Chemokine expression in rheumatoid arthritis (RA): evidence of RANTES and macrophage inflammatory protein (MIP)-1 beta production by synovial T cells

Earlier studies from this laboratory provided evidence for restricted cytokine expression in the T cell population in RA tissues. Specifically, IL-2, IL-4, IL-6 and interferon-gamma (IFN-gamma) gene expression levels were low. The selective chemoattractant and activation effects of chemokines on leucocytes identify them as potentially ideal candidates in mediating selective inflammatory processes in RA. Accordingly, we undertook studies to examine constitutive chemokine gene expression in RA tissues. RANTES, monocyte chemotactic protein-1 (MCP-1) and MIP-1 beta gene expression was examined in both the T and non-T cell populations in RA peripheral blood (PB), synovial fluid (SF) and synovial tissues (ST). Our results identified elevated levels of both RANTES and MIP-1 beta gene expression in circulating RA PB and SF T cells. By contrast, MCP-1 expression was virtually absent in RA PB, yet elevated MCP-1 mRNA levels were detected primarily in the non-T cell populations of the SF and ST samples. Histological examination of affected rheumatoid joints revealed extensive RANTES and MIP-1 beta expression in sites of lymphocyte infiltration and cell proliferation, namely the synovial lining and sublining layers. Fractionation or RA ST patient samples revealed that RANTES expression was restricted to the T cells, whereas MIP-1 beta expression was detected in both T and non-T fractions. These data suggest that MCP-1, MIP-1 beta and RANTES may have a central role in the trafficking of reactive molecules involved in immunoregulation and in the inflammatory processes in RA.

Psychological and social aspects of burns

Although the literature on the psychological consequences of burns is fairly extensive, the evidence gathered by the charity 'Changing Faces' over the last 2 years suggests that the resources allocated to psychological rehabilitation are still far from adequate. This article draws on the personal experience of one of the authors who was in a car fire 24 years ago, reviews some of the literature, briefly looks at the work done by Changing Faces and discusses some of the tasks of the 'burns team'. The authors are aware that generalizations about the consequences of burns are fraught with risk because every fire has its own causes and complications, but it is hoped that the themes expressed here do raise important general points.

Pancreas cancer as a second primary malignancy. A population-based study

BACKGROUND

The study of second primary malignancies may give clues to the etiology of various cancers. Little is known about risk factors for pancreatic carcinoma; therefore, its occurrence as a second primary malignancy was investigated.

METHODS

Data from the Surveillance, Epidemiology, and End-Results (SEER) program were used for the period from January 1, 1973 through December 31, 1990. Person-years of follow-up for various cancer sites were calculated, excluding the initial 6 months after diagnosis, and were multiplied times the age- and sex-specific incidence rates for pancreas cancer to calculate the expected number of second primary pancreas cancer cases. The observed number of cases was divided by the expected number to estimate the relative risk (RR) of pancreas cancer as a second primary cancer, and 95% confidence limits were calculated.

RESULTS

The risk of second primary cancer was elevated after lung cancer for men (RR 1.3, 95% CI 1.0-1.6) and women (RR 2.5, 95% CI 1.9-3.2). An elevation in risk also was found after head and neck cancer in women (RR 1.8, 95% CI 1.2-2.5) and bladder cancer in women (RR 1.5, 95% CI 1.1-2.0), but not in men. Other significant elevations were found after prostate cancer (RR 1.2, 95% CI 1.1-1.3), and a decreased risk was found after lymphoma in men (RR 0.2, 95% CI 0.0-0.8).

CONCLUSIONS

Second primary pancreas cancer is increased after tobacco-related malignancies, particularly in females, supporting the role of cigarette smoking as a risk factor for pancreas cancer and suggesting a stronger effect of cigarette smoking for women. The elevation in risk after prostate cancer and the decreased risk after lymphoma in males need to be confirmed in other data sets.

