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INTRACEREBRAL HÆMORRHAGE AND MICROANEURYSMS
594 with polyvalent antivenin. The normal first-aid known as " suck and cut " is effective if done at When the snake has been definitely once-as it usually is. identified as poisonous or the clinical condition indicates it, antivenin should be given as soon as possible. Usually specific antivenins are not available and a polyvalent antivenin is used. For bites by the larger or more dangerous vipers, blood-transfusion is indicated in addition to the other measures of treatment. Scorpion stings respond extremly well to emetine in a dose of gr. 1 (65 mg.) for adults and proportionately less for children. This is injected directly into the area of the sting. The pain is very rapidly reduced and the general and local effects of the poison are considerably lessened. This treatment has been the standard treatment for scorpion stings for a number of years in dispensaries and hospitals in Northern Nigeria. JEFFREY S. DODGE. Shipley, Yorks. treatment treatment
BONE-MARROW CULTURE IN INFECTIOUS DISEASES
SIR,-The letter of Dr. Johnston and Dr. Dalton (Feb. 24, 420) contains no reference to the isolation of acid-fast organisms from bone-marrow biopsy material. In Florida these isolations have occasionally been both diagnostic and lifesaving. Bone-marrow may be a valuable source of Mycobacterium p.
tuberculosis during the early stages of hoematogenous dissemination, when the tuberculin test may be negative. Unclassified mycobacteria may also be recovered and identified. Owing to the common resistance of these organisms to P.A.s. and isoniazid their identification is essential for efficient therapy. " Battey " bacilli and scotochromogens, both of the pathogenic (’ Tween ’-hydrolysis-negative) varieties, have been recovered in this way from cases of sarcoidosis and liver abscess, and a case of fatal disseminated scotochromogen mycobacteriosis in a child. This last case was reported in the American Review of Respiratory Diseases (vol. 96, p. 795), the first two isolations being obtained from bone-marrow biopsy material submitted to the Florida State laboratories. Bureau of Preventable Diseases, Florida State Board of Health, Jackonsville 32201.
S. HOWARD FERGUSON.
&ggr;-RADIATION DAMAGE TO STARR-EDWARDS VALVES that SIR,-Our suggestion y radiation was suitable for sterilising Starr-Edwards valves has not been supported by further experience. There are considerable batch-to-batch variations in the quality of the polytetrafluoroethylene (P.T.F.E.) used. This is inevitable, because a sintering process used during manufacture may cause imperfections at the boundaries between the particles.
Sections of two fibrils from the knitted P.T.F.E. ring of Edwards valve.
The white holes
during processing.
1.
2.
Lancet, 1967, ii, 1127. Davis, E., Landau, J., Ivry, M. in Clinical Capillary Microscopy. Springfield, 1966. Davis, E., Landau, J., Chazan, B. I. Biblthca. anat. 1965, 7, 543. Chazan, B. I., Eliashar, Y., Brezinski, A., Davis, E. Diabetes, 1964, 13, 291.
are where the degraded polymer has been lost The more degraded specimen (b) shows knife-cuts
the seccion. Reduced to about
a
third from
x
4000.
During irradiation any =C-F bonds that are broken are re-formed 2;in practice degradation is greatest at the imperfections, which act as centres for further degradation by oxidation in the presence of arterial blood. Unacceptable loss of strength of the P.T.F.E. has sometimes followed a few hours after placing the valve in the heart. The accompanying figure shows the damage in cross-sections of P.T.F.E. fibrils after sterilisation of a Starr-Edwards valve by irradiation and three not
weeks in contact with arterial blood. At present, Starr-Edwards valves or other prosthetic devices containing P.T.F.E. should not therefore be sterilised by irradiation. M. F. ALLADINE R. N. G. ATHERSTONE London Chest Hospital and K. LITTLE Research Wantage Laboratories, Wantage, Berks. J. R. P. GIBBONS.
