A case of bilateral anterior glenohumeral dislocation in a young weight trainer is presented. The patient, an insurance clerk, had been using a free weight bar in the bench press position and had become tired when the weight on the bar forced his arms into hyperextension in the midabducted position. The humeral shaft gradually pivoted on the bench and the humeral heads were slowly dislocated anteriorly by the weight of the bar. Simple closed reduction under sedation was performed and there were no complications. After six weeks in bilateral broad arm slings, with pendulum exercises from two weeks, the patient began to mobilise his arms and he achieved a full range of movements. This unusual mechanism of injury has not previously been reported and we recommend that bench pressing should be performed with a weight that can be "locked" to prevent crushing of the user. Furthermore, the bench should be narrow enough to allow the shoulders to overhang, allowing greater extension in the abducted position without the arm pivoting on the edge of the bench. (Br J Sports Med 1998;32:71-72)

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The threat of a vascular complication exists in association with any percutaneous arterial catheterization, but is greater in the more complex interventional techniques. During a 3 1/2-year period from January 1985 through June 1988, 4988 percutaneous transluminal coronary angioplasty procedures were performed at Emory University Hospital. All patients were given heparin during the cardiac intervention, and all had a catheter introducer left in place for several hours after completion of the procedure. Fifty-five iatrogenic vascular complications developed in 52 patients (1%), resulting in 54 corrective operations. Pseudoaneurysm, the most frequent complication, was seen in 35 patients (64%). This was followed by arteriovenous fistula in eight (15%), uncontrolled hemorrhage in six (11%), arterial thrombosis in three (6%), peripheral embolization in two (4%), and bowel ischemia in one patient. The outcome of surgical therapy in the entire group was quite acceptable with no operative mortality, no extremity amputation, and a 7.4% complication rate. Variables that correlated with an increased risk of peripheral vascular problems after percutaneous transluminal coronary angioplasty included advanced age, female gender, thrombolytic therapy, and postprocedural anticoagulation. Variables that did not appear to correlate were hypertension, diabetes, prior percutaneous transluminal coronary angioplasty, antiplatelet therapy, or the size of the guiding catheter used.

The reduction was small but could not be explained in terms of seasonal variation in folate intake and it suggests that smallbowel absorption may be affected by the fibre content of the diet. The mechanism might be similar to that of cholestyramine ' in lowering serum folate levels.The colonic flora may be changed by additional fibre. The urinary indican test is a crude indicator of gastrointestinal bacterial activity, but we found no consistent pattern of change.In the past dietary fibre has been considered physiologically inert. Interest in its metabolic role is now increasing, but research is still at an early stage. We hope that our findings will indicate some further lines of inquiry. In the meantime we conclude that we have not detected any metabolic effect that would contraindicate the use of bran in diverticular disease.We thank Miss P Hewitt, Mrs 0 Patrick, and Miss S Smith of the dietetic department, the nurses of Loddon ward, and the staff of the biochemistry department, Royal Berkshire Hospital, for their help; Dr E V Cox and the general surgeons for their co-operation and encouragement; Mr C Latto and Dr J I Mann for their advice; and Dr P H Coldwell for his radiological help. We are also grateful to the staff of the department of medical illustration, Radcliffe Infirmary, Oxford, for the illustrations and Mrs M Thorogood for the statistical analyses.All three studies form part of the work for an MS thesis (AJMB Medical3Journal, 1976, 1, 430-432 Summary Insulin increased the heart rates of seven diabetics with normal cardiovascular reflexes. This effect, which was not due to hypoglycaemia, was greater in the upright than in the supine position and was produced by as little as one unit given intravenously. This increase in heart rate may be a compensatory response to maintain cardiac output. IntroductionRecent observations have shown that insulin has an effect on the cardiovascular system that is independent of hypoglycaemia12; it provokes postural hypotension in diabetics with autonomic neuropathy' 2 and in patients who have had a sympathectomy.3 We aimed to determine whether a cardiovascular effect of insulin occurs in all diabetics or in only those with neuropathy.