- Email: [email protected]
CONFIDENTIALITY
933 of the broad anti-metastatic effect of thrombocytopenia, on the one hand, and the enhancing effect on tumour spread of agents (fibroblasts) inducing platelet aggregation, on the other. The results have intriguing implications for the therapy of human malignant disease. Department of Pathology and Department of Internal Medicine and
Presbyterian-University of Pennsylvania Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, U.S.A.
GABRIEL J. GASIC TATIANA B. GASIC SCOTT MURPHY.
TREATMENT OF LOWER-LIMB ŒDEMA IN RHEUMATOID ARTHRITIS
SIR The relief of lower-limb cedema in patients with rheumatoid arthritis may be a major problem of management, particularly in the provision of adequate footwear.1 Studies 2,3 have suggested a vascular cause for this oedema, and encouraged its dissolution by physical means. We have achieved similar results to those reported by Dr. Holt and Dr. Bennett (Sept. 30, p. 688) using materials freely available on any ward. The patient lies in bed with the feet elevated for half-anhour each morning and evening. At the end of the halfhour, a blue-line bandage is applied from the toes upwards. This is worn until the beginning of the next period of leg elevation. This treatment has the additional advantage of leaving the patient ambulant for all but one hour of the day. Rheumatism Research Unit, School of Medicine, 44 Clarendon Road, Leeds LS2 9PJ.
IAN HASLOCK.
LOCALISATION OF HUMAN ENTEROKINASE SIR,—Enterokinase (enteropeptidase, EC3.4.4.8) initiates the pancreatic digestion of dietary protein by conversion of
trypsinogen into trypsin, which in
turn
activates the other
pro-enzymes of the pancreas. Thus enterokinase is a key enzyme for the utilisation of protein, the absence of which entails severe clinical symptoms.1 Recently, Eggermont et al.have proposed that the Brunner glands may be involved in the formation and secretion of enterokinase. They base their concept on a demonstrated correlation between the presence of enterokinase and of
proteolytic
Brunner glands at different levels of human duodenum. Enterokinase and Brunner glands are found only in biopsy specimens from the upper part of the duodenum. However, we have shown that in the rat duodenum enterokinase is exclusively present in the villi and on the subcellular level bound to the superficial brush-border membrane of the villous epithelial cells. 3-6 No enterokinase activity is found in the Brunner glands or in the crypts of Lieberkuhn. Experiments now performed with pieces of human intestine (see accompanying figure) reveal that the human enterokinase has the same principal distribution within the duodenal wall as is found for enterokinase in the rat. Furthermore, human enterokinase activity present in a mucosal homogenate is not soluble but strongly particle-bound, as brush-border enzymes like the disaccharidases. These findings make it very unlikely that enterokinase is formed in the Brunner glands. They strongly support the concept that enterokinase is synthesised in the epithelial cells of the villus and that enterokinase is a genuine brush-border enzyme in the same way as, for instance, sucrase. Moreover, we have found enterokinase activity in biopsies from all parts of human duodenum, although highest activities seem to be present in the upper duodenum (in collaboration with Professor A. Norden). Enterokinase has recently been immunochemically
CONFIDENTIALITY
SIR,-It seems that confidentiality has almost disappeared from the N.H.S. hospital service, and that anyone who telephones an outpatient department office states that he is a doctor can often get almost information about a patient. any I suggest that all doctors and their relatives who are to be admitted to hospital should prepare in advance (when they can) a statement to be" handed to a" senior hospital official and copied on any permission form they are asked to sign, as follows: or a
"
ward and
No information about my case is to be the telephone or otherwise to anyone other than members of the hospital staff directly concerned with the diagnosis and treatment, even if the enquirer states that he is a member of N.H.S. staff or is medically qualified." CONFIDENTIALITY.
given
over
The demanding, obtaining, or distribution of such information is completely improper and unprofessional when made by anyone not needing the information for diagnosis or treatment of the patient, and ought to be illegal. It has in several cases led to legal action in which damages and costs have amounted to thousands of pounds. A clear statement of policy on this matter is long overdue from the General Medical Council. All N.H.S. staff should be required to sign a statement as a condition of employment, undertaking to refuse information over the telephone or to anyone not entitled to it, unless the patient has given permission in writing. It is also clear that such information must not become available from computer banks. St. Peter’s Hospitals, London W.C.2. 1. Haslock, D. I., Wright, V. Ann. 2. Park, D. C., Swinburne, K. Br. 3. Swinburne, K. ibid. p. 1541.
A. E. FRANCIS. phys. Med. 1970, 10, med. J. 1964, i, 86.
236.
HOMOGENATE
Distribution of enterokinase duodenum.
activity
NUMBER
within wall of human
A small piece of intestine from upper duodenum of a 60-yearold man was horizontally sectioned in a cryostat. Each homogenate contains seven 20 u thick sections, serially cut from the tips of the villi to the muscle layer. s.M.==submucosal tissue Å =total activity; . = specific containing Brunner glands. activity (units per mg. protein). Highest total and specific activities were arbitrarily set at 100, to obtain relative activities.
Hadorn, B., Tarlow, M. J., Lloyd, J. K., Wolff, O. H. Lancet, 1969, i, 812. 2. Eggermont, E., Molla, A. M., Rutgeerts, L., Tytgat, G. ibid. 1971, ii, 369. 3. Nordstroom, C., Dahlqvist, A. Biochim. biophys. Acta, 1970, 198, 621. 4. Nordström, C., Danlqvist, A. Proceedings of 4th World Congress of Gastroenterology, Copenhagen, 1970, abstract no. 130. 5. Nordström, C., Dahlqvist, A. Biochim. biophys. Acta, 1971, 242, 209. 1.
