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NARCOTICS AND PARENTAL BEHAVIOUR
1076
hydrocarbons
as
an
established
measure
of bacterial surface
that this indeed plays a part in adherence to plastic hydrophobicity,3 material.22 Furthermore, we have found that lowering hydrophobicity by use of detergents reduces adherence of bacteria to
intravenous catheters.
Department of Paediatrics B, Beilinson Medical Center, Petah Tikva 49 100, Israel
S. ASHKENAZI
NARCOTICS AND PARENTAL BEHAVIOUR
SIR,-Mr Cave (April 21, p 910) has put forward evidence that narcotic addiction interferes with parental behaviour; as well as the detrimental effect of intoxication, there is a preoccupation with obtaining drugs and attendant financial problems. In addition, narcotics may disrupt normal parental behaviour by specific pharmacological effects. In rats maternal behaviour is regulated by progesterone and oestradiol;4oestradiol lowers brain f3-endorphin levels,5 and subcutaneous morphine disrupts maternal behaviour.Direct brain application of morphine suggests that the effect may be mediated by the medial preoptic area, an area involved in the oestrogen-stimulated onset of maternal behaviour.7 Friern Hospital, Friern Barnet Road, London N11 3BP
MALCOLM P. I. WELLER
HEADACHE AND DEPRESSION
SIR,-In addition to the evidence given in your editorial (March 3, p 495) linking abnormalities of 5-hydroxytryptamine (5-HT) with both depression and headache, platelet 5-HT uptake has been reported to be reduced both in patients with depressive illnessand in migraineurs between attacks.9 labels a site associated with the active uptake of 5-HT, and in depressive illness decreased imipramine binding sites have been reported both in and in brain." Interest has thus been aroused in the possibility that reduced 3H-imipramine binding sites may be a biochemical marker for depressive illness. We have found that drugfree classical migraineurs also have a significant decrease in platelet binding sites between attacks.12 This finding extends the evidence relating abnormalities of 5-HT to both depression and migraine and suggests that reduced platelet binding sites may not be specific for depressive illness.
3H-imipramine
plateletslO
3H-imipramine
3H-imipramine
D. P. GEANEY MRC Unit and University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
J. M. ELLIOTT M. G. RUTTERFORD M. SCHACHTER D. G. GRAHAME-SMITH
3
Rosenberg M, Gutnick D, Rosenberg E. Adherence of bacteria to hydrocarbons. A simple method for measuring cell-surface hydrophobicity FEMS Microbiol Lett
4.
Bridges RS, Russell DW. Steroidal interactions in the regulation of maternal behaviour in virgin female rats effects of testosterone, dihydrotestosterone, oestradiol, progesterone and the aromatase inhibitor 1,4,6-androstatriene-3, 17-dione. J
1980; 9:
INTERMITTENT ABDOMINAL COMPRESSION DURING CARDIOPULMONARY RESUSCITATION
SIR,-Experimental work has shown that blood flow during cardiopulmonary resuscitation (CPR) with closed-chest massage is achieved by a thoracic pump mechanism rather than by direct compression of the heart between sternum and spine. The extent to which these mechanisms operate in clinical CPR is unclear. Various modifications of standard CPR have been conceived, aimed at an increase in intrathoracic (and, therefore, arterial) pressure; these modifications include prolonged chest compression, simultaneous compression and ventilation, abdominal binding and compression, and use of the MAST garment.’ These interventions have been tested clinically on a limited basis. However, most of them are impractical for routine use during CPR on patients, andfor many of them the impact on coronary blood flow is uncertain.2In animal studies, the magnitude of coronary blood flow, as judged by the level of "diastolic" blood pressure, is critical in determining survival
during CPR.3 A practical
variation of standard CPR with the potential to increase "diastolic" blood pressure during the release phase of thoracic compression consists of alternating compression of chest and abdomen, as described by Ralston et al4 during CPR in dogs; these workers used a mechanical device to compress the chest. We have limited experience with this method, done manually, in eight patients with various modes of cardiac arrest, admitted to our medical intensive care unit. These patients had their ECG and arterial pressure monitored via a radial artery cannula, and in some of them pulmonary arterial pressures were monitored via a balloontipped pulmonary artery catheter. Pressures were obtained after calibration and referenced to mid-chest level. After cessation of circulation immediate CPR was done according to American Heart Association standards, interposed with alternating thoracic and abdominal compressions, done by two physicians. No concomitant drug therapy was given during these short resuscitative efforts. Timing of the two manoeuvres appeared to be critical in promoting blood pressure. In one patient (fig 1) an increased blood pressure, produced by the combined approach, occurred, but in the Cary JM, Ross BK, Culver BM, Butler J. New developments in cardiopulmonary resuscitation. JAMA 1980; 244: 1366-70 2. Niemann JT, Rosborough JP, Ung S, Criley JM. Coronary perfusion pressure during experimental cardiopulmonary resuscitation Ann Emerg Med 1982; 11: 127-31. 3. Pearson JW, Redding JS. Influence of peripheral vascular tone on cardiac resuscitation Anesth Analg 1965, 44: 746-52. 4. Ralston SH, Babbs CF, Niebauer MJ Cardiopulmonary resuscitation with interposed abdominal compression in dogs Anesth Analg 1982; 61: 645-51 1. Luce JM,
ECG
29-33.
