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PRIAPISM DURING REGULAR DIALYSIS
278 In the disc sensitivity test, 25 µg. discs of colistin sulphate have been shown to produce zones of inhibition with organisms that have minimum inhibitory concentrations in the range usually obtained after the recommended intramuscular dose of 2,000,000 units of C.S.M.S. every 8 hours. The larger 100 µg. discs should be used for testing organisms in urinary infections, since urine normally contains a higher level of colomycin than blood (200400 gg. per ml.). They can also be used to test organisms that are resistant to inhibition by the 25 µg. discs with a view to increasing the dose of colomycin administered if they prove sensitive.
the agricultural community, both official and commercial, whilst concerned about its toxicity, nevertheless consider it
We do not provide instructions as to inoculum size, 3 a survey carried out in 1970, Castle and Elstub found that a variety of different methods of spreading the inoculum were used and there was little evidence of any correlation between the type of inoculum, method of spreading, and the resulting growth. We would, however, be happy to provide information on these points if required. Serum levels of colomycin are reported to average 10-14 g. per ml. after 2,000,000 units and > 25 µg. per ml. after 3,000,000 units intramuscularly. However, these levels do vary widely. Polymyxins act synergistically with the natural bactericidal systems against Escherichia, but are adversely affected, possibly by the calcium present in
CONTRIBUTIONS TO THE LANCET SIR,--In your issue of Jan. 4 (p. 54) I noted the " analysis " under the above title, and reflected upon the purpose of this revelation. To summarise, you reject five out of six signed articles submitted, contributions emanate from sixty countries around the world, and some 5% derive from developing countries. All, no doubt, interesting figures; but without further information the figures are virtually meaningless. The rejection-rate may indicate that five out of six articles are of poor quality, of inappropriate content for The Lancet, limitations of space, &c., &c. The second point of geographic origins of contributions is likewise on first sight impressive and indicative of world-wide respect which The Lancet engenders. Certainly 50% of contributions originating from outside the U.K. is notable, but again this proportion could reflect a deliberate bias on the part of the editor(s). It may be that you have predetermined as a deliberate policy, for example, that only 50% of contributions should be from within the U.K. and that (to promote sales for example) you reserve 20% of space for U.S.A. contributions. The third point-that some 4-5% of contributions derive from underdeveloped territories-is interesting, but what proportion of those 566 that achieved publication were from developing countries ? Taking as acknowledged that The Lancet has international status over and above many local journals in developing countries, I raise the issue as to whether it is in the interests of the local journals that you should publish such articles. Is it not derogatory to the improvement of the standards and circulation of such journals ? Are the articles of more worldwide significance than of local interest ? On what basis do you make your selection ? -The issue cannot be avoided by replying that you are not responsible for the submissions (and I admit to personal guilt!). It is a serious point as to whether you should encourage overseas authors by accepting the cream of articles, or whether you should support the development of local journals by referring back all articles for first refusal by the local journal. The criteria for acceptance are critical. The essence of this letter is to point out that the mere publication of such figures without an accompanying" explanation (is there a distinction between " signed articles and " signed contributions " ?) of editorial policy and intent is somewhat valueless-though perhaps ego-inflating on first sight. And to stimulate you into publishing a clear statement-or have I missed the relevant editorial ?
since, in
serum, in their action
against Pseudomonas.4
Pharmax Medical Limited, Bourne Road, Bexley, Kent DA5 1NX.
SUSAN F. SULLMAN, Head of Technical Services Department.
PRIAPISM DURING REGULAR DIALYSIS SIR,--The correspondence following the paper by Dr Port and others (Nov. 30, p. 1287) describes the difficulties of treatment of this condition, particularly when Peyronie’s disease has developed. The most heroic treatment, including surgery, seems to be of little value. May I draw attention to the paper by Heslop et al.5, describing the value of ultrasonic therapy in these cases, which the authors describe as having " material advantages over radiotherapy, surgery, steroid therapy, or other drug administration " ? Manchester Victoria Memorial
Jewish Hospital, Cheetham, Manchester M8 8TT.
BERNARD SANDLER.
PARAQUAT SIR,—The letter of Dr Binnie (Jan. 18, p. 169) about paraquat requires some comment. Inquiry of the Regional Poisons Centres does not confirm his quoted figures. In the United Kingdom in 1974 there were 34 deaths due to paraquat, of which 21 were suicides, 7 of unknown circumstances, and 2 homicidal. The deaths were not concentrated in any particular area as Dr Binnie’s figures might suggest. A recent review of paraquat poisoning6 showed that, at the time of writing, of 97 cases recorded in the medical literature 29 recovered, and our own records of other cases confirm this proportion. It is to be hoped that the recently suggested treatmentwill improve these figures. The ethical justification for the continued use of paraquat must be in its great value in helping food production. Due to its unique properties it is at present irreplaceable by other herbicides in most applications. In well over 100 countries 3. 4.
Castle, A. R., Elstub, J. J. clin. Path. 1971, 24, 773. Davis, S. D., Iannetta, A., Wedgwood, R. O. J. infect. Dis. 1971, 123, 392.
5. Heslop, R. W., Oakland, D. J., Maddox, B. T. Br. J. Urol. 1967, 39. 6. Fletcher, K., in Forensic Toxicology (edited by B. Ballantyne); p. 86. Bristol, 1974. 7. Smith, L. L., Wright, A., Wyatt, I., Rose, M. S. Br. med. J. 1974, iv, 569.
indispensable. Imperial Chemical Industries Limited, Alderley Park, near Macclesfield, Cheshire SK10 4TJ.
K. FLETCHER.
Department of Tropical Community Health,
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA.
REX FENDALL.
