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A TALMUDIC HANGOVER

A TALMUDIC HANGOVER

1117 TABLE II-TYPE OF WORK DONE BY CREW MEMBERS WITH ALLERGIC VARIABLES INFLUENCING SURVIVAL IN 440 PATIENTS WITH HD REACTIONS TO CUTTLEFISH I I ...

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1117 TABLE II-TYPE OF WORK DONE BY CREW MEMBERS WITH ALLERGIC

VARIABLES INFLUENCING SURVIVAL IN 440 PATIENTS WITH HD

REACTIONS TO CUTTLEFISH

I

I

I

-

I

.

*Processed cuttlefish.

doctors. All 66 cases were crew members who handled cuttlefish. In 1987, the estimated incidence of allergic reactions described was about 1% annually, after adjustment to the 4-month long cuttlefish catching season, and the proportion of the crew on board who handle cuttlefish (about three-quarters of a trawler’s crew). In the years 1983-86, 5 fishermen with severe bronchial asthma or status asthmaticus were evacuated from ship to shore and later on repatriated to Poland. In 1987 there were 2 such cases. These allergic reactions are important because asthma on a ship without a doctor is difficult to treat. Status asthmaticus developed in some cases treated by doctors, and some patients had to be brought home from distant fishing grounds.

ship’s

S. TOMASZUNAS Z. WĘCŁAWIK M. LEWIŃSKI

Insitute of Maritime and Tropical Medicine,

80-519 Gdynia, Poland

1. Salvaggio JE, Taylor G, Weill H. Occupational asthma and rhinitis. In: Merchant JA, ed. Occupational respiratory diseases. US Dept Health Hum Services (NIOSH Publ 86-102). Washington: US Government Printing Office, 1986. 461-77.

*First levels are not shown and are the opposite of second level, except for histological subtype where first level = lymphocyte predominance or nodular sclerosis, and for stage where first level = stage I or II. tIn accordance with statistical model relative risk and 95% confidence interval indicated only for second level of prognostic variable compared with first level (relative risk = 1).). MC mixed cellulanty; LD lymphocyte depletion. =

between the two studies, especially for patients in stages IIA and IIIA. While Gobbi et al selected therapy mainly on the basis of unfavourable histology (MC or LD), in our study this criterion was not used since chemotherapy was added to radiotherapy in stage IIA patients with mediastinal bulk, and was the only treatment in stage IIIA2.2 Our findings show that the prognostic value of some patients’ variables at diagnosis can be affected by a series of factors which are difficult to identify but which probably depend on the treatments in the patient population studied. Previous studies in selected groups of HD patients have shown that post-staging factors related to treatment, such as the early response to chemotherapy can be more important for prognosis than staging variables.

PROGNOSTIC FACTORS IN HODGKIN’S DISEASE

SIR,-In the prognosis of Hodgkin’s disease (HD), Dr Gobbi and colleagues (March 26, p 675) show that erythrocyte sedimentation rate (ESR), stage, histological subtype, and age at diagnosis are, in decreasing order, the major determinants influencing survival. In contrast, albumin concentration, sex, mediastinal bulk, haemoglobin levels, and constitutional symptoms at diagnosis had less or no prognostic value. Gobbi et al devise an equation for predicting survival time in individual patients. To verify whether this set of prognostic variables had the same influence on survival in the population of HD patients observed at our institution, we reviewed staging and survival data of 440 patients who were diagnosed as having HD from January, 1969, to March, 1987 (median follow-up 51 months). All patients underwent similar evaluation as in Gobbi and colleagues’ study, although treatment patterns (radiotherapy in 123 cases, chemotherapy in 228, and combined therapy in 89) differed in some respects. Information about the nine prognostic variables at diagnosis was available. Variables were coded according to Gobbi and colleagues’ table II. Multivariate analysis of survival was done by the proportional hazards model.’1 The results of our survival analysis are summarised in the table. Our findings confirmed the prognostic value of age and histological subtype but revealed no significant influence of ESR and stage, which were the two most important predictors of survival in Gobbi and colleagues’ study. Additionally our analysis indicated that age at diagnosis and presence of constitutional symptoms are important for prognosis; Gobbi et al found that constitutional symptoms were not so

important.

Although Gobbi et al used more complex statistical techniques, their data combined with ours offer a wide and composite picture of the main variables influencing the prognosis of HD. To explain why different sets of prognostic variables were found in the two analyses, we

would say that

patient series

Department of Haematology, University of Florence, 50134 Florence, Italy

1. Cox DR. Regression models and life-tables. J 2. Desser RH, Golomb HM, Ultmann JE, et al.

A. BOSI A. MESSORI C. CASINI G. BELLESI G. LONGO P. ROSSI FERRINI

R Stat Soc 1972, 34: 187-220. Prognostic classificanon of Hodgkin’s

disease in pathologic stage III based on anatomic considerations. Blood 1977; 49: 883-93. 3. Levis A, Vitolo U, Ciocca-Vasino MA, et al Predictive value of the early response to chemotherapy in high-risk stages II and III Hodgkin’s disease. Cancer 1987; 60: 1713-19.

A TALMUDIC HANGOVER

SIR,-Julia Littlewood and colleagues (March 12, p 558) may be interested to know of a very severe headache secondary to red wine described in the Babylonian Talmud, written almost seventeen centuries ago.1 A Roman matron had said to Rabbi Judah, whose face was always red and shining: "You are a sage and yet you are a drunkard!". The rabbi replied: "You may well believe me that I taste no wine besides that of Kiddush and Havdalah, and the four cups of Passover, on account of which I have to bind my temples from Passover until Pentecost (seven weeks later)". Kiddush and Havdalah refer to the ushering in of the Sabbath on Friday evening and the conclusion of the Sabbath on a Saturday night. Although the colour of the wine is not specified, Jewish law states that red wine is always to be preferred for ceremonial occasions, and it is inconceivable that the great Talmudic sage used anything but red wine

to

fulfil these

obligations.

of Epidemiology,

Department Ministry of Health, 92149 Jerusalem, Israel

PAUL E. SLATER

follow-up was much shorter in our study and our

was more

"recent". Also the

treatments

differed

1 Tractate Nedarim 49b. In: Babylonian Talmud London: Soncino

Press, 1936.