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Although it did not confirm the harmful effect of mechanical bowel preparation (suggested by previous meta-analyses), this meta-analysis including almost 5000 patients, demonstrates with a high level of evidence that any kind of mechanical bowel preparation should be omitted before colonic surgery.

For the management of non-palpable breast cancer, accurate pre-operative localisation is essential to achieve complete resection with optimal cosmetic results. Radioguided occult lesions localisation (ROLL) uses the radiotracer, injected intra-tumourally for sentinel lymph node identification to guide surgical excision of the primary tumour. In a multicentre randomised controlled trial, we determined if ROLL is superior to the standard of care (i.e. wire-guided localisation, WGL) for preoperative tumour localisation. Women (>18 years.) with histologically proven non-palpable breast cancer and eligible for breast conserving treatment with sentinel node procedure were randomised to ROLL or WGL. Patients allocated to ROLL received an intra-tumoural dose of 120 Mbq technetium-99 m nanocolloid. The tumour was surgically removed, guided by gamma probe detection. In the WGL group, ultrasound- or mammography-guided insertion of a hooked wire provided surgical guidance for excision of the primary tumour. Primary outcome measures were the proportion of complete tumour excisions (i.e. with negative margins), the proportion of patients requiring re-excision and the volume of tissue removed. Data were analysed according to intention-to-treat principle. This study is registered at ClinincalTrials.gov, number NCT00539474. In total, 314 patients with 316 invasive breast cancers were enrolled. Complete tumour removal with negative margins was achieved in 140/162 (86 %) patients in the ROLL group versus 134/152 (88 %) patients in the WGL group (P = 0.644). Re-excision was required in 19/162 (12 %) patients in the ROLL group versus 15/152 (10 %) (P = 0.587) in the WGL group. Specimen volumes in the ROLL arm were significantly larger than those in the WGL arm (71 vs. 64 cm(3), P = 0.017). No significant differences were seen in the duration and difficulty of the radiological and surgical procedures, the success rate of the sentinel node procedure, and cosmetic outcomes. In this first multicentre randomised controlled comparison of ROLL versus WGL in patients with histologically proven breast cancer, ROLL is comparable to WGL in terms of complete tumour excision and re-excision rates. ROLL, however, leads to excision of larger tissue volumes. Therefore, ROLL cannot replace WGL as the standard of care.

To study the relation between essential tremor (ET) and Parkinson's disease (PD), we compared the frequency of familial tremor in relatives of patients with PD (N = 391), ET (N = 140), and the combination of ET and PD (N = 125) with the frequency in patients with progressive supranuclear palsy (PSP) (N = 99) and normal age-matched controls (N = 104). Tremor was present in 96 (5.1%) of 1,874 parents and siblings of patients with PD, 152 of 650 (23.4%) relatives of patients with ET, 91 (20.7%) of 439 relatives of patients with ET-PD, 12 of 462 (2.6%) relatives of patients with PSP, and 10 of 448 (2.2%) relatives of normal controls. The high frequency of familial tremor among relatives of patients with PD, and especially those with the ET-PD combination, compared with relatives of patients with PSP or of normal controls suggests that there is an association of PD and familial tremor. Since the most common form of familial tremor is ET, our study provides support for the notion that ET and PD are pathogenetically related. We also found that parents with tremor lived on the average 9.2 years longer than those without tremor. The association of familial tremor with significantly increased longevity suggests that familial tremor confers some anti-aging influence. Alternatively, tremor may be a simple byproduct of the aging process.

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