- Email: [email protected]
IRON-DEXTRAN: TOTAL-DOSE INFUSION TECHNIQUE
1015
We put these findings forward in the hope that they may help to throw light on the aetiology and development of neoplasia in the reticuloendothelial system. We should like to thank Dr. J. E. Cates for permission to publish this case; and Mr. R. H. Poulding for his technical assistance. We wish also to acknowledge the receipt of research grants from the South Western Regional Hospital Board and the Ethel Showering
I should like to thank Dr. A. M. Nussey for kindly permitting publish this case and for his advice; Dr. J. C. McKinnell for his report on the necropsy findings; and Mr. G. Billington, H.M. Coroner, for permission to refer to the postmortem report. me to
Selly Oak Hospital, Birmingham.
M. EHTISHAMUDDIN.
IRON-DEXTRAN: TOTAL-DOSE INFUSION
Fund.
TECHNIQUE
Department of Pathology, Southmead Hospital, Bristol.
F. J. W. LEWIS I. L. FRASER MARGARET MACTAGGART.
STUDY LEAVE
SIR,-It is generally agreed that the
rules should govern those working in the National Health Service, no matter in which region they work. Yet there are gross discrepancies in the grant of study leave by different regional boards, and by different hospital groups under the same regional board. same
SiR,—The technique of total-dose infusion of irondextran (’ Imferon ’) described by Basuand Dr. Powell (Aug. 3) is useful in many other conditions in which rapid and effective correction of severe iron deficiency is
imperative. One obvious use is in patients with gynxcological disorders
the preparation of in the limited time
available before elective surgery. 30 patients treated with infusion of imferon in this hospital have been followed for long enough to assess the degree of response. The average rise in haemoglobin per week was 1.04 g. per 100 ml. Only 1 of the 30 patients showed a
Last year, while working under one regional board, I was reaction to the infusion. This occurred within ten seconds of 3 weeks’ study leave with full pay; this year, working beginning the infusion-i.e., during the " test-dose " period in under another regional board, I had 1 day’s study leave with which the rate of administration was only 20 drops per minute. full pay, to sit an examination. The patient had nausea and palpitations, associated with facial The sanction of study leave in this group depends on rank. and coughing. The infusion was stopped immediately, flushing I do not think it makes any sense that a registrar should have and rapid recovery took place within fifteen minutes without 2 weeks’ study leave whereas a senior house-officer has study . any special treatment. One hour later, a 2 ml. test-dose of leave only for the day of an examination. If there is to be any imferon was injected intramuscularly, followed by four 5 ml. discrimination at all, it should be for different examinations injections given on alternate days in the outpatient clinic. and certainly not for different ranks. There were no further untoward effects and response was German Hospital, N. satisfactory. S. E.8. CHATTERJEE. London,
granted
TRANYLCYPROMINE
further instance 1-7 of a fatal reaction to tranylcypromine (’ Parnate ’). The patient is known to have been an amphetamine addict. A woman of 39, who had an unhappy married lif, had a history of depression for about seven years. For this-she had dexamphetamine (in the form of ’Daprisal ’ tablets, 6-8 daily) for several years and later became addicted to it. She was once admitted to a psychiatric hospital with disturbed
SIR,-Iwish
to
draw attention
to a
paranoid state after taking a large amount of and she improved after this drug was withdrawn. She was then given tranquillisers, mainly of the phenothiazine group, but she also had isocarboxazid (‘Marplan’) (10 mg.t.d.s.) for a few weeks. Finally she was given tranylcypromine (10 mg. twice daily), and while this drug was being given she had some rigors. On the eighth day of the treatment she complained of headache and was later found unconscious. It was later discovered that she had taken 16 tablets of tranylcypromine earlier that day. On admission to hospital she was comatose and breathing stertorously. Her pupils were fixed, equal, and dilated. There was some neck stiffness, deep reflexes were brisk, and the plantar responses were extensor. Her blood-pressure was 170/110 mm. Hg, compared with a recent record of 120/80. In view of the history of overdose, gastric lavage was performed. Her condition deteriorated rapidly, her temperature rose to 107.4°F, and apnoea developed. Measures were taken to restore breathing by means of a respirator. A lumbar puncture demonstrated a subarachnoid haemorrhage. She never regained consciousness and died five days later. Postmortem examination showed a haemorrhage about 11/2 in. in diameter in the left frontal lobe and adjacent part of the parietal lobe. A little blood had entered the ventricles, and there was a small amount of bloodstaining of the subarachnoid space around the brain-stem. There was no evidence of aneurysm or significant atheroma of the cerebral arteries.
