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NC'TICE This material may, 5e protected by ccpy;lgnt {aw (Tltle 1''7 U.S. Code). 392 PRETARATIONS USED IN TH! CDLLitORaSTIY£ STSlDY Preparanon Subtype HBeAV anu-HBe Serunv plasma State. 8pIA9• ,d ann-HSe Serum I Freezedned A .d HBeAg Serum L,qurd B ad antt-HBe Ptasma Lquad C ay HBeAg I Serum Llqutd D ry antrHBe Serum Liquid E av HBeeSg Serum ~ L+qutd F ad HBe-ig Serum L Liquid Gt ad aato-HBe Serum Freeze dried 'fnqa.ed Den.e.Rsfirenci Pretarsr+s er'He'eluu ~ Surfaas AwrrRn. tCoOed duMrorea( 1111rnuA Ilsieearee Map.ruon Twelve laboratories contnbuted data from a total of 31 aamys. All parttapanes used solid phase ndiotrttmunoassays-the 'AL'SRIA II~' commercial kit (Abbott) :tn six, a ttsodifiatloaof the cornmercul kit in two.t and the reantrung fotu laboratones used their local method. aassy,data were analysed using the standard method: of parallel' lineaisays:° potencies ofthe samples were expressed'relattve to the proposed standard. For each sample, potencv ratios from replicate assan of Individual laboratona were combined by taking their geometric rrlntts. The frequency distributions of'these valiies are shown in the figure. No obvious dlffereneY were found between estimates obtained from laboratories using duYercnt forms of radiouttmunoassav. There was reasonable agreement between the potencv estimates obtained bv the different laboratories. The potency estimates obtained for the coded duplicate of the standard (sample G)'were remarkably close to unity. Furthermore, there was betteragreemenr between latlorntona for the potency of sample G than for the other samplei: Nevertheless, the variation found between potency estimates of the individual coded prepantlons for the different laboratories were cotsstdered to be smallitn practtcal'rerms:. In 1982 the National Biological Standards Board authorlsed the atablishtnenr of the preparation coded' 8015,49 as the British Reference Preparatson of Hepanns B Surface .jnugen ( HtAg), with an assigned unttage of 100 unsts per ampoule. The Hepatitis qdvuay Group has recommendefl° thar all donations ofblood destttsed [o contrtbute to protcat iracttonauon ar 'Hopus R. Rar S. Joraan T. t4an AD. tmqrwaet eeenem.er a H R~i~.rreenrne.+~+n co0uet<rcWn4waun,ur..ns{eem JC"..Par_ IIM0:7]:.Ip-2)a Finnv01. Sotrtel nrt4a,. W.bpra6arae, iraeC. L:xrdonGruTin. I9Ta • A4na.rvCyrwy on Toruq.iar rM Presence oi Hep.rnrr.ta.arraua Anrisen ana AnnawdeTlrq:repon. Irr 1 I , F r -irt- 7 j P-Me ~ I of .ol- t Fs.qaseaey df.rribsi.r .(p.e.aey . etim.aarx s.mpt.. A-Gia term. eif proy...d nf.ese.e.pe.pa•atioa Each box deroeea the mea.n potenirv obtnmed bv une Iaborato" br radtotmmuna.ua•'open boees (Abbott commercrai kit). hatched boxes. (modtficaanao(Abbon lurt. Cifled boees lorher methorls) ~ THEL1 vCET.Al.'GUST 14. 