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BLOOD COAGULATION AND PLATELET ABNORMALITIES IN CYANOTIC CONGENITAL HEART-DISEASE
607
During therapy, two patients experienced isolated but severe episodes of bronchitis, which responded well to therapy, including short courses (3-5 days) of oral rather
Within 4-10 weeks after the cessation of oral three steroids, patients noted symptoms of severe allergic rhinitis, and two of these also had recurrences of nasal polyps for which they had undergone polypectomies several years ago. Mild numular eczema appeared in one case about 4 months after triamcinolone aerosols were introduced and 10 weeks after oral therapy with prednisone
prednisone.
stopped. Although our studies are still in progress and our data have not been analysed statistically, we feel that suspensions of corticosteroids, such as triamcinolone acetonide, when inhaled in the form of high-pressure aerosols, can effectively control severe asthma, can maintain adequate levels of pulmonary function and of exercise tolerance, with doses about ten times smaller than those required orally, and may not interfere noticeably with adrenal cortical function nor produce any immediate undesirable side-effects. Almost all of our patients seemed extremely enthusiastic and eager to continue aerosol therapy. We find ourselves influenced as much by these patients’ attitudes as we are by the objective clinical and laboratory data, since we believe that improvement can best be estimated when viewed from several angles.
was
Allergy & Asthma Clinic, 155 Cook Street, Denver, Colorado 80206, U.S.A.
CONSTANTINE J. FALLIERS.
STOOL-WEIGHT AND TRANSIT-TIME AFTER ILEOCOLONIC RESECTION
SIR,-For the patients having ileocolonic resection by Dr Cummings and his colleagues (Feb. 17, p. 344), stool-weight (W g. per day) and transit-time (t hours) are related in a similar way to that of the healthy subjects described by Burkitt et al.l For the patients, the described
relationship derived from the data in table n (p. 345) is log t= 3-067 ±0-541-0-6700-195 log W. For normal subjects the relation was found to be log t= 2-816—0561 log W. The apparent volumes (V ml.) of the intestinal compartment of the patients, calculated2 as V= (W.t/24) ml., assuming that the stool density is 1, are as follows:
There is also the question of the colon’s contribution to reabsorption of water in health. Cummings and his colleagues cite the standard assessment of colonic water absorption by comparing " composition of normal stool ... The assumption to that of ileostomy fluid " (p. 347). inherent in this comparison may be incorrect.33 Direct measurement of the volumes entering and leaving the colon in healthy volunteers suggests that the large bowel normally reabsorbs 1-0-1-5 litres of water per day rather than the 05 litres calculated from the usual comparisons of ileostomy output with stool output.4 Department of Biochemistry, University of Oxford, South Parks Road, Oxford OX1 3QU. Gastroenterology Unit, St. Mary’s Hospital, Mayo Clinic, Rochester, Minnesota 55901, U.S.A.
""’’-’’&’’’’-’8"",’’’’.&.a...............................,.& -&.I"’’’’’’’’’’’A.’’’’’’’
SIR,-I find the paper of Dr Ihenacho and others (Feb. 3, p. 231) on consumption coagulopathy in cyanotic congenital heart-disease (C.H.D.) very interesting, but I should like to mention two things: 1. I have studied the effect of vitamin K administered both
intramuscularly and orally on the low activity of prothrombincomplex (Quick value) and on the low activity of factors 11, v, and vn in children with c.H.D.’The patients had normal plateletcounts and fibrinolytic activity. Oral administration of vitamin K proved ineffective, whereas that given parenterally caused significant increases in the Quick values and levels of factors II and vii in the majority of cases. These suggested that in some of the patients with C.H.D. the absorption of vitamin K is reduced and the hepatic synthesis of coagulation factors impaired. In addition, of course, there could also be disseminated intravascular coagulation in these patients. 2. I have studied the platelet functions in children with congenital heart-disease. In the acyanotic patients (30 cases) the results were normal. In cyanotic patients (35 cases) we have observed protracted bleeding-time, increased capillary fragility, °
and reduced clot retraction in whole blood. These symptoms are secondary and are associated with the low platelet number. Platelet adhesiveness was significantly increased when measured both in vivo and in vitro, as was also platelet aggregation. I think that these platelet abnormalities play an important part in thrombogenesis and in the beginning of disseminated intravascular coagulation in patients with C.H.D.
