The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.     

Colorectal cancer, screening and survival: the influence of socio-economic deprivation

OBJECTIVES: To determine the extent to which socio-economic deprivation explains colorectal cancer prevalence, subject participation in screening, and postoperative survival and life expectancy. METHODS: Regression analyses of clinical data from a large randomized controlled trial, augmented by geographical-based indices of deprivation. RESULTS: Deprivation appears to exert no significant impact on colorectal cancer prevalence but is a major factor explaining subject participation in screening. Cancer detection at later stages reduces life expectancy at time of treatment. Females from more-deprived areas have poorer post-treatment life expectancies and survival prospects, independently of their screening behaviour. CONCLUSIONS: Screening increases the chances of having a cancer treated at an earlier stage, and treatment at an earlier stage is associated with longer subsequent life expectancy. However, those from more-deprived areas are less likely to accept an invitation to be screened.     

Mass population screening for colorectal cancer: factors influencing subjects' choice of screening test

OBJECTIVES: To identify socio-demographic, economic, medical and attitudinal factors that explain subjects' choice of test for screening for colorectal cancer (biennial faecal occult blood test versus once-only flexible sigmoidoscopy). METHODS: Data obtained from a questionnaire, administered by general practitioners and returned by approximately 2700 asymptomatic subjects. Thereafter, logistic regression modelling to explain willingness to participate in screening, whether or not a test preference is expressed, and the nature of the preference. RESULTS: An interest in undertaking screening is more probable if the subject is white, older, married and possesses a high health motivation. An intention to participate is more probable if the subjects are particularly worried about the disease, feel themselves to be particularly susceptible to it, and have already had experience of screening for colorectal and (if female) other cancers. Persons in receipt of a household income below 10,000 Pounds are less likely to express an interest in screening. Women are more likely to express a test preference and this preference is more likely to be for the faecal occult blood test. Subjects' worries and perception of risk are associated with reported experiences of cancer, stomach problems and depression. A positive attitude towards screening is positively associated with frequency of dental visits. CONCLUSIONS: Socio-demographic, economic and other factors evidently influence subjects' preferences for particular screening tests and, by implication, the likelihood of compliance with any future screening offer. The models support the view that participation in colorectal cancer screening has as much to do with a positive attitude towards health and health promotion generally as with any specific concern about the disease.     

Right hemisphere contributions to the comprehension of low-imagery words

A priming experiment, with normal university students as subjects, was used to investigate whether the right cerebral hemisphere contributes to the comprehension of low-imagery words. Each hemisphere's access to semantic representations of low-imagery words was gauged by comparing responses to low-imagery targets preceded by associated low-imagery primes (e.g., BELIEF-IDEAL) with responses to the same targets when they were preceded by unrelated primes (e.g., FATE-IDEAL). All primes and targets were independently projected to the left or right visual fields (LVF or RVF), and temporally separated by a stimulus onset asynchrony of 250 ms. There was a clear RVF advantage in response speed and accuracy measures, confirming the left hemisphere's advantage in processing low-imagery words. Nonetheless, the priming effects provided evidence that the right hemisphere contributes to the comprehension of low-imagery words, as primes projected to the RVF equally facilitated responses to associated targets subsequently appearing in either visual field. In contrast, primes directed to the LVF did not facilitate responses to associated targets projected to the LVF or RVF. The results suggest that low-imagery words projected to the left hemisphere activated low-imagery associates in both hemispheres to an equivalent degree, whereas low-imagery primes directed to the right hemisphere failed to activate low-imagery associates in either hemisphere. Like Kounios and Holcomb's (1994) study of event-related response potentials evoked by abstract and concrete words, the findings indicate that while the left hemisphere is the primary processor of low-imagery/abstract words, the right hemisphere plays a subsidiary role in the comprehension of these words.     

Influence of caloric restriction on the development of atherosclerosis in nonhuman primates: progress to date

Caloric restriction (CR) has been observed to retard aging processes and extend the maximum life span in rodents. In an effort to evaluate the effect of this nutritional intervention on physiologic variables in higher species, several nonhuman primate trials are ongoing. In particular, a study evaluating the independent effect of CR on the extent of atherosclerosis was initiated in 1993 in 32 adult cynomolgus monkeys. Therefore, the trial was designed to achieve identical cholesterol intake after animals were randomized to a control group or a calorie-restricted group (30% reduction from baseline caloric intake). The animals were routinely evaluated for glycated proteins, plasma insulin and glucose levels, insulin sensitivity, and specific measures for abdominal fat distribution by CT scans over a 4-year interval. The results from 4 years of intervention demonstrate that CR improves cardiovascular risk factors (such as visceral fat accumulation) and improves insulin sensitivity. In contrast to other primate studies with normolipidemic animals, CR had no independent effects on plasma lipid levels and composition in the presence of equivalent amounts of dietary cholesterol intake. Preliminary analysis of atherosclerotic lesion extent in the abdominal aorta has failed to demonstrate differences between control animals and CR animals. Follow- up studies are being conducted to determine the effect of CR on atherosclerosis extent in coronary and carotid arteries.      

Inherited disorders of 3-methylcrotonyl CoA carboxylation

The clinical course of 4 patients who had reduced activities of 3-methylcrotonyl CoA carboxylase (also called 3-methylcrotonylglycinuria) is described. Two children presented with a metabolic acidosis, one in the neonatal period and the other with episodes of acidosis that started in the second year of life. In the other 2 children neurological symptoms were prominent, one having infantile spasms and the other developmental regression with a skin rash and alopecia. Three of the children responded well to oral biotin and dietary protein restriction but the fourth, despite a biochemical response to biotin, has a severe neurological handicap. The clinical presentation of inborn errors of 3-methylcrotonyl CoA carboxylase is variable. Metabolic acidosis may not be conspicuous and instead neurological features may predominate.     

Suspected poisoning in children. Study of the incidence of true poisoning and poisoning scare in a defined population in North East Bristol

The distinction between true and suspected poisoning in children has not been made clear in previous work on childhood poisoning. A study of suspected poisoning in children under 15 years of age in a defined population of North East Bristol from November 1970 to July 1973 carried out by the Health Education Council Medical Research Division included 53,000 child-years at risk. The number of suspected poisonings was 3-4/1000 population aged under 15 years per year, with a higher incidence in younger age groups. Detailed investigation of the circumstances of the accidents carried out by a multidisciplinary team showed that at least 65%, and possibly as many as 78% were poisoning scares and not true poisoning. The evidence used by the casualty doctor and by the parents to diagnose poisoning was explored, and in many cases was circumstantial. Children with fathers in nonmanual occupations were over-represented. This may reflect differences in patterns of utilization behaviour rather than true differences in incidence.