Presbyterian-University of Pennsylvania Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, U.S.A.
GABRIEL J. GASIC TATIANA B. GASIC SCOTT MURPHY.
TREATMENT OF LOWER-LIMB ŒDEMA IN RHEUMATOID ARTHRITIS
SIR The relief of lower-limb cedema in patients with rheumatoid arthritis may be a major problem of management, particularly in the provision of adequate footwear.1 Studies 2,3 have suggested a vascular cause for this oedema, and encouraged its dissolution by physical means. We have achieved similar results to those reported by Dr. Holt and Dr. Bennett (Sept. 30, p. 688) using materials freely available on any ward. The patient lies in bed with the feet elevated for half-anhour each morning and evening. At the end of the halfhour, a blue-line bandage is applied from the toes upwards. This is worn until the beginning of the next period of leg elevation. This treatment has the additional advantage of leaving the patient ambulant for all but one hour of the day. Rheumatism Research Unit, School of Medicine, 44 Clarendon Road, Leeds LS2 9PJ.
IAN HASLOCK.
LOCALISATION OF HUMAN ENTEROKINASE SIR,—Enterokinase (enteropeptidase, EC3.4.4.8) initiates the pancreatic digestion of dietary protein by conversion of
trypsinogen into trypsin, which in
turn
activates the other
pro-enzymes of the pancreas. Thus enterokinase is a key enzyme for the utilisation of protein, the absence of which entails severe clinical symptoms.1 Recently, Eggermont et al.have proposed that the Brunner glands may be involved in the formation and secretion of enterokinase. They base their concept on a demonstrated correlation between the presence of enterokinase and of
proteolytic
Brunner glands at different levels of human duodenum. Enterokinase and Brunner glands are found only in biopsy specimens from the upper part of the duodenum. However, we have shown that in the rat duodenum enterokinase is exclusively present in the villi and on the subcellular level bound to the superficial brush-border membrane of the villous epithelial cells. 3-6 No enterokinase activity is found in the Brunner glands or in the crypts of Lieberkuhn. Experiments now performed with pieces of human intestine (see accompanying figure) reveal that the human enterokinase has the same principal distribution within the duodenal wall as is found for enterokinase in the rat. Furthermore, human enterokinase activity present in a mucosal homogenate is not soluble but strongly particle-bound, as brush-border enzymes like the disaccharidases. These findings make it very unlikely that enterokinase is formed in the Brunner glands. They strongly support the concept that enterokinase is synthesised in the epithelial cells of the villus and that enterokinase is a genuine brush-border enzyme in the same way as, for instance, sucrase. Moreover, we have found enterokinase activity in biopsies from all parts of human duodenum, although highest activities seem to be present in the upper duodenum (in collaboration with Professor A. Norden). Enterokinase has recently been immunochemically
CONFIDENTIALITY
SIR,-It seems that confidentiality has almost disappeared from the N.H.S. hospital service, and that anyone who telephones an outpatient department office states that he is a doctor can often get almost information about a patient. any I suggest that all doctors and their relatives who are to be admitted to hospital should prepare in advance (when they can) a statement to be" handed to a" senior hospital official and copied on any permission form they are asked to sign, as follows: or a
"
ward and
No information about my case is to be the telephone or otherwise to anyone other than members of the hospital staff directly concerned with the diagnosis and treatment, even if the enquirer states that he is a member of N.H.S. staff or is medically qualified." CONFIDENTIALITY.
given
over
The demanding, obtaining, or distribution of such information is completely improper and unprofessional when made by anyone not needing the information for diagnosis or treatment of the patient, and ought to be illegal. It has in several cases led to legal action in which damages and costs have amounted to thousands of pounds. A clear statement of policy on this matter is long overdue from the General Medical Council. All N.H.S. staff should be required to sign a statement as a condition of employment, undertaking to refuse information over the telephone or to anyone not entitled to it, unless the patient has given permission in writing. It is also clear that such information must not become available from computer banks. St. Peter’s Hospitals, London W.C.2. 1. Haslock, D. I., Wright, V. Ann. 2. Park, D. C., Swinburne, K. Br. 3. Swinburne, K. ibid. p. 1541.
A. E. FRANCIS. phys. Med. 1970, 10, med. J. 1964, i, 86.
236.
HOMOGENATE
Distribution of enterokinase duodenum.
activity
NUMBER
within wall of human
A small piece of intestine from upper duodenum of a 60-yearold man was horizontally sectioned in a cryostat. Each homogenate contains seven 20 u thick sections, serially cut from the tips of the villi to the muscle layer. s.M.==submucosal tissue Å =total activity; . = specific containing Brunner glands. activity (units per mg. protein). Highest total and specific activities were arbitrarily set at 100, to obtain relative activities.
Hadorn, B., Tarlow, M. J., Lloyd, J. K., Wolff, O. H. Lancet, 1969, i, 812. 2. Eggermont, E., Molla, A. M., Rutgeerts, L., Tytgat, G. ibid. 1971, ii, 369. 3. Nordstroom, C., Dahlqvist, A. Biochim. biophys. Acta, 1970, 198, 621. 4. Nordström, C., Danlqvist, A. Proceedings of 4th World Congress of Gastroenterology, Copenhagen, 1970, abstract no. 130. 5. Nordström, C., Dahlqvist, A. Biochim. biophys. Acta, 1971, 242, 209. 1.