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BRONCHIAL LAVAGE
932 To quot,o axt apparently fur-fetched examples in 1954 Lovett Doust1 claimed good results in schizophrenia by rhythmic sensory bombardment " (photic or sonic), which be tricul to connect with the principle of doaoxygonation. 25 years ago when Mayor-Gross2 reported on the therapy of schizophrenia, he quoted (with due caution) a roviow3 of 1600 cases (in the literature) subjected to pyroxial treatment, which wa,s widely advocated in the first quarter of this century. No doubt the third quarter will see an attempt to treat the disease with hypothermia, which now is so much in the "
foreground.4
The biology of the human organism and the theory of its adaptation are very complex matters, and any attempt to claim monopoly for one isolated mechanism, or one isolated level of behaviour, will lead to fallacious conclusions. While neither side is yet victorious, both will continue to share in an honest endeavour to master the
problem. STEPHEN KRAUSS.
THIRTY-MINUTE SCREENING TEST FOR PHÆOCHROMOCYTOMA SIR,—Dr. Hingerty’s test (April 13) has the merit of requiring no special apparatus, but his reporting of results in terms of µg of pressor amines excreted seems to me open to criticism, for the following reasons : (1) No results are given for percentage recovery of noradrenaline added to urine. Using the technique described by Dr. Hingerty, but taking noradrenaline as comparison standard without prior adsorption and elution, recoveries, in my experience, have been around 30%, and have varied considerably in different estimations. Admittedly the extent of error from this source could be partially reduced if a recoveryestimation was included in each analysis. Dr. Hingerty’s comparison standard, however, is prepared in advance and kept for repeated use on the assumption that the percentage recovery remains constant. (2) Visual comparison of fluorescence intensity is likely to be misleading, particularly at low concentrations, where even a threefold difference of intensity is by no means obvious unless instrumental comparison is made. The presence of other fluorescent substances, not infrequently encountered in urine extracts, could make even semiquantitative assessment impossible unless filters were used, as in commercial fluorimeters. (3) The details given of the method of preparation of alumina are insufficient to allow of exact repetition ; it is, however. known that the temperature of drying and the final water content of the " dry " alumina exert a considerable influence on its adsorptive properties. Dr. Hingerty may have been fortunate in having alumina which regularly gave quantitative recovery of pressor amines, but my experience in this respect has been discouraging.
A simple routine method for estimation of pressor amines in urine is certainly required, but I am not convinced that the method described is sufficiently reproducible to be useful, except possibly when excretion is enormously increased. To judge by published data, the output ofcatechol amines in phaeochromocytorrm is not always increased to this extent. 1. Lovett 2.
3. 4. 5.
6.
Doust, J.
more
likelv requirement.
Department of Clinical Chemistry, Royal Infirmary, Edinburgh.
SAMUEL C. FRAZER.
BRONCHIAL LAVAGE to thank Dr. Trobridge for describing simple technique of bronchial lavage (March 16). With it. little practice, the method may be further simpli. fied by posturing the patient while the saline is poured in (as is done during broncbography). This will avoid the theoretical dangers of flooding and soiling " other parts of the lung. Recently, I had the opportunity of finding acid-fast hacilli in the bronchial lavage of a woman who had persistently negativesputa and laryngeal swabs. She had eosinophilia in the blood and had in fact been transferred to a general medical ward. In view of Dr. Trobridge’s report, every patient who has difficulty in raising sputum should have bronchial lavage instead of the traditional swabbing of the larynx or washing of the stomach.
SIR,—I wish
his
In the present situation, the studies on the relationships between schizopathy and endocrinopathy, inaugurated by J31ouler5 of Ziirich and supported by our Bristol and St. Ebba’s groups (April 13), must be allowed to ripen. This is nothing more than a revival of the much earl.or metabolic idea underlying Gjessing’s studies in catatonics.6 If this trend bears fruit, as it may, we shall not expect the psychotherapists of schizophrenia to retreat into the next trench and to abandon schizophrenics as untouchables. Similarly, there is no need for clinical workers who value the insulin technique for its standardisation, and for the prognostic criteria worked out on an immense material, to abandon it. Some will find all the trouble worth while in selected cases without neglecting other therapeutic approaches to personality as a whole.
Reading.
