- Email: [email protected]
EFFECT OF NEPHRECTOMY ON TRANSFUSION REQUIREMENTS OF HÆMODIALYSIS PATIENTS
1015
rotating dialysis population awaiting transplantation,
tary effects would be understandable. This leads me to ask the simple question, is schizophrenia relatively uncommon in patients with parkinsonism ?. Compounds which are effective against parkinsonian rigidity (such as biperiden and procyclidine) are also capable of relieving torsion-spasm, whether or not this is phenothiazineinduced.6-7 In parkinsonism and torsion-spasm, muscle tone is increased, whereas in choreoathetosis hypotonia is typical. Is it going too far, therefore, to suggest that8 schizophrenia is a manifestation of reduced psychic tone, and released quasi-purposive thought-processes ? Whatever the poles of the antagonistic clinical phenomena eventually prove to be in psychophysiological terms, I suggest that the functional poles could be choreiform (schizophrenic) and parkinsonian (obsessional). Compulsive mental happenings can be inseparable concomitants of postencephalitic tics and the oculogyric crises accompanying
enough time may not be available achieve optimal hemoglobin levels. Liverpool Regional Urological Centre, Sefton Hospital, Liverpool 15.
oarkinsonism.
J. P. CRAWFORD. EFFECT OF NEPHRECTOMY ON TRANSFUSION REQUIREMENTS OF HÆMODIALYSIS PATIENTS SIR,-We note with interest that in the paper by Dr. van Ypersele de Strihou and his colleague (Oct. 4, p. 705), it has again been shown that even severely diseased kidneys still have some erythropoietic activity. However, we doubt whether patients on regular haemodialysis require as much blood as was given by these workers. In this unit, blood is given only as a life-saving measure. Analysing our own figures from Jan. 1, 1968, we find that we have only administered 17 units of blood in 318 patientmonths. Despite this policy, our patients have a mean haemoglobin level of 9.1 g. per 100 ml., with a range of 6 g. to 14 g. The two patients with haemoglobins of 6 g. per 100 ml. have both started haemodialysis during the past month, and we anticipate much better figures when they are established on dialysis. The indications for transfusion and number of units transfused are as shown below:
(a) 8 units for 4 patients with septicaemia: in 2 patients this was sequel to shunt infection. (b) 3 units to 2 patients whose haemoglobins had dropped to 4 g. per 100 ml., with symptoms. Both these patients have required no further blood over the past 15 months. (c) 2 units for a patient with a psychiatric illness who would not dialyse and became severely uraemic. (d) 2 units for a patient with severe menorrhagia due to breakthrough " bleeding. (e) 1 unit for uncontrollable haemorrhage from infected Cimino-
a
"
Brescia fistula. (f) 1 unit in preparation for femoral cannulation, period of peritoneal dialysis.
following
a
Prerequisites for such a policy are: (1) adequate dialysis (usually 3 x 10 hours per week) with a generous diet (1 g. protein per kg. per day); (2) regular monitoring of the blood-flow through the Kiil kidney, ensuring a minimum flow of 140 ml. per minute, with prophylactic shunt or fistula revision as required; (3) high-quality Kiil kidneys of British manufacture, with minimal dead-space; (4) regular parenteral iron and folic acid; and (5) monthly systemic testosterone to persistently anaemic patients, aiming for a
haemoglobin in excess of 7-5
g. per 100 ml. It is readily admitted that occasionally a patient will not maintain desirable haemoglobin levels, and that, in a rapidly 5. 6.
Corner, B. D. Proc. R. Soc. Med. 1952, 45, 451. Burns, C. Br. med. J. 1963, i, 260. 7. Mucklow, E. S., Metz, H. T. Develop. Med. Child Neurol. 1964, 6, 598. 8. Crawford, J. P. Psychosynthesis. A " Project for a Scientific Psychology." London, 1956.
to
enable
patients
to
B. J. HAWE H. J. GOLDSMITH.
ULTRASONICS IN MEDICINE SIR,-In a letter on July 19 (p. 163) Dr. Douglas Gordon referred to the proposed formation of an International Federation of Medical Ultrasonics. Your readers may like to know that, following a joint scientific meeting of the British Institute of Radiology and the Hospital Physicists’ Association on ultrasonic diagnostics, a short business meeting is to be held at the British Institute of Radiology at 5 P.M. on Dec. 3. The meeting will discuss whether a U.K. society for medical ultrasonics should be formed, or whether contact with the International Federation should be effected through a small committee representing British professional bodies interested in medical ultrasonics. The procedure for electing a U.K. representative on the steering committee of the international organisation will also be discussed.
