- Email: [email protected]
Christmas Quiz
1254 and
v) fell by about 30%, and this is significant both statistically, and, probably, in practice. Ampicillin is one of the most widely prescribed antibiotics both in hospital and general practice. The drug was not used in this hospital for the prophylaxis of wound sepsis in either 1971
Letters to the Editor SURVIVAL IN ACUTE MYELOID LEUKÆMIA
1974, and the decline in sensitive strains is attribu-
or
increasing therapeutic use of this antibiotic. Our policy of administering a single, intra-incisional dose of cephaloridine for the prophylaxis of wound .sepsis has not encouraged the emergence of either resistant strains of previously sensitive bacteria or of inherently resistant bacteria. On the other hand, the widespread therapeutic use of ampicillin both in hospital and general practice has resulted in a higher proportion of ampicillin-resistant strains in 1974 than in 1971. Should the cephalosporins become as widely prescribed in the future as ampicillin is now, a similar pattern could well table
to
the
emerge for them. We thank Dr K. Froome and his staff in the
Department of Patho-
logy. The following have given generously of their advice: Dr E. J. L. Lowbury (Birmingham), Dr J. D. Anderson (York), Dr C. H. Dash and Dr R. B. Sykes (Glaxo Laboratories), and Mr J. A. Lewis (LC.L, Pharmaceuticals Division). Requests for reprints should be addressed to A. V. P.
SIR,-In their
paper Dr
Burge and his colleagues (Oct. 4,
p. 621) were critical of the intensive treatment of acute myelogenous leukaemia (A.M.L.). They now seem (Nov. 29, p. 1091)
have modified their views in a rather confusing manner. They remain critical of the M.R.C. leukaemia regimens, and state that, because there is no "cure" for A.M.L., special-centre treatment is "inhuman". However, they end their letter by stating that "Undoubtedly centres are needed which aim to improve the treatment of acute myeloid leukaemia" and this must leave the reader wondering just what they do mean. So far two major points have been emphasised—namely, that trials from major centres have advanced knowledge of the disease and that secondly the contention that the quality of life suffers during aggressive treatment is an oversimplification. A detailed comparative analysis of the paper by Dr Burge and his colleagues is needed to place their results in perspective. to
Adults with A.M.L. had a median survival of 2 months in the 1940s.4 The advent of chemotherapeutic agents and better supportive care have resulted in increased frequency of remission and length of survival. In many studies, but not all (table I), the link between remission and survival has been estabTABLE I-EFFECTS OF CHEMOTHERAPY IN A.M.L.
REFERENCES
1. 2. 3. 4. 5.
Evans, C., Pollock, A. V. Br. J. Surg. 1973, 60, 434. Pollock, A. V., Rosenberg, I. L. Br. med. J. 1974, ii, 558. Evans, C., Pollock, A. V., Rosenberg, I. L. Br. J. Surg. 1974, 61, 133. Pollock, A. V., Evans, M. ibid. 1975, 62, 292. Pollock, A. V., Evans, M. J. antimicrob. Chemother. 1975, suppl. 1, p. 71. 6. Lowbury, E. J. L., Ayliffe, G. A. J. Drug Resistance in Antimicrobial Therapy. Springfield, Illinois, 1974. 7. Alder, V. G., Gillespie, W. A. Lancet, 1967, ii, 1062. 8. Richmond, M. H., Sykes, R. B. Adv. microb. Physiol. 1973, 9, 31. 9. Lacey, R. W. J. antimicrob. Chemother. 1975, 1, 25.
’Median survival of those
achievmg complete remission was 104 weeks.
Ara C = cytarabine
Christmas Quiz
lished; therefore ANYONE READ THE LANCET? How well have you read The Lancet in the past 1. 2. 3. 4.
year? Copenhagen?
