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EXPERIMENTS ON THE NEWBORN
976 Londoner herself?
Her wonderful statue,
one
of the best
preserved Babylonian sculptures, dating from the 2nd millenium B.C., in the form of a nude winged goddess, can be seen as the famous " Burney Plaque in the Warburg Institute of the University of London. "
Centre de Radiothérapie, Clinique Universitaire de Radiologie, Hôpital Cantonal, Geneva.
H. CLIVE SIMS.
EXCHANGE TRANSFUSION FOR SEVERELY BURNED CHILDREN SiR,—It is generally admitted that there are 3 stages in the severe-burn syndrome: initial shock (hypovoltmic shock); " secondary " shock ( ? toxxmia); and septic complications. Hypovolsmic shock and septicaemia can be controlled by conventional methods. The major problem today is the management of the so-called secondary shock, the pathophysiology of which is still uncertain. In view of the possible existence of toxxmia, exchange transfusions have been used to eliminate the postulated toxic products in six children, aged 6 months to 9 years, with severe second and third grade burns covering 65% and more of the body-surface. All presented gross hxmaturia and encephalopathic signs. Five showed striking improvement of renal function (increased diuresis and decreased hsematuria) and regression of centralnervous symptoms. Three children recovered, aged 3 years, 21/2 years, and 10 months, and with 65%, 70%, and 70% of their body-surfaces affected, respectively; the three others, 6 months (85% of body-surface affected), 41/2 years (90%), and 9 years (85%), died despite transitory improvement. Empirically we recommend exchange transfusions in all children with burns involving 50% or more of the bodysurface, starting as soon as primary shock is under control, and repeated if toxic signs recur. M. BETTEX F. KUFFER A. SCHARLI M. KUMMER.
Kinderchirurgische Abteilung, Universitäts-Kinderklinik, 3000 Bern, Switzerland.
blood-volume of the infant at and following birth and the mechanisms influencing it. Considerable risk is involved at birth in every infant. It is therefore especially important to obtain knowledge about these risks and by proper care to avoid them to the largest possible extent. With regard to the question of consent, we obtained this from every mother. But even so, we consider the final
responsibility to be the investigators’. The study was carried out in the Helsinki University Institute. Expert advice and consent were obtained from the heads of the radioisotope and chemical laboratories. The dosage of 1251-tagged human serum-albumin used once in each infant, 0-15-0-25 mC, was considered safe. We benefited from previous blood-volume studies in planning this study. But an identical study has not been carried out. The number of cases studied was necessary to obtain significant differences illustrating the rate and mechanism of placental transfusion. From our experience, we have not observed disturbance in thyroid metabolism as a result of the use of Lugol’s solution in the newborn infant in the dosage given. Karolinska Sjukhuset,
Stockholm, Sweden.
JOHN LIND ALICE C. YAO MIKKO HIRVENSALO
SUPPRESSION OF THE PRIMARY ANTIBODY RESPONSE BY SYNGENEIC SMALL LYMPHOCYTES SIR,-We have suggested 12that lymphoid-system homoeostasis is based on reciprocal equilibrium between the cells of the plasmatic series and the lymphocytes. We describe here experiments showing disturbance of this equilibrium: administration of 1 x 10 syngeneic non-immune small lymphocytes 24 hours after administration of an antigen led to a striking suppression of the antibody response. Male mice of BALB/c strain weighing 22-26 g. from Stolbovaya animal farm were used for experiments. A suspension of small lymphocytes was extracted from the spleens of the intact donors by a modified method.3 The spleens were gently crushed in a Potter homogeniser in a medium consisting of Hanks’ neutral solution with 20% inactivated calf serum (1 ml. of medium per spleen). After filtration through four layers of gauze and addition of 3 ml. of 10%
EXPERIMENTS ON THE NEWBORN SIR,-The article by Dr. Yao and her colleagues (Feb. 24, p. 380), which describes a series of experiments done in Stockholm on 301 newborn infants, prompts the following
questions. 1. Was valid consent obtained from both parents of each of the 301 infants ? 2. Whose expert advice did the authors seek on whether or not the dosage of radioactive material used was safe ? 3. Is not 301 an unnecessarily large number of newborns to submit to these procedures, especially since the authors have reported previous almost identical experiments done on other large numbers of newborn infants ? 4. Could not the administration of Lugol’s iodine to newborn infants subsequently profoundly disturb their thyroid metabolism ? M. H. PAPPWORTH. London W. 1.
