1343
ing swimming
to
asthmatic children, doctors and others
should bear in mind the potential hazard of bronchial irritation by chlorine. But the risks are probably small in relation to the benefits of sterilisation.
MINDS UNDER THE FLIGHTPATH NO-ONE ought to have to live under the narrow landing corridor to a major airport, but a lot of housing, much of it in the public sector, is so sited. Near London’s Heathrow classroom teaching can be interrupted, lipreading is a useful skill, and subsidies have to be provided for soundproofing buildings. A preliminary communication, published exactly ten years ago, suggested
that stress from exposure to aircraft was reflected in increased admissions to hospital for mental illness. Noise annoys,2 and the din of jet engines is no exception, but the notion that illness severe enough to warrant inpatient psychiatric care might ensue came as a surprise. The first attempt to confirm these findings was by Gattoni and Tarnopolsky ;3 a couple of chi-squared values get near the magic figure when the data are rearranged to suit the original hypothesis, but that is all. Now Tarnopolsky and his colleagues have published a further chapter in the Hounslow/Heathrow/Springfield Hospital saga4 as part of a Medical Research Council programme under the direction of Prof. Michael Shepherd. The latest inquiry is more thorough than the one by Abey-Wickrama et al.,’ and it is on a much larger scale than anything that has gone before. The three studies based on Springfield admissions differ greatly in the way residence, hospital catchment, and noise boundaries were handled. Another negative result would not have been surprising, but instead we get in the third inquiry4 a highly significant trend in the reverse direction-more noise, lower admission-rates. Tarnopolsky and his coworkers do not seem to know what to make of this finding. They warn against drawing conclusions from "exploratory research", yet this was not a pilot study but a careful investigation based on a population of about a million people and covering forty times as many admissions and twice the duration of the earlier studies. Dr Tarnopolsky has kindly provided us with a copy of a paper,5 given at a congress in Freiburg last year, which provides a further twist to the tale. Admissions to the Holloway Sanatorium at Virginia Water, a hospital about one-sixth the size of Springfield and serving a population under the baleful influence of the airport but much more rural in character, support the noise hypothesis for first admissions of single people and for all admissions except for the noisiest zone where the population at risk is small and we are advised to ignore the aberration. Even after a decade of research, therefore, it is not possible to say whether aircraft noise can seriously damage the psyche-indeed it is doubtful if anything 1.
Abey-Wickrama I, a’Brook MF, Gattoni FEG, Herridge CF. Mental hospital admissions and aircraft noise. Lancet 1969; ii: 1275-77.
2. Editorial. Noise, annoyance, and mental health. Lancet 1977; i: 1090. 3. Gattoni F, Tarnopolsky A. Aircraft noise and psychiatric morbidity. Psychol Med 1973; 3: 515-20. 4. Jenkins LM, Tarnopolsky A, Hand DJ, Barker SM. Comparison of three studies of aircraft noise and psychiatric hospital admissions conducted in the same area. Psychol Med 1979; 9: 681-93. 5. Hand DJ, Tarnopolsky A, Barker SM, Jenkins LM. Relationships between psychiatric hospital admissions and aircraft noise: a new study. In: Proceedings of Third International Congress on Noise as a Public Health Problem. (In press.)
