Golf: a game of life and death--reduced mortality in Swedish golf players.

The specific health benefits achieved from different forms and patterns of leisure-time physical activity are not established. We analyzed the mortality in a cohort of Swedish golf players. We used the Swedish Golf Federation's membership registry and the nationwide Mortality Registry. We calculated standardized mortality ratios (SMR) with stratification for age, sex, and socioeconomic status. The cohort included 300 818 golfers, and the total number of deaths was 1053. The overall SMR was 0.60 [95% confidence intervals (CIs): 0.57-0.64]. The mortality reduction was observed in men and women, in all age groups, and in all socioeconomic categories. Golfers with the lowest handicap (the most skilled players) had the lowest mortality; SMR=0.53 (95% CI: 0.41-0.67) compared with 0.68 (95% CI: 0.61-0.75) for those with the highest handicap. While we cannot conclude with certainty that all the 40% decreased mortality rates are explained by the physical activity associated with playing golf, we conclude that most likely this is part of the explanation. To put the observed mortality reduction in context, it may be noted that a 40% reduction of mortality rates corresponds to an increase in life expectancy of about 5 years.

pHi monitoring of the sigmoid colon after aortoiliac surgery. A five-year prospective study.

OBJECTIVES: to determine whether sigmoid-pHi diagnose colon ischaemia after aortoiliac surgery? DESIGN: single-centre, non-randomised, prospective study. PATIENTS AND METHODS: of 83 patients operated on between 1994 and 1998, 41 with risk factors for the development of colon ischaemia were monitored peri- and/or postoperatively with sigmoid-pHi. Peri-operative mortality was 26% (8/31) after operation for a ruptured abdominal aortic aneurysm (AAA), nil after operation for non-ruptured AAA. Thirty-five postoperative colonoscopies were performed. All non-survivors were examined post-mortem. RESULTS: of six patients developing colon ischaemia after emergency operations (five for ruptured AAA) all had pHi-values <7.1 for 16-80 h. In two patients with transmural gangrene, and who had pHi-values below 6.6, pHi-monitoring permitted early diagnosis, colectomy and recovery. Three patients with mucosal gangrene were treated conservatively and recovered. Nine patients without ischaemic lesions had pHi-values <7.1, during 1-5 h, without adverse outcome. Bilateral ligation of the internal iliac arteries increased the risk of colon ischaemia (p<0.0001). CONCLUSIONS: pHi-monitoring was diagnostic for colon ischaemia. Mucosal and transmural gangrene were distinguished. The importance of the internal iliac circulation was demonstrated. The low mortality rate, and the fact that no patient died from bowel ischaemia, suggests that sigmoid pHi-monitoring may improve survival after ruptured AAA.

Muscle strength, endurance, and aerobic capacity in rheumatoid arthritis: a comparative study with healthy subjects.

Isometric/isokinetic muscle strength and isokinetic endurance of the lower extremities as well as aerobic capacity were evaluated in 67 patients (43 female, 24 male; mean age 53 years, range 23-65) with classical/definite rheumatoid arthritis (RA) of functional class II. Results obtained were compared with those of a healthy reference group matched for age and sex. Disease characteristics of the group with RA were registered and lifestyle characteristics, such as work load, exercise, diet, smoking, and alcohol habits, were reported by both groups. Generally, results showed that the group with RA had decreased functional capacity. Isometric hip and knee muscle strength of the rheumatoid group was reduced to about 75% of normal function, isokinetic knee muscle strength at the velocities of 60 and 180 degrees/s to about 65% and 75% of normal function respectively, isokinetic endurance of the knee muscle groups to about 45%, and aerobic capacity to about 80% of the results obtained for the healthy reference group. Analyses of variance showed that the rheumatoid group, compared with the healthy group, had significantly reduced function on all isometric and isokinetic tests of the extensors and flexors of the knee. Results for isometric hip muscle strength were similar--all tests but one yielding highly significant differences. To avoid unnecessary functional deficits it seems important to include muscular training in rehabilitation programmes for patients with RA.

Gastric acid responses to graded i.v. infusion of pentagastrin and histalog in peptic ulcer patients before and after antrum-bulb resection.

Gastric acid responses to graded i.v. infusion of pentagastrin and Histalog were determined in peptic ulcer patients. Single-day multiple-dose tests were performed. The sensitivity to the humoral stimuli as determined by the calculated ED50's was not significantly different for duodenal ulcer patients with moderate (DUmod) or massive (DUmass) observed hypersecretion or for gastric ulcer (GU) patients: median ED50's of pentagastrin were 6.2, 6.6, and 13.1 mug/h in 18 DUmod, 22 DUmass and 7 GU patients respectively, and median ED50's of Histalog were 16.6, 25.3, and 17.1 mg/h in 14 DUmod, 10 DUmass and 6 GU patients respectively. Antrum-bulb resection significantly reduced basal acid secretion and maximal acid responses to the humoral stimuli (about 45% reduction) but did not significantly change the loss of gastric contents to the intestine or the sensitivity to the humoral stimuli (median ED50 of pentagastrin increased from 5.2 to 6.7 mug/h in 14 patients, and median ED50 of Histalog increased from 16.0 to 20.8 mg/h in 12 patients), suggesting that the intact antrum-bulb region of the ulcer patient is controlling the capacity to secrete acid, and indicating that antrum-bulb gastrin is an important trophic factor for the parietal cells in man.