Soft tissue sarcoma of the hand or foot: conservative surgery and radiotherapy.

Purpose. Conservative treatment in the form of limited surgery and post-operative radiotherapy is controversial in hand and foot sarcomas, both due to poor radiation tolerance of the palm and sole, and due to technical difficulties in achieving adequate margins.This paper describes the local control and survival of 41 patients with soft tissue sarcoma of the hand or foot treated with conservative surgery and radiotherapy. The acute and late toxicity of megavoltage radiotherapy to the hand and foot are described. The technical issues and details of treatment delivery are discussed. The factors influencing local control after radiotherapy are analysed.Subjects . Eighteen patients had sarcomas of the hand and 23 of the foot. All patients received post-operative radiotherapy, the majority receiving a dose of 60 Gy in 2-Gy daily fractions using a two-phase treatment.Results . The acute and late toxicity of treatment were within acceptable limits. The actuarial 5-year overall survival of the whole patient group was 67.6% and the local relapse-free survival was 44%.The local control was similar in tumours of hand and foot, and in patients treated at first presentation or relapse.Discussion. Post-operative radiotherapy to the hand or foot appears to be a well tolerated treatment resulting in long-term local control in a significant proportion of patients. The increased frequency of recurrence within the high-dose volume suggests the need for the use of higher total doses of radiotherapy.

Racial differences in nasal fossa dimensions determined by acoustic rhinometry.

Sixty acoustic rhinographs from subjects of three different ethnic groups (Caucasian [Europeans], Negro, and Oriental) were examined at baseline and after decongestion. The main parameters analysed were minimal cross-sectional area (MCA), the distance at which this occurred (D), nasal volume at 0-4 cm (Vol), mean cross-sectional area at 0-6 cm (MA), and the cross-sectional area at 10 points in the nose (0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, and 6 cm) analysed as a series (A). Values from left and right were combined and mean values used. Analysis was carried out using multiple linear regression and grouped linear regression with analysis of covariance and, for A, multifactorial analysis of variance. For MCA, race was the main determining factor with Orientals and Caucasians significantly lower than Negroes: p<0.0001 (corrected means and 95% confidence intervals [c.i.]: Orientals: 0.63 cm2, 0.55-0.71 cm2; Caucasians: 0.69 cm2, 0.62-0.77 cm2; Negroes: 0.87 cm2, 0.79-0.95 cm2). Height alone correlated with D in the decongested state (p<0.0001); race as well as height in non-decongested noses (p = 0.018). There were significant racial differences in Vol in both decongested (p = 0.014), and non decongested noses (p<0.0001). In the non-decongested state MA was significantly different in all racial groups: p<0.0001 (corrected means and c.i.: Orientals: 3.89 cm2, 3.47-4.31 cm2; Caucasians: 4.67 cm2, 4.27-5.09 cm2; Negroes: 5.13 cm2, 4.72-5.53 cm2). In the decongested state there was a significant difference between Negroes and the other two groups (p = 0.015), and Orientals and Caucasians were a homogenous population. We conclude that race has a significant effect on acoustic rhinometry measurements and this needs to be taken into account.

Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections.

Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated. The largest group studied had low back pain with limited straight-leg raising (SLR) and in them the beneficial effect of manipulation in hastening pain relief was highly significant. In similar patients without limitation of SLR, the effect was of borderline significance. In all the other groups, treated patients also recovered more quickly than their controls. Traction, for patients with low back pain and sciatica, and epidural injections when a root palsy was present also produced some significant pain relief. The effect of sclerosants for back pain was less clear.

Outcome of respiratory illness occurring in the first year of life.

This paper describes the outcome of respiratory illness presented by a birth cohort of infants in the first year of life who were born to mothers in two inner London group general practices in terms of the ventilatory capacity measured at their fifth birthday. A history of two or more episodes of "lower" respiratory illness in the first year of life was associated with a significant reduction in peak expiratory flow when compared with those who had no such history. Boys had significantly higher peak flow rates than girls; those whose parents were in manual occupations had significantly lower peak flow rates than those whose parents were in non-manual occupations. There was a significant interaction between sex and social class.

Patterns of respiratory illness in the first year of life.

This paper describes a study of respiratory illness during the first year of life in a cohort of infants who were born between 1975 and 1978 to mothers who were registered with two inner London group general practices. The types of respiratory illness and their relation to the season of the year and season of birth of the child are examined. The relations among the frequency and type of respiratory illness and several social and family factors that have previously been shown to be associated with high levels of respiratory morbidity are also described.

A cross-cultural comparison of health status values.

