Task and postural factors are related to back pain in helicopter pilots.

BACKGROUND: A previous survey by Shear et al. revealed a high prevalence of back pain in Royal Navy helicopter aircrew, compared with controls. It was recommended that a second survey be undertaken, taking account of flying tasks and cockpit ergonomics. This was the purpose of the present investigation. METHOD: A questionnaire containing items on back pain and posture was circulated to all 246 acting pilots, with returns of 75%. The questionnaire sought information on pain in both the flying pilot and co-pilot/instructor roles. RESULTS: The 12-mo prevalence of back pain was 80%. Task-related back pain was greatest in instrument flying (72%) and least in the co-pilot and instructor roles (24%). Self-ratings of posture indicated that forward flexed trunk postures predominated in the flying roles and were most extreme in instrument flying. In non-flying roles, symmetrical, reclining postures were more often reported. No demographic or psychosocial variables were significantly related to back pain prevalence or disability. CONCLUSIONS: Much of the back pain experienced by helicopter pilots appears to be due to the posture needed to operate the cyclic and collective controls. In instrument flying, it is suggested that the visual demands of scanning the displays may exacerbate the pain by causing the pilot to lean further forward.

p27 immunostaining is related to prognosis in malignant mesothelioma.

AIMS: To evaluate the prognostic value of the proliferation-associated antigen p27 in malignant mesothelioma. METHODS AND RESULTS: Sections from 36 patients with malignant mesothelioma were immunohistochemically stained for the p27 antigen. The results were quantified by recording the proportion of positively stained nuclei and these data were tested for association with patient survival. p27 expression was also compared with tumour type, MIB-1 expression, apoptotic and mitotic indices. Patients with pleural malignant mesothelioma showing low p27 expression (< 53% of cells positive) survived for significantly shorter periods of time than those with high p27 expression (> or = 53% of cells positive) (P=0.04). The 50% survival time of subjects with low p27 was 4-6 months whereas for those with high p27 expression it was 10-11 months. There was no significant association between p27 expression and MIB-1, apoptotic or mitotic indices. CONCLUSIONS: Low p27 expression in pleural malignant mesothelioma is associated with a significantly worse prognosis. p27 appears to be an independent prognostic variable which may be of value in counselling patients with malignant mesothelioma.

Mitotic and in situ end-labeling apoptotic indices as prognostic markers in malignant mesothelioma.

The prognostic role of mitotic and apoptotic indices in 60 patients with malignant mesothelioma was examined on hematoxylin-eosin-stained sections. The findings were compared with apoptotic indices determined by in situ end labeling (ISEL) in 35 of the cases. There was a significant survival advantage associated with lower mitotic counts and a lower apoptotic index defined by ISEL (P < .05). There was no association between the apoptotic index derived from the hematoxylin-eosin-stained sections and prognosis (P = .90). However, there was a positive association between the apoptotic counts calculated from hematoxylin-eosin- and ISEL-stained sections (P < .01). The mitotic count and ISEL apoptotic index are potentially useful markers of prognosis in malignant mesothelioma.

Cytological diagnosis of bronchopneumonia at post mortem.

We assessed the value of cytology in the rapid diagnosis of bronchopneumonia at post mortem. Cytology scrapes were taken from 249 lung lobes during 50 autopsies. Slides were stained with a modified Giemsa technique and a neutrophil polymorph score recorded on a scale of 0-3. Histology blocks from the same area were then scored for the degree of bronchopneumonia present. Bronchopneumonia was found histologically in 22 patients, but macroscopic examination had identified only eight of these. A cytological neutrophil polymorph score of 2 or more to indicate bronchopneumonia yielded a sensitivity of 52% and a specificity of 98% in terms of lobes. This gave a positive predictive value of 92% and a negative predictive value of 86% for the presence of bronchopneumonia. All eight patients with a cytology score of 3 had histological evidence of bronchopneumonia. Conversely, all patients with a definitive diagnosis of bronchopneumonia exhibited cytology scores of at least 1. Post mortem cytology scrapes reliably predict bronchopneumonia and are superior to gross examination. This is a rapid, reliable and cheap method that can be readily performed in all necropsy practices.

Prognosis in malignant mesothelioma related to MIB 1 proliferation index and histological subtype.

The aims of this study were to evaluate the use of the proliferation marker MIB 1 and histological subtype as indicators of prognosis in malignant mesothelioma. Sections from 41 cases of malignant mesothelioma were histologically subtyped on hematoxylin and eosin sections and stained immunohistochemically for the proliferation marker MIB 1. A proliferation index was derived and the results compared with patient survival data. A statistically significant difference was found between the survival of patients having a low and high MIB 1 index (P < .001). Patients with tumors having a low MIB 1 index lived significantly longer than those with a high MIB 1 index. Patients with the spindle cell histological subtype of malignant mesothelioma had significantly shorter survival times than those with the epithelioid or mixed tumors (P < .01). The MIB 1 proliferation index and histological tumor subtype are useful markers of prognosis in malignant mesothelioma.