55
bupivacaine 1mg/kg deep to the anterior rectus sheath during the operation. Had we also injected bupivacaine deep to the muscle, between it and the rectus sheath, a more complete block might have
pharmaceutical industry has been encouraging cholesterol testing in primary care. We believe that this practice may fail to conform with the ABPI Code of Practice for the pharmaceutical industry.2
resulted.
National Forum for Coronary Heart Disease Prevention, London WC1
IMOGEN SHARP
Coronary Prevention Group, 60 Great Ormond Street, London WC1 N 3HR, UK
MIKE RAYNER
L. R. MCNICOL Department of Anaesthesia, and Biochemistry Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
C. S. MARTIN N. G. SMART R. W. LOGAN
NJ, Fitzpatrick GJ, Moore KP, et al. Anaesthesia for congenital hypertrophic pyloric stenosis: a review of 350 patients. Br J Anaesth 1987; 59:
1. MacDonald
B, Hutton J. Changing medical practice: a study of reflotron use in general practice. York: Centre for Health Economics Consortium, 1989. 2. Association of the British Pharmaceutical Industry. Code of practice for the pharmaceutical industry. London: ABPI, 1988. 1. Leese
672-77.
Purcell-Jones G, Dorman F, Sumner E. The use of opioids in neonates: a retrospective study of 933 cases. Anaesthesia 1987; 42: 1316-20. 3. Hatch DJ. Analgesia in the neonate. Br Med J 1987; 294: 920. 4. Booker PD. Post-operative analgesia for neonates? Anaesthesia 1987; 42: 343-45. 5. Anand KJS, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl in pre-term babies undergoing surgery: effects on the stress response. Lancet 1987; i: 243-47. 6. Anand KJS, Sippell WG, Schofield NM, Aynsley-Green A. Does Halothane 2.
anaesthesia decrease the metabolic and endocrine stress response of newborn infants undergoing operation? Br Med J 1988; 296: 668-72. 7. Owens ME. Pain in infancy: conceptual and methodological issues. Pain 1984; 20: 213-30. 8. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317: 1321-29. 9. McGrath PA. An assessment of children’s pain: a review of behavioural, physiological and direct scaling techniques. Pain 1987; 31: 147-76 10. Marshall RE, Stratton WC, Moore JA, Boxerman SB. Circumcision I: Effects upon newborn behaviour. Infant Behav Devel 1980; 3: 1-14.
Cholesterol testing with desk-top machines SIR,-Research on the relation between serum cholesterol concentration and coronary risk may have encouraged the growing interest in cholesterol testing as a means of assessing an individual’s risk of coronary heart disease (CHD). The development of desk-top measuring machines could now be allowing more tests to be carried out. The pharmaceutical industry may also be encouraging cholesterol testing to increase the prescription of cholesterol-
Psychotic symptoms in basal ganglia sclerosis SIR,-Your Nov 18 editorial on psychotic symptoms in Alzheimer’s disease mentions the association of delusions with basal ganglia calcification. This association has been repeatedly emphasised, but never statistically proven.12 We have evaluated cranial computed tomographic scans and neuropsychiatric symptoms in patients with unilateral or bilateral basal ganglia calcificationFahr’s syndrome3--and a random sample of patients without calcification, at the same time. The table shows patients’details. We showed in a log-linear model4 that the clinical disturbances and diagnoses were largely determined by the patients’ age and by atrophic brain disorders, which were more prevalent in the Fahr’s syndrome group. After correction for these confounding variables, the odds ratios did not support an increased rate of dementia in patients with basal ganglia sclerosis. However, the odds ratios for paranoid or affective syndromes, classified clinically as organic or non-organic disorders, was slightly increased in patients with basal ganglia calcification (odds ratios below 2).5 These differences were
significant (p < 0’05).
lowering drugs.
AGE AND DIAGNOSIS OF PATIENTS WITH BASAL GANGLIA CALCIFICATION AND CONTROLS
biennial conference of AC’. ;anticipatory care teams working for the prevention- et cardiovascular disease), delegates were asked about their practice with respect to cholesterol testing. A total of 220 questionnaires were completed by general practitioners, practice nurses, and health visitors, of whom 209 (95%) were doing cholesterol testing as. paÌ1: of their programme of risk assessment for CHD. 33 (15%) respondents were mainly using a desk-top measuring machine to measure cholesterol concentrations in blood samples, and the remainder were using their local hospital laboratory. 64% (21/33) of those using a desk-top machine were testing blood cholesterol in all their patients participating in a CHD prevention programme, compared with 33% (58/174) of those who were mainly using their local hospital At the
recent
laboratory to assess samples. We asked about how desk-top measuring machines had been acquired and the results were: No of
findings agree with the hypothesis that basal ganglia are implicated in sensory gating, cognition, and affect.6 This weak Our
association, however, should not encourage the notion that there was a clinically distinct Fahr’s syndrome of a specific of specific clinical symptoms, such as delusions. This weak statistical association cannot account for the various neuropsychiatric disturbances in individuals, which should be investigated in every case.
