The Ministry of Defence's equal opportunities policy, which was introduced in 1993, means that female recruits to army training regiments have been exposed to the same rigorous, physically demanding exercise as men. We noticed a fourfold increase in referrals between 1994 and 1996 and decided to investigate whether this reflected increased referral of women. Subjects, methods, and resultsAlthough radiography is the main diagnostic tool for detecting bone trauma, radionuclide bone scanning is more effective at showing stress fractures, shin splints, and covert fractures. We studied the bone scans of all recruits of an army training regiment who were referred with suspected trauma from 1 April 1995 to 31 March 1997. During this time 4222 recruits (3367 men and 855 women) carried out basic fitness training and were assessed at the regiment.On referral each patient was assessed to determine the site of injury and for the symptoms and signs of bone pain, tenderness, and swelling. A gamma camera was used to take static bone scans of the pelvis and lower limbs three hours after an injection of 555 MBq technetium-99m oxidronate. Scans were reported routinely by one of two nuclear medicine consultants (MAM and CA).In 1997 the scans of all people referred from the training regiment were retrieved and all identifying information removed. Scans were then reassessed and reported blind by MAM. Scans were classified as abnormal if stress fractures or shin splints were present. To test intraobserver agreement MAM reviewed 50 randomly selected scans four weeks later. Agreement on normality was found in 42 out of 50 cases (84%, = 0.66). For interobserver agreement the same scans were assessed by a second consultant (CA) unaware of the patients' identity and previous results. There was agreement in 44 out of 50 cases (88%, = 0.74).A total of 143 men and 121 women were referred with signs and symptoms of lower limb trauma for routine diagnostic radionuclide bone scanning during the study period. The age range was 16-26 (mean 19.5, SD 2.1) for men and 16-30 (20.1, 2.6) for women (P > 0.05 by Student's t test). Nine recruits (three men and six women) were referred twice as a result of repeat injury, resulting in 273 scans.The table shows the numbers of stress fractures and shin splints in men and women. In all, 71% (103/146) of scans were abnormal for men and 76% (97/127) for women, suggesting that no significant sex bias exists in the referral pattern ( 2 = 1.07; P > 0.2). For the nine subjects who had two scans we classified the results as abnormal if either or both of the scans showed an abnormality. This gave an abnormality rate of 71% (101/143) for men and 77% (93/121) for women.The rate of referral for bone scanning was 4.2% (143/3367) for men and 14.2% (121/855) for women (difference 10%, 95% confidence interval 7.5% to 12.3%). A two tailed 2 test with Yates's correction showed that this difference was highly significant ( 2 = 112.4, P < 0.001). Similarly, the difference in the percentage of male and female recruits with abnor...

Boxers who had fought fewer bouts had a tendency to perform better at psychometric tests than those boxers who had fought more bouts. Tc-99m HMPAO SPECT cerebral perfusion scanning showed that controls had less aberrations in cerebral perfusion than the boxers.In conclusion, significant differences were shown in two neurophysiological variables between young amateur sportsmen who box and those who do not. The long term effects of these findings remain unknown.(7 Neurol Neurosurg Psychiatry 1 995;59:368-374)

The findings in a previous paper have provided further support for regimes of treatment which reduce the intestinal uptake of calcium and therefore its urinary excretion in the management of recurrent calcium urolithiasis (Blacklock and Macleod, 1974).Dietary measures have already been used towards this end and Nordin (1972) considers that a diet low in calcium and low in oxalates is the simplest and most effective approach in the treatment of this condition. Sodium phytate has been shown to form a relatively insoluble complex with calcium in the gut and the effect of this has been to lower urinary calcium in patients with idiopathic hypercalciuria (Henneman et al., 1958); there is however an increase in urinary phosphate excretion at the same time . Oral administration of sodium phosphate similarly has the effect of reducing intestinal calcium absorption and urinary calcium excretion but the urinary phosphorus excretion in the form of orthophosphate increases at the same time. Therapeutic use of both sodium phytate and sodium phosphate is therefore accompanied by a possibility of increased tendency to calcium phosphate precipitation on account of the increase in its activity product ratio. (Pak et al., 1971). The thiazides as a group reduce urinary calcium excretion and increase renal excretion of phosphate as pyrophosphate with a concomitant increase in the urinary sodium and potassium. Calcium balance studies carried out at the time of thiazide treatment suggest that calcium is retained during such treatment (Lamberg and Kuhlback, 1959; Lichwitz et al., 1961;Higgins et al., 1964; Yendt, Gagne and Cohamin, 1966;Harrison and Rose, 1968).Sodium cellulose phosphate, the sodium salt of the phosphoric ester of cellulose (Whatman Biochemicals Ltd) is an ion exchange cellulose with special affinity for divalent cations because of the steric configuration of the phosphate radicals attached to the cellulose molecule. In the stomach it exchanges sodium for calcium which is eliminated in the faeces so preventing the absorption of dietary calcium; it similarly binds with secreted calcium preventing its reabsorption. The diminution in calcium absorption is accompanied by a reduction in the renal excretion of calcium and a slight increase in urinary phosphorus but the urine saturation with brushite (CaHP04*2H20), a probable nidus for calcium stones, is reduced (Pak, 1973).This paper describes some observations on the effect of sodium cellulose phosphate on intestinal calcium uptake and urinary calcium excretion in patients with urolithiasis. Further observations are made on the results of a limited clinical application of the substance. Materials and Methods Clinical DataThe effect of cellulose phosphate was evaluated in a series of patients who exhibited intestinal hyperabsorption of calcium and hypercalciuria. All had full general and metabolic investigation including excretion urography. Cases of overt hyperparathyroidism were excluded.