1982 Y.H.S: fraenonatsoo centres should' be tested bw techniques that give a'"paitlve" result for a concentration of:2 BntLSh units oi' HBaAg'ml. Subsequently a funher.study was carrted out to esttmate the detection hmtts, reiattve to the British Reference Prepantton, of' methods used bv the participants. Preliminary results have shown that labontones in the study detecred~ the presence of 5epantu antigen at a concentration of 0• i uruts/ml. In some laboratories as little as 0- 125 unstvttil could be routinely detected. Thus the assav methods Inedm the study should rullv fulfil the recommendatton of the Hepatitis Xdvtsorv Group. We.rhank the Colla.rng for parrmctp¢nnf in the srudrDnEtuaoethBouil IBirntsn{hamh Dr C. H Camcron ano Dr D S. Dane tLondonl: Dr R. ) Cn.faedlCathlkel;DnR.HopttnslElmburyhl:DrR:S.LnerndDr8 S CatoAndfi (ElstreeR Dr Ataryret Supran ILondonl Dr P. PNton:me: ILondank Dr E. G. Wlleeler and Dr 4': 1 Jenktns tBrentwoodc Prot: AJ. Zuekerm.n. DrHaui Snuth, and Dr.H. Bo.errnan I Londonc Dr R. I Gererv (Betbeada: C.S.A.); Prof R: Thomsaen. Dr: R' lierlrch, and Dr K Lcelea (G3tttnjen. West Gerasanvl:.andDr P J CamptieiL.standardsprocessinq saetwn- V.LB.S.C.. +haorr;anased the.lutnFutton oi,the ampoailcn. Nxrrol!lerarre rw aWO9cal. s[arbNa aMcanrrp. , Lonorr YWSaRa V.ALERIE SE.iGRUATL .4WRAG FERGUsQ. D. 11 \'1rlliRiTH G. C. S..HIZD Nddlesa H a.p wai.Nfteal. Smoa: Lonoon 1st C. H. C.tmF.RU% PASSIVE SMOKING SEVERELY DECREASES PLATELET SE.'9SCTfYITY TO A:P7TIAGGREGATORY PROSTAGLANDINS Sta,-tn the editorlal (,Aarch 6. p. 548) and'tnahe ensuing carre- spotsdence on passtve smoking the risk of the development of atherosclerosis has norbeen mentioned. Cnpubiishedstudla(H! S: and 0: Burghuber; and E. Walter) suggest that plateleu function is severely u7ected in urwken, and (here ts some evidence ehar cigarette smoking msght exert Irs action via dtmtnnhal vasculltr prostacyclln (PGI=) svnthesu ' and decreased senstt tvttv of platelets to antugsregatorq protraglandlns, ' We have looked'at the erTeas of passive smoktng on platelet senstttvtty. We measured platelet sensltlvttv to the anruggregatory prostagiandins (E11 I_, D.) before, during, and after passive smoking tn esghcmale and'fbur female smokers aged 22-31'and in eight male and'one female non-smokers aged 24-30 In a 18 m3 room thtrty cigarettes of a strong brand ('Gi(anes') were smoked by testers, to give a smoke concentration calculated to resemble that in diseea, restaurants, and the like. The rest sublens were exposed to the smoke for 15 rnut: Blood was sampled immediately before and at the end of the smoking penod and 20 and 60 mtn afterwards froma Lvbttal vein without occlusion, u•uh 3•8"/e sodlum ctrrae as annewgulant. f'Platelet senslttvtt y as nsp ressed as I nko ( t he amount of PG' in tsglml platelet rich plasma necnurv to halve the aggregarwn Induced by I wrnoUl .a1)P); Passive smoking (table) reduced platelet senstnvtry to the antuggregatory PGs, being much more severe tn non-smokers than tnsmokess. 