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Background:This study sought to determine the safety of single agent capecitabine, a pro-drug of 5FU, in patients with metastatic non-pancreatic neuroendocrine tumours (NETs).Methods:Multicentre phase II, first-line study design. Oral capecitabine was administered on days 1–14 of 3-week cycles.Results:Treatment was safe and well tolerated. Common toxicities were diarrhoea and fatigue.Conclusion:The study provides evidence to support the use of capecitabine as a substitute for infusional 5FU in the management of NETs.

Survivin, the smallest member of the inhibitor-of-apoptosis family, is a promising target for anticancer therapies. It plays key roles in apoptosis and the cell cycle, and has been shown to be upregulated in many cancer types while being minimally expressed in normal adult tissue. A number of survivin-directed anticancer therapies are currently in development, including transcriptional repressors, antisense oligonucleotides, hammerhead ribozymes, small interfering RNAs (siRNAs), dominant-negative mutants, small molecular inhibitors, cyclin-dependent kinase (CDK) inhibitors and immunotherapies. This article reviews the roles of survivin in mitosis and apoptosis, its regulation and the pre-clinical and clinical data on the emerging survivin-directed therapies.

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A 29-year-old man presented with a shotgun wound over his sacrum at close range. Physical examination revealed a large soft tissue defect just off the midline over the buttocks and sacrum (Fig. 1). Gross blood was found on rectal examination. Shock room films showed a wide scatter pattern of the pellets (Fig. 2). The patient was taken to the operating room for proctoscopy. Proctoscopy revealed multiple rectal mucosal injuries. A diverting loop colostomy was performed and the sacral wound was debrided. He was taken back to the operating room once more for a planned further debridement. The patient did well postoperatively.Shotguns can cause a wide variety of injuries as a result of a number of variables such as weapon-victim distance, type of weapon, and number of pellets. 1 The injuries are caused by the blast effect as well as soft tissue saturation with multiple pellets. Because the energy of the blast is dissipated into the tissue as the pellets scatter, a permanent cavity is created, one much larger than one from a nonfragmenting bullet. 2 Proper treatment of these injuries often requires multiple procedures to ensure adequate debridement of devitalized tissues. REFERENCES1. Velmahos GC, Safaoui M, Demetriades D. Management of shotgun wounds: do we need classification systems? Int Surg. 1999;84: 99 -104. 2. Glezer JA, Minard G, Croce MA, et al. Shotgun wounds to the abdomen.Fig. 1. Close range shotgun wound to the buttocks.Fig. 2. The pellets from the shotgun wound demonstrate a wide spread on a pelvis film taken in the shock room.