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Reduced intensity conditioning (RIC) for allogeneic stem cell transplantation allows stable donor cell engraftment with the maintenance of a graft versus malignancy effect. Many different regimens exist employing various combinations of chemotherapy, radiotherapy and T-cell depletion. We examined the role of non-T-cell depleted RIC regimens in 56 patients with haematological malignancies. Patients received fludarabine phosphate for 5 days (30 mg/m2 in 35 patients, 25 mg/m2 in 21 patients) and melphalan for 1 day (140 mg/m2 in 36 patients, 100 mg/m2 in 20 patients). Immunosuppression was with CyA alone in 33 patients and CyA/MTX in 23 patients. Twenty-four of the 26 patients with chimerism data showed >95% donor chimerism at 3 months post transplant. aGVHD occurred in 18% of patients receiving CyA/MTX compared to 53% of patients receiving CyA. The 100-day mortality rate was 0.16 (95%CI 0.08-0.28) and 1-year nonrelapse mortality was 0.24 (95%CI 0.13-0.38). Thirty-three patients remained alive and in CR at a median of 19 months post transplant (range 3-38 months). We have shown that patients transplanted with fludarabine phosphate, melphalan 100 mg/m2 and with CyA/MTX as post transplant immunosuppression can achieve good disease control with an acceptable level of toxicity. Further studies are required to confirm these findings.

Surgical approaches to ovulation induction have developed from the traditional wedge resection to modern minimal access techniques, usually employing laparoscopic ovarian diathermy (LOD) or laser. This provides a single treatment option with a good rate of unifollicular ovulation, thereby minimizing the need for extensive ultrasound monitoring because of a low risk of multiple pregnancy. There is no difference between the cumulative conception rates between LOD and gonadotropin therapy after 12 months, although the latter produces higher pregnancy rates at 6 months. Ovarian surgery carries minimal risks, namely those of general anaesthesia, pelvic adhesions, and ovarian damage—all of which can be avoided by careful operative technique.

We sought to clarify pathological features and genetic alterations in colorectal carcinomas with characteristics of nonpolypoid growth. Colorectal carcinomas resected at Showa University Hospital in Tokyo included 86 with characteristics of polypoid growth (PG) and 21 with those of nonpolypoid growth (NPG). Mutations of APC, Ki-ras, and p53 genes, as well as microsatellite instability (MSI), were analysed using fluorescence-based polymerase chain reaction–single-strand conformation polymorphism (PCR–SSCP). Carcinomas with an NPG pattern were smaller than PG tumours (P<0.0001). Carcinomas with a PG pattern were more likely to harbour Ki-ras mutations (36%) than NPG tumours (0%; P<0.0001). Mutation types in the APC gene differed significantly between PG and NPG carcinomas (P=0.0189), including frameshift mutations in 66% of PG carcinomas but no NPG carcinomas. Presence of a p53 mutation at a ‘hot spot’ also was more likely in PG carcinomas (37%) than in NPG carcinomas (0%; P=0.0124). No significant difference in presence of MSI was evident between carcinomas with PG and NPG patterns. In conclusion, significant genetic differences were evident between carcinomas with PG and NPG patterns. Genetic changes in NPG carcinomas differed from those of the conventional adenoma–carcinoma sequence. Assuming that some nonpolypoid growth lesions transform rapidly into advanced carcinomas, 20% of all colorectal carcinomas may progress in this manner.

To rationalise medication in the elderly, physicians often change multiple dose regimens to once daily in the belief that this improves compliance. Effective methods for measuring compliance have only come into use during the last decade. Partly as a result of this, high quality studies comparing once daily with other regimens in the elderly, are lacking. What evidence there is, from investigations which used suboptimum methods and/or mixed (elderly/younger) patient groups, does not justify the widely held view that 'once a day is best', particularly when compared with twice daily regimens.

The gastrointestinal epithelium is believed to induce tolerance in Dept. Microbiology, Univerity College, Galway, Eire epithelial T cells under normal conditions. During inflammation, Purpose. IL-8 secretion is induced in gastric epithelial cell epithelial cells may become immunogenic and have the potential to lines by H. pylori (Hp) in a strain-specific manner. The activate CD4+ T cells. The induction of anergy or reactivity may be response of gastric epithelial cells to lipopolysaccharide controlled by the differential expression of adhesion molecules (LPS) of gastrointestinal flora is relevant to both Hp-induced necessary for T cell activation. As there is a marked infiltration of chronic gastritis and bacterial overgrowth in the achlorhy- the gastric epithelium with activated CD4 T cells during infection effects of LPS from different bacteria on IL-B secretion from with H. pylor;, we have studied the effect of cytokines induced gastric and colonic cell lines.

In this paper I review the early descriptions of what I take to be Crohn's disease, to suggest by bibliography and quotations from some of the early papers, that it is not a new disease of the twentieth century.