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INJURY FROM DISRUPTED GOLF BALL
375
Perhaps the abnormal platelet and fibroblast interaction with fibrin observed in our patient is somehow related to her defective wound healing. We would welcome additional information on wound healing from colleagues who have Glanzmann’s thrombasthenia patients in their care.
INJURY FROM DISRUPTED GOLF BALL SiR,—Iwas interested in your account of eye injuries from disrupted golf balls (Jan. 22, p. 181). I have encountered one case in which a boy who was dismantling a golf ball received
Minetti, Ospedale Maggiore,
We thank Prof.F. Vaccari and Dr B.
Bergamo, for allowing us to study this patient. GIUSEPPE REMUZZI Ospedale Maggiore, ELISABETTA MARCHESI Bergamo, Italy Laboratory for Hæmostasis and Thrombosis Research, Istituto di Ricerche
GIOVANNI DE GAETANO MARIA BENEDETTA DONATI
Farmacologiche "Mario Negri", Milan, Italy
LABIOAURICULAR REFLEX
SIR,-Reflexes involving the chin, mouth, and eyes are well recognised in dementia.1-3 I have noted a reflex involving the ears. In several patients with intellectual impairment, vigorous stroking of the upper lip with a lateral motion elicits an upward and sometimes backward movement of the ipsilateral ear4 (see figure). The reflex is usually bilateral. It is found either alone or in association with palmomental, snout, grasp, and other reflexes. It is most common in patients with mental impairment due to
X-ray of injured hand. the contents of the centre as a high-pressure injection in his index finger (see figure). The radio-opaque material was removed. Healing was delayed, but eventually he regained full function. Accident and Emergency Department, General Hospital, P. A. M. WESTON Nottingham NG1 6HA SODIUM BICARBONATE AND
TRICYCLIC-ANTIDEPRESSANT POISONING
SiR,—Iappreciated your comments’ on my work with sodium bicarbonate in the treatment of tricyclic antidepressant
Reflex
involving mouth
and
overdosage. In puppies pretreated with sodium bicarbonate so that the pH is normal before the infusion of antidepressant, arrhythmias developed with similar doses of antidepressant and disappeared with further infusion of sodium bicarbonate. Gaultier2 suggested that the antiarrhythmic effect is due to
ears.
seen in patients with cerebral infarction-when it is usually most prominent on the side exhibiting corticospinal signs. It was absent in 50 consecutive adult neurological patients with a normal mental-status examination and in 8 premature and 8 full-term newborns. The labioauricular reflex is probably mediated through the trigeminal and facial nerves. The retraction and elevation of the ears probably occurs through contraction of the retroauricular muscle’ via a primitive reflex unmasked by loss of cortical inhibition.
Alzheimer’s disease. At times it is also
MacLachlan Stroke Unit, Department of Neurosciences,
Sunnybrook Medical Centre, V. C. HACHINSKI
Toronto, Ontario M4N 3M5, Canada
sodium rather than bicarbonate, but I did not find that a bolus of sodium chloride had the antiarrhythmic effect of a similar equimolar dose of sodium bicarbonate. Furthermore the arrhythmias could be stopped by raising pH by hyperventilation and arrhythmias could be induced by the addition of carbon dioxide to the inspired gases during the pre-arrhythmia phase of the experiments. Trometamol (THAM) also stopped the arrhythmias.3 In my opinion it is the bicarbonate (causing a rapid increase in pH) rather than sodium ion which has the beneficial effect, which is due not only to correction of acidosis but also, probably, to the change induced in the intracellular/ extracellular ionic balance. The incidence of tricyclic-antidepressant overdosage has declined significantly in Australia since the introduction of safety packaging of these tablets.4 Royal
Children’s
Hospital,
Parkville, Victoria 3052, Australia
T. C. K. BROWN
1 Blake, J R , Kunkle, E. C. Archs Neurol. Psychiat. 1951, 63, 337. 1. Lancet, 1976, ii, 838.
2 de Ajuriaguerra, J., Rego, A., Rissot, R. Encephale, 1963, 52, 189. 3 Wartenburg, R The
Examination of Reflexes.
4 Hachinski, V. C. IV Panamerican ober, 1975; abstr. p. 137.
Chicago, 1945. Congress of Neurology, Mexico City,
5 Henser, M. J Neurol. 1976, 212, 95.
2. Gaultier, M. ibid. p.
Oct-
1258.
3. Brown, T. C. K., Barker, G. A., Dunlop, M. E., intens. Care, 1973, 1, 203. 4. Brown, T. C. K Aust. pædiat. J. 1975, 11, 190.
