- Email: [email protected]
Eisai London Research Laboratories at UCL
681
conclusions were always backed up with objective research. His interest in ethology led him to enlist the support of Konrad Lorenz, Niko Tinbergen, and Robert Hinde. During Bowlby’s lifetime, psychoanalysis came under such heavy attack from both behaviourists and biologically minded psychiatrists that it was in danger of disappearing. Bowlby rescued the baby whilst letting the bathwater go, and, more than anyone else, proved that
psychoanalytical insights could receive scientific backing. His work has inspired a great deal of valuable research. John Bowlby was an excellent physician in the widest sense of Anyone in distress who turned to him would be sure of an finding expert who, at the same time, was a warm, caring human being with a unusual capacity for attentive listening. Despite his that word.
achievements, he was not in the least pompous. To the end of his
life, he was always prepared to learn from others and to entertain new possibilities. Anyone who was present at the launch of his last book at the Tavistock Clinic will remember his courageous speech, made from a wheel-chair at the age of eighty-three, which was as clear and cogent as if he had been in good health and forty years younger.
Although his achievements have been widely recognised, I still importance of his work has been underestimated. Biological psychiatrists are suspicious of anyone calling himself a psychoanalyst; and the psychoanalytical establishment thought that Bowlby was not really "one of us". Bowlby was unclassifiable, like everyone of independent mind, and this has delayed the final recognition of his proper status. To my mind, he is one of the three or four really great psychiatrists of the twentieth century. Anthony Storr
fluoroscopy time to median survey value or less, and reducing hospital mean doses to the survey third quartile value or less. The 1983 survey showed that entrance skin-doses per film for nominally same type of radiograph varied 5-20 fold within and between hospitals, so as a first step the report recommends that hospitals should regularly monitor levels of entrance surface dose in each X-ray room for a few common X-ray procedures. The report also lists radiographic projections that should not be included routinely--eg, an axial view when a skull X-ray is requested.
the
The third group of measures recommended is the introduction of
dose-saving equipment, with prime consideration being given to rare-earth screens, to optimum operation of film processors and image intensifiers, and to carbon-fibre components-measures that cost from nothing to c280 per man Sv saved, and which were discussed in The Lancet two years ago.2 The recommendations made in the report are common-sense and most can be implemented without much difficulty. However, pressure from women aged under 50 for mammographic breast screening may make it necessary for screening services, especially those in the private sector, to reassess their policies
measures
carefully.
think that the
Noticeboard Avoiding
unnecessary
patient exposure to
radiation About 87% of the total collective dose of ionising radiation that the population of the UK receives from man-made sources come from diagnostic X-rays. About half of this contribution is unnecessary, says a reportl by a joint working party from the Royal College of Radiologists and the National Radiation Protection Board published last week, which lists measures for reducing the current annual collective population dose of ionising radiation from medical X-rays by about 7500 man Sv per year-an excess that the working party says could be responsible for a hypothetical 100-250 of the 160 000 cancer fatalities that occur each year. The report estimates that about 20% of X-ray examinations are unnecessary because the probability that they will provide information useful for clinical management is extremely low, and that elimination of such examinations would give a potential annual collective dose saving of 3200 man Sv. The report recommends a College booklet Making the Best Use of a Department of Radiology, which contains referral guidelines for twelve categories of radiological examinations covering over 70 important clinical circumstances and which has been introduced, as part of a research project, into five NHS hospitals, where it has been accepted as hospital policy. Special mention is made of the need to justify mammography screening in women aged over 50, employmentrelated chest screening, and the use of computed tomography (CT). The number of CT scanners has doubled in the past 5 years in the UK to about 200. The working party says that all requests for a CT scan should be vetted by an experienced radiology. CT examinations carry high-dose implications, which the working party thinks not all radiologists are fully aware of, so it recommends rapid publication of the results of an NRPB national survey on CT practice and patient doses still in progress. Savings would also be achieved by good organisation and quality control, because the reasons for a large proportion of repeat examinations are no more than the mislaying or poor quality of the original film. Other suggestions for minimising patient dose include reducing the number of films per examination to the median value or less of that obtained in a survey of 20 hospitals done in 1983, reducing
1. Patient dose reduction in diagnostic radiology. Report by the Royal College of Radiologists and the National Radiological Protection Board. Documents of the NRPB, 1990, vol 1. London: HM Stationery Office, 1990. 2. Anon. Radiation protection in the UK: an opportunity missed. Lancet 1988; ii: 315-16.
