- Email: [email protected]
HYDROGEN PEROXIDE AND GAS EMBOLISM
875
hospital. In Dr. Cargill’s view hospital consultants should tighten up this procedure, for neglect to send information to the family doctor could be as serious as neglect to order a clinical test. But Dr. Cargill thought that the family doctor also often failed in communication, especially when his advice was sought by the patient in the no man’s land of human relations. Here the doctor often could and should offer valuable help; but his authority was based not on scientific fact, but on education and experience, and he should offer his dvice-not as cut-and-dried assertion but as personal opinion. Dr. Cargill rated smoking as a painful boomerang to this technique of overconfident assertion. In the past, many doctors had disapproved of smoking without scientific evidence: today, when we had the evidence, their advice was dangerously ignored. It was a warning to doctors that before assuming the necromancer’s wand they should put aside the little black bag. Miss June Neill, who is a member of the team at the Caversham centre in North London, believed that a social worker might succeed in persuading a patient to admit his, or her, real worries, which were often presented to the doctor only under the cloak of physical symptoms. The patient regarded difficulties in human relations as a failure which he was reluctant to admit to the doctor, and sometimes he found it easier to explain them to a stranger. But she insisted that it must be clear that the social worker was offering an extra service and that contact with her did not mean dismissal from the doctor’s attention. Dr. Charles Fletcher suggested that the first thing for a doctor to find out was what the patient was afraid of. The patient was always anxious to know what was the diagnosis of his illness, what was its treatment, what would be the outcome, and how long the disorder was likely to last. The good doctor must learn to answer all these questions and where necessary to overcome the patient’s reluctance to ask them. The doctor’s replies might be guarded by tact and sympathy, but he should offer intelligible and satisfying information. Doctors must be educated to answer questions, and patients must be educated to ask them.
HYDROGEN PEROXIDE AND GAS EMBOLISM
peroxide has been put to surgical uses on grounds. Because the liberated oxygen was believed to inhibit the growth of sporing organisms, wounds were irrigated with a solution of hydrogen peroxide, and in Hirschsprung’s disease peroxide enemas HYDROGEN
tenuous
believed
break up the accumulation of hard of the risk of perforation of the scybala. now bowel, peroxide is seldom, if ever, used in this way, though some surgeons still use peroxide wash-outs at operation to remove the adherent meconium from the bowel in intestinal obstruction caused by mucoviscidosis. Danis et al.1 reported oxygen embolisation in a child with rectal atresia and rectoperineal fistula after irrigation of the distal colon beyond the colostomy with dilute hydrogen peroxide to remove barium and meconium. The legs and the lower half of the trunk suddenly became cyanosed and swollen, and on radiological examination gas was seen in the portal venous system. This child recovered, but Shaw et al. were not so fortunate. They used 1% hydrogen peroxide to wash out inspissated were
On
1. 2.
to
account
Danis, R. K., Brodeur, A. E., Shields, J. J. pediat. Surg. 1967, 2, 131. Shaw, A., Cooperman, A., Fusco, J. New Engl.J. Med. 1967, 277, 238.
meconium in a neonate with mucoviscidosis. They saw gas bubbles spread widely in the vessels of the ileum, but later blood-flow was resumed and appeared normal. Because of increasing abdominal distension, the abdomen was reopened on the fifth day of life, and gangrene with perforation of the distal ileum was disclosed. In subsequent experiments, Shaw et al. showed that bubbles of gas appeared in the veins of the small intestine in dogs only when 0-75% or stronger solutions of peroxide were used, but they were unable to reproduce the gangrene of the intestine. Danis et al. produced gas embolisation in dogs with a steep rise in portal venous pressure and filling of the portal system with gas. Clearly, hydrogen peroxide is dangerous for washing out the bowel. Moreover, the practice is no longer necessary in mucoviscidosis. An end-to-side ileostomy,3 combined with a pancreatic extract given by mouth and instilled into the ileostomy, usually results in the rapid liquefaction of the inspissated meconium.
