Blood and neoplastic diseases. Rational approach to the chemotherapy of human malignant disease-II.

There was good correlation between radiology and endo-scopy in diagnosing duodenal deformity, but precise diagnosis of active ulceration requires direct vision at endoscopy.6 Should barium-meal examinations be abandoned as initial investigations in dyspepsia and replaced by endoscopy? The lack of trained staff and equipment for endoscopy in most areas at the district general hospital level makes this an unrealistic suggestion. This study emphasizes the importance of the availability of an endoscopy service for the investigation of the upper digestive tract as already recommended by the British Society for Digestive Endoscopy. 7 General-practitioner clinical assistants can contribute greatly to providing an adequate endoscopy service, but even with more staff the endoscopy department would not be able to carry out the many investigations for dyspepsia currently performed in the x-ray department. Moreover, initial screening by a combined barium-meal examination and cholecystogram with subsequent endoscopy in selected patients will provide the most accurate diagnostic approach to the problem of dyspepsia. Conclusions Dyspepsia is a common complaint, the numbers seen in this study being confirmed by previous larger surveys. Many patients with dyspepsia have a specific lesion and in many the symptoms are severe enough to require surgery. Patients with specific lesions of the oesophagus, stomach, or duodenum may remain undiagnosed unless an endoscopy service is available. Thus, endoscopy services, based on district general hospitals, need to be further developed. The appointment and training of general-practitoner clinical assistants can contribute to the provision of an adequate service. Nevertheless, the combination of a cholecystogram with the barium-meal examination will avoid the delays in diagnosis which result if the investigations are ordered separately. who referred patients to the survey; and Mrs. H. M. Shephard, who coordinated our records throughout, and her secretarial colleagues. Lastly, we thank the staff of the departmnent of endoscopy, Gloucestershire Royal Hospital, for their support. Tnis survey was supported in part by a grant from the research comxnittee of the South Western Regional Hospital Board. The usual way of measuring a response to chemotherapy in man is to assess the reduction in ,tumour size and improvement in the patient's general condiftion. Unfortunately, many types of tumour do not respond ito chemotherapy using these criteria, but it must not be inferred that the therapy is ineffective in killing many tumour cells. Data on the volume of a tumour are unreliable when used as the sole end-point for estimation of the fraction of tumour …