- Email: [email protected]
NSAIDS
293
haemagglutination test) and weak activation in 15 (positive indirect haemagglutination test). Both patients with strong T activation and 3 of the 15 patients with weak activation were on haemodialysis for ARF-ie, 29% of the positive cases were in ARF. Only 2 of the 43 patients without T activation (5%) had ARF, and both were precipitated by haemorrhagic shock. The correlation between T activation on red blood cells and the presence of free haemoglobin in serum was significant (p<0’01). Neuraminidase activity was increased in 10 of the 17 patients with exposed T antigens (59%), including the ARF patients. Bacteria known to release neuraminidase (ie, Bacteroides, enterococci, Pseudomonas) were identified in smears from 77% of the patients with exposed T antigens. Since A hypogaea lectin reacts not only with the neuraminidase-exposed Thomsen-Friedenreich (T) antigen but also with at least three more cryptantigens (Tk, Th, Tx) exposed by other microbial enzymes,it is unlikely that all our cases of exposed T antigens can be attributed to neuraminidase. While several mechanisms for the pathogenesis of ARF in septic shock have been suggested, no one theory has gained universal acceptance. Our results indicate that exposure of T antigens on cell membranes of erythrocytes and on kidney glomeruli may well play a role in the pathogenesis of haemolysis and ARF in septic patients.
GUNTHER LENZ ULRIKE GOES DIETHARD BARON HERMANN JUNGER WOLFGANG HELLER UDO SUGG REINHARD LISSNER
Departments of Anaesthesiology and Surgery, University of Tübingen, 7400 Tübingen, West Germany
NSAIDS
SiR,—If you stand up tall and speak out pompously it works all right: "I would advise a non-steroidal anti-inflammatory drug". But they are not worth getting too earnest about. Each one comes complete with a double-blind, cross-over, latin square trial demonstrating significantly unimportant superiority over suboptimal doses of aspirin, but there is little to choose between most of them for all that. There are the -fens and -profens, -acs, -fenacs, - fenamics, -azones, and all sorts, and each one is found to "have a place" in the treatment of rheumatoid/osteo/spondyl/arthritis. The odd one takes a nose-dive, like benoxaprofen, but otherwise it is the reverse of the "Ten Green Bottles", and they get more and more. Some are probably genuinely stronger than others, but mostly these claims are damn lies-statistical damn lies at that-for they really just mean that you need fewer milligrams of one drug than another to get the same mediocre effect, and who cares about that? Though marvellous in acute gout because it is so inflammatory, not one of them will take away the sort of pain you cannot put up with, like a fracture or burn or a crumbling hip; they only help the medium sort, that you could tolerate if you put your mind to it but fortunately do not have to. Students use them preferentially for their hangovers, believing them to be better than aspirin. One cannot say "non-steroidal anti-inflammatory drug" comfortably. NSAID is hardly any better. Luckily it does not make an acronym, unless you are Polish or Nigerian, so perhaps it will not last; and luckily too it would hate to drop the "non-steroidal" bit and risk sharing an acronym with acquired immunodeficiency syndromes. Humdrum they may be, but there is nothing queer about the -profens. They need a nicer collective name, less pretentious, and certainly nothing like "prostaglandin synthetase inhibitors" which is just pure swank. I like to call them all "aspirintype drugs", but that is a bit hard on the pharmaceutical firms who make them, for aspirin is old and they are all fairly new. Perhaps we might try out "new sorts of aspirin in disguise", or NSAID for short. Kisdon House,
Muker, near Richmond,
H. WYKEHAMBALME
North Yorkshire DL116QG 11. Bird GWG,
Wmgham J. "New"
cryptantigens and classification 1983; 36: 195-96
lectins for the identification of
erythrocyte
of erythrocyre polyagglutinability.J Clin Pathol
Commentary from Westminster A Labour