Budapest, Hungary. *
1.
Burkitt, D. P., Walker,
A. R.
P., Painter, N. S. Lancet, 1972,
ii, 1408.
2.
Parsons, D. S. ibid. Jan. 20, 1973, p. 152.
S. F. PHILLIPS.
BLOOD COAGULATION AND PLATELET ABNORMALITIES IN CYANOTIC CONGENITAL HEART-DISEASE
2nd Department of Pædiatrics, Semmelweis University Medical School,
For the patients, the apparent volume of the intestinal compartment (V) is largely, but not entirely, determined by the amount of colon remaining. We wish to point out that the colon is a major determinant of transit-time from mouth to anus and that the diameter of the stool as it sits in the distal colon may be a critical factor in determining such transit. If this is so, then the findings that in both normal subjects and in patients with ileocolonic resection the transit-time is inversely proportional to approximately the square root of the stoolweight may mean that stool-weight is related to the square of the diameter of the colon. It should be possible to test these ideas directly.
D. S. PARSONS.
B. GOLDSCHMIDT.
ANOPHELES SPECIES AVAILABLE
SiR.—The Department of Health and Social Security’s Malaria Reference Laboratory at Horton Hospital, Epsom, is closing at the end of March. Its activities are being transferred to the London School of Hygiene and Tropical Medicine. For many years past, two colonies of Anopheles have been maintained. One, Anopheles labranchiae atroparvus, was started in 1934 from the eggs of a single specimen and is still functioning. The other species, Anopheles stephensi, Giller, J., Phillips, S. F. Gastroenterology, 1970, 58, 951. Phillips, S. F., Giller, J. J. Lab. clin. Med. (in the press). 5. Goldschmidt, B. Acta pœdiat. hung. 1970, 11, 135. 6. Goldschmidt, B. Acta pædiat. scand. (in the press). * Temporary address: Institute for Thrombosis Research, Rikshospitalet, Oslo, Norway. 3. 4.
During therapy, two patients experienced isolated but severe episodes of bronchitis, which responded well to therapy, including short courses (3-5 days) of oral rather
Within 4-10 weeks after the cessation of oral three steroids, patients noted symptoms of severe allergic rhinitis, and two of these also had recurrences of nasal polyps for which they had undergone polypectomies several years ago. Mild numular eczema appeared in one case about 4 months after triamcinolone aerosols were introduced and 10 weeks after oral therapy with prednisone
prednisone.
stopped. Although our studies are still in progress and our data have not been analysed statistically, we feel that suspensions of corticosteroids, such as triamcinolone acetonide, when inhaled in the form of high-pressure aerosols, can effectively control severe asthma, can maintain adequate levels of pulmonary function and of exercise tolerance, with doses about ten times smaller than those required orally, and may not interfere noticeably with adrenal cortical function nor produce any immediate undesirable side-effects. Almost all of our patients seemed extremely enthusiastic and eager to continue aerosol therapy. We find ourselves influenced as much by these patients’ attitudes as we are by the objective clinical and laboratory data, since we believe that improvement can best be estimated when viewed from several angles.
was
Allergy & Asthma Clinic, 155 Cook Street, Denver, Colorado 80206, U.S.A.
CONSTANTINE J. FALLIERS.
STOOL-WEIGHT AND TRANSIT-TIME AFTER ILEOCOLONIC RESECTION
SIR,-For the patients having ileocolonic resection by Dr Cummings and his colleagues (Feb. 17, p. 344), stool-weight (W g. per day) and transit-time (t hours) are related in a similar way to that of the healthy subjects described by Burkitt et al.l For the patients, the described
relationship derived from the data in table n (p. 345) is log t= 3-067 ±0-541-0-6700-195 log W. For normal subjects the relation was found to be log t= 2-816—0561 log W. The apparent volumes (V ml.) of the intestinal compartment of the patients, calculated2 as V= (W.t/24) ml., assuming that the stool density is 1, are as follows:
There is also the question of the colon’s contribution to reabsorption of water in health. Cummings and his colleagues cite the standard assessment of colonic water absorption by comparing " composition of normal stool ... The assumption to that of ileostomy fluid " (p. 347). inherent in this comparison may be incorrect.33 Direct measurement of the volumes entering and leaving the colon in healthy volunteers suggests that the large bowel normally reabsorbs 1-0-1-5 litres of water per day rather than the 05 litres calculated from the usual comparisons of ileostomy output with stool output.4 Department of Biochemistry, University of Oxford, South Parks Road, Oxford OX1 3QU. Gastroenterology Unit, St. Mary’s Hospital, Mayo Clinic, Rochester, Minnesota 55901, U.S.A.