Anyone interested is invited to attend the meeting, or to communicate with one of the undersigned or with Dr. Gordon. Institute of Cancer
Research, Sutton, Surrey. Department of Medical Physics, Bristol General Hospital.
C. R. HILL. P. N. T. WELLS.
Round the World France French psychiatrists are not happy at all. Their discontent took on a spectacular form last month when they staged a protest march along Paris streets to call public and Governmental attention to their problems. The psychiatrists involved were medical Civil Servants working on the staffs of mental hospitals. This Civil Servant status dates back to 1838, when a corps of midecinsfonctionnaires was created to help protect the public against the dangerous acts of insane criminals or potential criminals on the loose. Over the years, this " police " aspect of their original role has gradually evolved towards a larger share of treatment in State-run mental institutions, the number of whose inmates has kept on increasing. With this growth, there has been no adequate rise in the number of Civil Servant psychiatrists. They are only 800 strong (for a total of 125,000 mental-hospital beds), against an estimated need for at least 2000. Moreover, they are badly short of attendants. Besides being overworked, they are poorly paid; and recruiting methods tend to create a hierarchy with which the psychiatrists do not agree. For the past nine years, the psychiatrists have been asking the Government for easier working conditions, improved salaries, and fairer recruiting standards. For the past three years, they have been doing this through their union; and the better status they are trying to obtain was at last going to be seriously considered earlier this year when suddenly the French Government then in office collapsed. The new Minister of Health, according to the psychiatrists, has proved much less cooperative than his predecessor, and the situation has deteriorated to the extent that a march had to be staged in protest and an " administrative strike " decided on: the psychiatrists continue to treat patients, but have stopped paper work. This action is being supported by the unions of mental-hospital attendants, which have issued statements to that effect.
rotating dialysis population awaiting transplantation,
tary effects would be understandable. This leads me to ask the simple question, is schizophrenia relatively uncommon in patients with parkinsonism ?. Compounds which are effective against parkinsonian rigidity (such as biperiden and procyclidine) are also capable of relieving torsion-spasm, whether or not this is phenothiazineinduced.6-7 In parkinsonism and torsion-spasm, muscle tone is increased, whereas in choreoathetosis hypotonia is typical. Is it going too far, therefore, to suggest that8 schizophrenia is a manifestation of reduced psychic tone, and released quasi-purposive thought-processes ? Whatever the poles of the antagonistic clinical phenomena eventually prove to be in psychophysiological terms, I suggest that the functional poles could be choreiform (schizophrenic) and parkinsonian (obsessional). Compulsive mental happenings can be inseparable concomitants of postencephalitic tics and the oculogyric crises accompanying
enough time may not be available achieve optimal hemoglobin levels. Liverpool Regional Urological Centre, Sefton Hospital, Liverpool 15.
oarkinsonism.
J. P. CRAWFORD. EFFECT OF NEPHRECTOMY ON TRANSFUSION REQUIREMENTS OF HÆMODIALYSIS PATIENTS SIR,-We note with interest that in the paper by Dr. van Ypersele de Strihou and his colleague (Oct. 4, p. 705), it has again been shown that even severely diseased kidneys still have some erythropoietic activity. However, we doubt whether patients on regular haemodialysis require as much blood as was given by these workers. In this unit, blood is given only as a life-saving measure. Analysing our own figures from Jan. 1, 1968, we find that we have only administered 17 units of blood in 318 patientmonths. Despite this policy, our patients have a mean haemoglobin level of 9.1 g. per 100 ml., with a range of 6 g. to 14 g. The two patients with haemoglobins of 6 g. per 100 ml. have both started haemodialysis during the past month, and we anticipate much better figures when they are established on dialysis. The indications for transfusion and number of units transfused are as shown below:
(a) 8 units for 4 patients with septicaemia: in 2 patients this was sequel to shunt infection. (b) 3 units to 2 patients whose haemoglobins had dropped to 4 g. per 100 ml., with symptoms. Both these patients have required no further blood over the past 15 months. (c) 2 units for a patient with a psychiatric illness who would not dialyse and became severely uraemic. (d) 2 units for a patient with severe menorrhagia due to breakthrough " bleeding. (e) 1 unit for uncontrollable haemorrhage from infected Cimino-
a
"
Brescia fistula. (f) 1 unit in preparation for femoral cannulation, period of peritoneal dialysis.
