192
haemorrhage, and 1 with epistaxis). No increases in platelet counts were observed. While the PAF antagonist was well tolerated subjectively during treatment, most patients showed a prolonged "haemostasis time" (a modified bleeding-time test3) after treatment; the Duke bleeding time was not changed. In contrast with the observation of Lohmann et al we conclude that WEB 2086 is ineffective for treatment of chronic idiopathic thrombocytopenia and should be used with caution in
thrombocytopenic patients. G. GIERS Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, D-6300 Glessen, West Germany
H. JANZARIK E. R. KEMPE C. MUELLER-ECKHARDT
HF, Adamus WS, Meade CJ. Idiopathic thrombocytopenia treated with PAF-acether antagonist WEB 2086. Lancet 1988; ii: 1147. 2. Casals-Stenzel J, Muacevic G, Weber KH. Pharmacological actions of WEB 2086, a new specific antagonist of platelet activating factor. J Pharmacol Exp Ther 1987; 241: 978-81. 3. Janzarik H, Heinnch D, Boedecker RH, Lasch HG. "Haemostasis time", a modified bleeding time test and its comparison with the Duke and Ivy/template bleeding times, II: application in bleeding disorders. Blut 1988; 57: 111-16.
varicella or zoster; 68 (53%) were on members of staff. Thus large numbers of staff still have to be traced and screened. In teaching institutions, with many new staff entering the hospital every year, there will always be some whose immunity to VZV is unknown at the time they come into contact with patients. The only effective policy is routine screening for VZV antibody status at the pre-employment health check, as argued by Dr Sutherland and her colleagues (June 16, p 1460). Unfortunately, tests with the sensitivity required, such as enzyme immunoassays, radioimmunoassays, or fluorescent antibody tests, are available only in specialist laboratories. However, developments in commercial tests and the provision of standardised reagents for VZV serology may permit the wider application of the assays that are needed for effective control measures against nosocomial VZV infections.
1. Lohmann
ALISON MURRAY H. O. KANGRO R. B. HEATH
Department of Virology, St Bartholomew’s Hospital, London EC1A 7BE, UK 1. Heath RB. Varicella vaccines. In: Zuckerman
AJ, ed. Recent developments in prophylactic immunization. London: Kluwer Academic Publishers, 1989: 86-96. 2. Campbell-Benzie A, Kangro HO, Heath RB The development and evaluation of solid-phase radioimmunoassay. (RIA) procedure for the determination of susceptibility of varicella. J Virol Methods 1981; 2: 149-58.
Screening hospital staff for antibodies to varicella-zoster virus
An artist in the
SIR, Lancet correspondents (May 5, p 1100; June 16, p 1460) rightly draw attention to the potential for cross-infection associated with varicella-zoster virus (VZV) infections in hospital. A vaccine would be an important means of protecting susceptible staff and thus preventing outbreaks but the use of current live varicella vaccines for this purpose cannot be recommended on present evidence’ and the development of an effective subunit vaccine is likely to take years. So what can we do in the meantime to prevent hospital outbreaks of varicella? Despite the potentially disastrous consequences of such outbreaks few hospitals have a contingency plan to deal with the risk of cross-infection. Action is usually only taken when cases of varicella or zoster (normally more than one) have been diagnosed in patients or staff. However, the only way to contain the infection is to stop the chain of transmission by isolating or excluding susceptible contacts, and this means a lot of extra work for clinicians and administrators. Furthermore, virology laboratories are usually required to do urgent serological tests, often at short notice, on large numbers of specimens. We experienced these difficulties in 1986 when 32 laboratory-confirmed cases of varicella occurred in staff over 3 weeks: the first 3 cases were in nurses working on the oncology wards. 622 sera from staff had to be tested for VZV antibody2 over a 2-week period and duty rosters in high-risk areas had to be continually revised. Testing was often delayed because staff were off duty at the time of contact tracing or because agency staff were being
operating-room
SIR,—The bright lights and intense concentration, with possibly a
complement the green of the gowns-there could be inspiring subject for a figurative painter. Mr Victor Riddell
spot of red to no more was
the first surgeon who allowed
me to
paint when he
was
operating at St George’s Hospital, London. Since then I have painted many other surgeons at work. The occasional light-hearted conversation across the patient surprised me a little, but, as a portrait painter, I know that conversation does not interfere with concentration.
