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WHOLE BLOOD STORED IN HALF-STRENGTH-TRISODIUM CITRATE
152 NITROFURAZONE IN SCABIES
SIR,-After the resettlement of refugees from Bangladesh in northern suburb of Calcutta in 1971-72 scabies became a common problem in everyday medical practice. During the epidemic, there was acute shortage of benzylbenzoate emulsion 25% in the local market. ’Furacin’ (soluble ointment of nitrofurazone 0.2% w/w in water-soluble base) was advised in 10 patients for local application on the grounds that the drug’s antibacterial properties might help to relieve the patient from secondary bacterial infection. In most cases nitrofurazone controlled the scabies. Encouraged by this result, I tried nitrofurazone ointment on another 20 such patients aged 10 to 50 of either sex. Complete clinical cure was observed in 16 (80%). Because of the risk of side-effects if the ointment were applied over an extended area of skin surface this treatment was advised in mild to moderate cases only. No significant sideeffects were observed clinically. Laboratory studies, such as liver-function tests, could not be done. These observations suggest a hitherto unreported antiscabies action of nitrofurazone. a
6 Sarsuna Main Road, Calcutta-700 061 West Bengal, India
S. P. ROY CHOWDHURY
WHOLE BLOOD STORED IN HALF-STRENGTH-
TRISODIUM CITRATE
of erythrocyte A.T.P. or 2,3-D.P.G. concentrations after storage of whole blood at 4-6°C, when 600 ml from each of five healthy male donors was equally divided and stored in these concentrations (see table). Clotting studies were not significantly different, and there were no clinically significant differences for electrolytes, fibrinogen, pH, osmotic fragility, blood-gases, haematocrit, haemoglobin, formed elements, or plasma haemoglobin. Half-strength citrate3 and A.C.D.-A4 solutions have been used clinically during extracorporeal centrifugal platelet-pheresis, with no untoward effects. Platelets collected by these means function normally,3 and clotting studies were nor-
tenance
mal.3
4 6
By using lower sodium-citrate concentrations it may be possible to supply relatively non-toxic blood without compromising quality in those clinical situations requiring the transfusion of large quantities in short periods of time. Department of Hæmatology, Gibson Laboratories, Radcliffe Infirmary, Oxford OX2 6HE
JOHN MILTON MISHLER, IV JOHN H. DARLEY STEWART CEDERHOLM-WILLIAMS
3.
Mishler, J. M., Janes, A. W., Lowes, B., Farfan, C., Emerson, P. M. Br. J. Hœmat. 1976, 34, 387. 4. Olson, P. R., Cox, C., McCullough, J. Vox Sang. (in the press). 5. Mishler, J. M., Borberg, H., Reuter, H., Gross, R. Blut (in the press). 6. Mishler, J. M., Borberg, H. Unpublished.
Commentary from Westminster
SIR,-Additives (adenosine, inosine, guanosine, adenine, hexoses, and dihydroxyacetone) have been tried experimentally and clinically in efforts to maintain physiological concentrations of erythrocyte adenosine triphosphate (A.T.P.) and 2,3-diphosphoglycerate (2,3-D.P.G.) in acid-citrate-dextrose1 (A.C.D.) and citrate-phosphate-dextrose preserved blood.’ These additives, singly or in combinations, have proved sucA.T.P. AND
2,3-D.P.G.