FAIR
THE handiest instrument for pulling facts quickly out of store is still the human brain. Unfortunately, for scientists and many others, the explosion of new data has left even their best brains far behind; and they have for many years been looking to the computer and other little gadgets to help them catch up. FAIR (fast access information retrieval) is an experiment which began in Hampstead two years ago, in the division of biomedical engineering of the National Institute for Medical Research, and which holds promise for research-workers whose desk or back garden is too small to hold a computer. The emphasis in FAIR is not on the " where can I get some references for my " paper ? inquiry but on rapid follow-up of an idea or a question 4-in an effort to cut losses down the " ideas drain " by providing prompt answers from a large collection of literature on a fairly small subject. FAIR’S method of constructing an economical on-desk library is by feature-card index and microfiche file. Like any information retrieval system it depends very largely for efficiency on the use of a good language. and Pickford4 and his colleagues believe there is a way of compiling, by computer or electronic data processing, an information retrieval language regardless of subject without performing the intuitive tasks that have hitherto had to suffice. For a ’start, from September, 1965, to November, 1966, they made a collection of literature on biomedical engineering ; and they found they had 1488 articles from 220 different journals (the literature is certainly " scattered " here). The collection was then circulated (in batches of four reprints at a time) to collaborators from the Biological Engineering Society, the Hospital Physicists Association, and elsewhere, who allocated keywords (descriptors), up to a total of 15 descriptors in order of importance, which defined the scope of the paper. Each reprint was sent to two collaborators so that the two sets of descriptors and the retrieval languages derived from both circulations could be compared. The descriptors having been punched on cards, they were presented to a computer programmed to select those which best satisfied certain criteria based on frequency of occurrence of a particular word or phrase and on the importance attached to descriptors in each list. This part of the research has been completed; and an 3. 4.
Bishop, H. C., Koop, C. E. Ann. Surg. 1957, 145, Pickford, A. G. A. Aslib Proc. 1967, 19, 79.
410.
hospital. In Dr. Cargill’s view hospital consultants should tighten up this procedure, for neglect to send information to the family doctor could be as serious as neglect to order a clinical test. But Dr. Cargill thought that the family doctor also often failed in communication, especially when his advice was sought by the patient in the no man’s land of human relations. Here the doctor often could and should offer valuable help; but his authority was based not on scientific fact, but on education and experience, and he should offer his dvice-not as cut-and-dried assertion but as personal opinion. Dr. Cargill rated smoking as a painful boomerang to this technique of overconfident assertion. In the past, many doctors had disapproved of smoking without scientific evidence: today, when we had the evidence, their advice was dangerously ignored. It was a warning to doctors that before assuming the necromancer’s wand they should put aside the little black bag. Miss June Neill, who is a member of the team at the Caversham centre in North London, believed that a social worker might succeed in persuading a patient to admit his, or her, real worries, which were often presented to the doctor only under the cloak of physical symptoms. The patient regarded difficulties in human relations as a failure which he was reluctant to admit to the doctor, and sometimes he found it easier to explain them to a stranger. But she insisted that it must be clear that the social worker was offering an extra service and that contact with her did not mean dismissal from the doctor’s attention. Dr. Charles Fletcher suggested that the first thing for a doctor to find out was what the patient was afraid of. The patient was always anxious to know what was the diagnosis of his illness, what was its treatment, what would be the outcome, and how long the disorder was likely to last. The good doctor must learn to answer all these questions and where necessary to overcome the patient’s reluctance to ask them. The doctor’s replies might be guarded by tact and sympathy, but he should offer intelligible and satisfying information. Doctors must be educated to answer questions, and patients must be educated to ask them.