useful can be learned from further retrospective studies based on one airport and relating to the early 1970s (even the largest study covers no admissions after Dec. 31, 1972). Intuitively, it would seem unlikely that two populations, one living right under the jets and one further off, would be the same in every respect other than exposure to aircraft noise, but this is difficult to check on at a distance of seven years or more. The problem of social matching is made even harder by the fact that demographic risk factors for psychiatric illness come in unusual packages (an unemployed graduate living on his own, for example). Furthermore, admission or community care for a mental problem is nowadays as likely to be determined on social as on medical grounds; nor can the question of immigrant communities around Heathrow be neglected. more
COLONIC COMPLICATIONS OF ACUTE PANCREATITIS "AcuTE pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera," proclaimed Sir Berkeley Moynihan1 in 1925. This opinion has been supported by an ever-increasing list of complications both intra-abdominal and extra-
abdominal.22 The incidence of primary acute pancreatitis in the United Kingdom varies greatly from year to year,3 but overall the disease seems to be increasing, particularly when associated with alcohol or drugs. Unless this increase is due to very mild forms of pancreatitis, there is likely to be an increase in the complications seen. Abscess and pseudocyst are the commonest intra-abdominal complications; damage to the colon (obstruction, fistula, bleeding, or stricture) is rare, but often life-threatening. (The watery-diarrhoea syndrome with varied serum levels of intestinal polypeptides might also be added to the colonic complications.4 Abcarian and his colleagues5 have reviewed 65 published case reports of colonic complications of acute pancreatitis, together with 10 of their own cases managed in a three-year period in Cook County Hospital, Chicago. This represented 1% of the total number of patients admitted with acute pancreatitis (predominantly alcoholic) during that same period. It is surprising that such colonic complications are not more common since the transverse mesocolon is an intimate anterior relation of the pancreas. 2 of the 10 Chicago patients died, and this creditably low mortality rate was attributed to a high index of clinical suspicion coupled with early aggressive surgery, particularly for colonic bleeding and fistula. Several useful clinical lessons emerge from this paper. The older patients (over 50 years) with mild pancreatitis may have pseudo-obstruction of the colon which must not be mistaken for malignant obstruction or ischaemic colitis; they have a good prognosis. Pseudocysts, inflammatory masses and abscesses must be carefully monitored by repeated clinical examination, ultrasonography, and barium studies to 1. 2.
Moynihan B. Acute pancreatitis. Ann Surg 1925; 81: 132-42. Carey LC. Extra-abdominal manifestations of acute pancreatitis. Surgery 1979; 86: 337-42.
3. Bourke JB. Variation in annual incidence of primary acute pancreatitis in Nottingham 1969-74. Lancet 1975; ii: 967-69. 4. Burbige, EJ, Manning, RJ, Belber JP. Watery diarrhea syndrome with elevated levels of vasoactive intestinal polypeptide associated with pancreatitis and pancreatic pseudocyst. Am J Gastroenterol 1978; 70: 136-40. 5. Abcarian H, Eftaiha M, Kraft AR, Nyhus LM. Colonic complications of acute
pancreatitis. Arch Surg 1979: 114: 995-1001.
ing swimming
to
asthmatic children, doctors and others
should bear in mind the potential hazard of bronchial irritation by chlorine. But the risks are probably small in relation to the benefits of sterilisation.
MINDS UNDER THE FLIGHTPATH NO-ONE ought to have to live under the narrow landing corridor to a major airport, but a lot of housing, much of it in the public sector, is so sited. Near London’s Heathrow classroom teaching can be interrupted, lipreading is a useful skill, and subsidies have to be provided for soundproofing buildings. A preliminary communication, published exactly ten years ago, suggested
that stress from exposure to aircraft was reflected in increased admissions to hospital for mental illness. Noise annoys,2 and the din of jet engines is no exception, but the notion that illness severe enough to warrant inpatient psychiatric care might ensue came as a surprise. The first attempt to confirm these findings was by Gattoni and Tarnopolsky ;3 a couple of chi-squared values get near the magic figure when the data are rearranged to suit the original hypothesis, but that is all. Now Tarnopolsky and his colleagues have published a further chapter in the Hounslow/Heathrow/Springfield Hospital saga4 as part of a Medical Research Council programme under the direction of Prof. Michael Shepherd. The latest inquiry is more thorough than the one by Abey-Wickrama et al.,’ and it is on a much larger scale than anything that has gone before. The three studies based on Springfield admissions differ greatly in the way residence, hospital catchment, and noise boundaries were handled. Another negative result would not have been surprising, but instead we get in the third inquiry4 a highly significant trend in the reverse direction-more noise, lower admission-rates. Tarnopolsky and his coworkers do not seem to know what to make of this finding. They warn against drawing conclusions from "exploratory research", yet this was not a pilot study but a careful investigation based on a population of about a million people and covering forty times as many admissions and twice the duration of the earlier studies. Dr Tarnopolsky has kindly provided us with a copy of a paper,5 given at a congress in Freiburg last year, which provides a further twist to the tale. Admissions to the Holloway Sanatorium at Virginia Water, a hospital about one-sixth the size of Springfield and serving a population under the baleful influence of the airport but much more rural in character, support the noise hypothesis for first admissions of single people and for all admissions except for the noisiest zone where the population at risk is small and we are advised to ignore the aberration. Even after a decade of research, therefore, it is not possible to say whether aircraft noise can seriously damage the psyche-indeed it is doubtful if anything 1.
