To assess the age- and sex-specific prevalence and risk factors for aneurysms of the abdominal aorta, the authors performed a population-based study in 5,419 subjects (42% men, 58% women) aged 55 years and over. The proximal and distal diameter of the abdominal aorta were measured by ultrasound. An aneurysm was defined as a distal aortic diameter of 35 mm or more or a dilatation of the distal part of the the abdominal aorta of 50% or more. The mean distal and proximal aortic diameter increased 0.7 mm and 0.3 mm, respectively, with every 10 years of age. In 2.1% (95% confidence interval (CI) 1.7-2.5) of the study population, an aneurysm was present, or in 4.1% (95% CI 3.2-4.9) of the men and 0.7% (95% CI 0.4-1.0) of the women. Subjects with an abdominal aneurysm were more likely to be smokers and they had higher serum cholesterol levels and higher prevalence of cardiovascular disease compared with subjects without an aneurysm. The authors conclude that the ultrasound diameter of the abdominal aorta clearly increases with age in both men and women and that the prevalence of aneurysms of the abdominal aorta in older adults in relatively high, especially in men.

Computer-based patient records, although an area of active research, are not in widespread use. In June 1992, 38% of Dutch general practitioners had introduced computer-based patient records. Of these, 70% had replaced the paper patient record with a computer-based record to retrieve and record clinical data during consultations. Possible reasons for the use of computer-based patient records include the nature of Dutch general practice and the early and active role of professional organizations in recognizing the potential of computer-stored patient records. Professional organizations issued guidelines for information systems in general practice, evaluated available systems, and provided postgraduate training that prepares physicians to use the systems. In addition, professional organizations successfully urged the government to reimburse general practitioners part of the expenses related to the introduction of computer-based patient records. Our experience indicates that physicians are willing and able to integrate information technology in their practices and that professional organizations can play an active role in the introduction of information technology.

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Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.

Recent findings suggest a relationship between low serum cholesterol concentrations and risk of death from violent causes, notably suicide.' 2 To explain a possible association between low cholesterol and violent death, a role for serotonin metabolism was suggested by Engelberg and subsequently elaborated by Salter.34 According to these views low cholesterol may be accompanied by a decrease in serum free tryptophan. As a consequence there is less supply of this amino acid to the brain, where it is used to synthesise serotonin. Low serotonin concentrations have been observed in depression and suicide. To our knowledge, no studies have been reported on serotonin metabolism and its relation to cholesterol levels in humans.We assessed whether serotonin metabolism is different in subjects with chronically low serum cholesterol concentrations by comparing serotonin in healthy middle aged men with low serum cholesterol concentrations (4 5 mmol/l or lower) and a reference group with concentrations between 6-0 and 7 0 mmol/l. Subjects, methods, and resultsA cholesterol screening study among 30359 men aged CommentWe found that plasma serotonin concentrations are lower in untreated men with persistently low serum cholesterol concentrations (-4.5 mmol/l) than in a reference group. This supports the hypothesis that serotonin metabolism may be implicated in the observed association between low cholesterol concentrations, behavioural changes, and violent death.The serotonin variables we determined are indirect measures of central nervous system serotonin activity, believed to be involved in the increased risk of violent death. Although plasma and platelet serotonin indices are an accepted model for serotonergic brain neurones, this has limitations that may partly explain the lack of an association of low cholesterol concentrations with platelet serotonin concentrations or serotonin binding as measured in our study. Our finding of lower plasma serotonin concentrations in men with low cholesterol, however, indicates that serotonin metabolism is altered in these subjects.To our knowledge, this is the first study in humans investigating the relation of serum cholesterol and serotonin metabolism. One study in monkeys showed animals with low cholesterols to have lower central nervous system serotonin activity.5 The implications of these findings are unclear, however, as these animals had their cholesterol concentration lowered or increased during dietary intervention.