Thirty-six patients underwent curative resection of a primary pancreatic carcinoma from January 1977 to September 1987; 26 had Whipple resections, seven had total pancreatectomies, and three had distal pancreatectomies. Twenty-six patients manifested recurrent disease, four died of intercurrent disease, and six were apparently cured. Median survival was 11.5 months with actuarial survival at 2 and 5 years of 32% and 17%, respectively. Of the eventual recurrences, 19% were local only (pancreatic bed, regional nodes, adjacent organs, and immediately adjacent peritoneum) and 73% had a component of local failure. All patients failing did so with a component in the intraabdominal cavity. Peritoneal (42%) and hepatic failures (62%) were common. Extraabdominal metastases were documented in only 27%, but never as a sole site. Fourteen patient and tumor characteristics were evaluated for any relationships with failure or survival. No single variable independently predicted for local failure. However, a group of three (age > 60 years, T2 or T3 stage, and location of tumor in the body or tail) was associated with a substantial local failure risk (85% of all patients with local failure). Multivariate analysis showed that low tumor grade (P = O.oOZ), female sex (P = 0.002), and adjuvant radiation (P = 0.02) were all independent predictors of prolonged survival. Ten patients were treated in an adjacent setting. Those given 55 Gy or greater had improved local control (50% versus 25%) and cure (33% versus none) when compared with patients treated to lower doses. The authors conclude that local failure after curative resection remains a significant problem and further efforts to improve local control are warranted. However, peritoneal and hepatic relapses occur frequently. Thus, adjuvant treatment strategies using wide-field radiation techniques or intraperitoneal therapy, in combination with local tumor bed irradiation and chemotherapy, should be explored. Cancer 66:56-61,1990. ANCREATIC CARCINOMA remains a devastating P problem for the patient as well as those charged with its management. By recent estimates, this malignancy will account for 3% of the total cancer incidence in adults and 5% of the total deaths, taking 24,500 lives in the US in 1988.' Moreover, the incidence has risen over the last 40 years.2 Even in the highly selected subgroup that undergoes "curative" resection, the expected 5-year survival is in the range of 0% to 18%,3 with median survivals of 10 to 14 month^.^,^ For the remainder of patients, approximately one third will have unresectable locoregional disease only and the rest will have metastases at pre~entation.~ In patients who have undergone complete resection, a previous randomized study from the Gastrointestinal Tumor Study Group (GITSG) as well as a follow-up non-randomized registration study have shown a survival advantage for patients treated with postoperative combined radiation and 5-fluorouracil (5-FU).637 In light of this 56

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SYNOPSIS The frequency of vestibular symptoms in 104 headache patients during the headache‐free phase was studied. The group was comprised of 84 patients with migraine (24 classical and 60 common) 12 with tension and 8 with cluster headache. Fifty‐four headache‐free subjects served as controls. All the participants filled out a vestibular symptom questionnaire. Patients with classical migraine reported significantly more vestibular symptoms than the controls. Specifically they had more dizzy spells (r = 0.002) and vertigo episodes (r = 0.01) not associated with the headache. They also had more frequent motion sickness spells. Of the classical migraine patients reporting motion sickness 87% experienced it at least once in 6 weeks compared to only 11% of the controls. Classical migraine patients also probably have an especially “sensitive” vestibular system, as evidenced by increased tendency to visual vertigo (r = 0.005) and significantly increased dizziness when they themselves were spinning. The common migraine patients showed a tendency to vestibular impairment that was not statistically significant. Recent findings of vestibular function abnormalities in this group may suggest an evolving dysfunction that is not yet symptomatic. Patients with tension and cluster headache did not differ from the controls in all the vestibular symptoms studied. In summary, our findings indicate clearly a vestibular impairment in classical migraine. The relation to “benign recurrent vertigo,” problems in the relationship of the occurrence of motion sickness to migraine and the possible mechanism causing the vestibular dysfunction are discussed.

To investigate possible risk factors for Parkinson's disease (PD) we conducted a case-control study of 150 PD patients and 150 age- and sex-matched controls. We interviewed and examined all 300 subjects. We collected demographic data including lifetime histories of places of residence, source of drinking water, and occupations such as farming. Subjects completed a detailed questionnaire regarding herbicide/pesticide exposure. Rural living and drinking well water were significantly increased in the PD patients. This was observed regardless of age at disease onset. Drinking well water was dependent on rural living. There were no significant differences between cases and controls for farming or any measure of exposure to herbicides or pesticides. These data provide further evidence that an environmental toxin could be involved in the etiology of PD.

Endoscopic and histologic features of BE at initial diagnosis are predictive of index HGD and cancer as well as with risk of BE progression.

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Employing optical density methods, platelet aggregation in response to 1.275, 1.7, and 3.4 micrometer adenosine diphosphate was tested in 46 patients with migraine and 46 controls matched by age, sex, and race. The migraine patients demonstrated platelet hyperaggregability when compared with controls, as manifested by a lower threshold for the platelet-release reaction and increased platelet stickiness following aggregation. There was no correlation of platelet hyperaggregability with the severity of migraine or with the occurrence of migraine-associated neurologic symptoms, suggesting that platelet hyperaggregability is a concomitant feature of the migraine syndrome but not dependent on the occurrence of the actual headache. As platelet hyperaggregability may predispose to development of intravascular platelet aggregates or mural thrombi, the hyperaggregability found here may help explain the increased incidence of stroke and heart attack in migraine patients that has been reported elsewhere.

A detailed questionnaire concerning life history of headache and its characteristics was administered to 1,809 nonmedical volunteers. Questions dealt with severity of headache, the nature of preceding and accompanying phenomena (nausea, visual scotomata, neurologic symptoms), precipitating factors, and history of other illness. For the total sample and in the 25 to 39 age group, severe or disabling headaches were significantly more frequent in women and mild headaches were significantly more common in men. Migraine characteristics were common with mild headache. An association between hypertension and severe headache was found in women, between asthma and severe headache in men.