Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31-71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > -1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.

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The CA125 tumour marker has an established clinical role in monitoring the course of ovarian cancer during and after therapy (Rustin et al, 1996a(Rustin et al, , 1996b. In addition this marker is of value as a prognostic indicator (Gadducci et al, 1995;Nagele et al, 1995) and in the differential diagnosis of pelvic adnexal masses in symptomatic patients (Jacobs et al, 1990;Tingulstad et al, 1996). CA125 is also currently under investigation as a potential screening test for ovarian cancer (Jacobs et al, 1993). Although the role of CA125 in screening remains controversial, there is evidence that serum elevation is associated with an increased risk of ovarian cancer. We have previously reported that asymptomatic postmenopausal women with a CA125 ≥ 30 U ml -1 have a 36-fold increased risk of diagnosis for ovarian cancer in the subsequent year (Jacobs et al, 1996). This data was derived from a multimodal screening study which used pelvic ultrasound as a secondary test. We have now been able to perform a further analysis to quantify the value of pelvic ultrasound in refining the risk of cancer amongst asymptomatic women with CA125 elevation. METHODS DesignThe overall study design has been described in a previous report (Jacobs et al, 1988(Jacobs et al, , 1993. A total of 22 000 post-menopausal women, aged ≥ 45 years underwent serum CA125 screening. Women with a CA125 level ≥ 30 U ml -1 underwent an ultrasound. Transabdominal and/or transvaginal ultrasonography was used to measure the diameter of each ovary in three planes and to document ovarian morphology. Ovarian volume was calculated using the formula for an ovoid (Campbell et al, 1989). Ovarian morphology was classified as normal if the ovaries exhibited uniform hypoechogenicity and smooth outlines. All other morphological appearances were classified as abnormal. Women with abnormal results on scan were referred to a gynaecologist for assessment and further management. All women were followed up annually during the study by a questionnaire that specifically enquired about any illness or hospital visit in the previous year. When information suggested that a study participant may have had a gynaecological malignancy, histopathological and clinical information was obtained from the general practitioner and/or hospital. Statistical analysisIndex cancers were defined as primary invasive epithelial carcinomas of the ovary and fallopian tube (Jacobs et al, 1996). The risk of index cancer at time interval t from the date of ultrasound in volunteers with scans satisfying a particular ultrasound criterion (abnormal ovarian morphology and volume over a specified cutoff) was calculated by dividing the number of volunteers with scans satisfying that criterion who developed index cancers within time t by the total number of volunteers with scans satisfying the criterion. Cumulative risk curves were constructed by plotting the calculated risk values against time. The observed risk of index cancer for all 22 000 study volunteers as well as for all volunteers with CA125 ≥ 30 U ml...