Two year follow-up study of stressors and occupational stress in submariners.

BACKGROUND: Submariners are an occupational group within the Royal Navy (RN) who work in isolated and extreme conditions. This preliminary study forms part of a longitudinal study of occupational stress in the RN. AIMS: To compare stress prevalence in submariners with matched controls and to identify predictors of occupational stress in submariners over a 2 year follow-up period. METHODS: Participants completed a Work and Well-Being Questionnaire to measure occupational stressors and the General Health Questionnaire-12 (GHQ-12) to measure stress at time point 1, and a follow-up GHQ-12 2 years later. Demographically matched controls from the surface fleet of the RN were identified for each submariner. Regression models were developed for submariners and their controls to predict future stress at time point 2 using psychosocial predictors from time point 1. RESULTS: Participants comprised 144 submariners and 144 general service controls. There were no differences between submariners and their surface fleet counterparts in the prevalence of occupational stress. Nevertheless, different predictors for the development of stress were found between the two groups. For submariners, over-commitment and rank were the main predictors; whereas for controls, the predictors were length of service, body mass index and physical work. CONCLUSIONS: Submariners were not more likely to suffer from occupational stress than surface fleet controls in the RN. However, the psychosocial predictors of stress were significantly different for this RN specialist group, demonstrating the importance of developing individual models of stress for different occupational groups.

Diffuse large-cell lymphoma of B-cell origin and deficient T-cell function in a patient with rheumatoid arthritis.

An increased incidence of non-Hodgkin's lymphoma has been described in patients with rheumatoid arthritis. Mechanisms related to abnormal immune regulation have been postulated, but no patients with rheumatoid arthritis and lymphoma have been previously well characterized immunologically. We describe here a patient with long-standing rheumatoid arthritis in whom a B-cell diffuse large-cell lymphoma developed. He was found to have a severe T-cell immunodeficiency and evidence of persistent Epstein-Barr virus infection. Epstein-Barr nuclear antigen was not found to be present within lymphoma cells. The combination of defective T-cell function and persistent Epstein-Barr virus infection may have predisposed this patient with rheumatoid arthritis to the development of a malignant clone of B lymphocytes.

Plasma exchange in idiopathic thrombocytopenic purpura.

Two cases of adult-onset idiopathic thrombocytopenic purpura (ITP), refractory to conventional therapy, were treated. Because of recent successful reports of plasma exchange in ITP, this technique was performed on each patient. In both cases, the therapy was unsuccessful in controlling their disease, suggesting that in refractory adult-onset ITP, plasma exchange may not be an effective mode of therapy.

Efficacy of targeted supradose cisplatin and concomitant radiation therapy for advanced head and neck cancer: the Memphis experience.

PURPOSE/OBJECTIVE: To evaluate the feasibility, response rates, and toxicity of a Phase II study using targeted supradose cisplatin and concurrent radiation therapy in unresectable Stage III-IV head and neck squamous cell carcinoma. METHODS AND MATERIALS: Sixty patients presenting between 6/93-9/94 were enrolled, 44 (73%) of whom had T4 and/or N2-N3 nodal disease. All patients were treated with rapid targeted superselective intraarterial infusions of cisplatin (150 mg/m2 weekly x 4) and simultaneous sodium thiosulfate intravenously (9 g/m2) for systemic neutralization of cisplatin. Concurrent (day 1) daily radiation therapy was delivered to the primary tumor and overt nodal disease to 66-74 Gy while the uninvolved lower neck received 50 Gy, at 2.0 Gy/fraction. RESULTS: Fifty-one (85%) patients completed the full RADPLAT protocol as planned. Fifty-seven of 60 patients were evaluable for response. Histological (n = 50) or clinical (n = 7) assessment of primary site revealed a complete response (CR) in 52 patients, partial response (PR) in 4, and stable disease (SD) in 1. Of the 40 patients presenting with nodal metastases, pathological (n = 31) or clinical (n = 6) assessment revealed a CR in 25, PR in 11, and SD in 1, while 3 were unevaluable. Overall, for both primary site and nodal disease, CR was attained in 44 (75%), PR in 12 (23%), and SD in 1 (2%) of the 57 evaluable patients. Only 2 (4%) of 57 evaluable patients have recurred above the clavicle, 1 in the primary site and 1 in the regional lymph nodes. Twelve patients (23%) have failed in distant sites. Grade III/VI toxicity has included gastrointestinal in 6, hematologic in 6, mucosal in 12, vascular in 4, and neurological in 4 patients. CONCLUSION: Concurrent radiation therapy and targeted supradose cisplatin (i.e., RADPLAT) can be safely delivered with high response rates and excellent loco-regional control in advanced Stage III/IV head and neck squamous cell carcinoma.

