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“The headaches had been getting worse. One of his riding companions was Tom Zerfoss, the genial one man student health service at Vanderbilt. He took care of Warren and Cinina and other friends without charge. Tom's wife, Kate Savage Zerfoss, was an ophthalmologist in private practice with an office full of modern equipment. She examined Warren on Tuesday morning, February 6. Her diagnosis was: traumatic cataract. The history she took from the patient revealed more, about six years ago the vision had become too dim in the damaged left eye after constant swimming in the ocean. Dr Zerfoss advised the cataract should be immediately removed.rsquo; ()

Infrequently, cases of ischaemic optic neuropathy are reported following cardiac surgery. A large study from the Mayo Clinic now documents that this complication is indeed quite infrequent: occurring in 17 of 27 951 patients undergoing cardiopulmonary bypass over an 18 year period. Moreover, the only independent risk factor that could be identified for the development of this rare complication of cardiopulmonary bypass was a low postoperative haemoglobin concentration or presence of diffuse atherosclerotic vascular disease. (OpenUrlCrossRefPubMedWeb of Science)

The cause of type 1 diabetes remains yet to be defined. Nevertheless, a new drug called Dia Pep 277, a laboratory made peptide appears to have helped a small number of diabetic patients. The drug maintained C peptide levels and by doing so pancreatic B cell function in 15 human volunteers for up to 10 months. Wide scale testing of this drug is currently being organised. (OpenUrlCrossRefPubMed)

Marfan syndrome is a heritable connective tissue disorder resulting from mutations in the gene for fibrillin-1. The diagnosis is usually established on a set of well defined clinical criteria. Molecular analysis of the fibrillin-1 gene is now available. In a study from Belgium, a significantly higher incidence of dislocated lenses was found in patients with Marfan syndrome with a FBN-1 mutation than those without it. No correlation was found between the severity of the phenotype and the position and nature of the FBN-1 mutation. (OpenUrlCrossRefPubMedWeb of Science)

Prostate carcinoma remains the most common form of carcinoma in most Western societies. A search for genetic causes of this carcinoma have up until recently has been unproductive. Now preliminary evidence locates a defect in the RNASEL gene on chromosome 1 as being responsible for a small percentage of cases. However, in these cases the carcinoma appears to be among the most aggressive. Individuals with this genetic mutation appear to have poor clinical outcomes. Further studies of genetic factors predisposing patients to prostatic carcinoma are under way. (OpenUrlCrossRefPubMedWeb of Science)

The aetiology of most cases of Parkinson's disease remains obscure. In recent studies of mice folic acid deficiency appears to increase the risk for Parkinson's disease. Moreover, in mice fed adequate amounts of folic acid dopamine neurons underwent spontaneous repair even after intentionally being damaged. Patients with Parkinson's disease have for some time been known often to have low levels of folic acid, but it remains unclear whether this is a cause or defect of this disorder. (OpenUrlCrossRefPubMedWeb of Science)

Coronary heart disease is the leading cause of death among postmenopausal women in most of the Western world. In previous study postmenopausal women who take hormone replacement therapy have approximately a 30% less risk of developing coronary heart disease compared with untreated postmenopausal women. Now, a study from the University of California, San Diego, of raloxifene, a selective oestrogen receptor modulator, documents that over a 4 year study period, the drug did not significantly affect the risk of cardiovascular events in the overall study group. However, it did reduce the risk of cardiovascular events in the women with increased cardiovascular risk factors. Further studies are necessary before the use of raloxifene can be recommended to prevent coronary heart disease in postmenopausal women. (OpenUrlCrossRefPubMedWeb of Science)

The controversy continues concerning whether or not men should have routine prostate (specific antigen) PSA screening. A new study from Stanford University School of Medicine concludes that PSA score between 2 ng/ml and 9 ng/ml are clinically useless in predicting the size and aggressiveness of prostate tumours. The authors of this study concluded that PSA values in the middle range have a limited relation to surgical cure rates. (OpenUrlCrossRefPubMedWeb of Science)

High blood pressure is a significant risk factor for the development of cardiovascular disease. Now a community based prospective cohort study from the Framingham Heart Study suggests that the residual lifetime risk for middle aged patients (55–65 years of age) for developing hypertension and stage 1 high blood pressure or higher is 90%. This obviously indicates that with an ageing population hypertension will continue to be a major public health burden. The authors suggest that significant efforts should be made to alter middle age life styles in order to prevent the development of hypertension. (OpenUrlCrossRefPubMedWeb of Science)

Cholesterol lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) decreases cardiovascular morbidity and mortality in patients with coronary heart disease and in healthy men at high risk for coronary heart disease. Regrettably, many patients on these drugs consider them a cure-all and make no attempt to adhere to a low fat diet. Now a study from Finland suggests that patients who maintain a modified Mediterranean type diet rich in omega-3 fatty acids potentiate the cholesterol's lowering effect of statins and in addition counteract the fasting insulin elevating effects attributed to statins. Moreover, no decrease in serum levels of β carotene and ubiqnique-10, two important antioxidants was found. The authors emphasise the importance of diet as an integral part of statin treatment of the patient with hypercholesterolamia. (OpenUrlCrossRefPubMedWeb of Science)

Drivers and front seat passengers in cars are put at peril when back seat passengers do not fasten their own seat belts. In a study from the University of Tokyo data from car crashes from 1995–99 indicate that drivers and front seat passengers using their seat belts but riding with unbelted back seat passengers are at a two to threefold risk of injury and nearly a fivefold risk for death compared to those travelling with companions using seat belts in the back seat. The force of the unbelted back seat passenger being thrown forward in collisions appears to be a major source of morbidity and mortality. (OpenUrl)

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