Conclusions: AZD4547 had an acceptable safety profile but minimal activity in this predominantly FGFR1/FGFR3amplified cohort. Evaluation of other targeted agents in Lung-MAP is ongoing.

Incidental adenocarcinoma of the prostate has been divided into stage A1--less than 3 foci of well differentiated adenocarcinoma present and stage A2--3 or more foci of poorly differentiated tumor present. The clinical significance of these 2 stages has been well documented, with stage A1 lesions causing no increased mortality, while up to 30 per cent of patients with clinical stage A2 disease will have positive pelvic lymph nodes at exploration and, thus, will have surgical stage D1 tumor. Most pathology laboratories submit only a fraction of the transurethral resection chips for permanent blocks. In an effort to evaluate the over-all incidence and distribution of stages A1 and A2 lesions were began a prospective study in 1978 whereby all prostatic chips were submitted for permanent sections. A review of 500 consecutive cases of transurethral resection for clinically benign prostates before 1978 revealed 43 cases of adenocarcinoma: 10 (23 per cent) stage A1 and 33 (77 per cent) stage A2. A review of a similar series of 500 consecutive patients since 1978 revealed 71 cases of adenocarcinoma: 17 (24 per cent) clinical stage A1 and 54 (76 per cent) clinical stage A2. Thus, we found that since 178 incidental adenocarcinoma of the prostate has increased by 65 per cent and the distribution of stages A1 and A2 lesions has remained unchanged, 76 per cent of these lesions being clinical stage A2 with its much greater clinical significance. Evaluation of every chip does make a clinically significant difference in the subsequent management of patients with incidental adenocarcinoma of the prostate.

The major blood group antigens A, B or O(H) are present on normal bladder epithelium. The presence or absence of these antigens on the cell surface of bladder tumors has been determined in a retrospective longitudinal study using biopsy material from 322 patients who fit the following criteria: 1) the patient presented initially with a superficial bladder tumor, 2) the patient had followup examination for at least 5 years or until evidence of tumor invasion of bladder muscle and 3) the paraffin-embedded tumor specimens were still available. Of 80 patients with stage A tumors that subsequently became invasive 71 (88 per cent) showed deletion of A, B or H antigens from the original superficial tumor. On the other hand, of 146 patients who had no recurrence of superficial tumor for at least 5 years 127 (87 per cent) retained A, B or H antigens. Of 96 patients who had 1 or more superficial recurrences 87 (90 per cent) retained antigens on the initial and subsequent tumors. Analysis of transitional cell surface antigens should help in the identification of those patients with superficial disease who are at greatest risk for invasive bladder cancer.

Tracheotomy is performed on patients with airway obstruction or prolonged mechanical ventilation. Tracheotomy patients are increasingly being referred to hospice and palliative care. This case series describes a process for evaluating the ongoing need for tracheotomy and the impact of tracheotomy removal. A retrospective cohort design was used in which charts were reviewed of all tracheotomy patients referred to the palliative care unit between November 1, 1998, and July 31, 2001. Tracheotomy was present in 13 of 791 palliative care unit admissions. Persistent airway obstruction contraindicated tracheotomy removal in 5 patients. The remaining patients had a successful "button" trial with subsequent tracheotomy removal. They incurred no complications and exhibited improved functional status and decreased symptom burden. Tracheotomy removal is safe and beneficial in this patient subset and should be considered an alternative to prolonged tracheotomy.