Drinking and driving pancreatitis

Alcohol abuse is the leading etiologic factor of pancreatitis, although many heavy drinkers do not develop pancreatic damage. Alcohol promotes pancreatitis through a combination of remote (e.g., increased gut permeability to bacterial products such as lipopolysaccharide) and more proximal effects (e.g., altered pancreatic cholinergic inputs), including oxidative damage at the level of the pancreatic acinar cell. Recent evidence indicates that alcohol exposure to rodents disturbs proteostasis in the exocrine pancreas, an effect counterbalanced by homeostatic processes that include both the unfolded protein response (UPR) and autophagy. A corollary to this notion is that pancreatitis results when adaptive responses are insufficiently robust to alleviate the cellular stress caused by alcohol.     

Epilepsy and Driving

The status of the epileptic applicant for a licence to drive a private motor vehicle has changed from total prohibition through a stage of partial approval subject to medical assessment to the present conditional right to a driving licence. We report a study of a series of patients which shows that many and probably most epileptics have obtained driving licences by concealment of their condition, yet the new regulations continue to expect true declarations. It is suggested that, in common with applicants for a public service vehicle or a heavy goods vehicle driving licence, the applicant for a licence to drive a private motor vehicle should provide a medical report of fitness. The epileptic should be included in a general category of medically restricted drivers subject to individual medical assessment.