- Email: [email protected]
PROTEIN-LOSING ENTEROPATHY
889 may be useful in differential
space-occupying is unlikely to be a meningioma. suggests that
a
its presence lesion in the frontal lobe
diagnosis:
Department of Neurology, The London Hospital, London, E.1.
J. C.
PHEMISTER.
honourable grade of assistant medical officer in the London County Council hospital service. I feel therefore that our senior negotiators and representatives should know more of the work and plight of permanent J.H.M.O.S. J.H.M.O.
SIR,-Concerning the shortage of British doctors, I am surprised that no-one has mentioned the fact that there are many married women doctors who are unemployed and who would welcome part-time posts such as clinical assistantships. It seems a pity that these are usually given to local general practitioners, who are already overworked. strongly thought of schoolwelcome part-time; at times I have even considered delivering soap-powder coupons, which seems a waste of 6 years’ medical training! There are some openings for part-time work in general practice, but the hours are not usually convenient for a housewife; and in clinics more and more work is arranged on a full-time basis. University posts such as demonstratorships are not easily obtainable and are only very rarely part-time. More clinical assistantships would be welcomed by housewives who wish to continue in practice and would at the same time help to solve the am one
of these and have
women are
national shortage of doctors. Purley, Surrey.
UNDERWORKED.
PROTEIN-LOSING ENTEROPATHY to the paper of Dr. Jarnum and Dr. Peterson (Feb. 25), I would like to add that a proteinlosing enteropathy together with fat malabsorption may
SIR,-With reference
be observed in advanced
hepatic cirrhosis. absorption test with 131I-labelled
We performed an oleic acid on 5 such patients and found considerable impairment of oleic-acid absorption in each case. The mean 48-hour stool excretion of oleic acid was 25-3% of the administered dose, with a range of 19’6%-26-0% (normal mean 2-8%, with a range of 0-3%-5-2%). The mean peak whole-blood radioactivity was 1-04% of the administered dose per litre of blood, with a range of 0-39%-1-36% (normal mean 2-3%, with a range of 177%-276%). Fat malabsorption associated with cirrhosis has been attributed to concomitant pancreatic disease and consequent deficiency of pancreatic enzymes.l The results of the oleicacid study, however, point to dysfunction of the small intestine, as oleic acid is absorbed by the small intestine without the aid of pancreatic lipase. Abnormalities in the duodenal and jejunal mucosa have been reported in advanced cirrhosis. 1.
were most
likely
related to
portal
2
hypertension.
.
Protein may leak
SIR,-On reading the description in the Platt report of the proposed new grade of medical assistant, one is struck by the remarkable similarity between this grade’s proposed status and duties, and those of the permanent top-scale J.H.M.o. The latter has long experience of a specialty but is always, in theory at least, under the supervision of a consultant. The numbers permanently in this grade are very small indeed and some years ago they realised their chances of getting similar jobs elsewhere had vanished, without warning, as no more permanent J.H.M.O.S were being appointed. I count among my colleagues a J.H.M.o. who until recently ran a mass X-ray unit, and another in day-to-day charge of a laboratory; and I was myself originally appointed to the
I
pathological changes
through such a mucosa. When intra13’I-labelled albumin was given to one of the above patients by Prof. A. De Vries, head of medical department D., Beilinson Hospital, much of the labelled albumin was lost in the stool, and albumin rapidly appeared in the peritoneal cavity. Many of the biochemical abnormalities in advanced cirrhosis, such as the low serum-carotene and vitamin-A level, and the increased prothrombin-time, may be related to fat malabsorption as well as to intrinsic liver disease. A protein-losing enteropathy may contribute to the hypoalbuminaemia of hepatic cirrhosis. Further studies are in progress to clarify these relationships. Department of Radioisotopes, Beilinson Hospital, MELVIN JAY SCHWARTZ. Petach Tikvah, Israel. venous
HOSPITAL DOCTORS
teaching, where married
These
Fast, B. B., Wolfe, S. J., Stormont, J. M., Davidson, C. S. Gastroenterology, 1959, 37, 321.