Endocrinol 1981, 90: 31-40 5. Shaikh AA, Naqvi RH, Shaikh SA. Concentrations of oestradiol-17 beta and progesterone in the peripheral plasma of the cynomolgus monkey (Macaca fascicularis) in relation to the length of the menstrual cycle and its component 6.
phases. J Endocrinol 1978; 79: 1-7. Bridges RS, Grimm CT. Reversal of morphine disruption of maternal behaviour by concurrent treatment with the opiate antagonist naloxone. Science 1982; 218: 166-68.
M, Rosenblatt JS, Komisaruk BR. Medical preoptic area and onset of maternal behaviour in the rat. J Comp Physiol Psychol 1977; 91: 146-64 8. Tuomisto J, Tukiainen E, Ahlfors UG. Decreased uptake of 5-hydroxytryptamine in blood platelets from patients with endogenous depression. Psychopharmacology (Berlin) 1979; 65: 141-47. 9. Malmgren R, Olsson P, Tornhng G, Unge G. The 5-hydroxytryptamine take-up mechanism in normal platelets and platelets from migraine and asthmatic patients. Thrombosis Res 1980; 18: 733-41. 10. Briley MS, Langer SZ, Raisman R, Sechter D, Zarifian E. Tritiated imipramine binding sites are decreased in platelets of untreated depressed patients. Science 1980; 209: 303-05. 11. Stanley M, Virgilio J, Gershon S. Tritiated imipramine binding sites are decreased in the frontal cortex of suicides. Science 1982; 216: 1337-39. 12 Geaney DP, Rutterford MG, Elliott JM, Schächter M, Peet KMS, Grahame-Smith DG Decreased platelet ’ H-imipramine binding sites in classical migraine. Neurol J 7. Numan
Neurosurg Psychiat (in press)
of ECG, blood pressure (BP), and pulmonary arterial pressure (PAP), continuing on the three strips below, from a patient resuscitated with thoracic (T) and alternating thoracic (T) and abdominal (A) compressions, resulting in higher blood pressures.
Fig 1-Recording
The
last
pressure
waves
on
the bottom
compressions only. Note concomitant compression.
increase
strip represent thoracic in PAP with abdominal
hydrocarbons
as
an
established
measure
of bacterial surface
that this indeed plays a part in adherence to plastic hydrophobicity,3 material.22 Furthermore, we have found that lowering hydrophobicity by use of detergents reduces adherence of bacteria to
intravenous catheters.
Department of Paediatrics B, Beilinson Medical Center, Petah Tikva 49 100, Israel
S. ASHKENAZI
NARCOTICS AND PARENTAL BEHAVIOUR
SIR,-Mr Cave (April 21, p 910) has put forward evidence that narcotic addiction interferes with parental behaviour; as well as the detrimental effect of intoxication, there is a preoccupation with obtaining drugs and attendant financial problems. In addition, narcotics may disrupt normal parental behaviour by specific pharmacological effects. In rats maternal behaviour is regulated by progesterone and oestradiol;4oestradiol lowers brain f3-endorphin levels,5 and subcutaneous morphine disrupts maternal behaviour.Direct brain application of morphine suggests that the effect may be mediated by the medial preoptic area, an area involved in the oestrogen-stimulated onset of maternal behaviour.7 Friern Hospital, Friern Barnet Road, London N11 3BP
MALCOLM P. I. WELLER
HEADACHE AND DEPRESSION
SIR,-In addition to the evidence given in your editorial (March 3, p 495) linking abnormalities of 5-hydroxytryptamine (5-HT) with both depression and headache, platelet 5-HT uptake has been reported to be reduced both in patients with depressive illnessand in migraineurs between attacks.9 labels a site associated with the active uptake of 5-HT, and in depressive illness decreased imipramine binding sites have been reported both in and in brain." Interest has thus been aroused in the possibility that reduced 3H-imipramine binding sites may be a biochemical marker for depressive illness. We have found that drugfree classical migraineurs also have a significant decrease in platelet binding sites between attacks.12 This finding extends the evidence relating abnormalities of 5-HT to both depression and migraine and suggests that reduced platelet binding sites may not be specific for depressive illness.
3H-imipramine
plateletslO
3H-imipramine
3H-imipramine
D. P. GEANEY MRC Unit and University Department of Clinical Pharmacology, Radcliffe Infirmary, Oxford OX2 6HE
J. M. ELLIOTT M. G. RUTTERFORD M. SCHACHTER D. G. GRAHAME-SMITH
3
Rosenberg M, Gutnick D, Rosenberg E. Adherence of bacteria to hydrocarbons. A simple method for measuring cell-surface hydrophobicity FEMS Microbiol Lett
4.