Lastly, the test might perhaps be more accurately described as a sixty-minute one. If a set of controls and st,anda,rds is prepared at the same time, two hours is a
W., Schneider, R. A. Dis. Nerv. Syst. 1954, 15, 12. Mayer-Gross, W. In Handbuch der Geisteskrankheiten, vol. IX, Berlin, 1932. Menninger-von Lerchenthal, E. Z. ges. Neurol. Psychiat. 1925, 97, 460. Glees, P. Personal communication. Bleuler, M. Endokrinologische Psychiatric. Stuttgart, 1954. Gjessing, R. Arch. Psychiat. Nervenkr. 1935, 104, 335.
"
North Middlesex Hospital, London, N.1 8.
SAMIR K. GUPTA.
IS BEMEGRIDE A SPECIFIC BARBITURATE ANTAGONIST ? SIR,—In 1954 Shaw et al.1 described their investiga. tions of bemegride (’ Megimide,’ &bgr;&bgr;-methylethylglutarimide) and claimed it to be a barbiturate antagonist. They based their opinion on experiments in which
they had found a reduction of sleeping-time in animals of several species that had been narcotised with pentobarbitonc, barbitone, or phenobarbitone, as well as on clinical experience. In 1955 Shaw2 stated that the action of bemegride was specific and that it did not affect the depressant actions of other anaesthetic agents such as etlier, chloroform, and morphine. Lately, voices have been raised against the specificity of bemegride, which is instead believed to act mainly as a central analeptic. Thus Hahn et al.3 have stated that it is "a functional and not a competitive antagonist." Danish work suggests that bemegride does not shorten barbiturate coma in man, that the patients do not wake up at higher serum-barbiturate levels, and that the rate of elimination of barbiturate from the blood is unaltered.4 Others also emphasise the potent action on reflex activity and respiration. " It is difficult to explain these clinical results and observations as the action of a simple biochemical antagonist."5 We believe that bemegride is a valuable drug in the treatment of certain forms of barbiturate intoxication, ACTION OF BEMEGRIDE
but
ON NARCOTISED MICE
do not think that the mode of action has been sufficiently clarified. We therefore compared the action of bemegride against barbiturates with its action against other narcotic agents. we
1. Straw, F. H., Simon, S. E., Cass, N., Shulman, A., Anstee, J. R., Nelson, E. R. Nature, Lond. 1954, 174, 402. 2. Shaw, F. II. Med. J. Aust. 1955, ii, 889. 3. Hahn, F., Oberdorf, A., Schunk, R. Dtsch. med. Wschr. 1956, 81, 1580. 4. Pedersen, J. Ugeskr. Laeg. 1956, 118, 773. 5. Louw, A., Sonne, L. M. Ibid, p. 761.
foreground.4
The biology of the human organism and the theory of its adaptation are very complex matters, and any attempt to claim monopoly for one isolated mechanism, or one isolated level of behaviour, will lead to fallacious conclusions. While neither side is yet victorious, both will continue to share in an honest endeavour to master the
problem. STEPHEN KRAUSS.
THIRTY-MINUTE SCREENING TEST FOR PHÆOCHROMOCYTOMA SIR,—Dr. Hingerty’s test (April 13) has the merit of requiring no special apparatus, but his reporting of results in terms of µg of pressor amines excreted seems to me open to criticism, for the following reasons : (1) No results are given for percentage recovery of noradrenaline added to urine. Using the technique described by Dr. Hingerty, but taking noradrenaline as comparison standard without prior adsorption and elution, recoveries, in my experience, have been around 30%, and have varied considerably in different estimations. Admittedly the extent of error from this source could be partially reduced if a recoveryestimation was included in each analysis. Dr. Hingerty’s comparison standard, however, is prepared in advance and kept for repeated use on the assumption that the percentage recovery remains constant. (2) Visual comparison of fluorescence intensity is likely to be misleading, particularly at low concentrations, where even a threefold difference of intensity is by no means obvious unless instrumental comparison is made. The presence of other fluorescent substances, not infrequently encountered in urine extracts, could make even semiquantitative assessment impossible unless filters were used, as in commercial fluorimeters. (3) The details given of the method of preparation of alumina are insufficient to allow of exact repetition ; it is, however. known that the temperature of drying and the final water content of the " dry " alumina exert a considerable influence on its adsorptive properties. Dr. Hingerty may have been fortunate in having alumina which regularly gave quantitative recovery of pressor amines, but my experience in this respect has been discouraging.
A simple routine method for estimation of pressor amines in urine is certainly required, but I am not convinced that the method described is sufficiently reproducible to be useful, except possibly when excretion is enormously increased. To judge by published data, the output ofcatechol amines in phaeochromocytorrm is not always increased to this extent. 1. Lovett 2.