BEHAVIOUR THERAPY IN A CASE OF TRANSVESTISM
SIR,-Dr. Barker and his colleagues (March 4) destreatment of a case of transvestism, and some doubts whether the patient’s improvement expressed was due to deconditioning. Furthermore, they criticised the method used in terms of expense, unpleasantness to the patient (and why not also to the therapist ?), and length of treatment. I hope the following rather different case-report may stimulate further debate on the factors contributing to a patient’s recovery. The method, incidentally, did not have the disadvantages of which Dr. Barker complained. A 17-year-old boy was brought to the psychiatric clinic by his father because the police found him wandering on the local cribed their
dressed in his mother’s underclothes, rubber shoes, and a plastic waterproof. His first episode of transvestism had been at the age of 9 when the family moved to London. The patient had felt extremely isolated since his friends had been left behind. His only occasional companion had been a girl cousin whom he envied because of her great ease in social relationships. It was this girl’s clothes he had first put on as they enabled him to imagine he was garbed with her personality. Since that time he had regularly dressed up in feminine clothes, usually his mother’s, as they were close to hand. He said that he had dressed in women’s underclothes and walked around the common on one previous occasion, and got back home without being noticed. He insisted that whilst dressed up he felt at ease with the world, imagining he was a sociable girl. He was grossly ignorant of sexual matters and had no homosexual inclinations or phantasy. He had a younger brother of 5. He had a few minor neurotic traits as a child and left grammar school at the age of 15 because of difficulties. He disliked the discipline, felt he was picked on by one of the masters, and frequently played truant and told lies. He was now working in a surveyor’s office and attending night school in order to sit his G.C.E. His full scale I.Q. (Wechsler) was 112, but this was thought to be a low estimate. The psychologist found him so shy that she constantly had to repeat questions because she could not hear what he said; and she commented on his considerable disjunction with the world. Certainly he felt at a distance from his parents emotionally, had few friends, and no interests except football. His central problem was considered to be one of isolation and an inability to make close rewarding relationships with others. His perversion was seen as an aspect of this primary difficulty. In fact much support was found to bear out the existential views of Medard Boss3 on sexual perversion. It was predicted that if the boy was helped out of his isolation his perversion would improve pari passu. At the first interview I saw both the patient and his father. I common
2. 3.
Astaldi, G., Strosselli, E. Amer. J. dig. Dis. 1960, 5, 603.
Boss, M. Meaning and Content of Sexual Perversions.
New York, 1949.
space-occupying is unlikely to be a meningioma. suggests that
a
its presence lesion in the frontal lobe
diagnosis:
Department of Neurology, The London Hospital, London, E.1.
J. C.
PHEMISTER.
honourable grade of assistant medical officer in the London County Council hospital service. I feel therefore that our senior negotiators and representatives should know more of the work and plight of permanent J.H.M.O.S. J.H.M.O.
SIR,-Concerning the shortage of British doctors, I am surprised that no-one has mentioned the fact that there are many married women doctors who are unemployed and who would welcome part-time posts such as clinical assistantships. It seems a pity that these are usually given to local general practitioners, who are already overworked. strongly thought of schoolwelcome part-time; at times I have even considered delivering soap-powder coupons, which seems a waste of 6 years’ medical training! There are some openings for part-time work in general practice, but the hours are not usually convenient for a housewife; and in clinics more and more work is arranged on a full-time basis. University posts such as demonstratorships are not easily obtainable and are only very rarely part-time. More clinical assistantships would be welcomed by housewives who wish to continue in practice and would at the same time help to solve the am one
of these and have
women are
national shortage of doctors. Purley, Surrey.
UNDERWORKED.
PROTEIN-LOSING ENTEROPATHY to the paper of Dr. Jarnum and Dr. Peterson (Feb. 25), I would like to add that a proteinlosing enteropathy together with fat malabsorption may
SIR,-With reference
be observed in advanced
hepatic cirrhosis. absorption test with 131I-labelled
We performed an oleic acid on 5 such patients and found considerable impairment of oleic-acid absorption in each case. The mean 48-hour stool excretion of oleic acid was 25-3% of the administered dose, with a range of 19’6%-26-0% (normal mean 2-8%, with a range of 0-3%-5-2%). The mean peak whole-blood radioactivity was 1-04% of the administered dose per litre of blood, with a range of 0-39%-1-36% (normal mean 2-3%, with a range of 177%-276%). Fat malabsorption associated with cirrhosis has been attributed to concomitant pancreatic disease and consequent deficiency of pancreatic enzymes.l The results of the oleicacid study, however, point to dysfunction of the small intestine, as oleic acid is absorbed by the small intestine without the aid of pancreatic lipase. Abnormalities in the duodenal and jejunal mucosa have been reported in advanced cirrhosis. 1.
were most
likely
related to
portal
2
hypertension.