Inaccuracy of ultrasonography and MRI in staging early prostatic cancer Computed tomography cannot identify prostatic disease, so it has been replaced by ultrasonography and magnetic resonance imaging (MRI) for diagnosis and staging. Early assessments, on small numbers of patients, had yielded promising results. However, the encouraging results have not been confirmed in a multicentre studyl in which 230 patients thought clinically to have localised prostatic’ cancer were assessed with transrectal ultrasonography and MRI before undergoing radical prostatectomy. Ultrasonography accurately staged 66% of advanced disease and 46% of confined disease; the corresponding figures for MRI were 77% and 57%. Neither technique could reliably differentiate microscopical local from advanced disease in patients who seemed clinically to have surgically resectable disease. For every 100 patients with ultrasound results suggesting extension of disease beyond the prostate, 37 were false positives; the proportion falsely diagnosed by ultrasonography as having confined disease was 51 %; the corresponding figures for MRI were 29% and 37%. Furthermore, ultrasonography identified only 59%, and MRI 60%, of malignant lesions that had one dimension exceeding 5 mm. Clearly at the present stage of development ultrasonography and MRI are not accurate techniques for staging early prostatic cancer. Does the solution lie in refinements of these techniques, as those who reported the study seem so strongly to believe? MD, Zerhouni EA, Gatsonis CA, et al. Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer N Engl J Med 1990;
1. Rifkin
323: 621-26.
Eisai London Research Laboratories at UCL
Eisai, a Japanese pharmaceutical company, is investing more than
50 million over the next 15 years to build and run a new research laboratory for neuroscience, especially the study of diseases of the central nervous system, on the University College London campus. The laboratory will be part of a new research centre at UCL that will include a Medical Research Council building for cell biology. The initial investment of C 12 m will go to the building and equipment of the laboratory, expected to open in the autumn of 1991. After 50 years Eisai will freely transfer ownership of the building to UCL which, with its Centre for Neurosciences, established in 1979, was chosen by Eisai for its experience in this area. Scientists recruited for the laboratory will hold part-time teaching and research posts at the
College.
conclusions were always backed up with objective research. His interest in ethology led him to enlist the support of Konrad Lorenz, Niko Tinbergen, and Robert Hinde. During Bowlby’s lifetime, psychoanalysis came under such heavy attack from both behaviourists and biologically minded psychiatrists that it was in danger of disappearing. Bowlby rescued the baby whilst letting the bathwater go, and, more than anyone else, proved that
psychoanalytical insights could receive scientific backing. His work has inspired a great deal of valuable research. John Bowlby was an excellent physician in the widest sense of Anyone in distress who turned to him would be sure of an finding expert who, at the same time, was a warm, caring human being with a unusual capacity for attentive listening. Despite his that word.
achievements, he was not in the least pompous. To the end of his
life, he was always prepared to learn from others and to entertain new possibilities. Anyone who was present at the launch of his last book at the Tavistock Clinic will remember his courageous speech, made from a wheel-chair at the age of eighty-three, which was as clear and cogent as if he had been in good health and forty years younger.
Although his achievements have been widely recognised, I still importance of his work has been underestimated. Biological psychiatrists are suspicious of anyone calling himself a psychoanalyst; and the psychoanalytical establishment thought that Bowlby was not really "one of us". Bowlby was unclassifiable, like everyone of independent mind, and this has delayed the final recognition of his proper status. To my mind, he is one of the three or four really great psychiatrists of the twentieth century. Anthony Storr
fluoroscopy time to median survey value or less, and reducing hospital mean doses to the survey third quartile value or less. The 1983 survey showed that entrance skin-doses per film for nominally same type of radiograph varied 5-20 fold within and between hospitals, so as a first step the report recommends that hospitals should regularly monitor levels of entrance surface dose in each X-ray room for a few common X-ray procedures. The report also lists radiographic projections that should not be included routinely--eg, an axial view when a skull X-ray is requested.
the
The third group of measures recommended is the introduction of
dose-saving equipment, with prime consideration being given to rare-earth screens, to optimum operation of film processors and image intensifiers, and to carbon-fibre components-measures that cost from nothing to c280 per man Sv saved, and which were discussed in The Lancet two years ago.2 The recommendations made in the report are common-sense and most can be implemented without much difficulty. However, pressure from women aged under 50 for mammographic breast screening may make it necessary for screening services, especially those in the private sector, to reassess their policies
measures
carefully.
