The authors treated 14 patients with advanced squamous cell carcinoma (SCC) of the skin or lip with one to four cycles of combination chemotherapy consisting of cisplatin by bolus injection, and 5-fluorouracil (5-FU) and bleomycin by continuous 5-day infusion. Objective responses were seen in 11 of the 13 evaluable patients (84%). Four patients had a complete remission (30%) and seven patients, a partial remission (54%). Local control after definitive complementary radiation and/or surgical treatment was achieved in seven patients. Toxic side effects was acceptable; they consisted of nausea and vomiting in all patients, transient skin changes, hematologic (Grade 3/4) abnormalities in four patients, and pulmonary fibrosis in one elderly patient. These results show that this chemotherapy combination could play a role in reducing the tumor mass and in facilitating definitive treatment to obtain better functional and cosmetic results in advanced SCC of the skin.

Incidence of various Hodgkin (HL) and non-Hodgkin lymphoma (NHL) subtypes and association with viruses in Lebanon are not known. We undertook a nationwide study of 272 patients diagnosed with lymphoma in 2007. HL comprised 32.7 % (n = 89) of cases while NHL represented 67.3 % (n = 183). Consistent with the literature, nodular sclerosis was the most predominant HL subtype (n = 57/89). Among NHL, B-cell NHL represented 88 % (n = 161/183), T-cell NHL 9 % (n = 17/183), whereas in 2.7 % it was not classifiable. The B-cell NHL comprised predominantly diffuse large B-cell lymphoma (46 %) and follicular lymphoma (23 %). 81 cases were reviewed by a panel of pathologists with 87.6 % concordance rate. Serology was negative for hepatitis C in 122 tested cases. HIV was positive in 2 cases. Two adult T-cell leukemia/lymphoma were HTLV-I positive. EBV IgG were positive in 88.5 % of cases. 38 EBV seropositive cases [27 NHL (24 B-cell, 3 T-cell) and 11 HL] were studied for EBV genome expression using EBV-encoded RNA (EBER)-in situ hybridization. EBER expression was positive in 8 (21 %) cases (6 HL, 2 T-cell NHL). The distribution of lymphoma subtypes in Lebanon appears similar to that of Western countries. The high rate of EBV positivity in HL and T-cell lymphoma by EBER deserves further investigation.

(Anesth Analg. 2017;124(4):1168–1173) Cricoid force (CF) is used to occlude the esophageal lumen and prevent regurgitation during surgery. However, excessive CF can deform the cricoid cartilage, oppose the vocal cords, interfere with tracheal tube passage, and result in ineffective gas exchange. Due to differences in cricoid plate size, women may require less CF than is recommended in the literature (at least 44 N). The authors of the present study hypothesized that gender differences exist in the necessary CF application to prevent regurgitation. Using a Glidescope video laryngoscope in anesthetized and paralyzed patients, they assessed the effectiveness of different CFs in occluding the esophageal entrance in men and women.

The current study provides evidence that the median force necessary to occlude the esophageal entrance to prevent regurgitation is less in women compared with men. Applying the appropriate cricoid force in women should also decrease airway-related problems that tend to occur with the use of excessive forces. The findings of the current study may only be applicable to patients with normal body habitus.

Mortality data are essential to identify the public health importance of different diseases and allocate resources appropriately. This descriptive study was carried out to assess the pattern of mortality in Basra governorate in southern Iraq using the death records from the civil registry system for 2 years (1978 and 2007). The overall age-standardized mortality rate was lower in 2007 than 1978 (7.95 versus 8.70 per 1000), so too were the age-specific mortality rates, with the exception of that for young adults, which was 22% higher. The leading cause of death in both years was cardiovascular diseases, while cancer was the third leading cause in 1978 and the second in 2007. Mortality rates were 45.5% lower for infectious diseases in 2007 compared with 1978, 39.5% lower for respiratory diseases, 50.0% lower for digestive system diseases, 66.7% higher for congenital malformations and 4-fold higher for endocrine and nutritional diseases.

No abstract

5220 Background: lymphoid neoplasms represent a diverse group of neoplasms that are broadly classified into non-Hodgkin lymphomas (NHL) and Hodgkin lymphoma (HL). Incidence of particular subtypes and pathogenic associations with certain viral infections are derived from data from the Western world. Little is known about such associations in developing countries; accordingly, this prospective study evaluates newly diagnosed cases of lymphomas in Lebanon and evaluates the incidence of particular subtypes and possible association with various viral infections. Patients and Methods: this was a collaborative nationwide study that included all patients diagnosed with lymphoma in Lebanon in 2007. Epidemiological, clinical and histological data were collected. Available lymphoma tissue (stained slides and paraffin-embedded tissue) was reviewed by a panel of pathologists. Blood was collected for serologic testing for the following viruses: hepatitis C (HCV), HIV, EBV, and HTLV-I. Results: 275 cases, 140 (50.7%) males and 136 (49.3%), with lymphoma were diagnosed. Eighty one cases (76 from academic centers and 5 from community hospitals) were reviewed by the pathology panel. The overall concordance rate was 87.6% (71/81); there was discordance in 6 (7.4%) cases: 3 originally diagnosed as diffuse large B cell lymphoma (DLBCL) were revised to high-grade follicular lymphomas, 1 small lymphocytic lymphoma (SLL) previously DLBCL, 1 DLBCL previously low grade lymphoma, 1 DLBCL previously lymphoblastic lymphoma; 4 cases were considered equivocal on revision. The enrolled cases were classified as follows: 183(66.5%) NHL (150 cases B cell lymphoma - 81 DLBCL, 35 follicular, 12 marginal zone/MALT, 11 mantle cell, 7 SLL/CLL, 2 transformed follicular/DLBCL, 2 lymphoblastic; 16 cases T cell lymphoma - 7 peripheral T cell NOS, 4 anaplastic, 2 lymphoblastic, 1 angioimmunoblastic, 1 NK cell, 1 adult T cell leukemia/lymphoma (ATLL); 17 unclassified); and 92(33.5%) HL (60 nodular sclerosis, 5 mixed cellularity, 5 lymphocyte predominant, 1 lymphocyte-rich, 21 unclassified). Blood was obtained from 120 patients. Serology was negative for HCV in all tested cases. HIV was positive in 2 cases (1 NHL, 1 HL). EBV IgG were positive in 106 (88.3%) cases (68/77 NHL, 38/43 HL). Also, 38 EBV seropositive cases (27 NHL (24 B-cell type & 3 T-cell type), 11 HL) were studied for latent membrane protein-1 (LMP-1); LMP-1 staining was positive in 8(21%) cases, of which 6 were HL and 2 were T-cell NHL. Only one case with peripheral T cell lymphoma (ATLL) tested positive for HTLV-1. Conclusions: our epidemiological study showed that two-thirds of lymphoma cases diagnosed over a year were NHL. Reviewing almost one-third of cases showed an 87.6% concordance rate in diagnosis. Serologic testing of viruses did not reveal any specific pattern that suggests an association between the tested viruses (HCV, HIV, EBV, and HTLV-I) and lymphoma. However, LMP-1 testing was positive in 54.5% of IgG positive HL cases and in 66.7% of IgG positive T-cell NHL. These finding confirm a strong association of EBV with HL and T-cell lymphoma. Disclosures: Bazarbachi: Hoffman La Roche: Research Funding.