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NEONATAL HYDROCEPHALUS TREATED BY COMPRESSIVE HEAD WRAPPING
334 total of 6, 8, and 10 days, respectively. Cessation of 0, therapy in case 3 was followed by return of the murmur and bounding peripheral pulsation. 30-35% 02 was then readministered for a further 10 days; there was no second relapse. The Pao, was measured intermittently by radial arterial stab in 2 cases; in 30 % 0 .the mean Pay,was 80 mm. Hg and in 35 % 0it was 136 mm. Hg. The highest Pao2 recorded was 152 mm. Hg. In each case the fundi were examined carefully and repeatedly: no effects of oxygen toxicity were observed. In cases 1 and 2 no other therapy apart from O2 was given. In case 3 digoxin and diuretics had been given for 9 days before starting O2 therapy without controlling the cardiac failure. This infant had striking water-hammer pulses and a very loud murmur and thrill; the clinical, radiological, and E.C.G. improvement in 35% 0was particularly dramatic in this case. All 3 infants have been seen repeatedly at the follow-up clinic and are considered ncrmal with respect to both cardiopulmonary status and development.
Obviously since
no
our
findings
must
be treated with
cardiac-catheterisation studies
were
caution,
performed.
return of cardiac status to normal in the clinical diagnosis. Also, the fact that supports P.D.A. and cardiac failure were recognised only on 3 occasions in 21 months suggests that the condition was not overdiagnosed. Clearly, though, more sophisticated studies are required before these preliminary findings can be accepted. If and when confirmation is received it may prove possible to treat a relatively common and serious problem by applying a physiological principle. In the meantime it will be wise to continue to use oxygen with care in such infants. Apart from the risks of oxygen toxicity it is also possible that a raised P a02 might induce a fall in pulmonary vascular resistance without closing the P.D.A.; in such a case the left-to-right shunt and cardiac failure might then be accentuated. It is of interest that all our 3 mothers were heavy smokers. While this may be a coincidence, it is at least possible that maternal smoking might increase the likelihood of P.D.A. either by having a direct effect on the ductus or by lowering the oxygen-carrying capacity of the infant’s blood at a critical time. We hope to investigate this possibility further.
However, the rapid each
case
University of Bristol, Department of Child Health, Southmead Hospital, Bristol.
PETER M. DUNN BRIAN D. SPEIDEL.
NEONATAL HYDROCEPHALUS TREATED BY COMPRESSIVE HEAD WRAPPING Sn,-In the article by Dr Epstein and his colleagues1 there are two points worth pondering. First, since the patients selected by the authors had " normal or only slightly raised intraventricular pressure ", how can they be sure that these patients were not going to prove to have " compensated hydrocephalus "? All of us have seen patients with the astiological factors noted by the authors in their cases, manifesting an " arrested " or " compensated " state. Not everyone therefore will agree with the authors’ statement that " Untreated human neonatal hydrocephalus, secondary to an obstruction of C.S.F. circulation, is more often relentlessly progressive." Second, it is a pity that the authors did not carry their historical research beyond 1823. They might then have learnt why Barnard’s suggestion was given up. One quote will suffice here:
elastic bandage as expansion, and yet not
an
to exert pressure sufficient to to cause undue compression."$
Department of Neurosurgery, K. E. M. Hospital, Parel, Bombay 12.
prevent
S. K. PANDYA.
ERRORS IN PHENYTOIN DOSAGE
SIR,—Dr Clow and his colleagues (Aug. 4, p. 256) stated that Parke-Davis would shortly be improving the identification of’Epanutin’ capsules by dose stamping and colour coding. For the information of your readers, epanutin capsules 50 mg. are now presented in a no. 4 white opaque hard gelatin capsule overprinted with the name Parke-Davis and PD 50 to indicate the product strength. This change was implemented as from week commencing May 7, 1973. Epanutin capsules 100 mg. are now presented in a no. 3 capsule with a white opaque body and an orange cap. Parke-Davis and PD 100 are printed on the capsule. This change was made as from July 16, 1973. The contents of each of the above capsules remain unchanged.
J. R. ARCHER, Parke-Davis, Pontypool, Mon. NP4 8YH.
Director, professional services.
Wilks, Diseases of the Nervous System, p. 145. Cited by the editor of Rest and Pain, by John Hilton. London, 1887.
2. Dr
Obituary MARY ELIZABETH MAUREEN STEPHENS
M.B.Cantab., M.R.C.P. Stephens, a research fellow in the gastroenterology laboratory at St. Thomas’s Hospital, London, died early in June at the age of 32. Her death has ended a medical career which had seemed very promising. Dr Elizabeth
" Liz " Stephens, as she was affectionately known to her friends and colleagues, had a very distinguished undergraduate record. She won scholarships to Girton College, Cambridge, where she did her preclinical studies, and to University College Hospital, London where she also won numerous prizes and medals during her clinical years. Her preregistration and postregistration appointments were held in some of the best medical units of London’s hospitals. Her interests gradually drifted towards gastroenterology, in which she specialised during the last few years of her life. She published two papers on aflatoxins and folic acid. Liz Stephens’ interests were not confined to medicine. She was an accomplished pianist and, in her undergraduate years, actively participated in drama. She had a warm, pleasing personality, and she won the respect of her colleagues with her shy but determined and conscientious ways. Her patients were well looked after-and knew it. M.S.
