Nuytinck et al,1 on the basis of a review of autopsy specimens and reports in 35 trauma cases, hypothesize that "whole-body inflammation" indexed by increased organ weight and intraorgan accumulation of neutrophils represents a preclinical stage of multiple organ failure (MOF). The attractiveness of such a unitary theory of the origin of adult respiratory distress syndrome (ARDS) and See also p 1519. MOF is enhanced by the investigators' claim that the greatest increases in organ weight and the most pronounced signs of whole-body inflammation were found in those patients who died of ARDS, hypovolemic shock, and MOF. Unfortunately, the absence of certain data prevents acceptance of the investigators' hypothesis and leaves open to serious question the conclusions they have drawn.
Of greatest concern is the absence of a contemporaneous control group. Surely there were patients in the Netherlands in whom heart attacks caused sudden death during the period spanned