RAPID DIAGNOSIS OF VIRAL ENCEPHALITIS

234

basis, that the medically qualified clinical biochemist is

an

in

essential part of clinical medicine. Dr Buckley-Sharp’s remarks (July 26, p. 178) about clinical chemical results being used without due acknowledgment in publications are certainly correct. I also feel that such chemistry as is done in many clinical departments is not subjected to adequate quality control. If editors insisted on this, there would be more space in the journals for really meaningful contributions. Might I add finally that I strongly support the views of Professor K. G. M. M. Alberti and others (July 26, p. 177) and look forward to the time when there will be considerably more of us who are practising clinical biochemistry as a clinical subject. Department of Clinical Biochemistry, Royal Victoria Infirmary, A. L. LATNER. Newcastle upon Tyne NE1 7RU.

be

INTRAVENOUS TYRAMINE PRESSOR RESPONSE IN DEPRESSION

SIR,—Could the increased tyramine pressor response in primary depressives reported by Dr Ghose and others (June 14, p. 1317) be a function of investigator bias ? We are not told whether the person administering the drug and controlling the speed of injection and overall rate of administration knew which subjects were patients and which controls. State University of New York at Stony Brook, Health Sciences Center, School of Medicine, Stony Brook, N.Y. 11794, U.S.A.

RICHARD ABRAMS.

POSTOPERATIVE THROMBOSIS IN THAI WOMEN

high-risk patients undergoing major surgery ". It is to hoped, however, that the inclusion in the trial of 156 cases undergoing total hip replacement does not imply

that the

proved for implant surgery of this kind, a very high mortality from pulmonary

embolism (1-4% 1). deserves separate investigation before any conclusion may be drawn. It differs from the other operative procedures studied in the trial, because of the significance to the clinical result of increased wound hæmatoma formation which has been noted to occur by the authors. -In the trial the mortality was greatly reduced, but while 14 lives were saved 41 additional wound hxmatomas were induced. Whereas this will probably be of little significance in most general surgical procedures, it is not the case in total hip replacement. Charnley2 noted that 7 out of 21 patients with wound hsematomas eventually lost their prosthesis because of deep sepsis-in other words, the operation had failed.’ Clearly this is a point which might cause considerable anxiety to many orthopaedic surgeons, and one about which more information would be desirable.

Hip arthroplasty surely similarly large scale

on a

Department of Surgery, Western Infirmary, Glasgow G11 6NT.

J. R. LOUDON M. A. TEHRANI.

RAPID DIAGNOSIS OF VIRAL ENCEPHALITIS

SIR,-Your excellent editorial3 on the rapid-diagnosis of viral disease makes no mention of the use of rapid ultrastructural examination of brain biopsies in the diagnosis of viral encephalitis. Using a rapid ’Araldite’ embedding technique4 thin sections can be examined on the transmission electron microscope (E.M.) within 24 hours of receipt of the specimen in the E.M. laboratory; if the specimen is received in the morning it can be examined the same

auu

1347) carefully evaluated the low incidence of postoperative thromboembolic complications in Thai women. They state that ethnic factors may be responsible. I should like to raise a question which, though it may be oversimplification, could be of interest. Stasis is generally agreed to be prominent in the events leading to postoperative thromboembolism and many devices and positions have been evaluated in attempts to avoid prolonged venous stasis. Many pictures from South-East Asia show people resting with the knees acutely bent and the buttocks on the calves. I understand that this is a favourite resting and, at times, working position. Is this also true in Thailand ? If so, these people must be quite well accustomed to venous stasis of the legs. An operation would create little further challenge to the endothelium and local fibrinolytic systems of veins well adapted to prolonged stasis. Western adults attempting to rest or sit in a similar position for any length of time would probably have a high incidence of lower-extremity thrombi. Perhaps we should be interested in preoperative conditioning of the lower-extremity venous system as a preventive technique in high-risk groups ? p.

is also it carries

case

although

day.

The usefulness of this technique is illustrated by the case of a woman, aged 53, with a history of ’flu-like illness followed by progressive confusion for one week before admission. On admission she was alert with expressive dysphagia, her neck was stiff, the right pupil was larger than the left and reacted sluggishly to light, and the left plantar reflex was extensor. A left carotid angiogram showed a lesion in the left temporal region. An echoencephalogram showed that midline structures were shifted from left to right by 3mm. The cerebrospinal fluid contained 175 white cells (all lymphocytes) per c.mm. and a protein of 200mg. per 100 ml. She was thought to have a viral encephalitis 1. 2. 3. 4.

Charnley, J. Internal publications no. 30. Centre for Hip Surgery, Wrightington, 1971. Charnley, J. Internal publications no. 14. Centre for Hip Surgery, Wrightington, 1968. Lancet, 1975, i, 1411. Rowden, G., Lewis, M. G. J. clin. Path. 1974, 27, 505.

Rockford School of Medicine of the

University of Illinois, Rockford, Illinois 61101, U.S.A.

RICHARD F. NOVAK.

LOW-DOSE HEPARIN AND TOTAL HIP REPLACEMENT

SIR,—The results of the international multicentre trial (July 12, p. 45) provide convincing evidence of the value of prophylactic low-dose heparin in preventing pulmonary embolism following major surgery. The authors feel that " This form of prophylaxis against venous thromboembolism can now be recommended for use on a large scale

Transmission electron microscopy: inclusions consistent with herpes virus.

