- Email: [email protected]
EPIDEMIOLOGY OF RENIN
103 A pharmacologist would not have forgotten that the discovery of captopril is a model for the design of enzyme inhibitors, and would not have denied that the primary effect of this drug is inhibition of angiotensin converting enzyme. Many antihypertensive agents were found by chance (guanethidine, propranolol, clonidine) and, secondarily, became tools for investigating blood pressure control. In contrast the development of inhibitors of the renin-angiotensin system was the result of concepts about the equilibrium between sodium intake, renal function, renin release, and blood pressure, ideas which have been verified and amplified by the pharmacological inhibition of the renin-angiotensin system. A biologist would be aware of recent progress on the purification of renin, converting enzyme, and angiotensinogen. The primary structure of renin and angiotensinogen have also been elucidated A’:;IlllJM
Mite fauna in housedust.
correlation
was
found between MCLS
score
and mite
count
(r=0-29). The mite patterns are summarised in the figure. No specific mite was found in the dust of MCLS homes, and Dermatophagoïdes pteronyssinus and cheyletid species were found in all samples. In our previous comparative studies no significant difference was found between dust mite counts or mite fauna in samples from children’s asthma and control homes. 10The only difference was in the number of mites from asthmatic children with and without positive skin tests to mite antigen. Our latest survey reveals nothing special for dust mite fauna in Kawasaki disease. Hamashima et al9 mentioned the possible role in MCLS of mites, as vectors of particles in mite gut dust mites. Kato et al 12 have found the anaerobic bacterium Propionibacterium acnes in the sera of 5 out of 8 patients, in a lymph-node biopsy specimen from 1 patient, and in housedust mites. They also discussed the possibility of mites acting as vectors or sharing an antigen with this agent. These aspects require further study before the role, if any, of housedust mites in Kawasaki disease can be defined. We thank Dr K. Furusho and his
colleagues for help in collecting dust
samples
A. ISHII T. YATANI H. KATO
Department of Parasitology, Miyazaki Medical College, Miyazaki 889-16, Japan, and Department of Paediatrics, Kurume University School of Medicine
T. FUJIMOTO
EPIDEMIOLOGY OF RENIN
SIR,—Lancet editorials are widely read as authoritative reviews of
problems. Unfortunately, your April 2 article on renin is line with this tradition. Your writer has approached this broad topic with a narrow mind, as exemplified by his statement that is a sure indication of "The multiplication of papers on renin uncertainty". An alternative view is that this multiplicity reflects the dynamic evolution of renin research. Who wrote this editorial? An epidemiologist should know that methods of renin measurement are difficult to standardise, that intra-subject variability exists and that the two variables with which remn is generally correlated (blood pressure and dietary sodium) are as difficult to measure as renin itself. He would also know that an inverse correlation between renin and blood pressure has been observed in several free-living populations, thus raising questions about the significance of "normal" renin in hypertensive patients. A clinician should be aware that a renin measurement is helpful five to ten times more often than is a well accepted test such as urmarv vanillvlmandelic acid, because unilateral renal disease and primary aldosteronism are five to ten times more common than phaeochromocytoma. Carefully standardised measurements of plasma renin are consistently predictive of blood pressure responses
and the rational design of renin inhibitors is in progress. A geneticist would know that the molecular basis of the genetics of hypertension is being studied, including the structure of the genes coding for the regulatory protein factors involved in the control of blood pressure. Uncertainty about the value of the renin measurement as an indicator of prognosis should not be confused with information the measurement may provide about mechanisms of blood pressure control, differential diagnosis of hypertension, and the selection of an initial antihypertensive drug.
J. MENARD
INSERM U36, 17 rue du Fer-à-Moulin, 75005 Paris, France
T. A. KOTCHEN P. CORVOL
TREATMENTS FOR GASTRO-OESOPHAGEAL REFLUX
SIR,—Your May 14 editorial does not present a balanced view of the value of treating gastro-oesophageal reflux with agents other than H2-receptor antagonists or antacids: it ignores the numerous controlled trials demonstrating the clinical benefit, not just "usefulness", of the other drugs mentioned. For example, alginates reduce symptoms in patients with gastro-oesophageal reflux or oesophagitis, 1-5 and, by means of scintiscanning5and pH monitoring,1 have been shown to reduce episodes of reflux. Similarly studies have demonstrated the benefit of treating these conditions with metoclopramide6,7 or domperidoneas well as by alginate-carbenoxolone.9 The Hz-receptor antagonists and antacids reduce the acidity of the refluxed gastric contents whereas other compounds lower the incidence of reflux (alginates) or enhance the rate of gastric emptying (metoclopramide, domperidone) or increase the rate of oesophageal clearing (bethanecol10), the different mechanisms of action having obvious implications for the clinician when deciding upon a patient’s treatment.
current not in
Pharmaceutical Division, Reckitt & Colman, Kingston-upon-Hull HU8 7DS
N. C. VAREY
...
to
different classes of antihypertensive
agents.
