- Email: [email protected]
RECORD ORDER
263 24 scans and the left lobe in 6. In most cases the difference in size was slight, although in a few cases it was striking. This also supports the view of an anatomical variant with the right tending to be the dominant lobe. It is obviously important for workers in this specialty to be aware of this variant in interpreting scans in patients with thyroid abnormalities. Our results show a lower mean twenty-four-hour 1311 uptake in the group with asymmetrical uptakes but unfortunately Thomson did not report on this aspect; our series is too small to allow any valid conclusion to be made from this finding, but it does suggest the need for further studies of this tvoe. Radioisotope Department, St. Joseph’s Hospital, F. R. ORR Hamilton, Ontario, G. K. INGHAM. Canada.
NEUROPATHY AND LIVER DISEASE SIR,-Iwas interested in the article by Dr. Dayan and Dr. Williams (July 15, p. 133) describing demyelinisation in peripheral nerves of ten cirrhotic patients. Although they state that " Peripheral neuropathy does not seem to have been
THE MYSTIQUE OF THE BARIUM MEAL SIR,-I read, with great amusement, Dr. Nelson’s article (July 8, p. 92). He obviously writes from a superior, almost Olympian, viewpoint-but even Zeus slept occasionally. The correct name of the twice-cited German surgeon is Trendelenburg, and not Trendelenberg. However, his name is correctly spelt with "a capital T, whereas, further on, Dr. Nelson refers twice to a bucky ", this time not with a capital B. I have no doubt that Dr. Nelson knows that G. Bucky was an American radiologist-he happened to be a cousin of mine.
gives
recorded as a complication of hepatic failure ", my co-authors and I have published such observations recently, among other neurological complications of hepatic insufficiency (Revta clin. esp. 1967, 104, 60). In this article I coined the term " hepatic neuropathy " to embrace all the psychoneurological complications of liver failure, including the following:
(a) Hepatic encephalopathy: 1. Transient. 2. Permanent
(chronic hepatocerebral degeneration). (b) Hepatic myelopathy. (c) Hepatic peripheral neuropathy (neuritis and polyneuritis). (d) Retrobulbar neuritis.
interesting observations of Dr. Dayan and Dr. Williams important neuropathological basis to our statementmade on purely clinical grounds-that hepatic failure can sometimes induce peripheral neuropathy. The
University Radiology Clinic, Cantonal Hospital, Geneva.
H. CLIVE SIMS.
an
Department of Internal Medicine, Clinica La Paz, Madrid, Spain.
J. ORTIZ-VAZQUEZ.
VITAMIN-B12 DEFICIENCY IN PSYCHIATRY SIR,-Dr. Oxnard and Dr. Smithwrite that in the peripheral blood of vitamin-B12-deficient animals " minor but statistically significant changes, particularly in the mean corpuscular volume, can be demonstrated ". I am prompted to
report
an
otherwise normal
woman
whose serum-vitamin-
153 {J.{J.g. per ml., and mean corpuscular volume B12-level (M.C.v.) 106 c.[L. The mean value for females is quoted in the Handbook of Biological Values 2 as 87 c.[L, with a 95% range from 74 to 98 c.{J.. The value obtained was thus 3-5 S.D. beyond the mean-in other words there are fewer than 1-5 chances in 1000 of finding this value in a normal population. It would be interesting to measure the M.C.v. in a number of was
RECORD ORDER SIR,-In recent years I have looked at many kinds of hospital folder and one of the least satisfactory is now standard for the Welsh region. Case-history sheets are draped over gussets and other documents in an irritating way which makes it difficult to write in long-hand, and there are other more serious
disadvantages. for standardisation has been overstated. EIRIAN WILLIAMS. Thornton, Pembrokeshire. The
case
vitamin-B12-deficient people without pernicious anxmia. Headquarters, Canadian Contingent, United Nations, Nicosia, Cyprus, C.F.P.O. 5001.
