Journal of the Royal Society of Medicine Volume 85 December 1992
If simple analgesics and topical remedies were prescribed with sufficient skill and conviction, the misuse of NSAIDs would largely disappear and, with it the morbidity emanating from the popular use of drugs such as ibuprofen, the latter having an undeserved reputation for safety despite evidence to the contrary3. 0 M P JOLOBE Consultant Geriatrician Tameside General Hospital Fountain Street Ashton-under-Lyne OL6 9RW
References 1 Bradlow A. Gout and hyperuricaemia. Med Int 1990;75:3132-5 2 Editorial. Topical NSAID's: gimmick or a godsend. Lancet 1989;ii:779-80 3 Murray MD, Brater C, Tierney WM, et aL Ibuprofen associated renal impairment in a large general internal medicine practice. Am J Med Sci 1990;299:222-9
Why do hospital doctors wear white coats? Farraj and Barron (January 1991 JRSM, p 43) reflect on the reasons for hospital doctors wearing white coats. The most common reason given for this in the article was 'easy recognition by colleagues and patients'. Thus, like a cluster of cows or sheep, An innate tendency, in herding instinct together keep And, clad in white coats Like a bevy of white goats Gather round in a consultative heap.
It may be, in some cases, a determination As a form of psychological desperation To become remote By donning a coat Preventing a patient's contamination. I had hoped the wearing of a uniform would be terrific, Would improve cerebration in some way specific To better the thinking versatility For the patient's meliorability To a reasoned cure, lucid and scientific.
Psychiatrists, pediatricians and some consultants are spiffy, sartorial, To distinguish them from those others, doctorial, Who, dressed in white Occasion a fright By resembling some beings inquisitorial. In North America, many of us dress in green It is possibly a colour more serene. (Swiped from the OR via front or back door) But are they, then, bacteriologically clean? In some cases white coats are thought to enhance status, So that no one, perish the thought!, would venture to pat us, Thus we keep ourselves warm And cluster and conform And we'll all pretend it was the patient who passed the flatus. F I JACKSON
11560 University Avenue Edmonton, Alberta, Canada T6G 1Z4
Mitral valve prolapse, keratoconus and Down's syndrome Attention has been focused on the conspicuous relationship between mitral valve prolapse and keratoconus (August 1992 JRSM, p 446). Reference was made to the fact that both conditions are associated with comparatively rare inherited collagen diseases such as Ehlers-Danlos syndrome, Marfan's syndrome and osteogenesis imperfecta. Without any aspiration to become involved in the theoretical discussion of collagen metabolism I would like to highlight also the much greater extent to which keratoconus and mitral valve prolapse occurs in a very much commoner condition, Down's syndrome. People with this abnormality suffer a 5% prevalence of keratoconus' and a massive 50% prevalence of mitral valve prolapse2. In sharp contrast the prevalence of keratoconus in the general population lies between only 0.02 and 0.05%34 and that for mitral valve prolapse only about 7%5. Personal observation of a group of 60 people with Down's syndrome living in the community showed that five had keratoconus and that three of these had the auscultatory signs of mitral valve prolapse. In an age and sex matched group in my general practice population I found only one patient with mitral valve prolapse and no one with keratoconus. The clear message from these findings is that keratoconus and mitral valve prolapse, existing either alone or together, must be added to the already long list of the known medical hazards to which people with Down's syndrome are particularly at risk6. Doctors involved in the primary care of people with Down's syndrome need to be aware that keratoconus can lead to considerable corneal scarring and preventable visual loss. Additionally, because of the high prevalence of mitral valve prolapse there needs to be a heightened awareness ofthe risks of subacute bacterial endocarditis when surgical procedures, especially in dentistry, are undertaken in this group of people. 151 St Helen's Road GWYN HOWELLS Swansea SAl 4DF
References 1 Cullen JF, Butler HG. Mongolism and keratoconus. Br J Ophthalmol 1963;47:321-30 2 Barnett ML, Friedman D, Kastner T. The prevalence of mitral valve prolapse in patients with Down's syndrome: implications for dental management. Oral Surg Oral Med Oral Pathol 1988;66:445-7 3 Ihalainen A. Clinical and epidemiological features of keratoconus. Genetic and external factors in the pathogenesis of the disease. Acta Ophthalmol 1986;64(suppl 178):00 4 Kennedy RH, Bourne WM, Dyer JA. Clinical and epidemiological features of keratoconus in a defined population. Invest Ophthalmol Vis Sci 1985;(ARVO
suppl.):26 5 Savage DD, Garrison RJ, Devereaux RB, et aL Mitral valve prolapse in the general population. Epidemiological features: the Framingham study. Am Heart J 1983; 106:541-86 6 Howells G. Down's syndrome and the general practitioner. J R Coil Gen Pract 1989;39:470-5
Mitral valve prolapse and keratoconus I read with interest the article by Sharif, Casey and Coltart (August 1992 JRSM, p 446) who found a very high prevalence of mitral valve prolapse in patients
773
If simple analgesics and topical remedies were prescribed with sufficient skill and conviction, the misuse of NSAIDs would largely disappear and, with it the morbidity emanating from the popular use of drugs such as ibuprofen, the latter having an undeserved reputation for safety despite evidence to the contrary3. 0 M P JOLOBE Consultant Geriatrician Tameside General Hospital Fountain Street Ashton-under-Lyne OL6 9RW
References 1 Bradlow A. Gout and hyperuricaemia. Med Int 1990;75:3132-5 2 Editorial. Topical NSAID's: gimmick or a godsend. Lancet 1989;ii:779-80 3 Murray MD, Brater C, Tierney WM, et aL Ibuprofen associated renal impairment in a large general internal medicine practice. Am J Med Sci 1990;299:222-9
Why do hospital doctors wear white coats? Farraj and Barron (January 1991 JRSM, p 43) reflect on the reasons for hospital doctors wearing white coats. The most common reason given for this in the article was 'easy recognition by colleagues and patients'. Thus, like a cluster of cows or sheep, An innate tendency, in herding instinct together keep And, clad in white coats Like a bevy of white goats Gather round in a consultative heap.
