research institute such as those of the UK, USA, and Australia. Most of the equivalent medical science is to be found in medical school departments and is funded from programme and project grants of the MRC, for which total annual expenditure is $NZ 8690 000). The department of community health in the Auckland School of Medicine, which has six university-funded staff led by Prof Robert Beaglehole, has in the past three years reported a total of forty-six new research grants, the value totalling $NZ 2765 407. If this is neglect, give me excess of it.
Department of Physiology, University of Auckland, Auckland, New Zealand
Former scientific secretary, Medical Research Council of New Zealand
Music in the
SIR,--Operating-room noise levels are often high enough to interfere with communication among the theatre team, to increase patient apprehension and stress, and to divert attention or to cause irritability, resulting in compromised patient safety. In the United States background music is often chosen and provided by the principal surgeon who may arrive in the operating room with his own radio or tape, or compact disk player. Strict operating room electrical codes do not seem to apply, and these machines are rarely inspected for ground leakage and electrical faults and are usually powered by improvised electrical cords. Record players are sometimes purchased for a favoured operatingroom staff by a frequently visiting surgeon. While low-volume background music is probably helpful in relieving stress, noisy music is not. Some kinds of music are soothing, some are not. Music played loud enough to be perceptible may induce tranquillity in some and be annoying to others. We have yet to discover one of these record machines that was provided by an anaesthetist. Mr Hodge and Mr Thompson (April 14, p 891) are surgeons. While there is no doubt that a startling noise can result in a slip of the knife, we suggest that the anaesthetist attempting to listen to cardiac and respiratory sounds through a stethoscope and pay attention to a myriad of audiovisual alarms is impeded by continuous noise and by startling sounds. Monitor alarms are intended to be intrusive and annoying, although more easily recognised and specific alarms are being developed. Operating rooms are too noisy; radios and record players are not necessary to the surgical procedure and can easily be eliminated. Department of Anesthesia, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA
ARTHUR J. L. SCHNEIDER JULIEN F. BIEBUYCK
Cardiac arrest telephone numbers SIR,-Delay in the arrival of the resuscitation team to a patient with cardiopulmonary arrest will affect outcome, and this has clearly been shown for out-of-hospital cardiac arrest.1 The telephone code which hospital staff dial to summon the resuscitation team is not standardised in the UK even though doctors and nurses change jobs. When we asked 100 UK hospitals (20 selected at random from
Pituitary-adrenocortical function in treated Hodkgin disease SIR,-Dr Razavi and colleagues (April 21, p 931) report a significant impact of psychosocial factors, especially distress, on outcome of patients with breast cancer. They conclude that changes in the neuroendocrine system may be the major link between emotional processes and the course of cancer. We decided to investigate hormonal indices known to be influenced by psychosocial factors in the context of other malignant diseases. Within a trial comparing two chemotherapy regimens (plus radiotherapy) in patients with Hodgkin disease1 we did a pilot study on 21 men aged 18-48 years at between 4 months and 13 years after the end of treatment. Matched healthy individuals served as controls. Corticotropin (ACTH) and cortisol levels were measured before and after stimulation with 100 I-lg corticotropin-releasing hormone (CRH; Bissendorf Peptide, Wedemark) given intravenously. We also measured baseline levels of luteinising hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone, and 17 a-hydroxyprogesterone (17-OHP). All tests were done between 0800 and 1100 hours. Statistical evaluation was done by Wilcoxon (within group) and Dunn (between group) tests. After both treatment regimens, patients differed from controls in having increased baseline levels of LH, FSH, and prolactin. However, FSH increased by less in patients on ABOEP (see table) than in those on COPP regimen, which confirms the reduced long-term toxicity of ABOEP.* For both groups together ACTH levels 60 min before stimulation were above normal (p < 005) but fell to normal by time zero. Patients had increased cortisol levels 60 min before CRH (p < 0 005); cortisol levels fell during the run-in but and in controls (p