45 days, above it on 51, and below it on 84. Patients received heparin for a median of four days, and the kaolin cephalin clotting time was within the therapeutic range for a median of one day in each patient (though never in 13 patients) ( Doctors ignored 26% of all the measurements of kaolin cephalin clotting time that required a change in heparin infusion rate and changed the infusion rate in the wrong direction in 12%. Although in the right direction, 850% of the remaining changes failed to achieve a therapeutic kaolin cephalin clotting time. The therapeutic range was achieved on 27% of the days by infusion pump and on 19% of the days by burette (p >0 05). The mean (SD) infusion rate required to achieve a therapeutic kaolin cephalin clotting time of 60 seconds was 1404 (432) U/h (n=28, range 690-2500 U/h) (1513 (417) U/h in men and 1278 (429) U/h in women (p >0 05)). There was no significant relation between the therapeutic infusion rate and the age or weight of the patient. CommentHeparin control in our hospital is poor, with 260' of kaolin cephalin clotting times being ignored, 12%o of responses being made in the wrong direction, and a high degree of inaccuracv in remaining responses. Accurate control is complicated by two other factors: firstly, there is wide interpatient variation in drug clearance and responses of the kaolin cephalin clotting time to given plasma heparin concentrations3; and, secondly, the response to heparin is not linear, so that a given increment in the heparin infusion rate will not result in a proportionate increment in the kaolin cephalin clotting time. ' Heparin should be delivered by infusion as this avoids potentially dangerous peaks of heparin activity (and correspondingly greater risk of haemorrhage) that sometimes occur after bolus injections.5Although we expected infusion pumps to maintain a steadier rate of infusion than burettes operated by nurses, the difference in control was not significant, and so other factors must also affect control.If the concept of a therapeutic range of kaolin cephalin clotting time is accepted more attention should be paid to it when controlling treatment with heparin, a potentially dangerous drug. As the kaolin cephalin clotting time approaches the therapeutic range lower increments in the heparin infusion rate should be made to achieve equivalent increments in the kaolin cephalin clotting time. Individual titration of the infusion rate is necessary to optimise efficiency and reduce potential toxicity. Long and short kaolin cephalin clotting times should not be ignored.We thank the consultant staff of Llandough Hospital for allowing us to use their patients for this study. Interest in complementary medicine is clearly increasing,' 2 but no one has asked the general public why they seek such treatment. We carried out a study at the Centre for Alternative Therapies to evaluate the characteristics of patients seeking treatment. The scope of their presenting problems, the reasons why patients elect to be treated by complementary medicine, patien...

Glomerulosclerosis severity in nonneoplastic parenchyma can predict the rate of renal function decrease after radical nephrectomy. This histopathological parameter should be assessed in all tumor nephrectomy specimens, given that preserving renal function is important for quality of life and clinical outcome in patients with renal cancer.

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