- Email: [email protected]
The Savoy hospital not a plush hotel?
*Positive: if mother and/or father had tonsillectomy; tp-value relating to the groups positive and negative; *without physician families. Table: Tonsillectomy prevalence in children (percentage)
Figure: Penetration of various antibiotics into pancreatic juice Percentage
of
serum
concentrations shown.
a more important part in causing fatal complications in necrotising pancreatitis than did the pathogens usually found in pancreatic necrotic tissue. Indeed, a previous study in which the broad-spectrum antibiotic imipenem was used prophylactically in patients with necrotising pancreatitis, showed no significant effect on mortality. However, imipenem has rather poor penetration into pancreatic tissue-eg, we have shown that the concentration of imipenem in pancreatic juice is only 7% of that in the serum.2 This finding is in contrast to clindamycin3 which has a concentration in pancreatic juice that is 35% of the concentration in serum and ofloxacin4 and pefloxacin,s which have a penetration of 84% and 89%, respectively, into the pancreatic juice (figure). Thus, although Sainio and colleagues clearly show a beneficial effect of prophylactic treatment with cefuroxime in severe pancreatitis, we believe that even better results would be obtained with ofloxacin, pefloxacin, or possibly even clindamycin. ‘
*Gunnar
Tydén,
Christina
We analysed for those two groups of families children’s data on tonsillectomy according to the tonsillectomy status of their parents. The table shows our results. Physicians’ children had significantly fewer tonsillectomies (18-3%) than those in the general population (33-0%), suggesting that having a medical doctor as father or mother represents a protective factor. Having at least one parent with positive tonsillectomy status increases significantly the probability of the child having a tonsillectomy, irrespective of the professional status of the parents (physician or other). Thus, tonsillectomy seems to be largely a familytransmissible surgical procedure in which the role of psychological and environmental factors deserves further attention. Living in a physician family in which neither of the parents has had a tonsillectomy seems to be the best way to avoid this often ritualistic and traumatic2,3 surgical procedure. Unfortunately, we do not have enough data in our physician sample to analyse with sufficient statistical power the tonsillectomy status of otorhinolaryngologists’ children. *Gianfranco
Domenighetti, Brigitte
E
Bisig
*Cantonal Health Office, 6500 Bellinzona, Switzerland; and Faculty of Economics and Social Sciences, University of Geneva; and Institute of Social and Preventive Medicine, University of Zurich (B E Bisig)
Brattström, Anna-Stina Malmborg
Departments of *Transplantation Surgery and Microbiology, Karolinska Institute,
Huddinge Hospital, 141 86 Huddinge, Sweden
1
Casabianca A, Gutzwiller F, Martinoli S. Revisiting informed consumer of surgical procedures: the physicianpatient. Int J Techn Assess Health Care 1993; 9: 505-13. American Child Health Association. Physical defects: the pathway to correction. New York: Research Div Am Child Health Assoc, 1934. Ham C. Health care variations: assessing the evidence. London: King’s Fund Institute, 1988.
Domenighetti G, the
1
2
3
4
5
Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter trial of antibiotic prophylaxis of septic complications in acute necrotising pancreatitis with imipenem. Surg Gynecol Obstet 1993; 176: 480-83. Brattström C, Malmborg AS, Tydén G. Penetration of imipenem into human pancreatic juice following single intravenous dose administration. Chemotherapy 1989; 35: 83-87. Brattström C, Malmborg AS, Tydén G. Penetration of clindamycin, cefoxitin and pipercillin into pancreatic juice in man. Surgery 1988; 103: 563-67. Brattström C, Malmborg AS, Tydén G. Penetration of ciprofloxacin and ofloxacin into human allograft pancreatic juice. J Antimicrob Chemother 1988; 22: 213-19. Malmborg AS, Brattström C, Tydén G. Penetration of pefloxacin into human allograft pancreatic juice. J Antimicrob Chemother 1990; 25: 393-97.
Tonsillectomy: procedure
a
family-transmissible surgical
SiR-To the debate on parents’ influence on the decision to undertake tonsillectomy in children (Fried, Sept 9, p 714, and Edelmann, Oct 21, p 1110), we offer a statistical subanalysis of Swiss data from a recently published study comparing the life-long history (prevalence) of seven common surgical procedures between representative samples of families of physicians and of the general population.’ Tonsillectomy in physicians’ families was regarded as the gold standard because of the key position of medical doctors to recognise the risks as well as the benefits of medical
procedures. 1376
2 3
The
most
Savoy hospital
not
a
plush hotel?
SIR—Porter (Nov 4, p 1216) is of course correct that Henry VII’s prestige project, the Savoy Hospital, "was not a plush hotel". But it was planned, designed, and built to the highest international standards, those of the S Maria Nuova Hospital in Florence.’ Certainly the art was of royal quality, the angel pendants on the roof were by Humphrey Coke (as at Corpus Christi and Christ Church, Oxford) and the east window Last Judgment by Bernard Flower (of King’s College Chapel, Cambridge). The staff wore blue gowns with a red Tudor rose on the breast and more than 100 beds had counterpanes and curtains paled in Tudor colours white and green with a red rose in the centre. J H Baron Gastroenterology Unit,
1
St
Mary’s Hospital, London W2 1NY,
UK.
Somerville R. The Savoy: Manor, Hospital, Chapel. Chancellor and Council of the Duchy of Lancaster: London, 1960.
DEPARTMENT OF ERROR Multiple Introductions of HIV-1 subtype E mto the western hemisphereIn the US printing of this short report by Artenstein and colleagues (Nov 4, p 1197), Donald S Burke’s name was omitted as the final author.
