A cohort profile of the Graham Roberts study cohort

Purpose

The Graham Roberts Study was initiated in 2018 and is the first Trials Within Cohorts (TwiCs) study for bladder cancer. Its purpose is to provide an infrastructure for answering a breadth of research questions, including clinical, mechanistic, and supportive care centred questions for bladder cancer patients.

Participants

All consented patients are those aged 18 or older, able to provide signed informedconsent and have a diagnosis of new or recurrent bladder cancer. All patients are required to have completed a series of baseline questionnaires. The questionnaires are then sent out every 12 months and include information on demographics and medical history as well as questionnaires to collect information on quality of life, fatigue, depression, overall health, physical activity, and dietary habits. Clinical information such as tumor stage, grade and treatment has also been extracted for each patient.

Findings to date

To date, a total of 125 bladder cancer patients have been consented onto the study with 106 filling in the baseline questionnaire. The cohort is made up of 75% newly diagnosed bladder cancer patients and 66% non-muscle invasive bladder cancer cases. At present, there is 1-year follow-up information for 70 patients, 2-year follow-up for 57 patients, 3-year follow-up for 47 patients and 4-year follow-up for 19 patients.

Future plans

We plan to continue recruiting further patients into the cohort study. Using the data collected within the study, we hope to carry out independent research studies with a focus on quality of life. We are also committed to utilizing the Roberts Study Cohort to set up and commence an intervention. The future studies and trials carried out using the Roberts Cohort have the potential to identify and develop interventions that could improve the prevention, diagnosis, and treatment of bladder cancer.

Use of a simple pain model to evaluate analgesic activity of ibuprofen versus paracetamol

OBJECTIVE

To evaluate the analgesic activity of ibuprofen against paracetamol using a simple pain model.

DESIGN

A double-blind study.

SETTING

Twenty general practitioners in Harare, Zimbabwe.

PATIENTS

Adults with acute sore throat of a maximum of two days' duration.

INTERVENTIONS

One hundred and thirteen patients with acute pain associated with tonsillo-pharyngitis randomly received either 400 mg ibuprofen or 1000 mg paracetamol. The study design included repeated administration up to 48 hours to assess tolerability.

MAIN OUTCOME MEASURES

At hourly intervals for six hours after the first dose of treatment, the patients evaluated pain intensity on swallowing, difficulty in swallowing and global pain relief according to visual analogue scales.

RESULTS

Ibuprofen 400 mg was significantly more effective than paracetamol 1000 mg in all three ratings, at all time-points for pain intensity and difficulty in swallowing, and from two hours onwards for pain relief. There were no serious adverse effects and no statistically significant difference in the incidence of adverse effects in the two treatment groups.

CONCLUSIONS

Sore throat pain provided a sensitive model to assess the analgesic efficacy of class I analgesics and discriminated between the analgesic efficacy of ibuprofen and paracetamol.

Melanocytic nevi in schoolchildren in Queensland

In a group of 211 schoolchildren in Queensland less than 12 years of age, the mean total melanocytic nevus (mole) count was 28 (median 19), and the mean count for raised nevi was 11 (median 8). The upper aspect of the back and chest were the most commonly affected sites, with the neck being the third. Boys had significantly (p less than 0.01) more melanocytic nevi than girls, and prevalence was highest in children with pale skin and light-colored hair. Nonwhite heritage had a protective effect independent of pigmentary characteristics. Total numbers of nevi on children also were related to maternal tendency to large numbers of moles and to family history of melanoma. The only significant association observed for the presence of large (greater than 5 mm) nevi on children was a family history of melanoma. The children studied come from a general population that has the highest known risk of melanoma. In Australia they have been shown to have the highest prevalence of nevi ever reported in the prepubertal age group. These descriptive data, together with the specific pigmentary and family associations described, extend the known links between benign nevi and malignant melanoma.

On the uses of intracranial pressure monitoring

Intracranial pressure monitoring with an intra-ventricular catheter, an external transducer and a continuous chart recorder was undertaken in 15 patients with acute brain damage and in six patients suspected of suffering from long-standing raised intracranial pressure. In the acute cases, monitoring was useful in the diagnosis of raised intracranial pressure and in the assessing of the efficacy of its treatment. In the chronic cases, the clinical suspicion of raised pressure was confirmed or refuted without doubt. Complications were minimal, and the method was judged to be of considerable value in selected cases.

