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Acquired hearing impairment and psychiatric disorder amongst Australian Vietnam veterans
324
program for
computation of the maximal likelihood of linkage between PKD2 and each marker locus. Negative lod scores were obtained for close linkage (ie, low recombination fractions) to the MS markers, and all positive lod scores or MS markers remained below 0-5 even at recombination frequencies of 0-3 or more. In contrast positive lod scores up to 2-12 (at a recombination frequency of 0.11) were obtained with YNH24, indicating that PKD2 may be located in the vicinity of D2S44 on the short arm of chromosome 2:7 DNA Probe MS1 MS31 MS43a YNH24
marker Locus D1S7 D7S21 D12S11 D2S44
Lod score at recombination fraction of. 0.01 005 0 10 0.20 0.30 0.40 -8-67-4 54-2-82-1-26-0-52-015 0.21 0.01 0.25 -5-36 -2-09 -0-88 0.24 0.42 0.24 -6-19 -2,20 -0-77 1.90 1.36 0-67 0-80 1-90 2.12
Although the existence of more than two loci for ADPKD cannot
Australia between 1983 and 1988. This unit used DSM-IIP during that time. 63 veterans had been given a total of 142 axis I (syndromal) and axis II (personality problems) principal diagnoses. The diagnoses were substance abuse or dependence (mainly
alcohol) 34, paranoia 1, schizophrenia or schizophreniform disorders 2, major depression or dysthymia 30, post-traumatic stress disorder 21, generalised anxiety disorders 17, panic disorders 9, personality disorder 19, agoraphobia (with or without panic) 9,13 (21 %) of these 63 veterans had successfully claimed hearing disability, and both post-traumatic stress disorder (8) and agoraphobia (5) were significantly over-represented amongst those successfully claiming hearing disability. Claims records have definite limitations
out at this moment, the present observation should encourage the analysis of other unlinked ADPKD families for linkage to D2S44 and neighbouring loci.
trauma.
Institute of Forensic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
Department of Psychiatry, Repatriation General Hospital,
be ruled
SØREN NØRBY
Section of Clinical Genetics, Department of Paediatrics,
1.
ST, Breuning MH, Davies KE, et al. A highly polymorphic DNA marker linked to adult polycystic kidney disease on chromosome 16. Nature 1985; 317: 542-44. 2. Romeo G, Devoto M, Costa G, et al. A second locus for autosomal dominant polycystic kidney disease. Lancet 1988; ii: 8-11. 3. Kimberling WJ, Fain PR, Kenyon JB, et al. Linkage heterogeneity of autosomal dominant polycystic kidney disease. N Engl J Med 1988; 319: 913-18. 4. Nørby S, Sørensen AWS, Boesen P. Non-allelic genetic heterogeneity of autosomal dominant polycystic kidney disease? In: Bartsocas C, ed. Genetics of kidney disorders: Proceedings of Fifth International Clinical Genetics Seminar, vol I. New York: Alan R. Liss, 1989: 83-88. 5. Wong Z, Wilson V, Patel I, Povey S, Jeffreys AJ. Characterization ofa panel of highly variable minisatellites cloned from human DNA. Ann Human Genet 1987; 51: 269-88. 6. Nkamura Y, Leppert M, O’Connell P, et al. Variable number of tandem repeat (VNTR) markers for human gene mapping. Science 1987; 235: 1616-22. 7. Anon. Human gene mapping 10, table 4: polymorphic human DNA segments. Cytogenet Cell Genet 1989; 51: 664. 1. Reeders
Acquired hearing impairment and psychiatric disorder amongst Australian Vietnam veterans SIR,—The machinery of modern warfare is a potent source of acoustic trauma to the hair cells of the cochlea, the damage being greatest around 4 kHz.l 20-30% of serving military personneP and up to 42% of American veterans in the Vietnam conflict3 have been found to have hearing loss (usually of high-frequency sounds) as a result of such trauma. High-tone hearing impairment affects the capacity to identify the content of speech in the presence of competing noise. Despite the prevalence of hearing loss among former military personnel and the potential for interference with social communication the psychiatric consequences do not seem to have been studied previously.’ 