No portion of this paper may be reproduced without permission of the authors. Discussion papers are research materials circulated by their authors for purposes of information and discussion. They have not undergone formal peer review or the editorial treatment accorded RFF books and other

No portion of this paper may be reproduced without permission of the authors. Discussion papers are research materials circulated by their authors for purposes of information and discussion. They have not undergone formal peer review or the editorial treatment accorded RFF books and other

factors, natural history and treatment responses of the specific phenotypes. Ultimately, this has the potential to enable tailoring of treatment regimes to individual patients. Currently this is not possible as the treatment guidelines for COPD do not differ according to phenotype, other than by severity

Treatment-resistant depression is a significant clinical problem with great morbidity and mortality (1). The report by Murrough et al. (2), published concurrently with this editorial, of their two-site randomized controlled clinical trial of ketamine in patients with treatment-resistant depression

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

THE CHAIRMAN of the Board of a large and successful industrial organization once told me the secret of his success in the business world. "As soon as I am 60 per cent sure, " he said, "I take action. If I had waited until I was 100 per cent sure, I would still be delivering newspapers. " He then proceeded to level a tirade of criticism against the members of the medical pro-fession for withholding information from the public on the—to him—poor excuse that they were not 100 per cent sure of how to prevent coronary artery disease. Whether or not he is right, 100 per cent certainty does not exist, and somewhere along the line the results of medical research have to

chi ve of S ID

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

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

patients with chronic rhinosinusitis and allergy With each new year, we witness numerousadvancements in our understanding of chronic rhinosinusitis and welcome novel treat-ments to improve outcomes in our patients. This January edition of the American Journal of Rhinology and Allergy includes a