TREATMENT OF HEPATIC COMA
SIR,-Dr. Jones and his colleagues in their article last week
(p. 169) report initial striking improvement after treatment by exchange blood-transfusion in a proportion of their patients with hepatic coma consequent upon hepatic necrosis. In spite of this, however, all their patients died. A regimen of treatment, which I have reported, when slightly modifiedhas in my hands resulted in a far happier outcome.3Ihave also pointed out that I am not alone in this respect.5 It has occurred to me that in my own experience some of the most impressive recoveries were in patients who had been given massive blood-transfusions because of severe haemorrhages into the bowel or elsewhere. I can cite the case of a young doctor, who made a complete recovery after a period of coma lasting a fortnight.4 Similar recovery has occurred in other patients under my care. I am therefore not discussing merely a single instance. I should like to suggest that it is possible that exchange blood-transfusion accompanied by the supportive regimen, which I have described, might possibly lead to better results. University Department of Clinical Biochemistry, The Royal Victoria Infirmary, A. L. LATNER. Newcastle upon Tyne 1. 1. Latner, A. L. Br. med. J. 1950, ii, 748. 2. Latner, A. L. Lancet, 1953, i, 1253. 3. Latner, A. L. ibid. 1952, ii, 44. 4. Latner, A. L. Proc. Nutr. Soc. 1954, 13, 139. 5. Latner, A. L. Lancet, 1954, i, 51.
P. D. NEWBERRY.
PSYCHIATRIC BEDS
SIR,-Your leading article (July 1,
p. 30) states that the Ministry of Health’s announcement, in 1961, that the number of beds for psychiatric patients would be reduced by half by the mid-1970s was based on a projection of a downward trend observed in the numbers of resident psychiatric patients between 1954 and 1959, as reported by Tooth and Brooke.3 You then say:
" Yet, when it was published, the Tooth-Brooke projection was as being unrealistic and statistically unsound. Despite these criticisms, however, a recently published census,4 carried out by Miss Brooke for the Ministry in 1963, of all patients in psychiatric hospitals and units shows that the predictions were substantially correct, and that the rundown forecast was, in fact, being maintained at the time criticised
of the census."
I do not know what evidence you have for this astonishing statement, but the figures given by Miss Brooke for 1963 show the reverse to be true; my criticisms5 are more than borne out. The figures for chronic residents in psychiatric hospitals, as published by Miss Brooke, are: 1954, 112,113 1; 1959, 77,711; 1963, 88,684.2 Had the downward trend of the Tooth-Brooke projection continued, the number of chronic residents in psyOxnard, C. E., Smith, W. T. Lancet, 1967, i, 161. Biological Handbooks; Blood and Other Body Fluids (edited by Dorothy S. Dittmer,) Federation of American Societies for Experimental Biology, Washington, D.C., 1961. 3. Tooth, G. C., Brooke, E. M. Lancet, 1961, i, 710. 4. Brooke, E. M. Census of Patients in Psychiatric Beds, 1963. H.M. Stationery Office, 1967. 5. Watt, D. C. Lancet, 1963, i, 559; ibid. p. 997.
1. 2.
NEUROPATHY AND LIVER DISEASE SIR,-Iwas interested in the article by Dr. Dayan and Dr. Williams (July 15, p. 133) describing demyelinisation in peripheral nerves of ten cirrhotic patients. Although they state that " Peripheral neuropathy does not seem to have been
THE MYSTIQUE OF THE BARIUM MEAL SIR,-I read, with great amusement, Dr. Nelson’s article (July 8, p. 92). He obviously writes from a superior, almost Olympian, viewpoint-but even Zeus slept occasionally. The correct name of the twice-cited German surgeon is Trendelenburg, and not Trendelenberg. However, his name is correctly spelt with "a capital T, whereas, further on, Dr. Nelson refers twice to a bucky ", this time not with a capital B. I have no doubt that Dr. Nelson knows that G. Bucky was an American radiologist-he happened to be a cousin of mine.
gives
recorded as a complication of hepatic failure ", my co-authors and I have published such observations recently, among other neurological complications of hepatic insufficiency (Revta clin. esp. 1967, 104, 60). In this article I coined the term " hepatic neuropathy " to embrace all the psychoneurological complications of liver failure, including the following:
(a) Hepatic encephalopathy: 1. Transient. 2. Permanent
(chronic hepatocerebral degeneration). (b) Hepatic myelopathy. (c) Hepatic peripheral neuropathy (neuritis and polyneuritis). (d) Retrobulbar neuritis.
interesting observations of Dr. Dayan and Dr. Williams important neuropathological basis to our statementmade on purely clinical grounds-that hepatic failure can sometimes induce peripheral neuropathy. The
University Radiology Clinic, Cantonal Hospital, Geneva.
H. CLIVE SIMS.
an
Department of Internal Medicine, Clinica La Paz, Madrid, Spain.
