SMOKING AND HEALTH
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1189 than 86 units per litre (+1 1 s.D.) was found in more than half the patients. Similarly, serum-inorganic-phosphorus was increased and serum-total-calcium decreased (4-06 : 0-38 meq. per litre, P < 0-005) in most patients. These changes were not closely related to signs of liver or bone disease. The activity of the intestinal isoenzyme was inversely related to the level of total calcium (regression coefficient kl= -785, ski =3’86, P < 0’05). The increase in intestinal alkaline phosphatase in our patients was too great to be explained by blood-group, and an increase due to food intake could also be excluded. A retarded turnover of serum-intestinal-alkaline-phosphatase 5 or an increased tendency to release the enzyme from the brush border of the intestinal mucosa must be considered. This latter idea i supported by our results in children with active caeliac sprue in whom the activity of the intestinal isoenzyme of serum-alkaline-phosphatase was up to three times greater than that of children under treatment, although the activity of the enzyme in the intestinal mucosa was reduced.9 Kowarski and Schachter 10 found that release of Ca2+- dependent A.T.P.ase from the intestinal mucosa was increased by vitamin-D deficiency. The identity of Ca2+- dependent A.T.P.ase and intestinal alkaline phosphatase 11 and involvement of the enzymes in calcium transport 12 was suggested. The increase in serum-intestinal-isoenzyme in patients on maintenance haemodialysis seems to be related to the development of secondary hyperparathyroidism in such patients. 4 1st Institute of Medical Chemistry and Department of Internal Medicine of Strahov, Charles University, 121 08 Prague, Czechoslovakia. J. ŠT&Ebreve;PÁN T. PILAŘOVÁ. SMOKING AND HEALTH SIR,-In reply to Dr Abrahamson (April 19, p. 917), over 30 years ago, following my repeated self-administra- tion of nicotine by various routes-orally, subcutaneously, transcutaneously, and intravenously-I was satisfied that smoking was essentially a means of self-administering nicotine.13 I tried to interest several manufacturing chemists in producing a solution suitable for administering nicotine in suitable dosage by atomiser, but without success. About two years ago, when I first heard about the new smoking product, I wrote to Imperial Chemical Industries and, citing my earlier work on nicotine, suggested its administration by aerosol, but this was rejected by their chief medical officer. I now think it is time the Department of Health took this important matter in hand. It could prove a great boon not only to smokers’ health but also to the many victims of their irritant air pollution. 43 Church Street, Gharb, Gozo, Malta. LENNOX JOHNSTON. SIR,-Dr Abrahamson (April 19, p. 917) suggests nicotine aerosol inhalations as a substitute for cigarette smoking. Aerosol sprays were used to compare the effects of nicotine inhalations with cigarette smoking in man* by Herxheimer et al. in 1967.14 We showed that the circulatory effects were so closely matched that we recommended investigation of the use of nicotine aerosols as a substitute in those people 9. Jodl, J., Lojda, Z., Št&ebreve;pán, J. Acta pœdiat. scand. 1974, 63, 666. 10. Kowarski, S., Schachter, D. J clin. Invest. 1973, 52, 2765. 11. Haussler, M. R., Nagode, L. A., Rasmussen, H. Nature, 1970, 228, 1199. 12. Birge, S. J., Gilbert, H. R. J. clin. Invest. 1974, 54, 710. 13. Johnston, L. M. Lancet, 1942, ii, 742. 14. Herxheimer, A., Griffiths, R. L., Hamilton, B., Wakefield, M. ibid. 1967, ii, 754. with chronic respiratory diseases who have difficulty in giving up cigarettes. Stoke Mandeville Hospital, Aylesbury, Bucks. MARION A. WAKEFIELD. C3 STANDARDS SiR,-We were interested to read Dr Vladutiu’s letter (April 26, p. 979) analysing the problems of estimating C3 by radialimmunodiffusion, as a routine laboratory proce- dure. Like his laboratory, we have encountered the same difficulties. Recently we had the opportunity of examining sera from 90 blood-donors (40 males and 50 females) to try to establish a normal range of values for C3, using a commercial antiserum. Using a commercial standard, C3 was measured on serum separated within 30 minutes of collection, and on aliquots exposed to glass at 37 °C for 7 and 14 days, respectively. The results were: This variability seems to offer three unsatisfactory