However,
a
low
friction
arthroplasty hip replacement by Sir John Charnley was a very different experience. I spent several days at King Edward VII Hospital, Midhurst, and on the first day I filled a sketch book with drawings of the operation, from the scrubbing up to the final sutures. These drawings are reproduced in Prof Williarn Waugh’s book about John Charnley,l reviewed in your issue of July 7. I had plenty of time to improve and complete these drawings because three identical operations were done in one day.
employed.
As in
In that outbreak 53 (85%) of the staff were found to be susceptible. A definite history of chickenpox or shingles, determined by questioning, proved to be a good indicator of immune status:
exactly what to do next. One day Sir John dropped a piece of bone cement as it was passed to him by
This approach might reduce the burden of laboratory testing but doubt if questioning alone can form the basis for a programme to prevent outbreaks of VZV infection in hospital. Since 1986, when a policy of questioning staff on their history of we
chickenpox and/or shingles was adopted, our experience suggests that a clinical and laboratory workload in any investigation of potential outbreaks will remain. In 1989, 700 VZV antibody tests were done in our laboratory, 429 (61-3%) being for screening purposes. 129 tests
were
done because of a
contact
with
a case
of
a
ballet everyone knew
the theatre sister. It rolled to my feet and I picked it up and was to find it was. I still have it. He crossed his arms, how hot surprised hunched his shoulders, looking angry, with closed eyes (figure), until the new cement was ready. He asked me to copy some of my drawings for him and he signed my sketchbook. Later, Mrs Ros Cocks, his chief physiotherapist, told me that he had shown her the book, saying "I’ve had a lovely day today: there was an artist in the theatre drawing me all the time". I was very privileged to see this great surgeon at work. His magnetic personality, skill, and determination, which have helped so many, are unforgettable. Pound House,
Angmering Village,
JULIET PANNETT
Sussex BN16 4AL, UK
1.
Waugh W. John Charnley: Verlag, 1990.
the
man
and the
hip. Berlin
and
Heidelberg: Springer-
haemorrhage, and 1 with epistaxis). No increases in platelet counts were observed. While the PAF antagonist was well tolerated subjectively during treatment, most patients showed a prolonged "haemostasis time" (a modified bleeding-time test3) after treatment; the Duke bleeding time was not changed. In contrast with the observation of Lohmann et al we conclude that WEB 2086 is ineffective for treatment of chronic idiopathic thrombocytopenia and should be used with caution in
thrombocytopenic patients. G. GIERS Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, D-6300 Glessen, West Germany
H. JANZARIK E. R. KEMPE C. MUELLER-ECKHARDT
HF, Adamus WS, Meade CJ. Idiopathic thrombocytopenia treated with PAF-acether antagonist WEB 2086. Lancet 1988; ii: 1147. 2. Casals-Stenzel J, Muacevic G, Weber KH. Pharmacological actions of WEB 2086, a new specific antagonist of platelet activating factor. J Pharmacol Exp Ther 1987; 241: 978-81. 3. Janzarik H, Heinnch D, Boedecker RH, Lasch HG. "Haemostasis time", a modified bleeding time test and its comparison with the Duke and Ivy/template bleeding times, II: application in bleeding disorders. Blut 1988; 57: 111-16.
varicella or zoster; 68 (53%) were on members of staff. Thus large numbers of staff still have to be traced and screened. In teaching institutions, with many new staff entering the hospital every year, there will always be some whose immunity to VZV is unknown at the time they come into contact with patients. The only effective policy is routine screening for VZV antibody status at the pre-employment health check, as argued by Dr Sutherland and her colleagues (June 16, p 1460). Unfortunately, tests with the sensitivity required, such as enzyme immunoassays, radioimmunoassays, or fluorescent antibody tests, are available only in specialist laboratories. However, developments in commercial tests and the provision of standardised reagents for VZV serology may permit the wider application of the assays that are needed for effective control measures against nosocomial VZV infections.
