- Email: [email protected]
DECOMPRESSION TREATMENT IN PREGNANCY
833 that death-rates among older women are mostly or entirely due to their higher proportion of advanced tumours. The decreasing age-specific death-rates among older women in the period 1950-65 might therefore be due to earlier medical attention in later years. We think that for such and other reasons comparisons of mortality between cohorts are insufficient as a basis for such conclusions as that mass cytological screening is important. A careful registry of all new cases of cervical cancer preceding, during, and after such screening surveys is an essential tool to evaluate such nroerammes.
Netherlands Organisation Against Cancer, 33 de Lairessestraat, Amsterdam.
L. MEINSMA J. J. VERSLUYS.
DECOMPRESSION TREATMENT IN PREGNANCY several points about the paper by Mr. SIR,-There Blecher and Professor Heyns (Sept. 23, p. 621) that are open In the American Journal of Obstetrics and to criticism. Gynecology Cotter et aLl describe observations on pregnancy at altitude which clearly show that there is an acute reduction in oxygen tension in the transplacental circulation. Johannesburg is over 6000 ft.; it may well be that the decompression methods used merely prove favourable at high altitudes, since they could very likely correct these effects. JOHN SOPHIAN Worthing, Sussex. are
control group of 34 diabetics without R.A. matched, as as possible, for sex, age, duration of diabetes, adequacy of diabetic control, and type of treatment. Diabetic retinopathy was graded i to ill according to the Quir6z classification 6 and arterial hypertension by mean diastolic levels in mm. Hg and
a
nearly
(91-100, grade i, 101-120, grade II; > 120, grade in). The accompanying figure shows our findings. Although diabetic patients with R.A. had diabetic retinopathy somewhat less often than control diabetics without R.A., and grade-m retinopathy was found only in this latter group, the difference is not statistically significant (P > 0.05). The high incidence of diabetic retinopathy in both groups of patients studied reflects that in our hospital’s overall diabetic population. We did not find that the frequency of hypertension in our diabetic patients with R.A. was less than in those without R.A. Indeed, those without R.A. had somewhat less hypertension than those with it. There did not seem to be any relation between the presence or absence of diabetic retinopathy in our rheumatoid group and the type of treatment they had received for arthritis. This controlled study has not confirmed the findings of Powell and Field of a statistically significant lesser degree of diabetic retinopathy in patients with rheumatoid arthritis. Departments of Medicine and Immunology, Institute Nacional de la Nutrición, 261 Dr. Jiménez, DAVID KERSHENOVICH DONATO ALARCÓN-SEGOVIA. Mexico 7, D.F.
EVAPORATION OF ALCOHOL FROM URINE? DIABETIC RETINOPATHY AND RHEUMATOID ARTHRITIS 2 have presented findings suggesting and Field SIR,-Powell that diabetic patients with rheumatoid arthritis (R.A.) have less diabetic retinopathy than would be expected from other studies of diabetic populations. Patients with R.A. have also been found to have less hypertension than the general population,3 and even to have a tendency to hypotension,4 despite the fact that R.A. is a disease with vascular involvement of its own. The possibility that R.A. and/or its treatment give some kind of protection against sclerotic vascular disease seems important, and we therefore decided to try to confirm the findings of Powell and Field. For this purpose, we studied a group of 34 diabetic patients with R.A. (classical and definite by the criteria of the American Rheumatism Association 5) 1. Cotter, 2. 3. 4. 5.
J. R., Blechner, J. N., Prystowsky, H. Am. J. Obstet. Gynec. 1967, 99, 1. Powell, E. D., Field, R. A. Lancet, 1964, ii, 17. Zondek, S. G. Acta med. scand. 1955, 152, 231. Turner, L. W., Lansbury, J. Am. J. Med. 1954, 227, 503. Ropes, M. W., Bennett, G. A., Cobb, S., Jacox, R., Jessar, R. A. Bull. rheum. Dis. 1958, 9, 175.
SiR.-The Road Safety Act, 1967, will lead to many prosecutions based on blood-alcohol levels. Under this Act, the accused is required to provide a blood or urine sample for analysis. The police have been instructed to discard the first urine sample, since it is now established that the alcohol concentration of this sample is in no way related to the bloodalcohol concentration at the time of passing the sample. The second sample, passed about half an hour after the bladder has been emptied by the first sample, is accepted as having a direct relation to the average blood-concentration during the half-hour interval between the two samples. It is this sample that is to be used for analysis under the Act. Few people are able to provide a second sample of substantial volume, and it follows that the sample available for analysis will be small. The sample is further divided into two parts, one for the prosecution, and one for the defence, and each sample is accommodated in a 6 fl. oz. (170 ml.) container. Many specimens will consist of a fluid ounce (28 ml.) of urine or less. An analyst in a provincial forensic laboratory has already suggested that a low figure in the second sample was due to evaporation of alcohol from the urine into the large air-space in the container, with subsequent escape into the atmosphere when the container was opened. A careful search has failed to reveal any published work on the evaporation of alcohol from urine samples, and there seems to be nothing to support such an opinion. Original work in Germany has shown that blood, in a container where the air/blood ratio is 10/1, loses a thousandth part of its alcohol content by evaporation, and that this degree of loss is of no significance. By an application of law it can be proved that the loss from urine is also minute, but few doctors can recall physics and mathematics with enough ease to argue this proof in court. This unit has undertaken an investigation into this aspect of urine analysis, and these
Boyle’s
Duration of diabetes in relation to diabetic retinopathy and hypertension in patients with diabetes and with diabetes and R.A.
