THE LANCET, OCTOBER
25,1975
813
Is it not absurd that the one subject in which the young surgeon should not be tested is the specialty of surgery in which he will spend his professional life? Surely it is obvious that we must examine in this. It is not possible to accept three examinations in postgraduate surgery. I believe the present Primary is misconceived; it is anatomy and physiology taught in a way too irrelevant to clinical problems. In particular it is a bad method of assessing the would-be surgeon; it does not distinguish between those who are suitable for training in surgery and those who are not, though it is often used to do so. Surely those unsuitable should be excluded during the initial 3-year apprenticeship in basic surgical training. An examination in surgery in general, similar to the present final F .R.C.S. together with basic sciences appropriate to all surgeons, should mark the end of basic training. It should provide entry to higher training in the chosen specialty. At the end of higher surgical training there should be an examination in the specialty and in the basic sciences in some depth, appropriate to that specialty. This would clearly indicate completion of training at a high standard and be comparable and perhaps reciprocal to other English-speaking countries and many European ones. Having had some years as chairman of one of the specialist advisory committees, my long-held view is that certificat ion after higher training by the present method, almost a rubber stamp, is quite inadequate-indeed somewhat farcical. A twostage examination, the first in surgery in general, the second in the specialty at the end of training, is surely more logical than our present examination at the beginning of all this.
on colchicine therapy, and the other symptoms were moderately relieved in most cases. We think that colchicine may prove useful in the treatment of Behcet's disease. Department of Medicine and Physical Therapy, University of Tokyo, Tokyo, Japan, 113.
N.
MATSUMURA
Y.
MIZUSHIMA.
CLOFIBRATE IN PREVENTION OF ISCHlEMIC HEART-DISEASE Sm,-We agree with the valuable comments made by Dr Chakrabarti and Dr Meade (April 5, p, 799) on the possible antifibrinolvtic effect of clofibrate. In 1969 we studied a small group of atherosclerotic men treated with 1·50-2·25 g clofibrate per day," 2 All our patients (mean age 44 years) satisfied the criteria for atherosclerosis-e-Le., either having increased serum-total-lipids, serum-cholesterol, and changes in the lipidogram or recent vascular complications associated with hyperlipidremia. Patients were followed up for at least 3 months and their blood/chemistry, coagulation, and fibrinolytic activity was determined before, during, and after treatment with clofibrate and an appropriate diet. Changes in blood-coagulation were studied by measuring the coagulation-time of whole-blood samples in siliconised EFFECTS OF CLOFIBRATE ON BLOOD-COAGULATION AND FIBRINOLYTIC ACTIVITY
University Department of
Ort hope dic Surgery,
-
Princess Margaret Rose
Orthopa:d ic Hospital, Fairmilehead, Edinburgh EHIO 7ED.
J.
I. P.
JAME S
LEUCOCYTE MOVEMENT AND COLCHICINE TREATMENT IN BEHCET'S DISEASE SlR,-Beh~et's disease
is unusually common in Japan.' One of the characteristic findings in this disease is a cutaneous hypersensitivity. Leucocyte infiltrations can be induced in skin even by pricking with a needle, resulting in a small pustule. We have compared the chemotactic activity of polymorphonuclear leucocytes (P.M.N.) from patients with Behcet's disease with those from normal subjects. The chemotactic activity was assessed by a slightly modified procedure of Boyden ',3 using a 1'21'Millipore filter and guinea-pig-complement complexes activated by zymosan as a chemotactic factor. We assessed in duplicate the chemotactic activity of P.M.N. from 13 patients with the complete type of Behcet's disease and from 15 healthy controls. The average chemotactic index calculated after the method of Baum et al, 3 was 280 ± 47 in Behcet's disease and 164±24 in controls. The difference was statistically significant (p < 0'05) . Baum et al.,> using a 31'- Millipore filter, reported that the average chemotactic index of P.M.N. was 553 in healthy controls, 320 in connective-tissue diseases, 414 in diabetes mellitus, and 434 in infectious diseases. Therefore, the high chemotactic activity OfP.M.N. in Behcet's disease is noteworthy. We tried treating patients with Behcet's disease with colchicine, a strong inhibitor of P.M.N. chemotaxis.' One tablet of colchicine (0 '5 mg) was given twice daily to 12 patients with the complete type of Behcet's disease. All 12 patients had had ocular symptoms, stomatitis, and arthralgia for more than 2 years. The ocular symptoms did not occur in 7 of 12 patients for eight to nine months I. Shimizu, T .]ap.]. Ophtha/mol. 1974, 18,282. 2. Ward, P. A., Cochrane, C. G ., Miiller-Eberhard, H . I .]. expoMed . 1965, 122,327. 3. Baurn, I ., Mowat, A. G ., Kirt, I. A.]. Lab. clin, Med. 1971,77,501. 4. Wall ace, S., Omokoku, B., Ertel, N. H. Am.]. Med . 1970,48,443.
B.L.T. (units) C.T., (min) H.T.T. (min)
.. ..
..
..
.. ..
