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Keep legs up
Annotations REFERENCES
childbearing age.sIt is possible that hormonal differences account for the increased prevalence of the disease in women, and that oral contraceptives potentiate the risk. Benign breast tumors are negatively associated with oral contraceptive use (Table Il. Similar findings are reported by Vessey and associates.gThere was no association, either positive or negative, of oral contraceptive use with newly diagnosed breast cancer, although the number of cases in our study (231 was too small to allow statistical comparison. The data suggest that oral contraceptives are “protective” against the development of benign breast tumors. Since patients with benign tumors appear to be at risk to develop subsequent malignant breast disease,” the protective effect of oral contraceptives might also extend to breast cancer. The associations reported in this study are not likely to be due to chance. The findings are not explained by differences in age, race, hospital, marital status, parity, or cigarette smoking. We doubt that the results are significantly influenced by bias on the part of nurse monitors or admitting physicians. The study documents associations-positive and negative- between oral contraceptive use and three important disease states, Furthermore, it demonstrates the value of the case-control method in epidemiologic research. David J. Greenblatt, M.D. Boston Collaborative Drug Surveillance Program 400 Totten Pond Road Waltham, Mass. 02154
1. Boston Collaborative Drug Surveillance Program: Oral contraceptives and venous thromboembolic disease, surgically confirmed gallbladder disease, and breast tumors, Lancet 1:1399, 1973. 2. Mantel, N., and Haenszel, W.: Statistical aspects of the analysis of data from retrospective studies of disease, J. Natl. Cancer Inst. 22:719, 1959. 3. Vessey, M. P., and Doll, R.: Investigation of relation between use of oral contraceptives and thromboembolic disease, Br. Med. J. 2:199, 1968. 4. Vessey, M. P., and Doll, R.: Investigation of relation between use of oral contraceptives and thromboembolic disease: a further report, Br. Med. J. 2:651, 1969. 5. Sartwell, P. E., Masi, A. T., Arthes, F. G., et al.: Thromboembolism and oral contraceptives: an epidemiologic case-control study, Am. J. Epidemiol. 90~366, 1969. 6. Fuertes-de la Haba, A., Curet, J. O., Pelegrina, I., et al.: Thrombophlebitis among oral and nonoral contraceptive users, Obstet. Gynecol. 38:269, 1971. 7. Dugdale, M., and Masi, A. T.: Hormonal contraception and thromboembolic disease: effects of the oral contraceptives on hemostatic mechanisms, J. Chronic Dis. 23:775,1971. 8. Kaye, M. D., and Kern, F.: Clinical relationships of gallstones, Lancet 1:1228, 1971. 9. Vessey, M. P., Doll, R., and Sutton, P. M.: Oral contraceptives and breast neoplasia: a retrospective study, Br. Med. J. 3:719, 1972. 10. Potter, J. F., Slimbaugh, W. P., and Woodward, S. C.: Can breast carcinoma be anticipated? A follow-up of benign breast biopsies, Ann. Surg. 167:829, 1968.
Keep legs up
It is well known that arteriosclerotic obliterative arteritis with gangrene occurs frequently in the feet and legs, but is rare in the arms and hands, The feet and legs of many people with this disease must be amputated, but extremely rarely, if ever, is amputation necessary for this disease in the arms and hands. It is also known that arteriosclerosis is a disease of high pressure vessels and not of low pressure vessels even though the same blood with all its chemical ingredients flows through all vessels.’ Intralurninal pressure is, therefore, an important factor that predisposes to arteriosclerosis. The higher the arterial blood pressure the more severe the associated arteriosclerosis tends to be. Furthermore, it is known that the pressure in the vessels of the feet and legs becomes considerably higher upon standing due to the force of gravity’ and is lower with the feet and legs at heart level. Placing the feet at heart level can be done as a preventive measure by lying down frequently during the day, using footrests, reclining chairs, rockers and couches, lying on the floor, and even putting feet on the desk in the office. This practice is certainly beneficial for normal people who wish to prevent or delay arteriosclerosis of the legs and for patients with impairment of arterial blood flow. Keeping the feet up, at heart level, also assists venous return2 and further reduces arterial blood pressure. Standing still frequently and for long
678
periods of time impairs venous return and in turn increases the pressure head which the arterial flow must overcome. Walking and contracting the leg muscles pumps blood back to the heart2 and assists arterial flow by reducing vis a tergo. Arteries of the legs are prone to obliterative arteriosclerotic endarteritis, and anything that reduces arterial blood pressure cannot be injurious but certainly could be beneficial. The peculiarities of the vessels and circulation to the legs and feet have been described previously in detail.2 With quiet standing and with the full effects of gravity, capillary pressure in the toes and feet must exceed the pressure in the ascending aorta. Keeping the legs and feet up could reduce the degree of arteriosclerosis in the lower extremities. Keep the legs and feet at heart level. lldane
G. E. Burch, M.D. University School of Medicine and Charity Hospital New Orleans, La.
REFERENCES
1. Burch, G. E., and Phillips, J. H.: Hypertension and arteriosclerosis, AM. HEART J. 60:163,1960. 2. Burch, G. E.: A primer of venous pressure, 2nd printing, Springfield, Ill. 1972, Charles C Thomas, Publisher.