**Our note was deliberately terse: good readers, like good eaters, are usually concerned more with the fare that is placed before them than with the source of the ingredients that
included or excluded. But this short note its like (3 column-inches), predecessors covering the years from 1966 onwards, may have had some slight value in providing evidence and solace to disappointed authors who had been notified in the previous twelve months that their were
the agricultural community, both official and commercial, whilst concerned about its toxicity, nevertheless consider it
We do not provide instructions as to inoculum size, 3 a survey carried out in 1970, Castle and Elstub found that a variety of different methods of spreading the inoculum were used and there was little evidence of any correlation between the type of inoculum, method of spreading, and the resulting growth. We would, however, be happy to provide information on these points if required. Serum levels of colomycin are reported to average 10-14 g. per ml. after 2,000,000 units and > 25 µg. per ml. after 3,000,000 units intramuscularly. However, these levels do vary widely. Polymyxins act synergistically with the natural bactericidal systems against Escherichia, but are adversely affected, possibly by the calcium present in
CONTRIBUTIONS TO THE LANCET SIR,--In your issue of Jan. 4 (p. 54) I noted the " analysis " under the above title, and reflected upon the purpose of this revelation. To summarise, you reject five out of six signed articles submitted, contributions emanate from sixty countries around the world, and some 5% derive from developing countries. All, no doubt, interesting figures; but without further information the figures are virtually meaningless. The rejection-rate may indicate that five out of six articles are of poor quality, of inappropriate content for The Lancet, limitations of space, &c., &c. The second point of geographic origins of contributions is likewise on first sight impressive and indicative of world-wide respect which The Lancet engenders. Certainly 50% of contributions originating from outside the U.K. is notable, but again this proportion could reflect a deliberate bias on the part of the editor(s). It may be that you have predetermined as a deliberate policy, for example, that only 50% of contributions should be from within the U.K. and that (to promote sales for example) you reserve 20% of space for U.S.A. contributions. The third point-that some 4-5% of contributions derive from underdeveloped territories-is interesting, but what proportion of those 566 that achieved publication were from developing countries ? Taking as acknowledged that The Lancet has international status over and above many local journals in developing countries, I raise the issue as to whether it is in the interests of the local journals that you should publish such articles. Is it not derogatory to the improvement of the standards and circulation of such journals ? Are the articles of more worldwide significance than of local interest ? On what basis do you make your selection ? -The issue cannot be avoided by replying that you are not responsible for the submissions (and I admit to personal guilt!). It is a serious point as to whether you should encourage overseas authors by accepting the cream of articles, or whether you should support the development of local journals by referring back all articles for first refusal by the local journal. The criteria for acceptance are critical. The essence of this letter is to point out that the mere publication of such figures without an accompanying" explanation (is there a distinction between " signed articles and " signed contributions " ?) of editorial policy and intent is somewhat valueless-though perhaps ego-inflating on first sight. And to stimulate you into publishing a clear statement-or have I missed the relevant editorial ?
since, in
serum, in their action
against Pseudomonas.4
Pharmax Medical Limited, Bourne Road, Bexley, Kent DA5 1NX.
SUSAN F. SULLMAN, Head of Technical Services Department.
PRIAPISM DURING REGULAR DIALYSIS SIR,--The correspondence following the paper by Dr Port and others (Nov. 30, p. 1287) describes the difficulties of treatment of this condition, particularly when Peyronie’s disease has developed. The most heroic treatment, including surgery, seems to be of little value. May I draw attention to the paper by Heslop et al.5, describing the value of ultrasonic therapy in these cases, which the authors describe as having " material advantages over radiotherapy, surgery, steroid therapy, or other drug administration " ? Manchester Victoria Memorial
Jewish Hospital, Cheetham, Manchester M8 8TT.
BERNARD SANDLER.
PARAQUAT SIR,—The letter of Dr Binnie (Jan. 18, p. 169) about paraquat requires some comment. Inquiry of the Regional Poisons Centres does not confirm his quoted figures. In the United Kingdom in 1974 there were 34 deaths due to paraquat, of which 21 were suicides, 7 of unknown circumstances, and 2 homicidal. The deaths were not concentrated in any particular area as Dr Binnie’s figures might suggest. A recent review of paraquat poisoning6 showed that, at the time of writing, of 97 cases recorded in the medical literature 29 recovered, and our own records of other cases confirm this proportion. It is to be hoped that the recently suggested treatmentwill improve these figures. The ethical justification for the continued use of paraquat must be in its great value in helping food production. Due to its unique properties it is at present irreplaceable by other herbicides in most applications. In well over 100 countries 3. 4.
Castle, A. R., Elstub, J. J. clin. Path. 1971, 24, 773. Davis, S. D., Iannetta, A., Wedgwood, R. O. J. infect. Dis. 1971, 123, 392.
5. Heslop, R. W., Oakland, D. J., Maddox, B. T. Br. J. Urol. 1967, 39. 6. Fletcher, K., in Forensic Toxicology (edited by B. Ballantyne); p. 86. Bristol, 1974. 7. Smith, L. L., Wright, A., Wyatt, I., Rose, M. S. Br. med. J. 1974, iv, 569.
indispensable. Imperial Chemical Industries Limited, Alderley Park, near Macclesfield, Cheshire SK10 4TJ.
K. FLETCHER.
Department of Tropical Community Health,
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA.
REX FENDALL.
**Our note was deliberately terse: good readers, like good eaters, are usually concerned more with the fare that is placed before them than with the source of the ingredients that
included or excluded. But this short note its like (3 column-inches), predecessors covering the years from 1966 onwards, may have had some slight value in providing evidence and solace to disappointed authors who had been notified in the previous twelve months that their were