20 mtts afterpasstve smoking, platelet senstavttv staned to return to basal values and Ihls happened more qulcklv in non- smokers. However, the baseline values in smokers were siptfantly lower (p<0•01p than those in non,smokers. A decrease In platelet sensitivity is the maror deterrrttnant of haemouanc re;ulatton' and mav thus be responsible for early changes preceding stherosclerosls.5 In combination with our 1.Uwa I• ~eeeN~r A ERret elnKarne on i ne fenn.er-n si R+wae.elrn rn ru aena. 1 n, Y(i G.lM1.rrqrara i Fieenae. i W I>; ae.vr 41 wGW A. Rdalisa A. aveyrueer O. 5ronnqrr H. Pvdn aA. Innaen:e of z.,.< andp.ree tero" enppreter rnunnr+,o anr r.qreprn.. pnrqundw uw nrum. r0ea.0ee.ea !. u rwWen aM Mn-e/rwen Is 1' r. G.l Pnrr,yuwl+aIFue•.. IwSl arr m7 1. Auen.Yl O. s~.auMer H. l'ernanen an PUncMnwetrn.nY t3ranruurre.ra.ucne Rv.apa.CUr IAlrerrnluney.eit I: a'- T.n.-l ]rrAe I N I. Yl 112 - 1S a SSanqar. H Rar.r. 1.ScMenrwrer6PtarNn .eneu,m- r« am~mesnon qertqLa6rs u cavmr.nen d•,ur aeo.wvn uapna t+R*om Anr,Na.e..r INL aL- aro-s7 4. Smarww H: RW.nan I. Q41salra K. PaclNneer U. P,asw.P 1'aluao( pt+reler .r,ers m wa.arepreo.pruaYtanMmiPGi . PG.E.. K'.D - SJ p.nemi .wa..mr7au.,nraresqa u.aun{ ye Pmr.yu.enu...w.u laa.r. 7: I_S,t2. 2~2~5~22 23

fHELANCET•AL'GL'ST 14. 1982 tL%TELET SE.ySITtt'ITY IEFOREANDAFTER PASStvE SMOKING PG I Scfore End 20 min j, 60 mm ,ti'o+uwokm I 1 1. 1 26a0•11 2 16s0r21' 1•16=0~21• 35z0•19 1' s, te•7_3,1 i32-5_.•2. I2e•2z4-1• ~2 4•7:2•8 D- ~2 7x3 6 55•6b5-3 51.3s4•2 M•6z4-1 Sin.ir,rr l. 1•i5a0-26 I I2•0lo0•19 2•06c0-IB l•93z0•23 E, 27-8m?•3 30•6c3•i 3t.0o4 •II 29-1_2•9' ID. ~ u- 9:a• I I ' sa•6_4•s s9•e:3•r 45-2z1-e ReWrs.a ne PG,mn oweia run .plmm... .MtrnsSE.~t. •pCL 01. findings of deaessed PGi2 formation in umbilical artmesia bt+bia born to mothers who smoked° the severe changes we found after pautvrstnolung, apectally trt non•smokers, point to an important risk in non•smokers exposedi to cigarette smoke for a long time., .•Uthough not much is known about the long-term tnfluence of passive smoking nn the rtsk for development of atherosclerosis, our dYta do indicate that passive cigarette smoking, besides being an important soctal' issue. may be a health problem too. Q'e thank Vsna Vlouralis and'.%1ana l:anellopoui6s for lechmcal rawtancc and Claudu D.aak fnr.secrer anavhe lo. The srudy. ~.u supportedbd a granl of [he Fonds aur Fdrderung der wwenschafduchen Fonehunt;.. .lihere.cierout Retearcf+ Gloua., t)tp.rtmem o(.NtdwJ PMwwe.-. ana Alherateuraw uq Theannaut Rmorcn Grouo o('.Ine Auurun Aod.m.. o( Scunta H. St:Y2aNGE)t A-1(/901,.nn.. Auuna A. KEFALlD IS EARLY TRE.9TMF1`fT OF OESOPHAGEAL YARBCFS SIR,-Wliile we agree with Freeman and colleagues (;ilrlV 10,, p. 66) that vasopressin or its analogues may have a place in the muugement,of acute vanceai bleeding, we believe its roirisat best subs3dtary. Since the patients moar at risk are those wbo rebleed early, the aun of management in vanceal bleeding should be to prevent rebleeding as much as to control the presenting haemorrhage. To this end we have developed a practice oftaanagLng vartceal' bleeding which provides results equally as good as thoae obtained with givpresstn by Freeman et ai. and which a11o serxs as a basts for long-term management. If bleeding u aatve, a Luston tube' is inflated in the gasatc