The Work of a Lipid Clinic: an Audit of Performance

An audit of the work of a lipid clinic revealed the need topromote awareness of the problem of hypercholesterolaemla, particularlyamong the ethnic minority groups. Significant reductions inserum lipid levels and blood pressure were achieved, thoughtarget levels were reached in only 40 per cent of patients.Efforts to encourage weight reduction among the obese and todiscourage smoking had limited success. The establishment ofa lipid clinic ensures ready access to paramedical advice andpermits effective treatment of hyperlipidaemia and other coronaryrisk factors. Such a service costs approximately £500per patient per year.     

Pulsatile masses surrounding vascular prostheses: real-time US color flow imaging

A prospective evaluation of color flow mapping and real-time ultrasound was performed to determine if pseudoaneurysms could be distinguished from other causes of masses surrounding vascular grafts of the lower extremities. Twelve palpable pulsatile masses were imaged. Diagnoses were confirmed at angiography (n = 11), computed tomography (n = 7), aspiration biopsy (n = 5), and operative intervention (n = 6). A swirling pattern of blood flow was seen in six of seven cases of pseudoaneurysm. Lack of flow signals was noted in four of the five collections representing hematoma (n = 2) or infection (n = 2). The seventh case was later shown to be an infected, thrombosed pseudoaneurysm. The single false-positive diagnosis was made early in the series when the flow signals detected were due to transmitted arterial pulsations. The authors conclude that color Doppler flow imaging is useful in the differential diagnosis of pulsatile masses associated with prosthetic grafts. Prosthetic graft pseudoaneurysms have a specific appearance of swirling blood flow arising from a wide neck and are distinguishable from traumatic or iatrogenic pseudoaneurysms of the native vascular tree.     

Psoriasis and diabetes: a population-based cross-sectional study

Background Previous reports have shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between psoriasis and diabetes. Objectives To study the association between psoriasis and diabetes. Methods A cross‐sectional study was performed utilizing the database of Clalit Health Services (CHS). Patients who were diagnosed with psoriasis were compared with CHS enrolees without psoriasis regarding the prevalence of diabetes. Patients with diabetes were identified using the CHS chronic diseases registry. Chi‐squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. Results The study included 16 851 patients with psoriasis and 74 987 subjects without psoriasis (control patients). The proportion of diabetes was significantly higher in patients above 35 years (P < 0.05). The age‐adjusted proportion of diabetes was significantly higher in psoriasis patients as compared to the control group [odds ratio (OR), 1.38, P < 0.05] and was similar in men and women (OR, 1.32, 1.45, respectively). A multivariate logistic regression model showed that psoriasis was significantly associated with diabetes, independently of age and gender (OR, 1.58, P < 0.001). Conclusions Our study supports previous reports of an association between psoriasis and diabetes. Dermatologists taking care of patients with psoriasis should be aware of this association and advise the patients to reduce additional risk factors such as smoking, hypertension or dyslipidemia.     

THE CIRCADIAN VARIATION OF THYROTROPHIN IN PATIENTS WITH PRIMARY THYROIDAL DISEASE

We have used a highly sensitive immunochemiluminometric assay (ICMA) for human TSH to study the effect of thyroid status on the circadian variation in TSH levels. Three subjects with Graves' disease, three with toxic multinodular goitre and three with euthyroid multinodular goitre were sampled every hour for 24 h. The results obtained were compared to those from five euthyroid control subjects. It was found that some patients with hyperthyroidism and suppressed basal TSH levels exhibited a 24 h secretory pattern similar to that seen in normal subjects with peak TSH levels occurring at night. In addition two subjects with a euthyroid multinodular goitre demonstrated levels of TSH below the normal range despite being clinically and biochemically euthyroid. TSH suppression in these subjects is probably related to some degree of thyroid autonomy and possible development of hyperthyroidism in the future.     

Do increasing levels of income deprivation have an effect on the prescribing of OTC medication?

□ People who are on a low income frequently visit their general practitioner to obtain medication that is also available over the counter, because it will be dispensed at no cost to them □ This activity reduces the amount of time available for the GP to treat more serious illnesses □ This leads to inequity when compared with the service provided in more affluent areas □ Pharmacists should be more involved in the provision of free health care to these patients