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FLUORIDATION OF WATER-SUPPLIES
200
isoenzyme patterns in disease-e.g., an increase of L.D.H. 1 (fastest anodic fraction) in coronary thrombosis, and an increase of L.D.H. 5 (cathodic fraction) in liver disease. In sera an additional band of faster mobility than L.D.H. 1 is found. This band is not N.A.D.-dependent in its development; it is due to direct reduction of tetrazolium salt by SH groups in the albumin. This technique and results of investigations into the " nothing dehydrogenase " reaction will be presented more fully in a paper to the Biochemical Society in July. Queen Mary’s Hospital, Roehampton, HANNA BARNETT. London, S.W.15.
FLUORIDATION OF WATER-SUPPLIES SIR,-Fluoridation may be good for children’s teeth, but no one has investigated how much harm may be done to fish-and to the plankton, &c., on which fish feed-by the discharge into rivers of fluoridated effluents. It would be sad if the fish in our streams, and the pleasure they give to anglers and the food they and aquatic insects provide for birds, were destroyed. FRANKLIN BICKNELL. London, W.l. CLINICAL TRIAL OF NEW ORAL DIURETIC— SKF 8542 SIR,-In reference to the results obtained by Dr. Donnelly and his colleagues (Feb. 3), we administered
2,4,7-triamino-6-phenylteridine (SKF 8542)
to:
(a) 4 patients who had a moderate degree of heart-failure with oedema. In 3 the results were comparable with those of other diuretics in similar conditions. In 1 patient with impaired function of the kidneys a rapid increase in urxmia was observed, which returned to normal after interruption of the treatment.
patients who had severe heart-failure with oedema and resistant to treatment with most diuretics (e.g., chlorthalidone). SKF 8542 by itself induced a slight increase in natriuresis but the combination of SKF 8542 with chlorthalidone gave very satisfactory results, with a more favourable Na/K ratio and a more pronounced weight loss than that obtained with a combination of spironolactone (’ Aldactone ’) and chlorthalidone). A representative case in the accompanying table shows a comparison of the results obtained in a patient with severe cardiac decompensation. In 1 of those patients a transient psychotic reaction was observed 2 days after interruption of the drug. (b)
4
were
(c) 4 patients with cirrhosis of the liver and ascites; here also the results were favourable. SKF 8542 appears to us to be of value in selected cases for the following reasons: (1) It evidently has a potassium-saving effect. It seems very useful in patients who become resistant the usual diuretics when it can be administered simultaneously with them. One has to be cautious about the renal and cerebral compli.
(2)
to
cations.
J. V. JOOSSENS R. VERWILGHEN R. VERBERCKMOES, TRAVELLERS’ DIARRHŒA
SIR,-Your interesting annotation (July 14) omits one of travellers’ diarrhoea which is immediately curable and may be numerically important-namely, giardiasis, I have diagnosed this infestation three times in colleagues troubled by persistent diarrhoea acquired abroad; in one the symptoms had come on suddenly in Rome three months before I saw him, and besides diarrhoea he had cause
and anorexia. The other two had had diarrhea a much longer time. Numerous present in the stools of two; in the third none could be found. All three were immediately cured by five days’ treatment with mepacrine. nausea
intermittently for trophozoites were
Medical Unit, Royal Infirmary, Cardiff.
A. H.
JAMES,
DEMETHYLCHLORTETRACYCLINE AND GASTRIC CANCER of June 30 erroneous reference annotation SIR,-In your was made to my early work concerned with the localisation of brain tumours. The fluorescent properties of fluorescein were utilised for the recognition of brain tumours. Following intravenous injection of the dye, needle biopsy material was examined under an ultraviolet light. Brain tumour tissue was characterised by a brilliant yellow-green fluorescence. In our opinion this technique should be very helpful to the neurosurgeon and as an aid to the pathologist in choosing tissue fragments most likely to contain malignant cells for frozen sections. This work was summarised and illustrated with coloured photographs in a monograph.! Whereas it is our contention that there is some specific binding of this and related dyes to the nucleoproteins of malignant tissue, the localisation in brain tumours is primarily the result of disruption of the so-called bloodbrain barrier. Roswell Park Memorial Institute, Buffalo, New York.
GEORGE E. MOORE.
THE FIBERSCOPE
SiR,—I disagree with some of Dr. Kemp’s criticism fiberscope (July 14) and with his suggested modi-
of the
fications. Like others, I have failed to introduce the tip of the instruinto the duodenum. But, even if this could be done, I doubt if the view obtained would be satisfactory; for the fiberscope, like the cystoscope, has a right-angled objective, excellent for examining the interior of relatively large cavities, but useless for looking down tubes. I have always thought that a gastrointestinal panendoscope should have a foreoblique viewing system, like its genitourinary counterpart. Having used the fiberscope for the past seven months, I now find that I can examine the stomach better with it than with the standard semirigid gastroscope. To stiffen the fiberscope 1. Diagnosis and Localization of Brain Tumors. Springfield, Ill., 1953.
ment
During the whole period the patient was maintained in bed on a salt-free diet and received digitalis. The results are expressed as the mean of the daily values obtained during each period.
isoenzyme patterns in disease-e.g., an increase of L.D.H. 1 (fastest anodic fraction) in coronary thrombosis, and an increase of L.D.H. 5 (cathodic fraction) in liver disease. In sera an additional band of faster mobility than L.D.H. 1 is found. This band is not N.A.D.-dependent in its development; it is due to direct reduction of tetrazolium salt by SH groups in the albumin. This technique and results of investigations into the " nothing dehydrogenase " reaction will be presented more fully in a paper to the Biochemical Society in July. Queen Mary’s Hospital, Roehampton, HANNA BARNETT. London, S.W.15.