.
Protein may leak
SIR,-On reading the description in the Platt report of the proposed new grade of medical assistant, one is struck by the remarkable similarity between this grade’s proposed status and duties, and those of the permanent top-scale J.H.M.o. The latter has long experience of a specialty but is always, in theory at least, under the supervision of a consultant. The numbers permanently in this grade are very small indeed and some years ago they realised their chances of getting similar jobs elsewhere had vanished, without warning, as no more permanent J.H.M.O.S were being appointed. I count among my colleagues a J.H.M.o. who until recently ran a mass X-ray unit, and another in day-to-day charge of a laboratory; and I was myself originally appointed to the
I
pathological changes
through such a mucosa. When intra13’I-labelled albumin was given to one of the above patients by Prof. A. De Vries, head of medical department D., Beilinson Hospital, much of the labelled albumin was lost in the stool, and albumin rapidly appeared in the peritoneal cavity. Many of the biochemical abnormalities in advanced cirrhosis, such as the low serum-carotene and vitamin-A level, and the increased prothrombin-time, may be related to fat malabsorption as well as to intrinsic liver disease. A protein-losing enteropathy may contribute to the hypoalbuminaemia of hepatic cirrhosis. Further studies are in progress to clarify these relationships. Department of Radioisotopes, Beilinson Hospital, MELVIN JAY SCHWARTZ. Petach Tikvah, Israel. venous
HOSPITAL DOCTORS
teaching, where married
These
Fast, B. B., Wolfe, S. J., Stormont, J. M., Davidson, C. S. Gastroenterology, 1959, 37, 321.
BEHAVIOUR THERAPY IN A CASE OF TRANSVESTISM
SIR,-Dr. Barker and his colleagues (March 4) destreatment of a case of transvestism, and some doubts whether the patient’s improvement expressed was due to deconditioning. Furthermore, they criticised the method used in terms of expense, unpleasantness to the patient (and why not also to the therapist ?), and length of treatment. I hope the following rather different case-report may stimulate further debate on the factors contributing to a patient’s recovery. The method, incidentally, did not have the disadvantages of which Dr. Barker complained. A 17-year-old boy was brought to the psychiatric clinic by his father because the police found him wandering on the local cribed their
dressed in his mother’s underclothes, rubber shoes, and a plastic waterproof. His first episode of transvestism had been at the age of 9 when the family moved to London. The patient had felt extremely isolated since his friends had been left behind. His only occasional companion had been a girl cousin whom he envied because of her great ease in social relationships. It was this girl’s clothes he had first put on as they enabled him to imagine he was garbed with her personality. Since that time he had regularly dressed up in feminine clothes, usually his mother’s, as they were close to hand. He said that he had dressed in women’s underclothes and walked around the common on one previous occasion, and got back home without being noticed. He insisted that whilst dressed up he felt at ease with the world, imagining he was a sociable girl. He was grossly ignorant of sexual matters and had no homosexual inclinations or phantasy. He had a younger brother of 5. He had a few minor neurotic traits as a child and left grammar school at the age of 15 because of difficulties. He disliked the discipline, felt he was picked on by one of the masters, and frequently played truant and told lies. He was now working in a surveyor’s office and attending night school in order to sit his G.C.E. His full scale I.Q. (Wechsler) was 112, but this was thought to be a low estimate. The psychologist found him so shy that she constantly had to repeat questions because she could not hear what he said; and she commented on his considerable disjunction with the world. Certainly he felt at a distance from his parents emotionally, had few friends, and no interests except football. His central problem was considered to be one of isolation and an inability to make close rewarding relationships with others. His perversion was seen as an aspect of this primary difficulty. In fact much support was found to bear out the existential views of Medard Boss3 on sexual perversion. It was predicted that if the boy was helped out of his isolation his perversion would improve pari passu. At the first interview I saw both the patient and his father. I common
2. 3.
Astaldi, G., Strosselli, E. Amer. J. dig. Dis. 1960, 5, 603.
Boss, M. Meaning and Content of Sexual Perversions.
New York, 1949.