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CANNULATION OF RADIAL ARTERY
225
Lliy and McCaffery1 facilities the passage of the guide eccentric strictures and xsophageal diverticula in the region of the stricture. Secondly, we do not use general anaesthesia and suggest that its use increases the risk of the procedure. With the use of pharyngeal anxsthesia and intravenous diazepam, or before that drug became available, intramuscular Omnopon,’ patients tolerate the procedure well. Using dusmethod, we have been able to manage a group of frail " eiderly patients with peptic " stricture of the lower esophagus with low mortality and morbidity. re
in the presence of
narrow or
has been in the past. Whether it will continue to be unjustifiable remains to be seen. Finally, may I recommend to Professor Fine the old " adage, the spectator sees most of the game " ? University Department of Surgery, Perth Medical Centre, Shenton Park, Western Australia, 6008.
DEPRESSION OF D.N.A.-POLYMERASE ACTIVITY BY LITHIUM
Division of Gastroenterology, Prince Henry and Prince of
Wales Hospitals, Sydney, Australia.
DAVID
J.
DE
CARLE.
SIR,-I submit that the simplest method of obviating the dangers of the Eder Puestow dilators is to perform the dilatation under image-intensification screening. In this way, the guide wire and the dilator are clearly visualised. This is the technique I employ in our clinic. There is, however, one difficulty in this method of dilatation. There are some fibrous strictures which will not permit passage of the guide wire. These strictures will require direct dilatation with the conventional gum-elastic bougie. Groote Schuur
Hospital, Observatory, Cape Town.
W. SILBER.
CANNULATION OF RADIAL ARTERY
SIR,-Dr Wyatt and others (June 8, p. 1135) modified their technique of radial-artery cannulation to decrease ischasmic complications. To their list we would add choice of a non-tapered catheter. A study from our department,I using portable arteriograms, compared non-tapered catheters (Longdwels, Becton, Dickinson and Co., Rutherford, New Jersey) withMedicut’ (Aloe Medical, St. Louis, jB1Ìssouri). There was a significant difference in favour of the non-tapered catheter regarding number of occluded arteries with catheter in place, number of occluded arteries after catheter removal, and thrombus formation. Therefore, we recommend use of a 20-gauge non-tapered catheter for long-term radial-artery cannulation. Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, 32610, U.S.A.
B. N. CATCHPOLE.
SiR,—The mode of action of lithium in preventing depression is obscure. This appears to result from the ease with which lithium ions diffuse between serum and tissues and its differential uptake and elimination by different tissues.1 The effect of lithium has been adequately reviewed,l2and observations document the possible effect on electrolyte balance 3-6 and retention 4 with localisation of lithium in the kidneys as well as heart and central nervous system of subjects with symptoms of intoxication.6 In our studies on D.N.A. polymerase from a cell-line derived from kidney tissue and its regulation by antibiotics,’ an anticoagulant, and cations,89 an intriguing question came to mind: could the clinical picture of toxicity reflect a depression in the activity of an enzyme involved in D.N.A. synthesis under in-vitro conditions ? A possible site of action for lithium might reside in its ability to suppress D.N.A. polymerase activity. The activities of the enzymes isolated from both the cytoplasm and nucleiwere inhibited essentially to the same degree in a 1.
Gattozzi, A. A. Natn. Inst.
ment.
Hlth Publ. 5033,
Washington,
1970. 2. 3. 4. 5.
6. 7. 8. 9.
Gershon, S. Clin. Pharm. Ther. 1970, 11, 168. Tupin, J. P., Schlagenhauf, G. K., Creason, D. L. Am. J, Psychiat. 1968, 125, 536. Platman, S. R., Fieve, R. R. Archs gen. Psychiat. 1969, 20, 285. King, L. J., Carl, J. L., Archer, E. G., Castellanet, M. J. Pharm. Therap. 1969, 168, 163. Schou, M., Amdissen, A., Trap-Jensen, J. Am. J. Psychiat. 1968, 125, 520. Lazarus, L. H., Kitron, N. Biochem. Pharm. 1973, 22, 3115. Lazarus, L. H., Kitron, N. J. mol. Biol. 1973, 81, 529. Lazarus, L. H., Kitron, N. Archs Biochem. Biophys. (in the press).
MARK RAVIN ROBERT KIRBY.
LIMULUS ASSAY FOR GRAM-NEGATIVE ENDOTOXIN
SIR,-Iwas interested to read Professor Fine’s remarks (June 22, p. 1295) on the Limulus lysate test. The object of my letter (April 27, p. 817), in commenting on Dr Wilkinson and his colleagues’ paper (March 30, p. 521), draw attention to the fact that a positive lysate does not necessarily indicate the presence of endotoxin. Quite apart from the existence of any reacting foreign material which may find its way into the bloodstream, Md it is demonstrated that organs and tissues of the body, sub;ected to the many disease processes to which they are hesr, cannot liberate material which gives a positive lysate tes:, this test must continue to be regarded as non-specific. Consequently, to assume that a positive test indicates the presence of endotoxaemia is unjustifiable at present and
Inhibition of D.N.A.-polymerase activity from kidney cells by lithium ions.
1. Lilly, J. O., McCaffery, T. D. Jr. Am. J. dig. Dis. 1971, 16, 1137. 2. Downs, J. B., Rackstein, A. D., Klein, E. F., Hawkins, I. F. Anesthesiology, 1973, 38, 283.