The ease with which imferon is given by continuous infusion is so much appreciated by the patient and the response is so predictable and rapid that this technique has now been adopted as routine for the management of patients with severe iron deficiency in this hospital. Royal Samaritan Hospital for Women, Victoria Road, Glasgow. 1. Basu, S. K. Lancet, 1963, i,
R. S. LANE. 1430.
Appointments
behaviour and
amphetamine,
1. Zeck, P. Med. J. Aus. 1961, ii, 607. 2. Mason, A. Lancet, 1962, i, 1073. 3. McClure, J. L. ibid. p. 1351. 4. Womack, A. M. Brit. med. J. Aug. 10, 1963, p. 366. 5. Blackwell, B. Lancet, Aug. 24, 1963, p. 414. 6. Enoch, D. ibid. p. 463. 7. Low-Beer, G. A., Tidmarsh, D. Brit. Med. J. Sept.
COLEMAN, D. J., M.B. Lond., F.F.A. R.C.S. : consultant anaathetist, National Hospital, Queen Square, London. EvANS, D. K., M.B. Lond., F.R.C.S. : consultant orthopaedic surgeon, United Sheffield
Hospitals and Regional Hospital
Board
spinal injuries unit.
MORGAN, J. G., M.B., B.sc. Wales, F.F.A. R.C.S.: consultant anxsthetist, United Cardiff Hospitals and Welsh Hospital Board. MoRRis, J. E., M.B., B.SC. Wales, D.C.H., D.P.H., D.i.H.: chief assistant M.O.H., headquarters staff, Lancashire health department. OATES, J. K., M.B. Lond., M.R.C.P. : consultant venereologist, Westminster
Hospital,
London.
M.B. Manc., F.F.A. R.C.S., D.A.: honorary consultant anaesthetist, French Hospital and Dispensary, London. * SHAw, J. F., M.B. Lond., F.R.C.S. : consultant neurological surgeon, Western General Hospital and Royal Infirmary, Edinburgh. WALTON, W. J., M.B. Lond., F.F.A. R.C.S.l., D.A.: consultant anxsthetist, Derby area. St. George’s Hospital, London: CATFORD, G. V., M.B. Brist., F.R.C.S., D.o.: consultant surgeon in ophthalmology. KERR, 1. H., M.B. Cantab., M.R.C.P., F.F.R., D.M.R.D.: consultant radiologist. LAMBERT, H. P., M.D. Cantab., M.R.C.P. : consultant physician with an
PLANTEVIN, O.M.,
interest in infectious diseases.
PHILLIPS, C. I., surgeon in
PH.D. Brist., M.D. Aberd., ophthalmology. *
F.R.C.S., D.P.H., D.o.: consultant
Amended notice.
Wessex Regional Hospital Board: AsHTON, FRED, M.A., M.D. Cantab.: consultant physician in geriatrics, Southampton hospital group. CARTER, D. M., M.B. Lond., D.P.M.: S.H.M.O. in psychiatry, Herrison hos-
pital
group.
MOFFATT, W. H.,
M.B.
Belf.,
M.R.C.P.l.:
Bournemouth and East Dorset
POLAK, ADOLF, mouth
B.A., M.D. Cantab., group.
consultant
physician
in
geriatrics,
hospital
group. M.R.C.P. : consultant
physician,
Ports-
hospital
Births, Marriages, and Deaths 14, 1963, p. 684.
QUILLIAM -On Nov. 1. at his home, "Clovelly", Yester Park, Chislehurst, Kent, Dr. R. L. Quilliam, radiologist, St. James’ Hospital, Balham.
