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ANTITRYPSIN DEFICIENCY
1515 OBSTETRICS AND GYNÆCOLOGY IN THE UNDERGRADUATE CURRICULUM
SIR,-Your report (June 16, p. 1378) on the memorandum from the General Medical Council contains the sentence " But surgery and midwifery are now regarded as mainly suitable for postgraduate study and training ". Elsewhere is " The G.M.C. endorses the view of the Royal Commission on Medical Education that the object of the undergraduate courseis to produce not a fully qualified doctor but an educated man who will become fully qualified by postgraduate training ’ ". Surely nobody concerned with medical education can seriously maintain that a newly qualified doctor can be educated if surgery and midwifery are made just subjects of postgraduate study and training. Training for the craft of these subjects is for the postgraduate years, but an understanding of them, their methods and results will be necessary for a long time to come, for undergraduates. Must the argument be rehearsed yet again ? Why is there so little understanding of modern surgery and obstetrics by those who talk and write about medical education ? Like generals fighting the last war but one, their minds seem to be rooted in the past of their own experiences and prejudices. An index of this is the use of the word " midwifery ". This subject is for midwives. Obstetrics is the study for doctors. Those who do not know the difference have no right to be pontificating about the place of obstetrics in the medical curriculum, for they obviously do not understand what they are talking about. Gynaecology does not appear in your article. Even the diehards must be aware of the " permissive society " and so the importance of this subject in undergraduate education ; that is if they know about modern gynaecology. Please let us have those responsible for medical education at least knowing something of what is actually being taught, rather than assuming that nothing has changed since they were undergraduates. St. Thomas’s
Hospital
Medical School, London SE1.
A.T. deficiency. Positive immunoperoxidase reaction indicating the presence of oft A.T. is black. The reaction is positive on the ribosomes (R), the membranes (M), and deposits of amorphous material in dilated lumina of endoplasmic reticulum. Note that the reaction was positive mainly at periphery of deposits (asterisk).
method which can be applied to electron microscopy and has been already used to detect serum-proteins synthesised by the hepatocytes.5 Immunoperoxidase-positive material was visible not only in the lumina but also on the membranes and ribosomes of the endoplasmic reticulum (see
accompanying figure). PHILIP RHODES.
ANTITRYPSIN DEFICIENCY
SIR,-According to your leader of April 28 (p. 925) on antitrypsin (xl A.T.) deficiency, quoting Talamo,l amorphous material antigenically similar to fxi A.T. would have been demonstrated within the rough endoplasmic reticulum on electron microscopy. Indeed (1) amorphous material has been detected in the cytoplasm of the hepatocytes of these patients on electron microscopy,2.3 and (2) amorphous material seen on optical microscopy has been shown to be antigenically similar to Ki A.T. by immunofluorescence, 2,3 a method which cannot be applied to electron microscopy. To the best of our knowledge, there is no direct evidence for antigenic similarity between Ki A.T. and the amorphous material seen on electron microscopy. Recently, we had the opportunity to study liver specimens from 7 patients with «1 A.T. deficiency (6 with ZZ and 1 with FZ phenotype for the Pi [protease inhibitor] system): the liver was histologically normal in 6 patients and cirrhotic in 1. On electron microscopy, amorphous material was detected in the dilated lumina of endoplasmic reticulum of the hepatocytes in all these patients. This material was shown to be antigenically similar to xl A.T. by immunoperoxidase (anti ot, A.T. antibodies coupled with horseradish peroxidase 4), a Ki
Talamo, R. C J. Allergy clin. Immun. 1971, 48, 240. Sharp, H., Freir, E. in Pulmonary Emphysema and Proteolysis (edited by C. Mittman); p. 101. New York, 1972. 3. Lieberman, J., Mittman, C., Gordon, H. W. Science, 1972, 175, 63. 4. Avrameas, S. Immunochemistry, 1969, 6, 43. 1. 2.
Electron microscopy appearance of hepatocytes in patient with
Unité de Recherches de
Physiopathologie Hépatique, INSERM, Hôpital Beaujon, 92110 Clichy, France. Laboratoire d’Histologie et de Cytologie Pulmonaire, Hôpital Laënnec, 75006 Paris, France.
G. FELDMANN.
J. BIGNON P. CHAHINIAN.
DIARRHŒA, GASTRIC HYPERSECRETION, AND " CHOLECYSTOKININ-LIKE " HORMONE SIR,-Elias et al.6 described a patient with pancreatic and a non-!3 islet-cell tumour of the pancreas cholera "
"
containing
gastric inhibitory peptide (G.i.p.). They overproduction of G.I.P. from the tumour. Syndromes secondary to excessive production of gastrin or glucagon or secretin from none islet-cell tumours have previously been reported. G.I.P. appears to complete the list of known gastrointestinal hormones which have been reported to be elaborated by non-p islet-cell tumours, except for cholecystokinin (c.c.K.). We have studied a patient with diarrhoea, severe gastric hypersecretion, andevidence of a gastric secretagogue in the serum (rat bioassay), but low or normal serumgastrin as determined by radioimmunoassays over three suggest
a
an
years.
Investigation of pancreatic secretion showed a much increased basal volume and bicarbonate as well as secretin-stimulated 5. 6.
Feldmann, G., Penaud-Laurencin, J., Crassous, J., Benhamou, J.-P. Gastroenterology, 1972, 63, 1036. Elias, E., Polak, J. M., Bloom, S. R., Pearse, A. G. E., Welbourn, R. B., Booth, C. C., Kuzio, M., Brown, J. C. Lancet, 1972, ii, 791.