Before clofibrate
After clofibrate
p
19'0± 6·5 26·0 ±13·9 21'8± 8'4
9'0±2'1 10'0±2'7 13'6 ±4'4
25,1975
813
Is it not absurd that the one subject in which the young surgeon should not be tested is the specialty of surgery in which he will spend his professional life? Surely it is obvious that we must examine in this. It is not possible to accept three examinations in postgraduate surgery. I believe the present Primary is misconceived; it is anatomy and physiology taught in a way too irrelevant to clinical problems. In particular it is a bad method of assessing the would-be surgeon; it does not distinguish between those who are suitable for training in surgery and those who are not, though it is often used to do so. Surely those unsuitable should be excluded during the initial 3-year apprenticeship in basic surgical training. An examination in surgery in general, similar to the present final F .R.C.S. together with basic sciences appropriate to all surgeons, should mark the end of basic training. It should provide entry to higher training in the chosen specialty. At the end of higher surgical training there should be an examination in the specialty and in the basic sciences in some depth, appropriate to that specialty. This would clearly indicate completion of training at a high standard and be comparable and perhaps reciprocal to other English-speaking countries and many European ones. Having had some years as chairman of one of the specialist advisory committees, my long-held view is that certificat ion after higher training by the present method, almost a rubber stamp, is quite inadequate-indeed somewhat farcical. A twostage examination, the first in surgery in general, the second in the specialty at the end of training, is surely more logical than our present examination at the beginning of all this.
on colchicine therapy, and the other symptoms were moderately relieved in most cases. We think that colchicine may prove useful in the treatment of Behcet's disease. Department of Medicine and Physical Therapy, University of Tokyo, Tokyo, Japan, 113.
N.
MATSUMURA
Y.
MIZUSHIMA.
CLOFIBRATE IN PREVENTION OF ISCHlEMIC HEART-DISEASE Sm,-We agree with the valuable comments made by Dr Chakrabarti and Dr Meade (April 5, p, 799) on the possible antifibrinolvtic effect of clofibrate. In 1969 we studied a small group of atherosclerotic men treated with 1·50-2·25 g clofibrate per day," 2 All our patients (mean age 44 years) satisfied the criteria for atherosclerosis-e-Le., either having increased serum-total-lipids, serum-cholesterol, and changes in the lipidogram or recent vascular complications associated with hyperlipidremia. Patients were followed up for at least 3 months and their blood/chemistry, coagulation, and fibrinolytic activity was determined before, during, and after treatment with clofibrate and an appropriate diet. Changes in blood-coagulation were studied by measuring the coagulation-time of whole-blood samples in siliconised EFFECTS OF CLOFIBRATE ON BLOOD-COAGULATION AND FIBRINOLYTIC ACTIVITY
University Department of
Ort hope dic Surgery,
-
Princess Margaret Rose
Orthopa:d ic Hospital, Fairmilehead, Edinburgh EHIO 7ED.
J.
I. P.
JAME S
LEUCOCYTE MOVEMENT AND COLCHICINE TREATMENT IN BEHCET'S DISEASE SlR,-Beh~et's disease
is unusually common in Japan.' One of the characteristic findings in this disease is a cutaneous hypersensitivity. Leucocyte infiltrations can be induced in skin even by pricking with a needle, resulting in a small pustule. We have compared the chemotactic activity of polymorphonuclear leucocytes (P.M.N.) from patients with Behcet's disease with those from normal subjects. The chemotactic activity was assessed by a slightly modified procedure of Boyden ',3 using a 1'21'Millipore filter and guinea-pig-complement complexes activated by zymosan as a chemotactic factor. We assessed in duplicate the chemotactic activity of P.M.N. from 13 patients with the complete type of Behcet's disease and from 15 healthy controls. The average chemotactic index calculated after the method of Baum et al, 3 was 280 ± 47 in Behcet's disease and 164±24 in controls. The difference was statistically significant (p < 0'05) . Baum et al.,> using a 31'- Millipore filter, reported that the average chemotactic index of P.M.N. was 553 in healthy controls, 320 in connective-tissue diseases, 414 in diabetes mellitus, and 434 in infectious diseases. Therefore, the high chemotactic activity OfP.M.N. in Behcet's disease is noteworthy. We tried treating patients with Behcet's disease with colchicine, a strong inhibitor of P.M.N. chemotaxis.' One tablet of colchicine (0 '5 mg) was given twice daily to 12 patients with the complete type of Behcet's disease. All 12 patients had had ocular symptoms, stomatitis, and arthralgia for more than 2 years. The ocular symptoms did not occur in 7 of 12 patients for eight to nine months I. Shimizu, T .]ap.]. Ophtha/mol. 1974, 18,282. 2. Ward, P. A., Cochrane, C. G ., Miiller-Eberhard, H . I .]. expoMed . 1965, 122,327. 3. Baurn, I ., Mowat, A. G ., Kirt, I. A.]. Lab. clin, Med. 1971,77,501. 4. Wall ace, S., Omokoku, B., Ertel, N. H. Am.]. Med . 1970,48,443.
B.L.T. (units) C.T., (min) H.T.T. (min)
.. ..
..
..
.. ..
Before clofibrate
After clofibrate
p
19'0± 6·5 26·0 ±13·9 21'8± 8'4
9'0±2'1 10'0±2'7 13'6 ±4'4