think that the
Noticeboard Avoiding
unnecessary
patient exposure to
radiation About 87% of the total collective dose of ionising radiation that the population of the UK receives from man-made sources come from diagnostic X-rays. About half of this contribution is unnecessary, says a reportl by a joint working party from the Royal College of Radiologists and the National Radiation Protection Board published last week, which lists measures for reducing the current annual collective population dose of ionising radiation from medical X-rays by about 7500 man Sv per year-an excess that the working party says could be responsible for a hypothetical 100-250 of the 160 000 cancer fatalities that occur each year. The report estimates that about 20% of X-ray examinations are unnecessary because the probability that they will provide information useful for clinical management is extremely low, and that elimination of such examinations would give a potential annual collective dose saving of 3200 man Sv. The report recommends a College booklet Making the Best Use of a Department of Radiology, which contains referral guidelines for twelve categories of radiological examinations covering over 70 important clinical circumstances and which has been introduced, as part of a research project, into five NHS hospitals, where it has been accepted as hospital policy. Special mention is made of the need to justify mammography screening in women aged over 50, employmentrelated chest screening, and the use of computed tomography (CT). The number of CT scanners has doubled in the past 5 years in the UK to about 200. The working party says that all requests for a CT scan should be vetted by an experienced radiology. CT examinations carry high-dose implications, which the working party thinks not all radiologists are fully aware of, so it recommends rapid publication of the results of an NRPB national survey on CT practice and patient doses still in progress. Savings would also be achieved by good organisation and quality control, because the reasons for a large proportion of repeat examinations are no more than the mislaying or poor quality of the original film. Other suggestions for minimising patient dose include reducing the number of films per examination to the median value or less of that obtained in a survey of 20 hospitals done in 1983, reducing
1. Patient dose reduction in diagnostic radiology. Report by the Royal College of Radiologists and the National Radiological Protection Board. Documents of the NRPB, 1990, vol 1. London: HM Stationery Office, 1990. 2. Anon. Radiation protection in the UK: an opportunity missed. Lancet 1988; ii: 315-16.
Inaccuracy of ultrasonography and MRI in staging early prostatic cancer Computed tomography cannot identify prostatic disease, so it has been replaced by ultrasonography and magnetic resonance imaging (MRI) for diagnosis and staging. Early assessments, on small numbers of patients, had yielded promising results. However, the encouraging results have not been confirmed in a multicentre studyl in which 230 patients thought clinically to have localised prostatic’ cancer were assessed with transrectal ultrasonography and MRI before undergoing radical prostatectomy. Ultrasonography accurately staged 66% of advanced disease and 46% of confined disease; the corresponding figures for MRI were 77% and 57%. Neither technique could reliably differentiate microscopical local from advanced disease in patients who seemed clinically to have surgically resectable disease. For every 100 patients with ultrasound results suggesting extension of disease beyond the prostate, 37 were false positives; the proportion falsely diagnosed by ultrasonography as having confined disease was 51 %; the corresponding figures for MRI were 29% and 37%. Furthermore, ultrasonography identified only 59%, and MRI 60%, of malignant lesions that had one dimension exceeding 5 mm. Clearly at the present stage of development ultrasonography and MRI are not accurate techniques for staging early prostatic cancer. Does the solution lie in refinements of these techniques, as those who reported the study seem so strongly to believe? MD, Zerhouni EA, Gatsonis CA, et al. Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer N Engl J Med 1990;
1. Rifkin
323: 621-26.
Eisai London Research Laboratories at UCL
Eisai, a Japanese pharmaceutical company, is investing more than
50 million over the next 15 years to build and run a new research laboratory for neuroscience, especially the study of diseases of the central nervous system, on the University College London campus. The laboratory will be part of a new research centre at UCL that will include a Medical Research Council building for cell biology. The initial investment of C 12 m will go to the building and equipment of the laboratory, expected to open in the autumn of 1991. After 50 years Eisai will freely transfer ownership of the building to UCL which, with its Centre for Neurosciences, established in 1979, was chosen by Eisai for its experience in this area. Scientists recruited for the laboratory will hold part-time teaching and research posts at the
College.