- Email: [email protected]
A STRIPPER ASTRAY
1180 Much more investigation is needed, howcan be drawn concerning the mechanbefore conclusions ever, ism of production of these effects.
central toxic action. Our
findings reaffirm the clinical utility of ristocetin, especially in enterococcal and staphylococcal infections, but direct attention to potentially reversible haematological complications, including, for the first time, thrombocytopenia. In the patients studied, toxicity seemed to be a function of dosage. It is suggested that appropriate serial hsematological studies be performed in all patients receiving this drug, and that extreme caution be observed in those with compromised renal function. A more detailed report will follow elsewhere.s EUGENE
Walter Reed Army Hospital, Washington 12, D.C.
He died within
a
My personal experience is different, and I currently silver methods in the routine dyeing of sex chromatin in very different kinds of healthy and pathological tissues. It is easily done and when the impregnation with silver is good (a result not always obtained) the bright appearance of the cellular picture is entirely satisfactory, for especially photomicrography, because of the excellent contrasts obtained. A good example is the accompanying photograph of a malignant tumour. My observations will be published more fully later. Faculty of Medicine, C. BARRIO CUADRILLERO. University of Seville. A STRIPPER ASTRAY
few hours. Postmortem examina-
The patient had not vomited before the rupture. I wish to thank Dr. E. Grahame Jones for permission this case. Royal Gwent Hospital, Mon.
the reticulum
J. GANGAROSA
tion revealed right ventricular hypertrophy, a purulent bronchitis, 14 oz. of greenish mucoid fluid in the right pleural sac, 4 oz. of bloodstained fluid in the left pleural sac. There was a rupture of the stomach at the cardiac sphincter.
Newport,
(for example, Nissl bodies,
use
Captain, Medical Corps, U.S. Army.
SPONTANEOUS RUPTURE OF THE ŒSOPHAGUS AND BRONCHIAL ASTHMA was interested to read that Dr. Raffle (May 3) SIR,-I had found no previous record of spontaneous rupture of ’the oesophagus in association with bronchial asthma, for this accident occurred in a patient here last year. An obese male, aged 62, was admitted with an acute exacerbation of his recurrent bronchitis, from which he had suffered for many years. He was confused, cyanosed, dyspnoeic, and wheezing. Improvement followed treatment with antibiotics, intermittent oxygen, and aminophylline, but he remained confused. Nineteen days after admission his condition suddenly worsened and he seemed to have had a pulmonary embolus.
alkaline fixatives of nuclein, &c.)."
to
report
R. C. R. CONNOR.
STAINS FOR SEX CHROMATIN
SIR,-According to Lindsay and Barr,’7 " the sex chromatin lacks well-developed argyrophilic properties " and " the accessory body is strongly argyrophilic and refractory to basic dyes; the reverse is true for the sex chromatin ".
Forty-six years earlier Ramon y Cajal8 wrote: " Colloidal silver which always resists dyeing of the basophil substances and, strangely, of the nucleinic or chromatic framework of ordinary cells ", and " colloidal silver never impregnates any material which is distinctly basophil, much less tissue treated with either neutral or slightly 6. Gangarosa, E. J., Landerman, N. S., Rosch, P. J., Herndon, E. G.
In
preparation.
7. Lindsay, H. A., Barr, M. L. J. Anat., Lond. 1955, 89, 48. 8. Ramón y Cajal, S. Trab. Lab. Invest. Biol. Univ. Madr. 1910,
8, 27.
Sex chromatin: two fibrocytes in a section of colourless nsevus of breast from a woman aged 55 (stained with silver carbonate).
