Guidance on ill health retirement

Doctors are increasingly being asked by their patients to provide a report in support of an application for them to retire from work on the grounds of ill health. There is evidence that some applications may be motivated more by financial incentives than by ill health. Doctors should be wary of a conflict of interest, know the pension company's criteria for ill health retirement and provide objective medical evidence. The decision as to whether the patient fulfils the criteria is best left to another doctor who is acting as an advisor to the pension company.     

Activation or frustration of anti-tumor responses by T-cell-based immune modulation

Cataleptogenic effects of haloperidol (1 mg/kg i.p.) in rats was antagonized by caffeine and theophylline (10-50 mg/kg i.p.), and by selective adenosine A2 receptor antagonist (3,7-dimethyl-1-propargylxanthine) (3 and 6 mg/kg i.p.). Selective A1-adenosine receptor antagonist (8-cyclopentyltheophylline) (1.5 and 3 mg/kg i.p.) was not able to reduce this effect of haloperidol. These results confirm the antagonistic interaction between adenosine A2A and dopamine D2 receptors, and suggest the involvement of adenosine A2 receptors in the mechanisms of catalepsy.     

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Chromosome analysis of G-banded peripheral blood lymphocytes was performed on two groups of plutonium workers with 20-50% and >50% maximum permissible body burdens (MPBB) of plutonium from the British Nuclear Fuels plc (BNFL) facility at Sellafield, UK, 10 years after an earlier study had reported increases in both symmetrical and asymmetrical aberrations. For each plutonium exposure group there was a significant difference in frequencies of symmetrical aberrations between plutonium workers, workers with similar histories of exposure to mainly external gamma radiation but with little or no intakes of plutonium, and controls with negligible exposure (<50 mSv). In contrast, no significant differences for asymmetrical aberrations were found, and since these are short-lived, this suggests that recent exposure of mature lymphocytes was minimal. Frequencies of symmetrical aberrations had increased significantly since the earlier sampling time. Additional external radiation exposure was negligible in the plutonium worker groups over this period. These results are consistent with the hypothesis that hemopoietic precursor cells are being irradiated by internally deposited plutonium with subsequent selection resulting in only cells with symmetrical aberrations reaching the peripheral lymphocyte pool. After removal of aberrations involving only chromosomes 7 and/or 14, which are thought to arise in vivo during immunological development, the breakpoints involved in the aberrations were distributed randomly among the chromosomes according to length in all three groups of workers. Within the chromosomes the distribution between terminal, interstitial and centromeric regions for the plutonium workers did not conform to that expected, there being an excess in the terminal regions and a deficit in the interstitial regions.     

Three-year prospective adherence to three breast cancer screening modalities

PURPOSES: To determine the long-term risk/benefit ratio of phacoemulsification and intraocular lens (IOL) implantation combined with trabeculotomy to manage eyes with pseudoexfoliation syndrome and co-existing cataract. SETTING: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine; Kurihara Eye Clinic; Departments of Ophthalmology, Tenri Hospital, Kumamoto University, and Matsue Red Hospital; Nagata Eye Clinic, Japan. METHODS: This multicenter retrospective study comprised 49 eyes of 36 patients with pseudoexfoliation syndrome and co-existing cataract who had the combined procedure for uncontrolled intraocular pressure (IOP) (> 21 mm Hg) even on antiglaucoma medication. RESULTS: After a mean follow-up of 20.0 months +/- 13.2 (SD), IOP in all 49 eyes was well controlled (< or = 21 mm Hg). Mean IOP at the final examination was 14.6 +/- 2.6 mm Hg on a mean of 0.9 +/- 0.8 glaucoma medications. Complications included an IOP spike in 11 eyes and fibrin exudation in 1 eye. CONCLUSION: Phacoemulsification and IOL implantation combined with trabeculotomy was an effective treatment for patients with pseudoexfoliation syndrome and cataract.     

Analysis of the conversion of delta-(L-alpha-aminoadipoyl)-L-cysteinyl-D-alpha-aminobutyrate by active-site mutants of Aspergillus nidulans isopenicillin N synthase

In order to study the present situation of music therapy in hospitals of pediatrics and of child and adolescent psychiatry in the FRG, a postal survey at these hospitals was performed. The personnel situation, methods of music therapy and indications for music therapy were examined. The data are analysed according to the kind and the size of hospital; they are compared to results obtained in a survey at out-patient pediatrics and to a similar survey from the year 1990.     

