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The dose of combination chemotherapy in Hodgkin's disease is commonly calculated from a formula based on the body surface area. A method is described for measuring the intensity of combination chemotherapy actually received compared to the calculated planned dose. The technique is applied to 56 patients receiving mustine, vinblastine, procarbazine and prednisolone, but would also be suitable for other cytotoxic regimens. The planned dosage intensity had to be significantly reduced in over half of the patients because of marrow toxicity. Splenectomized patients received a higher dose intensity than those in whom the procedure was not performed. [ABSTRACT FROM AUTHOR]

The first child born after in-vitro fertilisation, (IVF)-treatment, just passed its 26th birthday in July 2004. Since that birth-assisted reproduction techniques (ART) became a practicable technology, they had been used all over the world, and more than 2 million children were born after IVF-treatment. Despite all success in this field, ART is neither accepted nor used for all infertile couples, although this might be the only possibility of becoming pregnant. Two different kinds of ART refusal are distinguishable: the primary refusal being for financial, psychosocial, moral, ethical and medical reasons including the risk of severe ovarian hyperstimulation syndrome, the risk of multiple pregnancies and the risk of malformations. The secondary refusal includes dropouts after one or more unsuccessful IVF-treatments mainly influenced by the outcome of previous cycles (prognostic factors: oocyte and embryo count, embryo quality, females age) associated with psychological and emotional aspects. However, financial factors seem to be the most potent reasons for ART-refusal.

Objective: To record every patient with proved colorectal adenocarcinoma presenting from a defined population over two years in 1968-9 and during 1980-2, and to compare treatment and outcome over seven years., Design: Retrospective in 1968-9 and prospective in 1980-2., Setting: Aberdeen general hospitals., Subjects: Every patient presenting to the four general surgical units with histological proof of colorectal adenocarcinoma., Main Findings: On average, one new patient presented each week per 100,000 population. The proportion of patients aged 65 and over rose from 67% to 71%. An operation was performed on 385 patients in 1968-9 and on 399 during 1980-2. At laparotomy the proportion of patients who seemed to be curable and had a radical operation rose slightly, from 56% to 61%, and operative mortality fell from 9% to 5%. In all there were 421 survivors of curative surgery, and seven years later three quarters were either alive (51%) or had died without recurrence (25%). In both studies some 40% of patients were considered incurable when they presented, but the number who had a palliative resection rose from 59% to 85%., Conclusions: The contribution of radical surgery to the treatment of colorectal adenocarcinoma is substantial, with three quarters of patients so treated showing no evidence of recurrence after seven years. Operative mortality in an elderly population is now low, and improvement in late outcome is more likely to come from developments in adjuvant therapy than in operative technique. A continuing problem is that 40% of patients are not curable when they present, although palliative resection can now be offered to over 80%.

A case is reported illustrating a rare and puzzling cause of long standing anaemia and abnormal liver function tests. The diagnosis of Castleman's disease came to light only after an adrenal mass was noted during ultrasound examination. Removal of the mass led to a rapid reversal of all the abnormalities.

Factors V, VII, VIII, X, XI, and XII of the coagulation system, platelet count, and antithrombin III levels were assayed in 20 healthy volunteers aged 20-40 years and 61 elderly subjects aged 66-96 years whose skinfold thickness was also measured. Factors XI, XII, and antithrombin III levels tended to increase in women and decrease in men while factors X, VII, and V tended to increase in both males and females with advancing years. No age or sex differences were found in platelet counts or factor VIII levels. Factor VIII levels were inversely correlated with obesity in elderly males (r = -0.56, p < 0.005).

Non-cytotoxic Fc receptor blocking antibodies against autologous B lymphocytes were sought in sera from patients with chronic lymphocytic leukaemia (CLL), using a rosette inhibition assay. They were found in 11 of 52 (21%) of patients with CLL, but were not associated with previous blood transfusion or pregnancy, suggesting that they were unlikely to have resulted from allogeneic stimulation. Fc receptor blockade was more commonly detected in sera from patients with stage B rather than stage A CLL (Binet classification), though this did not achieve significance beyond the 90% level, and it was noted in 62.5% of those with lymphocyte doubling times of less than one year, compared with 36.3% of those whose lymphocyte doubling time was more than one year. The results indicate that autologous Fc receptor blocking antibody activity occurs in sera from patients with CLL, is more likely to be generated by the tumour itself than by allogeneic stimulation, and is associated with increased tumour load. Such antibodies may permit tolerance of tumour by the host.