CARBOHYDRATE METABOLISM IN THE NEWBORN
MICROANEURYSMS
therefore arises that they are present before clinical symptoms bring the patient to the physician. Conjunctival micropools are strongly associated with vascular disease during life, and are often seen in middle-aged and younger sufferers. It seems that these findings dovetail well with the postmortem findings of the pathologists. The easy accessibility of the vessels of the conjunctiva to biomicroscopy allows us to see micropools in a sample of vessels-a finding which probably reflects what is happening in the small vessels elsewhere in the body. Capillary Research Laboratory, ELI DAVIS. Hadassah University Hospital, Jerusalem.
Starr-
across
INTRACEREBRAL HÆMORRHAGE AND
SIR,-In connection with your leading articleand the subsequent correspondence on this topic, the findings of my colleagues and myself2 of conjunctival vascular micropools (" microaneurysms ") are of interest. Conjunctival micropools are nearly three times more common in patients with vascular disease (including hypertension and diabetes mellitus) than in healthy controls or in patients with non-vascular diseases in the same age-groups. They can be seen on biomicroscopy at the time of the first clinical diagnosis of the disease. The possibility
a
SIR,-The finding by Dr. Schiff and Dr. Lowy (March 2, 475) of an increase in serum-insulin secretion in small for dates " babies with hypoglycxmia seems to confirm a hitherto unproven suspicion that we are dealing with a transient hyperinsulinism in these infants who show signs of intrauterine malnutrition.3 Their report also lends scientific respectability to the somewhat empirical but clinically effective treatment of this condition with intramuscular hydrocortisone.34 In the light of this important and exciting Hammersmith work it seems that hydrocortisone may exert its chief effect in these cases by blotting out " any excessive insulin activity, thus allowing an early return to a more stable normoglycaemia than can be realised by giving only carbohydrates of whatever sort by "
p.
"
whatever route. Further experience during the past few years with the hydrocortisone therapy of neonates with idiopathic hypoglycsemia has suggested that a quicker and more clearcut response can often be achieved by using a rather larger dose than that previously recommended (25 mg., repeated as dictated by Alladine, M. F., Atherstone, R. G., Crawford, C. G., Gibbons, J. R. P. Lancet, 1966, ii, 969. 2. Little, K. Proceedings of the 4th International Conference on Electron Microscopy; p. 165. (London, 1954); The Effects of High Doses of Ionising Radiation on Organic High Polymers. H.M. Stationery Office; 1.
1957.
3. 4.
Creery, Creery,
R. D. G. Devl Med. Child Neurol. 1966, R. D. G. Lancet, 1963, i, 1423.
8, 746.
BONE-MARROW CULTURE IN INFECTIOUS DISEASES
SIR,-The letter of Dr. Johnston and Dr. Dalton (Feb. 24, 420) contains no reference to the isolation of acid-fast organisms from bone-marrow biopsy material. In Florida these isolations have occasionally been both diagnostic and lifesaving. Bone-marrow may be a valuable source of Mycobacterium p.
tuberculosis during the early stages of hoematogenous dissemination, when the tuberculin test may be negative. Unclassified mycobacteria may also be recovered and identified. Owing to the common resistance of these organisms to P.A.s. and isoniazid their identification is essential for efficient therapy. " Battey " bacilli and scotochromogens, both of the pathogenic (’ Tween ’-hydrolysis-negative) varieties, have been recovered in this way from cases of sarcoidosis and liver abscess, and a case of fatal disseminated scotochromogen mycobacteriosis in a child. This last case was reported in the American Review of Respiratory Diseases (vol. 96, p. 795), the first two isolations being obtained from bone-marrow biopsy material submitted to the Florida State laboratories. Bureau of Preventable Diseases, Florida State Board of Health, Jackonsville 32201.
S. HOWARD FERGUSON.
&ggr;-RADIATION DAMAGE TO STARR-EDWARDS VALVES that SIR,-Our suggestion y radiation was suitable for sterilising Starr-Edwards valves has not been supported by further experience. There are considerable batch-to-batch variations in the quality of the polytetrafluoroethylene (P.T.F.E.) used. This is inevitable, because a sintering process used during manufacture may cause imperfections at the boundaries between the particles.