following
a
Prerequisites for such a policy are: (1) adequate dialysis (usually 3 x 10 hours per week) with a generous diet (1 g. protein per kg. per day); (2) regular monitoring of the blood-flow through the Kiil kidney, ensuring a minimum flow of 140 ml. per minute, with prophylactic shunt or fistula revision as required; (3) high-quality Kiil kidneys of British manufacture, with minimal dead-space; (4) regular parenteral iron and folic acid; and (5) monthly systemic testosterone to persistently anaemic patients, aiming for a
haemoglobin in excess of 7-5
g. per 100 ml. It is readily admitted that occasionally a patient will not maintain desirable haemoglobin levels, and that, in a rapidly 5. 6.
Corner, B. D. Proc. R. Soc. Med. 1952, 45, 451. Burns, C. Br. med. J. 1963, i, 260. 7. Mucklow, E. S., Metz, H. T. Develop. Med. Child Neurol. 1964, 6, 598. 8. Crawford, J. P. Psychosynthesis. A " Project for a Scientific Psychology." London, 1956.
to
enable
patients
to
B. J. HAWE H. J. GOLDSMITH.
ULTRASONICS IN MEDICINE SIR,-In a letter on July 19 (p. 163) Dr. Douglas Gordon referred to the proposed formation of an International Federation of Medical Ultrasonics. Your readers may like to know that, following a joint scientific meeting of the British Institute of Radiology and the Hospital Physicists’ Association on ultrasonic diagnostics, a short business meeting is to be held at the British Institute of Radiology at 5 P.M. on Dec. 3. The meeting will discuss whether a U.K. society for medical ultrasonics should be formed, or whether contact with the International Federation should be effected through a small committee representing British professional bodies interested in medical ultrasonics. The procedure for electing a U.K. representative on the steering committee of the international organisation will also be discussed.
Anyone interested is invited to attend the meeting, or to communicate with one of the undersigned or with Dr. Gordon. Institute of Cancer
Research, Sutton, Surrey. Department of Medical Physics, Bristol General Hospital.
C. R. HILL. P. N. T. WELLS.
Round the World France French psychiatrists are not happy at all. Their discontent took on a spectacular form last month when they staged a protest march along Paris streets to call public and Governmental attention to their problems. The psychiatrists involved were medical Civil Servants working on the staffs of mental hospitals. This Civil Servant status dates back to 1838, when a corps of midecinsfonctionnaires was created to help protect the public against the dangerous acts of insane criminals or potential criminals on the loose. Over the years, this " police " aspect of their original role has gradually evolved towards a larger share of treatment in State-run mental institutions, the number of whose inmates has kept on increasing. With this growth, there has been no adequate rise in the number of Civil Servant psychiatrists. They are only 800 strong (for a total of 125,000 mental-hospital beds), against an estimated need for at least 2000. Moreover, they are badly short of attendants. Besides being overworked, they are poorly paid; and recruiting methods tend to create a hierarchy with which the psychiatrists do not agree. For the past nine years, the psychiatrists have been asking the Government for easier working conditions, improved salaries, and fairer recruiting standards. For the past three years, they have been doing this through their union; and the better status they are trying to obtain was at last going to be seriously considered earlier this year when suddenly the French Government then in office collapsed. The new Minister of Health, according to the psychiatrists, has proved much less cooperative than his predecessor, and the situation has deteriorated to the extent that a march had to be staged in protest and an " administrative strike " decided on: the psychiatrists continue to treat patients, but have stopped paper work. This action is being supported by the unions of mental-hospital attendants, which have issued statements to that effect.