We put these findings forward in the hope that they may help to throw light on the aetiology and development of neoplasia in the reticuloendothelial system. We should like to thank Dr. J. E. Cates for permission to publish this case; and Mr. R. H. Poulding for his technical assistance. We wish also to acknowledge the receipt of research grants from the South Western Regional Hospital Board and the Ethel Showering
I should like to thank Dr. A. M. Nussey for kindly permitting publish this case and for his advice; Dr. J. C. McKinnell for his report on the necropsy findings; and Mr. G. Billington, H.M. Coroner, for permission to refer to the postmortem report. me to
Selly Oak Hospital, Birmingham.
M. EHTISHAMUDDIN.
IRON-DEXTRAN: TOTAL-DOSE INFUSION
Fund.
TECHNIQUE
Department of Pathology, Southmead Hospital, Bristol.
F. J. W. LEWIS I. L. FRASER MARGARET MACTAGGART.
STUDY LEAVE
SIR,-It is generally agreed that the
rules should govern those working in the National Health Service, no matter in which region they work. Yet there are gross discrepancies in the grant of study leave by different regional boards, and by different hospital groups under the same regional board. same
SiR,—The technique of total-dose infusion of irondextran (’ Imferon ’) described by Basuand Dr. Powell (Aug. 3) is useful in many other conditions in which rapid and effective correction of severe iron deficiency is
imperative. One obvious use is in patients with gynxcological disorders
the preparation of in the limited time
available before elective surgery. 30 patients treated with infusion of imferon in this hospital have been followed for long enough to assess the degree of response. The average rise in haemoglobin per week was 1.04 g. per 100 ml. Only 1 of the 30 patients showed a
Last year, while working under one regional board, I was reaction to the infusion. This occurred within ten seconds of 3 weeks’ study leave with full pay; this year, working beginning the infusion-i.e., during the " test-dose " period in under another regional board, I had 1 day’s study leave with which the rate of administration was only 20 drops per minute. full pay, to sit an examination. The patient had nausea and palpitations, associated with facial The sanction of study leave in this group depends on rank. and coughing. The infusion was stopped immediately, flushing I do not think it makes any sense that a registrar should have and rapid recovery took place within fifteen minutes without 2 weeks’ study leave whereas a senior house-officer has study . any special treatment. One hour later, a 2 ml. test-dose of leave only for the day of an examination. If there is to be any imferon was injected intramuscularly, followed by four 5 ml. discrimination at all, it should be for different examinations injections given on alternate days in the outpatient clinic. and certainly not for different ranks. There were no further untoward effects and response was German Hospital, N. satisfactory. S. E.8. CHATTERJEE. London,
granted
TRANYLCYPROMINE
further instance 1-7 of a fatal reaction to tranylcypromine (’ Parnate ’). The patient is known to have been an amphetamine addict. A woman of 39, who had an unhappy married lif, had a history of depression for about seven years. For this-she had dexamphetamine (in the form of ’Daprisal ’ tablets, 6-8 daily) for several years and later became addicted to it. She was once admitted to a psychiatric hospital with disturbed
SIR,-Iwish
to
draw attention
to a
paranoid state after taking a large amount of and she improved after this drug was withdrawn. She was then given tranquillisers, mainly of the phenothiazine group, but she also had isocarboxazid (‘Marplan’) (10 mg.t.d.s.) for a few weeks. Finally she was given tranylcypromine (10 mg. twice daily), and while this drug was being given she had some rigors. On the eighth day of the treatment she complained of headache and was later found unconscious. It was later discovered that she had taken 16 tablets of tranylcypromine earlier that day. On admission to hospital she was comatose and breathing stertorously. Her pupils were fixed, equal, and dilated. There was some neck stiffness, deep reflexes were brisk, and the plantar responses were extensor. Her blood-pressure was 170/110 mm. Hg, compared with a recent record of 120/80. In view of the history of overdose, gastric lavage was performed. Her condition deteriorated rapidly, her temperature rose to 107.4°F, and apnoea developed. Measures were taken to restore breathing by means of a respirator. A lumbar puncture demonstrated a subarachnoid haemorrhage. She never regained consciousness and died five days later. Postmortem examination showed a haemorrhage about 11/2 in. in diameter in the left frontal lobe and adjacent part of the parietal lobe. A little blood had entered the ventricles, and there was a small amount of bloodstaining of the subarachnoid space around the brain-stem. There was no evidence of aneurysm or significant atheroma of the cerebral arteries.