Open circles represent cytoplasmic enzyme. Closed circles represent enzyme from the nucleus. Enzymes were isolated and assayed as previously described.7.88
was to
:est
Lliy and McCaffery1 facilities the passage of the guide eccentric strictures and xsophageal diverticula in the region of the stricture. Secondly, we do not use general anaesthesia and suggest that its use increases the risk of the procedure. With the use of pharyngeal anxsthesia and intravenous diazepam, or before that drug became available, intramuscular Omnopon,’ patients tolerate the procedure well. Using dusmethod, we have been able to manage a group of frail " eiderly patients with peptic " stricture of the lower esophagus with low mortality and morbidity. re
in the presence of
narrow or
has been in the past. Whether it will continue to be unjustifiable remains to be seen. Finally, may I recommend to Professor Fine the old " adage, the spectator sees most of the game " ? University Department of Surgery, Perth Medical Centre, Shenton Park, Western Australia, 6008.
DEPRESSION OF D.N.A.-POLYMERASE ACTIVITY BY LITHIUM
Division of Gastroenterology, Prince Henry and Prince of
Wales Hospitals, Sydney, Australia.
DAVID
J.
DE
CARLE.
SIR,-I submit that the simplest method of obviating the dangers of the Eder Puestow dilators is to perform the dilatation under image-intensification screening. In this way, the guide wire and the dilator are clearly visualised. This is the technique I employ in our clinic. There is, however, one difficulty in this method of dilatation. There are some fibrous strictures which will not permit passage of the guide wire. These strictures will require direct dilatation with the conventional gum-elastic bougie. Groote Schuur
Hospital, Observatory, Cape Town.
W. SILBER.
CANNULATION OF RADIAL ARTERY
SIR,-Dr Wyatt and others (June 8, p. 1135) modified their technique of radial-artery cannulation to decrease ischasmic complications. To their list we would add choice of a non-tapered catheter. A study from our department,I using portable arteriograms, compared non-tapered catheters (Longdwels, Becton, Dickinson and Co., Rutherford, New Jersey) withMedicut’ (Aloe Medical, St. Louis, jB1Ìssouri). There was a significant difference in favour of the non-tapered catheter regarding number of occluded arteries with catheter in place, number of occluded arteries after catheter removal, and thrombus formation. Therefore, we recommend use of a 20-gauge non-tapered catheter for long-term radial-artery cannulation. Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Florida, 32610, U.S.A.
B. N. CATCHPOLE.
SiR,—The mode of action of lithium in preventing depression is obscure. This appears to result from the ease with which lithium ions diffuse between serum and tissues and its differential uptake and elimination by different tissues.1 The effect of lithium has been adequately reviewed,l2and observations document the possible effect on electrolyte balance 3-6 and retention 4 with localisation of lithium in the kidneys as well as heart and central nervous system of subjects with symptoms of intoxication.6 In our studies on D.N.A. polymerase from a cell-line derived from kidney tissue and its regulation by antibiotics,’ an anticoagulant, and cations,89 an intriguing question came to mind: could the clinical picture of toxicity reflect a depression in the activity of an enzyme involved in D.N.A. synthesis under in-vitro conditions ? A possible site of action for lithium might reside in its ability to suppress D.N.A. polymerase activity. The activities of the enzymes isolated from both the cytoplasm and nucleiwere inhibited essentially to the same degree in a 1.
Gattozzi, A. A. Natn. Inst.
ment.
Hlth Publ. 5033,
Washington,
1970. 2. 3. 4. 5.
6. 7. 8. 9.
Gershon, S. Clin. Pharm. Ther. 1970, 11, 168. Tupin, J. P., Schlagenhauf, G. K., Creason, D. L. Am. J, Psychiat. 1968, 125, 536. Platman, S. R., Fieve, R. R. Archs gen. Psychiat. 1969, 20, 285. King, L. J., Carl, J. L., Archer, E. G., Castellanet, M. J. Pharm. Therap. 1969, 168, 163. Schou, M., Amdissen, A., Trap-Jensen, J. Am. J. Psychiat. 1968, 125, 520. Lazarus, L. H., Kitron, N. Biochem. Pharm. 1973, 22, 3115. Lazarus, L. H., Kitron, N. J. mol. Biol. 1973, 81, 529. Lazarus, L. H., Kitron, N. Archs Biochem. Biophys. (in the press).
MARK RAVIN ROBERT KIRBY.
LIMULUS ASSAY FOR GRAM-NEGATIVE ENDOTOXIN
SIR,-Iwas interested to read Professor Fine’s remarks (June 22, p. 1295) on the Limulus lysate test. The object of my letter (April 27, p. 817), in commenting on Dr Wilkinson and his colleagues’ paper (March 30, p. 521), draw attention to the fact that a positive lysate does not necessarily indicate the presence of endotoxin. Quite apart from the existence of any reacting foreign material which may find its way into the bloodstream, Md it is demonstrated that organs and tissues of the body, sub;ected to the many disease processes to which they are hesr, cannot liberate material which gives a positive lysate tes:, this test must continue to be regarded as non-specific. Consequently, to assume that a positive test indicates the presence of endotoxaemia is unjustifiable at present and
Inhibition of D.N.A.-polymerase activity from kidney cells by lithium ions.
1. Lilly, J. O., McCaffery, T. D. Jr. Am. J. dig. Dis. 1971, 16, 1137. 2. Downs, J. B., Rackstein, A. D., Klein, E. F., Hawkins, I. F. Anesthesiology, 1973, 38, 283.
Open circles represent cytoplasmic enzyme. Closed circles represent enzyme from the nucleus. Enzymes were isolated and assayed as previously described.7.88
was to
:est