Search

Postgraduate training in the United Kingdom is undergoing radical changes following the `Calman Report'. Commissioned in response to a European Union (EU) Directive, this contained recommendations to allow reciprocal recognition of all EU trained specialists. We present the findings of a postal questionnaire sent to representatives of the European Federation of Oto-Rhino-Laryngological Societies and the otolaryngology professors of the UK and Ireland with a response rate of 62.7%. Aspects assessed included clinical and surgical experience, examinations, teaching, research, length, regulation and perception of training. The programmes share similar teaching and research experience but substantial differences exist in most other areas. The accredited UK trainee has a much wider clinical and surgical repertoire than those from the Continent. Greek trainees were trained to the lowest minimum standard. The requirements of a training system are largely determined by the level of clinical experience and surgical skill required by an independent specialist in a given country.

The possible association between lipoprotein(a) [Lp(a)] and albumin excretion rate (AER) is a topic that generates conflicting views. In addition, Lp(a) phenotypes have not previously been considered as factors influencing AER. In order to clarify this issue, we studied 70 non-insulin-dependent diabetes mellitus (NIDDM) patients without clinically detectable macroangiopathy, 27 with microalbuminuria and 43 without it. Both groups were matched for the known variables that could influence AER and serum Lp(a) levels. Lp(a) was determined by enzyme-linked immunosorbent assay (ELISA), and Lp(a) phenotypes were assessed by electrophoresis followed by immunoblotting. Lp(a) phenotypes were grouped as follows: `small' (F, S1 and S2), `big' (S3 and S4) and `null'. The NIDDM patients with microalbuminuria presented higher serum Lp(a) concentrations than the patients without it [15.7 mg dL -1 (95% CI 0.5-36.5) vs. 4.5 mg dL -1 (95% CI 0.1-18.5); P < 0.001] and a direct correlation between Lp(a) and AER was observed ( r = 0.34; P < 0.01). AER was significantly different when Lp(a) phenotypes were considered [`small': median 19 mug min -1 (range 1-195); `big': median 9.5 mug min -1 (range 1-186); `null': 4 mug min -1 (range 1-9); P = 0.04]. None of the NIDDM patients with a `null' phenotype showed an AER of > 10 mug min -1 . In conclusion, this case-control study provides evidence that microalbuminuria is associated with high serum Lp(a) in NIDDM without clinically detectable macroangiopathy. Furthermore, NIDDM patients with a `null' phenotype could be considered at low risk for the development of microalbuminuria.