Is cancer related to hypertension or to its treatment?

Three questions related to cancer and blood pressure are discussed. (i) Is cancer related in some way to hypertension, or to blood pressure? Several studies show a relation of blood pressure and cancer in populations. However, our own experience, based on a cohort of 15,411 subjects with BP measured in the 1970s and with 1,392 fatal cancers since, shows no relation of cancer risk and diastolic pressure. Nor were cancer numbers (n=72) observed in the 1,078 untreated hypertensives of the Glasgow Blood Pressure Clinic different from those expected (n=71.2) in a control population matched for age, sex and smoking habit. (ii) Do antihypertensive drugs promote cancer? Atenolol and calcium channel blockers have been suspected of this, but evidence of larger studies, including two of our own, is negative: relative risk for cancer in our patients taking CCB was 1.02 (CI 0.82-1.27). (iii) Do antihypertensive drugs protect against cancer? A study of ours based on the Glasgow Clinic raises this possibility: relative risk for incident cancer amongst 1,559 patients taking ACE inhibitor was 0.72 (CI 0.55-0.92).     

Transabdominal versus endovaginal pelvic sonography: prospective study

Transabdominal and endovaginal pelvic sonograms were obtained in 108 nonpregnant patients referred for pelvic sonography. The studies were independently obtained by two radiologists and interpreted on the basis of identical clinical information. The sonograms were then compared for anatomic detail and abnormalities. A determination was made about which examination, if either, was superior. Follow-up was performed through a review of the medical records and follow-up studies. Overall, the endovaginal study was judged superior in 65 cases (60.2%), equal in 39 (36.1%), and inferior in four (3.7%). The authors conclude that the endovaginal examination can effectively replace the transabdominal examination as the initial approach for routine pelvic sonography.     

The hip or not.

Pathologies within the ileopsoas compartment can present as hip pain and as such can be mistaken for diseases of the hip joint. Radiological investigations are useful in helping to differentiate between these pathologies.     

Building sickness, are symptoms related to the office lighting?

Office lighting has been suggested as one of the possible factors in producing 'building sickness'. Health questionnaires were completed by 106 out of 109 (97%) workers in six randomly sampled multi-occupied offices in each of two buildings, one air-conditioned and one naturally ventilated. There was a significantly higher prevalence of work-related headache and work-related lethargy in the air-conditioned building than in the naturally ventilated one. There was also less daylight in the air-conditioned building and lower mean luminance and illuminance of the work positions despite there being more lights on (p less than 0.01). The workers had a greater dislike of fluorescent lighting (p less than 0.01) and overall found the lighting to be less comfortable (p less than 0.01) and glare readings were higher. The workers perceived their control of lighting as poorer (p less than 0.001) and consequently there was less agreement about it (p less than 0.001). Those with work-related headache found the lighting less comfortable (p = 0.059) and perceived more glare (p less than 0.05). This study suggests the need to maximize the use of natural light from untinted windows, to reduce the impingement of fluorescent tubes on the line of sight and to return the control of levels of lighting to each individual worker.     

Intravenous digital subtraction renal angiography: use in screening for renovascular hypertension

Intravenous digital subtraction renal angiography (DSRA) has been compared with conventional angiography only in small, selected series of hypertensive patients. The authors prospectively examined with intravenous DSRA 94 patients at increased risk for renovascular hypertension and compared these studies with conventional angiography. A stenosis of at least one main renal artery was identified with intravenous DSRA in 22 patients and confirmed in 20 patients. No significant stenoses were seen with conventional angiography in any of the 64 patients in whom lesions were not seen with intravenous DSRA. Since inadequate DSRA studies were considered positive for renal artery stenosis, the sensitivity of intravenous DSRA was 100% (25 of 25); specificity, 93% (64 of 69); positive predictive value, 83% (25 of 30); and negative predictive value, 100% (64 of 64). The authors conclude that intravenous DSRA is a sensitive test for identifying stenosis of the main renal arteries and is appropriate to use as a screening test among patients at increased risk for renovascular hypertension.     

Induction of fertility in a man with hypogonadotropic hypogonadism with very low seminal volume

Pituitary function studies were performed on a 31-year-old man who had oligospermia and a very low seminal volume (0.1 ml). The low testosterone and gonadotropin levels, the remarkable testosterone response to human chorionic gonadotropin (hCG) stimulation, and the sluggish luteinizing hormone (LH) response to luteinizing hormone stimulating hormone (LH-RH) stimulation suggested the presence of hypogonadotropic hypogonadism. Treatment with a combination of human menopausal gonadotropin (hMG)-hCG resulted in the increase in the volume of seminal fluid and the sperm density. His wife achieved two pregnancies during the treatment. This report indicates that the findings of oligospermia and very low seminal volume should be followed by an investigation of the hypothalamo-pituitary testicular axis. Fertility in men with hypogonadotropic hypogonadism can be effectively induced with a combination of hMG-hCG treatment.