The safety of intraoperative lumbar subarachnoid drainage for acutely ruptured intracranial aneurysm: technical note

Recently, some concern has arisen regarding the safety of intraoperative spinal drainage for brain relaxation in aneurysm surgery, due to anecdotal association with both aneurysmal rebleeding and increases in symptomatic vasospasm. To address these concerns, we reviewed our experience with frequent spinal drainage and early surgery in 432 consecutive cases of surgically treated aneurysmal subarachnoid hemorrhage. Unless contraindicated by mass effect or associated pathology, all grade I-III patients referred within 14 days were treated with spinal drainage at surgery. In this cohort (n = 314), there were no cases of meningitis or nerve root injury. Only one case of intraoperative rebleeding could be associated with spinal drain placement (0.3%). In grade IV-V patients, 47% required preoperative ventriculostomy, and 11% were ineligible for spinal drainage due to mass effect. There were, however, no complications related to spinal drainage in the remaining 23 patients. Permanently-shunted hydrocephalus (8%) and symptomatic vasospasm (19%) were infrequent overall. When analyzed by grade, spinal drains were generally associated with equal or reduced incidence of these developments when compared to patients without spinal drainage. We conclude that brain relaxation can be safely and effectively obtained using intraoperative spinal drains during early aneurysm surgery.     

Do HPV-negative cervical carcinomas exist?

Based on improvements in HPV detection technology, it appears that an almost 100% HPV association is reached for cervical cancer, as demonstrated in an accompanying paper in this issue of the Journal. Factors which may explain the rare cases in which no HPV DNA is detectable include: improper sampling; disruption of HPV by integration events; the existence of still unidentified HPVs; sensitivity of the method; and the mechanism of transformation. Finally, epidemiological studies identifying HPV independent risk factors are necessary to answer the question of whether HPV independent pathways exist for cervical carcinogenesis.     

International Conference on Peyronie's disease advances in basic and clinical research. March 17-19, 1993. Introduction

The articles in this section of the Journal support the theory that the lesion of Peyronie's disease is a scar that has developed following trauma to the erect penis in a susceptible individual. The scar involves only the tunica albuginea and does not extend into the erectile tissue. Factors related to the formulation of this scar, discussed on a biochemical and cellular level, are elucidated in the following papers.     

Macronutrient intake and cardiovascular risk factors in older coloured South Africans

A cross-sectional analytical study was undertaken to investigate the macronutrient intake and cardiovascular risk factor profile of community-dwelling older coloured (mixed descent) South Africans. A sample of 200 subjects aged 65 years and above in Cape Town was randomly drawn using a two-stage cluster design. Trained field workers interviewed subjects to obtain demographic, dietary and life-style data, to draw fasting blood samples for the analysis of plasma lipids, and to take anthropometric measurements. Nutrient intake was assessed using a validated quantified food frequency questionnaire. Blood pressure was measured according to the guidelines of the American Heart Association. The mean daily energy intake was 7984 (3245) kJ and 6979 (2219) kJ for men and women, respectively. Twenty-nine per cent of the subjects had energy intakes less than two-thirds of the RDA. Dietary fat intake comprised 32.4% of total energy intake, which is in line with the prudent dietary guidelines. The inadequate fibre intake (mean = 17(8) g/day) was attributed to the low consumption of fruit and vegetables. Anthropometric assessment indicated that the women tended towards overnutrition, while the men appeared to be undernourished. Lipid profiles fell within the lower end of the moderate risk band for cardiovascular disease and a high prevalence of hypertension (71.7%) was identified. The survey findings indicate a need for health promotion activities to encourage increased physical activity levels and an increased consumption of vegetables, fruit, wholegrain cereals and low fat dairy products in this population.     

Bilateral internal mammary artery atherosclerosis: a late complication of delayed repair of coarctation of the aorta

A 58-year old patient who had undergone repair of aortic coarctation at 19 years of age, subsequently developed coronary artery disease requiring coronary artery bypass surgery. At operation both internal mammary arteries were found to be totally occluded with calcific atherosclerosis. We therefore advise that the internal mammary arteries should be assessed carefully in patients with similar past histories.