- Email: [email protected]
Now pruritis is not hard to describe
showed CD33, Mo-1+, CD34+, B4+. Infiltrated leukaemic cells showed the presence of myeloid (CD33+) and B-cell lineage antigen (B4*) in tonsil and pleural effusion. We have not so far been able to deduce why leukaemic cells showed differences of differentiation in bone marrow and in the pleural space, or why heterogeneity of surface markers differed. We know that there are T cells in the tonsils, fibroblasts, and monocytes, which may produce interleukin-6 in the pleural space. Before and after treatment for acute undifferentiated leukaemia we measured serum interleukin-6 by enzyme-linked immunoassay and bone-marrow-cell mRNA analysis by reverse-transcription PCR. Our patient had higher interleukin-6 in serum and in the pleural space than did other leukaemic patients (data not shown). We did not examine whether these leukaemic cells responded to interleukin-6, but we clearly demonstrated in-vivo differentiation of the undifferentiated cells in the pleural space as well as in our patient described above. Malignant cells, such as leukaemic cells and follicular lymphoma cells, may be induced to differentiate into more mature cells by the stimulation of interleukin-3, interleukin-6, or organspecific cytokines (such as interleukin-6) in the pleural space. On the other hand, expression of adhesion molecules might be regulated by cytokines, and the specific adhesive surface molecules may determine the placing of malignant cells.1
of salt-containing fluids or food is encouraged.Efforts to achieve early home therapy through use of home-made sugar-salt solutions proved impractical in many settings and are no longer encouraged. WHO recommendations encourage the use of the most easily available and culturally acceptable salt-containing fluid or food, such as traditional drinks or soup. ORS use is also encouraged, but only when it is readily available and mothers have been taught its use. The objective of WHO recommendations is not to favour one source of salt over another, but to ensure that at least one is used, along with other fluids and food. Almroth and Latham’s proposal that ORS use should be limited is understandable, but difficult to implement. How, for example, should a mother decide when ORS use is, or is not, appropriate? By considering ORS as one of several possible sources of salt, any of which may be used in the early management of diarrhoea in the home, WHO guidelines mean that mothers avoid this decision, which seems a more practical approach.
and,
1
Ikematsu I, Tomizuka H, Hatake K, et al. Endobronchial granulocytic sarcoma presenting as bronchial submucosal tumour in acute myelogenous leukaemia. Acta Haematol 1994; 91: 216.
Rational home management of diarrhoea SIR-Almroth and Latham (March 18, p 709) correctly emphasise the importance of continued feeding and increased use of various readily available, culturally acceptable fluids in the home management of childhood diarrhoea. Their comments to the contrary notwithstanding, this is precisely the recommendation of WHO,’ and the combination of these practices, not "ORS [oral rehydration solution] access rate", is the principal indicator used by WHO and United Nations Children’s Fund (UNICEF) to monitor progress in home treatment practices for diarrhoea. Since its inception in 1978, the WHO programme for control of diarrhoeal diseases has consistently advocated that breastfeeding should not be interrupted during diarrhoea and that feeding should be continued, except during initial rehydration of children with clinically evident dehydration. In no patient, however, should food be withheld for more than 4 hours.2 WHO has never suggested that withholding of food and breastmilk "for 24 hours" was acceptable. The promotion of specific fluids for early home treatment of diarrhoea has been based on physiological considerations, treatment objectives, feasibility, and experience. The deficits of water and salt that characterise diarrhoeal dehydration can only be prevented if both substances are provided in sufficient quantity before dehydration is evident. Providing food and water, which WHO recommends for all children treated at home,’ is certainly sufficient for most children whose illness is mild and for whom clinically significant dehydration is not a risk. However, in children with more severe illness, salt should also be provided. WHO guidelines are based on the view that early home therapy can prevent dehydration in some at-risk children 1314
use
Nathaniel F Pierce Programme for Control of Diarrhoeal Diseases, World Health Organization, 1211 Geneva, Switzerland
1
2
*Kiyohiko Hatake, Hiroshi Tomizuka, Kazuo Muroi, Yasusada Miura *Division of Haematology, Department of Medicine, Jichi Medical School, Minamikawachi, Kawachi, Tochigi, Japan 329-04
thus,
WHO Programme for Control of Diarrhoeal Diseases. The selection of fluids and food for home therapy to prevent dehydration from diarrhoea: guidelines for developing a national policy. Geneva: WHO, 1993. WHO Programme for Control of Diarrhoeal Diseases. A manual for the treatment of diarrhoea: for use by physicians and other senior health workers. Geneva: WHO, 1990.
