41 These studies5 were supported by a Special Project grant from the Council for Tobacco Research-U.S.A., Inc. The Wharton School, Regional Science Department, RICHARD J. HICKEY University of Pennsylvania, RICHARD C. CLELLAND Philadelphia, DAVID E. BOYCE. U.S.A. Pennsylvania 19174, Biology Department, Community College of Philadelphia, Philadelphia, EVELYN J. BOWERS. Pennsylvania 19103, U.S.A.
Japan and Australia. The dividing line between " heavy (highest quartile) and " normal " middle-aged Japanese males a decade ago, 5 ft. 7 in. (170 cm.) in height, was less than 132 lb. (60 kg.). There may well have been too few individuals in that group with weight and serum-cholesterol of sufficient magnitude to be reflected in vascular disease mortality. There has been found, on the other hand, a continuous relationship between arterial pressure and relative weight throughout the spectrum of weight, despite the general leanness of this population. "
Hospital of St. Raphael, New Haven, Connecticut 06511,
DOCTORS AND SMOKING
U.S.A.
SIR,-No doubt Mr Harris (Dec. 14, p. 1458) is right. We shouldn’t smoke, even us older ones. But for every on smoking there’s one on geriatrics; I don’t know which frightens me more. We all have to find our " own way of resolving Swift’s dilemma: Every man to live long; but no man would be old."
DONALD S. DOCK.
publication
desires
Department of Anatomy, Medical School, Newcastle upon Tyne NE1 7RU.
SIR The report by Dr Everson and others (June 22, 1290) prompted a survival study of 274 Wilms’ tumour patients treated at the Sidney Farber Cancer Center (Children’s Cancer Research Foundation) of Boston in 1945-69. For successive quinquennia after 1945, the 3-year survival-rates rose steadily: 18%, 19%, 48%, 55%, and 67%. The trend paralleled that reported by Dr Everson and his colleagues, even though the two series may have differed in patient selection and treatments. Published reports show nearly flat survival curves for Wilms’-tumour patients following the third year after diagnosis. 1-3 In our series, 14 late deaths have occurred among 140 patients alive at 36 months. Actuarial analysis of the data shows excess mortality up to 25 years, although the small numbers at risk beyond 15 years must be interpreted with caution (see accompanying figure). Cause of late mortality in 4 patients was recurrent Wilms’ tumour, another with trisomy 184 died with an acute infection. 9 others, including 5 who presented with disseminated disease or required multiple courses of therapy, died in p.
J. E. GRAY.
ANTIGENIC SITES RELATED TO HUMAN SERUM-PROTEINS ON HBsAg AND SPECIFICITY OF IMMUNOSORBENTS
SIR,-We read with great interest the letter by Goudeau al.l showing that hepatitis-B surface antigen (HBsAg) may be non-specifically adsorbed to immunosorbents prepared by linking antibodies to ’Sepharose’ 4B. This non-specific binding was also observed in our experiments.2 However, the finding of Goudeau et al. fails to support et
the conclusion that it seems highly improbable that HBsAg particles carry normal serum-proteins on their surface. The reasons are: (1) the authors used HBsAg preparations containing normal human serum-proteins (N.H.S.) which inhibit the immunospecific binding of HBsAg to insolubilised antibodies against N.H.S. 2; (2) the decision whether or not an immunospecific attachment of HBsAg to insolubilised antibodies against components of N.H.s. occurs may be based only on comparative quantitative studies in which insolubilised non-immune y-globulins serve as controls and in which non-specific adsorption of HBsAg is suppressed. Our studies suggest that HBsAg carries antigenic sites related to some components of N.H.S.2 Virology Laboratory, New York Blood Center, New York, New York 10021, U.S.A.
SURVIVAL IN WILMS’ TUMOUR
-
A. R. NEURATH.
sustained remission with treatment-associated disorders. 4 of the 9 developed second neoplasms in irradiated sites," and the remainder had pulmonary (3) or renal (2) failure after treatment of these organs with radical surgery, intense irradiation, and actinomycin D in conventional doses.6 Mortality after the third year thus resulted chiefly from Cassady, J. R., Tefft, M., Filler, R. M., Jaffe, N., et al. Cancer, 1973, 32, 598. 2. Aron, B. S. ibid. 1974, 33, 637. 3. Hussey, D. H., Castro, J. R., Sullivan, M. P., Sutow, W. W. Radiology, 1971, 101, 663. 4. Geiser, C. F., Schindler, A. M. Pediatrics, Springfield, 1969, 44, 111. 5. Li, F. P., Cassady, J. R., Jaffe, N. Cancer (in the press). 6. Jaffe, N., Li, F. P. Radiology (in the press). 1.
OBESITY AND CORONARY-ARTERY DISEASE
SIR,—It to
bear
on
may be worth bringing additional information issues raised by Leelarthaepin et’ al. (Nov. 23,
1217). They alluded to the dispute about obesity as an independent risk factor in coronary-artery disease and stressed the association between food intake, weight, and p.
the known risk factor, serum-cholesterol. Preliminary results from a longitudinal study of Japanese men and women (Atomic Bomb Casualty Commission, Hiroshima and Nagasaki) suggest that, when blood-pressure is removed as a confounding variable, initial relative weight is not correlated with subsequent cardiovascular mortality-rate. The implication of these findings, however, must necessarily be tempered by the realisation that relative weight is by no means the same kettle of fish in 1.
Goudeau, A., Houwen, B., Dankert, J. Lancet, Nov. 30, 1974, p.
2.
Neurath, A. R., Prince, A. M., Lippin, A. Proc. natn. Acad. Sci. 1974, 71, 2663.
