1100
graphy (due to natural lysis of the autologous material after 28 days), is further evidence for this mode of removal of degraded fibrinogen/fibrin. Animal experiments are now being nerformed
to
confirm
our
destruction of fibrinogen.
to the site of R. J. HAWKER LINDA M. HAWKER G. A. L. WILKINSON J. D. HAMER
observations relating
-
Department of Surgery, Queen Elizabeth Hospital, University of Birmingham.
IS THE URINE CONCENTRATING ABILITY DEFECTIVE IN THE AFRICAN?
study of 7 Nigerians and 4 Europeans resident in Lagos, Nigeria, Kenney’ reported that the maximum urine concentration was greater in European than in Nigerian subjects, no matter how he provoked hydropxnia. In a later review article2 Kenney stated that the mechanism of urine conSIR,-In
a
centration is defective in the African. In my view the urine-concentrating ability is no less adequate in the African than in the European. This view is based on studies of 60 healthy Ghanaians (West Africans), 16 of whom had haemoglobin AS (sickle-cell trait), and 44 haemo-
globin AA. The sickle-cell trait to concentrate
subject has a moderately reduced ability
urine.34have confirmed this in my 16 sickle-
cell-trait subjects; my patients with haemoglobin AA had maximum urine osmolalities ranging from 900 to 1300 mosmol/kg (average over 1000) whereas those with the sickle-celltrait had values ranging from 600 to about 1000 mosmol/kg (average 700). The range of values for Kenney’s European subjects are similar to the range I obtained in my Ghanaian Hb AA subjects. Kenney did not record the haemoglobin genotype of his subjects, because I think it was not determined. In the coastal belt West Africa about 25% of the population have the sickle-cell trait.’ It is likely therefore that some of Kenney’s Nigerian subjects had the sickle-cell trait, particularly those who had maximum urine osmolality consistently below 800
the patient required more understanding of the person with the disease; social, cultural, and psychological factors were important to the nursing care of patients, and to handle this the nurse needed a broader educational base. It is interesting that others are just now recognising this; but nurses are criticised for being ahead of the times. Another way that nurses were ahead of the times was in the development of assistants, nursing aids, &c. Granted this was forced on them in some ways, and the practical nurses themselves demanded recognition and licensure. This seems to be one of your criticisms also. Still you seem to praise the physician for developing assistants. 1149
Arlington Parkway,
MARY LOUISE ATKINSON
Atlanta, Georgia 30324, U.S.A.
IS PRE-ECLAMPSIA AN IMMUNE-COMPLEX DISEASE?
SIR,-As pointed out in your editorial (Sept. 13, p. 487), the basic pathological mechanism underlying hypertension in pregnancy continues to be elusive.I suggest that arthritis may sometimes be a feature of the pre-eclamptic syndrome (P.E.T.) and that more investigation based on the possibility of an immune-complex disease may well prove fruitful. I have had the opportunity of talking to 6 women who, when pregnant felt they had mild arthritic symptoms affecting their proximal interphalangeal joints. Of the 6, 3 had been worried that they might be developing rheumatoid arthritis, 5 had a close family history of autoimmune disease, and at follow-up one year later 2 felt they had painless residual joint swelling and had found it necessary to have their rings
values for maximum urine osmolality in his African subjects were a mixture of normal values for the Hb AA and lower values for the Hb AS. The conclusion is inescapable that the healthy African with Hb AA is capable of concentrating his urine no less efficiently than the European.
enlarged. 79 randomly selected pregnant women were then studied to determine whether there was an association between finger swelling and an increased erythrocyte sedimentation-rate (E.S.R.). The E.S.R. was between 50 and 150 mm in the first hour in 25 patients (31.6%), and of these 15 (60%) had finger swelling. In the group with an E.s.R. below 50 mm, only 14 of the 54 patients (16%) had finger swelling. The correlation between finger swelling and elevation of the E.s.R. is significant (P
graphy (due to natural lysis of the autologous material after 28 days), is further evidence for this mode of removal of degraded fibrinogen/fibrin. Animal experiments are now being nerformed
to
confirm
our
destruction of fibrinogen.
to the site of R. J. HAWKER LINDA M. HAWKER G. A. L. WILKINSON J. D. HAMER
observations relating
-
Department of Surgery, Queen Elizabeth Hospital, University of Birmingham.