Increased physiological dead space/tidal volume ratio during exercise in burned children

Exercise testing enables the simultaneous evaluation of the cardiovascular and respiratory systems' ability to perform gas exchange. The physiological responses to exercise have not been previously reported in the postburn child. This investigation was designed to evaluate residual cardiopulmonary impairment in patients convalescing from severe burns. Spirometry, lung volumes and exercise stress testing were completed on 40 children with a mean time postburn injury of 2.6 +/- 1.9 years and mean burn size of 44 +/- 22 per cent TBSA. Respiratory variables studied during exercise included expired volume, tidal volume and respiratory rate, and physiological dead space/tidal volume (VD/VT) ratios. Stress testing revealed an increased VD/VT ratio consistent with uneven ventilation-perfusion relationships. The data indicate that patients who survive thermal injury may not regain normal cardiopulmonary homeostasis.

Immunohistochemical detection of oncogene proteins and neuroendocrine differentiation in different stages of prostate cancer

The progression of prostatic adenocarcinoma from localized disease to metastatic carcinoma appears to be a multi-step sequence. The expression of common oncogenes/oncosuppressor genes and the mediating effect of neuroendocrine tumor cells may play a role in this progression. The expression of the more frequently investigated oncogenes/oncosuppressor genes (p53, c-myc, c-erbB-2, bcl-2) and the presence of neuroendocrine cells were assessed in prostatic cancer tissue from patients with localized and metastatic cancer. These oncogenes/oncosuppressor genes were evaluated according to tumor stage and grade and their relationship to one another. Grade was not related to any of the oncogene markers or to the presence of neuroendocrine cells. Advancing stage was associated with a significant increase in p53 expression, while other markers remained constant in all stages. Neuroendocrine cells, p53, c-myc, c-erbB-2 and bcl-2 were rarely co-expressed at any stage of prostate cancer.

Factors associated with glycemia and microvascular complications among James Bay Cree Indian diabetics of Quebec

We conducted a chart review of physician diagnosed diabetics to obtain plasma glucose levels (fasting plasma glucose and glycosylated hemoglobin) over a retrospective 30 month time span and data on the presence or absence of current renal or ophthalmic microvascular complications. Multiple logistic regression was used to determine factors associated with the presence of microvascular complications. Poor glycemic control reflected by a need of insulin therapy (odds ratio (OR) = 2.7, confidence internal (CI): 1.1, 6.7), increased serum triglyceride levels (OR = 4.5, CI: 2.0, 9.9) and duration of illness of more than five years (OR = 3.0, CI: 1.2, 7.8) were found to be associated with the presence of microangiopathies. Process of care and temporary reversion to traditional lifestyle and diet did not influence glycemic control. Our results points towards a need for an increased awareness of lipid disorders in diabetic patients and a better understanding of how social and psychological factors are related to metabolic outcomes.

Passive immunization of rhesus macaques against SIV infection and disease

To evaluate the role of humoral immunity against simian immunodeficiency virus (SIV), we tested whether passive immunization with plasma from SIVmac251 vaccine-protected or healthy infected animals would protect rhesus monkeys against intravenous infection with ten 50% animal infectious doses of the cell-free homologous virus. The challenge dose of this SIVmac251 virus stock had previously caused persistent infection in all (21 of 21) nonimmunized controls. A plasma pool was obtained from a donor that had been immunized with an inactivated whole SIVmac251 vaccine produced in human T cells. This plasma pool contained low levels of SIVmac binding and neutralizing antibody but had a high titer of antibodies recognizing human cell proteins. Given 4 or 18 hr before intravenous challenge, this plasma completely protected three of eight recipients from infection and delayed virus detection in one recipient. The five unprotected animals had only a transient or undetectable p27 antigenemia and low virus load in their PBMCs, and all survived at least 7 months after infection. By contrast, no protection was observed in 6 monkeys given inactivated, pooled plasma or purified immunoglobulin (Ig) from healthy SIVmac251-infected animals. This plasma pool and the Ig preparation contained high levels of SIV-binding and neutralizing antibody but no reactivity to human cellular components. Five of the six recipients had persistent antigenemia after challenge and four died acutely from simian AIDS in 4-7 months. These studies suggest that passive transfer of antibody to human cellular antigens can confer protection against SIVmac whereas passive transfer of neutralizing antibodies without human cellular antibodies does not protect against the homologous virus and may enhance infection.

