Psychological consequences of the 1998 landslide in Sarno, Italy: a community study.

OBJECTIVE: This community study assessed the prevalence of post-traumatic stress disorder (PTSD) and the psychosocial consequences of the landslide which occurred in Sarno, Southern Italy, in May 1998. METHOD: A random sample (n=272) of the population living in the highest risk area of Sarno, and a control group recruited in a small town situated near the disaster area, but not affected by the event, were assessed 1 year after the disaster by standardized instruments. RESULTS: Of the subjects recruited in Sarno, 27.6% met DSM-IV criteria for PTSD; 59% subjects recruited in Sarno and 35% of the control group were identified as "probable cases" by the GHQ-30 (P<0.0001). Subjects recruited in Sarno had significantly higher scores on the four GHQ-30 subscales identified by factor analysis. CONCLUSION: This study emphasizes the negative impact of a natural catastrophic event on mental health, and the need for preventive interventions.

A double-blind placebo controlled trial of simvastatin for the treatment of dyslipidaemia in renal allograft recipients.

BACKGROUND: With current techniques, renal failure patients are now able to regain near-normal health following renal transplantation. However, the development of premature cardiovascular disease is a major problem. Dyslipidaemia may be an important contributor to this. The use of lipid lowering agents in renal allograft recipients has been limited by potential interaction of these agents with the now widely used immunosuppressive agent, cyclosporine. AIM: This study was designed to investigate efficacy and safety of simvastatin in subjects taking either cyclosporine or azothioprine post renal transplantation. METHODS: Fifty-one subjects (32 females, 19 males -- mean age 51 +/- 12.5 yr) who were at least 1 yr post transplant, had creatinine < or = 2.5 mmol/L and a total cholesterol > or = 6 mmol/L were enrolled in a prospective, double-blind, placebo-controlled study. After an initial 10-wk dietary period, the last 4 wk on placebo, subjects were randomised to receive either 5 mg simvastatin/d for 6 wk followed by 10 mg simvastatin/d for 6 wk, or matching placebo. After this 12-wk double-blind phase, there was an open-label phase when all subjects were treated with 10 mg simvastatin/d for a period of 36 wk. RESULTS: Compared to placebo, 5 mg simvastatin/d significantly decreased total cholesterol by 20% (p < 0.01), low-density lipoprotein cholesterol (LDL cholesterol) by 29% (p < 0.01), and Apolipoprotein B (ApoB) by 26% (p < 0.01). Increasing simvastatin to 10 mg/d did not lead to further significant changes. But high-density lipoprotein cholesterol (HDL cholesterol) increased by 9% (p < 0.01) and Apolipoprotein A1 (ApoA1) by 7% (p < 0.01) only on 10 mg simvastatin/d. During the open-label phase, subjects previously randomised to placebo achieved similar significant changes to their lipoprotein profile. The benefits achieved from simvastatin were maintained to the end of the study. There were three withdrawals from the study, all from the simvastatin/ cyclosporine group. Two subjects had musculoskeletal pain and 1 had abdominal pain. Minor adverse events were similar in both the simvastatin- and placebo-treated groups. CONCLUSION: Low-dose simvastatin is an effective and well-tolerated agent in the treatment of dyslipidaemia in renal allograft recipients.

Effects of physical activity and diet on lipoprotein(a).

Lipoprotein(a) [Lp(a)] represents a class of lipoproteins with some structural similarity to low density lipoprotein (LDL), but containing a unique apoprotein, apoprotein(a). First reported in 1963, Lp(a) is now considered to have an independent role in the development of atherosclerotic lesions. The level of Lp(a) in the blood is under strong genetic influence and does not appear to be alterable by lifestyle factors known to influence other lipoproteins. Regular moderate exercise has been shown to favorably alter other lipoproteins, and recent attention has focused on whether Lp(a) level can be influenced by physical activity. Current data from cross-sectional and intervention studies show little effect of moderate exercise on serum Lp(a) concentration. One possible exception may be an elevation of serum Lp(a) concentration in adult endurance and power athletes who exercise intensely on a daily basis. However, not all studies have taken into account possible racial or ethnic differences in Lp(a) concentrations and the skewed distribution observed within most populations. Standard dietary intervention such as a low fat diet recommended for weight loss and control of other blood lipids has little effect on serum Lp(a) level. At present, serum Lp(a) concentration does not appear to be significantly altered by realistic dietary changes and moderate physical activity as recommended for health. The synergistic effect on cardiovascular disease risk when both LDL-cholesterol and Lp(a) are elevated highlight the importance of attending to those risk factors that can be modified by exercise and other lifestyle changes.

Acute effects of treadmill running on lipoprotein(a) levels in males and females.

This investigation examined the acute response of serum lipoprotein(a) (Lp(a)) concentration immediately after, and during several days following, level and downhill motorized treadmill running. Eight males ran for 1 h on a level motorized treadmill at an intensity producing 90% maximum heart rate (MHR). On a separate occasion, three males and three females performed downhill (negative 13.4% incline) treadmill running at an intensity producing 75-80% MHR. For both protocols, serial blood samples were taken pre- and post-exercise and at the same time of day 1, 3, 5, and 7 days following exercise. Levels of Lp(a), creatine kinase (CK), C-reactive protein (CRP), and ferritin were measured. Repeated measures statistical analysis (Friedman ANOVA) showed no significant change in the median level of Lp(a) (level run, 5.0 mg.dl-1; downhill run, 7.45 mg.dl-1) across time following either protocol. After level running, ferritin levels 5 and 7 d post-exercise were significantly (P < 0.05) lower compared with immediately and 1 d post-exercise measures (Friedman ANOVA). Following level running, the Wilcoxon signed rank test showed significant (P < 0.05) elevations in CK levels immediately, 1 and 5 d post-exercise compared with pre-exercise values. Following downhill running. CK level was significantly elevated up to 3 d post-exercise (Wilcoxon signed rank). Calculated plasma volume did not change significantly following either protocol. These data suggest that Lp(a) does not change acutely in response to level or downhill treadmill running up to 60 min duration.