IS THE URINE CONCENTRATING ABILITY DEFECTIVE IN THE AFRICAN?
study of 7 Nigerians and 4 Europeans resident in Lagos, Nigeria, Kenney’ reported that the maximum urine concentration was greater in European than in Nigerian subjects, no matter how he provoked hydropxnia. In a later review article2 Kenney stated that the mechanism of urine conSIR,-In
a
centration is defective in the African. In my view the urine-concentrating ability is no less adequate in the African than in the European. This view is based on studies of 60 healthy Ghanaians (West Africans), 16 of whom had haemoglobin AS (sickle-cell trait), and 44 haemo-
globin AA. The sickle-cell trait to concentrate
subject has a moderately reduced ability
urine.34have confirmed this in my 16 sickle-
cell-trait subjects; my patients with haemoglobin AA had maximum urine osmolalities ranging from 900 to 1300 mosmol/kg (average over 1000) whereas those with the sickle-celltrait had values ranging from 600 to about 1000 mosmol/kg (average 700). The range of values for Kenney’s European subjects are similar to the range I obtained in my Ghanaian Hb AA subjects. Kenney did not record the haemoglobin genotype of his subjects, because I think it was not determined. In the coastal belt West Africa about 25% of the population have the sickle-cell trait.’ It is likely therefore that some of Kenney’s Nigerian subjects had the sickle-cell trait, particularly those who had maximum urine osmolality consistently below 800
the patient required more understanding of the person with the disease; social, cultural, and psychological factors were important to the nursing care of patients, and to handle this the nurse needed a broader educational base. It is interesting that others are just now recognising this; but nurses are criticised for being ahead of the times. Another way that nurses were ahead of the times was in the development of assistants, nursing aids, &c. Granted this was forced on them in some ways, and the practical nurses themselves demanded recognition and licensure. This seems to be one of your criticisms also. Still you seem to praise the physician for developing assistants. 1149
Arlington Parkway,
MARY LOUISE ATKINSON
Atlanta, Georgia 30324, U.S.A.
IS PRE-ECLAMPSIA AN IMMUNE-COMPLEX DISEASE?
SIR,-As pointed out in your editorial (Sept. 13, p. 487), the basic pathological mechanism underlying hypertension in pregnancy continues to be elusive.I suggest that arthritis may sometimes be a feature of the pre-eclamptic syndrome (P.E.T.) and that more investigation based on the possibility of an immune-complex disease may well prove fruitful. I have had the opportunity of talking to 6 women who, when pregnant felt they had mild arthritic symptoms affecting their proximal interphalangeal joints. Of the 6, 3 had been worried that they might be developing rheumatoid arthritis, 5 had a close family history of autoimmune disease, and at follow-up one year later 2 felt they had painless residual joint swelling and had found it necessary to have their rings
values for maximum urine osmolality in his African subjects were a mixture of normal values for the Hb AA and lower values for the Hb AS. The conclusion is inescapable that the healthy African with Hb AA is capable of concentrating his urine no less efficiently than the European.
enlarged. 79 randomly selected pregnant women were then studied to determine whether there was an association between finger swelling and an increased erythrocyte sedimentation-rate (E.S.R.). The E.S.R. was between 50 and 150 mm in the first hour in 25 patients (31.6%), and of these 15 (60%) had finger swelling. In the group with an E.s.R. below 50 mm, only 14 of the 54 patients (16%) had finger swelling. The correlation between finger swelling and elevation of the E.s.R. is significant (P
