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GRISEOFULVIN FOR SCLERODERMA
260
distressing epilation which commonly follows the alternative of X-irradiation. University of Melbourne Department of Medicine, St. Vincent’s Hospital,
treatment
Melbourne, Australia.
A. G. BAIKIE A. S. D. SPIERS.
GRISEOFULVIN FOR SCLERODERMA to give good results in the of certain rheumatic diseases-e.g., shoulder-hand syndrome, periarthritis of the shoulder, cervical-root brachialgia, and acute attacks of gout. This antibiotic is apparently also effective in the treatment of scleroderma and Raynaud’s
SIR,-Griseofulvin is known
treatment
syndrome. My co-workers and I have reported the case of a young woman, aged 27 years, with progressive scleroderma, treated with fine-particle griseofulvin for six consecutive months at a dosage of 600 mg. per day.1 Rapid regression of the accompanying Raynaud’s syndrome and slow but gradual replacement of the thickened skin with skin of a more normal appearance followed this treatment. The general condition of the patient
also improved considerably. However, no improvement was noticed in the joint-lesions during administration of the antibiotic ; in fact they deteriorated. We have continued therapy with griseofulvin in this patient for twenty-seven months to date; the improvement in her general condition, skin lesions, and Raynaud’s syndrome after six months’ treatment has been maintained. In four other patients with scleroderma, treated with griseofulvin for several months, we have noticed similar results, but in a fifth patient no benefit has been noticed after nine months’ treatment. ’
M. GIORDANO.
Naples.
ANTIHISTAMINES IN HYDROPS FŒTALIS SiR,ŇIt was with particular interest that we read the report by Dr. Bierme and Dr. Bierm62 of the value of promethazine in arresting the progress of hydrops foetalis in utero. This drug is known to affect antibody production3 and to delay the homograft rejection process.4 We have recently observed that promethazine may interfere with red-cell agglutination in vitro, possibly owing to some modification of the cell surface. We are therefore carrying out in-vivo tests which we hope may be of value in relation to Rh immunisation. Serology Section, Department of Pathology, Royal Women’s Hospital, Melbourne, Australia.
HYPERINSULINISM AND HIGH SUCROSE INTAKE SiR,ŇThat hyperinsulinxmia is atherogenic is well documented.l As part of an investigation into the atherogenic effect of dietary sucrose,2 experiments were carried out to study serum-insulin levels during glucose-tolerance tests. Two subjects, a 31-year-old male catering officer (no. 1) and a EFFECTS OF HIGH SUCROSE DIET ON BLOOD-SUGAR AND SERUM-INSULIN LEVELS DURING ORAL GLUCOSE-TOLERANCE TESTS
JEAN U. BARRIE BRIAN D. TAIT.
A CORONARY-CARE UNIT
SiR,ŇThe paper of Dr. Lawrie and his colleagues (July 15, p. 109) will be of great interest to all who are involved in the care of patients with myocardial infarction. However, we must challenge their statement that " The construction, equipment and, particularly, the staffing requirements make the establishment of units an impracticable proposition in the majority of The Edinburgh unit is research orientated and of the equipment described is unnecessary in a purely clinical unit. Elaborate monitoring apparatus with memory tape and automatic electrocardiogram (E.C.G.) recording is not essential to routine clinical management. Large oscilloscopes displaying the E.C.G. for trained nurses to monitor are cheaper and probably as effective. Separate sound-proof cubicles are not necessary, and a small open ward eliminates the need for additional remote oscilloscopes and simplifies nursing. A resident physician is not required in the hospital where all staff are trained in resuscitation.
hospitals ". some
1. 2. 3. 4.
The essential requirements for a coronary-care unit are an separate from the general wards, specially trained nursing staff, and the immediate availability of resuscitative equipment. At this hospital a five-bedded unit dealing with about 300 admissions a year has been’ operating for nine months with results similar to those obtained in Edinburgh. The patients are cared for, both when within the unit and later, by the appropriate admitting firm, but the unit itself is under the overall direction of one consultant physician. There is a permanent qualified nursing staff of eight, but no doctor resident in the unit. Although, as Dr. Lawrie and his colleagues suggest, new forms of therapy may arise as a result of research carried out within the major units, it is unlikely that more effective and simpler manoeuvres than direct-current defibrillation and transvenous pacemaking will be devised in the foreseeable future. These techniques are within the capacity of all physicians, and in order to make any impact on the national mortality from this disease they must be made available in every hospital dealing with acute medical admissions. This is most effectively achieved in some form of coronary-care unit. There will be few units established as costly and elaborate as the one in Edinburgh, but much can be achieved in this direction by the ordinary district hospitals. B. L. PENTECOST The General Hospital, N. M. C. MAYNE. 4. Birmingham area
Giordano, M., Ara, M., Tirri, G. Reumatismo, 1966, 18, 314. Biermé, S., Biermé, R. Lancet, 1967, i, 574. Saunders, J. C., Muchmore, E. Br. J. Psychiat. 1964, 110, 84. Eyal, Z., Warwick, W. J., Mayo, C. H., Lillehei, R. C. Science, N.Y. 1965, 148, 1468.
