Pediatric Hodgkin's disease in India

Twenty-one percent of all Hodgkin's disease in India was seen in the pediatric age groups at the Tata Memorial Hospital (Bombay, India). From 1975 to 1982, 151 cases of children were reviewed. The youngest presentation was at 3 years in three patients, with a marked male: female ratio of 5.5:1. Twenty-six patients were previously treated before referral while the remaining 125 cases were investigated and treated according to the prevalent protocols in 1975 to 1978 and 1979 to 1982. Clinical staging revealed 54% of patients in stages I and II with symptoms in 20%, and 46% of patients in stages III and IV with symptoms in 67%. Staging laparotomy was performed in 27 patients, with a total changes of staging in 17 children (63%). The mixed cell types (46%) and lymphocytic predominant types (31%) were the most common histologic presentations. Nine percent nodular sclerosis and 9% lymphocytic-depleted varieties were also observed. Five percent of all cases were not classifiable. Minimum adequate treatment was completed in 87 cases. Comparisons were made between the treatments administered to 40 patients during the initial period 1975 to 1978 when individualized treatment was administered, and the later 47 patients during the 1979 to 1982 period, when chemotherapy was the mainstay of treatment with involved field radiation.     

Management of Hodgkin's disease in western India

The authors report a retrospective analysis of 441 patients with Hodgkin's disease seen at the Tata Memorial Hospital, Bombay, over a 4-year period from 1975 to 1978. Clinicopathologic features seem to vary from those reported in the western literature, but are similar to the patterns observed in Africa and South America. Thirty-three percent of all malignant lymphomas were Hodgkin's disease. Histologically, the mixed cell (MC) type (40%) and the lymphocytic predominant (LP) type (24%) were the most common, with 52% of patients presenting in Stages III and IV. The nodular sclerosis (NS) variant occurred in only 11% of the cases. Systemic symptoms were present in 24% of clinical Stage I patients, and increased steadily to 85% in Stage IV patients. Bone marrow biopsies in 242 patients were found to be of little value in Stages I and II. Thirty of 34 patients with positive bone marrow biopsy were in clinical Stages III B and IV, whereas 24 of 34 patients showed MC and LD patterns. Lymphangiography in 104 patients altered the clinical staging of Stages I and II in 27% of the cases with accuracy of 80%. Staging laparotomy performed in 93 patients altered the stage in 45% of clinical Stage I and 62% of Stage II patients. Splenic involvement was common in the presence of systemic symptoms (67%) and MC/LD histology (82%). The incidence of liver involvement was 16% in 15 patients with all, but one, associated with splenic pathology. The clinical stage and histopathologic variants of the disease bear an excellent correlation with a significant impact on treatment responses and total survival. The survival rates for Stage I were 81%, Stage II 76%, Stage IIIA 71%, and Stage IIIB and IV 46% at 48 months. The LP type had the best prognosis with 85% survival at 48 months, whereas the survival in the depleted variety was only 56%. Surprisingly, the MC type did better with a 64% survival, while the nodular sclerosis group had 59% surviving at 48 months.     

Tardive dyskinesia in India: a prevalence study

We screened the entire inpatient population (N = 1963) of a state hospital near Bombay, India, for tardive dyskinesia (TD) using specific diagnostic criteria. Prevalence of TD was found to be 9.6%, which was much lower than that reported from the Western countries. Percent prevalence of TD was greatest in the age group 41 to 50, after which it seemed to decline. TD patients had received neuroleptic treatment for significantly longer periods and in significantly greater amounts than non-TD patients. The principal reason for the relatively low prevalence of TD in India is probably the practice of using neuroleptics in comparatively small doses (mean daily dose is about 200 mg of chlorpromazine equivalents). A possible contribution of racial-genetic factors cannot be excluded.     

The Role of the EEG in Epilepsy of Long Duration

Although the electroencephalogram's (EEG's) relevance in the initial work-up of individuals with epilepsy is well-defined, its role in epilepsy of long duration remains uncertain. A literature survey revealed eight studies that had evaluated epileptiform patterns (EPs) in series of patients but none of these were derived from outpatients presenting for regular follow-up. Such EEG results are crucial for determining disability benefits that are often denied to people with normal records. We therefore randomly surveyed 100 adult outpatients attending the seizure follow-up clinic at Cook County Hospital. An EP was detected in 33 patients, 36 had normal records, and 31 had non-EP abnormalities. The presence of an EP was significantly related to an etiology of head injury, duration of epilepsy, age of onset before age 20 years, and receiving more than one antiepileptic drug (AED). The presence of an EP did not correlate with seizure frequency, seizure type, or presence of a neurological deficit. A prior EEG increased the proportion with an EP only to 41%. The relatively low proportion of people who demonstrated an EP suggests that (a) the presence of an EP on an EEG should not be a factor in deciding about disability benefits for individuals with epilepsy, and (b) that use of an EP as an eligibility criterion for entry into a research series is likely to generate a select group of patients, thus making it difficult to generalize results.