choices. First, to ensure that all sera are freshly separated as for CHso estimations. This is not always possible in a large hospital with limited staff and facilities, particularly with outpatients. Secondly, sera can be aged for a minimum of 7 days. Although C3 estimations may not be urgent, this can cause an inordinate delay in a report reaching the pati- ent’s notes. The third choice is to accept sera of any age, quoting an extended range of normal, to include the lowest value found in fresh sera and the highest value in 7-day sera. The normal range for either fresh or aged sera is already wide, and to extend it further makes the estimation almost valueless. We are attempting, if not very successfully, to examine only fresh sera. Correction factors applied to results on aged sera are unsatisfactory, since individual specimens vary in their rate of conversion of C3 to C3c and C3d. As an example one blood-donor serum increased on 7-day ageing from 110 to 115 mg. per 100 ml., another from 100 to 170 mg. per 100 ml. We would be interested to hear of any solutions to this problem, and would fully endorse the suggestion that C3 standards and standard C3 antisera are urgently required. Department of Clinical Immunology, Institute of Pathology, London Hospital, Whitechapel, London E1 1BB. JOHN PERRIN. ASSESSMENT OF CADAVERIC KIDNEYS FOR TRANSPLANTATION SIR,-Mr Baxby and his colleagues described the assessment of cadaver kidney viability by the lactate concentration and pH in the perfusate. They state that the perfusion-rate was kept low at about 30 ml. per minute, and it was increased over the next 10 minutes as quickly as possible, but always in such a way as to keep the systolic pressure below 60 mm. Hg. Then an aliquot of the perfusate was taken for determination of lactate and pH one hour after the start of the perfusion. There is a potential pitfall in this type of estimation, since the concentration of hydrogen ion as well as lactate may vary with the perfusion-rate, and ultimately the total volume of the perfusate which is collected. For example, a 1. Baxby, K., Taylor, R. M. R., Anderson, M., Johnson, R. W. G., Swinney, J. Lancet, 1974, ii, 977.
Transcript of SMOKING AND HEALTH
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than 86 units per litre (+1 1 s.D.) was found in more thanhalf the patients. Similarly, serum-inorganic-phosphoruswas increased and serum-total-calcium decreased (4-06 :0-38 meq. per litre, P < 0-005) in most patients. These
changes were not closely related to signs of liver or bonedisease. The activity of the intestinal isoenzyme wasinversely related to the level of total calcium (regressioncoefficient kl= -785, ski =3’86, P < 0’05). The increasein intestinal alkaline phosphatase in our patients was toogreat to be explained by blood-group, and an increase dueto food intake could also be excluded. A retarded turnoverof serum-intestinal-alkaline-phosphatase 5 or an increasedtendency to release the enzyme from the brush border ofthe intestinal mucosa must be considered. This latter ideai supported by our results in children with active caeliacsprue in whom the activity of the intestinal isoenzyme ofserum-alkaline-phosphatase was up to three times greaterthan that of children under treatment, although the
activity of the enzyme in the intestinal mucosa was reduced.9Kowarski and Schachter 10 found that release of Ca2+-dependent A.T.P.ase from the intestinal mucosa was
increased by vitamin-D deficiency. The identity of Ca2+-dependent A.T.P.ase and intestinal alkaline phosphatase 11and involvement of the enzymes in calcium transport 12 wassuggested. The increase in serum-intestinal-isoenzyme inpatients on maintenance haemodialysis seems to be relatedto the development of secondary hyperparathyroidism insuch patients. 4
1st Institute of Medical Chemistry andDepartment of Internal Medicine of
Strahov, Charles University,121 08 Prague, Czechoslovakia.
J. ŠT&Ebreve;PÁNT. PILAŘOVÁ.
SMOKING AND HEALTH
SIR,-In reply to Dr Abrahamson (April 19, p. 917),over 30 years ago, following my repeated self-administra-tion of nicotine by various routes-orally, subcutaneously,transcutaneously, and intravenously-I was satisfiedthat smoking was essentially a means of self-administeringnicotine.13 I tried to interest several manufacturing chemistsin producing a solution suitable for administering nicotinein suitable dosage by atomiser, but without success.