1. Lohmann
ALISON MURRAY H. O. KANGRO R. B. HEATH
Department of Virology, St Bartholomew’s Hospital, London EC1A 7BE, UK 1. Heath RB. Varicella vaccines. In: Zuckerman
AJ, ed. Recent developments in prophylactic immunization. London: Kluwer Academic Publishers, 1989: 86-96. 2. Campbell-Benzie A, Kangro HO, Heath RB The development and evaluation of solid-phase radioimmunoassay. (RIA) procedure for the determination of susceptibility of varicella. J Virol Methods 1981; 2: 149-58.
Screening hospital staff for antibodies to varicella-zoster virus
An artist in the
SIR, Lancet correspondents (May 5, p 1100; June 16, p 1460) rightly draw attention to the potential for cross-infection associated with varicella-zoster virus (VZV) infections in hospital. A vaccine would be an important means of protecting susceptible staff and thus preventing outbreaks but the use of current live varicella vaccines for this purpose cannot be recommended on present evidence’ and the development of an effective subunit vaccine is likely to take years. So what can we do in the meantime to prevent hospital outbreaks of varicella? Despite the potentially disastrous consequences of such outbreaks few hospitals have a contingency plan to deal with the risk of cross-infection. Action is usually only taken when cases of varicella or zoster (normally more than one) have been diagnosed in patients or staff. However, the only way to contain the infection is to stop the chain of transmission by isolating or excluding susceptible contacts, and this means a lot of extra work for clinicians and administrators. Furthermore, virology laboratories are usually required to do urgent serological tests, often at short notice, on large numbers of specimens. We experienced these difficulties in 1986 when 32 laboratory-confirmed cases of varicella occurred in staff over 3 weeks: the first 3 cases were in nurses working on the oncology wards. 622 sera from staff had to be tested for VZV antibody2 over a 2-week period and duty rosters in high-risk areas had to be continually revised. Testing was often delayed because staff were off duty at the time of contact tracing or because agency staff were being
operating-room
SIR,—The bright lights and intense concentration, with possibly a
complement the green of the gowns-there could be inspiring subject for a figurative painter. Mr Victor Riddell
spot of red to no more was
the first surgeon who allowed
me to
paint when he
was
operating at St George’s Hospital, London. Since then I have painted many other surgeons at work. The occasional light-hearted conversation across the patient surprised me a little, but, as a portrait painter, I know that conversation does not interfere with concentration.
However,
a
low
friction
arthroplasty hip replacement by Sir John Charnley was a very different experience. I spent several days at King Edward VII Hospital, Midhurst, and on the first day I filled a sketch book with drawings of the operation, from the scrubbing up to the final sutures. These drawings are reproduced in Prof Williarn Waugh’s book about John Charnley,l reviewed in your issue of July 7. I had plenty of time to improve and complete these drawings because three identical operations were done in one day.
employed.
As in
In that outbreak 53 (85%) of the staff were found to be susceptible. A definite history of chickenpox or shingles, determined by questioning, proved to be a good indicator of immune status:
exactly what to do next. One day Sir John dropped a piece of bone cement as it was passed to him by
This approach might reduce the burden of laboratory testing but doubt if questioning alone can form the basis for a programme to prevent outbreaks of VZV infection in hospital. Since 1986, when a policy of questioning staff on their history of we
chickenpox and/or shingles was adopted, our experience suggests that a clinical and laboratory workload in any investigation of potential outbreaks will remain. In 1989, 700 VZV antibody tests were done in our laboratory, 429 (61-3%) being for screening purposes. 129 tests
were
done because of a
contact
with
a case
of
a
ballet everyone knew
the theatre sister. It rolled to my feet and I picked it up and was to find it was. I still have it. He crossed his arms, how hot surprised hunched his shoulders, looking angry, with closed eyes (figure), until the new cement was ready. He asked me to copy some of my drawings for him and he signed my sketchbook. Later, Mrs Ros Cocks, his chief physiotherapist, told me that he had shown her the book, saying "I’ve had a lovely day today: there was an artist in the theatre drawing me all the time". I was very privileged to see this great surgeon at work. His magnetic personality, skill, and determination, which have helped so many, are unforgettable. Pound House,
Angmering Village,
JULIET PANNETT
Sussex BN16 4AL, UK
1.
Waugh W. John Charnley: Verlag, 1990.
the
man
and the
hip. Berlin
and
Heidelberg: Springer-
