ANTIHISTAMINES IN HYDROPS FŒTALIS
1
260 distressing epilation which commonly follows the alternative treatment of X-irradiation. A. G. BAIKIE A. S. D. SPIERS. University of Melbourne Department of Medicine, St. Vincent’s Hospital, Melbourne, Australia. GRISEOFULVIN FOR SCLERODERMA SIR,-Griseofulvin is known to give good results in the treatment of certain rheumatic diseases-e.g., shoulder-hand syndrome, periarthritis of the shoulder, cervical-root brachi- algia, and acute attacks of gout. This antibiotic is apparently also effective in the treatment of scleroderma and Raynaud’s syndrome. My co-workers and I have reported the case of a young woman, aged 27 years, with progressive scleroderma, treated with fine-particle griseofulvin for six consecutive months at a dosage of 600 mg. per day.1 Rapid regression of the accompany- ing Raynaud’s syndrome and slow but gradual replacement of the thickened skin with skin of a more normal appearance followed this treatment. The general condition of the patient also improved considerably. However, no improvement was noticed in the joint-lesions during administration of the anti- biotic ; in fact they deteriorated. We have continued therapy with griseofulvin in this patient for twenty-seven months to date; the improvement in her general condition, skin lesions, and Raynaud’s syndrome after six months’ treatment has been maintained. In four other patients with scleroderma, treated with griseofulvin for several months, we have noticed similar results, but in a fifth patient no benefit has been noticed after nine months’ treatment. ’ M. GIORDANO. Naples. ANTIHISTAMINES IN HYDROPS FŒTALIS SiR,ŇIt was with particular interest that we read the report by Dr. Bierme and Dr. Bierm6 2 of the value of promethazine in arresting the progress of hydrops foetalis in utero. This drug is known to affect antibody production 3 and to delay the homograft rejection process.4 We have recently observed that promethazine may interfere with red-cell agglutination in vitro, possibly owing to some modification of the cell surface. We are therefore carrying out in-vivo tests which we hope may be of value in relation to Rh immunisation. JEAN U. BARRIE BRIAN D. TAIT. Serology Section, Department of Pathology, Royal Women’s Hospital, Melbourne, Australia. A CORONARY-CARE UNIT SiR,ŇThe paper of Dr. Lawrie and his colleagues (July 15, p. 109) will be of great interest to all who are involved in the care of patients with myocardial infarction. However, we must challenge their statement that " The construction, equipment and, particularly, the staffing requirements make the establish- ment of units an impracticable proposition in the majority of hospitals ". The Edinburgh unit is research orientated and some of the equipment described is unnecessary in a purely clinical unit. Elaborate monitoring apparatus with memory tape and automatic electrocardiogram (E.C.G.) recording is not essential to routine clinical management. Large oscilloscopes displaying the E.C.G. for trained nurses to monitor are cheaper and probably as effective. Separate sound-proof cubicles are not necessary, and a small open ward eliminates the need for additional remote oscilloscopes and simplifies nursing. A resident physician is not required in the hospital where all staff are trained in resuscitation. 1. Giordano, M., Ara, M., Tirri, G. Reumatismo, 1966, 18, 314. 2. Biermé, S., Biermé, R. Lancet, 1967, i, 574. 3. Saunders, J. C., Muchmore, E. Br. J. Psychiat. 1964, 110, 84. 4. Eyal, Z., Warwick, W. J., Mayo, C. H., Lillehei, R. C. Science, N.Y. 1965, 148, 1468. The essential requirements for a coronary-care unit are an area separate from the general wards, specially trained nursing staff, and the immediate availability of resuscitative equipment. At this hospital a five-bedded unit dealing with about 300 admissions a year has been’ operating for nine months with results similar to those obtained in Edinburgh. The patients are cared for, both when within the unit and later, by the appropriate admitting firm, but the unit itself is under the overall direction of one consultant physician. There is a permanent qualified nursing staff of eight, but no doctor resident in the unit. Although, as Dr. Lawrie and his colleagues suggest, new forms of therapy may arise as a result of research carried out within the major units, it is unlikely that more effective and simpler manoeuvres than direct-current defibrillation and transvenous pacemaking will be devised in the foreseeable future. These techniques are within the capacity of all physi- cians, and in order to make any impact