About two years ago, when I first heard about the newsmoking product, I wrote to Imperial Chemical Industriesand, citing my earlier work on nicotine, suggested itsadministration by aerosol, but this was rejected by theirchief medical officer.
I now think it is time the Department of Health tookthis important matter in hand. It could prove a great boonnot only to smokers’ health but also to the many victims oftheir irritant air pollution.43 Church Street,
Gharb,Gozo, Malta. LENNOX JOHNSTON.
SIR,-Dr Abrahamson (April 19, p. 917) suggests nicotineaerosol inhalations as a substitute for cigarette smoking.Aerosol sprays were used to compare the effects of nicotineinhalations with cigarette smoking in man* by Herxheimeret al. in 1967.14 We showed that the circulatory effects wereso closely matched that we recommended investigation ofthe use of nicotine aerosols as a substitute in those people
9. Jodl, J., Lojda, Z., Št&ebreve;pán, J. Acta pœdiat. scand. 1974, 63, 666.10. Kowarski, S., Schachter, D. J clin. Invest. 1973, 52, 2765.11. Haussler, M. R., Nagode, L. A., Rasmussen, H. Nature, 1970,
228, 1199.12. Birge, S. J., Gilbert, H. R. J. clin. Invest. 1974, 54, 710.13. Johnston, L. M. Lancet, 1942, ii, 742.14. Herxheimer, A., Griffiths, R. L., Hamilton, B., Wakefield, M.
ibid. 1967, ii, 754.
with chronic respiratory diseases who have difficulty ingiving up cigarettes.
Stoke Mandeville Hospital,Aylesbury,Bucks. MARION A. WAKEFIELD.
C3 STANDARDS
SiR,-We were interested to read Dr Vladutiu’s letter(April 26, p. 979) analysing the problems of estimating C3by radialimmunodiffusion, as a routine laboratory proce-dure. Like his laboratory, we have encountered the samedifficulties. Recently we had the opportunity of examiningsera from 90 blood-donors (40 males and 50 females) to tryto establish a normal range of values for C3, using acommercial antiserum. Using a commercial standard, C3was measured on serum separated within 30 minutes ofcollection, and on aliquots exposed to glass at 37 °C for 7and 14 days, respectively. The results were:
This variability seems to offer three unsatisfactorychoices. First, to ensure that all sera are freshly separatedas for CHso estimations. This is not always possible in alarge hospital with limited staff and facilities, particularlywith outpatients. Secondly, sera can be aged for a minimumof 7 days. Although C3 estimations may not be urgent, thiscan cause an inordinate delay in a report reaching the pati-ent’s notes. The third choice is to accept sera of any age,quoting an extended range of normal, to include the lowestvalue found in fresh sera and the highest value in 7-day sera.The normal range for either fresh or aged sera is alreadywide, and to extend it further makes the estimation almostvalueless. We are attempting, if not very successfully, toexamine only fresh sera.
Correction factors applied to results on aged sera areunsatisfactory, since individual specimens vary in their rateof conversion of C3 to C3c and C3d. As an example oneblood-donor serum increased on 7-day ageing from 110 to115 mg. per 100 ml., another from 100 to 170 mg. per 100ml.We would be interested to hear of any solutions to this
problem, and would fully endorse the suggestion that C3standards and standard C3 antisera are urgently required.
Department of Clinical Immunology,Institute of Pathology,
London Hospital, Whitechapel,London E1 1BB. JOHN PERRIN.
ASSESSMENT OF CADAVERIC KIDNEYSFOR TRANSPLANTATION
SIR,-Mr Baxby and his colleagues described theassessment of cadaver kidney viability by the lactateconcentration and pH in the perfusate. They state thatthe perfusion-rate was kept low at about 30 ml. per minute,and it was increased over the next 10 minutes as quicklyas possible, but always in such a way as to keep the systolicpressure below 60 mm. Hg. Then an aliquot of theperfusate was taken for determination of lactate and pHone hour after the start of the perfusion.There is a potential pitfall in this type of estimation,
since the concentration of hydrogen ion as well as lactatemay vary with the perfusion-rate, and ultimately the totalvolume of the perfusate which is collected. For example, a
1. Baxby, K., Taylor, R. M. R., Anderson, M., Johnson, R. W. G.,Swinney, J. Lancet, 1974, ii, 977.