It may be, in some cases, a determination As a form of psychological desperation To become remote By donning a coat Preventing a patient's contamination. I had hoped the wearing of a uniform would be terrific, Would improve cerebration in some way specific To better the thinking versatility For the patient's meliorability To a reasoned cure, lucid and scientific.
Psychiatrists, pediatricians and some consultants are spiffy, sartorial, To distinguish them from those others, doctorial, Who, dressed in white Occasion a fright By resembling some beings inquisitorial. In North America, many of us dress in green It is possibly a colour more serene. (Swiped from the OR via front or back door) But are they, then, bacteriologically clean? In some cases white coats are thought to enhance status, So that no one, perish the thought!, would venture to pat us, Thus we keep ourselves warm And cluster and conform And we'll all pretend it was the patient who passed the flatus. F I JACKSON
11560 University Avenue Edmonton, Alberta, Canada T6G 1Z4
Mitral valve prolapse, keratoconus and Down's syndrome Attention has been focused on the conspicuous relationship between mitral valve prolapse and keratoconus (August 1992 JRSM, p 446). Reference was made to the fact that both conditions are associated with comparatively rare inherited collagen diseases such as Ehlers-Danlos syndrome, Marfan's syndrome and osteogenesis imperfecta. Without any aspiration to become involved in the theoretical discussion of collagen metabolism I would like to highlight also the much greater extent to which keratoconus and mitral valve prolapse occurs in a very much commoner condition, Down's syndrome. People with this abnormality suffer a 5% prevalence of keratoconus' and a massive 50% prevalence of mitral valve prolapse2. In sharp contrast the prevalence of keratoconus in the general population lies between only 0.02 and 0.05%34 and that for mitral valve prolapse only about 7%5. Personal observation of a group of 60 people with Down's syndrome living in the community showed that five had keratoconus and that three of these had the auscultatory signs of mitral valve prolapse. In an age and sex matched group in my general practice population I found only one patient with mitral valve prolapse and no one with keratoconus. The clear message from these findings is that keratoconus and mitral valve prolapse, existing either alone or together, must be added to the already long list of the known medical hazards to which people with Down's syndrome are particularly at risk6. Doctors involved in the primary care of people with Down's syndrome need to be aware that keratoconus can lead to considerable corneal scarring and preventable visual loss. Additionally, because of the high prevalence of mitral valve prolapse there needs to be a heightened awareness ofthe risks of subacute bacterial endocarditis when surgical procedures, especially in dentistry, are undertaken in this group of people. 151 St Helen's Road GWYN HOWELLS Swansea SAl 4DF
References 1 Cullen JF, Butler HG. Mongolism and keratoconus. Br J Ophthalmol 1963;47:321-30 2 Barnett ML, Friedman D, Kastner T. The prevalence of mitral valve prolapse in patients with Down's syndrome: implications for dental management. Oral Surg Oral Med Oral Pathol 1988;66:445-7 3 Ihalainen A. Clinical and epidemiological features of keratoconus. Genetic and external factors in the pathogenesis of the disease. Acta Ophthalmol 1986;64(suppl 178):00 4 Kennedy RH, Bourne WM, Dyer JA. Clinical and epidemiological features of keratoconus in a defined population. Invest Ophthalmol Vis Sci 1985;(ARVO
suppl.):26 5 Savage DD, Garrison RJ, Devereaux RB, et aL Mitral valve prolapse in the general population. Epidemiological features: the Framingham study. Am Heart J 1983; 106:541-86 6 Howells G. Down's syndrome and the general practitioner. J R Coil Gen Pract 1989;39:470-5
Mitral valve prolapse and keratoconus I read with interest the article by Sharif, Casey and Coltart (August 1992 JRSM, p 446) who found a very high prevalence of mitral valve prolapse in patients
773