on the national mortality from this disease they must be made available in every hospital dealing with acute medical admissions. This is most effectively achieved in some form of coronary-care unit. There will be few units established as costly and elaborate as the one in Edinburgh, but much can be achieved in this direction by the ordinary district hospitals. B. L. PENTECOST N. M. C. MAYNE. The General Hospital, Birmingham 4. HYPERINSULINISM AND HIGH SUCROSE INTAKE SiR,ŇThat hyperinsulinxmia is atherogenic is well docu- mented.l As part of an investigation into the atherogenic effect of dietary sucrose,2 experiments were carried out to study serum-insulin levels during glucose-tolerance tests. Two subjects, a 31-year-old male catering officer (no. 1) and a EFFECTS OF HIGH SUCROSE DIET ON BLOOD-SUGAR AND SERUM-INSULIN LEVELS DURING ORAL GLUCOSE-TOLERANCE TESTS 27-year-old female dietician (no. 2) volunteered to take a diet containing 400 g. sucrose daily for a week. Both subjects had a 50 g. oral glucose-tolerance test with serum-insulin estimations before and on the 8th day of the trial. Subject 1, height 5 ft. 9 in. (175 cm.), weighed 164 lb. (74-5 kg.) before and 167 lb. (75-8 kg.) after the experiment; subject 2, height 5 ft. 7 in. (170 cm.), weighed 140 lb. (63-6 kg.) before and 144 lb. (65-4 kg.) after the experiment. 14 days after returning to normal diet the test was repeated in both subjects. Glucose levels were estimated by the glucose-oxidase method, and serum-insulin was immunoassayed.3 The effects of this high sucrose consumption on the serum- insulin response during glucose-tolerance tests are shown in the accompanying table. If excessive insulin response can be defined as insulin levels rising about 100 fLU per ml. serum during an oral glucose-tolerance test,4 then both subjects may be considered to have hyperinsulinxmia during the stage of 1. Peters, N., Hales, C. N. Lancet, 1965, i, 1144. Nikkilä, E. A., Miettinen, T. A., Vesenne, M. R., Pelkonen, R. ibid. 1965, ii, 508. Vallance- Owen, J. Q. Jl Med. 1965, 34, 485. Welborn, T. A., Breckenridge, A., Rubinstein, A. H., Dollery, C. T., Fraser, T. R. Lancet, 1966, i, 1336. 2. Yudkin, J. ibid. 1957, ii, 155. 3. Hales, C. N., Randle, P. J. Biochem. J. 1963, 88, 137. 4. Grodsky, G. M., Karam, J. H., Pavlatos, F. C., Forsham, P. H. Lancet, 1965, i, 290.
Transcript of ANTIHISTAMINES IN HYDROPS FŒTALIS
260
distressing epilation which commonly follows the alternativetreatment of X-irradiation.
A. G. BAIKIEA. S. D. SPIERS.
University of MelbourneDepartment of Medicine,St. Vincent’s Hospital,Melbourne, Australia.
GRISEOFULVIN FOR SCLERODERMA
SIR,-Griseofulvin is known to give good results in thetreatment of certain rheumatic diseases-e.g., shoulder-handsyndrome, periarthritis of the shoulder, cervical-root brachi-algia, and acute attacks of gout. This antibiotic is apparentlyalso effective in the treatment of scleroderma and Raynaud’ssyndrome.My co-workers and I have reported the case of a young
woman, aged 27 years, with progressive scleroderma, treatedwith fine-particle griseofulvin for six consecutive months at adosage of 600 mg. per day.1 Rapid regression of the accompany-ing Raynaud’s syndrome and slow but gradual replacement ofthe thickened skin with skin of a more normal appearancefollowed this treatment. The general condition of the patientalso improved considerably. However, no improvement wasnoticed in the joint-lesions during administration of the anti-biotic ; in fact they deteriorated. We have continued therapywith griseofulvin in this patient for twenty-seven months todate; the improvement in her general condition, skin lesions,and Raynaud’s syndrome after six months’ treatment has beenmaintained. In four other patients with scleroderma, treatedwith griseofulvin for several months, we have noticed similarresults, but in a fifth patient no benefit has been noticed afternine months’ treatment.
’
M. GIORDANO.Naples.
ANTIHISTAMINES IN HYDROPS FŒTALIS
SiR,ŇIt was with particular interest that we read the reportby Dr. Bierme and Dr. Bierm6 2 of the value of promethazinein arresting the progress of hydrops foetalis in utero. This drugis known to affect antibody production 3 and to delay thehomograft rejection process.4 We have recently observed thatpromethazine may interfere with red-cell agglutination in vitro,possibly owing to some modification of the cell surface. Weare therefore carrying out in-vivo tests which we hope may beof value in relation to Rh immunisation.
JEAN U. BARRIEBRIAN D. TAIT.
Serology Section,Department of Pathology,Royal Women’s Hospital,Melbourne, Australia.
