In the treatment of cancer or of any other disease, the physician or surgeon wishes to give the patient the most effective treatment. On some occasions cure is almost certain, e.g. following excision of a small rodent ulcer; on others treatment will be based upon a judgement designed to offer

THE TREATMENT options available to the phy-sician who wishes to prevent impending stroke are limited. This is because over half of the patients who have a cerebral infarction, have it without prior warn-ing so that there is no time for a physician to provide anything in the way of prevention. Among

Recent clinical research has greatly contributed to our understanding of the natural history and important prognostic variables associated with ovarian cancer. In comparison, progress in the management of this disease has been disappointingly slow (Slevin, 1986). Ovarian cancer is still the commonest fatal gynaecological cancer in women, accounting for over 3,500 deaths per annum in Great Britain. Although surgical intervention ls jpotentially curative in the early stage, 70-80 % of patients present when the disease has spread beyond the ovary due to its initial asymptomatic course (Weiss, 1986). Thus presenting symptoms, even when they are of short duration, usually represent advanced disease. The current standard approach for stage III ovarian cancer consists of total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy followed by chemotherapy. The actual response rate to chemotherapy and the overall duration of survival, is critically dependent on initial aggressive surgical debulking (Griffiths et al., 1979; Young et al., 1978). Patients with minimal residual disease (less than 2cm) after surgery are more likely to obtain pathologically complete remissions with induction chemotherapy and this group has the best prospect for long-term survival (Ozols & Young, 1984). Unfortunately, only a minority of women fall into this category. The majority of patients have bulky

OVER the past 10 years a steadily increasing number of asymptomatic peoplewith diastolic blood pressures between 90 and 100 mm Hg have been treatedwith antihypertensive drugs, more in the United States than anywhere else in the world. The expanding treatment of these 20 to 25 million people

The present supplement of the European Respiratory Journal contains a number of reviews concerning Treatment of Respiratory Failure. Important progress has been made in this area since the early 1990s. This supplement is the result of a symposium held in Barcelona on January 18, 2003. The symposium

.l The article by Fayad et all in this issue of the Journal of Child Neurol-ogy is another in a series of anecdotal treatment reports with small numbers of patients, this one with disappointing results; however, the authors correctly point out the need

European community more than a million individuals develop cancer every year (Moller Jensen et al., 1990). Of these cases, over 50 % will be aged over 70 years and this proportion will gradually increase as a result of longevity since age is a major risk determinant for malig-treat-nancy. Despite the frequency of cancer in the elderly, ment has often been given on an ad hoc basis and very rarely have structured management schemes been tested in prospective randomised trials. Undertreatment of cancer has been rife, irrespective of tumour site and the discipline of the clinician looking after the patient. Who are the elderly? No agreement exists as to the definition of the elderly, who have been variously described as being aged from over 65 years to over 85 years. The majority of clinical trials have excluded patients aged over 70 years so by default this can be described as the oncological definition of old age. There has also been a tacit assumption that the words elderly and frail are synonymous. That this is not true is confirmed by a recent general practice survey. In 1990, Hall et al. studied 775 registered patients aged more than 75 years and used Kings Fund Categories to determine their dependence: 1. Fit and active. 2. Lifestyle disturbed appreciably, but not housebound. 3. Lifestyle severely disturbed and housebound. 4. Bedfast. There were two males in category 4 and the remainder were classified as one fit, two partially disabled, and three housebound. The distribution by age is shown in Table I. This shows that over 90 % of men aged between 75 and 84 were mobile, as compared with 80 % of women of the same age. Even among those aged 85 years, 78 % of males and 56 % of females were either fully fit or only partially disabled. Thus the majority of the elderly are not suffering a restricted lifestyle because of chronic disease. At present, general practitioners in Britain are under pressure to screen the elderly for treatable diseases. This does not appear to extend to screening for cancer. Breast screening is being offered to women aged 50-65, and those over 65 are not being encouraged to attend. That there is extensive unrecognised malignancy has been demonstrated in an autopsy

In this issue of the Journal, Smith et al. [1] report significant study was undertaken without significant specific funding. If such support had been available, the study might have beenimprovements in people with AIDS and cryptosporidiosis after combined paromomycin and azithromycin therapy. Crypt- larger or based at multiple centers, which would have improved the statistical power of the study. Funding for clinical treatmentosporidiosis remains one of the most vexing and opportunistic infections. Sadly, only an intact immune system allows resolu- studies of cryptosporidiosis outside of the AIDS Clinical Trials Group system has been noticeably scarce.tion, and no therapeutic ‘‘magic bullet’ ’ exists [2]. For those without sufficient immunity, who have human immunodefi- During these halcyon days in which highly active (and highly expensive) antiretroviral therapy (HAART) has decreasedciency virus (HIV) resistant to drug therapy, who are too poor to afford antiviral drugs, or who have chemotherapy or malnu- deaths from AIDS, the incidence of opportunistic infections has fallen. Further complicating the above issues, then, is thetrition-associated disease, we must continue to search for the effective specific therapy that has evaded us so far. fact that there are simply fewer people with AIDS and crypt-osporidiosis available for therapeutic studies at any given insti-The results of Smith et al. [1] are interesting for several reasons. The study found a degree of clinical and parasitologic tution, at least in the parts of the world where HAART is available. Additional antiviral drug resistance may or may notresponse heretofore unseen in such a population. The signifi-cance of this should not be underestimated. Hundreds if not change these circumstances in the future. Even if AIDS be-

This editorial refers to ‘Physiological evaluation of the provisional side branch intervention strategy for bifur-cation lesions using fractional flow reserve’ † by B.-K. Koo et al., on page 726 Percutaneous coronary interventions (PCIs) on coronary arteries in which the lesion involves a

A number of treatments for cystic fibrosis have evolved over the past four decades, based on the experience of cli-nicians involved in the care of these patients. Some of these treatments were developed without the benefit of large randomised controlled trials which would have been di