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Neutralisers of endotoxin and of proinflammatory cytokines have had little success in the treatment of septic shock. Now work on adults in the USA (Journal of the American Medical Association 1997;277:482-7) has shown some benefit from a bradykinin receptor blocker, deltibant. In 27 patients with Gram negative sepsis given the highest dose of the drug the observed 28 day mortality was less than half of that expected. In the trial as a whole, which included over 500 patients, there was no significant effect on risk adjusted 28 day mortality.

Sir James Spence was clearly a much loved man who had in abundance the gift of inspiring people. One of those deeply affected by him was Dr F J W Miller, a former recipient of the British Paediatric Association’s James Spence medal, who shortly before he died in March 1996 submitted an article about Spence to the Journal of Medical Biography (1997;5:1-7). Spence was born on the Northumberland coast in 1892 and spent almost the whole of his life in Newcastle, dying there of lung cancer in 1954. He occupied the chair of child health from 1942 until his death. He was a holistic paediatrician before the word became much overused and was a leader in …

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