by a polysomnographer blinded to treatment. Secondary outcomes included ESS, quality of life, resource use and cost. Main results 90 patients were randomised and 83 were analysed. All devices reduced AHI compared with no treatment by 26% (95% CI 11% to 38%, p=0.001) for SP1, 33% (95% CI 24% to 41%) for SP2 and 36% (95% CI 24% to 45%, p<0.001) for bMAD. ESS was 1.51 (95% CI 0.73 to 2.29, p<0.001, SP1) to 2.37 (95% CI 1.53 to 3.22, p<0.001, bMAD) lower than no treatment (p<0.001 for all). Compliance was lower for SP1, which was the least preferred treatment at trial exit. All devices were cost-effective compared with no treatment at a £20 000/quality-adjusted life year (QALY) threshold. SP2 was the most cost-effective up to £39 800/QALY. Conclusions Non-adjustable MADs achieve clinically important improvements in mild to moderate OSAHS and are cost-effective. Of those trialled, the semi-bespoke MAD is an appropriate first choice. [ABSTRACT FROM AUTHOR]

The article discusses medical treatments in early breast cancer and the side effects of endocrine therapy and chemotherapy. The major risk factors for metastatic disease include the absence of estrogen and progestogen receptors. Statistics are given for breast cancer mortality after treatment with tamoxifen and with anthracycline. Oophorectomy only benefits premenopausal women. Recurrence risk and survival statistics are provided. Data includes the effect of age and type of tumor on chemotherapy outcomes, The side effects from drugs and adjuvant treatment include hot flushes, fatigue, osteoporosis, and oral mucositis.

Comments on several medical issues in Great Britain. Accuracy in the portrayal of preclinical education by Professor Peter Richards; Commendation for the Quit for Life, a program promoting healthy lifestyles; Criticism on the article emphasizing on poorly designed studies.

Comments on several issues related to medical care in Great Britain. Prevalence of a family history of diabetes in the first degree; Use of oxygen concentrators for treatment of patients; Administration of adjuvant chemotherapy for early breast cancer.

Examines the tamofixen administration versus aminoglutethimide on advanced breast cancer. Duration of treatment; Occurrence of side effects; Efficacy of tamofixen and aminoglutethimide.

Background: Some patients started on nasal intermittent positive pressure ventilation (NIPPV) with the Monnal D ventilator deteriorate after a period. The effects of changing them to the Nippy ventilator were investigated.Methods: The records of such patients were examined retrospectively. Comparisons were made between blood gas tensions and overnight oximetry records before NIPPV, 12 weeks after the initiation of NIPPV with the Monnal D, at the time of deterioration, and 12 weeks after initiation of treatment with the Nippy ventilator.Results: Ten patients (seven women) were identified. Prior to starting NIPPV their mean (SD) age was 59.6 (8.39) years and their mean arterial oxygen and carbon dioxide tensions (PaO2 and PaCO2) while breathing air were 6.1 (1.79) and 9.6 (3.28) kPa, respectively. All were started on NIPPV with the Monnal D with improvements in symptoms, PaO2, PaCO2, and overnight oximetry after 12 weeks of treatment. After a mean interval of 118 (69.0) weeks all measures of ventilation had deteriorated and the patients were converted to the Nippy ventilator. Twelve weeks after initiation of treatment with the Nippy ventilator symptoms and overnight oximetry were improved again and the mean PaO2 and PaCO2 were 8.9 (1.27) and 6.9 (0.45) kPa, respectively. After a total mean period of 59 (26.9) weeks on the Nippy all but one of the patients have maintained this improvement.Conclusions: Support with NIPPV using the Monnal D ventilator may fail after an interval and changing to the Nippy ventilator can reverse this deterioration, probably because of its superior responsiveness to leaks and patient effort. The regular follow up of patients on long term NIPPV is necessary if secondary treatment failure is to be identified and effectively treated. [ABSTRACT FROM AUTHOR]

The article reports on neoadjuvant treatment of breast cancer, which aims to downstage large cancers before operation to reduce the use of mastectomy. In a research setting, the primary tumor is used as a measure of responsiveness to treatment. The immediate preoperative Arimidex compared with tamoxifen (IMPACT) trial tests the efficacy of neoadjuvant treatments on a small group of patients to help quickly identify new treatments.

The article discusses chemotherapy regimens for breast cancer in the United Kingdom. Adjuvant chemotherapy trials include NEAT, TACT, and CALGB 9741. Chemotherapy and tamoxifen are effective in women with high risk estrogen receptor positive cancer. Adjuvant treatment for patients with operable breast cancer includes endocrine treatment and chemotherapy. Trastuzumab is used in patients whose breast cancers overexpress HER2 and improves survival in patients with metastatic disease when used in combination with paclitaxel and docetaxel. Bisphosphonate treatment is used to reduce bone loss.

Focuses on the adjuvant chemotherapy for early breast cancer. Assessment on the patients with clinically localized breast cancer; Clinical trials on chemotherapy as an adjuvant to surgery; Postponement of the psychological blow of relapse.

Examines the efficacy of the combination treatment of tamoxifen and aminoglutethimide in advanced breast cancer. Comparison of drugs as single agents; Use of the standard criteria for staging disease and for defining objective response; Disadvantages of the combined endocrine treatment.

Examines a tamoxifen-induced tumor regression associated with dermatomyositis in women. Mechanism of dermatomyositis; Interaction of tamoxifen with cell components; Impact of long plasma half life to the patients.

Examines the prevention of doxorubicin-induced alopecia by scalp cooling with gel packs in patients with advanced breast cancer. Absence of hair loss; Occurrence of biochemical impairment of liver function; Number of patients with total alopecia.

Examines the effects of cyproheptadine on the regression of carcinoid tumor. Production of serotonin, histamine and kallikrein by carcinoid tumors; Regression of xenographs of the human colon cancer after treatment with an antiserotonin compound; Effects of cyproheptadine on tumor growth by blocking the effects of amine hormones.

Introduction: Non-invasive ventilation (NIV) improves prognosis in patients with motor neuron disease (MND) in the absence of major bulbar involvement. However, some experience a rapid and unexpected decline in respiratory function and may undergo emergency tracheal intubation. Weaning from invasive ventilation can be difficult, and reported independence from invasive ventilation is uncommon with poor prognosis. The outcomes of patients with MND referred to a specialist weaning service following emergency tracheal intubation were examined and compared with MND patients electively initiating NIV., Methods: A case note review was performed on all patients with MND invasively ventilated and referred to a specialist weaning service between 1992 and 2007. Outcomes were compared with those electively commenced on NIV during the same period., Results: Thirty patients were referred for weaning from invasive ventilation which was started in 17 before MND was diagnosed. Fourteen patients (47%) were weaned from invasive ventilation but still required NIV, 13 failed to wean, and three died. Seventeen were discharged home from hospital. The median survival from tracheal intubation was 13.7 months (95% CI 0 to 30.8) for those previously diagnosed and 7.2 months (95% CI 5.1 to 9.4) for those not previously known to have MND. Comparison with patients initiated electively on NIV demonstrated similar survival estimates to that from emergency intubation (median 9.4 (95% CI 6.9 to 12.0) vs 7.8 (95% CI 2.6 to 12.9) months respectively)., Conclusion: The prognosis in MND following acute respiratory failure and intubation is not always complete ventilator dependence if patients are offered a comprehensive weaning programme.