395
patients treated with penicillamine.13 The a depressing effect on the granulopoietic cells indicates that the effect on the lymphocyte-counts is not due to an overall cystostatic effect similar to that obtained with alkylating agents such as cyclophosphamide. The immunosuppressive action of penicillamine may be
to occur
in
R.A.
TABLE II-TYPE OF EVENTS AND MALE OLYMPIC FINALISTS AGED
35-64, MUNICH, 1972
lack of signs of
of R.A. as well as in chronic in which hepatitis penicillamine has a beneficial
of value in the
aggressive
treatment
effect. 14 Departments of Internal Medicine and Rheumatology, University Hospital, S-221 85 Lund, Sweden.
L. BRANDT B. SVENSSON.
*
Types of categories-for example, in yachting, there (Dragon, Finn, Dutch, Tempest, Soling, Star).
are
6 events
The 3 elderly sportsmen had taken part in events of skill rather than in strength (equestrian sport). In this context it appears unwise for football referees to continue beyond 45 years of age, and for sport enthusiasts to indulge in competitive tennis or to jog for 7 miles as reported by Professor Opie. But for the misleading statement on age, I agree with Professor Opie’s general conclusions (smoking,
45.
SUDDEN DEATH AND SPORT
SIR.,-In the article by Professor Opie (Feb. 1, p. 263) on sudden deaths in sportsmen, the statement " as a group, these subjects were characterised by (1) a mean age above thirty... " is confusing, when in fact the mean age is 40 years (derived from table 11: range 17-58; mean and median 40 years). Although of course 40 is above 30, the statement is misleading. It is not surprising that facts are misrepresented in a national newspaper,15 which has headlined the findings (" Sorry sport, you’re too old at 30 "). The statement has been made both in the summary and discussion of the original article, and this would indeed cause much alarm to sport enthusiasts over 30 years of age. I wish to present the age-distribution of Olympic finalists (Munich, 1972) to restore the confidence of sportsmen aged 30 and over. Table I shows that 17% of the 1252 1252 1972*
TABLE I-AGE-DISTRIBUTION OF
OLYMPIC
FINALISTS, MUNICH,
adverse family history, &c.). It is also interesting to observe that 13 of the 19 deaths (including 3 unknown smoking habits) occurred among smokers, and 11 of them were smoking more than 20 cigarettes per day. This is a finding of great significance, because smoking is rare amongst keen sportsmen 16 (percentage smokers in some groups: 63-73% between social classes i and v; British doctors 49%; Empire Games competitors 16%; Opie’s paper 81% amongst 16 sudden deaths of known smoking habits). In this context it appears that smoking caused and sport precipitated the sudden deaths. I have been advocating 16,17 increased sports participation by the community for reasons of health, and some physical activity (under medical supervision) is especially needed for persons over 30 years in the general population of affluent countries. I hope this letter will dispel the fear of sport enthusiasts over 30 and that they will exercise their judgment in the choice of sporting events befitting their age. The question of sport under medical supervision and discouragement of smoking amongst sportsmen cannot be overemphasised. -
Department of Medical Statistics, Welsh National School of Medicine, Heath Park, Cardiff CF4 4XN.
Compiled from the three volumes published by the Organising Committee for the Games of the XXth Olympiad, Munich, 1972.
Olympic
finalists
30 years of age
(mean 261; S.D. 5.2 quartiles, Qi==22-3, Q2=25.4, Q3=28.9 years). In a short letter it is not possible to give a breakdown of sporting events in which 213 (17%) of Olympic finalists have excelled in open competition. Table l gives the breakwere over
down of events for 72 finalists aged 35 or over, and shows that in yachting, shooting, or archery, and in equestrian events, age is not a handicap in achieving excellence even in competitive sport. 2 of the 4 long-distance runners, Wolde, aged 38, won a bronze and Foster, aged 40, was 8th in marathon. Weidner (39) was 6th in the 50 km. walk. The 7 finalists in the other categories were drawn from football, volley ball, discus (2), shotput, hammer, and
fencing. The selection of sporting events for enthusiasts aged 40 is important. Even in the Olympics, only 21 (1’7%) of the finalists were over 40, and only 3 (0-3%) were over
T. KHOSLA.
METHYSERGIDE AND MYOCLONUS a femoral endarterectomy a 34-year-old had cerebral hypoxia secondary to obstruction of the endotracheal cannula, from which he recovered. He then had action and intention myoclonic movements, 18 as well as dysarthria. The movements affected the facial muscles and the four extremities and they were precipitated by all voluntary movements, preventing the patient from
SIR,-During
man
carrying
out any
daily activity.
We used various drugs, among them methysergide, in view of the excellent results in a similar case.19 Methysergide is an antagonist of serotonin, opposing its action at the level of post-synaptic fixation.20 We gave 6 mg. per day, increasing the dose to reach 12 mg. per day ten days later. Throughout the myoclonic movements became more frequent, their amplitude increased, dysarthria was more
over
13. Bluestone, R., Goldberg, L. S. Ann. rheum. Dis. 1973, 32, 50. 14. Lange, J., Schumacher, K., Witscher, H. P. Dt. med. Wschr. 1971, 96, 139. 15. Daily Express (London) Feb. 3, 1975, p. 7.
16. Khosla, T. Lancet, 1972, ii, 1318. 17. Khosla, T. Br. J. prev. soc. Med. 1971, 25, 114. 18. Lance, J. W., Adams, R. D. Brain, 1963, 86, 111. 19. Bedard, P., Bouchard, R. Lancet, April 20,1974, p. 738. 20. Rohmer, J. M., Warter, G., Coquillat, J., Maitrot, D., Kurtz, D., Michelletti, G., Mack, G., Mandel, P. Revue Neurol. 1973, 128, 323.
patients treated with penicillamine.13 The a depressing effect on the granulopoietic cells indicates that the effect on the lymphocyte-counts is not due to an overall cystostatic effect similar to that obtained with alkylating agents such as cyclophosphamide. The immunosuppressive action of penicillamine may be
to occur
in
R.A.