1325.
Actuarial survival curve, with 95% confidence intervals, for 140 Wilms’-tumour patients alive at 36 months after diagnosis. Controls are U.S. children of comparable ages.
Japan and Australia. The dividing line between " heavy (highest quartile) and " normal " middle-aged Japanese males a decade ago, 5 ft. 7 in. (170 cm.) in height, was less than 132 lb. (60 kg.). There may well have been too few individuals in that group with weight and serum-cholesterol of sufficient magnitude to be reflected in vascular disease mortality. There has been found, on the other hand, a continuous relationship between arterial pressure and relative weight throughout the spectrum of weight, despite the general leanness of this population. "
Hospital of St. Raphael, New Haven, Connecticut 06511,
DOCTORS AND SMOKING
U.S.A.
SIR,-No doubt Mr Harris (Dec. 14, p. 1458) is right. We shouldn’t smoke, even us older ones. But for every on smoking there’s one on geriatrics; I don’t know which frightens me more. We all have to find our " own way of resolving Swift’s dilemma: Every man to live long; but no man would be old."
DONALD S. DOCK.
publication
desires
Department of Anatomy, Medical School, Newcastle upon Tyne NE1 7RU.
SIR The report by Dr Everson and others (June 22, 1290) prompted a survival study of 274 Wilms’ tumour patients treated at the Sidney Farber Cancer Center (Children’s Cancer Research Foundation) of Boston in 1945-69. For successive quinquennia after 1945, the 3-year survival-rates rose steadily: 18%, 19%, 48%, 55%, and 67%. The trend paralleled that reported by Dr Everson and his colleagues, even though the two series may have differed in patient selection and treatments. Published reports show nearly flat survival curves for Wilms’-tumour patients following the third year after diagnosis. 1-3 In our series, 14 late deaths have occurred among 140 patients alive at 36 months. Actuarial analysis of the data shows excess mortality up to 25 years, although the small numbers at risk beyond 15 years must be interpreted with caution (see accompanying figure). Cause of late mortality in 4 patients was recurrent Wilms’ tumour, another with trisomy 184 died with an acute infection. 9 others, including 5 who presented with disseminated disease or required multiple courses of therapy, died in p.
J. E. GRAY.
ANTIGENIC SITES RELATED TO HUMAN SERUM-PROTEINS ON HBsAg AND SPECIFICITY OF IMMUNOSORBENTS
SIR,-We read with great interest the letter by Goudeau al.l showing that hepatitis-B surface antigen (HBsAg) may be non-specifically adsorbed to immunosorbents prepared by linking antibodies to ’Sepharose’ 4B. This non-specific binding was also observed in our experiments.2 However, the finding of Goudeau et al. fails to support et
the conclusion that it seems highly improbable that HBsAg particles carry normal serum-proteins on their surface. The reasons are: (1) the authors used HBsAg preparations containing normal human serum-proteins (N.H.S.) which inhibit the immunospecific binding of HBsAg to insolubilised antibodies against N.H.S. 2; (2) the decision whether or not an immunospecific attachment of HBsAg to insolubilised antibodies against components of N.H.s. occurs may be based only on comparative quantitative studies in which insolubilised non-immune y-globulins serve as controls and in which non-specific adsorption of HBsAg is suppressed. Our studies suggest that HBsAg carries antigenic sites related to some components of N.H.S.2 Virology Laboratory, New York Blood Center, New York, New York 10021, U.S.A.
SURVIVAL IN WILMS’ TUMOUR
-
A. R. NEURATH.
sustained remission with treatment-associated disorders. 4 of the 9 developed second neoplasms in irradiated sites," and the remainder had pulmonary (3) or renal (2) failure after treatment of these organs with radical surgery, intense irradiation, and actinomycin D in conventional doses.6 Mortality after the third year thus resulted chiefly from Cassady, J. R., Tefft, M., Filler, R. M., Jaffe, N., et al. Cancer, 1973, 32, 598. 2. Aron, B. S. ibid. 1974, 33, 637. 3. Hussey, D. H., Castro, J. R., Sullivan, M. P., Sutow, W. W. Radiology, 1971, 101, 663. 4. Geiser, C. F., Schindler, A. M. Pediatrics, Springfield, 1969, 44, 111. 5. Li, F. P., Cassady, J. R., Jaffe, N. Cancer (in the press). 6. Jaffe, N., Li, F. P. Radiology (in the press). 1.
OBESITY AND CORONARY-ARTERY DISEASE
SIR,—It to
bear
on
may be worth bringing additional information issues raised by Leelarthaepin et’ al. (Nov. 23,
1217). They alluded to the dispute about obesity as an independent risk factor in coronary-artery disease and stressed the association between food intake, weight, and p.
the known risk factor, serum-cholesterol. Preliminary results from a longitudinal study of Japanese men and women (Atomic Bomb Casualty Commission, Hiroshima and Nagasaki) suggest that, when blood-pressure is removed as a confounding variable, initial relative weight is not correlated with subsequent cardiovascular mortality-rate. The implication of these findings, however, must necessarily be tempered by the realisation that relative weight is by no means the same kettle of fish in 1.
Goudeau, A., Houwen, B., Dankert, J. Lancet, Nov. 30, 1974, p.
2.
Neurath, A. R., Prince, A. M., Lippin, A. Proc. natn. Acad. Sci. 1974, 71, 2663.
1325.
Actuarial survival curve, with 95% confidence intervals, for 140 Wilms’-tumour patients alive at 36 months after diagnosis. Controls are U.S. children of comparable ages.
