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ECONOMIC VALUE OF THE PSYCHIATRIC INPATIENT
836 Evidence accumulated during the past twenty years clearly indicates that hypersensitivity to the inflammatory and pyrogenic metabolites of progesterone plays an important part in the cause of disturbances associated with the corpus luteum phase of the menstrual cycle. The accumulated facts further suggest the following hypothesis : The 5-P metabolites of progesterone and testosterone form a class of compounds with properties opposed to those of adrenal steroids, typified by cortisone. They
inflammatory and pyrogenic -as opposed to cortisone, anti-inflammatory and anti-pyretic. They promote allergic reactions while cortisone is anti-allergic. They may even be allergenic, in a rigorous sense, by combining with protein as haptens. Acne and other disorders in adolescent boys and girls, premenstrual and menopausal phenomena in women, neurotic disturbances in ageing men, are manifestations of faulty handling by the organism of these inflammatory compounds and of hypersensitivity to them. are
which is
University of Rochester School of Medicine and Dentistry, Rochester, New York.
Fig. l-Effect of insulin (10-1 units per ml.) in vitro on net gas exchange of human adipose tissue obtained under general anaesthesia.
GEORGE P. HECKEL.
GLUCOSE UPTAKE AND GAS EXCHANGE IN HUMAN ADIPOSE TISSUE INCUBATED IN VITRO
SIR,-Adipose tissue has been shown to be insulin sensitive in vivo and in vitro. Winegrad and Renold1 showed that insulin increases the glucose uptake, glucose oxidation, and lipid synthesis of rat epididymal fat in vitro. In similar experiments Ball et al .2 found that insulin caused an increase of the respiratory quotient. We investigated the action of insulin on glucose uptake and the respiratory quotient of human adipose tissue in vitro. Adipose subcutaneous tissue was obtained from patients undergoing surgery. They were all free from metabolic disGeneral anxsthesia was induced by thiopentone orders. sodium (’Pentothal Sodium’). The piece of adipose tissue was obtained at the beginning of the operation; it was immediately soaked in Ringer bicarbonate buffer containing glucose (300 mg. per 100 ml.), and was then cut into fragments of about 70 mg.; the subsequent procedure was the same as previously described for rat epididymal-fat pad.3 The respiratory quotient was calculated and expressed2 as follows: Adipose tissue was incubated in a Warburg flask, without any potassium hydroxide in the centre well for carbondioxide absorption. In these circumstances, if oxygen carbon-dioxide equals output (the respiratory consumption quotients ==1), no pressure change will be observed. If carbon-dioxide output exceeds oxygen uptake, a positive pressure will be
observed, and vice-versa. The results
are
therefore expressed as 1. of gas exchanged by the tissue during incubation. Glucose was determined after incubation for three hours by the method of Huggett and Nixon.4 The glucose uptake by human fat insulin effect is evident in the table:
showing
a
significant
The data accord with the results obtained with rat adipose tissue. Fig. 1 illustrates the changes in the respiratory quotient of human adipose tissue, with and without insulin. No insulin 1. 2. 3. 4.
Winegrad, A. L., Renold, A. E. J. biol. Chem. 1958, 233, 267. Ball, E. G., Martin, D. B., Cooper, O. ibid. 1959, 234, 774. Pozza, G., Ghidoni, A. Clin. chim. acta, 1962, 7, 55. Huggett A. St. G., Nixon, D. A. Lancet, 1957, ii, 368.
111’111’1_1--
Fig. 2-Effect of insulin adipose tissue obtained
(10-1 units per ml.) in vitro during brachial-plexus block.
on
human
effect is detectable. This result differs from data previously described for rat adipose tissue, in which a sharp increase in 3 gas exchange was shown to be induced by insulin.2 To ascertain whether this was possibly related to some enzymic inhibition by thiopentone sodium, the same expefiment was repeated, using human adipose tissue obtained during anaesthesia by brachial-plexus block from patients under. going plastic surgery of the hands. Fig. 2 shows the results obtained; no insulin effect is detectable.
Our results suggest that human adipose tissue is insulin sensitive in relation to glucose uptake but not in relation to gas exchange. The injection of anxsthetics into the patients from whom the tissue was obtained did not influence the findings on gas exchange. G. POZZA Istituto di Clinica Medica Generale e di Terapia Medica, A. GHID0NI Università di Milano, C. BASILICO. Milan, Italy. ECONOMIC VALUE OF THE PSYCHIATRIC INPATIENT
indeed
SIR,-If psychiatric hospital inpatients who are of capable earning their living are not allowed to do so, as Dr. Bickford alleges (March 30, p. 714), whose fault is it ? Certainly the blame cannot be laid on the Minister of Health, the regional hospital board, the management committee, or any lay administrator. Why does not the responsible doctor do the proper thing-arrange a fully paid job for the patient, either outside or inside the hospital ? There is no law or regulation to prevent this. Some years ago I reported1 10 persons who were patients in Park Prewett Hospital one day and became fully paid employees the next, and at the present moment we have 5 ex-patients on the staff of the hospital. In addition 11 patients work in the vicinity but continue to live in hospital wards. Park Prewett Hospital, Basingstoke, Hampshire. 1.
