Summary Pancreatic cancer has a poor response to conventional chemotherapy and radiotherapy. Inhibition of matrix metalloproteinase activity involved in tumour invasion and metastases is a novel biological approach for cancer treatment. This multicentre phase II clinical trial assessed marimastat, an oral matrix metalloproteinase inhibitor, in patients with advanced pancreatic cancer. A total of 113 patients received marimastat for 28 days at 100 mg b.d. (n = 9), 25 mg o.d. (n = 90) or 10 mg b.d. (n = 14). Patients with a response to treatment could continue marimastat beyond 28 days. Of 113 patients, 90 (80%) completed the 28-day study and 83 (73%) continued treatment. The principal side effect was arthralgia in 14 (12%) patients at 28 days and 33 (29%) patients over the whole study. There were 31 patients (27%) who required dose modification. Of 76 patients with evaluable CA19-9 levels, 23 (30%) showed no increase or fall in CA19-9. Of 83 patients with radiologically assessable disease, 41 (49%) had stable disease. The median survival was 245 days for those with a stable or falling CA19-9 level 128 days in those with rising CA19-9. The overall survival was 3.8 months. 1865-1870© 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2001.2168, available online at http://www.idealibrary.com on http://www.bjcancer.com daily dose (Drummond et al, 1995). The aim of this study was to evaluate the effect and define the tolerability of marimastat in patients with advanced pancreatic cancer. MATERIALS AND METHODS Study designThis was a multicentre open phase II pilot clinical trial to assess the effect of 28 days' administration of oral marimastat (British Biotech Pharmaceuticals Ltd, Oxford, UK) in patients with advanced pancreatic cancer with a facility to continue treatment in those patients with a clinical, serological or radiological 'response' to treatment. Marimastat was administered at a dose of 100 mg b.d., 25 mg o.d. or 10 mg b.d. with the option to reduce the dose in the event of toxicity. Patients were recruited from five centres throughout the UK between August 1995 and December 1997. Ethical committee approval was obtained from the research ethics committee at each investigating centre prior to study commencement. Study objectivesThe aims of this study were:1. To evaluate the effect of 28 days' treatment with oral marimastat on tumour size measured by computerize tomography (CT), disease progression was assessed by the level of cancer antigen CA19-9 and pain, mobility and analgesic use scores 2. To define the tolerability of marimastat 3. To assess the tumour response, safety and tolerability in patients treated beyond 28 days. Patient selectionPatients with radiologically and/or histologically/cytologically proven advanced pancreatic cancer were considered for study entry. Inclusion criteria were: (1) patients over 18 years of age; (2) Eastern Cooperative Oncology Group (ECOG) performance status of 0-2; (3) estimated survival of at least 3 months and the ability to take food by mouth. Exclusion criteria inc...

Despite improvements in implant technology and surgical technique, failure of total hip arthroplasty (THA) remains a persistent problem. This article reports clinical outcomes at a mean follow-up of 42 months using the Restoration cone/conical modular femoral revision stem (Stryker, Newbury, United Kingdom). A prospective cohort study was performed of 46 consecutive patients who underwent revision THA between January 2004 and June 2007. Patients were reviewed pre- and postoperatively at regular intervals for clinical and radiological assessment. Forty-six patients (17 men, 29 women) with a mean age of 72 years (range, 44-93 years) were observed for a mean of 42 months (range, 28-66 months). Indications for surgery included aseptic loosening/osteolysis (38/46 [83%]), periprosthetic fracture (4/46 [9%]), and infection (4/46 [8%]). Median time from index procedure was 16 years (range, 1-26 years). No patient was lost to follow-up. Two patients (4%) with well-fixed asymptomatic stems died during follow-up. Three patients (7%) sustained an early postoperative dislocation. One patient sustained a periprosthetic fracture after a fall. This was treated by osteosynthesis, and stem revision was not required. Mean Oxford Hip Score improved from 42 points (range, 24-57 points) to 28 points (range, 18-51 points) at 3-month follow-up (P=.003). Median stem subsidence was 1.0 mm (standard error of the mean, ±1.7 mm; range, 0-7mm) at last follow-up. No patient developed loosening or osteolysis around the stem. The Restoration femoral revision system has favorable clinical and radiological outcomes at a mean follow-up of 42 months.

The reduction in frequency of dressing changes coupled with low levels of wound leakage observed using the combination of the glue and nonabsorbent dressings (O+T), makes this combination of wound closing products ideal for facilitating enhanced recovery and early discharge programmes in elective hip arthroplasty.

This is the first study to report squeaking from MoP THAs. The squeaking hip phenomenon is not exclusive to CoC THAs. Noisy hip implants may have social implications, and patients should be aware of this. We have shown a relationship between noise and a lower OHS. However, longer follow-up is needed to link noise to a poorly functioning implant.