20 807 of the 49 211 Australians known to have fought in Vietnam have sought to have disability identified as war-related by the Department of Veterans’ Affairs. Such claims can be accepted, rejected outright, or rejected as no incapacity found or evidenced at the time of assessment. We have scrutinised a random 1-in-20 sample of claimants, looking at psychiatric and at disability claims. 248 of 1042 veterans whose claims were studied had successfully claimed for hearing disability as a result of war service and 228 for psychiatric disability. 65 had claimed successfully on both grounds,
and, with
no
incapacity found
Daw Park, South Australia 5041
MARIANNE SCHWARTZ
Rigshospitalet, Copenhagen
or
evidenced claims taken into
account, significantly more veterans with a successful psychiatric claim than without a successful claim for psychiatric morbidity had also been successful in claiming hearing impairment (65/228 vs 183/814; p < 0-05 chi-squared). We also looked at the discharge diagnoses of all veterans discharged from a Veterans’ Affairs psychiatric unit in South
as
sources
for
epidemiological study. Nevertheless, the associations identified could, if confirmed by further research, have important implications for the health needs of those exposed to acoustic DAVID I. BEN-TOVIM NICHOLAS L. S. POTTS RENUS J. DORTMANS ALAN M. WEISS ROBYN POTTER
Kringlebotn M, Gundersen T, Krokstad A, et al. Noise-induced hearing loss: can they be explained by basilar membrane movement? Acta Otolaryngol 1979; suppl 360:
98-101. 2. Bender DR, Mueller HG. Military noise induced hearing loss: incidence and mangement. Mil Med 1984; 149: 154-58. 3. Center for Disease Control. Center for Disease Control Vietnam Experience Study: health status of Vietnam veterans II, physical health. JAMA 1988; 259: 2709-14. 4. Jones EM, White AS. Mental health and acquired hearing impairment: a review. Br J Audiol 1990; 24: 3-9. 5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington: American Psychiatric Association, 1980.
Xenon for anaesthesia SIR,-Commenting on the paper by Professor Lachmann and colleagues (June 16, p 1413) Dr Nunn and Dr Halsey (July 14, p 112) state that anaesthetists want much more solid evidence of xenon’s efficacy and safety. Xenon, being an inert gas, is incapable of oxidising reactions, unlike the "gold standard" agent nitrous oxide. The danger with all anaesthetic gases is that when they are supplied without oxygen they cause anoxic asphyxia. The reversal of the gradient for oxygen transport across the alveolar membrane even removes the oxygen present in blood returning to the lung. This causes a very rapid fall in systemic arterial oxygen tension and fatal. Nunn and Halsey state that a long series of controlled studies would be required for xenon to be accepted. It would appear that the physical properties of the gas determine its efficacy. For example, the anaesthetic action of another inert gas, argon, has been demonstrated at high partial pressures under hyperbaric conditions. Since Lachmann et al have demonstrated that a xenon and oxygen mixture can induce a state of anaesthesia and is superior to nitrous oxide, where are the grounds for demanding further controlled studies? is
soon
Department of Community Medicine, Wolfson Institute of Occupational Health, University of Dundee, Ninewells, Dundee, UK
P. B. JAMES
CORRECTIONS of value of propranolol in prevention of variceal In this article by Dr P. C. Hayes and colleagues (July 21, p 153) refs 10 and 21 should be transposed, and the index trial referred to in paragraph 5 of the Results section was number 33 in the reference list.
Meta-analysis haemorrhage.