Effects of mannitol and steroid therapy on intracranial volume-pressure relationships in patients

The intracranial volume-pressure response was measured in 61 patients undergoing continous monitoring of intraventicular pressure. This test, which determlnes the increase in intracranial pressure induced by an addition of 1 ml in ventricular CSF volume in 1 sencond, yields information concerning spatial compensation in patients with intracranial space-occupying processes. On the basis of variability tests, a change in volume-pressure response of 2 mm Hg/ml was accepted as significant. Pronounced enlargement of the ventricles interferes with the test. In patients with intracranial hypertension, intravenous mannitol (0.5gm/kg) and intramuscular betamethasone (26 mg) both reduce the volume-pressure response significantly more than they reduce intracranial pressure. This suggests that these agents favorably alter the configuration of the volume-pressure curve.

Intracranial volume--pressure relationships during experimental brain compression in primates. 3. Effect of mannitol and hyperventilation

In 10 anaesthetized and ventilated baboons a steady level of raised intracranial pressure was achieved by graduated inflation of an extradural balloon. Measurements were made of the ventricular fluid pressure, and of the change in this pressure after injection of 0·05 ml into the ventricle, the volume-pressure response. This response was studied at normocapnia and at hypocapnia (induced by hyperventilation), and before and after the intravenous administration of mannitol under normocapnic and hypercapnic conditions. During hypocapnia, ventricular fluid pressure and the volume-pressure response were reduced equally. Mannitol, however, caused a greater reduction in the volume-pressure response than in ventricular fluid pressure. The intravenous administration of mannitol therefore produces a beneficial effect on intracranial capacitance which is greater than observation of intracranial pressure alone indicates.

Intracranial volume--pressure relationships during experimental brain compression in primates. 2. Effect of induced changes in systemic arterial pressure and cerebral blood flow

In eight anaesthetized, ventilated adult baboons, the intracranial volume-pressure response was examined at differing levels of raised intracranial pressure during induced changes in systemic arterial pressure and cerebral blood flow. The volume-pressure response is defined as the change in ventricular fluid pressure caused by a volume addition of 0·05 ml to the lateral ventricle. At normal intracranial pressure, the volume-pressure response was unchanged by alterations in systemic arterial pressure and cerebral blood flow. At raised intracranial pressure, however, systemic arterial hypertension rendered the intracranial contents more sensitive to the effects of an addition to the ventricular volume as shown by an increased volume-pressure response. When intracranial pressure was increased, there was a significant linear correlation between the volume-pressure response and both arterial pressure and cerebral blood flow. The clinical implication of this phenomenon is that arterial hypertension in patients with increased intracranial pressure is likely to have a deleterious effect by increasing brain tightness.

Intracranial volume--pressure relationships during experimental brain compression in primates. 1. Pressure responses to changes in ventricular volume

Intermittent additions of 0·05 ml saline were made into the lateral ventricle of anaesthetized, ventilated baboons at regular intervals during continuous inflation of a supratentorial extradural balloon. Close correlation was observed both between the increase in ventricular fluid pressure (VFP) immediately after the injection and the volume in the balloon (P < 0·001); and between the increase in ventricular pressure and the pressure immediately before the injection (P < 0·001). This change in ventricular fluid pressure, which is termed the volume-pressure response (VPR), helps to delineate the stage reached on the intracranial volume-pressure curve, and is therefore a measure of the capacity of the intracranial contents to compensate for the volume changes produced by an expanding intracranial lesion. The VPR is currently being used in patients and the clinical implications of confirming its validity experimentally are therefore discussed.

The incidence of right inguinal hernia following appendicectomy

A retrospective study of 549 patients who had undergone repair of an inguinal hernia is presented. It is noted that appendicectomy does not predispose to the development of a right inguinal hernia.

Brachial plexus lesions associated with traumatic asphyxia

Among 19 patients admitted to hospital following a major disaster it was noted that 15 showed evidence of traumatic asphyxia and 7 had sustained brachial plexus injury. Three such cases are presented, the possible pathogenesis of the brachial plexus lesions is discussed, and the diagnostic difficulty presented by unconscious traumatically asphyxiated patients with monoparesis is highlighted.