May, 1975, Vol. 89, No. 5
childbearing age.sIt is possible that hormonal differences account for the increased prevalence of the disease in women, and that oral contraceptives potentiate the risk. Benign breast tumors are negatively associated with oral contraceptive use (Table Il. Similar findings are reported by Vessey and associates.gThere was no association, either positive or negative, of oral contraceptive use with newly diagnosed breast cancer, although the number of cases in our study (231 was too small to allow statistical comparison. The data suggest that oral contraceptives are “protective” against the development of benign breast tumors. Since patients with benign tumors appear to be at risk to develop subsequent malignant breast disease,” the protective effect of oral contraceptives might also extend to breast cancer. The associations reported in this study are not likely to be due to chance. The findings are not explained by differences in age, race, hospital, marital status, parity, or cigarette smoking. We doubt that the results are significantly influenced by bias on the part of nurse monitors or admitting physicians. The study documents associations-positive and negative- between oral contraceptive use and three important disease states, Furthermore, it demonstrates the value of the case-control method in epidemiologic research. David J. Greenblatt, M.D. Boston Collaborative Drug Surveillance Program 400 Totten Pond Road Waltham, Mass. 02154
1. Boston Collaborative Drug Surveillance Program: Oral contraceptives and venous thromboembolic disease, surgically confirmed gallbladder disease, and breast tumors, Lancet 1:1399, 1973. 2. Mantel, N., and Haenszel, W.: Statistical aspects of the analysis of data from retrospective studies of disease, J. Natl. Cancer Inst. 22:719, 1959. 3. Vessey, M. P., and Doll, R.: Investigation of relation between use of oral contraceptives and thromboembolic disease, Br. Med. J. 2:199, 1968. 4. Vessey, M. P., and Doll, R.: Investigation of relation between use of oral contraceptives and thromboembolic disease: a further report, Br. Med. J. 2:651, 1969. 5. Sartwell, P. E., Masi, A. T., Arthes, F. G., et al.: Thromboembolism and oral contraceptives: an epidemiologic case-control study, Am. J. Epidemiol. 90~366, 1969. 6. Fuertes-de la Haba, A., Curet, J. O., Pelegrina, I., et al.: Thrombophlebitis among oral and nonoral contraceptive users, Obstet. Gynecol. 38:269, 1971. 7. Dugdale, M., and Masi, A. T.: Hormonal contraception and thromboembolic disease: effects of the oral contraceptives on hemostatic mechanisms, J. Chronic Dis. 23:775,1971. 8. Kaye, M. D., and Kern, F.: Clinical relationships of gallstones, Lancet 1:1228, 1971. 9. Vessey, M. P., Doll, R., and Sutton, P. M.: Oral contraceptives and breast neoplasia: a retrospective study, Br. Med. J. 3:719, 1972. 10. Potter, J. F., Slimbaugh, W. P., and Woodward, S. C.: Can breast carcinoma be anticipated? A follow-up of benign breast biopsies, Ann. Surg. 167:829, 1968.
Keep legs up
It is well known that arteriosclerotic obliterative arteritis with gangrene occurs frequently in the feet and legs, but is rare in the arms and hands, The feet and legs of many people with this disease must be amputated, but extremely rarely, if ever, is amputation necessary for this disease in the arms and hands. It is also known that arteriosclerosis is a disease of high pressure vessels and not of low pressure vessels even though the same blood with all its chemical ingredients flows through all vessels.’ Intralurninal pressure is, therefore, an important factor that predisposes to arteriosclerosis. The higher the arterial blood pressure the more severe the associated arteriosclerosis tends to be. Furthermore, it is known that the pressure in the vessels of the feet and legs becomes considerably higher upon standing due to the force of gravity’ and is lower with the feet and legs at heart level. Placing the feet at heart level can be done as a preventive measure by lying down frequently during the day, using footrests, reclining chairs, rockers and couches, lying on the floor, and even putting feet on the desk in the office. This practice is certainly beneficial for normal people who wish to prevent or delay arteriosclerosis of the legs and for patients with impairment of arterial blood flow. Keeping the feet up, at heart level, also assists venous return2 and further reduces arterial blood pressure. Standing still frequently and for long
678
periods of time impairs venous return and in turn increases the pressure head which the arterial flow must overcome. Walking and contracting the leg muscles pumps blood back to the heart2 and assists arterial flow by reducing vis a tergo. Arteries of the legs are prone to obliterative arteriosclerotic endarteritis, and anything that reduces arterial blood pressure cannot be injurious but certainly could be beneficial. The peculiarities of the vessels and circulation to the legs and feet have been described previously in detail.2 With quiet standing and with the full effects of gravity, capillary pressure in the toes and feet must exceed the pressure in the ascending aorta. Keeping the legs and feet up could reduce the degree of arteriosclerosis in the lower extremities. Keep the legs and feet at heart level. lldane
G. E. Burch, M.D. University School of Medicine and Charity Hospital New Orleans, La.
REFERENCES
1. Burch, G. E., and Phillips, J. H.: Hypertension and arteriosclerosis, AM. HEART J. 60:163,1960. 2. Burch, G. E.: A primer of venous pressure, 2nd printing, Springfield, Ill. 1972, Charles C Thomas, Publisher.
May, 1975, Vol. 89, No. 5