Sections of two fibrils from the knitted P.T.F.E. ring of Edwards valve.
The white holes
during processing.
1.
2.
Lancet, 1967, ii, 1127. Davis, E., Landau, J., Ivry, M. in Clinical Capillary Microscopy. Springfield, 1966. Davis, E., Landau, J., Chazan, B. I. Biblthca. anat. 1965, 7, 543. Chazan, B. I., Eliashar, Y., Brezinski, A., Davis, E. Diabetes, 1964, 13, 291.
are where the degraded polymer has been lost The more degraded specimen (b) shows knife-cuts
the seccion. Reduced to about
a
third from
x
4000.
During irradiation any =C-F bonds that are broken are re-formed 2;in practice degradation is greatest at the imperfections, which act as centres for further degradation by oxidation in the presence of arterial blood. Unacceptable loss of strength of the P.T.F.E. has sometimes followed a few hours after placing the valve in the heart. The accompanying figure shows the damage in cross-sections of P.T.F.E. fibrils after sterilisation of a Starr-Edwards valve by irradiation and three not
weeks in contact with arterial blood. At present, Starr-Edwards valves or other prosthetic devices containing P.T.F.E. should not therefore be sterilised by irradiation. M. F. ALLADINE R. N. G. ATHERSTONE London Chest Hospital and K. LITTLE Research Wantage Laboratories, Wantage, Berks. J. R. P. GIBBONS.
CARBOHYDRATE METABOLISM IN THE NEWBORN
MICROANEURYSMS
therefore arises that they are present before clinical symptoms bring the patient to the physician. Conjunctival micropools are strongly associated with vascular disease during life, and are often seen in middle-aged and younger sufferers. It seems that these findings dovetail well with the postmortem findings of the pathologists. The easy accessibility of the vessels of the conjunctiva to biomicroscopy allows us to see micropools in a sample of vessels-a finding which probably reflects what is happening in the small vessels elsewhere in the body. Capillary Research Laboratory, ELI DAVIS. Hadassah University Hospital, Jerusalem.
Starr-
across
INTRACEREBRAL HÆMORRHAGE AND
SIR,-In connection with your leading articleand the subsequent correspondence on this topic, the findings of my colleagues and myself2 of conjunctival vascular micropools (" microaneurysms ") are of interest. Conjunctival micropools are nearly three times more common in patients with vascular disease (including hypertension and diabetes mellitus) than in healthy controls or in patients with non-vascular diseases in the same age-groups. They can be seen on biomicroscopy at the time of the first clinical diagnosis of the disease. The possibility
a
SIR,-The finding by Dr. Schiff and Dr. Lowy (March 2, 475) of an increase in serum-insulin secretion in small for dates " babies with hypoglycxmia seems to confirm a hitherto unproven suspicion that we are dealing with a transient hyperinsulinism in these infants who show signs of intrauterine malnutrition.3 Their report also lends scientific respectability to the somewhat empirical but clinically effective treatment of this condition with intramuscular hydrocortisone.34 In the light of this important and exciting Hammersmith work it seems that hydrocortisone may exert its chief effect in these cases by blotting out " any excessive insulin activity, thus allowing an early return to a more stable normoglycaemia than can be realised by giving only carbohydrates of whatever sort by "
p.
"
whatever route. Further experience during the past few years with the hydrocortisone therapy of neonates with idiopathic hypoglycsemia has suggested that a quicker and more clearcut response can often be achieved by using a rather larger dose than that previously recommended (25 mg., repeated as dictated by Alladine, M. F., Atherstone, R. G., Crawford, C. G., Gibbons, J. R. P. Lancet, 1966, ii, 969. 2. Little, K. Proceedings of the 4th International Conference on Electron Microscopy; p. 165. (London, 1954); The Effects of High Doses of Ionising Radiation on Organic High Polymers. H.M. Stationery Office; 1.
1957.
3. 4.
Creery, Creery,
R. D. G. Devl Med. Child Neurol. 1966, R. D. G. Lancet, 1963, i, 1423.
8, 746.