Idiopathic cervical fibrosis--a new member of IgG4-related sclerosing diseases: report of 4 cases, 1 complicated by composite lymphoma.

Idiopathic cervical fibrosis is a rare tumefactive inflammatory-sclerosing lesion involving the soft tissues of the head and neck, and a proportion of patients also have synchronous or metachronous inflammatory fibrosclerosing lesions in other anatomic sites. The latter finding suggests that this entity may represent a member of IgG4-related sclerosing diseases. We report 4 cases to support this postulation. The patients were male adults aged 42 to 89 years, who presented with an infiltrative, firm cervical mass. Two patients also had IgG4-related chronic sclerosing sialadenitis of submandibular gland and lymphadenopathy. Histologically, the cervical soft tissue lesions had ill-defined borders, consisting of coalescent nodular lymphoid aggregates accompanied by a sclerotic stroma. Nerve infiltration, skeletal muscle invasion, and phlebitis were present. There was a significant increase in IgG4 plasma cells (87 to 327 per high-power field, with IgG4/IgG ratio of 63% to 98%). In the soft tissue lesion of 1 patient, there were expansile foci comprising dense sheets of plasma cells and small lymphoid cells that exhibited κ light chain restriction and clonal immunoglobulin gene rearrangement, consistent with supervening extranodal marginal zone lymphoma. The adjacent lymph node from the same patient showed Epstein-Barr virus (EBV)-positive classical Hodgkin lymphoma with typical morphology and immunophenotype (CD30, CD15, PAX5). Thus lymphoma can supervene in the chronic inflammatory background similar to that recently documented for IgG4-related sclerosing disease of the ocular adnexa.

The development of Cantonese Lexical Neighborhood Test: a pilot study.

OBJECTIVE: This study aimed at developing a theoretically driven open-set speech recognition test for pediatric clinical population of cochlear implant and/or hearing aid users, with Cantonese Chinese as their first language, to track progress in speech recognition performance as an outcome measurement of their rehabilitation. METHODS: Six monosyllabic and six disyllabic word lists were generated from the Cantonese CHILDES language database, constructed according to the Neighborhood Activation Model. There were three lexically "easy" and three lexically "hard" word lists in each sub-test, with 25 items in each list. Four pediatric cochlear implant users and 10 hearing aid users, with bilateral congenital severe to profound sensorineural hearing impairment and below the age of 10, participated in the study. Their performances on word recognition and phoneme recognition with the new test lists, as well as the inter-list equivalency, inter-rater reliability, and face validity of the new materials, were investigated. RESULTS: Word recognition was higher among disyllables than monosyllables. Lexically "easy" disyllabic words were better recognized than their "hard" counterparts and the monosyllables. No significant difference was noted among the three lists in each combination of syllable structure and lexical property. High inter-rater reliability, as well as high correlation between Cantonese LNT score and a receptive vocabulary test score, were revealed. CONCLUSIONS: These newly developed test lists provided reliable information on spoken word recognition of pediatric hearing prosthesis users with severe to profound hearing impairment. Inter-list equivalency and inter-rater reliability allowed monitoring of rehabilitation progress on such specific pediatric clinical population with this new test. (255).

Effects of labelling on income, work and social function among hypertensive employees.

Two hundred and thirty hypertensive Canadian steelworkers were followed for 5 years after screening and referral. Data on income, absenteeism and measures of work and social function were collected on these men and on a matched group of 230 normotensive employees. In the fifth year after screening, hypertensive employees earned an average of Can. $1093 less than normotensive employees despite similar incomes in the year before screening. This adverse effect on income was observed regardless of awareness of hypertension at the time of screening or compliance with treatment. Illness-related absenteeism among hypertensives rose in the year following screening and remained elevated for 4 years after screening. Normotensive and hypertensive employees reported similar levels of physical ability and psychological well-being. These findings need verification in other settings before inclusion in cost-effectiveness analyses of the management of hypertension.

Is there a trade-off between income and health? The case of hypertensive steelworkers in Canada.

It is often assumed that medical treatment creates a trade-off between good health and income; that is, an individual "pays" for good health by an income loss (at least at the early stages of treatment) compared, for example, with the no-treatment choice. We examined empirical data on hypertensive steelworkers in Canada to evaluate whether such a trade-off exists. We found none. Indeed, those who participated in a treatment program to reduce their blood pressure not only gained improved health but also made small income "gains." Our findings thus challenge the validity of the trade-off assumption and call for further studies of its generalizability.

Incidence of low back pain and pre-placement x-ray screening.

The primary purpose of pre-placement back x-ray screening is to reduce the incidence of low back problems. This study was designed to address the specific question of whether or not this objective is achieved, without directly looking at the predictive value of radiological abnormalities of the lumbar spine. Two retrospective cohorts of steelworkers were identified: one group hired before, and one after, introduction of back x-rays into an otherwise identical pre-placement medical examination. The two cohorts were stratified by age and work activity, and by use of a modified life table method were followed for 12 years. All health incidents, modified work, lost time, or permanent job changes were noted. Analysis revealed no statistically significant differences between cohorts for the parameters studied. The inclusion of low back x-ray screening into a comprehensive pre-placement medical examination had no significant effect on the subsequent incidence of low back pain in the cohort of steelworkers studied.