A case of chronic infection of the nasal mucosae, sinuses and conjunctivae with a microsporidian parasite in association with HIV infection and immune deficiency is reported. This microsporidian resembles both Encephalitozoon cuniculi and the newly described Encephalitozoon hellem by electron microscopy. This occurred in an adult male resident in the UK with no history of foreign travel. Although there are previous descriptions of conjunctival infections from the USA, this is the first description of infection of the nasal epithelium. Further studies are underway to classify this protozoan.

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Myeloma and other cancers For most patients with multiple myeloma treatment is palliative and comprises combined melphalan and prednisolone. Despite several clinical trials the evidence on more intensive combinations is conflicting. Nevertheless, in younger patients the results of trials of high dose chemotherapy with bone marrow transplantation seem promising. Cytotoxic drugs have no established role in the palliative treatment of cancers of the thyroid, kidney, and prostate. The lipid soluble nitrosoureas have been used for treating gliomas, but evidence that they improve quality of life or survival is unconvincing. Conclusions Systemic cytotoxic treatment has been remarkably successful in curing a few uncommon disseminated tumours, notably testicular cancer, acute lymphoblastic leukaemia, and Hodgkin's disease. This has encouraged the widespread use of chemotherapy for other more common cancers, but progress has been slow despite the enormous clinical research effort worldwide. We have therefore cautioned against the uncritical use of chemotherapy and stressed the importance of giving it selectively and only with adequate supportive care. The guidelines suggested in this paper should encourage the more effective use of chemotherapy in the palliation of advanced cancer and be useful as predetermined standards for medical audit; commissioners of health care may also find them useful when deciding how best to deploy available resources. They should be considered as complementary to innovative clinical research directed towards finding more active and less toxic treatments for disseminated cancer.

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