id

CORRESPONDENCE

PROFESSIONAL AND LITERARY ;TA;,;;RDS IN SCIENTIFIC To the Editor: We read with interest the excellent article of Schapira and Schapira (Am J Med 1989; 87: 434-436) on the topic of scientists as frustrated writers. As specialists of the medical language, we would like to congratulate the authors of such a notable work, and we are most pleased that the editors of the Journal have granted it the importance it deserves, by presenting it as a special article. We would like to make the following observations on this subject. The scientific language (and, consequently, the medical language) is aimed at being precise, concise, and simple. It should therefore be very different from the literary language, which is permeated with emotions and subjectivity [l]. Having emphasized this fundamental point, we agree with the authors’ belief that it would be advisable to change the routine format of medical writings to occasionally add a personal touch, which would alleviate the dryness and impersonality of such articles. However, complete freedom to relate one’s impressions in any manner should not be given in scientific writing. Certain professional and literary standards are required to judge when a personal reflection, an image, or a metaphor should be added. We must say “Yes” to imagination and originality, but “No” to rhetoric and to a lack of precision PI* We believe that it would be a great asset for all medical publications to have a Humanities section to provide a literary and paramedical outlet for so many frustrated writers, as are to be found in the medical profession. We would be willing to make do, however, with the correct use of the language, that is, the absence of solecisms, the use of adequate punctuation, the nonexcessive use of abbreviations and the passive voice, a lack of verbosity, and so forth [3]. Clarity in the exposition of concepts would be sufficient as the initial

aim in scientific writing. The literary and personal touch would come later, in a progressive endeavor for perfection. A. ORDO~EZ J. I. CHACON ‘Za Paz” Hospital Madrid, Spain 1. Ordonez Gallego A, Garcra Gir6n C: Diversos aspectos del lenguaje medico (Drverse aspects of the medical language). Med Clin @arc) 1988. 90. 419-421. 2. Ordonez Gallego A. Garcia Gir6n C: Las metaforas medicas (The medical metaphors). Med Clin @arc) 1989: 93: 374-376. 3. Christy NP: 2284: Timrd souls among the rums. Am J Med 1984; 76: 3-J. SubmItted

February

15. 1990, and accepted February 23, 1990

EFFECT OF CONTINUOUS NORMALIZATION OF SERUM COMPLEMENT LEVELS ON CLINICALLY EVIDENT LUPUS NEPHRITIS To the Editor: In their study of the effect of normalization of serum complement levels on the course of lupus nephritis (LN), Laitman and coworkers (Am J Med 1989; 87: 132138) extend their previous observations that early and sustained normalization of total hemolytic complement (CH& leads to better patient and renal outcome. We do have some reservations about their conclusions, however. They studied renal biopsy specimens in 39 patients with systemic lupus erythematosus (SLE) and abnormal CHsc results. They do not mention how they defined LN, and as almost 50% (19 of 39) of their patients had only mesangial abnormalities on biopsy, we suspect they included many patients without clinically evident LN. Mesangial disease, however, is an almost universal finding in all patients with SLE [l] and in itself does not indicate significant renal disease. If patients without clinical evidence of LN were included in this study, then the findings of this study are much less convincing, as patients without clinical renal disease have an excellent outcome [2]. TOM

HANS J.G.

C. NOSSENT, SWAAK, M.D.,

July 1990

Dr. Daniel den Hoed Clinic Rotterdam, The Netherlands 1. O’Dell J, Hays R. Guggenheim S. Steigerwald J: Systemic lupus erythematosus without clinrcal renal abnormalities: renal biopsy findings and climcal course. Ann Rheum Dis 1985: 44: 415-419. 2. Nossent JC, Bronsveld W. Swaak AJG: Systemic lupus erythematosus. Ill. Observabons on clinical renal Involvement and follow up of renal function: Dutch experience v&h 110 patients studied prospectively. Ann Rheum Dis 1989; 48: 810-816. Submitted November

and accepted February 23, 1990

The Reply: Drs. Nossent and Swaak make a valid point. We wish to correct the inadvertent omission of the following. In our study (Am J Med 1989; 87: 132-138), all patients had clinical evidence of renal disease with either abnormal urinalysis results (more than five red blood cells or white blood cells per high-power field or cellular casts) or proteinuria above 500 mg/24 hours. Approximately 50% (19 of 39) of our patients with LN had only mesangial changes on initial biopsy. After a mean follow-up of 116.7 f 11 months, however, patients with mesangial changes and chronic hypocomplementemia had a poor renal outcome. In contrast, patients with an initial biopsy showing diffuse proliferative glomerulonephritis in whom serum complement remained normal with immunosuppressive therapy did well. Thus, the original World Health Organization classification of glomerular disease is by itself not a good predictor of long-term renal outcome (Balow JE, Austin HA, Munez LR, et al: Effect of treatment on the evolution of renal abnormalities in lupus nephritis. N Engl J Med 1984; 311: 491-495). Although the number of patients in our study was small, we suggest that patients with clinically evident LN in whom serum complement levels can be continuously normalized have a better prognosis than those in whom complement levels are not normalized. DANIEL GLICKLICH, LEONARDA B. SABLAY, PETER BARLAND, NORMAN BANK,

Montefiore

M.D. Ph.D.

The American

15.1989,

Journal

of Medicine

M.D. M.D. M.D. M.D.

Medical Center Bronx, New York

Volume

89

125

Professional and literary standards in scientific writing.

id CORRESPONDENCE PROFESSIONAL AND LITERARY ;TA;,;;RDS IN SCIENTIFIC To the Editor: We read with interest the excellent article of Schapira and Scha...
141KB Sizes 0 Downloads 0 Views