J. ORTIZ-VAZQUEZ.
VITAMIN-B12 DEFICIENCY IN PSYCHIATRY SIR,-Dr. Oxnard and Dr. Smithwrite that in the peripheral blood of vitamin-B12-deficient animals " minor but statistically significant changes, particularly in the mean corpuscular volume, can be demonstrated ". I am prompted to
report
an
otherwise normal
woman
whose serum-vitamin-
153 {J.{J.g. per ml., and mean corpuscular volume B12-level (M.C.v.) 106 c.[L. The mean value for females is quoted in the Handbook of Biological Values 2 as 87 c.[L, with a 95% range from 74 to 98 c.{J.. The value obtained was thus 3-5 S.D. beyond the mean-in other words there are fewer than 1-5 chances in 1000 of finding this value in a normal population. It would be interesting to measure the M.C.v. in a number of was
RECORD ORDER SIR,-In recent years I have looked at many kinds of hospital folder and one of the least satisfactory is now standard for the Welsh region. Case-history sheets are draped over gussets and other documents in an irritating way which makes it difficult to write in long-hand, and there are other more serious
disadvantages. for standardisation has been overstated. EIRIAN WILLIAMS. Thornton, Pembrokeshire. The
case
vitamin-B12-deficient people without pernicious anxmia. Headquarters, Canadian Contingent, United Nations, Nicosia, Cyprus, C.F.P.O. 5001.
TREATMENT OF HEPATIC COMA
SIR,-Dr. Jones and his colleagues in their article last week
(p. 169) report initial striking improvement after treatment by exchange blood-transfusion in a proportion of their patients with hepatic coma consequent upon hepatic necrosis. In spite of this, however, all their patients died. A regimen of treatment, which I have reported, when slightly modifiedhas in my hands resulted in a far happier outcome.3Ihave also pointed out that I am not alone in this respect.5 It has occurred to me that in my own experience some of the most impressive recoveries were in patients who had been given massive blood-transfusions because of severe haemorrhages into the bowel or elsewhere. I can cite the case of a young doctor, who made a complete recovery after a period of coma lasting a fortnight.4 Similar recovery has occurred in other patients under my care. I am therefore not discussing merely a single instance. I should like to suggest that it is possible that exchange blood-transfusion accompanied by the supportive regimen, which I have described, might possibly lead to better results. University Department of Clinical Biochemistry, The Royal Victoria Infirmary, A. L. LATNER. Newcastle upon Tyne 1. 1. Latner, A. L. Br. med. J. 1950, ii, 748. 2. Latner, A. L. Lancet, 1953, i, 1253. 3. Latner, A. L. ibid. 1952, ii, 44. 4. Latner, A. L. Proc. Nutr. Soc. 1954, 13, 139. 5. Latner, A. L. Lancet, 1954, i, 51.
P. D. NEWBERRY.
PSYCHIATRIC BEDS
SIR,-Your leading article (July 1,
p. 30) states that the Ministry of Health’s announcement, in 1961, that the number of beds for psychiatric patients would be reduced by half by the mid-1970s was based on a projection of a downward trend observed in the numbers of resident psychiatric patients between 1954 and 1959, as reported by Tooth and Brooke.3 You then say:
" Yet, when it was published, the Tooth-Brooke projection was as being unrealistic and statistically unsound. Despite these criticisms, however, a recently published census,4 carried out by Miss Brooke for the Ministry in 1963, of all patients in psychiatric hospitals and units shows that the predictions were substantially correct, and that the rundown forecast was, in fact, being maintained at the time criticised
of the census."
I do not know what evidence you have for this astonishing statement, but the figures given by Miss Brooke for 1963 show the reverse to be true; my criticisms5 are more than borne out. The figures for chronic residents in psychiatric hospitals, as published by Miss Brooke, are: 1954, 112,113 1; 1959, 77,711; 1963, 88,684.2 Had the downward trend of the Tooth-Brooke projection continued, the number of chronic residents in psyOxnard, C. E., Smith, W. T. Lancet, 1967, i, 161. Biological Handbooks; Blood and Other Body Fluids (edited by Dorothy S. Dittmer,) Federation of American Societies for Experimental Biology, Washington, D.C., 1961. 3. Tooth, G. C., Brooke, E. M. Lancet, 1961, i, 710. 4. Brooke, E. M. Census of Patients in Psychiatric Beds, 1963. H.M. Stationery Office, 1967. 5. Watt, D. C. Lancet, 1963, i, 559; ibid. p. 997.
1. 2.