Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common.

BACKGROUND: Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons. OBJECTIVE: To assess workplace musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and their implications on surgical practice and occupational longevity. METHODS: An online survey was distributed to resident and surgeon members of the Canadian Society of Vascular Surgery. The survey collected data on demographics, operative volume, and work-related MSK symptoms. RESULTS: The survey was distributed to 188 surgeons and trainees. After three e-mailings, 109 surveys were returned (58% response rate). Of the responders, 87% were male, 51% were 45 years or older, and 56% had been in practice for 10 or more years. Workplace MSK symptoms were reported by 83% of the responders. The most common locations were the low back (78%), neck (74%), and shoulder (30%). Most responders (83%) believed that these symptoms were related to their operative environment. Almost half (48%) sought medical care. As a result of these MSK symptoms, 25% experience chronic pain with 8% reporting time off work as a consequence. Another 11% reported an impact on their operative performance with 14% considering early retirement. A lack of operating room system changes to prevent workplace injury and disability was noted by 85% of the responders although only 3% reported their disability to their department. CONCLUSIONS: Occupational MSK symptoms and disability are common among Canadian vascular surgeons. Further research is needed to create programs to improve surgeon morbidity.

Low prevalence of type 2 diabetes mellitus among patients with high levels of high-density lipoprotein cholesterol.

BACKGROUND: Diabetes mellitus and low levels of high-density lipoprotein cholesterol (HDL-C) are among several known risk factors for coronary artery disease. Recent research has shown potential mechanistic links between these two diseases. OBJECTIVES: The aim of our study was to characterize, by examining particular coronary artery disease risk factors, patients with extremely high and low levels of HDL-C who were referred to a prevention clinic. METHODS: We compared the phenotypes of 113 patients with HDL-C levels greater than the 90th percentile with 212 patients with levels less than the 10th percentile by using a retrospective chart review. RESULTS: The cohort with high HDL-C had a remarkable difference in the incidence of type 2 diabetes (1.8% vs 21.7%). The high HDL-C cohort also had a greater age (52.1 years vs 46.7 years), more light or moderate alcohol consumption (70.8% vs 49.4%), more healthy diet (30.1% vs 22.4%), more light or moderate exercise (90.8% vs 52.2%), and a lower body mass index (25.2 kg/m² vs 28.1 kg/m²). CONCLUSIONS: Compared with the low HDL-C group--and also the general population--the high HDL-C cohort had a remarkably low prevalence of diabetes mellitus.

Paediatric type III dyslipidaemia: a case of vanishing hyperlipidaemia.

An 11-year-old girl presented with palmar and tuberoeruptive xanthomas, and elevated triglycerides and total cholesterol levels. She had an apolipoprotein E2/E2 genotype. A diagnosis of type III dyslipidaemia was made and the patient started on niacin, fenofibrate and salmon oil. At age 18, her lipid levels were well controlled with fenofibrate once weekly. At age 21, the fenofibrate was discontinued and her lipid profile has been normal for the last 4 years. This case history may be consistent with a transient dyslipidaemia.