730 SHOULD THE LAX SET THE PACE?
SIR,-Congress proceedings and multiauthor books are often published with unjustifiable delay. Publication periods of 1-2 years are frequent; delays of 3-4 years have occurred. The reason is usually that a few contributors do not respect the deadline set by the editors, and that the editors wait for late contributions. Is this editorial policy fair to the readers? Is it fair to the contributors? Authors who fail to observe the deadline are given the opportunity to publish updated and interesting chapters. Those who comply with the editors’ request find themselves presenting chapters which are largely obsolete when the book is published. I cannot be alone in having this experience. Are there others who share my sentiments? It seems to me that pressure might be exerted on organisers/editors to close their office to manuscripts arriving after a particular date-for example, two months after the official deadline. If the pressure is sufficiently strong, the editors may be forced to choose between punctual and lax contributors. Readers and authors will gain if editors choose the punctual. Psychopharmacology Research Unit, University Institute of Psychiatry, Psychiatric Hospital,
Aarhus
DK-8240 Risskov, Denmark
MOGENS SCHOU
HLA-DRw4 AND RHEUMATOID ARTHRITIS
SIR,-Dr Dobloug and his colleagues (March 10, p. 548) offer evidence in support of the findings of Roitt et al.’ that HLA-DRw4 is associated with seropositivity for rheumatoid factor (R.F.) in patients with rheumatoid arthritis. These reports are based on small numbers of patients-39 and 37, respectively. In our published series of 95 patients2 we have found no such association. We have now analysed a total of 164 patients who met the criteria3 for classical or definite rheumatoid arthritis. The TABLE
I-HLA-DRW4
AND
DRW3
AND R.F. STATUS IN RHEUMATOID
ARTHRITIS
number of patients studied. Clearly the genetic factors contributing to the development of R.F. are of great interest and further studies must be performed before any firm conclusions are drawn. Departments of Medicine Guy’s Hospital,
and
Rheumatology,
London SE1 9RT
Department of Tissue Immunology, Hammersmith Hospital, London W12
G. S. PANAYI P. H. WOOLEY
J. R. BATCHELOR
IS MAINTENANCE DIGOXIN NECESSARY IN PATIENTS WITH SINUS RHYTHM?
SIR,-We were fascinated to read a paper by Dr Johnston and Professor McDevitt (March 17, p. 567) which suggested that most patients in sinus rhythm taking maintenance digoxin therapy do not benefit from it. We have come to a very similar conclusion. Our evidence’suggests that the exercise ability of patients with heart-failure due to myocardial disease is not improved by taking digoxin, provided the patients are in sinus rhythm. The one proviso we have made is that diuretics are used properly to control the salt and water retention which is an inevitable accompaniment of this condition. Department of Medicine, Charing Cross Hospital Medical School, London W6 8RF
D. J. MCHAFFIE A. GUZ
SIR,-The conclusion reached by Dr Johnston and ProfesMcDevitt-that digoxin can frequently be discontinued in appropriate patients-is welcome, and will not unduly surprise those dealing largely with the hospital care of the elderly. Given that many such patients are at the same time receiving diuretics, the risk of cation imbalance involving potassium, magnesium, and calcium is increased, and in such a setting serum-digoxin levels may be normal despite toxic manifestations.’ The frequency of a severe chest infection precipitating cardiac failure in the elderly is another situation where digoxin, given appropriately at the time, can be withdrawn after satisfactory treatment of the precipitating condition. Incidentally, what were the ages of the patients reported in the series? sor
Geriatric Unit, Stobhill Hospital, Glasgow G21 3UW
R. D. KENNEDY
BLINDNESS AND SCHIZOPHRENIA results for DRw4 and for R.F. status (seropositivity being defined as a titre of >40 and seronegativity as a titre of
SIR,-Congress proceedings and multiauthor books are often published with unjustifiable delay. Publication periods of 1-2 years are frequent; delays of 3-4 years have occurred. The reason is usually that a few contributors do not respect the deadline set by the editors, and that the editors wait for late contributions. Is this editorial policy fair to the readers? Is it fair to the contributors? Authors who fail to observe the deadline are given the opportunity to publish updated and interesting chapters. Those who comply with the editors’ request find themselves presenting chapters which are largely obsolete when the book is published. I cannot be alone in having this experience. Are there others who share my sentiments? It seems to me that pressure might be exerted on organisers/editors to close their office to manuscripts arriving after a particular date-for example, two months after the official deadline. If the pressure is sufficiently strong, the editors may be forced to choose between punctual and lax contributors. Readers and authors will gain if editors choose the punctual. Psychopharmacology Research Unit, University Institute of Psychiatry, Psychiatric Hospital,
Aarhus
DK-8240 Risskov, Denmark
MOGENS SCHOU
HLA-DRw4 AND RHEUMATOID ARTHRITIS
SIR,-Dr Dobloug and his colleagues (March 10, p. 548) offer evidence in support of the findings of Roitt et al.’ that HLA-DRw4 is associated with seropositivity for rheumatoid factor (R.F.) in patients with rheumatoid arthritis. These reports are based on small numbers of patients-39 and 37, respectively. In our published series of 95 patients2 we have found no such association. We have now analysed a total of 164 patients who met the criteria3 for classical or definite rheumatoid arthritis. The TABLE
I-HLA-DRW4
AND
DRW3
AND R.F. STATUS IN RHEUMATOID
ARTHRITIS
number of patients studied. Clearly the genetic factors contributing to the development of R.F. are of great interest and further studies must be performed before any firm conclusions are drawn. Departments of Medicine Guy’s Hospital,
and
Rheumatology,
London SE1 9RT
Department of Tissue Immunology, Hammersmith Hospital, London W12
G. S. PANAYI P. H. WOOLEY
J. R. BATCHELOR
IS MAINTENANCE DIGOXIN NECESSARY IN PATIENTS WITH SINUS RHYTHM?
SIR,-We were fascinated to read a paper by Dr Johnston and Professor McDevitt (March 17, p. 567) which suggested that most patients in sinus rhythm taking maintenance digoxin therapy do not benefit from it. We have come to a very similar conclusion. Our evidence’suggests that the exercise ability of patients with heart-failure due to myocardial disease is not improved by taking digoxin, provided the patients are in sinus rhythm. The one proviso we have made is that diuretics are used properly to control the salt and water retention which is an inevitable accompaniment of this condition. Department of Medicine, Charing Cross Hospital Medical School, London W6 8RF
D. J. MCHAFFIE A. GUZ
SIR,-The conclusion reached by Dr Johnston and ProfesMcDevitt-that digoxin can frequently be discontinued in appropriate patients-is welcome, and will not unduly surprise those dealing largely with the hospital care of the elderly. Given that many such patients are at the same time receiving diuretics, the risk of cation imbalance involving potassium, magnesium, and calcium is increased, and in such a setting serum-digoxin levels may be normal despite toxic manifestations.’ The frequency of a severe chest infection precipitating cardiac failure in the elderly is another situation where digoxin, given appropriately at the time, can be withdrawn after satisfactory treatment of the precipitating condition. Incidentally, what were the ages of the patients reported in the series? sor
Geriatric Unit, Stobhill Hospital, Glasgow G21 3UW
R. D. KENNEDY
BLINDNESS AND SCHIZOPHRENIA results for DRw4 and for R.F. status (seropositivity being defined as a titre of >40 and seronegativity as a titre of