The tobacco
industry and bioethics
SIR-We all know that tobacco companies are selling addictive substances and killing many people. The harmful effects of tobacco are no longer questioned, except by the tobacco industry. Cigarette smoking is the number one preventable cause of lung cancer and some other cancers. The Japan Tobacco Corporation produces not only cigarettes but also drugs (medical, not narcotic). Recently they marketed a new drug (azasetron hydrochloride, a 5-HT3 antagonist), which is effective against nausea and vomiting caused by anticancer chemotherapy. They have made a profit on sales of carcinogenic substances and now intend to make money from the victims. They should be ashamed of their behaviour. I ask Japanese doctors to stop using drugs produced by the tobacco industry. Hiroshi Kawane Department of Medicine, Kawasaki Medical School, Kurashiki City 701-01, Japan
Now
pruritis is
not hard to describe
SIR-Taniguchi and colleagues report (April 1, p 870) that the word " ", which is translated as itching in Japanese, is not contained in the Chinese characters for everyday use. They write that they cannot type this character with a Japanese typewriter. But new computer technology can make Chinese characters in several softwares. English and Japanese word processors are available and special font ", as we technology has been developed. We can write do here, with a Macintosh word processor (ex solowriter). Now Asian dermatologists who use Chinese letters can easily write the phrase pruritic eruption in reports or slides. *Hidekazu Yamada, Junichi Chihara, Tadashi Tezuka Department of Dermatology, Kinki University School of Medicine, Osakasayama, Osaka 589, Japan
of salt-containing fluids or food is encouraged.Efforts to achieve early home therapy through use of home-made sugar-salt solutions proved impractical in many settings and are no longer encouraged. WHO recommendations encourage the use of the most easily available and culturally acceptable salt-containing fluid or food, such as traditional drinks or soup. ORS use is also encouraged, but only when it is readily available and mothers have been taught its use. The objective of WHO recommendations is not to favour one source of salt over another, but to ensure that at least one is used, along with other fluids and food. Almroth and Latham’s proposal that ORS use should be limited is understandable, but difficult to implement. How, for example, should a mother decide when ORS use is, or is not, appropriate? By considering ORS as one of several possible sources of salt, any of which may be used in the early management of diarrhoea in the home, WHO guidelines mean that mothers avoid this decision, which seems a more practical approach.
and,
1
Ikematsu I, Tomizuka H, Hatake K, et al. Endobronchial granulocytic sarcoma presenting as bronchial submucosal tumour in acute myelogenous leukaemia. Acta Haematol 1994; 91: 216.
Rational home management of diarrhoea SIR-Almroth and Latham (March 18, p 709) correctly emphasise the importance of continued feeding and increased use of various readily available, culturally acceptable fluids in the home management of childhood diarrhoea. Their comments to the contrary notwithstanding, this is precisely the recommendation of WHO,’ and the combination of these practices, not "ORS [oral rehydration solution] access rate", is the principal indicator used by WHO and United Nations Children’s Fund (UNICEF) to monitor progress in home treatment practices for diarrhoea. Since its inception in 1978, the WHO programme for control of diarrhoeal diseases has consistently advocated that breastfeeding should not be interrupted during diarrhoea and that feeding should be continued, except during initial rehydration of children with clinically evident dehydration. In no patient, however, should food be withheld for more than 4 hours.2 WHO has never suggested that withholding of food and breastmilk "for 24 hours" was acceptable. The promotion of specific fluids for early home treatment of diarrhoea has been based on physiological considerations, treatment objectives, feasibility, and experience. The deficits of water and salt that characterise diarrhoeal dehydration can only be prevented if both substances are provided in sufficient quantity before dehydration is evident. Providing food and water, which WHO recommends for all children treated at home,’ is certainly sufficient for most children whose illness is mild and for whom clinically significant dehydration is not a risk. However, in children with more severe illness, salt should also be provided. WHO guidelines are based on the view that early home therapy can prevent dehydration in some at-risk children 1314
use
Nathaniel F Pierce Programme for Control of Diarrhoeal Diseases, World Health Organization, 1211 Geneva, Switzerland
1
2
*Kiyohiko Hatake, Hiroshi Tomizuka, Kazuo Muroi, Yasusada Miura *Division of Haematology, Department of Medicine, Jichi Medical School, Minamikawachi, Kawachi, Tochigi, Japan 329-04
thus,
WHO Programme for Control of Diarrhoeal Diseases. The selection of fluids and food for home therapy to prevent dehydration from diarrhoea: guidelines for developing a national policy. Geneva: WHO, 1993. WHO Programme for Control of Diarrhoeal Diseases. A manual for the treatment of diarrhoea: for use by physicians and other senior health workers. Geneva: WHO, 1990.
The tobacco
industry and bioethics
SIR-We all know that tobacco companies are selling addictive substances and killing many people. The harmful effects of tobacco are no longer questioned, except by the tobacco industry. Cigarette smoking is the number one preventable cause of lung cancer and some other cancers. The Japan Tobacco Corporation produces not only cigarettes but also drugs (medical, not narcotic). Recently they marketed a new drug (azasetron hydrochloride, a 5-HT3 antagonist), which is effective against nausea and vomiting caused by anticancer chemotherapy. They have made a profit on sales of carcinogenic substances and now intend to make money from the victims. They should be ashamed of their behaviour. I ask Japanese doctors to stop using drugs produced by the tobacco industry. Hiroshi Kawane Department of Medicine, Kawasaki Medical School, Kurashiki City 701-01, Japan
Now
pruritis is
not hard to describe
SIR-Taniguchi and colleagues report (April 1, p 870) that the word " ", which is translated as itching in Japanese, is not contained in the Chinese characters for everyday use. They write that they cannot type this character with a Japanese typewriter. But new computer technology can make Chinese characters in several softwares. English and Japanese word processors are available and special font ", as we technology has been developed. We can write do here, with a Macintosh word processor (ex solowriter). Now Asian dermatologists who use Chinese letters can easily write the phrase pruritic eruption in reports or slides. *Hidekazu Yamada, Junichi Chihara, Tadashi Tezuka Department of Dermatology, Kinki University School of Medicine, Osakasayama, Osaka 589, Japan