[The stria vascularis of the inner ear and its normal structural variations]

The ultrastructural effects of gentamicin on the stria vascularis of the inner ear of guinea pigs were studied by transmission electron microscopy. In a single specimen of an isolated, inner ear we found an unexpected variation in the structure of the stria vascularis in a normal, pigmented, guinea pig not treated with ototoxic drugs. There were prominent, wide protrusions from the apical surfaces of marginal cells into the endolymphatic space. This finding has not been previously reported and was seen in only 1 of 7 animals studied. It may be considered a normal structural variation, and is not pathological change in the stria vascularis due to ototoxic drugs.

[Treatment of urinary bladder cancer--a retrospective analysis]

Data on 482 stage A-0--D2 bladder cancer patients referred between 1975-86 were analyzed. Prognosticators of survival were stage, histologic subtype and differentiation. 143 patients with disease localized to the pelvis (stage A-0--D1) received definitive radiotherapy with 60 Gy or more, and 25 underwent preoperative irradiation and cystectomy. Later, a group of 56 selected patients with stage B--D1, referred between 1988-1991, received neo-adjuvant MCV chemotherapy (methotrexate, cisplatin and vinblastine) preceding either definitive radiotherapy or surgery. The 2-year overall actuarial survival rates were similar: 63% for radiotherapy only, 72% for cystectomy and 68% for neo-adjuvant chemotherapy; they were also similar when broken down by stage and grade.

Clinical characteristics of metachronous colorectal tumors

A cancer-registry-based study was conducted to investigate the survival patterns associated with metachronous colorectal tumors and to compare the survival of patients with single and metachronous colorectal tumors. The study included all 1,396 White patients with metachronous colorectal tumors diagnosed among 143,283 patients with primary colorectal tumors reported between 1973-1986 to the SEER program. The influence on survival of age at diagnosis, site of tumor and stage was evaluated by means of multivariate survival analysis, using Cox Proportional Hazards Models. Metachronous tumors developed more often following left-colon tumors. Stage distribution of the second tumors was better than that of single 47% of the second tumors were discovered in regionally-advanced or distant-metastatic stages. Survival from the second tumor diagnosed in the rectum was worse than that of a single tumor in the same stage and site. Only the stage of the second tumor was found to influence survival from metachronous tumors. The relatively high rate of diagnosis of advanced second colorectal tumors may reflect either improper follow-up after the diagnosis of the first tumor, or more aggressive biological characteristics of the second tumors.

Gamete-specific methylation correlates with imprinting of the murine Xist gene

We have investigated the potential role of DNA methylation as a regulator of imprinted Xist expression in mouse preimplantation embryos. The active paternal allele was found to be unmodified in sperm at CpG loci near the 5' end of the gene transcription unit. In contrast, on the inactive maternal allele, these same sites are initially methylated in the oocyte and then remain modified in the early embryo. In the male germ line, these methyl moieties are removed during spermatogenesis, and this occurs before the programmed reactivation of Xist in the testis. This represents a clear-cut example of a potential methylation imprinting signal that is reprogrammable and gamete derived.

Clinical characteristics of second primary tumors following breast cancer

In the Multiple Primary Tumor Registry of the Northern Israel Cancer Center we found 247 patients with breast cancer who developed a second primary tumor. The major sites of the second tumor were mainly the other breast (42%), colon (14%), ovary (8%), and endometrium (7%). Only 24% of the second tumors were diagnosed in asymptomatic patients on a routine follow-up examination; 60% of these patients had contralateral breast cancer and 8% had colon cancer. More patients in this group had localized disease as compared to those diagnosed following appearance of symptoms. The time interval between the first symptoms suggesting malignancy and the diagnosis was longer than 6 weeks in 7%, as compared to 24% in patients diagnosed with a single cancer. In 69 patients (30%), delay was found between the first medical consultation and diagnosis. The agents responsible for the delay were the specialist (32%), the system and normal tests (54%), and the patients (8%). In the diagnosis of a single tumor, the physician and the patient shared a similar percentage of responsibility (29% and 33%). Educational efforts aimed mainly at physicians and patients regarding the early detection of second primary tumors are advocated. Methods that have been proven to detect cancer early, such as mammography, stool for occult blood, and sigmoidoscopy, should be utilized in asymptomatic patients with single tumors in the same way as in the healthy population.