Whip to Man the NHS Defences THE Labour Party is now taking very seriously indeed its part in the general campaign of opposition to the Government’s policy of cutting back on state spending on the NHS-a campaign to which the TUC is adding its voice (see p 295). A high degree of organisation is now evident in Labour’s approach to the issue, since it has been decided by party policy-makers that the NHS’s difficulties offer the party one of its most promising opportunities to recruit electoral support. An important letter has now been sent by the party headquarters to all constituency Labour Parties and affiliated trade unions, setting out the most promising methods by which the party can organise opposition to the cuts, and calling for more information about the situation in the field to be sent back to the party’s coordinating unit which has been set up for the Save Our Health Service campaign. It is hoped by the organisers that the suggestions in the letter will considerably stiffen any resistance to health cuts which is offered by Labour members of health authorities. At the very least, says the letter, local parties can slow down "the pace at which the Tories feel politically able to move" on health cuts. Public opposition to the cuts can also be used, the letter goes on, "to win support for our policies on more ’difficult’ issues, notably private practice and privatisation. This involves linking these with the more readily understood cuts issue". (In other words, when the public agrees with the party, that is because of the force of Labour’s arguments, but when the public is unconvinced, that must be because the public does not understand the arguments.) The cuts issue must also be used to introduce the public to Labour’s "positive perspective for the development of the NHS". This should emphasise the aspects of the party’s ideas which cover better primary care, preventive health, and greater accountability, as well as increased health spending. Local authorities, whether controlled by Labour or not, have a vital role to play in the campaign, according to the party’s General Secretary, Mr Jim Mortimer, and its shadow Social Services Secretary, Mr Michael Meacher, who have sent out the letter. The key part of the advice given to local Labour groups, councillors, and health authority nominees is Mr Meacher’s belief that where financial or manpower cuts cannot be made without significant adverse effects on direct patient care, health authorities should resist. His view is that they should refuse to implement such damaging cuts on the grounds that they were not in the interests of the NHS. The official party advice does not address itself to the question of how Mr Meacher would react if the boot were on the other foot. If he were Secretary of State in a Labour Government, what would be his reaction if similar opposition were organised to "difficult" Government policies, such as the abolition of private medicine, or if industrialists refused to implement nationalisation of the pharmaceutical industry? Mr Meacher would of course, rightly, rely on his electoral mandate as justification. That is precisely what Mrs Thatcher and Mr Fowler now rely on. As things stand, Labour members of health authorities cannot be personally surcharged if they ignore DHSS policy directives, Mr Meacher points out. Additionally, the letter says, the party has had legal advice that the Secretary of State has "no legal powers to enforce manpower keeps within its cash limits".
cuts
if the
(health) authority
haemagglutination test) and weak activation in 15 (positive indirect haemagglutination test). Both patients with strong T activation and 3 of the 15 patients with weak activation were on haemodialysis for ARF-ie, 29% of the positive cases were in ARF. Only 2 of the 43 patients without T activation (5%) had ARF, and both were precipitated by haemorrhagic shock. The correlation between T activation on red blood cells and the presence of free haemoglobin in serum was significant (p<0’01). Neuraminidase activity was increased in 10 of the 17 patients with exposed T antigens (59%), including the ARF patients. Bacteria known to release neuraminidase (ie, Bacteroides, enterococci, Pseudomonas) were identified in smears from 77% of the patients with exposed T antigens. Since A hypogaea lectin reacts not only with the neuraminidase-exposed Thomsen-Friedenreich (T) antigen but also with at least three more cryptantigens (Tk, Th, Tx) exposed by other microbial enzymes,it is unlikely that all our cases of exposed T antigens can be attributed to neuraminidase. While several mechanisms for the pathogenesis of ARF in septic shock have been suggested, no one theory has gained universal acceptance. Our results indicate that exposure of T antigens on cell membranes of erythrocytes and on kidney glomeruli may well play a role in the pathogenesis of haemolysis and ARF in septic patients.