HYDROGEN PEROXIDE AND GAS EMBOLISM
peroxide has been put to surgical uses on grounds. Because the liberated oxygen was believed to inhibit the growth of sporing organisms, wounds were irrigated with a solution of hydrogen peroxide, and in Hirschsprung’s disease peroxide enemas HYDROGEN
tenuous
believed
break up the accumulation of hard of the risk of perforation of the scybala. now bowel, peroxide is seldom, if ever, used in this way, though some surgeons still use peroxide wash-outs at operation to remove the adherent meconium from the bowel in intestinal obstruction caused by mucoviscidosis. Danis et al.1 reported oxygen embolisation in a child with rectal atresia and rectoperineal fistula after irrigation of the distal colon beyond the colostomy with dilute hydrogen peroxide to remove barium and meconium. The legs and the lower half of the trunk suddenly became cyanosed and swollen, and on radiological examination gas was seen in the portal venous system. This child recovered, but Shaw et al. were not so fortunate. They used 1% hydrogen peroxide to wash out inspissated were
On
1. 2.
to
account
Danis, R. K., Brodeur, A. E., Shields, J. J. pediat. Surg. 1967, 2, 131. Shaw, A., Cooperman, A., Fusco, J. New Engl.J. Med. 1967, 277, 238.
meconium in a neonate with mucoviscidosis. They saw gas bubbles spread widely in the vessels of the ileum, but later blood-flow was resumed and appeared normal. Because of increasing abdominal distension, the abdomen was reopened on the fifth day of life, and gangrene with perforation of the distal ileum was disclosed. In subsequent experiments, Shaw et al. showed that bubbles of gas appeared in the veins of the small intestine in dogs only when 0-75% or stronger solutions of peroxide were used, but they were unable to reproduce the gangrene of the intestine. Danis et al. produced gas embolisation in dogs with a steep rise in portal venous pressure and filling of the portal system with gas. Clearly, hydrogen peroxide is dangerous for washing out the bowel. Moreover, the practice is no longer necessary in mucoviscidosis. An end-to-side ileostomy,3 combined with a pancreatic extract given by mouth and instilled into the ileostomy, usually results in the rapid liquefaction of the inspissated meconium.
FAIR
THE handiest instrument for pulling facts quickly out of store is still the human brain. Unfortunately, for scientists and many others, the explosion of new data has left even their best brains far behind; and they have for many years been looking to the computer and other little gadgets to help them catch up. FAIR (fast access information retrieval) is an experiment which began in Hampstead two years ago, in the division of biomedical engineering of the National Institute for Medical Research, and which holds promise for research-workers whose desk or back garden is too small to hold a computer. The emphasis in FAIR is not on the " where can I get some references for my " paper ? inquiry but on rapid follow-up of an idea or a question 4-in an effort to cut losses down the " ideas drain " by providing prompt answers from a large collection of literature on a fairly small subject. FAIR’S method of constructing an economical on-desk library is by feature-card index and microfiche file. Like any information retrieval system it depends very largely for efficiency on the use of a good language. and Pickford4 and his colleagues believe there is a way of compiling, by computer or electronic data processing, an information retrieval language regardless of subject without performing the intuitive tasks that have hitherto had to suffice. For a ’start, from September, 1965, to November, 1966, they made a collection of literature on biomedical engineering ; and they found they had 1488 articles from 220 different journals (the literature is certainly " scattered " here). The collection was then circulated (in batches of four reprints at a time) to collaborators from the Biological Engineering Society, the Hospital Physicists Association, and elsewhere, who allocated keywords (descriptors), up to a total of 15 descriptors in order of importance, which defined the scope of the paper. Each reprint was sent to two collaborators so that the two sets of descriptors and the retrieval languages derived from both circulations could be compared. The descriptors having been punched on cards, they were presented to a computer programmed to select those which best satisfied certain criteria based on frequency of occurrence of a particular word or phrase and on the importance attached to descriptors in each list. This part of the research has been completed; and an 3. 4.
Bishop, H. C., Koop, C. E. Ann. Surg. 1957, 145, Pickford, A. G. A. Aslib Proc. 1967, 19, 79.
410.