27-year-old female dietician (no. 2) volunteered to take a diet containing 400 g. sucrose daily for a week. Both subjects had a
glucose-tolerance test with serum-insulin estimations before and on the 8th day of the trial. Subject 1, height 5 ft. 9 in. (175 cm.), weighed 164 lb. (74-5 kg.) before and 167 lb. (75-8 kg.) after the experiment; subject 2, height 5 ft. 7 in. (170 cm.), weighed 140 lb. (63-6 kg.) before and 144 lb. 50 g. oral
(65-4 kg.) after the experiment.
14 days after returning to normal diet the test was repeated in both subjects. Glucose levels were estimated by the glucose-oxidase method, and serum-insulin was immunoassayed.3 The effects of this high sucrose consumption on the seruminsulin response during glucose-tolerance tests are shown in the accompanying table. If excessive insulin response can be defined as insulin levels rising about 100 fLU per ml. serum during an oral glucose-tolerance test,4 then both subjects may be considered to have hyperinsulinxmia during the stage of Peters, N., Hales, C. N. Lancet, 1965, i, 1144. Nikkilä, E. A., Miettinen, T. A., Vesenne, M. R., Pelkonen, R. ibid. 1965, ii, 508. VallanceOwen, J. Q. Jl Med. 1965, 34, 485. Welborn, T. A., Breckenridge, A., Rubinstein, A. H., Dollery, C. T., Fraser, T. R. Lancet, 1966, i, 1336. 2. Yudkin, J. ibid. 1957, ii, 155. 3. Hales, C. N., Randle, P. J. Biochem. J. 1963, 88, 137. 4. Grodsky, G. M., Karam, J. H., Pavlatos, F. C., Forsham, P. H. Lancet, 1965, i, 290.
1.
distressing epilation which commonly follows the alternative of X-irradiation. University of Melbourne Department of Medicine, St. Vincent’s Hospital,
treatment
Melbourne, Australia.
A. G. BAIKIE A. S. D. SPIERS.
GRISEOFULVIN FOR SCLERODERMA to give good results in the of certain rheumatic diseases-e.g., shoulder-hand syndrome, periarthritis of the shoulder, cervical-root brachialgia, and acute attacks of gout. This antibiotic is apparently also effective in the treatment of scleroderma and Raynaud’s
SIR,-Griseofulvin is known
treatment
syndrome. My co-workers and I have reported the case of a young woman, aged 27 years, with progressive scleroderma, treated with fine-particle griseofulvin for six consecutive months at a dosage of 600 mg. per day.1 Rapid regression of the accompanying Raynaud’s syndrome and slow but gradual replacement of the thickened skin with skin of a more normal appearance followed this treatment. The general condition of the patient
also improved considerably. However, no improvement was noticed in the joint-lesions during administration of the antibiotic ; in fact they deteriorated. We have continued therapy with griseofulvin in this patient for twenty-seven months to date; the improvement in her general condition, skin lesions, and Raynaud’s syndrome after six months’ treatment has been maintained. In four other patients with scleroderma, treated with griseofulvin for several months, we have noticed similar results, but in a fifth patient no benefit has been noticed after nine months’ treatment. ’
M. GIORDANO.
Naples.
ANTIHISTAMINES IN HYDROPS FŒTALIS SiR,ŇIt was with particular interest that we read the report by Dr. Bierme and Dr. Bierm62 of the value of promethazine in arresting the progress of hydrops foetalis in utero. This drug is known to affect antibody production3 and to delay the homograft rejection process.4 We have recently observed that promethazine may interfere with red-cell agglutination in vitro, possibly owing to some modification of the cell surface. We are therefore carrying out in-vivo tests which we hope may be of value in relation to Rh immunisation. Serology Section, Department of Pathology, Royal Women’s Hospital, Melbourne, Australia.