*** This letter has been shown
to
Dr. Yao and her col-
reply follows.-ED. L. SIR,-In answer to Dr. Pappworth’s questions,
leagues,
whose
we should like first to define the nature of our study. We consider it not as a series of experiments on the newborn but as clinical investigation. Hypovolxmia and hypervolxmia are known to occur in newborn infants, and it has been shown that they influence cardiorespiratory adaptation and may lead to untoward consequences. It is therefore of practical clinical importance to know the rate and amount of changes in the
Fig. 1-Glass tube for separation of small lymphocytes
from other
cells.
solution of gelatine to each 10 ml., the suspension was poured into test-tubes and kept at room temperature for 30-40 minutes until complete sedimentation of erythrocytes had taken place. Special glass tubes were filled with two layers of cotton-wool (fig. 1). The upper, loosely packed layer was saturated with the supernatant fluid from the test-tubes and the tubes were incubated at 37°C for 1 hour. They were then placed vertically in a Bunsen stand and washed with a large volume of Hanks’ solution until the fluid flowing from the tubes was clear. The cell suspension was then filtered through 16 layers of cambric. This filtrate contained 99% of small lymphocytes. The lymphocytes were washed with Hanks’ neutral solution and slowly injected (1 ml. in 10 minutes) into the jugular vein of recipient mice anacsthetised with hexobarbitone sodium (’ Evipan Sodium ’), 0-5 ml. of 0-5% solution intraperitoneally, 24 hours before or 24-26 hours after immunisation. A thymocyte suspension was prepared from thymus of adult intact mice by the same method as that used for the small lymphocytes. Recipients of small lymphocytes and thymocytes were immunised intravenously with sheep erythrocytes (s.E.), 2-5 x 105 in 0-2 ml., or bacterial 0 antigen (10 g. in 0-2 ml.). Blood was drawn from the 1. 2. 3.
Svet-Moldavsky, G. J. Nature, Lond. 1966, 209, 933. Zinzar, S. N., Svet-Moldavsky, G. J. ibid. 1967, 214, 295. Lamvik, J. O. Acta hœmat. 1966, 35, 294.
Her wonderful statue,
one
of the best
preserved Babylonian sculptures, dating from the 2nd millenium B.C., in the form of a nude winged goddess, can be seen as the famous " Burney Plaque in the Warburg Institute of the University of London. "
Centre de Radiothérapie, Clinique Universitaire de Radiologie, Hôpital Cantonal, Geneva.
H. CLIVE SIMS.
EXCHANGE TRANSFUSION FOR SEVERELY BURNED CHILDREN SiR,—It is generally admitted that there are 3 stages in the severe-burn syndrome: initial shock (hypovoltmic shock); " secondary " shock ( ? toxxmia); and septic complications. Hypovolsmic shock and septicaemia can be controlled by conventional methods. The major problem today is the management of the so-called secondary shock, the pathophysiology of which is still uncertain. In view of the possible existence of toxxmia, exchange transfusions have been used to eliminate the postulated toxic products in six children, aged 6 months to 9 years, with severe second and third grade burns covering 65% and more of the body-surface. All presented gross hxmaturia and encephalopathic signs. Five showed striking improvement of renal function (increased diuresis and decreased hsematuria) and regression of centralnervous symptoms. Three children recovered, aged 3 years, 21/2 years, and 10 months, and with 65%, 70%, and 70% of their body-surfaces affected, respectively; the three others, 6 months (85% of body-surface affected), 41/2 years (90%), and 9 years (85%), died despite transitory improvement. Empirically we recommend exchange transfusions in all children with burns involving 50% or more of the bodysurface, starting as soon as primary shock is under control, and repeated if toxic signs recur. M. BETTEX F. KUFFER A. SCHARLI M. KUMMER.