Natural killer cell function and expression of beta 7 integrin in psoriatic arthritis

OBJECTIVE

To examine the cytotoxic activity of natural killer (NK) cells from peripheral blood (PB) and synovial fluid (SF) of patients with psoriatic arthritis (PsA). The influence of selected inflammatory mediators on the cytolytic function and integrin expression of NK cells was also studied.

METHODS

Paired samples of PB and SF lymphocytes (PBL and SFL) were obtained from 8 patients with PsA for comparison of NK activity between PBL and SFL. In 6 patients the phenotype of NK cells was determined by flow cytometry using monoclonal antibodies (Mab) to natural killer associated antigen (NKH-1) and the beta 7 integrin, HML-1 (human mucosal lymphocyte adhesion molecule).

RESULTS

NK activity of PB samples was significantly greater than paired SF (p = 0.015). SF NK activity was enhanced by overnight culture with interleukin 2 (IL-2) (p < 0.05). A trend towards reduction of NK activity by prostaglandin E2 (PGE2) was noted (p = 0.06) whereas interleukin 6 (IL-6) and indomethacin had no significant effect. NK activity did not correlate with the percentage of NK cells in PB or SF. However, all SF samples contained a greater proportion of monocytes than PB samples. The expression of HML-1 on NK cells correlated with expression HML-1 on CD3+ cells (r = 0.82) and was greater in SF than PB in PsA and RA patients. Effects of IL-2 on HML-1 expression by NK cells were variable in the 3 patients studied.

CONCLUSION

In PsA, HML-1 is an activation marker on NK cells. IL-2 expands or maintains the population of HML-1/NKH1 positive cells and increases NK cytolytic activity. However, cytolytic activity of activated NK cells may be inhibited by monocyte derived PGE2.

Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?

PURPOSE

Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as dose the necessity of clarifying goals of treatment.

PATIENTS AND METHODS

We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor.

RESULTS

Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years.

CONCLUSION

These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.

Comparing comfort and wearability: custom-made vs. self-adapted mouthguards

Several studies have shown that mouthguards can reduce orofacial injuries among athletes. Comfort and wearability factors were compared among 40 high-school athletes for custom-made and self-adapted mouthguards. Both offered adequate protection, but overall the participants preferred the custom-made mouthguard.

An evaluation of an education programme, for prevention and early diagnosis of malignancy in Israel

A community-wide health education programme for the prevention and early detection of cancer was performed in the Krayot municipalities, north of Haifa, Israel, during the years 1985-86. In order to assess its effectiveness, an evaluation programme was conducted. The knowledge, attitudes and behaviour of women who had been exposed to the education programme and of a control group, were compared before the programme started and 2.5 years later, after it ended. The programme was conducted in five clinics and included changes in the functioning of the clinics and their teams to be used in the interaction with the insured women. A piloted questionnaire was used to evaluate knowledge, attitudes and behaviour of these women. Emphasis was placed on smoking, sun tanning, self-examination of breast and other aspects of possible early detection of cancer. The education programme was ineffective not only with regard to behaviour but also in relation to knowledge on the relationship between health behaviour and cancer. The need for the establishment of more effective means for health education is eminent. If health education programmes are to succeed, we must understand what motivates or prevents compliance with recommended health behaviour.

Full dose vincristine (without 2-mg dose limit) in the treatment of lymphomas

BACKGROUND

Most current lymphoma protocols limit vincristine dose to 2 mg per single dose. Because a lower dose of vincristine may be associated with poorer outcome, there is some rationale to increase the dose of vincristine.

METHODS

The feasibility of full dose vincristine (i.e., 1.4 mg/m2 without 2-mg dose limit) was prospectively evaluated in lymphoma patients treated with various combinations. After an initial dose of 1.4 mg/m2, patients were carefully monitored, and dose was modified according to toxicity.

