Incidence and mortality trends and geographic patterns of follicular lymphoma in Canada.

Background: Follicular lymphoma (fl) is the most common indolent lymphoma and the 2nd most common non-Hodgkin lymphoma, accounting for 10%-20% of all lymphomas in the Western world. Epidemiologic and geographic trends of fl in Canada have not been investigated. Our study's objective was to analyze incidence and mortality rates and the geographic distribution of fl patients in Canada for 1992-2010. Methods: Demographic and geographic patient data for fl cases were obtained using the Canadian Cancer Registry, the Registre québécois du cancer, and the Canadian Vital Statistics database. Incidence and mortality rates and 95% confidence intervals were calculated per year and per geographic area. Rates were plotted using linear regression models to assess trends over time. Overall data were mapped using Microsoft Excel mapping software (Redmond, WA, U.S.A.) to identify case clusters across Canada. Results: Approximately 22,625 patients were diagnosed with fl during 1992-2010. The age-standardized incidence rate of this malignancy in Canada was 38.3 cases per million individuals per year. Geographic analysis demonstrated that a number of Maritime provinces and Manitoba had the highest incidence rates, and that the provinces of Nova Scotia and Quebec had the highest mortality rates in the nation. Regional data demonstrated clustering of fl within cities or regions with high herbicide use, primary mining, and a strong manufacturing presence. Conclusions: Our study provides a comprehensive overview of the fl burden and its geographic distribution in Canada. Regional clustering of this disease in concentrated industrial zones strongly suggests that multiple environmental factors might play a crucial role in the development of this lymphoma.

Acral keratoses and leucocytoclastic vasculitis occurring during treatment of essential thrombocythaemia with hydroxyurea.

Hydroxyurea is used in essential thrombocythaemia to lower thromboembolic risk. Cutaneous adverse effects from hydroxyurea are diverse. Small vessel vasculitis has been rarely reported, and the coexistence of several different morphologies has not been described. We report a case of acral keratoses, psoriasiform plaques and leucocytoclastic vasculitis (LCV) in a patient with essential thrombocythaemia. A 69-year-old woman developed a confusing array of skin lesions including keratotic papules, psoriasiform plaques and keratoderma 4 years after commencing hydroxyurea therapy. The initial diagnosis was hand and foot psoriasis, but lesions were resistant to therapy. With an increase in the dose of hydroxyurea, the lesions ulcerated. Skin biopsies taken from different sites indicated different diagnoses, including LCV. Discontinuation of hydroxyurea yielded rapid improvement. Although the most commonly reported cutaneous adverse effect from hydroxyurea is leg ulceration, this can be preceded or accompanied by less dramatic skin lesions. Unless recognized, delayed diagnosis and lesion progression can occur.

Cutaneous annular sarcoidosis developing on a background of exogenous ochronosis: a report of two cases and review of the literature.

Exogenous (cosmetic) ochronosis is caused by the long term use of skin-lightening creams containing hydroquinone. Three cases of systemic sarcoidosis with cutaneous sarcoidal granulomas, which developed on ochronotic skin were last described by Jacyk in 1995. Dogliotti and Leibowitz previously reported cases of granulomatous ochronosis with sarcoid-like histological changes but with no associated systemic sarcoidosis. We report two additional cases of cutaneous sarcoidal granulomas, which developed on a background of cosmetic ochronosis in patients recently diagnosed with systemic sarcoidosis.

Impairment rating of the cardiovascular system: Idiopathic cardiomyopathy.

Disease of the cardiovascular system is the leading cause of morbidity and mortality among the adult population in the United States. Physicians performing impairment ratings attributable to cardiovascular disease are required to correlate the extent of the disease and its impact on a person's daily activities. A person's final impairment determination may vary based on the specific guidelines used (American Medical Association Guides to the Evaluation for Permanent Impairment, Social Security, State Worker Compensation requirements, etc.), the version of the guidelines (year, edition), and each guide's specific criteria. The examiner needs to know which rating system to use, the system's criteria, critical definitions, and potential limitations.

Cardiopulmonary rehabilitation and cancer rehabilitation. 1. Cardiac rehabilitation.