SiR,-An adventure with a warning.
a
vein
stripper
may be of
interest and
In a very obese woman, a high resection and " flush tie " of the long saphenous vein at the saphenous opening was performed. A Myers-type stripper was introduced in the long saphenous vein in front of the medial malleolus with the object of stripping out the vein. It passed up very easily except for a slight check in the mid-calf. A moment too late it was realised that the tip of the stripper had not appeared in the saphenous vein at the upper incision. The stripper could be palpated in the femoral vein at the saphenous opening, the tip being higher up. Gentle pulling failed to extract the stripper, the tip of which seemed to be caught or jammed above the inguinal ligament. Pulling was tried with the leg in all possible positions, and the patient was tilted feet down to distend the veins, but still the stripper would not come. It seemed almost certain that the external iliac vein would be torn if the stripper was forcibly pulled. Therefore an extraperitoneal exposure was made above the inguinal ligaThe stripper was immediately found impacted in a ment. small vein in the extraperitoneal fat 1 in. above the inguinal ligament. This vein appeared to be a small tributary of the external iliac vein. The little vein was divided, and the tip of the stripper pushed through and cut off with wire cutters. The stripper was then easily withdrawn and the ends of the vein tied. The operation was completed by closing the incisions and the short saphenous vein was ligated behind the knee. The patient recovered uneventfully, and there was no evidence of postoperative deep-vein thrombosis.
The lesson to be learnt from this case is that the operator should always know exactly how far up the leg the tip of the stripper has travelled. It is known that a stripper can enter the deep veins through one of the communicating veins, but I have never heard of any difficulty in pulling the stripper back again. It must be very rare indeed for a stripper to enter the deep veins and then escape through a tributary, though the angle of junction just above the inguinal ligament might favour this. Usually the stripper can be felt’in its passage all the way up the long saphenous vein, and often, in thin people, it can be seen through the skin as well. In obese people it can be very difficult to follow the course of the stripper, which could enter the deep veins without the operator’s knowledge. Perhaps the easiest way to be certain how far the stripper has travelled is to have another stripper of’ exactly the same length at hand so that the distance can be measured. The predicament described here occurred very easily and simply. The consequences could have been serious if the stripper had been pulled too forcibly. The importance of knowing the exact position of the tip of the stripper cannot be too strongly emphasised. Tottenham Hospital Group, London, N.15.
E. E. O’MALLEY.
central toxic action. Our
findings reaffirm the clinical utility of ristocetin, especially in enterococcal and staphylococcal infections, but direct attention to potentially reversible haematological complications, including, for the first time, thrombocytopenia. In the patients studied, toxicity seemed to be a function of dosage. It is suggested that appropriate serial hsematological studies be performed in all patients receiving this drug, and that extreme caution be observed in those with compromised renal function. A more detailed report will follow elsewhere.s EUGENE
Walter Reed Army Hospital, Washington 12, D.C.
He died within
a
My personal experience is different, and I currently silver methods in the routine dyeing of sex chromatin in very different kinds of healthy and pathological tissues. It is easily done and when the impregnation with silver is good (a result not always obtained) the bright appearance of the cellular picture is entirely satisfactory, for especially photomicrography, because of the excellent contrasts obtained. A good example is the accompanying photograph of a malignant tumour. My observations will be published more fully later. Faculty of Medicine, C. BARRIO CUADRILLERO. University of Seville. A STRIPPER ASTRAY
few hours. Postmortem examina-
The patient had not vomited before the rupture. I wish to thank Dr. E. Grahame Jones for permission this case. Royal Gwent Hospital, Mon.
the reticulum
J. GANGAROSA
tion revealed right ventricular hypertrophy, a purulent bronchitis, 14 oz. of greenish mucoid fluid in the right pleural sac, 4 oz. of bloodstained fluid in the left pleural sac. There was a rupture of the stomach at the cardiac sphincter.
Newport,
(for example, Nissl bodies,
use
Captain, Medical Corps, U.S. Army.