What drew the men to market in Where lies the wamie? Who wrote an unexpected French best-seller? What medical classic survived three fires, to become
an
octogenarian? 5. What is keh shih ping? 6. Howard, David, Renato-what’s the connection? 7. Lock last July, who next? 8. Erasmus and Paracelsus are well-known Baslers-who’s the fictional third? 9. Plunge the face in cold water-to treat what? 10. Who sniffed at the Thames and stole away? 11. What was New, died, yet ended much alive and Free? 12. They set out from Tokyo but never made Paris-what went
to induce complete remission, a state defined of clinical and haematological normality, is not merely a laboratory achievement, but crucial to the patient’s life prospects. The inference that one continues with aggressive treatment until the patient is either dead or in complete remission is nonsense. Table t clearly documents the increased survival due to chemotherapy, and the results should be related to the median survival (untreated) of 2 months reported by Tivey.4 Aggressive treatment of A.M.L. acknowledges the risk of marrow aplasia. Improvements in supportive care have reduced the numbers of patients who die. However, there are still patients who are either unresponsive to treatment, or who experience profound aplasia, and who die early during the induction phase. Dr Burge and his colleagues proposed an approach which, they suggest, is better in terms of quality of life and which provides an alternative philosophy for the treatment of A.M.L. It is important to examine their treatment programme in some detail.
in
wrong?
13. Forget the Curies, but remember whom? 14. What got the tadpoles swimming again? 15. When Christmas and Eastbourne met in Canada what was the result? A prize, a copy of the book Words (based on a B.B.C. Radio 3 series), will be awarded for the three most nearly correct solutions. Incomplete entries are eligible. Entries, which should be marked Christmas Competition and sent to the London office of The Lancet, will be held unopened until Monday, Feb. 2, to allow overseas readers to enter.
terms
Initial Treatment Protocol
They gave 6-mercaptopurine (6-M.P.) 150 mg daily together 1. Clink, H.MacD., Douglas, I. D. C. Lancet, 1975, ii, 988. 2. Baccarini, M. ibid p. 989. 3. Jacobs, P., Dubovsky, D, ibid. p. 1041. 4. Tivey, H. Ann. N.Y. Acad. Sci. 1954, 60, 322. 5. M.R.C. Leukæmia in Adults Working Party First Report. Br.
med. J. 1963, i, 7. 6. Gee, T. S., Yu, K. P., Clarkson, B. D. Cancer, 1969, 23, 1019. 7. Crowther, D., and others, Br. med. J. 1973, i, 131. 8. Gluckman, E., Basch, A., Varet, B., Dreyfus, B. Cancer, 1973, 31, 487. 9. Clarkson, B. D., Dowling, M. D., Gee, T. S., Cunningham, I. B., Burchenal, J. H. ibid. 1975, 36, suppl. p. 775.
v) fell by about 30%, and this is significant both statistically, and, probably, in practice. Ampicillin is one of the most widely prescribed antibiotics both in hospital and general practice. The drug was not used in this hospital for the prophylaxis of wound sepsis in either 1971
Letters to the Editor SURVIVAL IN ACUTE MYELOID LEUKÆMIA
1974, and the decline in sensitive strains is attribu-
or
increasing therapeutic use of this antibiotic. Our policy of administering a single, intra-incisional dose of cephaloridine for the prophylaxis of wound .sepsis has not encouraged the emergence of either resistant strains of previously sensitive bacteria or of inherently resistant bacteria. On the other hand, the widespread therapeutic use of ampicillin both in hospital and general practice has resulted in a higher proportion of ampicillin-resistant strains in 1974 than in 1971. Should the cephalosporins become as widely prescribed in the future as ampicillin is now, a similar pattern could well table
to
the
emerge for them. We thank Dr K. Froome and his staff in the
Department of Patho-
logy. The following have given generously of their advice: Dr E. J. L. Lowbury (Birmingham), Dr J. D. Anderson (York), Dr C. H. Dash and Dr R. B. Sykes (Glaxo Laboratories), and Mr J. A. Lewis (LC.L, Pharmaceuticals Division). Requests for reprints should be addressed to A. V. P.
SIR,-In their
paper Dr
Burge and his colleagues (Oct. 4,
p. 621) were critical of the intensive treatment of acute myelogenous leukaemia (A.M.L.). They now seem (Nov. 29, p. 1091)
have modified their views in a rather confusing manner. They remain critical of the M.R.C. leukaemia regimens, and state that, because there is no "cure" for A.M.L., special-centre treatment is "inhuman". However, they end their letter by stating that "Undoubtedly centres are needed which aim to improve the treatment of acute myeloid leukaemia" and this must leave the reader wondering just what they do mean. So far two major points have been emphasised—namely, that trials from major centres have advanced knowledge of the disease and that secondly the contention that the quality of life suffers during aggressive treatment is an oversimplification. A detailed comparative analysis of the paper by Dr Burge and his colleagues is needed to place their results in perspective. to
Adults with A.M.L. had a median survival of 2 months in the 1940s.4 The advent of chemotherapeutic agents and better supportive care have resulted in increased frequency of remission and length of survival. In many studies, but not all (table I), the link between remission and survival has been estabTABLE I-EFFECTS OF CHEMOTHERAPY IN A.M.L.