UNLABELLED: This self-directed learning module highlights cardiac rehabilitation issues facing able-bodied populations. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on various aspects of the management of cardiac disease and rehabilitation, including medication, exercise, risk-factor modification, secondary prevention, and surgery. Topics discussed include myocardial infarction, coronary artery disease, cardiomyopathy, and angina. New advances covered in this article include the various phases of cardiac rehabilitation, data on lifestyle adaptations for cardiac disease, and recent surgical advances for the treatment of severe heart failure. OVERALL ARTICLE OBJECTIVE: To review aspects of the management of cardiac disease and rehabilitation, including medication, exercise, risk-factor modification, secondary prevention, and surgery.

Cardiopulmonary rehabilitation and cancer rehabilitation. 2. Cardiac rehabilitation in disabled populations.

UNLABELLED: This self-directed learning module highlights the clinical characteristics, medical treatment, and rehabilitation interventions of several cardiac scenarios encountered in physiatric practice. It is part of the chapter on cardiac rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses myocardial infarction during amputation, stroke as a result of cardiac surgery, myocardial perfusion defects in spinal cord injury, and heart murmur in Down syndrome. It also covers current medical management and the benefits of comprehensive rehabilitation and interventions for specific impairments seen in these conditions. OVERALL ARTICLE OBJECTIVE: To describe the clinical characteristics, medical treatment, and rehabilitation interventions of 4 cardiac scenarios encountered in physiatric practice.

Cardiopulmonary rehabilitation and cancer rehabilitation. 3. Pulmonary rehabilitation.

UNLABELLED: This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with pulmonary diseases and in the pulmonary management of neurologic disorders. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Topics reviewed in the rehabilitation of pulmonary diseases include interdisciplinary programming for patients with chronic obstructive pulmonary disease, the role of rehabilitation in lung transplantation and lung volume reduction surgery, and chest physiotherapy and other rehabilitation strategies for patients with cystic fibrosis. The pulmonary management of several neuromuscular disorders is discussed, with attention to the recognition of early pulmonary dysfunction, the role of ventilatory muscle training, and the indications and options for assisted ventilation. OVERALL ARTICLE OBJECTIVE: (a) To review the assessment and therapeutic options in the rehabilitation of patients with pulmonary diseases and (b) to describe the pulmonary management of neurologic disorders.

Pulmonary rehabilitation in the acute inpatient rehabilitation hospital.

In closing, pulmonary rehabilitation in an inpatient rehabilitation hospital is not a new idea, but is now becoming more popular as the burden of care shifts away from the acute care hospital. Pulmonary rehabilitation has been demonstrated to be cost-effective, improve quality of life, and decrease the number of future hospital days for the patient. A few surveys have shown, however, that only 5% of pulmonary rehabilitation programs serviced inpatients in a rehabilitation hospital, and only 1% of 283 programs had a physiatrist as the medical director of the pulmonary rehabilitation program. Nine percent of programs surveyed serviced inpatients in rehabilitation units within the acute care hospital. Clearly, the majority of pulmonary rehabilitation programs are on an outpatient basis, and many of these are located within the walls of a rehabilitation hospital. Effective pulmonary rehabilitation can be done in the home setting when combined with outpatient therapy visits over a 12-week duration. The spectrum of pulmonary rehabilitation will continue to evolve into the twenty-first century, and clearly the rehabilitation hospital will be part of that change. Whether caring for very elderly COPD patients who are too debilitated to return home from the acute care hospital or managing ventilator-dependent patients with COPD, spinal cord injury, or neuromuscular disease, the IPR team and the rehabilitation hospital will have to demonstrate cost-effective outcomes. Physiatrists should play a major role in this evolution, on both a patient-benefit level and legislative level, to increase awareness of pulmonary rehabilitation.

Cutaneous cryptococcosis and Kaposi's sarcoma occurring in the same lesions in a patient with the acquired immunodeficiency syndrome.

A 34-year-old woman presented with a history of fever, malaise and skin lesions. A diagnosis of Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS) was established, and in addition, the skin lesion which was biopsied also demonstrated cryptococcal infection. Disseminated cryptococcosis was later confirmed and the disease ran a florid course. The co-existence of different diseases within the same lesion is a feature of human immunodeficiency virus (HIV) infection, this being the third documented case of simultaneous Kaposi's sarcoma and cutaneous cryptococcosis occurring at the same site in a patient with AIDS. The nature of this co-existence is discussed with reference to the pathogenesis of Kaposi's sarcoma.