ELECTROPHORESIS OF PLASMA-PROTEINS

ELECTROPHORESIS OF PLASMA-PROTEINS

1394 LETTERS TO THE EDITOR The high polymorph counts found during the early stages in both groups are similar to those recorded in In fact the prop...

259KB Sizes 2 Downloads 84 Views

1394

LETTERS TO THE EDITOR

The

high polymorph counts found during the early stages in both groups are similar to those recorded in In fact the proportion of many other outbreaks. was over polymorphs 50% in 8 of the 14 paralytic, and in 12 of the 17 non-paralytic cases. (In another case recently admitted to the respiration unit in Oxford, the C.S.F., examined a few hours before paralysis appeared, contained 1020 cells per c.mm., of which 96% were polymorphs.) Like your other correspondents we have not had the benefit of help from virus laboratories during this sharp outbreak. Department of Neurology (United J. DOMINIAN Oxford Hospitals), Stoke Mandeville L. E. ESPIR. M. Bucks. Hospital, Aylesbury, ELECTROPHORESIS OF PLASMA-PROTEINS

SiR,-In his letter of June 11, Dr. Christiansen reports splitting of the (3-globulin band in serum from some patients in the fasting state after heparin injection. He observes that no separation occurred when heparin was given after a fatty meal. We have found recently, however, in the course of some experiments on the clearing mechanism of heparin,

I have always emphasised that the entire segment within which a pain arises must be examined. In the case of the shoulder this involves examination of the neck, scapula, shoulder, elbow, wrist, and fingers. If Mr. Waugh will look at my Textbook of Orthopmdic Medicine (1954), he will find that I divide the examination of the shoulder into two parts. Stage 1 (p. 219) describes the preliminary examination that determines whether or not the shoulder area contains the Lesion. If this proves so, detailed examination of the tissues at the shoulder follows (pp. 220-236). London, W.I.

JAMES CYRIAX.

MORPHINE ANTAGONISTS

SiR,—I read with interest the observations by Dr.

Bonnycastle and Dr. Costa (Sept. 10) concerning the actions of bemegride ( (0-methyl-etbyl glutarimide, ’NP13,’ Megimide’) and amiphenazole (2 : 4-diamino-5-phenyl ’

thiazole hydrochloride,‘ DAPT,’‘ Daptazole,’DHA245’) given either individually or in combination as antagonists to opiate-induced or barbiturate-induced respiratory

depression

in rats.

Results of experiments with these drugs appear to indicate that the rat responds less like man than does the dog. The dog has been awakened under electro-encephalographic control’from morphine or light barbiturate narcosis by the gradual administration of amiphenazole alone, or from deep barbiturate narcosis with a mixture of amiphenazole and bemegride, without producing any clinical or electro-encephalographic signs of incipient convulsions. There further appeared to be an increase in respiratory activity before the animals awoke. However, respiratory minute-volume was not measured. When these drugs-especially bemegride-were administered more rapidly and in larger doses convulsions were produced which rapidly subsided. We have deliberately induced convulsions several times in a single experiment without the loss of an animal.

in collaboration with E. R. the decerebrate cat indicate that amiphenazole will increase the respiratory minute-volume. This increase is not wholly accounted for by any generalised movements (which indeed may be absent) indicative of increased motor activity. A similar dose of amiphenazole administered to the intact cat has produced no signs of increased motor activity. Comparison with nikethamide suggests that amiphenazole is at least as effective dose for dose in increasing respiratory ventilation. Bemegride, however, does produce signs of increased motor activity in doses which promote respiratory stimulation. Although not denying that in excessive doses these drugs have a central stimulant action we maintain that, if administered as advised in the treatment of barbiturate intoxication or morphine depression, they have a wide margin of safety. In regard to the reported signs of toxicity after the administration of bemegride2 or amiphenazole,3 these were observed in our earliest cases and were due to too rapid administration and excessive dosage, through lack of experience. We have since bad no cause for concern, but one should always be on the lookout for the occasional, perplexing case of idiosyncrasy. Finally I wish to refer to the high therapeutic safety of amiphenazole.4 1. Amiphenazole has been administered intravenously in

Preliminary experiments

Trethewie

Electrophoresis of ..

during alimentary lipaemia (a) before (b) after injection of heparin.

serum

and

that the splitting of the p-globulin band occurred in 2 cases during alimentary lipaemia before the administration of heparin ; 30 minutes after intravenous injection of heparin the splitting disappeared in the " cleared " serum. This is, however, a rare phenomenon : in 35 other cases we failed to observe this splitting after the fatty meal, although the electrophoresis took place under the same conditions. The absence of splitting in the fasting state and the disappearance after the administration of heparin support the hypothesis that splitting may be caused by some change in the lipoprotein pattern of the serum. S. GERÖ M. JAKAB M. BAUMAN S. ROHNY III. Medical Clinic, J. GÁCS. University of Budapest. HYDROCORTISONE IN PAINFUL SHOULDER

SiR,—Mr. Waugb (Nov. 5) must not think that my methods of examination fail to take account of pain referred to the shoulder, not only from the neck and thoracic outlet, but from the arm and forearm as well. In the article

on

hydrocortisone

that Dr. Troisier and I

1953,1 we devoted a quarter of the space to clinical examination ; for that alone shows where the injection must wrote in

be

given. 1.

Cyriax, J., Troisier, O. Brit. med. J. 1953, ii, 966.

on

divided doses over 20-30 minutes to 17 young healthy unnarcotised volunteers in doses of up to 225 mg. without producing any acute or residual symptoms or signs of toxicity. As much as 60-90 mg. was given in one dose on 12 separate occasions. 2. Amiphenazole has been given to a critically ill patient with congestive cardiac failure, bronchopneumonia, and postoperative shock following repair of a ruptured gastric ulcer. A dose of 15 mg. was administered half-hourly (720 mg. per 1. Shaw, F. H., Simon, S. E., Cass, N. M., Shulman, A., Anstee, J. R., Nelson, E. R. Nature, Lond. 1954, 174, 402. 2. Shulman, A., Shaw, F. H., Cass, N. M., Whyte, H. M. Brit. med. J. 1955, i, 1238. 3. Shaw, F. H., Shulman, A. Ibid, p. 1367. 4. Shulman, A. Unpublished.