George Armstrong Lecture 2000.
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Cooperative Behavior↗
Biomedical subjects
R Hind
Publications and source records attributed to R Hind.
The development of a community child and family mental health service.
The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.
Child↗
Dosimetric assessment of radiolabelled lipiodol as a potential therapeutic agent in colorectal liver metastases using combined CT and SPECT.
Lipiodol has previously been used as an agent for targeted radiotherapy by selective retention in primary hepatic tumours following direct hepatic arterial infusion. We have considered the potential dosimetry of 131I-labelled lipiodol in treating colorectal liver metastases. Fifteen patients with multiple colorectal liver metastases underwent selective hepatic angiography when 5 ml lipiodol labelled with 40 MBq 131I were infused. All patients underwent planar scintigraphy of the abdomen and thorax, single photon emission computed tomography (SPECT) of the liver and whole body counting on at least two occasions following lipiodol injection. Computed tomographic (CT) images of the liver were also taken typically 7 days postinjection. The lipiodol was found to deposit on the periphery of metastases of less than 10 cm diameter. In one patient a metastasis of diameter greater than 15 cm failed to infuse. In two patients the lobe of the liver containing metastases was not successfully infused. Overlay of CT and SPECT images confirmed concentration in metastases. Quantification of SPECT images indicated that between 55 and 100% (median 86%) of the injected activity was retained in the liver following injection, and tumour to liver ratios of dose delivered ranged from 1.21:1 to 4.7:1 (median 3.1:1). Tumour does ranged from 11.8 to 43.3 mGy MBq-1 injected. Dose to the lungs ranged from 0 to 46% of the liver dose (median 16%). Lipiodol has potential for treatment of colorectal liver metastases in targeted radiotherapy.
Colonic Neoplasms↗
Surgical excision alone is adequate treatment for primary colorectal cancer.
This debate examines the arguments for and against the proposal that surgical excision alone is adequate treatment for primary colorectal cancer. The arguments in favour are that the results from curative surgery are excellent and that despite many trials of adjuvant chemotherapy, radiotherapy and immunotherapy, the proposed benefits remain unproven. Recent improvements in surgical technique, particularly for dissection of rectal tumours, have shown the way towards further improvement using surgery alone, and it is clear from a national survey that technical factors related to individual surgeons play a large part in determining recurrence rates. With optimum primary treatment, surgical excision alone is indeed adequate therapy. The arguments against this motion are that although a considerable number of patients do survive with surgery, the 5-year survival rate is poor when there is extensive local invasion or lymphatic metastases. Surgery starts therapy by reducing the tumour load, but other modalities are required to destroy the cells which might subsequently develop into metastases. Trial results with adjuvant therapy are encouraging, although many contain too few patients. We cannot be content with the results of treatment of Dukes' Stage B and C tumours; more trials are needed to determine the best treatment for these patients.
Antineoplastic Combined Chemotherapy Protocols↗