12. Kato H Fujimoto T, Kondo M, et al. A variant strain of Propionibacterium acnes in the house dust mite a possible etiological agent of Kawasaki disease. Pediatr Jap 1983; 24: 325-30
1. Stanciu C, Bennett JR Alginate-antacid Lancet 1974;
i:
in
the reduction
of gastro-oesophageal reflux.
109-11.
2.
Barnado DE, Lancaster-Smith M, Strickland ID, Wright JT. A double-blind controlled trial of ’Gaviscon’ in patients with symptomatic gastro-oesophageal reflux. Curr Med Res Opinion 1974; 3: 388-91 3. Beeley M, Warner JO. Medical treatment of symptomatic hiatus hernia. Curr Med Res Opinion 1972; 1: 63-69. 4. Chevrel B. A comparative crossover study on the treatment of heartburn and epigastric pain: liquid Gaviscon and a mangnesium-aluminium antacid gel. J Int Med Res 8: 300-302. 1980; 5. Malmuc LS, Charkes ND, Littlefield J, Reilley J, Stern H, Rosenberg R, Fisher RS. The mode of action of alginic acid compound in the reduction of gastro-oesophageal
reflux. J Nucl Med 1979; 20: 1023-28 C, Bennett JR. Metaclopramide in gastro-oesophageal reflux.
6. Stanciu
Gut 1973; 14:
275-79.
7. Winnan J,
8.
Avella J, Callachan C, McCallum RW Double-blind trial of metaclopramide versus placebo-antacid in symptomatic gastro-oesophageal reflux. Gastroenterology 1980; 78: (part 2) 1292 Schulze Delrieu K, Summers RW, Finke D. Domperidone in reflux oesophagitis and
gastric stasis Lancet 1981; i: 159. 9. Reed PI, Davies WA. Controlled trial of a new dosage form of carbenoxolone (pyrogastrone) in the treatment of reflux oesophagitis. Dig Dis 1978; 23: 161-65. 10. Saco LS, Orlando RC, Levinson SL, Bozymski EM, Jones JD, Frakes JT Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive oesophagitis Gastroenterology 1982; 82: 1369-73.
Mite fauna in housedust.
correlation
was
found between MCLS
score
and mite
count
(r=0-29). The mite patterns are summarised in the figure. No specific mite was found in the dust of MCLS homes, and Dermatophagoïdes pteronyssinus and cheyletid species were found in all samples. In our previous comparative studies no significant difference was found between dust mite counts or mite fauna in samples from children’s asthma and control homes. 10The only difference was in the number of mites from asthmatic children with and without positive skin tests to mite antigen. Our latest survey reveals nothing special for dust mite fauna in Kawasaki disease. Hamashima et al9 mentioned the possible role in MCLS of mites, as vectors of particles in mite gut dust mites. Kato et al 12 have found the anaerobic bacterium Propionibacterium acnes in the sera of 5 out of 8 patients, in a lymph-node biopsy specimen from 1 patient, and in housedust mites. They also discussed the possibility of mites acting as vectors or sharing an antigen with this agent. These aspects require further study before the role, if any, of housedust mites in Kawasaki disease can be defined. We thank Dr K. Furusho and his
colleagues for help in collecting dust
samples
A. ISHII T. YATANI H. KATO
Department of Parasitology, Miyazaki Medical College, Miyazaki 889-16, Japan, and Department of Paediatrics, Kurume University School of Medicine
T. FUJIMOTO
EPIDEMIOLOGY OF RENIN
SIR,—Lancet editorials are widely read as authoritative reviews of
problems. Unfortunately, your April 2 article on renin is line with this tradition. Your writer has approached this broad topic with a narrow mind, as exemplified by his statement that is a sure indication of "The multiplication of papers on renin uncertainty". An alternative view is that this multiplicity reflects the dynamic evolution of renin research. Who wrote this editorial? An epidemiologist should know that methods of renin measurement are difficult to standardise, that intra-subject variability exists and that the two variables with which remn is generally correlated (blood pressure and dietary sodium) are as difficult to measure as renin itself. He would also know that an inverse correlation between renin and blood pressure has been observed in several free-living populations, thus raising questions about the significance of "normal" renin in hypertensive patients. A clinician should be aware that a renin measurement is helpful five to ten times more often than is a well accepted test such as urmarv vanillvlmandelic acid, because unilateral renal disease and primary aldosteronism are five to ten times more common than phaeochromocytoma. Carefully standardised measurements of plasma renin are consistently predictive of blood pressure responses
and the rational design of renin inhibitors is in progress. A geneticist would know that the molecular basis of the genetics of hypertension is being studied, including the structure of the genes coding for the regulatory protein factors involved in the control of blood pressure. Uncertainty about the value of the renin measurement as an indicator of prognosis should not be confused with information the measurement may provide about mechanisms of blood pressure control, differential diagnosis of hypertension, and the selection of an initial antihypertensive drug.
