The end of scientific journals?

for the condition) is likely. Indeed Levitt et al reported on three North American families with malignant hyperthermia in which linkage studies excluded the locus for the malignant hyperthermia gene from the 19q 13.1 region, where the gene for the ryanodine receptor is situated. 12 Similarly, the European Malignant Hyperthermia Group has found that malignant hyperthermia does not cosegregate with ageneinthe 19q 13.1 region.'3 Even in families in which the gene for the ryanodine receptor may be implicated the actual mutation may vary in different family members. Although Fujii et al found that a single point mutation in the porcine ryanodine receptor gene was associated with porcine malignant hyperthermia in five major breeds,'4 a similar mutation has been discovered in only one of 35 human pedigrees.'5 Although the DNA research provides an exciting new dimension to laboratory study ofmalignant hyperthermia, the importance of the clinical condition should not be forgotten. If a DNA based test for malignant hyperthermia became available family members would be more easily screened than at present with the in vitro muscle contracture test. One of the problems, however, is to identify and locate members of extended families. From our own work we know of two British families in which a second proband was discovered, and both died of malignant hyperthermia. Had the anaesthetist known that a family member had been recognised as being susceptible to malignant hyperthermia the trigger agent for the condition would not have been administered. The reason for these tragedies was not the lack of a suitable screening test but lack of communication between family members. Currently, detection of clinical episodes of malignant hyperthermia will remain largely the responsibility of the anaesthetist in the operating theatre. But detecting susceptibility to malignant hyperthermia in members of known malignant hyperthermia pedigrees is also essential to avoid further anaesthetic tragedies. F RICHARD ELLIS Reader in Anaesthesia, St James's University Hospital, Leeds LS9 7TF