GUNTHER LENZ ULRIKE GOES DIETHARD BARON HERMANN JUNGER WOLFGANG HELLER UDO SUGG REINHARD LISSNER
Departments of Anaesthesiology and Surgery, University of Tübingen, 7400 Tübingen, West Germany
NSAIDS
SiR,—If you stand up tall and speak out pompously it works all right: "I would advise a non-steroidal anti-inflammatory drug". But they are not worth getting too earnest about. Each one comes complete with a double-blind, cross-over, latin square trial demonstrating significantly unimportant superiority over suboptimal doses of aspirin, but there is little to choose between most of them for all that. There are the -fens and -profens, -acs, -fenacs, - fenamics, -azones, and all sorts, and each one is found to "have a place" in the treatment of rheumatoid/osteo/spondyl/arthritis. The odd one takes a nose-dive, like benoxaprofen, but otherwise it is the reverse of the "Ten Green Bottles", and they get more and more. Some are probably genuinely stronger than others, but mostly these claims are damn lies-statistical damn lies at that-for they really just mean that you need fewer milligrams of one drug than another to get the same mediocre effect, and who cares about that? Though marvellous in acute gout because it is so inflammatory, not one of them will take away the sort of pain you cannot put up with, like a fracture or burn or a crumbling hip; they only help the medium sort, that you could tolerate if you put your mind to it but fortunately do not have to. Students use them preferentially for their hangovers, believing them to be better than aspirin. One cannot say "non-steroidal anti-inflammatory drug" comfortably. NSAID is hardly any better. Luckily it does not make an acronym, unless you are Polish or Nigerian, so perhaps it will not last; and luckily too it would hate to drop the "non-steroidal" bit and risk sharing an acronym with acquired immunodeficiency syndromes. Humdrum they may be, but there is nothing queer about the -profens. They need a nicer collective name, less pretentious, and certainly nothing like "prostaglandin synthetase inhibitors" which is just pure swank. I like to call them all "aspirintype drugs", but that is a bit hard on the pharmaceutical firms who make them, for aspirin is old and they are all fairly new. Perhaps we might try out "new sorts of aspirin in disguise", or NSAID for short. Kisdon House,
Muker, near Richmond,
H. WYKEHAMBALME
North Yorkshire DL116QG 11. Bird GWG,
Wmgham J. "New"
cryptantigens and classification 1983; 36: 195-96
lectins for the identification of
erythrocyte
of erythrocyre polyagglutinability.J Clin Pathol
Commentary from Westminster A Labour
Whip to Man the NHS Defences THE Labour Party is now taking very seriously indeed its part in the general campaign of opposition to the Government’s policy of cutting back on state spending on the NHS-a campaign to which the TUC is adding its voice (see p 295). A high degree of organisation is now evident in Labour’s approach to the issue, since it has been decided by party policy-makers that the NHS’s difficulties offer the party one of its most promising opportunities to recruit electoral support. An important letter has now been sent by the party headquarters to all constituency Labour Parties and affiliated trade unions, setting out the most promising methods by which the party can organise opposition to the cuts, and calling for more information about the situation in the field to be sent back to the party’s coordinating unit which has been set up for the Save Our Health Service campaign. It is hoped by the organisers that the suggestions in the letter will considerably stiffen any resistance to health cuts which is offered by Labour members of health authorities. At the very least, says the letter, local parties can slow down "the pace at which the Tories feel politically able to move" on health cuts. Public opposition to the cuts can also be used, the letter goes on, "to win support for our policies on more ’difficult’ issues, notably private practice and privatisation. This involves linking these with the more readily understood cuts issue". (In other words, when the public agrees with the party, that is because of the force of Labour’s arguments, but when the public is unconvinced, that must be because the public does not understand the arguments.) The cuts issue must also be used to introduce the public to Labour’s "positive perspective for the development of the NHS". This should emphasise the aspects of the party’s ideas which cover better primary care, preventive health, and greater accountability, as well as increased health spending. Local authorities, whether controlled by Labour or not, have a vital role to play in the campaign, according to the party’s General Secretary, Mr Jim Mortimer, and its shadow Social Services Secretary, Mr Michael Meacher, who have sent out the letter. The key part of the advice given to local Labour groups, councillors, and health authority nominees is Mr Meacher’s belief that where financial or manpower cuts cannot be made without significant adverse effects on direct patient care, health authorities should resist. His view is that they should refuse to implement such damaging cuts on the grounds that they were not in the interests of the NHS. The official party advice does not address itself to the question of how Mr Meacher would react if the boot were on the other foot. If he were Secretary of State in a Labour Government, what would be his reaction if similar opposition were organised to "difficult" Government policies, such as the abolition of private medicine, or if industrialists refused to implement nationalisation of the pharmaceutical industry? Mr Meacher would of course, rightly, rely on his electoral mandate as justification. That is precisely what Mrs Thatcher and Mr Fowler now rely on. As things stand, Labour members of health authorities cannot be personally surcharged if they ignore DHSS policy directives, Mr Meacher points out. Additionally, the letter says, the party has had legal advice that the Secretary of State has "no legal powers to enforce manpower keeps within its cash limits".
cuts
if the
(health) authority