RESULTS

One hundred and four consecutive patients (31 with Hodgkin's disease and 73 with non-Hodgkin's lymphoma), aged 18-78 years were evaluated. The first dose was greater than 2 mg in 90% of the patients. The mean actual dose (percent of projected dose) was 100% in the first course and gradually decreased to 64% in the eighth course. The mean actual dose intensity of vincristine (percent of projected dose intensity) during the initial six cycles of prednisone, methotrexate, calcium leucovorin, doxorubicin, cyclophosphamide, etoposide, and mechlorethamine, vincristine, procarbazine, prednisone (ProMACE/MOPP), cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and MOPP/doxorubicin, bleomycin, and vinblastine (MOPP/ABV) was 82% and MOPP/doxorubicin, bleomycin, and vinblastine was 82%, 83%, and 87%, respectively. Symptoms of neuropathy developed in 92% of the patients and were usually of mild or moderate severity. Toxicity included World Health Organization (WHO) Grades 3 and 4 constipation in 10 (10%), and WHO Grade 3 peripheral neurotoxicity in 16 (15%) patients. Rapid improvement was usually noticed within a few weeks after withdrawal of vincristine. The median duration of symptoms from discontinuation of vincristine was 3 months for paresthesiae and motor weakness and 5 months for muscle cramps.

CONCLUSIONS

Full dose vincristine in lymphoma protocols is feasible but is associated with increased toxicity. The therapeutic advantage of full dose vincristine has yet to be proven.

Hodgkin's disease in childhood: treatment modalities, outcome and epidemiological aspects. The Northern Israel Cancer Center experience

PURPOSE

A retrospective analysis of Hodgkin's disease (HD) in children treated at the Northern Israel Cancer Center between 1971 and 1990 was conducted.

PATIENTS AND METHODS

Records of 102 patients < 18 years of age at diagnosis were reviewed. Patient characteristics were similar to those previously reported. There were 54 boys and 48 girls (1.1:1 boy:girl ratio), with more boys < 10 years of age. Forty-four patients were of Arab ancestry and 58 were Jewish; incidence rates were similar in both groups. The most common histological types were nodular sclerosing and mixed cellularity, the latter being more commonly diagnosed in the younger age group.

RESULTS

The outcome of various treatment modalities in childhood HD were evaluated. Sixty-five patients (64%) had stage I or II and 37 (34%) had stage III or IV at diagnosis. Patients with stage I-II received radiotherapy alone (20 patients), chemotherapy alone (10 patients), or a combined approach of chemotherapy plus radiotherapy (35 patients). Survival rates and median disease-free intervals were statistically similar in all three modalities. However, relapse rates were higher among patients receiving radiotherapy alone or chemotherapy alone (35% and 38%, respectively) compared with patients receiving chemotherapy plus radiotherapy (14%).

CONCLUSIONS

We conclude that a combined approach of chemotherapy plus radiotherapy is advantageous over radiotherapy alone or chemotherapy alone.

A district urinary catheter policy. Why have one?

A catheter audit was performed at the Central Manchester Trust, which found that there was excessive ordering, inappropriate catheter selection by size, materials, balloon size and poor guidelines on catheter storage. From these findings and from the available literature, we have proposed guidelines on catheter selection with the aim of offering the best patient care and to provide cost efficiency which may be of benefit to other hospitals.

Increased risk of lung cancer after breast cancer radiation therapy in cigarette smokers

BACKGROUND

Ionizing radiation is a lung carcinogen in a variety of settings, including after breast cancer radiation therapy. The authors explored whether cigarette smoking and breast cancer radiation therapy have a multiplicative effect on the risk of subsequent lung cancer.

METHODS

This case-control study investigated women registered with primary breast cancer in the Connecticut Tumor Registry who developed a second malignancy between 1986 and 1989. Those diagnosed with a subsequent primary lung cancer were compared with those diagnosed with a subsequent nonsmoking, nonradiation-related second malignancy, and age-adjusted odds ratios were calculated with logistic regression.

RESULTS

No radiation effects were observed within 10 years of initial primary breast cancer. Among both smokers and nonsmokers diagnosed with second primary cancers more than 10 years after an initial primary breast cancer, radiation therapy was associated with a 3-fold increased risk of lung cancer. A multiplicative effect was observed, with women exposed to both cigarette smoking and breast cancer radiation therapy having a relative risk of 32.7 (95% confidence interval [CI], 6.9-154). The radiation carcinogenic effect was observed only for the ipsilateral lung and not for the contralateral lung both in smokers and nonsmokers.