neuropathological aspect
-
-
-
HANS FORSTL
Departments of Psychiatry, Biostatistics, and Neuroradiology, Central Institute of Mental Health, 6800 Mannheim 1, West Germany
had
The primary health care professionals questioned a particular interest in CHD prevention, and therefore it was not unexpected that most were undertaking some cholesterol testing as part of their preventive work. Surprisingly few (only 1 in 7) of the respondents were using a desk-top measuring device, but such use seemed to increase the number of cholesterol tests done. The least expensive desk-top machine costs more than L4000-a non-reimbursable expense which must inhibit their widespread use in general practice. On the other hand the loan or gift of a machine by a pharmaceutical company is one way in which the
SILKE EDEN BERTRAM KRUMM KNUT KOHLMEYER
Cummings JL. Organic delusions: phenomenology, anatomical correlations and review Br J Psychiatry 1985; 146: 184-97. 2. Konig P. Psychopathological alterations in cases of symmetrical bilateral basal ganglia sclerosis. Biol Psychiatry 1989; 25: 459-68. 3. Fahr T Idiopathische Verkalkung der Hirengefässe. Centralbl Allg Pathol Pathol 1
Anat 1930; 50: 129-33. Fienberg SE The analysis of cross-classified categorical data. Cambridge, Mass: MIT Press, 1980. 5. Sandercock P The odds ratio: a useful tool in neurosciences. J Neurol Neurosurg Psychiatry 1989; 52: 817-20. 6. Schneider JS. Basal ganglia role in behaviour: importance of sensory gating and its relevance to psychiatry. Biol Psychiatry 1984; 19: 1693-710 4.
bupivacaine 1mg/kg deep to the anterior rectus sheath during the operation. Had we also injected bupivacaine deep to the muscle, between it and the rectus sheath, a more complete block might have
pharmaceutical industry has been encouraging cholesterol testing in primary care. We believe that this practice may fail to conform with the ABPI Code of Practice for the pharmaceutical industry.2
resulted.
National Forum for Coronary Heart Disease Prevention, London WC1
IMOGEN SHARP
Coronary Prevention Group, 60 Great Ormond Street, London WC1 N 3HR, UK
MIKE RAYNER
L. R. MCNICOL Department of Anaesthesia, and Biochemistry Royal Hospital for Sick Children, Glasgow G3 8SJ, UK
C. S. MARTIN N. G. SMART R. W. LOGAN
NJ, Fitzpatrick GJ, Moore KP, et al. Anaesthesia for congenital hypertrophic pyloric stenosis: a review of 350 patients. Br J Anaesth 1987; 59:
1. MacDonald
B, Hutton J. Changing medical practice: a study of reflotron use in general practice. York: Centre for Health Economics Consortium, 1989. 2. Association of the British Pharmaceutical Industry. Code of practice for the pharmaceutical industry. London: ABPI, 1988. 1. Leese
672-77.
Purcell-Jones G, Dorman F, Sumner E. The use of opioids in neonates: a retrospective study of 933 cases. Anaesthesia 1987; 42: 1316-20. 3. Hatch DJ. Analgesia in the neonate. Br Med J 1987; 294: 920. 4. Booker PD. Post-operative analgesia for neonates? Anaesthesia 1987; 42: 343-45. 5. Anand KJS, Sippell WG, Aynsley-Green A. Randomised trial of fentanyl in pre-term babies undergoing surgery: effects on the stress response. Lancet 1987; i: 243-47. 6. Anand KJS, Sippell WG, Schofield NM, Aynsley-Green A. Does Halothane 2.
anaesthesia decrease the metabolic and endocrine stress response of newborn infants undergoing operation? Br Med J 1988; 296: 668-72. 7. Owens ME. Pain in infancy: conceptual and methodological issues. Pain 1984; 20: 213-30. 8. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317: 1321-29. 9. McGrath PA. An assessment of children’s pain: a review of behavioural, physiological and direct scaling techniques. Pain 1987; 31: 147-76 10. Marshall RE, Stratton WC, Moore JA, Boxerman SB. Circumcision I: Effects upon newborn behaviour. Infant Behav Devel 1980; 3: 1-14.