235 and a left temporal brain biopsy was performed. Smear preparations showed necrotic tissue, numerous macrophages, degenerate neurones, reactive astrocytes,’ and perivascular cuffing with lymphocytes. Paraffin sections confirmed this. Transmission electron microscopy of thin sections of glutar-

aldehyde-fixed

material

postfixed

in osmium and

rapidly

em-

bedded in araldite showed viral inclusions of appearances

morphologically consistent accompanying figure).

with those of

herpes

virus

(see

It should be pointed out that this technique is useful when positive result is obtained. Localisation difficulties render a negative result insignificant.

a

Department of Neuropathology, Royal Infirmary,

Sheffield, and Department of Pathology, Weston Park Hospital, Sheffield.

W. R. TIMPERLEY P. D. NORRIS I. CARR.

ABNORMAL HAEMOGLOBINS IN WANDSWORTH SIR,-We were interested in the findings of Dr Buckley and others (July 12, p. 82) concerning abnormal hxmo-

globins

in South-East Staffordshire and we should like to of the points which they raise in terms

comment on some

of our

experiences. St. George’s Hospital, Tooting, is situated in a district with a considerable population of new Commonwealth origin. The 1971 census figures show that the total population of the Borough of Wandsworth was 302,260 of which 18,325 (5-5%) were from the West Indies and the African continent. It is not certain that the population served at St George’s Hospital is characteristic of the district but there is no particular reason to doubt it. Perhaps we may take " sickle screening tests " as a rough measure of hospital service to Black people of the district. During three weeks in April, 1975, our laboratory performed 2490 blood-counts (F.B.P.s) and 125 sickle-cell screening tests. That is 5% as many sickle tests as F.B.P.S. Since many of the F.B.P.s are repeated frequently on inpatients and sickling tests are seldom repeated, these figures suggest that almost every Black subject who crosses the hospital threshold has a sickle test, whether or own

there is a clinical or haematological indication. We question whether this is a useful custom. The following findings are based on samples submitted for haemoglobin studies on clinical or haematological grounds:

not

Hœmoglobinopathies January, 1974,

to

June, 1975

of Kattamis et al.2 appear similar to those of Buckley et al. We are perplexed at the suggestion that " couples of different racial groups who intend to marry should be screened for the presence of abnormal hsemoglobins ". That seems neither a profitable nor a proper pursuit. It might occasionally be instructive in couples of the same racial groups, but why would it benefit in marriages of different racial origin ? As Buckley and his colleagues " suggest, If this (intermarriage) process goes on, in a few generations these haemoglobin abnormalities will no longer be uncommon in Britons ". Probably true. It would be as well to get used to it rather than attempting to intervene with screening services of doubtful benefit, unless couples make a specific approach for assistance. Department of Hæmatology, St. George’s Hospital Medical School, London SW17 0QT.

JENNIFER A. TOOZE MICHAEL ROSE.

REFERENCE: REFERENCES

SIR,—Too often medical articles are written in the modern scientific vein which means the unselective quotation of authorities on almost every point mentioned in the discourse. Clarity, style, and readability are abandoned in favour of sentences constructed around numerous references ; and it is not unusual to find sentences in which there are more words in parentheses (as references) than in syntax. Consequently, authors may fail to develop their arguments to a well-reasoned conclusion. There is rarely need for more than half-a-dozen references in an original paper, which should answer a specific, question whenever possible. A review article may be expected to contain more references, but even in this instance it is questionable whether the prose should be overwhelmed by uninterrupted lines of references in parentheses: some selection is still necessary. Such is the emphasis-on reference that an author will sometimes strive to make one when none exists by citing a personal communication from an eminent colleague. It is perhaps understandable that an author may occasionally be reluctant to omit a reference in case he is judged to be unaware of it. Information retrieval is now a science in itself and an interested reader or a prospective author can readily construct his own comprehensive bibliography on almost any scientific subject. Should an author consider that he has compiled an important bibliography, he could always state this at the end of an article and offer it at a nominal charge. The perceptive reader will occasionally note the ludicrous situation in which authorities have been cited in reference when in reality they had only in turn quoted a more distant source. Though paradoxical, one is reminded of the adage that to refer only to one authority is a form of plagiarism whereas to refer to many authorities is accepted generally as a form of research. Postgraduate Medical Centre, Frimley Park Hospital, Surrey GU16 5UJ.

J. G. HANNINGTON-KIFF.

IMMUNOLOGICAL REACTIVITY IN BETA-THALASSÆMIA Raven and Tooze1 emphasised the importance of a-thalassxmia in subjects of Black African origin. It is interesting that Buckley et al. noted no consistent abnormalities in counts or morphology. The general experienceis that thalassæmia traits are associated with hypochromia and the corresponding indices. Nonetheless the findings

SIR,—Dr Marcolongo and his colleagues (May 17, p. 1141) reported a relationship between rheumatoid arthritis (R.A.) and &bgr;-thalassæmia trait, since they found a higher incidence of R.A. in patients with this condition (19-8%) than in a normal population (13-4±). They suggested that altered immunological reactivity may be responsible. 2.

1.

Raven, J. L., Tooze, J. A. Br. med. J. 1973, iv, 486.

Kattamis, C., Metaxotou-Mavromati, A., Karamboula, K., Nasika, E., Lehmann, H. Br. J. Hœmat. 1973, 25, 375.