Improving paediatric skills may, of course, influence this. A prospective, preferably computerised, review of these deliveries should be established. ACKNOWLEDGEMENTS: We are grateful to all the consultant staff in the
units studied for allowing us access to their cases and also to the records staff in the various hospitals for their help in tracing casenotes. Special thanks to Professor C.R. Whitfield for his helpful criticism ofthis paper. REFERENCES 1 Pettiti DB. Maternal mortality and morbidity in caesarean sections. Clin Obstet Gyneco11985; 28: 763-769.
2 Crowley P and Hawkins OS. Premature breech delivery - the Caesarean section debate. J Obstet Gynecol. 1980;1: 2-6. 3 Beischer NA and Mackay EV. Errors of fetal polarity. In Obstetrics and the Newborn. Ch 26, pI61-166. Published in Eastbourne by Saunders and Co. 1979. 4 Boyle MH, Torrance GW, Sinclair JC, Horwood SP. Economic evaluation of neonatal intensive care of very-Iow-birthweight infants. N Eng! J Med. 1983; 308: 1330-1337. 5 Dewhurst CJ. The ruptured caesarean section scar. J Obstet Gynecol. 1957; 64: 113-118. 6 Tahilramaney MP, Platt MD, Yeh S, DeVore GR, Sipos L, Paul RH. Ultrasonic estimation of weight in the very low-birthweight fetus: A resident versus staff physician comparison. Am J Obstet Gynecol. 1985; 151: 90-1.
0036-9330/92/11191/049 $2.00 in USA © 1992 Scottish Medical Journal
Scot Med J 1992; 37: 049-052
SEASONAL AND CLIMATIC VARIATION IN CHOLESTEROL AND VITAMIN C: EFFECT OF VITAMIN C SUPPLEMENTATION
S.M. MacRury, M. Muir, R. Hume Department of Medicine, Southern General Hospital, Glasgow Abstract: Vitamin C (ascorbic acid) is an important anti-oxidant which may help to reduce free radical damage and atheroma formation in blood vessels. In a studyin which a groupof healthy volunteer subjects werefollowed upfor 12 months and a group ofpatientswith vascular disease taking Vitamin C supplements werefollowedfor 23 months, we confirmed previous findings of seasonal variations in ascorbic acid and cholesterol and have shown an inverse relationship between leucocyte ascorbic acid and serum cholesterol tevels. In healthy control subjects the increase in ascorbate andfall in cholesterol during the summer monthswas reversed when the weather changed to a morewinter pattern,presumablydue to dietary alterations. Wefound thatascorbic acidlevelswerelowerinpatientswithperipheral vasculardisease and that although normal ascorbic acid levels were achieved with Vitamin C supplementation, when supplements were stopped at the height of a normal summer, there was afall in ascorbic acid and a rise in serum cholesterol to winter levels. Giventhesefindings we suggest thatpatientswith vascular disease shouldhave Vitamin C supplements throughout the year. Key words: Seasonal, cholesterol, Vitamin C, vitamin supplementation Introduction Ascorbic acid is an important anti-oxidant, helping to protect cell membranes from free radical damage and to reduce lipid peroxidation which may potentiate vascular damage. 1 Since man is unable to manufacture Vitamin C (ascorbic acid) for his own needs, he is dependent on dietary sources for his daily requirement of this Vitamin. Consequently, in Western countries there is a winter fall in the concentration of Vitamin C in the tissues because of the change in diet from summer to winter, i.e. less fresh fruits and salads are eaten during the winter despite the availability of such foods throughout the year.2 In a previous study we observed that there was a winter rise in serum cholesterol in normal individuals and that this rise could be prevented by the administration of Vitamin C? It seemed of interest to look at the fluctuations in cholesterol and ascorbic acid again, relating the changes in more detail to both season and climate. Patients with peripheral vascular disease have increased lipid peroxidation'' and this could be related to reduced ascorbic acid levels and hence low antioxidant status. The opportunity was therefore taken to Correspondence to: Dr R Hume, Consultant Physician, Medical Unit A, Southern General Hospital, Glasgow G51 4TF
observe the seasonal changes in the cholesterol and ascorbic acid levels in a group of patients suffering from severe peripheral vascular disease who were receiving Vitamin C supplements. Patients and methods Group I consisted of 13 healthy volunteers (6M, 7F). The Table I Baseline values for serum and leucocyte ascorbic acid In the 3 groups ofpatlents being studied. Normal Subjects
Normal Subjects
Vascular Patients
N
13
10
7
Age (years)
37 ±10
58±2
65±5
LAA (nmoI/lOSWBC)
l68±63
167 ±96
87±20
SAA (umoIIJ)
58±25
59±30
l3±4
Cholesterol (mmoIIJ)
5.3 ± 1.0
6.8± 1.6
6.2± 1.2
a, p
units studied for allowing us access to their cases and also to the records staff in the various hospitals for their help in tracing casenotes. Special thanks to Professor C.R. Whitfield for his helpful criticism ofthis paper. REFERENCES 1 Pettiti DB. Maternal mortality and morbidity in caesarean sections. Clin Obstet Gyneco11985; 28: 763-769.