fundus and maintained on traaton. When rausctntion is efiected' the vances are tmmediatel v iniected with sderosaar with the tube tn sttu.,els there is no oesophageal balloon on ttus rube, usteetxon is not techntally difficult and there u cheadvantage that a bloodless field is obtained. Furthermore„tt seems likeiy rhat pressure on the gutnc eariea aidi sclerosis by preventing retrograde flow ofsderoant. If there is no active bleeding at the tstne of endoaopy the vances ars tmected, without the tube. which an be passed Later if bleeding becomes a difFirultu: Sclerosis is cottaaued fortnigbtly until vaneeal obliteration is complete. Since ad'opttng thu policy 18 mottths ago we have treated suttem patients with acute vartceal bleeding. One died imtssed9ately on admtsston to hospital before endoRcopy could be arrmed out. Of ebe remausder. eight had sclerotherapy with the Lhton tube in sutn and :even had it wtthout the rube. Of these p.nean, one rebled three tnaa before dyusg of liver failure due to hepanc angtoaareo®a; the other fourteen remain well, although two rebled'before tbe,rvanas wQ2 obliterated. While giypresstm trught be of vaHte in vancol bieedusg when endoscopic sclerothenpv is unavailable, we believe that our simple policy taay be of greater value in most general hospnals., Dep.rtmeetoi\SWrcuG.uroencen>IeRr. RJ..DtCT•I!VSOr:kadensroxe t H.wo.nl: R BLHRLNs Niu. Ra.G C&OWW-60t p: _'QQ J. O: HL'tiTER e. D+6r CS L:nreser Ch..Sua.nrer. H. SJaerCn,er K UmNO/ anen pra.m+etmienna,+sn u d~man..nal 1. 11.0- aeru ,e .wnen: .w tmMC L- I N I-e1 11 t.'.aeen R R. Tt,t ttntrVtnc+"uW os(nunt ,reume+n ag bl..d,a{ emooe.Al wrem. Gur+wwt..,wer 1413. S4: 1-• 393 ICOSAPE."tTAENOIC ACm AND ISCHAEMIC HEART DISFaSE StR.-Dr Jones and Dr DRVra Qul,v 24, p. 2211 diacuas the decrease in circulating plaselets which various worsrrs have found to be produced by fish oils. But they state that Hay ttnd colle.gua ' used' "a staulhr fish oil and EPA supplesaatt" to that uaed by Thorngren and Gustafson.= There was a auaal da,fTerena. Hay a RlL used "Wlsxepa" (,iiarfleet Refining Cotsspsny: a subtudury of Imperial Foods), whtth is a refined deodoFtsed blead'of marine body oils with added annoxtdanes: it contains about 20°1% of farry aads as rtmnodontc (C20:Sr-3 or "EPA"), about 194% as ciupanodontc (C22:6n- 3) and leu than 14L u cetolac (U2: le- 11). The firss two are asenttall fatty aerdh and the third is tosu, at least to lower antmals, being an isomer of eruac aad (C22:1 R-9) found in eertatn rapaeed' oils, which cannot be oridised with ease by muscle mitochondrta unless adaptation has occurred and therefbre causes mvocardui fibrosis with sudden death. Thora;rert's volunteen, however,, changed their usual Swedish diet for eleven wee'rs to include "a predomtnatue of fish, mainly mackerel and sRlmon". These fish have cetoietc actd as a predommant farty acid, anaivses (in °70 of total actds) by Dr hlarv, Gale in our Instttute being: O,i c2P3 C2: 6 Cr'. I ,%latkere/ Lknmert ,;n.ren,r) 12- I 11'• 4 9.0 '. Salrtan (.Sdiwm uiarl 10-'_ t