J. MENARD
INSERM U36, 17 rue du Fer-à-Moulin, 75005 Paris, France
T. A. KOTCHEN P. CORVOL
TREATMENTS FOR GASTRO-OESOPHAGEAL REFLUX
SIR,—Your May 14 editorial does not present a balanced view of the value of treating gastro-oesophageal reflux with agents other than H2-receptor antagonists or antacids: it ignores the numerous controlled trials demonstrating the clinical benefit, not just "usefulness", of the other drugs mentioned. For example, alginates reduce symptoms in patients with gastro-oesophageal reflux or oesophagitis, 1-5 and, by means of scintiscanning5and pH monitoring,1 have been shown to reduce episodes of reflux. Similarly studies have demonstrated the benefit of treating these conditions with metoclopramide6,7 or domperidoneas well as by alginate-carbenoxolone.9 The Hz-receptor antagonists and antacids reduce the acidity of the refluxed gastric contents whereas other compounds lower the incidence of reflux (alginates) or enhance the rate of gastric emptying (metoclopramide, domperidone) or increase the rate of oesophageal clearing (bethanecol10), the different mechanisms of action having obvious implications for the clinician when deciding upon a patient’s treatment.
current not in
Pharmaceutical Division, Reckitt & Colman, Kingston-upon-Hull HU8 7DS
N. C. VAREY
...
to
different classes of antihypertensive
agents.
12. Kato H Fujimoto T, Kondo M, et al. A variant strain of Propionibacterium acnes in the house dust mite a possible etiological agent of Kawasaki disease. Pediatr Jap 1983; 24: 325-30
1. Stanciu C, Bennett JR Alginate-antacid Lancet 1974;
i:
in
the reduction
of gastro-oesophageal reflux.
109-11.
2.
Barnado DE, Lancaster-Smith M, Strickland ID, Wright JT. A double-blind controlled trial of ’Gaviscon’ in patients with symptomatic gastro-oesophageal reflux. Curr Med Res Opinion 1974; 3: 388-91 3. Beeley M, Warner JO. Medical treatment of symptomatic hiatus hernia. Curr Med Res Opinion 1972; 1: 63-69. 4. Chevrel B. A comparative crossover study on the treatment of heartburn and epigastric pain: liquid Gaviscon and a mangnesium-aluminium antacid gel. J Int Med Res 8: 300-302. 1980; 5. Malmuc LS, Charkes ND, Littlefield J, Reilley J, Stern H, Rosenberg R, Fisher RS. The mode of action of alginic acid compound in the reduction of gastro-oesophageal
reflux. J Nucl Med 1979; 20: 1023-28 C, Bennett JR. Metaclopramide in gastro-oesophageal reflux.
6. Stanciu
Gut 1973; 14:
275-79.
7. Winnan J,
8.
Avella J, Callachan C, McCallum RW Double-blind trial of metaclopramide versus placebo-antacid in symptomatic gastro-oesophageal reflux. Gastroenterology 1980; 78: (part 2) 1292 Schulze Delrieu K, Summers RW, Finke D. Domperidone in reflux oesophagitis and
gastric stasis Lancet 1981; i: 159. 9. Reed PI, Davies WA. Controlled trial of a new dosage form of carbenoxolone (pyrogastrone) in the treatment of reflux oesophagitis. Dig Dis 1978; 23: 161-65. 10. Saco LS, Orlando RC, Levinson SL, Bozymski EM, Jones JD, Frakes JT Double-blind controlled trial of bethanechol and antacid versus placebo and antacid in the treatment of erosive oesophagitis Gastroenterology 1982; 82: 1369-73.