"
I have myself tried it [repeated aspiration of c.s.F. from hydrocephalic patients] in two cases; but should never propose it again-not on account of the severity of the operation but from the want of possible success-when the fluid is drawn off it will and in order to prevent this, if a bandage be applied symptoms of compression follow. Our difficulty was so to regulate
again form, 1.
Epstein, F., Hochwald, G. M., Ransohoff, J. Lancet, 1973, i, 634.
Births, Marriages and Deaths DEATHS LING.—On July 30, in Perth, Western Australia, Thomas Mortimer
Ling, n.M.Oxon,
M.R.C.P., of
Shackleford, Surrey.
Obviously since
no
our
findings
must
be treated with
cardiac-catheterisation studies
were
caution,
performed.
return of cardiac status to normal in the clinical diagnosis. Also, the fact that supports P.D.A. and cardiac failure were recognised only on 3 occasions in 21 months suggests that the condition was not overdiagnosed. Clearly, though, more sophisticated studies are required before these preliminary findings can be accepted. If and when confirmation is received it may prove possible to treat a relatively common and serious problem by applying a physiological principle. In the meantime it will be wise to continue to use oxygen with care in such infants. Apart from the risks of oxygen toxicity it is also possible that a raised P a02 might induce a fall in pulmonary vascular resistance without closing the P.D.A.; in such a case the left-to-right shunt and cardiac failure might then be accentuated. It is of interest that all our 3 mothers were heavy smokers. While this may be a coincidence, it is at least possible that maternal smoking might increase the likelihood of P.D.A. either by having a direct effect on the ductus or by lowering the oxygen-carrying capacity of the infant’s blood at a critical time. We hope to investigate this possibility further.
However, the rapid each
case
University of Bristol, Department of Child Health, Southmead Hospital, Bristol.
PETER M. DUNN BRIAN D. SPEIDEL.
NEONATAL HYDROCEPHALUS TREATED BY COMPRESSIVE HEAD WRAPPING Sn,-In the article by Dr Epstein and his colleagues1 there are two points worth pondering. First, since the patients selected by the authors had " normal or only slightly raised intraventricular pressure ", how can they be sure that these patients were not going to prove to have " compensated hydrocephalus "? All of us have seen patients with the astiological factors noted by the authors in their cases, manifesting an " arrested " or " compensated " state. Not everyone therefore will agree with the authors’ statement that " Untreated human neonatal hydrocephalus, secondary to an obstruction of C.S.F. circulation, is more often relentlessly progressive." Second, it is a pity that the authors did not carry their historical research beyond 1823. They might then have learnt why Barnard’s suggestion was given up. One quote will suffice here:
elastic bandage as expansion, and yet not
an
to exert pressure sufficient to to cause undue compression."$
Department of Neurosurgery, K. E. M. Hospital, Parel, Bombay 12.
prevent
S. K. PANDYA.
ERRORS IN PHENYTOIN DOSAGE
SIR,—Dr Clow and his colleagues (Aug. 4, p. 256) stated that Parke-Davis would shortly be improving the identification of’Epanutin’ capsules by dose stamping and colour coding. For the information of your readers, epanutin capsules 50 mg. are now presented in a no. 4 white opaque hard gelatin capsule overprinted with the name Parke-Davis and PD 50 to indicate the product strength. This change was implemented as from week commencing May 7, 1973. Epanutin capsules 100 mg. are now presented in a no. 3 capsule with a white opaque body and an orange cap. Parke-Davis and PD 100 are printed on the capsule. This change was made as from July 16, 1973. The contents of each of the above capsules remain unchanged.
J. R. ARCHER, Parke-Davis, Pontypool, Mon. NP4 8YH.
Director, professional services.
Wilks, Diseases of the Nervous System, p. 145. Cited by the editor of Rest and Pain, by John Hilton. London, 1887.
2. Dr
Obituary MARY ELIZABETH MAUREEN STEPHENS
M.B.Cantab., M.R.C.P. Stephens, a research fellow in the gastroenterology laboratory at St. Thomas’s Hospital, London, died early in June at the age of 32. Her death has ended a medical career which had seemed very promising. Dr Elizabeth
" Liz " Stephens, as she was affectionately known to her friends and colleagues, had a very distinguished undergraduate record. She won scholarships to Girton College, Cambridge, where she did her preclinical studies, and to University College Hospital, London where she also won numerous prizes and medals during her clinical years. Her preregistration and postregistration appointments were held in some of the best medical units of London’s hospitals. Her interests gradually drifted towards gastroenterology, in which she specialised during the last few years of her life. She published two papers on aflatoxins and folic acid. Liz Stephens’ interests were not confined to medicine. She was an accomplished pianist and, in her undergraduate years, actively participated in drama. She had a warm, pleasing personality, and she won the respect of her colleagues with her shy but determined and conscientious ways. Her patients were well looked after-and knew it. M.S.
"
I have myself tried it [repeated aspiration of c.s.F. from hydrocephalic patients] in two cases; but should never propose it again-not on account of the severity of the operation but from the want of possible success-when the fluid is drawn off it will and in order to prevent this, if a bandage be applied symptoms of compression follow. Our difficulty was so to regulate
again form, 1.
Epstein, F., Hochwald, G. M., Ransohoff, J. Lancet, 1973, i, 634.
Births, Marriages and Deaths DEATHS LING.—On July 30, in Perth, Western Australia, Thomas Mortimer
Ling, n.M.Oxon,
M.R.C.P., of
Shackleford, Surrey.