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Notes: Summary. A radiolabelled monoclonal antibody (NDOG,) directed against placental alkaline phosphatase (PLAP) was used in the radio-immunodetection of ovarian carcinoma. Tumour deposits were successfully visualized in 11 of 15 patients and the abnormalities demonstrated were classified as focal or diffuse. Of the 11 patients, eight showed focal abnormalities alone and three had a diffuse abnormality, of which two also showed a focal abnormality. False-positive results may occur not only due to uptake of 123I by gut mucosa and an inadequately blocked thyroid gland but also from activity in an incompletely emptied bladder. A false-negative result occurred due to high background activity in the liver masking a known, discrete tumour deposit.

Notes: Objective 1. To audit the management of cervical carcinoma in the South West Region with the aim of identifying and addressing deficiencies. 2. To determine whether recent NHS restructuring has affected the provision of cancer care.Design Retrospective review of hospital case notes.Setting All hospitals in the South West Region of England.Population Three hundred and twenty-four women with a diagnosis of cervical carcinoma: 191 were diagnosed in 1989 and 133 in 1993.Main outcome measures Documentation of patient assessment and management.Results There was a mean delay of 17 days (range 0–66) from cervical smear to cytology report and 34 days (range 1–380) from general practitioner referral to attendance at a hospital clinic. Overall, 175 women (54%) had evidence of cytological assessment prior to treatment and 137 (42%) had a colpo-scopic assessment; 49% had cytological assessment and 37% had colposcopy in 1989, compared with 60% and 50%, respectively, in 1993. Excluding 49 cases of micro-invasive carcinoma, 238 case notes (86%) contained evidence of clinical examination; 195 women (71%) had had an examination under anaesthesia, 115 (42%) a chest radiograph, 123 (45%) an intravenous urogram or renal ultrasound, and 92 (33%) cystoscopy. One hundred and forty-seven women (53%) had FIGO staging recorded in the notes. As first line treatment, 69 had conservative surgery (39 for Stage IA), 138 had radiotherapy, and 107 had radical surgery. Ten had radical surgery for Stage IA but eight had a 〉 3 mm invasion or lymphatic/vascular spread. Thirty-one had Stage IB treated with radiotherapy of whom 14 were younger than 50 years of age. Following radical surgery 30% had evidence of sampling 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:14700328:BJO140:ges" location="ges.gif"/〉 10 nodes, and 9% had tumour extending to the resection margins.Conclusions Record keeping was inadequate but appeared to indicate inconsistent cytological, clinical, colposcopic and radiological assessment, leading to inappropriate clinical delays and conservative surgery. Radical surgery often appeared inadequate, but poor node sampling rates may also reflect insufficient histopathological preparation or reporting. There was a reduction in the number of new cases of cervical carcinoma diagnosed in 1993, perhaps reflecting an observed increase in cytological surveillance. No other alterations in clinical practice were observed over the four-year period. We feel it is imperative to standardise assessment throughout the region with a minimum clinical and histopathological dataset.

Notes: Two patients* developed a papulosquamous eruption in a widespread distribution which progressed with islands of sparing of uninvolved skin characteristic clinically of adult-onset pityriasis rubra pilaris (PRP). Biopsies from both patients showed multiple areas of nonfollicular and follicular suprabasilar and intra-epidermal acantholysis with minimal dyskeratosis. They also showed the usual histologic features of PRP with a thickened orthokeratosis and parakeratosis, a retained and sometimes thickened granular cell layer, and psoriasiform epidermal hyperplasia with a perivascular lymphohistiocytic infiltrate in the superficial dermis. Two previous patients with PRP have been reported with nonfollicular, focal acantholytic dyskeratosis and both were interpreted as most likely representing an incidental finding. We believe the acantholysis in these two cases is related to the disease process, and in our second patient, was helpful in establishing the diagnosis.

Notes: Objective To define and use a minimum clinical dataset for prospective data collection in order to audit the surgical management of cervical cancer in the South West of England. To compare this data set with a retrospective audit allowing assessment of the quality of care offered to patients.Design Prospective collection of a defined dataset on paper forms which were put into a computerised database for analysis. Registrations validated against histopathology databases and hospital coding.Setting All 13 hospitals in the South West of England which participated in the retrospective audit.Participants One hundred and sixty-five women with cervical cancer diagnosed in 1997.Main outcome measures Distribution of cases by hospital and surgeon; workload of individual surgeons; adequacy and accuracy of FIGO staging; adequacy of histological information; and adequacy of surgery.Results There is a trend to centralisation of cancer care and radical surgery in the region. Prospective collection of data has dramatically improved FIGO staging with 92% of all cases staged. For cases greater than Stage la, 98% were staged suggesting that a target of 100% staging is feasible. The histological dimensions of tumours were not measured in a high proportion of cases (20% of tumour diameters and 28% of tumour thicknesses). Apparent inadequacies in surgical management are explored. In 10/165 cases (6%) inappropriate conservative surgery may have been unavoidable, suggesting that a quality standard of 95% for appropriate radical surgical management of cervical cancer can be achieved. An anatomically complete removal of pelvic node-bearing tissue, yielding greater than 10 nodes in more than 95% cases, should be achievable with each surgeon/pathologist achieving a mean of more than 20 nodes.Conclusion Regional audit of cervical cancer management is feasible. It can be used to improve the quality of information on management and guide improved service provision.

Notes: Abstract The spatiotemporal distributions of major phytoplankton taxa were quantified to estimate the relative contribution of different microalgal groups to biomass and bloom dynamics in the eutrophic Neuse River Estuary, North Carolina, USA. Biweekly water samples and ambient physical and chemical data were examined at sites along a salinity gradient from January 1994 through December 1996. Chemosystematic photopigments (chlorophylls and carotenoids) were identified and quantified using high-performance liquid chromatography (HPLC). A recently-developed factor-analysis procedure (CHEMTAX) was used to partition the algal group-specific chlorophyll a (chl a) concentrations based on photopigment concentrations. Results were spatially and temporally integrated to determine the ecosystem-level dynamics of phytoplankton community-constituents. Seasonal patterns of phytoplankton community-composition changes were observed over the 3 yr. Dinoflagellates reached maximum abundance in the late winter to early spring (January to March), followed by a spring diatom bloom (May to July). Cyanobacteria were more prevalent during summer months and made a large contribution to phytoplankton biomass, possibly in response to nutrient-enriched freshwater discharge. Cryptomonad blooms were not associated with a particular season, and varied from year to year. Chlorophyte abundance was low, but occasional blooms occurred during spring and summer. Over the 3 yr period, the total contribution of each algal group, in terms of chl a, was evenly balanced, with each contributing nearly 20% of the total chl a. Cryptomonad, chlorophyte, and cyanobacterial dynamics did not exhibit regular seasonal bloom patterns. High dissolved inorganic-nitrogen loading during the summer months promoted major blooms of cryptomonads, chlorophytes, and cyanobacteria.

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