REFERENCES
1. 2. 3. 4. 5.
Evans, C., Pollock, A. V. Br. J. Surg. 1973, 60, 434. Pollock, A. V., Rosenberg, I. L. Br. med. J. 1974, ii, 558. Evans, C., Pollock, A. V., Rosenberg, I. L. Br. J. Surg. 1974, 61, 133. Pollock, A. V., Evans, M. ibid. 1975, 62, 292. Pollock, A. V., Evans, M. J. antimicrob. Chemother. 1975, suppl. 1, p. 71. 6. Lowbury, E. J. L., Ayliffe, G. A. J. Drug Resistance in Antimicrobial Therapy. Springfield, Illinois, 1974. 7. Alder, V. G., Gillespie, W. A. Lancet, 1967, ii, 1062. 8. Richmond, M. H., Sykes, R. B. Adv. microb. Physiol. 1973, 9, 31. 9. Lacey, R. W. J. antimicrob. Chemother. 1975, 1, 25.
’Median survival of those
achievmg complete remission was 104 weeks.
Ara C = cytarabine
Christmas Quiz
lished; therefore ANYONE READ THE LANCET? How well have you read The Lancet in the past 1. 2. 3. 4.
year? Copenhagen?
What drew the men to market in Where lies the wamie? Who wrote an unexpected French best-seller? What medical classic survived three fires, to become
an
octogenarian? 5. What is keh shih ping? 6. Howard, David, Renato-what’s the connection? 7. Lock last July, who next? 8. Erasmus and Paracelsus are well-known Baslers-who’s the fictional third? 9. Plunge the face in cold water-to treat what? 10. Who sniffed at the Thames and stole away? 11. What was New, died, yet ended much alive and Free? 12. They set out from Tokyo but never made Paris-what went
to induce complete remission, a state defined of clinical and haematological normality, is not merely a laboratory achievement, but crucial to the patient’s life prospects. The inference that one continues with aggressive treatment until the patient is either dead or in complete remission is nonsense. Table t clearly documents the increased survival due to chemotherapy, and the results should be related to the median survival (untreated) of 2 months reported by Tivey.4 Aggressive treatment of A.M.L. acknowledges the risk of marrow aplasia. Improvements in supportive care have reduced the numbers of patients who die. However, there are still patients who are either unresponsive to treatment, or who experience profound aplasia, and who die early during the induction phase. Dr Burge and his colleagues proposed an approach which, they suggest, is better in terms of quality of life and which provides an alternative philosophy for the treatment of A.M.L. It is important to examine their treatment programme in some detail.
in
wrong?
13. Forget the Curies, but remember whom? 14. What got the tadpoles swimming again? 15. When Christmas and Eastbourne met in Canada what was the result? A prize, a copy of the book Words (based on a B.B.C. Radio 3 series), will be awarded for the three most nearly correct solutions. Incomplete entries are eligible. Entries, which should be marked Christmas Competition and sent to the London office of The Lancet, will be held unopened until Monday, Feb. 2, to allow overseas readers to enter.
terms
Initial Treatment Protocol
They gave 6-mercaptopurine (6-M.P.) 150 mg daily together 1. Clink, H.MacD., Douglas, I. D. C. Lancet, 1975, ii, 988. 2. Baccarini, M. ibid p. 989. 3. Jacobs, P., Dubovsky, D, ibid. p. 1041. 4. Tivey, H. Ann. N.Y. Acad. Sci. 1954, 60, 322. 5. M.R.C. Leukæmia in Adults Working Party First Report. Br.
med. J. 1963, i, 7. 6. Gee, T. S., Yu, K. P., Clarkson, B. D. Cancer, 1969, 23, 1019. 7. Crowther, D., and others, Br. med. J. 1973, i, 131. 8. Gluckman, E., Basch, A., Varet, B., Dreyfus, B. Cancer, 1973, 31, 487. 9. Clarkson, B. D., Dowling, M. D., Gee, T. S., Cunningham, I. B., Burchenal, J. H. ibid. 1975, 36, suppl. p. 775.