Figure: Penetration of various antibiotics into pancreatic juice Percentage
of
serum
concentrations shown.
a more important part in causing fatal complications in necrotising pancreatitis than did the pathogens usually found in pancreatic necrotic tissue. Indeed, a previous study in which the broad-spectrum antibiotic imipenem was used prophylactically in patients with necrotising pancreatitis, showed no significant effect on mortality. However, imipenem has rather poor penetration into pancreatic tissue-eg, we have shown that the concentration of imipenem in pancreatic juice is only 7% of that in the serum.2 This finding is in contrast to clindamycin3 which has a concentration in pancreatic juice that is 35% of the concentration in serum and ofloxacin4 and pefloxacin,s which have a penetration of 84% and 89%, respectively, into the pancreatic juice (figure). Thus, although Sainio and colleagues clearly show a beneficial effect of prophylactic treatment with cefuroxime in severe pancreatitis, we believe that even better results would be obtained with ofloxacin, pefloxacin, or possibly even clindamycin. ‘
*Gunnar
Tydén,
Christina
We analysed for those two groups of families children’s data on tonsillectomy according to the tonsillectomy status of their parents. The table shows our results. Physicians’ children had significantly fewer tonsillectomies (18-3%) than those in the general population (33-0%), suggesting that having a medical doctor as father or mother represents a protective factor. Having at least one parent with positive tonsillectomy status increases significantly the probability of the child having a tonsillectomy, irrespective of the professional status of the parents (physician or other). Thus, tonsillectomy seems to be largely a familytransmissible surgical procedure in which the role of psychological and environmental factors deserves further attention. Living in a physician family in which neither of the parents has had a tonsillectomy seems to be the best way to avoid this often ritualistic and traumatic2,3 surgical procedure. Unfortunately, we do not have enough data in our physician sample to analyse with sufficient statistical power the tonsillectomy status of otorhinolaryngologists’ children. *Gianfranco
Domenighetti, Brigitte
E
Bisig
*Cantonal Health Office, 6500 Bellinzona, Switzerland; and Faculty of Economics and Social Sciences, University of Geneva; and Institute of Social and Preventive Medicine, University of Zurich (B E Bisig)
Brattström, Anna-Stina Malmborg
Departments of *Transplantation Surgery and Microbiology, Karolinska Institute,
Huddinge Hospital, 141 86 Huddinge, Sweden
1
Casabianca A, Gutzwiller F, Martinoli S. Revisiting informed consumer of surgical procedures: the physicianpatient. Int J Techn Assess Health Care 1993; 9: 505-13. American Child Health Association. Physical defects: the pathway to correction. New York: Research Div Am Child Health Assoc, 1934. Ham C. Health care variations: assessing the evidence. London: King’s Fund Institute, 1988.
Domenighetti G, the
1
2
3
4
5
Pederzoli P, Bassi C, Vesentini S, Campedelli A. A randomized multicenter trial of antibiotic prophylaxis of septic complications in acute necrotising pancreatitis with imipenem. Surg Gynecol Obstet 1993; 176: 480-83. Brattström C, Malmborg AS, Tydén G. Penetration of imipenem into human pancreatic juice following single intravenous dose administration. Chemotherapy 1989; 35: 83-87. Brattström C, Malmborg AS, Tydén G. Penetration of clindamycin, cefoxitin and pipercillin into pancreatic juice in man. Surgery 1988; 103: 563-67. Brattström C, Malmborg AS, Tydén G. Penetration of ciprofloxacin and ofloxacin into human allograft pancreatic juice. J Antimicrob Chemother 1988; 22: 213-19. Malmborg AS, Brattström C, Tydén G. Penetration of pefloxacin into human allograft pancreatic juice. J Antimicrob Chemother 1990; 25: 393-97.
Tonsillectomy: procedure
a
family-transmissible surgical
SiR-To the debate on parents’ influence on the decision to undertake tonsillectomy in children (Fried, Sept 9, p 714, and Edelmann, Oct 21, p 1110), we offer a statistical subanalysis of Swiss data from a recently published study comparing the life-long history (prevalence) of seven common surgical procedures between representative samples of families of physicians and of the general population.’ Tonsillectomy in physicians’ families was regarded as the gold standard because of the key position of medical doctors to recognise the risks as well as the benefits of medical
procedures. 1376
2 3
The
most
Savoy hospital
not
a
plush hotel?
SIR—Porter (Nov 4, p 1216) is of course correct that Henry VII’s prestige project, the Savoy Hospital, "was not a plush hotel". But it was planned, designed, and built to the highest international standards, those of the S Maria Nuova Hospital in Florence.’ Certainly the art was of royal quality, the angel pendants on the roof were by Humphrey Coke (as at Corpus Christi and Christ Church, Oxford) and the east window Last Judgment by Bernard Flower (of King’s College Chapel, Cambridge). The staff wore blue gowns with a red Tudor rose on the breast and more than 100 beds had counterpanes and curtains paled in Tudor colours white and green with a red rose in the centre. J H Baron Gastroenterology Unit,
1
St
Mary’s Hospital, London W2 1NY,
UK.
Somerville R. The Savoy: Manor, Hospital, Chapel. Chancellor and Council of the Duchy of Lancaster: London, 1960.
DEPARTMENT OF ERROR Multiple Introductions of HIV-1 subtype E mto the western hemisphereIn the US printing of this short report by Artenstein and colleagues (Nov 4, p 1197), Donald S Burke’s name was omitted as the final author.