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among islands and regions using nested, mixed-model ANOVA. We screened several potential estimators to find that the Chao 1 procedure provided the most stable values for local species richness. This estimator is the sum of the observed number of species and the quotient a 2 /2b, where a and b equal the number of species represented by one and two colonies, respectively.To analyse the local-regional species richness relationship in each habitat, we used a simple linear regression of the mean local richness per site in a region against habitatspecific regional richness. Linearity is supported by these and supplemental regressions using: (1) log-transformed richness data; (2) local richness standardized to 100 or more colonies per sample 18 ; and (3) the two alternative measures of local species diversity, Fisher's alpha and the Chao 1 estimator of local richness.

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Data are presented from 1,166 patients with Dukes B and C carcinoma of the colon who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol C-01 between November 1977 and February 1983. Patients were randomized to one of three therapeutic categories: 1) no further treatment following curative resection (394 patients); 2) postoperative chemotherapy consisting of 5-fluorouracil, semustine, and vincristine (379 patients); or 3) postoperative BCG (393 patients). The average time on study was 77.3 months. A comparison between patients receiving postoperative adjuvant chemotherapy and those treated with surgery alone indicated that there was an overall improvement in disease-free survival (P = .02) and survival (P = .05) in favor of the chemotherapy-treated group. At 5 years of follow-up, patients treated with surgery alone were at 1.29 times the risk of developing a treatment failure and at 1.31 times the likelihood of dying as were similar patients treated with combination adjuvant chemotherapy. Comparison of the BCG-treated group with the group treated with surgery alone indicated that there was no statistically significant difference in disease-free survival (P = .09). There was, however, a survival advantage in favor of the BCG-treated group (P = .03). At 5 years of follow-up, patients randomized to the surgery-alone arm were at 1.28 times the risk of dying as were similar patients treated with BCG. Further investigation disclosed that this survival advantage in favor of BCG was a result of a diminution in deaths that were non-cancer related. When analyses were conducted on which events not related to cancer recurrence were eliminated, the survival difference between the BCG and control groups became nonsignificant (P = .40); the cumulative odds at 5 years decreased from 1.28 to 1.10. The findings from this study are the first from a randomized prospective clinical trial to demonstrate that a significant disease-free survival and survival benefit can be achieved with postoperative adjuvant chemotherapy in patients with Dukes B and C carcinoma of the colon who have undergone curative resection.

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What’s known on the subject? and What does the study add? The suprapubic catheter (SPC) is a useful and widely used tool in urological practice. However, complications can arise from its insertion or ongoing care. Currently there are no guidelines relating to SPC usage. This study has reviewed the available clinical evidence relating to SPC usage. Where this is lacking, expert opinion has been sought. Guidelines are suggested to help maximise safety and ensure best practice in relation to SPC usage. OBJECTIVE To report the British Association of Urological Surgeons’ guidelines on the indications for, safe insertion of, and subsequent care for suprapubic catheters. METHODS A comprehensive literature search was conducted to identify the evidence base. This was reviewed by a guideline development group (GDG), who then drew up the recommendations. Where there was no supporting evidence expert opinion of the GDG and a wider body of consultees was used. RESULTS Suprapubic catheterisation is widely used, and generally considered a safe procedure. There is however a small risk of serious complications. Whilst the evidence base is small, the GDG has produced a consensus statement on SPC use with the aim of minimising risks and establishing best practice (Table 1). It should be of relevance to all those involved in the insertion and care of suprapubic catheters. Given the paucity of evidence, areas for future research and development are also highlighted. This review has been commissioned and approved by BAUS and the Section of Female, Neurological and Urodynamic Urology. Summary of recommendations for suprapubic catheters (SPCs) practice General considerations• Clinicians who are involved in the management of patients with long‐term catheters should consider in each case whether an SPC would offer advantages to the patient over the use of a urethral catheter• Patients in whom an SPC is felt to be appropriate should have access to an efficient and expert service for SPC insertion• Patients who are undergoing SPC placement either as an isolated or as a combined procedure should undergo an appropriate consent procedure with best practice including the provision of both verbal and written informationThe suprapubic catheterization procedure• If appropriate expertise for SPC insertion is not available at a particular time, suprapubic aspiration of urine using a needle of up to 21 gauge can be used as a means of temporarily relieving the patient’s symptoms (LE3)• A general or regional anaesthetic should be used if the bladder cannot be comfortably filled with at least 300 mL of fluid and in spinal cord injury patients with an injury level of T6 or above (LE3)• The use of antibiotic prophylaxis is recommended for patients where the urine is likely to be colonized with bacteria despite there being a lack of published data addressing this issue (LE3)• The different catheter insertion techniques and kits have not been compared in adequate clinical trials; the choice of technique is therefore a matter of individual preference. All...

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