I. ATKIN, Lancet, 1955, ii, 618.
inflammatory and pyrogenic -as opposed to cortisone, anti-inflammatory and anti-pyretic. They promote allergic reactions while cortisone is anti-allergic. They may even be allergenic, in a rigorous sense, by combining with protein as haptens. Acne and other disorders in adolescent boys and girls, premenstrual and menopausal phenomena in women, neurotic disturbances in ageing men, are manifestations of faulty handling by the organism of these inflammatory compounds and of hypersensitivity to them. are
which is
University of Rochester School of Medicine and Dentistry, Rochester, New York.
Fig. l-Effect of insulin (10-1 units per ml.) in vitro on net gas exchange of human adipose tissue obtained under general anaesthesia.
GEORGE P. HECKEL.
GLUCOSE UPTAKE AND GAS EXCHANGE IN HUMAN ADIPOSE TISSUE INCUBATED IN VITRO
SIR,-Adipose tissue has been shown to be insulin sensitive in vivo and in vitro. Winegrad and Renold1 showed that insulin increases the glucose uptake, glucose oxidation, and lipid synthesis of rat epididymal fat in vitro. In similar experiments Ball et al .2 found that insulin caused an increase of the respiratory quotient. We investigated the action of insulin on glucose uptake and the respiratory quotient of human adipose tissue in vitro. Adipose subcutaneous tissue was obtained from patients undergoing surgery. They were all free from metabolic disGeneral anxsthesia was induced by thiopentone orders. sodium (’Pentothal Sodium’). The piece of adipose tissue was obtained at the beginning of the operation; it was immediately soaked in Ringer bicarbonate buffer containing glucose (300 mg. per 100 ml.), and was then cut into fragments of about 70 mg.; the subsequent procedure was the same as previously described for rat epididymal-fat pad.3 The respiratory quotient was calculated and expressed2 as follows: Adipose tissue was incubated in a Warburg flask, without any potassium hydroxide in the centre well for carbondioxide absorption. In these circumstances, if oxygen carbon-dioxide equals output (the respiratory consumption quotients ==1), no pressure change will be observed. If carbon-dioxide output exceeds oxygen uptake, a positive pressure will be
observed, and vice-versa. The results
are
therefore expressed as 1. of gas exchanged by the tissue during incubation. Glucose was determined after incubation for three hours by the method of Huggett and Nixon.4 The glucose uptake by human fat insulin effect is evident in the table:
showing
a
significant
The data accord with the results obtained with rat adipose tissue. Fig. 1 illustrates the changes in the respiratory quotient of human adipose tissue, with and without insulin. No insulin 1. 2. 3. 4.
Winegrad, A. L., Renold, A. E. J. biol. Chem. 1958, 233, 267. Ball, E. G., Martin, D. B., Cooper, O. ibid. 1959, 234, 774. Pozza, G., Ghidoni, A. Clin. chim. acta, 1962, 7, 55. Huggett A. St. G., Nixon, D. A. Lancet, 1957, ii, 368.
111’111’1_1--
Fig. 2-Effect of insulin adipose tissue obtained
(10-1 units per ml.) in vitro during brachial-plexus block.
on
human
effect is detectable. This result differs from data previously described for rat adipose tissue, in which a sharp increase in 3 gas exchange was shown to be induced by insulin.2 To ascertain whether this was possibly related to some enzymic inhibition by thiopentone sodium, the same expefiment was repeated, using human adipose tissue obtained during anaesthesia by brachial-plexus block from patients under. going plastic surgery of the hands. Fig. 2 shows the results obtained; no insulin effect is detectable.
Our results suggest that human adipose tissue is insulin sensitive in relation to glucose uptake but not in relation to gas exchange. The injection of anxsthetics into the patients from whom the tissue was obtained did not influence the findings on gas exchange. G. POZZA Istituto di Clinica Medica Generale e di Terapia Medica, A. GHID0NI Università di Milano, C. BASILICO. Milan, Italy. ECONOMIC VALUE OF THE PSYCHIATRIC INPATIENT
indeed
SIR,-If psychiatric hospital inpatients who are of capable earning their living are not allowed to do so, as Dr. Bickford alleges (March 30, p. 714), whose fault is it ? Certainly the blame cannot be laid on the Minister of Health, the regional hospital board, the management committee, or any lay administrator. Why does not the responsible doctor do the proper thing-arrange a fully paid job for the patient, either outside or inside the hospital ? There is no law or regulation to prevent this. Some years ago I reported1 10 persons who were patients in Park Prewett Hospital one day and became fully paid employees the next, and at the present moment we have 5 ex-patients on the staff of the hospital. In addition 11 patients work in the vicinity but continue to live in hospital wards. Park Prewett Hospital, Basingstoke, Hampshire. 1.
I. ATKIN, Lancet, 1955, ii, 618.