2 Crowley P and Hawkins OS. Premature breech delivery - the Caesarean section debate. J Obstet Gynecol. 1980;1: 2-6. 3 Beischer NA and Mackay EV. Errors of fetal polarity. In Obstetrics and the Newborn. Ch 26, pI61-166. Published in Eastbourne by Saunders and Co. 1979. 4 Boyle MH, Torrance GW, Sinclair JC, Horwood SP. Economic evaluation of neonatal intensive care of very-Iow-birthweight infants. N Eng! J Med. 1983; 308: 1330-1337. 5 Dewhurst CJ. The ruptured caesarean section scar. J Obstet Gynecol. 1957; 64: 113-118. 6 Tahilramaney MP, Platt MD, Yeh S, DeVore GR, Sipos L, Paul RH. Ultrasonic estimation of weight in the very low-birthweight fetus: A resident versus staff physician comparison. Am J Obstet Gynecol. 1985; 151: 90-1.
0036-9330/92/11191/049 $2.00 in USA © 1992 Scottish Medical Journal
Scot Med J 1992; 37: 049-052
SEASONAL AND CLIMATIC VARIATION IN CHOLESTEROL AND VITAMIN C: EFFECT OF VITAMIN C SUPPLEMENTATION
S.M. MacRury, M. Muir, R. Hume Department of Medicine, Southern General Hospital, Glasgow Abstract: Vitamin C (ascorbic acid) is an important anti-oxidant which may help to reduce free radical damage and atheroma formation in blood vessels. In a studyin which a groupof healthy volunteer subjects werefollowed upfor 12 months and a group ofpatientswith vascular disease taking Vitamin C supplements werefollowedfor 23 months, we confirmed previous findings of seasonal variations in ascorbic acid and cholesterol and have shown an inverse relationship between leucocyte ascorbic acid and serum cholesterol tevels. In healthy control subjects the increase in ascorbate andfall in cholesterol during the summer monthswas reversed when the weather changed to a morewinter pattern,presumablydue to dietary alterations. Wefound thatascorbic acidlevelswerelowerinpatientswithperipheral vasculardisease and that although normal ascorbic acid levels were achieved with Vitamin C supplementation, when supplements were stopped at the height of a normal summer, there was afall in ascorbic acid and a rise in serum cholesterol to winter levels. Giventhesefindings we suggest thatpatientswith vascular disease shouldhave Vitamin C supplements throughout the year. Key words: Seasonal, cholesterol, Vitamin C, vitamin supplementation Introduction Ascorbic acid is an important anti-oxidant, helping to protect cell membranes from free radical damage and to reduce lipid peroxidation which may potentiate vascular damage. 1 Since man is unable to manufacture Vitamin C (ascorbic acid) for his own needs, he is dependent on dietary sources for his daily requirement of this Vitamin. Consequently, in Western countries there is a winter fall in the concentration of Vitamin C in the tissues because of the change in diet from summer to winter, i.e. less fresh fruits and salads are eaten during the winter despite the availability of such foods throughout the year.2 In a previous study we observed that there was a winter rise in serum cholesterol in normal individuals and that this rise could be prevented by the administration of Vitamin C? It seemed of interest to look at the fluctuations in cholesterol and ascorbic acid again, relating the changes in more detail to both season and climate. Patients with peripheral vascular disease have increased lipid peroxidation'' and this could be related to reduced ascorbic acid levels and hence low antioxidant status. The opportunity was therefore taken to Correspondence to: Dr R Hume, Consultant Physician, Medical Unit A, Southern General Hospital, Glasgow G51 4TF
observe the seasonal changes in the cholesterol and ascorbic acid levels in a group of patients suffering from severe peripheral vascular disease who were receiving Vitamin C supplements. Patients and methods Group I consisted of 13 healthy volunteers (6M, 7F). The Table I Baseline values for serum and leucocyte ascorbic acid In the 3 groups ofpatlents being studied. Normal Subjects
Normal Subjects
Vascular Patients
N
13
10
7
Age (years)
37 ±10
58±2
65±5
LAA (nmoI/lOSWBC)
l68±63
167 ±96
87±20
SAA (umoIIJ)
58±25
59±30
l3±4
Cholesterol (mmoIIJ)
5.3 ± 1.0
6.8± 1.6
6.2± 1.2
a, p