Cholesterol testing with desk-top machines SIR,-Research on the relation between serum cholesterol concentration and coronary risk may have encouraged the growing interest in cholesterol testing as a means of assessing an individual’s risk of coronary heart disease (CHD). The development of desk-top measuring machines could now be allowing more tests to be carried out. The pharmaceutical industry may also be encouraging cholesterol testing to increase the prescription of cholesterol-
Psychotic symptoms in basal ganglia sclerosis SIR,-Your Nov 18 editorial on psychotic symptoms in Alzheimer’s disease mentions the association of delusions with basal ganglia calcification. This association has been repeatedly emphasised, but never statistically proven.12 We have evaluated cranial computed tomographic scans and neuropsychiatric symptoms in patients with unilateral or bilateral basal ganglia calcificationFahr’s syndrome3--and a random sample of patients without calcification, at the same time. The table shows patients’details. We showed in a log-linear model4 that the clinical disturbances and diagnoses were largely determined by the patients’ age and by atrophic brain disorders, which were more prevalent in the Fahr’s syndrome group. After correction for these confounding variables, the odds ratios did not support an increased rate of dementia in patients with basal ganglia sclerosis. However, the odds ratios for paranoid or affective syndromes, classified clinically as organic or non-organic disorders, was slightly increased in patients with basal ganglia calcification (odds ratios below 2).5 These differences were
significant (p < 0’05).
lowering drugs.
AGE AND DIAGNOSIS OF PATIENTS WITH BASAL GANGLIA CALCIFICATION AND CONTROLS
biennial conference of AC’. ;anticipatory care teams working for the prevention- et cardiovascular disease), delegates were asked about their practice with respect to cholesterol testing. A total of 220 questionnaires were completed by general practitioners, practice nurses, and health visitors, of whom 209 (95%) were doing cholesterol testing as. paÌ1: of their programme of risk assessment for CHD. 33 (15%) respondents were mainly using a desk-top measuring machine to measure cholesterol concentrations in blood samples, and the remainder were using their local hospital laboratory. 64% (21/33) of those using a desk-top machine were testing blood cholesterol in all their patients participating in a CHD prevention programme, compared with 33% (58/174) of those who were mainly using their local hospital At the
recent
laboratory to assess samples. We asked about how desk-top measuring machines had been acquired and the results were: No of
findings agree with the hypothesis that basal ganglia are implicated in sensory gating, cognition, and affect.6 This weak Our
association, however, should not encourage the notion that there was a clinically distinct Fahr’s syndrome of a specific of specific clinical symptoms, such as delusions. This weak statistical association cannot account for the various neuropsychiatric disturbances in individuals, which should be investigated in every case.
neuropathological aspect
-
-
-
HANS FORSTL
Departments of Psychiatry, Biostatistics, and Neuroradiology, Central Institute of Mental Health, 6800 Mannheim 1, West Germany
had
The primary health care professionals questioned a particular interest in CHD prevention, and therefore it was not unexpected that most were undertaking some cholesterol testing as part of their preventive work. Surprisingly few (only 1 in 7) of the respondents were using a desk-top measuring device, but such use seemed to increase the number of cholesterol tests done. The least expensive desk-top machine costs more than L4000-a non-reimbursable expense which must inhibit their widespread use in general practice. On the other hand the loan or gift of a machine by a pharmaceutical company is one way in which the
SILKE EDEN BERTRAM KRUMM KNUT KOHLMEYER
Cummings JL. Organic delusions: phenomenology, anatomical correlations and review Br J Psychiatry 1985; 146: 184-97. 2. Konig P. Psychopathological alterations in cases of symmetrical bilateral basal ganglia sclerosis. Biol Psychiatry 1989; 25: 459-68. 3. Fahr T Idiopathische Verkalkung der Hirengefässe. Centralbl Allg Pathol Pathol 1
Anat 1930; 50: 129-33. Fienberg SE The analysis of cross-classified categorical data. Cambridge, Mass: MIT Press, 1980. 5. Sandercock P The odds ratio: a useful tool in neurosciences. J Neurol Neurosurg Psychiatry 1989; 52: 817-20. 6. Schneider JS. Basal ganglia role in behaviour: importance of sensory gating and its relevance to psychiatry. Biol Psychiatry 1984; 19: 1693-710 4.