Innervation of annulus fibrosis in low back pain. We apologise to DrM. H. Coppes and his colleagues for our printer’s omission of a line from their letter (July 21, p 189). The third paragraph should have begun "AChE-positive as well as NF-immunoreactive nerve fibres in the range ofA8 and C tenninals were abundant...".
program for
computation of the maximal likelihood of linkage between PKD2 and each marker locus. Negative lod scores were obtained for close linkage (ie, low recombination fractions) to the MS markers, and all positive lod scores or MS markers remained below 0-5 even at recombination frequencies of 0-3 or more. In contrast positive lod scores up to 2-12 (at a recombination frequency of 0.11) were obtained with YNH24, indicating that PKD2 may be located in the vicinity of D2S44 on the short arm of chromosome 2:7 DNA Probe MS1 MS31 MS43a YNH24
marker Locus D1S7 D7S21 D12S11 D2S44
Lod score at recombination fraction of. 0.01 005 0 10 0.20 0.30 0.40 -8-67-4 54-2-82-1-26-0-52-015 0.21 0.01 0.25 -5-36 -2-09 -0-88 0.24 0.42 0.24 -6-19 -2,20 -0-77 1.90 1.36 0-67 0-80 1-90 2.12
Although the existence of more than two loci for ADPKD cannot
Australia between 1983 and 1988. This unit used DSM-IIP during that time. 63 veterans had been given a total of 142 axis I (syndromal) and axis II (personality problems) principal diagnoses. The diagnoses were substance abuse or dependence (mainly
alcohol) 34, paranoia 1, schizophrenia or schizophreniform disorders 2, major depression or dysthymia 30, post-traumatic stress disorder 21, generalised anxiety disorders 17, panic disorders 9, personality disorder 19, agoraphobia (with or without panic) 9,13 (21 %) of these 63 veterans had successfully claimed hearing disability, and both post-traumatic stress disorder (8) and agoraphobia (5) were significantly over-represented amongst those successfully claiming hearing disability. Claims records have definite limitations
out at this moment, the present observation should encourage the analysis of other unlinked ADPKD families for linkage to D2S44 and neighbouring loci.
trauma.
Institute of Forensic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
Department of Psychiatry, Repatriation General Hospital,
be ruled
SØREN NØRBY
Section of Clinical Genetics, Department of Paediatrics,
1.
ST, Breuning MH, Davies KE, et al. A highly polymorphic DNA marker linked to adult polycystic kidney disease on chromosome 16. Nature 1985; 317: 542-44. 2. Romeo G, Devoto M, Costa G, et al. A second locus for autosomal dominant polycystic kidney disease. Lancet 1988; ii: 8-11. 3. Kimberling WJ, Fain PR, Kenyon JB, et al. Linkage heterogeneity of autosomal dominant polycystic kidney disease. N Engl J Med 1988; 319: 913-18. 4. Nørby S, Sørensen AWS, Boesen P. Non-allelic genetic heterogeneity of autosomal dominant polycystic kidney disease? In: Bartsocas C, ed. Genetics of kidney disorders: Proceedings of Fifth International Clinical Genetics Seminar, vol I. New York: Alan R. Liss, 1989: 83-88. 5. Wong Z, Wilson V, Patel I, Povey S, Jeffreys AJ. Characterization ofa panel of highly variable minisatellites cloned from human DNA. Ann Human Genet 1987; 51: 269-88. 6. Nkamura Y, Leppert M, O’Connell P, et al. Variable number of tandem repeat (VNTR) markers for human gene mapping. Science 1987; 235: 1616-22. 7. Anon. Human gene mapping 10, table 4: polymorphic human DNA segments. Cytogenet Cell Genet 1989; 51: 664. 1. Reeders
Acquired hearing impairment and psychiatric disorder amongst Australian Vietnam veterans SIR,—The machinery of modern warfare is a potent source of acoustic trauma to the hair cells of the cochlea, the damage being greatest around 4 kHz.l 20-30% of serving military personneP and up to 42% of American veterans in the Vietnam conflict3 have been found to have hearing loss (usually of high-frequency sounds) as a result of such trauma. High-tone hearing impairment affects the capacity to identify the content of speech in the presence of competing noise. Despite the prevalence of hearing loss among former military personnel and the potential for interference with social communication the psychiatric consequences do not seem to have been studied previously.’ 