Kinderchirurgische Abteilung, Universitäts-Kinderklinik, 3000 Bern, Switzerland.
blood-volume of the infant at and following birth and the mechanisms influencing it. Considerable risk is involved at birth in every infant. It is therefore especially important to obtain knowledge about these risks and by proper care to avoid them to the largest possible extent. With regard to the question of consent, we obtained this from every mother. But even so, we consider the final
responsibility to be the investigators’. The study was carried out in the Helsinki University Institute. Expert advice and consent were obtained from the heads of the radioisotope and chemical laboratories. The dosage of 1251-tagged human serum-albumin used once in each infant, 0-15-0-25 mC, was considered safe. We benefited from previous blood-volume studies in planning this study. But an identical study has not been carried out. The number of cases studied was necessary to obtain significant differences illustrating the rate and mechanism of placental transfusion. From our experience, we have not observed disturbance in thyroid metabolism as a result of the use of Lugol’s solution in the newborn infant in the dosage given. Karolinska Sjukhuset,
Stockholm, Sweden.
JOHN LIND ALICE C. YAO MIKKO HIRVENSALO
SUPPRESSION OF THE PRIMARY ANTIBODY RESPONSE BY SYNGENEIC SMALL LYMPHOCYTES SIR,-We have suggested 12that lymphoid-system homoeostasis is based on reciprocal equilibrium between the cells of the plasmatic series and the lymphocytes. We describe here experiments showing disturbance of this equilibrium: administration of 1 x 10 syngeneic non-immune small lymphocytes 24 hours after administration of an antigen led to a striking suppression of the antibody response. Male mice of BALB/c strain weighing 22-26 g. from Stolbovaya animal farm were used for experiments. A suspension of small lymphocytes was extracted from the spleens of the intact donors by a modified method.3 The spleens were gently crushed in a Potter homogeniser in a medium consisting of Hanks’ neutral solution with 20% inactivated calf serum (1 ml. of medium per spleen). After filtration through four layers of gauze and addition of 3 ml. of 10%
EXPERIMENTS ON THE NEWBORN SIR,-The article by Dr. Yao and her colleagues (Feb. 24, p. 380), which describes a series of experiments done in Stockholm on 301 newborn infants, prompts the following
questions. 1. Was valid consent obtained from both parents of each of the 301 infants ? 2. Whose expert advice did the authors seek on whether or not the dosage of radioactive material used was safe ? 3. Is not 301 an unnecessarily large number of newborns to submit to these procedures, especially since the authors have reported previous almost identical experiments done on other large numbers of newborn infants ? 4. Could not the administration of Lugol’s iodine to newborn infants subsequently profoundly disturb their thyroid metabolism ? M. H. PAPPWORTH. London W. 1.
*** This letter has been shown
to
Dr. Yao and her col-
reply follows.-ED. L. SIR,-In answer to Dr. Pappworth’s questions,
leagues,
whose
we should like first to define the nature of our study. We consider it not as a series of experiments on the newborn but as clinical investigation. Hypovolxmia and hypervolxmia are known to occur in newborn infants, and it has been shown that they influence cardiorespiratory adaptation and may lead to untoward consequences. It is therefore of practical clinical importance to know the rate and amount of changes in the
Fig. 1-Glass tube for separation of small lymphocytes
from other
cells.
solution of gelatine to each 10 ml., the suspension was poured into test-tubes and kept at room temperature for 30-40 minutes until complete sedimentation of erythrocytes had taken place. Special glass tubes were filled with two layers of cotton-wool (fig. 1). The upper, loosely packed layer was saturated with the supernatant fluid from the test-tubes and the tubes were incubated at 37°C for 1 hour. They were then placed vertically in a Bunsen stand and washed with a large volume of Hanks’ solution until the fluid flowing from the tubes was clear. The cell suspension was then filtered through 16 layers of cambric. This filtrate contained 99% of small lymphocytes. The lymphocytes were washed with Hanks’ neutral solution and slowly injected (1 ml. in 10 minutes) into the jugular vein of recipient mice anacsthetised with hexobarbitone sodium (’ Evipan Sodium ’), 0-5 ml. of 0-5% solution intraperitoneally, 24 hours before or 24-26 hours after immunisation. A thymocyte suspension was prepared from thymus of adult intact mice by the same method as that used for the small lymphocytes. Recipients of small lymphocytes and thymocytes were immunised intravenously with sheep erythrocytes (s.E.), 2-5 x 105 in 0-2 ml., or bacterial 0 antigen (10 g. in 0-2 ml.). Blood was drawn from the 1. 2. 3.
Svet-Moldavsky, G. J. Nature, Lond. 1966, 209, 933. Zinzar, S. N., Svet-Moldavsky, G. J. ibid. 1967, 214, 295. Lamvik, J. O. Acta hœmat. 1966, 35, 294.