3. 4. 5.
6.
Doust, J.
more
likelv requirement.
Department of Clinical Chemistry, Royal Infirmary, Edinburgh.
SAMUEL C. FRAZER.
BRONCHIAL LAVAGE to thank Dr. Trobridge for describing simple technique of bronchial lavage (March 16). With it. little practice, the method may be further simpli. fied by posturing the patient while the saline is poured in (as is done during broncbography). This will avoid the theoretical dangers of flooding and soiling " other parts of the lung. Recently, I had the opportunity of finding acid-fast hacilli in the bronchial lavage of a woman who had persistently negativesputa and laryngeal swabs. She had eosinophilia in the blood and had in fact been transferred to a general medical ward. In view of Dr. Trobridge’s report, every patient who has difficulty in raising sputum should have bronchial lavage instead of the traditional swabbing of the larynx or washing of the stomach.
SIR,—I wish
his
In the present situation, the studies on the relationships between schizopathy and endocrinopathy, inaugurated by J31ouler5 of Ziirich and supported by our Bristol and St. Ebba’s groups (April 13), must be allowed to ripen. This is nothing more than a revival of the much earl.or metabolic idea underlying Gjessing’s studies in catatonics.6 If this trend bears fruit, as it may, we shall not expect the psychotherapists of schizophrenia to retreat into the next trench and to abandon schizophrenics as untouchables. Similarly, there is no need for clinical workers who value the insulin technique for its standardisation, and for the prognostic criteria worked out on an immense material, to abandon it. Some will find all the trouble worth while in selected cases without neglecting other therapeutic approaches to personality as a whole.
Reading.
Lastly, the test might perhaps be more accurately described as a sixty-minute one. If a set of controls and st,anda,rds is prepared at the same time, two hours is a
W., Schneider, R. A. Dis. Nerv. Syst. 1954, 15, 12. Mayer-Gross, W. In Handbuch der Geisteskrankheiten, vol. IX, Berlin, 1932. Menninger-von Lerchenthal, E. Z. ges. Neurol. Psychiat. 1925, 97, 460. Glees, P. Personal communication. Bleuler, M. Endokrinologische Psychiatric. Stuttgart, 1954. Gjessing, R. Arch. Psychiat. Nervenkr. 1935, 104, 335.
"
North Middlesex Hospital, London, N.1 8.
SAMIR K. GUPTA.
IS BEMEGRIDE A SPECIFIC BARBITURATE ANTAGONIST ? SIR,—In 1954 Shaw et al.1 described their investiga. tions of bemegride (’ Megimide,’ &bgr;&bgr;-methylethylglutarimide) and claimed it to be a barbiturate antagonist. They based their opinion on experiments in which
they had found a reduction of sleeping-time in animals of several species that had been narcotised with pentobarbitonc, barbitone, or phenobarbitone, as well as on clinical experience. In 1955 Shaw2 stated that the action of bemegride was specific and that it did not affect the depressant actions of other anaesthetic agents such as etlier, chloroform, and morphine. Lately, voices have been raised against the specificity of bemegride, which is instead believed to act mainly as a central analeptic. Thus Hahn et al.3 have stated that it is "a functional and not a competitive antagonist." Danish work suggests that bemegride does not shorten barbiturate coma in man, that the patients do not wake up at higher serum-barbiturate levels, and that the rate of elimination of barbiturate from the blood is unaltered.4 Others also emphasise the potent action on reflex activity and respiration. " It is difficult to explain these clinical results and observations as the action of a simple biochemical antagonist."5 We believe that bemegride is a valuable drug in the treatment of certain forms of barbiturate intoxication, ACTION OF BEMEGRIDE
but
ON NARCOTISED MICE
do not think that the mode of action has been sufficiently clarified. We therefore compared the action of bemegride against barbiturates with its action against other narcotic agents. we
1. Straw, F. H., Simon, S. E., Cass, N., Shulman, A., Anstee, J. R., Nelson, E. R. Nature, Lond. 1954, 174, 402. 2. Shaw, F. II. Med. J. Aust. 1955, ii, 889. 3. Hahn, F., Oberdorf, A., Schunk, R. Dtsch. med. Wschr. 1956, 81, 1580. 4. Pedersen, J. Ugeskr. Laeg. 1956, 118, 773. 5. Louw, A., Sonne, L. M. Ibid, p. 761.