Concordance of histological classification of lung cancer with special reference to adenocarcinoma in Osaka, Japan, and the North-West Region of England.

In routinely collected data adenocarcinoma of the lung appeared to be 3 times more frequent in Osaka, Japan, than in the North-Western (NW) Region of England (Manchester). Before embarking on comparative epidemiological studies, it was decided to investigate the comparability of histological diagnosis. Specimens from 60 NW Region lung cancer patients and 52 Osaka patients were exchanged and reviewed. The entire material was then independently assessed by the WHO Collaborating Centre for Histological Classification of Tumours. The interpretation of the WHO Classification (WHO, 1981) by the NW Region and by Osaka was upheld by the WHO Collaborating Centre in 89% and 93% of all cases and in 97% and 100% of adenocarcinoma cases respectively. Agreement between the 2 centres was 88% for the main cell types. Differences in the frequency of adenocarcinoma of lung between the NW Region and Osaka are thus not due to diagnostic artefact and require further exploration. The aetiological implications of the finding that many Chinese and Japanese women with lung adenocarcinoma do not smoke (77% in Osaka) are discussed.

Annular tears in the dorsolumbar spine.

As part of a systemic study of the spine between D11 and S1 the distribution and severity of anterior and posterior annular tears has been assessed by charting the tears in sagittal slabs of 117 fresh specimens. No significant sex difference was seen. The number of cases with tears in multiple discs increases with age, but exceptions to this trend occurred in both young and elderly spines. Age adjusted correlation coefficients indicate that anterior and posterior tears at L4 and L5 do not predict tears at other levels. At L3 and above, significant positive correlations occur between multiple disc levels, particularly posteriorly. In patients 50o year old or more the mean anterior tear score rises sharply from L5 to peak at L2 and L1, but, in contrast, the mean posterior tear score falls from L4 to L1 in this age group. The increase in severity of anterior tears corresponds with increased mobility in the L4-L1 disc from 50-70 years. The data are compatible with 2 factors causing tears. One affects L4 and L5 in young adults and is possibly mechanical in nature; the second operates at a later age, promotes widespread disc involvement, and is primarily degenerative in nature. The increased prevalence and severity of anterior tears (and the associated increase in mobility) in the upper lumbar region in the middle aged and elderly may be a pathogenic factor in back pain for this age group.

Incidence of myeloid leukaemia in Lancashire.

Identification of a "cluster" of cases of acute myeloid leukaemia and chronic myeloproliferative disorders in Lytham St. Annes, Lancashire, prompted an analysis of the incidence of myeloid leukaemias in Lancashire (excluding Ormskirk Health District), as recorded by the Manchester Cancer Registry. Although statistically there was no significant difference in the trend of incidence between the whole former borough of Lytham St. Annes and the other districts studied, the reported incidence of these diseases in the area as a whole had almost doubled, and in two districts nearly trebled, between two consecutive 6 year periods, beginning in 1965. This represents a substantially larger increase than mortality data suggests has occurred nationally in the same period, and is unlikely to be due solely to more accurate diagnosis or reporting.

In-vitro mobility of the lumbar spine.

As part of a systematic study of the spine between D11 and S1 the response to stress has been assessed by measuring radiologically the total and segmental mobility of 103 specimens. The method was shown to be reproducible to within 10% of total mobility. No significant sex difference was seen. Total mobility varied widely, but mean total mobility fell with age. All lumbar segments became less mobile up to the fifth decade. Between the fifth and the eighth decade the mobility of the fifth lumbar segment continued to fall, whereas other lumbar segments became more mobile. The mobility of each segment also varied widely, but the mean segmental mobility fell progressively from L5 to D11. However, this smooth pattern of movement was seen in only 16 cases, mostly adolescents and young adults. Among the remainder, in which movement was irregularly distributed, there were 7 cases (4 aged less than 30 years) in which the mobility of at least 1 segment was more than 2 standard deviations above the mean. The cause of this hypermobility was not evident radiologically. It is suggested that segments with abnormally high mobility may be at risk.

Early rheumatoid disease. II. Patterns of joint involvement.

Data from the first research clinic visit (Fleming and others, 1976) have been subjected to factor analysis to identify early patterns of joint involvement. Nine patterns emerged. Two patterns, if present early, were found to have prognostic significance. An eventually more severe disease was associated with a pattern of large joint involvement (shoulder, elbow, wrist, knee) and a pattern based on metatarsophalangeal joints I and III.

Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine.

The distribution of end-plate lesions (Schmorl's nodes) and their relationship to bone density and disc degeneration have been studied in 50 post-mortem spines below D9 in subjects aged 13-96 years. Lesions were present in 76% of cases with a predominance in males. They were found more frequently in the lower than in the upper vertebral end-plate. They were also more common and more severe in the dorsolumbar (D10-L1) region than in the lower lumbar (L2-L5 region). In adults they were unrelated to age and bone density. Lesions were significantly related to disc degeneration in the D10-L1 region but not in the L2-L5 region. It is suggested that end-plate lesions arising in adolescence (or before) may predispose the dorsolumbar spine to disc degeneration in later life.

Pain in the back: An attempt to estimate the size of the problem.

British morbidity statistics are reviewed to try to estimate the size of the problem of the painful back. National Insurance figures yield an estimated 13.2 million working days lost in one year, though only 68% of this is identified in routinely published statistics. Other bodies of data (G.P. consultations, outpatient and inpatient flows, spinal supports supplied) indicate use of services by sufferers. The difficulties in retrieval caused by the structure of the international Classification of Diseases (ICD) and the effects of the latest revision of it are examined.