CONCENTRATIONS
BLOOD-CELLS) IN BLOOD
(mmol/1 RED
STORED IN STANDARD OR
HALF-STRENGTH
A.C.D-A
cessful, but the problem of citrate toxicity after infusion of
large quantities of stored blood has not been solved. In 1945 Loutit2 reported that blood preserved in sodium-citrate concentrations approximately 50% lower than those now used resulted in superior stored blood. Because occasional clots were observed in blood collected in glass bottles in those days, the citrate concentration was raised. We have reinvestigated Loutit’s findings, using a total polyvinyl-chloride plastic collection system (McGaw Laboratories, U.S.A.) and found no significant difference (Student’s t test for paired scores) between standard A.C.D.-A (2.2g trisodium citrate, 0.8g citric acid, 2-45g dextrose/dl anticoagulant solution, pH 4-9) and halfstrength A.C.D.-A (1-lg trisodium citrate, 0-8g citric acid, 2.45g dextrose/dl anticoagulant solution, pH 4-3) in mainGreenwalt, T. J., Jamieson, G. A. (editors). The Human Red Cell In Vitro. New York, 1974. 2. Loutit, J. F. J. Path. Bact. 1945, 51, 325. 1.
Waiting-lists Lengthen FROM A CORRESPONDENT
FOR many years the N.H.S. inpatient waiting-list stubbornly remained at around 500 000, with remarkably little change from year to year. The early 1970s saw a small decrease, but it was soon reversed and the total crept above half a million. Today the trend appears to have taken off and for the first time we are likely to hear of 600 000 people awaiting admission to hospital in England alone. At the end of 1973 the total inpatient waiting-list in all specialties in England was 508 617. This had increased to 517 424 a year later and to 519 552 at the end of September, 1975. But the next six months saw a steep rise and by the end of March last year there were 583 851 people awaiting admission. If Wales (38 189 were on the waiting-list in 1975) is included, then the 600 000 total was passed. More significant were the increasing numbers of people who were having to wait longer for hospital treatment. Of the 39 922 cases in England classified as urgent, 59% had waited for more than a month; and of the 543 929 nonurgent cases, 27% had waited for more than a year. When in 1975 the Department of Health and Social Security sent a circular to all health authorities and boards of governors asking them to review the management of their lists, it referred to an initial aim of admitting all urgent cases in less than a month and all other waiting-list patients in less than a year. Seventeen months later these targets are a long way from being achieved and, if anything, they are further off. The latest figures are for March, 1976. But now that the Department’s policy is to collect new statistics giving broad information about admissions in different specialties and areas, a fairly detailed picture is available of
SIR,-After the resettlement of refugees from Bangladesh in northern suburb of Calcutta in 1971-72 scabies became a common problem in everyday medical practice. During the epidemic, there was acute shortage of benzylbenzoate emulsion 25% in the local market. ’Furacin’ (soluble ointment of nitrofurazone 0.2% w/w in water-soluble base) was advised in 10 patients for local application on the grounds that the drug’s antibacterial properties might help to relieve the patient from secondary bacterial infection. In most cases nitrofurazone controlled the scabies. Encouraged by this result, I tried nitrofurazone ointment on another 20 such patients aged 10 to 50 of either sex. Complete clinical cure was observed in 16 (80%). Because of the risk of side-effects if the ointment were applied over an extended area of skin surface this treatment was advised in mild to moderate cases only. No significant sideeffects were observed clinically. Laboratory studies, such as liver-function tests, could not be done. These observations suggest a hitherto unreported antiscabies action of nitrofurazone. a
6 Sarsuna Main Road, Calcutta-700 061 West Bengal, India
S. P. ROY CHOWDHURY
WHOLE BLOOD STORED IN HALF-STRENGTH-
TRISODIUM CITRATE
of erythrocyte A.T.P. or 2,3-D.P.G. concentrations after storage of whole blood at 4-6°C, when 600 ml from each of five healthy male donors was equally divided and stored in these concentrations (see table). Clotting studies were not significantly different, and there were no clinically significant differences for electrolytes, fibrinogen, pH, osmotic fragility, blood-gases, haematocrit, haemoglobin, formed elements, or plasma haemoglobin. Half-strength citrate3 and A.C.D.-A4 solutions have been used clinically during extracorporeal centrifugal platelet-pheresis, with no untoward effects. Platelets collected by these means function normally,3 and clotting studies were nor-
tenance
mal.3
4 6
By using lower sodium-citrate concentrations it may be possible to supply relatively non-toxic blood without compromising quality in those clinical situations requiring the transfusion of large quantities in short periods of time. Department of Hæmatology, Gibson Laboratories, Radcliffe Infirmary, Oxford OX2 6HE
JOHN MILTON MISHLER, IV JOHN H. DARLEY STEWART CEDERHOLM-WILLIAMS
3.