li 11.3 The relevance of CZ2:1 fttry acids is that they probably decrease the number of circulating plateias. McDonald and collesgtsa 1'fed seven heaithv maies for 22 days with rapeseed oil containing 3946 eruclc acid (whtch supplied 38% total deetarv energy); tn.five of them there was a marked fall in platelet count whsch returned lo normal when their customarv diet was resumed:,On a traditional Eskimo d7et fOr.. IDO dYVs (only sql, fish. andwater) mvpluelet count deereased'from 226 0001/,1 to 52 0001/+1L and plateie'ts changed morphologlallv to giant fonns: this diet was very high m.C20:5, C22:6, and C22::. The first of these tended to displace atach-dontc aad (C20:4n-6) us, for instance, the different phosplsoltptds of' platelets' and cetoletc acid appeared in these as well as tn, lipoprotetns. erythrocyte membnna, adipose tissue, and skeletall muscie. But the dramatic utvease in bleeding time was prob.blv aused'partlv by the alteration in the struaure and therefore fluwdttv of the platelet membrana and'not only by the observed alterations in prostanotds:l the former may also have contributed to the decrease in platelet count since Hav et at. ' obtKrved a decruse on a diet containing negligible cetoleu aad: The references in ~ Jones and IDRna' Iener raise an impot'tant question of nomenclature. They twue refer to mmnodon3c tbd (C20:5n- 3), as "ercowpenranotc" T1sss word conatns three errors-one aademtc, one areless (the secvad .'e" should be .'a"), and one fundamental. The LLC.P.A.C•I:L'.B. Commtsaton on Biocheaual Vomenclature has decrreda in its asdom(or folly) thar the Greek trcool (or the common Epic dsalea form itucool.) must be anglictaed u"icoa•" therebr dropping one or two epsilotu: so "EPA" must be "IPA"' To be on the right side, Professor Crawford and'colleagua" from the Royd College of Surgeons in a current paper use both spellings in difftratt places. But trivial names for fatty aads are useful; Ikkt w continue to nll'C20:5R-3 tu'nnodonac actd and C22:6w-3 cluprttodonsc acid. Ih.ernw.rsuImrnwe ei Hrmr. Nl.mm.. Swr.n Cm,.t.ne.. As,MMn OS IuaA~ HCGN 5l.I.CLAIR ; HnCR.%S:.thra.r.V.S..rrR ER.ad.f..edrv,mwn.mnwni.or,on.v1- ucnmtn,cne.nrat.eae L.r., 1N:.,t2N-tp :' Tlwen~ttn ~t. Gw,.urw A ERtta ef t 1-.wt ,wtast u aer4 t.ev.oonae..c KW un.0it[Wee ~un.., i,~,b aN prew a~reta.mr li..t, IN I. i,. I IeP.fl. 1~. ~I:D,muaRE.. Re„et t'.N. Lt11rrEL ti,nr Dl'ERtt, a n.mt.a.~ m.nvT /,ra psnernrandDweO Mtn.m.er ni ,w.t mt.. 1. Prnttaunp o( Imenw,.eu Rapercd Canenm i(:ar.. le:4l M\-ttle +'. S.nc,rn M+l te.an.ten.aw a..n.,r...n a r E.a- m- In F,.,w.nII. R. I:nccnt•- 0. Prwn, R.. ,e Drvp rrtt..wr. ,yd srnrorn,n inwre.aun Elk.,r.tM+h Mewaw. iMnut-70. 1 )In[la„ M.M Tlle. ftlil„f ~T(Tr1Lle. 0. tYHR,4. .CW M 111R i.nO,fK L,C -/fn,C ~IT,Y,tM1 ~1YCIef ~~In.tnEWmOdR, M1at I.iMR'• IN11:]!: }.+-p n IL'1'.iCIL*D.CG-t.-01M{Ntntm,01:\y,MntWYIR Thennn,tnttrurtrJl,ow. F., re..r._ i .--. r.: 11-z1, ' taeara 31: Au, m K. Cn.f.~ `' Fwn ttr tanfrcv..i IWw,n p.vt,we..nr )naqnau>~.e A uW r.rnp.aaw uR.e f..w Sr r..r. i NI. 1 R24 .1 -.1