6.
Quiróz, J. A. Revta Invest. Clin. Hosp. Enferm. Nutr., Méx. 1952, 4, 375.
Netherlands Organisation Against Cancer, 33 de Lairessestraat, Amsterdam.
L. MEINSMA J. J. VERSLUYS.
DECOMPRESSION TREATMENT IN PREGNANCY several points about the paper by Mr. SIR,-There Blecher and Professor Heyns (Sept. 23, p. 621) that are open In the American Journal of Obstetrics and to criticism. Gynecology Cotter et aLl describe observations on pregnancy at altitude which clearly show that there is an acute reduction in oxygen tension in the transplacental circulation. Johannesburg is over 6000 ft.; it may well be that the decompression methods used merely prove favourable at high altitudes, since they could very likely correct these effects. JOHN SOPHIAN Worthing, Sussex. are
control group of 34 diabetics without R.A. matched, as as possible, for sex, age, duration of diabetes, adequacy of diabetic control, and type of treatment. Diabetic retinopathy was graded i to ill according to the Quir6z classification 6 and arterial hypertension by mean diastolic levels in mm. Hg and
a
nearly
(91-100, grade i, 101-120, grade II; > 120, grade in). The accompanying figure shows our findings. Although diabetic patients with R.A. had diabetic retinopathy somewhat less often than control diabetics without R.A., and grade-m retinopathy was found only in this latter group, the difference is not statistically significant (P > 0.05). The high incidence of diabetic retinopathy in both groups of patients studied reflects that in our hospital’s overall diabetic population. We did not find that the frequency of hypertension in our diabetic patients with R.A. was less than in those without R.A. Indeed, those without R.A. had somewhat less hypertension than those with it. There did not seem to be any relation between the presence or absence of diabetic retinopathy in our rheumatoid group and the type of treatment they had received for arthritis. This controlled study has not confirmed the findings of Powell and Field of a statistically significant lesser degree of diabetic retinopathy in patients with rheumatoid arthritis. Departments of Medicine and Immunology, Institute Nacional de la Nutrición, 261 Dr. Jiménez, DAVID KERSHENOVICH DONATO ALARCÓN-SEGOVIA. Mexico 7, D.F.
EVAPORATION OF ALCOHOL FROM URINE? DIABETIC RETINOPATHY AND RHEUMATOID ARTHRITIS 2 have presented findings suggesting and Field SIR,-Powell that diabetic patients with rheumatoid arthritis (R.A.) have less diabetic retinopathy than would be expected from other studies of diabetic populations. Patients with R.A. have also been found to have less hypertension than the general population,3 and even to have a tendency to hypotension,4 despite the fact that R.A. is a disease with vascular involvement of its own. The possibility that R.A. and/or its treatment give some kind of protection against sclerotic vascular disease seems important, and we therefore decided to try to confirm the findings of Powell and Field. For this purpose, we studied a group of 34 diabetic patients with R.A. (classical and definite by the criteria of the American Rheumatism Association 5) 1. Cotter, 2. 3. 4. 5.
J. R., Blechner, J. N., Prystowsky, H. Am. J. Obstet. Gynec. 1967, 99, 1. Powell, E. D., Field, R. A. Lancet, 1964, ii, 17. Zondek, S. G. Acta med. scand. 1955, 152, 231. Turner, L. W., Lansbury, J. Am. J. Med. 1954, 227, 503. Ropes, M. W., Bennett, G. A., Cobb, S., Jacox, R., Jessar, R. A. Bull. rheum. Dis. 1958, 9, 175.
SiR.-The Road Safety Act, 1967, will lead to many prosecutions based on blood-alcohol levels. Under this Act, the accused is required to provide a blood or urine sample for analysis. The police have been instructed to discard the first urine sample, since it is now established that the alcohol concentration of this sample is in no way related to the bloodalcohol concentration at the time of passing the sample. The second sample, passed about half an hour after the bladder has been emptied by the first sample, is accepted as having a direct relation to the average blood-concentration during the half-hour interval between the two samples. It is this sample that is to be used for analysis under the Act. Few people are able to provide a second sample of substantial volume, and it follows that the sample available for analysis will be small. The sample is further divided into two parts, one for the prosecution, and one for the defence, and each sample is accommodated in a 6 fl. oz. (170 ml.) container. Many specimens will consist of a fluid ounce (28 ml.) of urine or less. An analyst in a provincial forensic laboratory has already suggested that a low figure in the second sample was due to evaporation of alcohol from the urine into the large air-space in the container, with subsequent escape into the atmosphere when the container was opened. A careful search has failed to reveal any published work on the evaporation of alcohol from urine samples, and there seems to be nothing to support such an opinion. Original work in Germany has shown that blood, in a container where the air/blood ratio is 10/1, loses a thousandth part of its alcohol content by evaporation, and that this degree of loss is of no significance. By an application of law it can be proved that the loss from urine is also minute, but few doctors can recall physics and mathematics with enough ease to argue this proof in court. This unit has undertaken an investigation into this aspect of urine analysis, and these
Boyle’s
Duration of diabetes in relation to diabetic retinopathy and hypertension in patients with diabetes and with diabetes and R.A.
6.
Quiróz, J. A. Revta Invest. Clin. Hosp. Enferm. Nutr., Méx. 1952, 4, 375.