FLUORIDATION OF WATER-SUPPLIES SIR,-Fluoridation may be good for children’s teeth, but no one has investigated how much harm may be done to fish-and to the plankton, &c., on which fish feed-by the discharge into rivers of fluoridated effluents. It would be sad if the fish in our streams, and the pleasure they give to anglers and the food they and aquatic insects provide for birds, were destroyed. FRANKLIN BICKNELL. London, W.l. CLINICAL TRIAL OF NEW ORAL DIURETIC— SKF 8542 SIR,-In reference to the results obtained by Dr. Donnelly and his colleagues (Feb. 3), we administered
2,4,7-triamino-6-phenylteridine (SKF 8542)
to:
(a) 4 patients who had a moderate degree of heart-failure with oedema. In 3 the results were comparable with those of other diuretics in similar conditions. In 1 patient with impaired function of the kidneys a rapid increase in urxmia was observed, which returned to normal after interruption of the treatment.
patients who had severe heart-failure with oedema and resistant to treatment with most diuretics (e.g., chlorthalidone). SKF 8542 by itself induced a slight increase in natriuresis but the combination of SKF 8542 with chlorthalidone gave very satisfactory results, with a more favourable Na/K ratio and a more pronounced weight loss than that obtained with a combination of spironolactone (’ Aldactone ’) and chlorthalidone). A representative case in the accompanying table shows a comparison of the results obtained in a patient with severe cardiac decompensation. In 1 of those patients a transient psychotic reaction was observed 2 days after interruption of the drug. (b)
4
were
(c) 4 patients with cirrhosis of the liver and ascites; here also the results were favourable. SKF 8542 appears to us to be of value in selected cases for the following reasons: (1) It evidently has a potassium-saving effect. It seems very useful in patients who become resistant the usual diuretics when it can be administered simultaneously with them. One has to be cautious about the renal and cerebral compli.
(2)
to
cations.
J. V. JOOSSENS R. VERWILGHEN R. VERBERCKMOES, TRAVELLERS’ DIARRHŒA
SIR,-Your interesting annotation (July 14) omits one of travellers’ diarrhoea which is immediately curable and may be numerically important-namely, giardiasis, I have diagnosed this infestation three times in colleagues troubled by persistent diarrhoea acquired abroad; in one the symptoms had come on suddenly in Rome three months before I saw him, and besides diarrhoea he had cause
and anorexia. The other two had had diarrhea a much longer time. Numerous present in the stools of two; in the third none could be found. All three were immediately cured by five days’ treatment with mepacrine. nausea
intermittently for trophozoites were
Medical Unit, Royal Infirmary, Cardiff.
A. H.
JAMES,
DEMETHYLCHLORTETRACYCLINE AND GASTRIC CANCER of June 30 erroneous reference annotation SIR,-In your was made to my early work concerned with the localisation of brain tumours. The fluorescent properties of fluorescein were utilised for the recognition of brain tumours. Following intravenous injection of the dye, needle biopsy material was examined under an ultraviolet light. Brain tumour tissue was characterised by a brilliant yellow-green fluorescence. In our opinion this technique should be very helpful to the neurosurgeon and as an aid to the pathologist in choosing tissue fragments most likely to contain malignant cells for frozen sections. This work was summarised and illustrated with coloured photographs in a monograph.! Whereas it is our contention that there is some specific binding of this and related dyes to the nucleoproteins of malignant tissue, the localisation in brain tumours is primarily the result of disruption of the so-called bloodbrain barrier. Roswell Park Memorial Institute, Buffalo, New York.
GEORGE E. MOORE.
THE FIBERSCOPE
SiR,—I disagree with some of Dr. Kemp’s criticism fiberscope (July 14) and with his suggested modi-
of the
fications. Like others, I have failed to introduce the tip of the instruinto the duodenum. But, even if this could be done, I doubt if the view obtained would be satisfactory; for the fiberscope, like the cystoscope, has a right-angled objective, excellent for examining the interior of relatively large cavities, but useless for looking down tubes. I have always thought that a gastrointestinal panendoscope should have a foreoblique viewing system, like its genitourinary counterpart. Having used the fiberscope for the past seven months, I now find that I can examine the stomach better with it than with the standard semirigid gastroscope. To stiffen the fiberscope 1. Diagnosis and Localization of Brain Tumors. Springfield, Ill., 1953.
ment
During the whole period the patient was maintained in bed on a salt-free diet and received digitalis. The results are expressed as the mean of the daily values obtained during each period.