The extent to which the values attached to health states are similar in different cultures or social groups is important for understanding health and illness behaviors and for developing standardized health status measures. A cross-cultural study was conducted to compare the health status values obtained in a United States population (Seattle, Washington) with those from another English-speaking culture (London, England) on the Sickness Impact Profile, a standardized measure composed of 136 items. London judges rated the severity of dysfunction described in each item on an equal interval scale using the same methods of scaling and analysis employed in the Seattle study. A regression of English mean item values on US mean values yielded a slope of 1.00 and an intercept of -0.07, indicating that judges gave strikingly similar ratings to most items. Agreement was higher at the more severe end of the dysfunction continuum than at the least severe end, a finding consistent with the notion that what constitutes health is more difficult to define than what constitutes illness. While a universal conception of dysfunction may exist in English-speaking societies, the social and cultural determinants of health status values deserve more systematic study.

The epidemiology of chlamydial infections in childhood: a serological investigation.

Blood samples from 382 children between the ages of one and 15 years were tested for anti-chlamydial antibody. A low prevalence of antibody against Chlamydia trachomatis was found among children under the age of seven years. Antibody against the Chlamydial agent C IOL-207 was rare before the age of five years, but was found with increasing prevalence in older children. It is suggested that the mode of transmission of the two agents is different and that C IOL-207 may be transmitted at school.

Social class and ischaemic heart disease: use of the male:female ratio to identify possible occupational hazards.

In England and Wales there has been an increasing excess of ischaemic heart disease death rates among men and women of social classes IV and V compared with those in classes I and II and this excess is greater in young than in old adults. The male excess over women in IHD death rates is much greater in social classes I and II than in classes IV and V. Although men in professional occupations are at low risk for IHD compared with men in other occupations, women married to professional men are at an even lower risk compared with other women. Also, women married to men in unskilled occupations have relatively higher IHD rates than their husbands. These patterns are not seen for "all causes," cerebrovascular disease, chronic bronchitis, or stomach cancer, where the social class mortality gradients are similar in men and women. There may thus be factors associated with professional occupations that increase the risk of IHD despite the relatively low death rates of men engaged in them. In addition there may be factors operating in women in social classes IV and V that put them at a particularly high risk for the development of IHD.

Mitotic and labelling activity in normal human epidermis in vivo.

Labelling and mitotic indices were studied in the epidermis of twenty-eight young men. A mean labelling index of 5.5% was found from the whole study and a mean mitotic index of 0.06%. Mitotic index particularly was extremely variable; indices between 0.002 and 0.438% were found in individual biopsies. In the first two of three experiments in which mitotic index at 09.00 hours was compared with that at 15.00 hours, significant differences were found (15.00 hours greater than 09.00 hours by a factor of 2.6, P less than 0.001). However, in the third such experiment no such difference was found, suggesting that the timing and occurrence of diurnal rhythms of mitotic activity may not be consistent in normal human epidermis. In the one experiment in which it was investigated, a significantly higher mitotic index was found at 21.00 hours compared to 09.00 and 15.00 hours. Labelling index did not vary significantly at 09.00, 15.00 or 21.00 hours. However, labelling index did show a significant pattern of change over a 12-month period in two groups of subjects; peaks of labelling were seen in July and troughs in January. Very high ratios of labelled: mitotic cells were found, the median ratio for the whole study being ninety-eight labelled: one mitotic cell. This finding supports the possibility that not all labelled cells subsequently go on to divide in normal human epidermis.

The social parameters of tuberculous infection among children in the Transkei.

A survey of tuberculin sensitivity among children under 14 years of age was carried out in one location of the Transkei. The results were analysed to estimate the association between Heaf test conversion and two social factors, per capita income and overcrowded sleeping quarters. While poverty was found to be associated with a high prevalence of tuberculin sensitivity, overcrowding was not. The methods used and the results are discussed.

Doctor diagnosis and maternal recall of lower respiratory illness.

Epidemiological studies of respiratory illness in childhood have used the mother's recall of her child's respiratory illness experience as a measure of the frequency with which these illnesses occur. This paper explores the relationship between the diagnosis by the doctor of lower respiratory illnesses and the recall by the mother of the occurrence of these illnesses in a cohort of children in the first year of life. While there is a poor relationship between doctor diagnosis and maternal recall of these illnesses, the group of children reported by their mothers to have had bronchitis or pneumonia in the first year of life appear to suffer more respiratory illness than those children whose mothers recall no such illnesses.

Estimating the prevalence of disability in the community: the influence of sample design and response bias.

An estimate of the prevalence of physical disability in the community based upon a sample survey may be influenced by the sample design and the response to the method of data collection employed. In this paper we describe a postal survey of a sample of households in the London borough of Lambeth and the procedures used for calculating the influence of these factors on the estimate produced. These procedures can be used to adjust the estimate to take account of the relative chance of households falling into the sample and to correct for non-response bias.