""’’-’’&’’’’-’8"",’’’’.&.a...............................,.& -&.I"’’’’’’’’’’’A.’’’’’’’
SIR,-I find the paper of Dr Ihenacho and others (Feb. 3, p. 231) on consumption coagulopathy in cyanotic congenital heart-disease (C.H.D.) very interesting, but I should like to mention two things: 1. I have studied the effect of vitamin K administered both
intramuscularly and orally on the low activity of prothrombincomplex (Quick value) and on the low activity of factors 11, v, and vn in children with c.H.D.’The patients had normal plateletcounts and fibrinolytic activity. Oral administration of vitamin K proved ineffective, whereas that given parenterally caused significant increases in the Quick values and levels of factors II and vii in the majority of cases. These suggested that in some of the patients with C.H.D. the absorption of vitamin K is reduced and the hepatic synthesis of coagulation factors impaired. In addition, of course, there could also be disseminated intravascular coagulation in these patients. 2. I have studied the platelet functions in children with congenital heart-disease. In the acyanotic patients (30 cases) the results were normal. In cyanotic patients (35 cases) we have observed protracted bleeding-time, increased capillary fragility, °
and reduced clot retraction in whole blood. These symptoms are secondary and are associated with the low platelet number. Platelet adhesiveness was significantly increased when measured both in vivo and in vitro, as was also platelet aggregation. I think that these platelet abnormalities play an important part in thrombogenesis and in the beginning of disseminated intravascular coagulation in patients with C.H.D.
Budapest, Hungary. *
1.
Burkitt, D. P., Walker,
A. R.
P., Painter, N. S. Lancet, 1972,
ii, 1408.
2.
Parsons, D. S. ibid. Jan. 20, 1973, p. 152.
S. F. PHILLIPS.
BLOOD COAGULATION AND PLATELET ABNORMALITIES IN CYANOTIC CONGENITAL HEART-DISEASE
2nd Department of Pædiatrics, Semmelweis University Medical School,
For the patients, the apparent volume of the intestinal compartment (V) is largely, but not entirely, determined by the amount of colon remaining. We wish to point out that the colon is a major determinant of transit-time from mouth to anus and that the diameter of the stool as it sits in the distal colon may be a critical factor in determining such transit. If this is so, then the findings that in both normal subjects and in patients with ileocolonic resection the transit-time is inversely proportional to approximately the square root of the stoolweight may mean that stool-weight is related to the square of the diameter of the colon. It should be possible to test these ideas directly.
D. S. PARSONS.
B. GOLDSCHMIDT.
ANOPHELES SPECIES AVAILABLE
SiR.—The Department of Health and Social Security’s Malaria Reference Laboratory at Horton Hospital, Epsom, is closing at the end of March. Its activities are being transferred to the London School of Hygiene and Tropical Medicine. For many years past, two colonies of Anopheles have been maintained. One, Anopheles labranchiae atroparvus, was started in 1934 from the eggs of a single specimen and is still functioning. The other species, Anopheles stephensi, Giller, J., Phillips, S. F. Gastroenterology, 1970, 58, 951. Phillips, S. F., Giller, J. J. Lab. clin. Med. (in the press). 5. Goldschmidt, B. Acta pœdiat. hung. 1970, 11, 135. 6. Goldschmidt, B. Acta pædiat. scand. (in the press). * Temporary address: Institute for Thrombosis Research, Rikshospitalet, Oslo, Norway. 3. 4.