Acute irreversible cataracts in diabetes mellitus.

AIM: To report an unusual cause of blindness in a patient newly diagnosed with insulin-dependent diabetes mellitis (IDDM). METHOD: A 19-year-old man presented with classical symptoms of hyperglycaemia. On presentation his visual acuity and ophthalmic examination were normal. He was prescribed twice-daily insulin therapy and six weeks later presented with visual loss. He had only light and dark perception and was noted to have bilateral, dense, mature cataracts. OUTCOME: Right cataract extraction and intraocular lens implant was performed with restoration of vision. Despite good diabetic control the left cataract did not resolve. Seven months later the patient had left cataract extraction and intraocular lens implant, again with good result. CONCLUSION: Mature dense cataracts rarely occur and appear not to resolve with control of hyperglycaemia, as in this case, and require surgical treatment.

Lipoprotein(a) [Lp(a)] levels in middle-aged male runners and sedentary controls.

Serum Lipoprotein(a) [Lp(a)] concentration was compared between middle-aged well-trained Caucasian male endurance runners (N = 57), (mean age +/- SEM 47.8 +/- 0.7 yr) and age-, body mass-, and body mass index (BMI)-matched male nonathletic control subjects (N = 62), (mean age +/- SEM 48.7 +/- 0.8). The mean weekly training distance of the runners was (60.7 +/- 2.8 km.wk-1) at the time of testing. Median Lp(a) levels were not significantly different (P > 0.05) between the runners (15.0 mg.dl-1) and the control subjects (12.5 mg.dl-1). As expected, compared with control subjects, in runners levels of other lipoproteins and apoproteins were significantly more favorable for cardiovascular health (all P < 0.01). There was no significant relationship between Lp(a) and any other measured variable (lipid, anthropometric, or dietary) in the runners group. In the control group, the significant positive correlation between Lp(a) and LDL-C was no longer significant after correction for the estimated contribution of Lp(a) cholesterol to LDL-C. These cross-sectional data suggest that a lifestyle of moderate to intense exercise training does not exert a significant impact on the Lp(a) level.

CNS germinomas: curable tumours in two adolescents.

Two cases of central nervous system germinoma are described which highlight the various presentations of this tumour in different anatomical locations. The first case is that of a 15 year old boy with a suprasellar germinoma who presented with the classical triad of diabetes insipidus, visual disturbance and hypopituitarism. The need for full hormonal evaluation and replacement therapy is stressed. In the second case a 14 year old boy with pineal germinoma presented with features of raised intracranial pressure, Parinaud's syndrome and normal anterior pituitary function. Both cases were treated with corticospinal irradiation which resulted in regression of the tumours. Follow up has now been for over 4 years with no sign of recurrence.

Effect of oatbran on mild hyperlipidaemia.

OBJECTIVE: To determine whether adding 60 g oatbran per day to a low saturated fat, low cholesterol diet has any additional effect of lowering serum lipids. DESIGN: A double blind, prospective, randomised, placebo controlled crossover study. SETTING: Lipid clinic in a teaching hospital. SUBJECTS: Thirty-seven subjects (16 men, 21 women) with serum cholesterol of 5.5-8.0 mmol/L were recruited from staff and medical clinics. All subjects were aware of their hyperlipidaemia and no subject was previously treated with lipid lowering agents. INTERVENTIONS: After an eight-week diet period subjects were randomised to receive two muffins per day containing either 60 g of oatbran or the equivalent amount of fibre from wheatbran in a double blind crossover study. MAIN OUTCOME MEASURES: Measurement of lipids, lipoproteins and biochemical parameters at the end of each eight-week period. RESULTS: Mean serum lipid levels at the end of the oatbran and wheatbran periods were significantly different from each other only for low density lipoprotein (LDL) cholesterol (oatbran, 4.67 mmol/L; SD, 0.85; and wheatbran, 4.95 mmol/L; SD, 0.81; P < 0.01), the LDL/HDL (high density lipoprotein) ratio (oatbran, 3.68; SD, 1.25; and wheatbran, 4.01; SD, 1.25; P < 0.001) and apoprotein B (oatbran, 1.03 g/L; SD, 0.21; and wheatbran, 1.08 g/L; SD, 0.19; P < 0.05). CONCLUSION: Oatbran fibre is more effective than wheatbran fibre in lowering cholesterol in subjects with mild hyperlipidaemia who are already on a low saturated fat, low cholesterol diet.

Early diagnosis of Graves' optic neuropathy using visual evoked responses.

A 27 year old woman with Graves' disease developed progressive ophthalmopathy and was noted to have abnormal visual evoked responses (VER). She was treated with high dose prednisone with clinical improvement and return of the visual evoked responses to normal. On withdrawal of steroids symptoms recurred and VER again were abnormal. Orbital irradiation was given with improvement in the ophthalmopathy and VER again normalized. To our knowledge this report represents the first demonstration of improvement in VER with treatment in Graves' optic neuropathy.