The efficacy of transcutaneous electrical nerve stimulation (TENS) in relieving postoperative pain has been assessed by means of a prospective randomized controlled trial in 62 male patients undergoing unilateral inguinal herniorrhaphy. Thirty-four patients received TENS and 28 patients received sham TENS for 48 h after the operation. Pain was assessed by means of linear analogue pain scales, analgesic requirements and peak expiratory flow readings. We were unable to detect any significant differences in these variables when the two groups were compared. These results do not support the use of TENS.

Summary To examine the suggested biological difference between Japanese and British gastric cancers, immunohistochemistry was used to demonstrate eight markers of biological activity in a matched series of 40 Japanese and 33 British cases. There were no differences in the proportions of Japanese and British tumours positive to epidermal growth factor, epidermal growth factor receptor, transforming growth factor alpha, cripto or p53. A significantly greater proportion of British tumours were positive to c-erbB-2 whilst a significantly greater proportion of Japanese tumours were positive to nm23. British tumours had a significantly greater mean proliferating cell nuclear antigen proliferation index than Japanese tumours. These differences could be clinically significant.Keywords: gastric cancer; comparative biology There has been a widely held belief in the West that the superior results achieved by Japanese centres treating gastric cancer is, at least in part, the result of a difference in biological behaviour between Japanese and European tumours. There is some evidence to substantiate this theory: gastric cancer is the largest cancer killer in Japan, affecting a younger age group than in the West. Proximal lesions account for less than 10% of Japanese tumours compared with Europe and the US where, after a documented rise in the incidence of proximal tumours, the latter now constitute 30-40% of presenting cases (Meyers et al., 1987, Kampschoer et al., 1989. Histologically, intestinal-type tumours predominate in Japan compared with a higher proportion of diffuse-type tumours seen in the West (Cady et al., 1989).Stage-matched survival rates of Japanese patients are demonstrably better than their European counterparts (Miwa, 1979, Takayoshi et al., 1983Takeda et al., 1992).The aim of this study was to compare the malignant potential of a matched series of Japanese and European gastric cancers analysed immunohistochemically using a battery of markers representing different facets of biological activity. The eight markers chosen were: epidermal growth factor (EGF), the EGF receptor (EGFR), transforming growth factor alpha (TGF-a), cripto (a novel EGF-related growth factor), p53, c-erbB-2, the anti-metastasis factor nm23 and, finally, proliferation indices were calculated by the method of monoclonal antibody labelling of the proliferating cell nuclear antigen (PCNA).Overexpression of EGF and TGF-a, particularly in combination with overexpression of EGFR are associated with poor prognosis in gastric cancer (Tahara et al., 1986;Sugiyama et al., 1989;Yonemura et al., 1992) and probably play a role in autocrine stimulation of deregulated neoplastic growth (Sporn and Todaro, 1980). Cripto is a 188 amino acid peptide, the central portion of which shares structural homology with EGF and TGF-a (Ciccodicola et al., 1989). Overexpression increases with tumour stage and may be a sensitive marker of the progression of malignancy (Kuniyasu et al., 1991(Kuniyasu et al., , 1995. The c-erbB-2 oncogene encodes a peptide product simila...

The induction of adenocarcinomas in the glandular stomach of the adult male Wistar rat by N-methyl

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