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ANTIHISTAMINE DRUGS IN NEONATAL RESPIRATORY-DISTRESS SYNDROME
53
emptying the breasts of mothers with premature or ill babies, in the relief of mild milk engorgement, and in the early treatment of sore nipples. The breasts can be efficiently emptied in these last two conditions without causing further damage to the nipple and without the pain which is sometimes associated with manual expression. But we have had no experience with the breast pump in patients with acutely engorged breasts or with cracked nipples; we believe that acute engorgement can be largely avoided by the propitious use of stilboestrol, and, similarly, sore nipples can be prevented from cracking if they are rested early enough. The only disadvantages are minor ones-the glass shields are easily broken; if the shield is not accurately applied milk tends to leak between it and the breast during the resting phase of the pump’s action; and occasionally the pump cannot be used on oedematous arcelas, because it increases the oedema.
Egnell’s breast pump is available in this country from Allen & Hanburys, Ltd., Bethnal Green, London, E.2. St. Thomas’s Hospital, PETER J. HUNTINGFORD. London, S.E.1.
with sucrose than with starch. Similarly in the adipose tissue the proportion of linoleic acid falls with increasing sucrose intake and at a more rapid rate than that seen with starch.3 A reduction in the proportion of linoleic acid is also found in the liver lipid in children with kwashiorkor, a malnutritional state associated with a high dietary carbohydrate intake relative to protein. This reduction is greater than that seen in the liver -lipid whose accumulation has been non-malnutritional in
origin.3 Thus it
that dietary carbohydrate, especially way influences unsaturated-fatty-acid metabolism and this may be the mechanism operating in Yemenites whose increased sucrose consumption is associated sucrose,
seems
in
possible
some
with increased ischxmic heart-disease. Department of Physiology, Guy’s Hospital, London, S.E.1.
I. MACDONALD.
’
ANTIHISTAMINE DRUGS IN NEONATAL RESPIRATORY-DISTRESS SYNDROME SiR,—In the near future we should know how to prevent deaths from the pulmonary syndrome of the newborn. The observations of Dr. Davis (Dec. 30) on the effects of chlorpheniramine (’Piriton ’) are important. The value of this drug, if confirmed, is likely to be from its effects on secondary lesions which are so often the immediate cause
of death. The pulmonary syndrome of the newborn should be considered under four headings.
(1) Inhaled substances, especially squames and mucus. When vernix is inhaled it comes from the anterior part of the nose which is rich in sebaceous glands, not the skin. (2) Obstructive atelectasis, obstructive emphysema, interstitial emphysema, and pneumothorax. (3) " Hyaline membrane ".
(4) Secondary conditions, especially oedema, asphyxial hxmorrhages, massive haemorrhage, and bronchopneumonia. Secondary lesions are not confined to the thorax. These babies often develop massive retroperitoneal oedema and a large effusion into the peritoneal cavity. This is associated with cyanosis and hxmoconcentration-always more dangerous than anxmia. Adults occasionally show the retroperitoneal oedema in severe shock. In the near future I hope to publish a paper showing that laryngeal dysfunction in the second and third aspects of the pulmonary syndrome is most important. Hyaline membrane " must be itself a secondary disorder, we
DETERMINATION OF PROGESTERONE IN HUMAN PLASMA
SIR,-A recurrent difficulty in endocrine research is that results obtained by different techniques may not be comparable. It is, therefore, of considerable help to the investigator to have available the results of collaborative work in which two or more existing methods are applied to the same biological specimen. Several methods have been evolved for the quantitative determination of progesterone in human plasma,4-7 and in 1959 Prof. L. T. Samuels, of the University of Utah, arranged for the comparison of these methods in a series of recovery experiments in which progesterone was added to male plasma and deep-frozen aliquots were sent to the departments where the methods were evolved. In this first series difficulty was encountered in the application of the method of Sommerville and Deshpande to extracts from deep-frozen plasma, and although the results obtained by the other three methods were in good agreement they involved the use of correction factors based on estimated losses of from 26 to 60%. The results in this series were recently reviewed.8 Professor Samuels considered that the experiment ought to be repeated and that standards for use in the final calculation should be taken from the same solution used in the preparation of the unknowns. The following results are concerned with the recoveries obtained in the second series (1960) by the two British methods:
"
infrequently see it sine membrane. When the three primary types of lesion better we will for the secondary lesions so frequently. not
Derbyshire Royal Infirmary, Derby.
