751

ever,

Smyth found

that p-endorphin was cleaved by and that the now familiar smaller brain

endopeptidases peptides y-endorphin (p-lipotropin 61-77), a-endorphin (61-76), and methionine5-enkephalin (61-65) could be under conditions that have been used isolation. He in their implied that these smaller peptide artefacts of extraction and that j3-endorbe merely may phin (alias C-fragment) may be the only true physiologi-

generated from it cal entity.

OFFSHORE MEDICINE INCREASINGLY on the lips of Government committees and others concerned with the North Sea oil and gas industry is the term offshore medicine-a convenient label for an ill-defined collection of skills. That these skills are important was reflected two years ago by the establishment at Aberdeen University of an Institute of Environmental and Offshore Medicine. What is offshore medicine ? It is not a clinical specialty, and no specific postgraduate qualifications are needed to practise it; but the term embraces clinical and preventive skills not brought together elsewhere in medicine. As well as deepsea divers, the population at risk includes men who operate helicopters in difficult conditions and handle ships and submersibles in cold and heavy seas. There are the hazards of a heavy construction industry; and any accident is made harder to deal with by the distance from land. What plans can be made for medical emergencies offshore? The priorities adopted by the Diving Medical Advisory Committee are well suited, not just to divers, but to all sections of the North Sea community. The first is that all offshore personnel must be trained in first-aid; since many hours may elapse before a doctor arrives by sea or helicopter. Resuscitation during this period is the responsibility of a sick-bay attendant ("rig medic") or; if life-supporting measures are required in a pressure chamber, of a suitably trained diver. The second priority is to establish good communications between those at the site of an accident or acute illness and an on-call medical practitioner ashore. Voice communication with ships and offshore structures tends to be unreliable, and important messages passed verbally have to be confirmed by the cumbersome telex. Better communications, to G.P.O. telephone standards, are being installed in some of the more permanent structures but medical emergencies are not confined to these. Communicatior is probably the least reliable link in the provision oi emergency medical assistance offshore. Third in the lis1 of priorities is the training of medical practitioners ir the special problems that they might encounter, not leas) being immersion hypothermia. A number of these doctors must be fit enough and trained to attend a diver still under pressure. All must belong to a practice whict accepts that one of their number is liable to be called away at a few minutes’ notice, probably not to returr for several days. Next in priority is the availability of ar intensive-care team with transportable equipment. Its members must also be ready at short notice to be called away for several days at a time and should be trained tc enter a compression chamber. Finally, there must b(

facilities for evacuation of the sick or injured ashorenot always an easy task. Routine screening of personnel before they start work offshore does much to reduce the number of potential medical emergencies. The annual examination of all divers by an approved doctor, for instance, is required by Government regulations. To make all personnel proficient in first-aid requires a massive training programme. Special training for doctors in the unique biomedical problems of the diver is a particularly urgent task, but there is an eighteen-month waiting-list for the Royal Navy’s introductory course in underwater medicine. Advanced training of a few practitioners in diving emergencies has been undertaken by one oil company (Shell), but the universities have taken little interest in this sphere. Now a section of the oil industry has decided to inject more cash into the onshore facilities that are essential to support offshore medicine. Three companies (BP, Shell, and Esso) have agreed with Aberdeen University to set up a unit which offers a comprehensive medical service to the whole offshore industry-a service which extends far beyond the legal confines of the National Health Service.

OSTEOCHONDRITIS DISSECANS OSTEOCHONDRITIS dissecans is characterised by separation of a piece of articular cartilage which, together with a small piece of underlying bone, forms a loose body within the joint. Most commonly affected are the knee, on the medial femoral condyle, and the elbow, on the capitellum; less frequently the ankle, hip joint, or shoulder. The basic disorder is a type of epiphyseal ischoemic necrosis affecting only the periphery of the bony epiphysis. Konig gave the disorder its name in 1888 but for some time before that date the disease had been recognised. Paget described a case in 1870.’ Patients are usually aged between 15 and 40, and 85-90% are males. The aetiology is not clear. Trauma is a factor in half the patients. Hereditary factors have often been implicated. Some workers have reported cases in several members of one family. Smilliez suggested three possibilities to be considered when two or more members of one family are affected: that a tendency exists for anomalies of ossification in joints; that there is a dysostotic constitutional background, such as a number of members with short stature; and that a hereditary form of multiple epiphyseal disturbance is present. A study by Petrie3 sets the hereditary influences in perspective. He investigated 86 first-degree relatives of 34 patients with unequivocal radiological evidence of osteochondritis dissecans. Only 1 had evidence of the disorder-both elbows affected-and this was the brother of a patient with a lesion in one elbow. In addition, the medical records of second and third degree relatives who had a history suggesting joint disease revealed that none of these had been diagnosed as having osteochrondritis dissecans. Thus, although the disorder can be familial, the commonly seen lesions do not seem to have a genetic link. 1. 2.

Bart’s Hosp. Rep. 1870, 6, 1. Smillie, I. S. Osteochondritis Dissecans; p. 29. Edinburgh, 1960.

Paget, J. St.

3. Petrie, P. W. R. J. Bone Jt Surg. 1977, 59B, 366.

,

Osteochondritis dissecans.

751 ever, Smyth found that p-endorphin was cleaved by and that the now familiar smaller brain endopeptidases peptides y-endorphin (p-lipotropin 61...
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