No abstract

Background: Proinflammatory cytokines, especially tumour necrosis factor a (TNF-a), play a prominent role in the pathogenesis of cancer cachexia. Thalidomide, which is an inhibitor of TNF-a synthesis, may represent a novel and rational approach to the treatment of cancer cachexia. Aims: To assess the safety and efficacy of thalidomide in attenuating weight loss in patients with cachexia secondary to advanced pancreatic cancer. Methods: Fifty patients with advanced pancreatic cancer who had lost at least 10% of their body weight were randomised to receive thalidomide 200 mg daily or placebo for 24 weeks in a single centre, double blind, randomised controlled trial. The primary outcome was change in weight and nutritional status. Results: Thirty three patients (16 control, 17 thalidomide) were evaluated at four weeks, and 20 patients (eight control, 12 thalidomide) at eight weeks. At four weeks, patients who received thalidomide had gained on average 0.37 kg in weight and 1.0 cm 3 in arm muscle mass (AMA) compared with a loss of 2.21 kg (absolute difference 22.59 kg (95% confidence interval (CI) 24.3 to 20.8); p = 0.005) and 4.46 cm 3 (absolute difference 25.6 cm 3 (95% CI 28.9 to 22.2); p = 0.002) in the placebo group. At eight weeks, patients in the thalidomide group had lost 0.06 kg in weight and 0.5 cm 3 in AMA compared with a loss of 3.62 kg (absolute difference 23.57 kg (95% CI 26.8 to 20.3); p = 0.034) and 8.4 cm

Allelism in glutathione S-transferase GSTM1 and GSTT1 has been suggested as a risk factor in various cancers. Accordingly, we describe a group of case-control studies carried out to identify associations between GSTT1 genotypes and susceptibility to lung, oral, gastric and colorectal cancers. The frequencies of the putatively high risk GSTT1 null genotype were not increased in the lung, oral or gastric cancer cases compared with controls but the frequency of this genotype was significantly increased (P = 0.0011, odds ratio = 1.88) in the colorectal cancer cases. No significant interactions between the GSTT1 and GSTM1 null genotypes types were identified in the cancer groups studied. Indeed, no significant associations between GSTM1 genotypes and susceptibility were identified though further evidence was obtained that the protective effect of GSTM1*A and GSTM1*B is not equal. The data complement studies showing that GSTT1 null is associated with an increased susceptibility to total ulcerative colitis and suggests that this enzyme is important in the detoxification of unidentified xenobiotics in the large intestine.

The following article is intended to provide a review of the current state of enteral feeding; a rapidly changing and developing field. It covers the type of feed, the routes of access, and the problems that can occur with enteral feeding.

Background-Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant short term benefits. Aims-This study aimed firstly to reevaluate these short term effects, and secondly to establish whether there are any long term benefits. Subjects-One hundred patients admitted for elective moderate or major gastrointestinal surgery. Methods-In the inpatient phase, patients were randomised to receive a normal ward diet postoperatively, or the same diet supplemented with an oral dietary supplement. In the outpatient phase, patients were further randomised to receive their home diet, or their home diet supplemented with the oral dietary supplement for four months. Results-During the inpatient phase, patients treated with oral supplements had a significantly improved nutritional intake and lost less weight (2.2, 950/0 confidence interval (95% CI) 0*9 kg) compared with control patients (4.2 (0.78) kg, p< 0-001). Supplemented patients maintained their hand grip strength whereas control patients showed a significant reduction in grip strength (p<0-01). Subjective levels of fatigue increased significantly above preoperative levels in control patients (p<0-01) but not in the supplemented group. Twelve patients in the control group developed complications compared with four in the supplemented group (p<0.05). In the outpatient phase, supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups. Conclusions-The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinically significant benefits. These benefits, however, are restricted to the inpatient phase.