Primary diffuse large B‐cell lymphoma of the tonsil

BACKGROUND: The purpose was to evaluate the prognostic factors and treatment outcome of Indian patients with primary diffuse large B-cell lymphoma (DLBCL) of the tonsil treated at a single institution. METHODS: In all, 121 patients with DLBCL of the tonsil, treated at the Tata Memorial Hospital, Mumbai, India, from January 1990 to December 2002, were included. The median age was 45 years and the majority of patients (68%) were males. Systemic symptoms were present in 12% of patients; 28% presented with stage I and 67% had stage II disease. Treatment consisted of a combination of chemotherapy (CTh) and radiotherapy (RT) for the majority of patients (69.4%). Among those receiving RT, 64% received an RT dose of > or =45 Gy. RESULTS: After a median follow-up of 62 months, disease-free survival (DFS) and overall survival (OS) were 66.4% and 81.6%, respectively. Significant prognostic factors included: WHO performance score > or =2 (OS: 72.1% vs 95.6%, P = .016), bulky tumors (OS: 68.5% vs 86.9%, P = .001), presence of B-symptoms (OS: 36.7% vs 79.6%, P < .001), and Ann Arbor stage. On multivariate analysis; WHO performance score > or =2 (hazard ratio [HR], 4.27; 95% confidence interval [CI], 1.20-15.12), and B symptoms (HR, 6.27; 95% CI, 2.38-16.48), retained statistical significance. CTh + RT resulted in a significantly better outcome than those treated with CTh alone (OS: 85.7% vs 70.7%, P = .008). The complete response (P = .053), DFS (P = .039), and OS (P = .014) rates were significantly better for patients receiving an RT dose > or =45 Gy. CONCLUSIONS: Tumor bulk, WHO performance score, the presence of B symptoms, and Ann Arbor stage significantly influence outcome. A combined modality treatment, consisting of CTh and RT (with an RT dose of > or =45 Gy), results in a satisfactory outcome in patients with this uncommon neoplasm.     

Diagnosis of peripheral arterial disease in general practice: can the ankle–brachial index be measured either by pulse palpation or an automatic blood pressure device?*

Background: Despite its validity as a screening test for peripheral arterial disease (PAD), and its prognostic value, the ankle–brachial index (ABI) is infrequently used in primary care, probably because a Doppler device is required, along with the requisite skill for its use. We hypothesized that ABI could be accurately measured either by pulse palpation (pABI) or automatic blood pressure devices (autoABI) instead of Doppler method (dABI). Design and methods: In 54 subjects, we compared the results and the intra‐observer reproducibility of pABI to dABI, as well as the inter‐observer reproducibility of both pABI and autoABI to dABI. Arm and ankle systolic pressures were measured by the three methods by two observers. The first observer repeated pABI and dABI measurements. The results were compared by the Student paired t‐test. Reproducibility was assessed by the intra‐class correlation coefficient of agreement (R) and the Bland and Altman method. Results: The mean dABI obtained by the first observers was 1.03 ± 0.26 vs. a pABI of 0.85 ± 0.44 (p < 0.0001) and an autoABI of 1.09 ± 0.31 (p < 0.05). The intra‐observer R‐coefficient was at 0.89 for dABI vs. 0.60 for pABI (p < 0.05). The inter‐observer R‐coefficients were 0.79 for dABI vs. 0.40 for pABI (p < 0.05) and 0.44 for autoABI (p < 0.05). Conclusion: Neither pulse palpation nor automatic oscillometric devices can be recommended as reliable methods for ABI measurement.     

Prevalence of cervical spondylosis and musculoskeletal symptoms among coolies in a city of Bangladesh

To assess the prevalence of cervical spondylosis and musculoskeletal symptoms among coolies a cross-sectional study was performed in Narayangonj City of Bangladesh on a random sample of 98 male coolies, using a questionnaire and the results of cervical spine X-rays. Statistical associations were investigated using the chi-square test. The results show a considerably higher prevalence of cervical spondylosis among the coolies (39.8%). More than half (51.3%) of the cases of cervical spondylosis were in subjects below the age of 40 yr, and a significant association was found between age group and prevalence of cervical spondylosis. The study also observed a significant association between duration of occupation and prevalence of cervical spondylosis. Coolies who had worked for 10 to 15 yr, or more than 15 yr, had higher rates of cervical spondylosis. In this study it was found that those who carried heavier loads suffered more from cervical spondylosis. Musculoskeletal symptoms in multiple body regions (two or more) were more prevalent (61.2%) than those in single body region (29.6%). Symptoms in the hands/fingers were the most frequent followed by the back and arms/forearms. In conclusion, the high prevalence of cervical spondylosis and musculoskeletal symptoms among professional coolies may be associated with the practice of carrying heavy loads on the head. Further study with a large sample of population is required to investigate this problem and to explore preventive measures.     

Cross-sectional study on occupational noise and hypertension in the workplace

To determine whether noise conditions at the workplace are associated with hypertension in Japanese male blue-collar workers, the authors analyzed data obtained in an annual workplace health examination. Two hundred forty-two workers who used ear protectors at their jobs in a paper manufacturing plant served as a noisy workplace group, and 173 individuals who worked in a chemical plant comprised a nonnoisy workplace group. The prevalence of hypertension was 16.9% in the noisy workplace group and 34.7% in the nonnoisy workplace group (p < .01). A Mantel-Haenzel analysis showed the difference between the 2 groups to be significant. A logistic regression analysis with adjustment for confounding factors also showed a significant inverse association between hypertension and noise conditions at the workplace (odds ratio = 0.48; 95% confidence interval = 0.28-0.81). The implementation of guidelines for occupational noise management might have contributed to the workers' concern over the prevention of adverse health effects caused by workplace noise.