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1. A revised amino acid and carbohydrate composition of human Tamm-Horsfall glycoprotein is presented. 2. No significant differences were obtained in the amino acid composition of Tamm-Horsfall glycoprotein isolated from patients with cystic fibrosis. 3. The glycoprotein was shown to possess a high half-cystine content of 1 per 11-12 amino acid residues, which has been confirmed by performic acid oxidation and S-alkylation with iodoacetate and iodoacetamide. No thiol groups were detected in the glycoprotein. 4. Treatment of the glycoprotein with 0.5m-sodium hydroxide at 4 degrees C for 2 days did not release heterosaccharide material, which suggests that the predominant carbohydrate-protein linkages present are not of the O-glycosidic type. 5. No N-terminal amino acid was detected in the glycoprotein.

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The ethical issues surrounding orders not to resuscitate are complex and increasingly a matter for legislative acts and judicial decisions."I 13 Furthermore, decisions on resuscitation have implications for resource management. Despite these issues "Do not resuscitate" orders in many British hospitals are used without guidelines and without assessment of their effectiveness in preventing futile cardiopulmonary resuscitation.This survey indicates that in the absence of local guidelines about decisions on resuscitation many crash calls may be inappropriate. We advocate more discussion of patients' suitability for resuscitation between doctors, nurses, patients, and patients' relatives. We suggest that the most senior available doctor of the admitting team should be responsible for making initial resuscitation decisions, writing these in the medical notes, and communicating them to the ward nurses. Such decisions should follow locally agreed criteria based on knowledge of pre-arrest characteristics in relation to outcome. Patients' suitability for resuscitation should be reviewed on every consultant ward round, taking into account the views of all the staff caring for the patient and, when appropriate, the views of the patient or the patient's relatives, or both.We thank the nurses and junior doctors at Fazakerley Hospital for filling in the questionnaires, and Dr F J Nye for his comments on the manuscript.

1. Subunit molecular weights of 76000-82000 were obtained for native and alkylated Tamm-Horsfall glycoprotein by gel filtration on Sephadex G-200 in the presence of sodium dodecyl sulphate. 2. A further estimate of the subunit molecular weight of 79000+/-4000 was obtained by disc gel electrophoresis in sodium dodecyl sulphate. 3. A minimum value of the chemical molecular weight of 79000+/-6000 was obtained from the number of N-terminal amino acids released by cyanogen bromide cleavage of the glycoprotein. 4. Similar values were obtained for the subunit molecular weight of Tamm-Horsfall glycoprotein from patients with cystic fibrosis. 5. On ultracentrifugation both in 1.0% sodium dodecyl sulphate and in 70% formic acid, Tamm-Horsfall glycoprotein sedimented as a single component, slightly faster than serum albumin. 6. On reduction of the disulphide bonds the same subunit molecular weight was obtained, which suggested that these bonds are intrachain.