20 807 of the 49 211 Australians known to have fought in Vietnam have sought to have disability identified as war-related by the Department of Veterans’ Affairs. Such claims can be accepted, rejected outright, or rejected as no incapacity found or evidenced at the time of assessment. We have scrutinised a random 1-in-20 sample of claimants, looking at psychiatric and at disability claims. 248 of 1042 veterans whose claims were studied had successfully claimed for hearing disability as a result of war service and 228 for psychiatric disability. 65 had claimed successfully on both grounds,
and, with
no
incapacity found
Daw Park, South Australia 5041
MARIANNE SCHWARTZ
Rigshospitalet, Copenhagen
or
evidenced claims taken into
account, significantly more veterans with a successful psychiatric claim than without a successful claim for psychiatric morbidity had also been successful in claiming hearing impairment (65/228 vs 183/814; p < 0-05 chi-squared). We also looked at the discharge diagnoses of all veterans discharged from a Veterans’ Affairs psychiatric unit in South
as
sources
for
epidemiological study. Nevertheless, the associations identified could, if confirmed by further research, have important implications for the health needs of those exposed to acoustic DAVID I. BEN-TOVIM NICHOLAS L. S. POTTS RENUS J. DORTMANS ALAN M. WEISS ROBYN POTTER
Kringlebotn M, Gundersen T, Krokstad A, et al. Noise-induced hearing loss: can they be explained by basilar membrane movement? Acta Otolaryngol 1979; suppl 360:
98-101. 2. Bender DR, Mueller HG. Military noise induced hearing loss: incidence and mangement. Mil Med 1984; 149: 154-58. 3. Center for Disease Control. Center for Disease Control Vietnam Experience Study: health status of Vietnam veterans II, physical health. JAMA 1988; 259: 2709-14. 4. Jones EM, White AS. Mental health and acquired hearing impairment: a review. Br J Audiol 1990; 24: 3-9. 5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington: American Psychiatric Association, 1980.
Xenon for anaesthesia SIR,-Commenting on the paper by Professor Lachmann and colleagues (June 16, p 1413) Dr Nunn and Dr Halsey (July 14, p 112) state that anaesthetists want much more solid evidence of xenon’s efficacy and safety. Xenon, being an inert gas, is incapable of oxidising reactions, unlike the "gold standard" agent nitrous oxide. The danger with all anaesthetic gases is that when they are supplied without oxygen they cause anoxic asphyxia. The reversal of the gradient for oxygen transport across the alveolar membrane even removes the oxygen present in blood returning to the lung. This causes a very rapid fall in systemic arterial oxygen tension and fatal. Nunn and Halsey state that a long series of controlled studies would be required for xenon to be accepted. It would appear that the physical properties of the gas determine its efficacy. For example, the anaesthetic action of another inert gas, argon, has been demonstrated at high partial pressures under hyperbaric conditions. Since Lachmann et al have demonstrated that a xenon and oxygen mixture can induce a state of anaesthesia and is superior to nitrous oxide, where are the grounds for demanding further controlled studies? is
soon
Department of Community Medicine, Wolfson Institute of Occupational Health, University of Dundee, Ninewells, Dundee, UK
P. B. JAMES
CORRECTIONS of value of propranolol in prevention of variceal In this article by Dr P. C. Hayes and colleagues (July 21, p 153) refs 10 and 21 should be transposed, and the index trial referred to in paragraph 5 of the Results section was number 33 in the reference list.
Meta-analysis haemorrhage.
Innervation of annulus fibrosis in low back pain. We apologise to DrM. H. Coppes and his colleagues for our printer’s omission of a line from their letter (July 21, p 189). The third paragraph should have begun "AChE-positive as well as NF-immunoreactive nerve fibres in the range ofA8 and C tenninals were abundant...".