CONCLUSIONS

Breast cancer radiation therapy, as delivered before 1980, increased the risk of lung cancer after ten years in nonsmokers, and a multiplicative effect was observed in smokers. For both smokers and nonsmokers, this effect was observed only for the ipsilateral lung and not the contralateral lung. Modern techniques, however, significantly decrease the radiation dose to the lungs, which may decrease the risk of lung cancer. Nonetheless, due to the available choices in early-stage breast cancer treatment, current practices may need to be revised for young breast cancer patients who smoke.

Treatment of gastric adenocarcinoma with the combination of etoposide, adriamycin and cisplatin (EAP): comparison between two schedules

The results of two schedules of the combination of etoposide, doxorubicin, and cisplatin (EAP) in gastric cancer are reported. EAP-1 was administered as originally reported and consisted of i.v. doxorubicin (adriamycin) 20 mg/m2 on days 1 and 7, i.v. cisplatin 40 mg/m2 on days 2 and 8 and i.v. etoposide (VP-16) 120 mg/m2 (100 mg/m2 in patients aged 60-65) on days 4-6. EAP-2 consisted of i.v. adriamycin 40 mg/m2 on day 1, i.v. cisplatin 80 mg/m2 (total dose per cycle) given in 3 divided doses on days 1-3 and i.v. VP-16 100 mg/m2 on days 1-3. Cycles of the two regimens were repeated on day 22. Drug doses were reduced in patients over 65 years of age. Twenty patients were treated with EAP-1 and 43 with EAP-2. Forty-five of the 63 patients included in this study had advanced gastric carcinoma, 16 had radically resected stage III disease, and 2 had metastatic signet ring cell carcinoma of unknown primary origin. Thirty-eight patients with advanced gastric adenocarcinoma were evaluable for response. The response rate for EAP-1 (6/13, 46%) was similar to that of EAP-2 (13/25, 52%). The median duration of response was 8 months for EAP-1 and 6.5 months for EAP-2. Myelotoxicity of EAP-1 was much more severe than that of EAP-2. Hospitalization due to granulocytopenic fever was required in 15/78 (19%) EAP-1 versus 20/215 (9%) EAP-2 courses. Toxic deaths occurred in 3/20 treated with EAP-1 and in 1/45 treated with EAP-2. The difference in toxicity between the two regimens could not be attributed to differences in patients' characteristics or to dose intensity. We conclude that the modified EAP regimen (EAP-2) is effective in the treatment of gastric cancer and is less toxic than the original EAP.

Visual function and long-term chloroquine treatment

Ophthalmic examinations and selected tests of visual function were performed on 64 patients with rheumatoid arthritis who had received daily doses of 200 mg chloroquine sulphate for periods ranging from 3 to 11 months. Visual fields were determined by Humphrey automated perimetry and Amsler grids and a further battery of four tests of macular function (visual evoked potentials, critical flicker fusion threshold, Cambridge contrast sensitivity and the macular dazzle test) were administered. No case of retinal pigmentary abnormalities plus visual loss was found, but 2 patients were advised to cease chloroquine therapy on the basis of funduscopic findings. A small group of patients with relatively poor scores on one or more tests had normal visual fields and ophthalmic findings. There were no significant partial correlations between test results and the cumulative dose of chloroquine. These results support the opinion that currently recommended doses of chloroquine pose a minimal risk of retinal toxicity.

[Hodgkin's disease in childhood--northern Israel cancer center experience, 1971-1990]

Records of children treated for Hodgkin's disease between 1971-1990 were analyzed retrospectively, and 102 cases of children younger than 18 years when diagnosed were reviewed. There were 54 boys and 48 girls, with male predominance in those younger than 10 years. 44 patients were of Arab ancestry and 58 were Jewish; the incidence was similar in both groups. Most common were the nodular sclerosing and mixed cellularity types, the latter more common in the younger age group. The outcome of various treatments was evaluated. At diagnosis, 64% were in stages I or II and 34% in stages III or IV. 20 of those in stages I-II received radiotherapy (RT) alone, 10 chemotherapy (CT) alone, and 35 combined CT and RT. Survival rates and median disease-free intervals were statistically similar with all 3 modalities. However, relapse rates were higher with either RT or CT alone (35% and 38%, respectively) than with combined therapy (14%). We conclude that combined CT and RT is superior to RT or CT alone.