TABLE II-TYPE OF EVENTS AND MALE OLYMPIC FINALISTS AGED
35-64, MUNICH, 1972
lack of signs of
of R.A. as well as in chronic in which hepatitis penicillamine has a beneficial
of value in the
aggressive
treatment
effect. 14 Departments of Internal Medicine and Rheumatology, University Hospital, S-221 85 Lund, Sweden.
L. BRANDT B. SVENSSON.
*
Types of categories-for example, in yachting, there (Dragon, Finn, Dutch, Tempest, Soling, Star).
are
6 events
The 3 elderly sportsmen had taken part in events of skill rather than in strength (equestrian sport). In this context it appears unwise for football referees to continue beyond 45 years of age, and for sport enthusiasts to indulge in competitive tennis or to jog for 7 miles as reported by Professor Opie. But for the misleading statement on age, I agree with Professor Opie’s general conclusions (smoking,
45.
SUDDEN DEATH AND SPORT
SIR.,-In the article by Professor Opie (Feb. 1, p. 263) on sudden deaths in sportsmen, the statement " as a group, these subjects were characterised by (1) a mean age above thirty... " is confusing, when in fact the mean age is 40 years (derived from table 11: range 17-58; mean and median 40 years). Although of course 40 is above 30, the statement is misleading. It is not surprising that facts are misrepresented in a national newspaper,15 which has headlined the findings (" Sorry sport, you’re too old at 30 "). The statement has been made both in the summary and discussion of the original article, and this would indeed cause much alarm to sport enthusiasts over 30 years of age. I wish to present the age-distribution of Olympic finalists (Munich, 1972) to restore the confidence of sportsmen aged 30 and over. Table I shows that 17% of the 1252 1252 1972*
TABLE I-AGE-DISTRIBUTION OF
OLYMPIC
FINALISTS, MUNICH,
adverse family history, &c.). It is also interesting to observe that 13 of the 19 deaths (including 3 unknown smoking habits) occurred among smokers, and 11 of them were smoking more than 20 cigarettes per day. This is a finding of great significance, because smoking is rare amongst keen sportsmen 16 (percentage smokers in some groups: 63-73% between social classes i and v; British doctors 49%; Empire Games competitors 16%; Opie’s paper 81% amongst 16 sudden deaths of known smoking habits). In this context it appears that smoking caused and sport precipitated the sudden deaths. I have been advocating 16,17 increased sports participation by the community for reasons of health, and some physical activity (under medical supervision) is especially needed for persons over 30 years in the general population of affluent countries. I hope this letter will dispel the fear of sport enthusiasts over 30 and that they will exercise their judgment in the choice of sporting events befitting their age. The question of sport under medical supervision and discouragement of smoking amongst sportsmen cannot be overemphasised. -
Department of Medical Statistics, Welsh National School of Medicine, Heath Park, Cardiff CF4 4XN.
Compiled from the three volumes published by the Organising Committee for the Games of the XXth Olympiad, Munich, 1972.
Olympic
finalists
30 years of age
(mean 261; S.D. 5.2 quartiles, Qi==22-3, Q2=25.4, Q3=28.9 years). In a short letter it is not possible to give a breakdown of sporting events in which 213 (17%) of Olympic finalists have excelled in open competition. Table l gives the breakwere over
down of events for 72 finalists aged 35 or over, and shows that in yachting, shooting, or archery, and in equestrian events, age is not a handicap in achieving excellence even in competitive sport. 2 of the 4 long-distance runners, Wolde, aged 38, won a bronze and Foster, aged 40, was 8th in marathon. Weidner (39) was 6th in the 50 km. walk. The 7 finalists in the other categories were drawn from football, volley ball, discus (2), shotput, hammer, and
fencing. The selection of sporting events for enthusiasts aged 40 is important. Even in the Olympics, only 21 (1’7%) of the finalists were over 40, and only 3 (0-3%) were over
T. KHOSLA.
METHYSERGIDE AND MYOCLONUS a femoral endarterectomy a 34-year-old had cerebral hypoxia secondary to obstruction of the endotracheal cannula, from which he recovered. He then had action and intention myoclonic movements, 18 as well as dysarthria. The movements affected the facial muscles and the four extremities and they were precipitated by all voluntary movements, preventing the patient from
SIR,-During
man
carrying
out any
daily activity.
We used various drugs, among them methysergide, in view of the excellent results in a similar case.19 Methysergide is an antagonist of serotonin, opposing its action at the level of post-synaptic fixation.20 We gave 6 mg. per day, increasing the dose to reach 12 mg. per day ten days later. Throughout the myoclonic movements became more frequent, their amplitude increased, dysarthria was more
over
13. Bluestone, R., Goldberg, L. S. Ann. rheum. Dis. 1973, 32, 50. 14. Lange, J., Schumacher, K., Witscher, H. P. Dt. med. Wschr. 1971, 96, 139. 15. Daily Express (London) Feb. 3, 1975, p. 7.
16. Khosla, T. Lancet, 1972, ii, 1318. 17. Khosla, T. Br. J. prev. soc. Med. 1971, 25, 114. 18. Lance, J. W., Adams, R. D. Brain, 1963, 86, 111. 19. Bedard, P., Bouchard, R. Lancet, April 20,1974, p. 738. 20. Rohmer, J. M., Warter, G., Coquillat, J., Maitrot, D., Kurtz, D., Michelletti, G., Mack, G., Mandel, P. Revue Neurol. 1973, 128, 323.