Bridges RS, Russell DW. Steroidal interactions in the regulation of maternal behaviour in virgin female rats effects of testosterone, dihydrotestosterone, oestradiol, progesterone and the aromatase inhibitor 1,4,6-androstatriene-3, 17-dione. J
1980; 9:
INTERMITTENT ABDOMINAL COMPRESSION DURING CARDIOPULMONARY RESUSCITATION
SIR,-Experimental work has shown that blood flow during cardiopulmonary resuscitation (CPR) with closed-chest massage is achieved by a thoracic pump mechanism rather than by direct compression of the heart between sternum and spine. The extent to which these mechanisms operate in clinical CPR is unclear. Various modifications of standard CPR have been conceived, aimed at an increase in intrathoracic (and, therefore, arterial) pressure; these modifications include prolonged chest compression, simultaneous compression and ventilation, abdominal binding and compression, and use of the MAST garment.’ These interventions have been tested clinically on a limited basis. However, most of them are impractical for routine use during CPR on patients, andfor many of them the impact on coronary blood flow is uncertain.2In animal studies, the magnitude of coronary blood flow, as judged by the level of "diastolic" blood pressure, is critical in determining survival
during CPR.3 A practical
variation of standard CPR with the potential to increase "diastolic" blood pressure during the release phase of thoracic compression consists of alternating compression of chest and abdomen, as described by Ralston et al4 during CPR in dogs; these workers used a mechanical device to compress the chest. We have limited experience with this method, done manually, in eight patients with various modes of cardiac arrest, admitted to our medical intensive care unit. These patients had their ECG and arterial pressure monitored via a radial artery cannula, and in some of them pulmonary arterial pressures were monitored via a balloontipped pulmonary artery catheter. Pressures were obtained after calibration and referenced to mid-chest level. After cessation of circulation immediate CPR was done according to American Heart Association standards, interposed with alternating thoracic and abdominal compressions, done by two physicians. No concomitant drug therapy was given during these short resuscitative efforts. Timing of the two manoeuvres appeared to be critical in promoting blood pressure. In one patient (fig 1) an increased blood pressure, produced by the combined approach, occurred, but in the Cary JM, Ross BK, Culver BM, Butler J. New developments in cardiopulmonary resuscitation. JAMA 1980; 244: 1366-70 2. Niemann JT, Rosborough JP, Ung S, Criley JM. Coronary perfusion pressure during experimental cardiopulmonary resuscitation Ann Emerg Med 1982; 11: 127-31. 3. Pearson JW, Redding JS. Influence of peripheral vascular tone on cardiac resuscitation Anesth Analg 1965, 44: 746-52. 4. Ralston SH, Babbs CF, Niebauer MJ Cardiopulmonary resuscitation with interposed abdominal compression in dogs Anesth Analg 1982; 61: 645-51 1. Luce JM,
ECG
29-33.
Endocrinol 1981, 90: 31-40 5. Shaikh AA, Naqvi RH, Shaikh SA. Concentrations of oestradiol-17 beta and progesterone in the peripheral plasma of the cynomolgus monkey (Macaca fascicularis) in relation to the length of the menstrual cycle and its component 6.
phases. J Endocrinol 1978; 79: 1-7. Bridges RS, Grimm CT. Reversal of morphine disruption of maternal behaviour by concurrent treatment with the opiate antagonist naloxone. Science 1982; 218: 166-68.
M, Rosenblatt JS, Komisaruk BR. Medical preoptic area and onset of maternal behaviour in the rat. J Comp Physiol Psychol 1977; 91: 146-64 8. Tuomisto J, Tukiainen E, Ahlfors UG. Decreased uptake of 5-hydroxytryptamine in blood platelets from patients with endogenous depression. Psychopharmacology (Berlin) 1979; 65: 141-47. 9. Malmgren R, Olsson P, Tornhng G, Unge G. The 5-hydroxytryptamine take-up mechanism in normal platelets and platelets from migraine and asthmatic patients. Thrombosis Res 1980; 18: 733-41. 10. Briley MS, Langer SZ, Raisman R, Sechter D, Zarifian E. Tritiated imipramine binding sites are decreased in platelets of untreated depressed patients. Science 1980; 209: 303-05. 11. Stanley M, Virgilio J, Gershon S. Tritiated imipramine binding sites are decreased in the frontal cortex of suicides. Science 1982; 216: 1337-39. 12 Geaney DP, Rutterford MG, Elliott JM, Schächter M, Peet KMS, Grahame-Smith DG Decreased platelet ’ H-imipramine binding sites in classical migraine. Neurol J 7. Numan
Neurosurg Psychiat (in press)
of ECG, blood pressure (BP), and pulmonary arterial pressure (PAP), continuing on the three strips below, from a patient resuscitated with thoracic (T) and alternating thoracic (T) and abdominal (A) compressions, resulting in higher blood pressures.
Fig 1-Recording
The
last
pressure
waves
on
the bottom
compressions only. Note concomitant compression.
increase
strip represent thoracic in PAP with abdominal