A CORONARY-CARE UNIT
SiR,ŇThe paper of Dr. Lawrie and his colleagues (July 15,p. 109) will be of great interest to all who are involved in thecare of patients with myocardial infarction. However, we mustchallenge their statement that " The construction, equipmentand, particularly, the staffing requirements make the establish-ment of units an impracticable proposition in the majority ofhospitals ". The Edinburgh unit is research orientated andsome of the equipment described is unnecessary in a purelyclinical unit. Elaborate monitoring apparatus with memorytape and automatic electrocardiogram (E.C.G.) recording is notessential to routine clinical management. Large oscilloscopesdisplaying the E.C.G. for trained nurses to monitor are cheaperand probably as effective. Separate sound-proof cubicles arenot necessary, and a small open ward eliminates the need foradditional remote oscilloscopes and simplifies nursing. Aresident physician is not required in the hospital where allstaff are trained in resuscitation.
1. Giordano, M., Ara, M., Tirri, G. Reumatismo, 1966, 18, 314.2. Biermé, S., Biermé, R. Lancet, 1967, i, 574.3. Saunders, J. C., Muchmore, E. Br. J. Psychiat. 1964, 110, 84.4. Eyal, Z., Warwick, W. J., Mayo, C. H., Lillehei, R. C. Science, N.Y.
1965, 148, 1468.
The essential requirements for a coronary-care unit are anarea separate from the general wards, specially trained nursingstaff, and the immediate availability of resuscitative equipment.At this hospital a five-bedded unit dealing with about 300admissions a year has been’ operating for nine months withresults similar to those obtained in Edinburgh. The patientsare cared for, both when within the unit and later, by theappropriate admitting firm, but the unit itself is under theoverall direction of one consultant physician. There is a
permanent qualified nursing staff of eight, but no doctorresident in the unit.
Although, as Dr. Lawrie and his colleagues suggest, newforms of therapy may arise as a result of research carried outwithin the major units, it is unlikely that more effective andsimpler manoeuvres than direct-current defibrillation andtransvenous pacemaking will be devised in the foreseeablefuture. These techniques are within the capacity of all physi-cians, and in order to make any impact on the national mortalityfrom this disease they must be made available in every hospitaldealing with acute medical admissions. This is most effectivelyachieved in some form of coronary-care unit. There will befew units established as costly and elaborate as the one inEdinburgh, but much can be achieved in this direction by theordinary district hospitals.
B. L. PENTECOSTN. M. C. MAYNE.
The General Hospital,Birmingham 4.
HYPERINSULINISM AND HIGH SUCROSE INTAKE
SiR,ŇThat hyperinsulinxmia is atherogenic is well docu-mented.l As part of an investigation into the atherogenic effectof dietary sucrose,2 experiments were carried out to studyserum-insulin levels during glucose-tolerance tests. Two
subjects, a 31-year-old male catering officer (no. 1) and a
EFFECTS OF HIGH SUCROSE DIET ON BLOOD-SUGAR AND SERUM-INSULIN
LEVELS DURING ORAL GLUCOSE-TOLERANCE TESTS
27-year-old female dietician (no. 2) volunteered to take a dietcontaining 400 g. sucrose daily for a week. Both subjects had a50 g. oral glucose-tolerance test with serum-insulin estimationsbefore and on the 8th day of the trial. Subject 1, height 5 ft.9 in. (175 cm.), weighed 164 lb. (74-5 kg.) before and 167 lb.(75-8 kg.) after the experiment; subject 2, height 5 ft. 7 in.(170 cm.), weighed 140 lb. (63-6 kg.) before and 144 lb.
(65-4 kg.) after the experiment. 14 days after returning tonormal diet the test was repeated in both subjects. Glucoselevels were estimated by the glucose-oxidase method, andserum-insulin was immunoassayed.3The effects of this high sucrose consumption on the serum-
insulin response during glucose-tolerance tests are shown inthe accompanying table. If excessive insulin response can bedefined as insulin levels rising about 100 fLU per ml. serumduring an oral glucose-tolerance test,4 then both subjects maybe considered to have hyperinsulinxmia during the stage of1. Peters, N., Hales, C. N. Lancet, 1965, i, 1144. Nikkilä, E. A., Miettinen,
T. A., Vesenne, M. R., Pelkonen, R. ibid. 1965, ii, 508. Vallance-Owen, J. Q. Jl Med. 1965, 34, 485. Welborn, T. A., Breckenridge, A.,Rubinstein, A. H., Dollery, C. T., Fraser, T. R. Lancet, 1966, i, 1336.
2. Yudkin, J. ibid. 1957, ii, 155.3. Hales, C. N., Randle, P. J. Biochem. J. 1963, 88, 137.4. Grodsky, G. M., Karam, J. H., Pavlatos, F. C., Forsham, P. H. Lancet,
1965, i, 290.