Whole-blood caeruloplasmin measured by electron spin resonance was studied in 41 patients with chronic lymphocytic leukaemia. The levels were above normal at all stages of the disease, rose with increasing clinical involvement, and were higher in progressive than inactive disease. Whole-blood iron transferrin levels were more variable, and were significantly raised only in patients with marrow failure.

All young patients in the Grampian area attending the lymphoma review clinic who had received first line treatment for Hodgkin's disease and had attained complete remission without subsequent relapse were studied between 1980 and 1983. Chemotherapy with MVPP (mustine, vinblastine, procarbazine, and prednisolone) had more severe effects on the fertility of men than that of women; younger women and those taking oral contraceptives were more likely to retain fertility than those over 30 or not taking the pill at the time of chemotherapy, but these two effects could not be differentiated. Premature menopause was common after treatment with MVPP. Mantle radiotherapy had no discernible effect on gonadal function.

Increasing the haemoglobin concentration results in increased oxygen transport at the cost of increased blood viscosity. This suggested the concept of an optimum packed cell volume for maximising oxygen transport and a study was therefore conducted seeking supportive evidence. Linear cardiac output was measured as minute distance by Doppler ultrasound in 40 patients with haemopoietic disorders who had stable haemoglobin concentrations ranging from 30 to 200 g/l. The correlation between haemoglobin concentration and minute distance (r = -0.45; p less than 0.01) was negative, and correlations between haemoglobin concentration and mean blood pressure (r = 0.66; p less than 0.001) and haemoglobin concentration and peripheral resistance (r = 0.64; p less than 0.001) were positive. Calculated oxygen transport increased across the whole range of haemoglobin values. These results suggest that adjustment of peripheral resistance in response to oxygen availability overrides the influence of blood viscosity on cardiac output and that the optimum packed cell volume for oxygen transport is the highest that can be achieved.

Components of the fibrinolytic enzyme system, FR-antigen and fibrinogen, were measured in 20 healthy volunteers aged 20-40 years and in 61 elderly subjects aged 66-96 years. Plasminogen activator levels did not significantly differ between the 20-40 and 66-75 age groups, but were higher in those over 75. Plasminogen showed no change with age except for a fall in those over 75. Fibrinogen, FR-antigen, alpha(1)-antitrypsin, and alpha(2)-macroglobulin all rose with age, but the mean fibrinogen concentration fell in the very elderly.

A man with apparently quiescent Hodgkin's disease presented with acute severe isolated thrombocytopenic purpura. Splenectomy revealed macroscopic involvement with Hodgkin's tissue and cured the thrombocytopenia.

In a study of 133 anaemic and 111 non-anaemic hospital patients pallor of recent onset was the only symptom which was significantly associated with the severity of the anaemia. Dizziness in acute blood loss anaemia, and anorexia and painful tongue in vitamin-B(12) deficiency, were the only symptoms which might be helpful in diagnosing the type of anaemia. The frequency of glossitis in patients with megaloblastosis was confirmed, but neither glossitis nor nail changes were significantly more common in patients with iron-deficiency anaemia than in the control patients.

Two alternative methods for detecting vitamin B(12) deficiency in a psychiatric population have been compared: the ;direct' approach by microbiological assay of serum vitamin B(12) levels in all patients, and the ;indirect' approach where all patients are first screened for antigastric parietal cell antibodies and thereafter all positive reactors and other ;high-risk' patients have serum vitamin B(12) assayed. The indirect approach was found to be cheaper.

A case of microangiopathic haemolytic anaemia associated with malignant haemangio-endothelioma is described. It is suggested that haemolysis may have been due to mechanical trauma sustained by the red blood cells on passage through the tumour's abnormal vasculature.