Loughnan,
P. M. Anœsth.
Perhaps the abnormal platelet and fibroblast interaction with fibrin observed in our patient is somehow related to her defective wound healing. We would welcome additional information on wound healing from colleagues who have Glanzmann’s thrombasthenia patients in their care.
INJURY FROM DISRUPTED GOLF BALL SiR,—Iwas interested in your account of eye injuries from disrupted golf balls (Jan. 22, p. 181). I have encountered one case in which a boy who was dismantling a golf ball received
Minetti, Ospedale Maggiore,
We thank Prof.F. Vaccari and Dr B.
Bergamo, for allowing us to study this patient. GIUSEPPE REMUZZI Ospedale Maggiore, ELISABETTA MARCHESI Bergamo, Italy Laboratory for Hæmostasis and Thrombosis Research, Istituto di Ricerche
GIOVANNI DE GAETANO MARIA BENEDETTA DONATI
Farmacologiche "Mario Negri", Milan, Italy
LABIOAURICULAR REFLEX
SIR,-Reflexes involving the chin, mouth, and eyes are well recognised in dementia.1-3 I have noted a reflex involving the ears. In several patients with intellectual impairment, vigorous stroking of the upper lip with a lateral motion elicits an upward and sometimes backward movement of the ipsilateral ear4 (see figure). The reflex is usually bilateral. It is found either alone or in association with palmomental, snout, grasp, and other reflexes. It is most common in patients with mental impairment due to
X-ray of injured hand. the contents of the centre as a high-pressure injection in his index finger (see figure). The radio-opaque material was removed. Healing was delayed, but eventually he regained full function. Accident and Emergency Department, General Hospital, P. A. M. WESTON Nottingham NG1 6HA SODIUM BICARBONATE AND
TRICYCLIC-ANTIDEPRESSANT POISONING
SiR,—Iappreciated your comments’ on my work with sodium bicarbonate in the treatment of tricyclic antidepressant
Reflex
involving mouth
and
overdosage. In puppies pretreated with sodium bicarbonate so that the pH is normal before the infusion of antidepressant, arrhythmias developed with similar doses of antidepressant and disappeared with further infusion of sodium bicarbonate. Gaultier2 suggested that the antiarrhythmic effect is due to
ears.
seen in patients with cerebral infarction-when it is usually most prominent on the side exhibiting corticospinal signs. It was absent in 50 consecutive adult neurological patients with a normal mental-status examination and in 8 premature and 8 full-term newborns. The labioauricular reflex is probably mediated through the trigeminal and facial nerves. The retraction and elevation of the ears probably occurs through contraction of the retroauricular muscle’ via a primitive reflex unmasked by loss of cortical inhibition.
Alzheimer’s disease. At times it is also
MacLachlan Stroke Unit, Department of Neurosciences,
Sunnybrook Medical Centre, V. C. HACHINSKI
Toronto, Ontario M4N 3M5, Canada
sodium rather than bicarbonate, but I did not find that a bolus of sodium chloride had the antiarrhythmic effect of a similar equimolar dose of sodium bicarbonate. Furthermore the arrhythmias could be stopped by raising pH by hyperventilation and arrhythmias could be induced by the addition of carbon dioxide to the inspired gases during the pre-arrhythmia phase of the experiments. Trometamol (THAM) also stopped the arrhythmias.3 In my opinion it is the bicarbonate (causing a rapid increase in pH) rather than sodium ion which has the beneficial effect, which is due not only to correction of acidosis but also, probably, to the change induced in the intracellular/ extracellular ionic balance. The incidence of tricyclic-antidepressant overdosage has declined significantly in Australia since the introduction of safety packaging of these tablets.4 Royal
Children’s
Hospital,
Parkville, Victoria 3052, Australia
T. C. K. BROWN
1 Blake, J R , Kunkle, E. C. Archs Neurol. Psychiat. 1951, 63, 337. 1. Lancet, 1976, ii, 838.
2 de Ajuriaguerra, J., Rego, A., Rissot, R. Encephale, 1963, 52, 189. 3 Wartenburg, R The
Examination of Reflexes.
4 Hachinski, V. C. IV Panamerican ober, 1975; abstr. p. 137.
Chicago, 1945. Congress of Neurology, Mexico City,
5 Henser, M. J Neurol. 1976, 212, 95.
2. Gaultier, M. ibid. p.
Oct-
1258.
3. Brown, T. C. K., Barker, G. A., Dunlop, M. E., intens. Care, 1973, 1, 203. 4. Brown, T. C. K Aust. pædiat. J. 1975, 11, 190.
Loughnan,
P. M. Anœsth.