Abey-Wickrama I, a’Brook MF, Gattoni FEG, Herridge CF. Mental hospital admissions and aircraft noise. Lancet 1969; ii: 1275-77.
2. Editorial. Noise, annoyance, and mental health. Lancet 1977; i: 1090. 3. Gattoni F, Tarnopolsky A. Aircraft noise and psychiatric morbidity. Psychol Med 1973; 3: 515-20. 4. Jenkins LM, Tarnopolsky A, Hand DJ, Barker SM. Comparison of three studies of aircraft noise and psychiatric hospital admissions conducted in the same area. Psychol Med 1979; 9: 681-93. 5. Hand DJ, Tarnopolsky A, Barker SM, Jenkins LM. Relationships between psychiatric hospital admissions and aircraft noise: a new study. In: Proceedings of Third International Congress on Noise as a Public Health Problem. (In press.)
useful can be learned from further retrospective studies based on one airport and relating to the early 1970s (even the largest study covers no admissions after Dec. 31, 1972). Intuitively, it would seem unlikely that two populations, one living right under the jets and one further off, would be the same in every respect other than exposure to aircraft noise, but this is difficult to check on at a distance of seven years or more. The problem of social matching is made even harder by the fact that demographic risk factors for psychiatric illness come in unusual packages (an unemployed graduate living on his own, for example). Furthermore, admission or community care for a mental problem is nowadays as likely to be determined on social as on medical grounds; nor can the question of immigrant communities around Heathrow be neglected. more
COLONIC COMPLICATIONS OF ACUTE PANCREATITIS "AcuTE pancreatitis is the most terrible of all the calamities that occur in connection with the abdominal viscera," proclaimed Sir Berkeley Moynihan1 in 1925. This opinion has been supported by an ever-increasing list of complications both intra-abdominal and extra-
abdominal.22 The incidence of primary acute pancreatitis in the United Kingdom varies greatly from year to year,3 but overall the disease seems to be increasing, particularly when associated with alcohol or drugs. Unless this increase is due to very mild forms of pancreatitis, there is likely to be an increase in the complications seen. Abscess and pseudocyst are the commonest intra-abdominal complications; damage to the colon (obstruction, fistula, bleeding, or stricture) is rare, but often life-threatening. (The watery-diarrhoea syndrome with varied serum levels of intestinal polypeptides might also be added to the colonic complications.4 Abcarian and his colleagues5 have reviewed 65 published case reports of colonic complications of acute pancreatitis, together with 10 of their own cases managed in a three-year period in Cook County Hospital, Chicago. This represented 1% of the total number of patients admitted with acute pancreatitis (predominantly alcoholic) during that same period. It is surprising that such colonic complications are not more common since the transverse mesocolon is an intimate anterior relation of the pancreas. 2 of the 10 Chicago patients died, and this creditably low mortality rate was attributed to a high index of clinical suspicion coupled with early aggressive surgery, particularly for colonic bleeding and fistula. Several useful clinical lessons emerge from this paper. The older patients (over 50 years) with mild pancreatitis may have pseudo-obstruction of the colon which must not be mistaken for malignant obstruction or ischaemic colitis; they have a good prognosis. Pseudocysts, inflammatory masses and abscesses must be carefully monitored by repeated clinical examination, ultrasonography, and barium studies to 1. 2.
Moynihan B. Acute pancreatitis. Ann Surg 1925; 81: 132-42. Carey LC. Extra-abdominal manifestations of acute pancreatitis. Surgery 1979; 86: 337-42.
3. Bourke JB. Variation in annual incidence of primary acute pancreatitis in Nottingham 1969-74. Lancet 1975; ii: 967-69. 4. Burbige, EJ, Manning, RJ, Belber JP. Watery diarrhea syndrome with elevated levels of vasoactive intestinal polypeptide associated with pancreatitis and pancreatic pseudocyst. Am J Gastroenterol 1978; 70: 136-40. 5. Abcarian H, Eftaiha M, Kraft AR, Nyhus LM. Colonic complications of acute
pancreatitis. Arch Surg 1979: 114: 995-1001.