The ease with which imferon is given by continuous infusion is so much appreciated by the patient and the response is so predictable and rapid that this technique has now been adopted as routine for the management of patients with severe iron deficiency in this hospital. Royal Samaritan Hospital for Women, Victoria Road, Glasgow. 1. Basu, S. K. Lancet, 1963, i,
R. S. LANE. 1430.
Appointments
behaviour and
amphetamine,
1. Zeck, P. Med. J. Aus. 1961, ii, 607. 2. Mason, A. Lancet, 1962, i, 1073. 3. McClure, J. L. ibid. p. 1351. 4. Womack, A. M. Brit. med. J. Aug. 10, 1963, p. 366. 5. Blackwell, B. Lancet, Aug. 24, 1963, p. 414. 6. Enoch, D. ibid. p. 463. 7. Low-Beer, G. A., Tidmarsh, D. Brit. Med. J. Sept.
COLEMAN, D. J., M.B. Lond., F.F.A. R.C.S. : consultant anaathetist, National Hospital, Queen Square, London. EvANS, D. K., M.B. Lond., F.R.C.S. : consultant orthopaedic surgeon, United Sheffield
Hospitals and Regional Hospital
Board
spinal injuries unit.
MORGAN, J. G., M.B., B.sc. Wales, F.F.A. R.C.S.: consultant anxsthetist, United Cardiff Hospitals and Welsh Hospital Board. MoRRis, J. E., M.B., B.SC. Wales, D.C.H., D.P.H., D.i.H.: chief assistant M.O.H., headquarters staff, Lancashire health department. OATES, J. K., M.B. Lond., M.R.C.P. : consultant venereologist, Westminster
Hospital,
London.
M.B. Manc., F.F.A. R.C.S., D.A.: honorary consultant anaesthetist, French Hospital and Dispensary, London. * SHAw, J. F., M.B. Lond., F.R.C.S. : consultant neurological surgeon, Western General Hospital and Royal Infirmary, Edinburgh. WALTON, W. J., M.B. Lond., F.F.A. R.C.S.l., D.A.: consultant anxsthetist, Derby area. St. George’s Hospital, London: CATFORD, G. V., M.B. Brist., F.R.C.S., D.o.: consultant surgeon in ophthalmology. KERR, 1. H., M.B. Cantab., M.R.C.P., F.F.R., D.M.R.D.: consultant radiologist. LAMBERT, H. P., M.D. Cantab., M.R.C.P. : consultant physician with an
PLANTEVIN, O.M.,
interest in infectious diseases.
PHILLIPS, C. I., surgeon in
PH.D. Brist., M.D. Aberd., ophthalmology. *
F.R.C.S., D.P.H., D.o.: consultant
Amended notice.
Wessex Regional Hospital Board: AsHTON, FRED, M.A., M.D. Cantab.: consultant physician in geriatrics, Southampton hospital group. CARTER, D. M., M.B. Lond., D.P.M.: S.H.M.O. in psychiatry, Herrison hos-
pital
group.
MOFFATT, W. H.,
M.B.
Belf.,
M.R.C.P.l.:
Bournemouth and East Dorset
POLAK, ADOLF, mouth
B.A., M.D. Cantab., group.
consultant
physician
in
geriatrics,
hospital
group. M.R.C.P. : consultant
physician,
Ports-
hospital
Births, Marriages, and Deaths 14, 1963, p. 684.
QUILLIAM -On Nov. 1. at his home, "Clovelly", Yester Park, Chislehurst, Kent, Dr. R. L. Quilliam, radiologist, St. James’ Hospital, Balham.