relapsing after stopping treatment for acute lymphoblastic leukaemia depends on the time that has elapsed since they stopped treatment. In children relapsing during the first six months or so there is a high risk of early marrow recurrence and they should be considered for marrow transplantation during second remission if there is a suitable donor. In patients relapsing later prolonged haematological remission is possible. NX'e are presently studying the effect of more intensive induction and consolidation treatment in both groups of patients; whether this approach will increase the proportion of long-term survivors remains to be seen.Further central nervous system prophylaxis is imperative for all children who have a bone-marrow recurrence after stopping treatment; intrathecal chemotherapy is the most appropriate method because it is less likely to compromise the delivery of systemic chemotherapy and avoids the undesirable effects of further cranial irradiation. The role of further "delayed" irradiation in long-term survivors remains unclear and will perhaps be elucidated by extrapolation from results of trials evaluating the necessity for routine irradiation in all newly diagnosed cases of acute lymphoblastic leukaemia.

This review evaluates the available evidence dealing with the natural history of hepatic metastases in patients with colorectal cancer. Methods of detection of such metastases are discussed and the factors influencing survival after surgical resection are reviewed.

No abstract

1. Following the finding of high levels of oestrogen receptor proteins in pancreatic carcinoma tissue, two enzymes involved in sex-steroid biosynthetic pathways, aromatase and 5 alpha-reductase, have been measured. 2. Activities of aromatase, which converts testosterone into oestradiol, comparable with those found in pre-menopausal uterus (P less than 0.5) were found in all seven samples of pancreatic carcinoma tissue, and in a pooled sample of foetal pancreas. Measurable but significantly lower activities (P less than 0.001) of aromatase were found in seven specimens of normal pancreas. 3. 5 alpha-Reductase activity, which converts testosterone into the more potent androgen 5 alpha-dihydrotestosterone, was found in malignant pancreatic tissue at approximately half the level found in prostatic tissue (P less than 0.01) and at almost twice the levels found in either normal adult or pooled foetal pancreatic tissue (P less than 0.01). 4. These findings suggest that sex steroids are involved in foetal and adult pancreatic physiology. 5. Since these enzyme pathways are present in pancreatic carcinoma at greater levels than those in normal adult pancreas, it is possible that agents known to interfere with steroid metabolism could be of value in the treatment of this tumour.

Thirty-six patients were referred to the Liver Unit between 1971 and 1980 after unsuspected liver disease had been found at laparotomy. The preoperative diagnosis had been extrahepatic biliary obstruction in 16 patients and intra-abdominal malignancy in 15. Misdiagnosis resulted from insufficient attention to the history and physical signs in 31 patients and omission or misinterpretation of liver function tests and of other hepatobiliary investigations in the remaining 5 patients. The morbidity and mortality of the 36 patients within 1 month of operation was 61 per cent and 31 per cent respectively. All patients with viral or alcoholic hepatitis died, and severe complications, which included bacterial peritonitis, wound dehiscence and hepatic failure, developed in 13 of 15 in whom ascites due to cirrhosis or the Budd-Chiari syndrome was present before operation.