control need drugs
we can
not
G. R. OSBORN.
SUCROSE AND ISCHÆMIC HEART-DISEASE SiR,—The interesting suggestion that an increased sucrose intake in some way affects the incidence of ischxmic heart-disease and diabetes in Yemenite Jews1 appears to be difficult to reconcile with the " unsaturatedfatty-acid " hypothesis for ischxmic heart-disease. However, there is some evidence that carbohydrate, and especially sucrose, can influence the level of linoleic acid in liver and depot fat. The experimental evidence was found in rabbits which were given a fixed protein intake, but with varying amounts and types of carbohydrate. The results showed that not only was the amount of hepatic lipid greater with dietary sucrose than with dietary starch,2 but the proportion of linoleic acid in this lipid falls more rapidly 1. 2.
Lancet, 1961, ii, 1399. Macdonald, I. J. Physiol. (in the press).
There is reasonable agreement between the results of the methods. In the method of Short 6 the results were corrected for losses by a factor of 1-37. In the method of Sommerville and Deshpande,5 no correction was applied and the paper step, used initially to afford additional evidence of identity, was incorporated routinely in each assay and followed by a second alumina chromatogram.9 In our view, despite these satisfactory results, the progesterone technique had two major disadvantages. First, the use of the relatively insensitive isonicotinic acid hydrazone for spectrophotometry; and secondly, the fact that two alumina chromatograms were involved in addition to the paper chromatographic step. The more sensitive thiosemicarbazone had been used extensively during earlier work on the method, but was abandoned because of interference from impurities in the two
Macdonald, I. To be published. Zander, J., Simmer, H. Klin. Wschr. 1954, 32, 529. Sommerville, I. F., Deshpande, G. N. J. clin. Endocrin. 1958, 18, 1223. Short, R. V. J. Endocrin. 1958, 16, 415. Oertel, G. W., Weiss, S. P., Eik-Nes, K. B. J. clin. Endocrin. 1959, 19, 213. Short, R. V. in Hormones in Blood (edited by C. H. Gray and A. L. Bacharach); p. 405. London, 1961. 9. Deshpande, G. N., Turner, A. K., Sommerville, I. F. J. Obstet. Gynæc., Brit. Commonw. 1960, 67, 954.
3. 4. 5. 6. 7. 8.
emptying the breasts of mothers with premature or ill babies, in the relief of mild milk engorgement, and in the early treatment of sore nipples. The breasts can be efficiently emptied in these last two conditions without causing further damage to the nipple and without the pain which is sometimes associated with manual expression. But we have had no experience with the breast pump in patients with acutely engorged breasts or with cracked nipples; we believe that acute engorgement can be largely avoided by the propitious use of stilboestrol, and, similarly, sore nipples can be prevented from cracking if they are rested early enough. The only disadvantages are minor ones-the glass shields are easily broken; if the shield is not accurately applied milk tends to leak between it and the breast during the resting phase of the pump’s action; and occasionally the pump cannot be used on oedematous arcelas, because it increases the oedema.
Egnell’s breast pump is available in this country from Allen & Hanburys, Ltd., Bethnal Green, London, E.2. St. Thomas’s Hospital, PETER J. HUNTINGFORD. London, S.E.1.
with sucrose than with starch. Similarly in the adipose tissue the proportion of linoleic acid falls with increasing sucrose intake and at a more rapid rate than that seen with starch.3 A reduction in the proportion of linoleic acid is also found in the liver lipid in children with kwashiorkor, a malnutritional state associated with a high dietary carbohydrate intake relative to protein. This reduction is greater than that seen in the liver -lipid whose accumulation has been non-malnutritional in
origin.3 Thus it
that dietary carbohydrate, especially way influences unsaturated-fatty-acid metabolism and this may be the mechanism operating in Yemenites whose increased sucrose consumption is associated sucrose,
seems
in
possible
some
with increased ischxmic heart-disease. Department of Physiology, Guy’s Hospital, London, S.E.1.
I. MACDONALD.
’
ANTIHISTAMINE DRUGS IN NEONATAL RESPIRATORY-DISTRESS SYNDROME SiR,—In the near future we should know how to prevent deaths from the pulmonary syndrome of the newborn. The observations of Dr. Davis (Dec. 30) on the effects of chlorpheniramine (’Piriton ’) are important. The value of this drug, if confirmed, is likely to be from its effects on secondary lesions which are so often the immediate cause
of death. The pulmonary syndrome of the newborn should be considered under four headings.
