Extensive morbidity related to hemodialysis vascular access exists among end-stage renal disease (ESRD) patients, but the risk factors for this morbidity have not been extensively studied. Medicare ESRD patient data were obtained from 1984, 1985, and 1986. Hospitalization for vascular access morbidity (ICD-996.1, 996.6, or 996.7) was analyzed among prevalent patients and, using survival analysis, among incident patients to assess sex, age, race, and underlying cause of renal failure as risk factors. We found that 15 to 16% of hospital stays among prevalent ESRD patients were associated with vascular access-related morbidity. Black race, older age, female sex, and diabetes mellitus as a cause of kidney failure were all independent risk factors for access-related morbidity. The rate ratio comparing Blacks to Whites was 1.12 (95% C.I., 1.09, 1.16); > 64 years to 20 to 44 years, 1.53 (1.46, 1.59); men to women, 0.81 (0.79, 0.84); and diabetes to glomerulonephritis, 1.29 (1.24, 1.35). We conclude that hemodialysis vascular access malfunction causes much hospitalization among ESRD patients. Women, Blacks, the elderly, and diabetics appear to be at particularly high risk, and additional studies are needed to understand these patterns.

Since the introduction of drug therapy in depression, a wide range of pharmacological substances has been made available. It is possible to show that many of these substances are more effective than a placebo in the treatment of depression, but it is not an easy matter to evaluate them in relation to one another.

“Let him take a course of chymistry, or a course of rope dancing or a course of anything he is inclined at the time.”(Boswell'sLife of Johnson) (1)To many minds there can be but little change in the treatment of depression since Johnson prescribed these remedies in 1776. Indeed the place of chemistry is now prominent, although its application is apparently more important to the patient than its study. It is believed that an enzyme, mono-amine oxidase, found in cerebral tissues, plays a part in the genesis of depression. Amphetamine inhibits the destruction of adrenaline by amine oxidase (McIlwain, 6) and amphetamine is of value in the treatment of mild depression (Guttmann and Sargant, 5). Another substance is 5-hydroxytryptamine, or serotonin, which is said to excite cerebral neurones briefly between its liberation and destruction; it is a cerebral vasoconstrictor and is destroyed rapidly by amine oxidase (McIlwain, 6). Iproniazid (Marsilid) is a drug which inhibits amine oxidase and has been used in the treatment of depression (West and Dally, 10). Its central actions are considered to be similar to those of 5-hydroxytryptamine. Recently, Chessin (3) has described yet another amine oxidase inhibitor, phenelzine, which is the study of this paper.

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The Cancer Association (Rhodesia) SIR,-Shortly after publication in your correspondence columns (15 January, p. 172) of the letter from the honorary national secretary of the Cancer Association of Rhodesia, stating that the British Empire Cancer Campaign for Research had recently been refused permission to send funds to Rhodesia for the support of cancer research, I was advised by the Bank of England to make fresh applica-tion for permission to remit the necessary funds, and did so.I am happy to inform you that the Campaign has now received the desired permission.-I am, etc., F. B. TouRs, Secretary General.