SPONTANEOUS RUPTURE OF THE ŒSOPHAGUS AND BRONCHIAL ASTHMA was interested to read that Dr. Raffle (May 3) SIR,-I had found no previous record of spontaneous rupture of ’the oesophagus in association with bronchial asthma, for this accident occurred in a patient here last year. An obese male, aged 62, was admitted with an acute exacerbation of his recurrent bronchitis, from which he had suffered for many years. He was confused, cyanosed, dyspnoeic, and wheezing. Improvement followed treatment with antibiotics, intermittent oxygen, and aminophylline, but he remained confused. Nineteen days after admission his condition suddenly worsened and he seemed to have had a pulmonary embolus.
alkaline fixatives of nuclein, &c.)."
to
report
R. C. R. CONNOR.
STAINS FOR SEX CHROMATIN
SIR,-According to Lindsay and Barr,’7 " the sex chromatin lacks well-developed argyrophilic properties " and " the accessory body is strongly argyrophilic and refractory to basic dyes; the reverse is true for the sex chromatin ".
Forty-six years earlier Ramon y Cajal8 wrote: " Colloidal silver which always resists dyeing of the basophil substances and, strangely, of the nucleinic or chromatic framework of ordinary cells ", and " colloidal silver never impregnates any material which is distinctly basophil, much less tissue treated with either neutral or slightly 6. Gangarosa, E. J., Landerman, N. S., Rosch, P. J., Herndon, E. G.
In
preparation.
7. Lindsay, H. A., Barr, M. L. J. Anat., Lond. 1955, 89, 48. 8. Ramón y Cajal, S. Trab. Lab. Invest. Biol. Univ. Madr. 1910,
8, 27.
Sex chromatin: two fibrocytes in a section of colourless nsevus of breast from a woman aged 55 (stained with silver carbonate).
SiR,-An adventure with a warning.
a
vein
stripper
may be of
interest and
In a very obese woman, a high resection and " flush tie " of the long saphenous vein at the saphenous opening was performed. A Myers-type stripper was introduced in the long saphenous vein in front of the medial malleolus with the object of stripping out the vein. It passed up very easily except for a slight check in the mid-calf. A moment too late it was realised that the tip of the stripper had not appeared in the saphenous vein at the upper incision. The stripper could be palpated in the femoral vein at the saphenous opening, the tip being higher up. Gentle pulling failed to extract the stripper, the tip of which seemed to be caught or jammed above the inguinal ligament. Pulling was tried with the leg in all possible positions, and the patient was tilted feet down to distend the veins, but still the stripper would not come. It seemed almost certain that the external iliac vein would be torn if the stripper was forcibly pulled. Therefore an extraperitoneal exposure was made above the inguinal ligaThe stripper was immediately found impacted in a ment. small vein in the extraperitoneal fat 1 in. above the inguinal ligament. This vein appeared to be a small tributary of the external iliac vein. The little vein was divided, and the tip of the stripper pushed through and cut off with wire cutters. The stripper was then easily withdrawn and the ends of the vein tied. The operation was completed by closing the incisions and the short saphenous vein was ligated behind the knee. The patient recovered uneventfully, and there was no evidence of postoperative deep-vein thrombosis.
The lesson to be learnt from this case is that the operator should always know exactly how far up the leg the tip of the stripper has travelled. It is known that a stripper can enter the deep veins through one of the communicating veins, but I have never heard of any difficulty in pulling the stripper back again. It must be very rare indeed for a stripper to enter the deep veins and then escape through a tributary, though the angle of junction just above the inguinal ligament might favour this. Usually the stripper can be felt’in its passage all the way up the long saphenous vein, and often, in thin people, it can be seen through the skin as well. In obese people it can be very difficult to follow the course of the stripper, which could enter the deep veins without the operator’s knowledge. Perhaps the easiest way to be certain how far the stripper has travelled is to have another stripper of’ exactly the same length at hand so that the distance can be measured. The predicament described here occurred very easily and simply. The consequences could have been serious if the stripper had been pulled too forcibly. The importance of knowing the exact position of the tip of the stripper cannot be too strongly emphasised. Tottenham Hospital Group, London, N.15.
E. E. O’MALLEY.