Mishler, J. M., Janes, A. W., Lowes, B., Farfan, C., Emerson, P. M. Br. J. Hœmat. 1976, 34, 387. 4. Olson, P. R., Cox, C., McCullough, J. Vox Sang. (in the press). 5. Mishler, J. M., Borberg, H., Reuter, H., Gross, R. Blut (in the press). 6. Mishler, J. M., Borberg, H. Unpublished.
Commentary from Westminster
SIR,-Additives (adenosine, inosine, guanosine, adenine, hexoses, and dihydroxyacetone) have been tried experimentally and clinically in efforts to maintain physiological concentrations of erythrocyte adenosine triphosphate (A.T.P.) and 2,3-diphosphoglycerate (2,3-D.P.G.) in acid-citrate-dextrose1 (A.C.D.) and citrate-phosphate-dextrose preserved blood.’ These additives, singly or in combinations, have proved sucA.T.P. AND
2,3-D.P.G.
CONCENTRATIONS
BLOOD-CELLS) IN BLOOD
(mmol/1 RED
STORED IN STANDARD OR
HALF-STRENGTH
A.C.D-A
cessful, but the problem of citrate toxicity after infusion of
large quantities of stored blood has not been solved. In 1945 Loutit2 reported that blood preserved in sodium-citrate concentrations approximately 50% lower than those now used resulted in superior stored blood. Because occasional clots were observed in blood collected in glass bottles in those days, the citrate concentration was raised. We have reinvestigated Loutit’s findings, using a total polyvinyl-chloride plastic collection system (McGaw Laboratories, U.S.A.) and found no significant difference (Student’s t test for paired scores) between standard A.C.D.-A (2.2g trisodium citrate, 0.8g citric acid, 2-45g dextrose/dl anticoagulant solution, pH 4-9) and halfstrength A.C.D.-A (1-lg trisodium citrate, 0-8g citric acid, 2.45g dextrose/dl anticoagulant solution, pH 4-3) in mainGreenwalt, T. J., Jamieson, G. A. (editors). The Human Red Cell In Vitro. New York, 1974. 2. Loutit, J. F. J. Path. Bact. 1945, 51, 325. 1.
Waiting-lists Lengthen FROM A CORRESPONDENT
FOR many years the N.H.S. inpatient waiting-list stubbornly remained at around 500 000, with remarkably little change from year to year. The early 1970s saw a small decrease, but it was soon reversed and the total crept above half a million. Today the trend appears to have taken off and for the first time we are likely to hear of 600 000 people awaiting admission to hospital in England alone. At the end of 1973 the total inpatient waiting-list in all specialties in England was 508 617. This had increased to 517 424 a year later and to 519 552 at the end of September, 1975. But the next six months saw a steep rise and by the end of March last year there were 583 851 people awaiting admission. If Wales (38 189 were on the waiting-list in 1975) is included, then the 600 000 total was passed. More significant were the increasing numbers of people who were having to wait longer for hospital treatment. Of the 39 922 cases in England classified as urgent, 59% had waited for more than a month; and of the 543 929 nonurgent cases, 27% had waited for more than a year. When in 1975 the Department of Health and Social Security sent a circular to all health authorities and boards of governors asking them to review the management of their lists, it referred to an initial aim of admitting all urgent cases in less than a month and all other waiting-list patients in less than a year. Seventeen months later these targets are a long way from being achieved and, if anything, they are further off. The latest figures are for March, 1976. But now that the Department’s policy is to collect new statistics giving broad information about admissions in different specialties and areas, a fairly detailed picture is available of