(1) Inhaled substances, especially squames and mucus. When vernix is inhaled it comes from the anterior part of the nose which is rich in sebaceous glands, not the skin. (2) Obstructive atelectasis, obstructive emphysema, interstitial emphysema, and pneumothorax. (3) " Hyaline membrane ".
(4) Secondary conditions, especially oedema, asphyxial hxmorrhages, massive haemorrhage, and bronchopneumonia. Secondary lesions are not confined to the thorax. These babies often develop massive retroperitoneal oedema and a large effusion into the peritoneal cavity. This is associated with cyanosis and hxmoconcentration-always more dangerous than anxmia. Adults occasionally show the retroperitoneal oedema in severe shock. In the near future I hope to publish a paper showing that laryngeal dysfunction in the second and third aspects of the pulmonary syndrome is most important. Hyaline membrane " must be itself a secondary disorder, we
DETERMINATION OF PROGESTERONE IN HUMAN PLASMA
SIR,-A recurrent difficulty in endocrine research is that results obtained by different techniques may not be comparable. It is, therefore, of considerable help to the investigator to have available the results of collaborative work in which two or more existing methods are applied to the same biological specimen. Several methods have been evolved for the quantitative determination of progesterone in human plasma,4-7 and in 1959 Prof. L. T. Samuels, of the University of Utah, arranged for the comparison of these methods in a series of recovery experiments in which progesterone was added to male plasma and deep-frozen aliquots were sent to the departments where the methods were evolved. In this first series difficulty was encountered in the application of the method of Sommerville and Deshpande to extracts from deep-frozen plasma, and although the results obtained by the other three methods were in good agreement they involved the use of correction factors based on estimated losses of from 26 to 60%. The results in this series were recently reviewed.8 Professor Samuels considered that the experiment ought to be repeated and that standards for use in the final calculation should be taken from the same solution used in the preparation of the unknowns. The following results are concerned with the recoveries obtained in the second series (1960) by the two British methods:
"
infrequently see it sine membrane. When the three primary types of lesion better we will for the secondary lesions so frequently. not
Derbyshire Royal Infirmary, Derby.
control need drugs
we can
not
G. R. OSBORN.
SUCROSE AND ISCHÆMIC HEART-DISEASE SiR,—The interesting suggestion that an increased sucrose intake in some way affects the incidence of ischxmic heart-disease and diabetes in Yemenite Jews1 appears to be difficult to reconcile with the " unsaturatedfatty-acid " hypothesis for ischxmic heart-disease. However, there is some evidence that carbohydrate, and especially sucrose, can influence the level of linoleic acid in liver and depot fat. The experimental evidence was found in rabbits which were given a fixed protein intake, but with varying amounts and types of carbohydrate. The results showed that not only was the amount of hepatic lipid greater with dietary sucrose than with dietary starch,2 but the proportion of linoleic acid in this lipid falls more rapidly 1. 2.
Lancet, 1961, ii, 1399. Macdonald, I. J. Physiol. (in the press).
There is reasonable agreement between the results of the methods. In the method of Short 6 the results were corrected for losses by a factor of 1-37. In the method of Sommerville and Deshpande,5 no correction was applied and the paper step, used initially to afford additional evidence of identity, was incorporated routinely in each assay and followed by a second alumina chromatogram.9 In our view, despite these satisfactory results, the progesterone technique had two major disadvantages. First, the use of the relatively insensitive isonicotinic acid hydrazone for spectrophotometry; and secondly, the fact that two alumina chromatograms were involved in addition to the paper chromatographic step. The more sensitive thiosemicarbazone had been used extensively during earlier work on the method, but was abandoned because of interference from impurities in the two
Macdonald, I. To be published. Zander, J., Simmer, H. Klin. Wschr. 1954, 32, 529. Sommerville, I. F., Deshpande, G. N. J. clin. Endocrin. 1958, 18, 1223. Short, R. V. J. Endocrin. 1958, 16, 415. Oertel, G. W., Weiss, S. P., Eik-Nes, K. B. J. clin. Endocrin. 1959, 19, 213. Short, R. V. in Hormones in Blood (edited by C. H. Gray and A. L. Bacharach); p. 405. London, 1961. 9. Deshpande, G. N., Turner, A. K., Sommerville, I. F. J. Obstet. Gynæc., Brit. Commonw. 1960, 67, 954.
3. 4. 5. 6. 7. 8.