HYPERINSULINISM AND HIGH SUCROSE INTAKE SiR,ŇThat hyperinsulinxmia is atherogenic is well documented.l As part of an investigation into the atherogenic effect of dietary sucrose,2 experiments were carried out to study serum-insulin levels during glucose-tolerance tests. Two subjects, a 31-year-old male catering officer (no. 1) and a EFFECTS OF HIGH SUCROSE DIET ON BLOOD-SUGAR AND SERUM-INSULIN LEVELS DURING ORAL GLUCOSE-TOLERANCE TESTS
JEAN U. BARRIE BRIAN D. TAIT.
A CORONARY-CARE UNIT
SiR,ŇThe paper of Dr. Lawrie and his colleagues (July 15, p. 109) will be of great interest to all who are involved in the care of patients with myocardial infarction. However, we must challenge their statement that " The construction, equipment and, particularly, the staffing requirements make the establishment of units an impracticable proposition in the majority of The Edinburgh unit is research orientated and of the equipment described is unnecessary in a purely clinical unit. Elaborate monitoring apparatus with memory tape and automatic electrocardiogram (E.C.G.) recording is not essential to routine clinical management. Large oscilloscopes displaying the E.C.G. for trained nurses to monitor are cheaper and probably as effective. Separate sound-proof cubicles are not necessary, and a small open ward eliminates the need for additional remote oscilloscopes and simplifies nursing. A resident physician is not required in the hospital where all staff are trained in resuscitation.
hospitals ". some
1. 2. 3. 4.
The essential requirements for a coronary-care unit are an separate from the general wards, specially trained nursing staff, and the immediate availability of resuscitative equipment. At this hospital a five-bedded unit dealing with about 300 admissions a year has been’ operating for nine months with results similar to those obtained in Edinburgh. The patients are cared for, both when within the unit and later, by the appropriate admitting firm, but the unit itself is under the overall direction of one consultant physician. There is a permanent qualified nursing staff of eight, but no doctor resident in the unit. Although, as Dr. Lawrie and his colleagues suggest, new forms of therapy may arise as a result of research carried out within the major units, it is unlikely that more effective and simpler manoeuvres than direct-current defibrillation and transvenous pacemaking will be devised in the foreseeable future. These techniques are within the capacity of all physicians, and in order to make any impact on the national mortality from this disease they must be made available in every hospital dealing with acute medical admissions. This is most effectively achieved in some form of coronary-care unit. There will be few units established as costly and elaborate as the one in Edinburgh, but much can be achieved in this direction by the ordinary district hospitals. B. L. PENTECOST The General Hospital, N. M. C. MAYNE. 4. Birmingham area
Giordano, M., Ara, M., Tirri, G. Reumatismo, 1966, 18, 314. Biermé, S., Biermé, R. Lancet, 1967, i, 574. Saunders, J. C., Muchmore, E. Br. J. Psychiat. 1964, 110, 84. Eyal, Z., Warwick, W. J., Mayo, C. H., Lillehei, R. C. Science, N.Y. 1965, 148, 1468.
27-year-old female dietician (no. 2) volunteered to take a diet containing 400 g. sucrose daily for a week. Both subjects had a
glucose-tolerance test with serum-insulin estimations before and on the 8th day of the trial. Subject 1, height 5 ft. 9 in. (175 cm.), weighed 164 lb. (74-5 kg.) before and 167 lb. (75-8 kg.) after the experiment; subject 2, height 5 ft. 7 in. (170 cm.), weighed 140 lb. (63-6 kg.) before and 144 lb. 50 g. oral
(65-4 kg.) after the experiment.
14 days after returning to normal diet the test was repeated in both subjects. Glucose levels were estimated by the glucose-oxidase method, and serum-insulin was immunoassayed.3 The effects of this high sucrose consumption on the seruminsulin response during glucose-tolerance tests are shown in the accompanying table. If excessive insulin response can be defined as insulin levels rising about 100 fLU per ml. serum during an oral glucose-tolerance test,4 then both subjects may be considered to have hyperinsulinxmia during the stage of Peters, N., Hales, C. N. Lancet, 1965, i, 1144. Nikkilä, E. A., Miettinen, T. A., Vesenne, M. R., Pelkonen, R. ibid. 1965, ii, 508. VallanceOwen, J. Q. Jl Med. 1965, 34, 485. Welborn, T. A., Breckenridge, A., Rubinstein, A. H., Dollery, C. T., Fraser, T. R. Lancet, 1966, i, 1336. 2. Yudkin, J. ibid. 1957, ii, 155. 3. Hales, C. N., Randle, P. J. Biochem. J. 1963, 88, 137. 4. Grodsky, G. M., Karam, J. H., Pavlatos, F. C., Forsham, P. H. Lancet, 1965, i, 290.
1.