5-Fluorouracil infusion and mitomycin combination chemotherapy in the management of patients with advanced non-small-cell lung cancer.

We have carried out a phase II study evaluating the activity of a 5-fluorouracil drug combination in patients with advanced non-small-cell lung cancer. Patients were given 60 mg/m2 of methotrexate i.v. on day 1. On day 2, 750 mg/m2 of 5-fluorouracil was administered as a 24-h infusion daily for 3 days. Also on day 3, 10 mg/m2 of mitomycin was given i.v. along with folinic acid. Folinic acid was started on day 3 initially at a dose of 25 mg/m2 intravenously every 6 h for three doses, followed by a 2-h infusion of 200 mg/m2 daily on days 3 and 4. Therapy was repeated every 28 days. Fourteen of 35 patients (40%) experienced a partial response to chemotherapy. The median survival of the entire group was 19 weeks. Mucositis was a common side effect but severe leukopenia, anemia, renal insufficiency, and skin ulceration were rare. This study demonstrated that 5-fluorouracil infusion therapy has activity in advanced non-small-cell lung cancer but the responses are not durable. Further studies evaluating differing dose schedules and alternate 5-fluorouracil infusion-based drug combinations seems warranted.

Response of agranulocytosis to thymectomy in a patient with thymoma and chronic lymphocytic leukemia.

A patient with chronic lymphocytic leukemia presented with recurrent episodes of severe neutropenia. This neutropenia was initially responsive to prednisone but eventually became refractory. A spindle-cell thymoma was diagnosed and resected with dramatic improvement in his granulocytopenia. Both autologous and heterologous granulocyte macrophage colony growth were clearly inhibited by the patient's serum. This is the first reported case of severe granulocytopenia associated with a thymoma that seemed to be reversed following thymectomy.

Hyperendemic West African trypanosomiasis in a rural hospital setting.

Over 60 cases of trypanosomiasis presented to Eku Hospital between May 1983 and May 1985. During this time, within this previously unreported hyperendemic focus, 47 patients were documented microscopically. Their clinical characteristics are reported here. Seventy-four per cent were felt to have CNS involvement on presentation. Compliance with the therapeutic regimen was a major problem, requiring adjustments in the usually accepted management of this disorder.

Lymphoma simulating Crohn's colitis.

A patient with lymphomatous colitis whose disease mimicked Crohn's colitis has been presented. The diagnosis was not made despite multiple endoscopic biopsies. Lymphomatous colitis may produce a clinical and colonoscopic picture similar to Crohn's colitis.

Delayed hemolytic transfusion reaction caused by anti-LebH antibody.

A major delayed hemolytic transfusion reaction produced by an antibody to Lewisb is reported. Delayed hemolysis following transfusion with Leb-positive red cells was not reported to the blood bank. Severe hemolysis recurred following a second transfusion with Leb-positive cells, but was avoided thereafter with Leb-negative red cells. This is the first reported case of a serious delayed hemolytic transfusion reaction caused by anti-Leb.

Targeted chemoradiation for advanced head and neck cancer: analysis of 213 patients.

BACKGROUND: To determine the survival results, patterns of relapse, and organ preservation effects of a targeted chemoradiation protocol for patients with advanced (stage III-IV) carcinoma of the head and neck. METHODS: Analysis of 213 patients with stage III-IV squamous cell carcinoma treated at UT Memphis between June 1993 and March 1998. Treatment included weekly intra-arterial infusions of cisplatin (150 mg/m(2)/ week x 4) rapidly delivered to the tumor bulk, simultaneous intravenous thiosulfate for systemic drug neutralization, and conventional external-beam irradiation (180-200 cGy/fraction) to a total dose of 68-72 Gy. RESULTS: Tumor response, toxicity, disease control above the clavicle, pattern of relapse, and survival. There were 89 events of grade III-IV toxicity and 6 treatment-related deaths (grade V). Complete response in the primary and regional sites was obtained in 171 of 213 (80%) and 92 of 151 (61%), respectively. The rate of clearance of regional disease after neck dissection was 98%. There were 51 of 195 recurrences (26%): 11 local (5.6%), 5 regional (2.6%), and 35 distant (17.9%). The Kaplan Meier plot projections for overall and cancer-related 5-year survival was 38.8% and 53.6%, respectively, whereas disease control above the clavicle was 74.3%. CONCLUSIONS: We believe this chemoradiation protocol represents an effective management scheme for patients with advanced head and neck cancer with a high rate of organ preservation and possibly improved survival.