SIR,-Your report (June 16, p. 1378) on the memorandum from the General Medical Council contains the sentence " But surgery and midwifery are now regarded as mainly suitable for postgraduate study and training ". Elsewhere is " The G.M.C. endorses the view of the Royal Commission on Medical Education that the object of the undergraduate courseis to produce not a fully qualified doctor but an educated man who will become fully qualified by postgraduate training ’ ". Surely nobody concerned with medical education can seriously maintain that a newly qualified doctor can be educated if surgery and midwifery are made just subjects of postgraduate study and training. Training for the craft of these subjects is for the postgraduate years, but an understanding of them, their methods and results will be necessary for a long time to come, for undergraduates. Must the argument be rehearsed yet again ? Why is there so little understanding of modern surgery and obstetrics by those who talk and write about medical education ? Like generals fighting the last war but one, their minds seem to be rooted in the past of their own experiences and prejudices. An index of this is the use of the word " midwifery ". This subject is for midwives. Obstetrics is the study for doctors. Those who do not know the difference have no right to be pontificating about the place of obstetrics in the medical curriculum, for they obviously do not understand what they are talking about. Gynaecology does not appear in your article. Even the diehards must be aware of the " permissive society " and so the importance of this subject in undergraduate education ; that is if they know about modern gynaecology. Please let us have those responsible for medical education at least knowing something of what is actually being taught, rather than assuming that nothing has changed since they were undergraduates. St. Thomas’s
Hospital
Medical School, London SE1.
A.T. deficiency. Positive immunoperoxidase reaction indicating the presence of oft A.T. is black. The reaction is positive on the ribosomes (R), the membranes (M), and deposits of amorphous material in dilated lumina of endoplasmic reticulum. Note that the reaction was positive mainly at periphery of deposits (asterisk).
method which can be applied to electron microscopy and has been already used to detect serum-proteins synthesised by the hepatocytes.5 Immunoperoxidase-positive material was visible not only in the lumina but also on the membranes and ribosomes of the endoplasmic reticulum (see
accompanying figure). PHILIP RHODES.
ANTITRYPSIN DEFICIENCY
SIR,-According to your leader of April 28 (p. 925) on antitrypsin (xl A.T.) deficiency, quoting Talamo,l amorphous material antigenically similar to fxi A.T. would have been demonstrated within the rough endoplasmic reticulum on electron microscopy. Indeed (1) amorphous material has been detected in the cytoplasm of the hepatocytes of these patients on electron microscopy,2.3 and (2) amorphous material seen on optical microscopy has been shown to be antigenically similar to Ki A.T. by immunofluorescence, 2,3 a method which cannot be applied to electron microscopy. To the best of our knowledge, there is no direct evidence for antigenic similarity between Ki A.T. and the amorphous material seen on electron microscopy. Recently, we had the opportunity to study liver specimens from 7 patients with «1 A.T. deficiency (6 with ZZ and 1 with FZ phenotype for the Pi [protease inhibitor] system): the liver was histologically normal in 6 patients and cirrhotic in 1. On electron microscopy, amorphous material was detected in the dilated lumina of endoplasmic reticulum of the hepatocytes in all these patients. This material was shown to be antigenically similar to xl A.T. by immunoperoxidase (anti ot, A.T. antibodies coupled with horseradish peroxidase 4), a Ki
Talamo, R. C J. Allergy clin. Immun. 1971, 48, 240. Sharp, H., Freir, E. in Pulmonary Emphysema and Proteolysis (edited by C. Mittman); p. 101. New York, 1972. 3. Lieberman, J., Mittman, C., Gordon, H. W. Science, 1972, 175, 63. 4. Avrameas, S. Immunochemistry, 1969, 6, 43. 1. 2.
Electron microscopy appearance of hepatocytes in patient with
Unité de Recherches de
Physiopathologie Hépatique, INSERM, Hôpital Beaujon, 92110 Clichy, France. Laboratoire d’Histologie et de Cytologie Pulmonaire, Hôpital Laënnec, 75006 Paris, France.
G. FELDMANN.
J. BIGNON P. CHAHINIAN.
DIARRHŒA, GASTRIC HYPERSECRETION, AND " CHOLECYSTOKININ-LIKE " HORMONE SIR,-Elias et al.6 described a patient with pancreatic and a non-!3 islet-cell tumour of the pancreas cholera "
"
containing
gastric inhibitory peptide (G.i.p.). They overproduction of G.I.P. from the tumour. Syndromes secondary to excessive production of gastrin or glucagon or secretin from none islet-cell tumours have previously been reported. G.I.P. appears to complete the list of known gastrointestinal hormones which have been reported to be elaborated by non-p islet-cell tumours, except for cholecystokinin (c.c.K.). We have studied a patient with diarrhoea, severe gastric hypersecretion, andevidence of a gastric secretagogue in the serum (rat bioassay), but low or normal serumgastrin as determined by radioimmunoassays over three suggest
a
an
years.
Investigation of pancreatic secretion showed a much increased basal volume and bicarbonate as well as secretin-stimulated 5. 6.
Feldmann, G., Penaud-Laurencin, J., Crassous, J., Benhamou, J.-P. Gastroenterology, 1972, 63, 1036. Elias, E., Polak, J. M., Bloom, S. R., Pearse, A. G. E., Welbourn, R. B., Booth, C. C., Kuzio, M., Brown, J. C. Lancet, 1972, ii, 791.