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Registry for Radiation Workers, and combined cohort ofnuclear workers in United States future analysis of the registry, which will incorporate all registered cohorts and updated dose histories (in-National cluding internal doses) and have a longer follow up, Atomic homb survivors"0 Registry for Radiation American will provide a firmer basis for deriving risk estimates Whole cohort Doses <_500 mSv Workers workers* from low dose and low dose rate exposures. Cohort size 75 991 95 217 35 933 Person years 2 185 000 1 218 000 705 000 From its inception the registry has been guided by an Collective dose (man Sv) 18 000 3 198 1 140 a Range of doses 0-4 or more 0-0-5 0-0-5 or more 0-0-5 or more avisory committee of eminent epidemiologists. We are Excess relative risk per Sv grateful to themi for their guidance over many years, to Sir

12 Centers for Disease Control. Classification system for human T-lymphotropic virus type Illymphadenopathy-associated virus infections. Ann Intern Med 1986;105:234-7. 13 Centers for Disease Control. Revision of the case definition of acquired immunodeficiency syndrome for national reporting. MMWR 1985;34: 374-5. 14 Peto K, Pike MC, Armitage DR, et al. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples.

A recent paper by Walker et al. (2009) states that iron-deficiency anaemia can no longer be regarded as being a cause of porotic hyperostosis (PH) or cribra orbitalia (CO). It is argued here that this conclusion is not supported by the current literature on iron-deficiency anaemia and associated haematopoietic responses or consequences to this condition. Indeed, iron-deficiency anaemia is still a plausible candidate in any differential diagnosis of lesions identified as PH and/or CO.

OBJECTIVE -Patients with diabetes commonly have a greater degree of anemia for their level of renal impairment than those presenting with other causes of renal failure. To clarify the contribution and differing roles of diabetes and nephropathy in the development of anemia in diabetic patients, we examined the hematologic and hematinic parameters of diabetic patients without nephropathy.RESEARCH DESIGN AND METHODS -The study group was comprised of 62 patients with type 2 diabetes who had been followed for a median of 7 years. For the study, these patients had additional samples taken during their annual routine blood testing for the measurement of extra parameters, including serum ferritin, serum erythropoietin (Epo) levels, and the percentage of reticulocytes. These measurements were combined with the routine parameters Hb, hematocrit, HbA 1c , and glomerular filtration rate.RESULTS -In all, 8 of the 45 male patients (17.8%) and 2 of the 17 female patients (11.8%) were classified as anemic (Hb Ͻ13g/dl and Ͻ11.5g/dl, respectively). Although only a small number of the patients had anemia as defined by normal values, a retrospective analysis of individual patients over time revealed a sustained though small decrease in Hb from initial presentation. A statistically significant difference in Epo levels (P ϭ 0.016 by Kruskal-Wallis test) was observed from the group with the lowest (Hb Յ11.5) to that with the highest (Hb Ն14.5) Hb values, with a median Epo value of 37 (interquartile range 24 -42) vs. 13 (9 -15) IU/l, respectively. In contrast, there was no evidence of an increased reticulocyte response to higher levels of Epo (r ϭ 0.134 [Pearsons], P ϭ 0.36). Reticulocyte counts ranged from 44 (38 -57) to 76.5 (56 -83) in the lowest and highest Hb groups, respectively.CONCLUSIONS -Although only a small number of subjects in the group were overtly anemic, all subjects had an ongoing, small but significant decrease in Hb since presentation. This study of diabetic patients without nephropathy shows an expected increase in Epo production in response to lowering levels of Hb but without the expected reticulocyte response. Diabetes Care 28:1118 -1123, 2005I n the U.K., as in the rest of the Western world, diabetes is the most prevalent cause of renal failure. Over the next 10 years, the number of patients with diabetes and end-stage renal disease is expected to double, causing a significant increase in the burden of care for this patient population (1). Although the prognosis with diabetic nephropathy has improved since early reports (2,3), there remains an excess mortality of 70 -100 times that of an otherwise matched population (4). Survival rates on dialysis remain poor, with up to 33% of patients dying within a year of starting dialysis (4). Furthermore, for patients who require renal replacement therapy, morbidity as assessed by hospitalization is 2-3 times greater than for nondiabetic patients with end-stage renal failure (2). This excess of morbidity and mortality in part relates to the high incidence of cardiovascul...