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NOSOCOMIAL OR HOSPITAL?
870 confusion she remained fully conscious during this period and for most of it was on a normal ward diet. Shortly before her death a lung abscess and a tension pneumothorax developed. At necropsy the precise cause of death could not be determined. The liver weighed 886 g. and showed evidence of regeneration. A preliminary histological examination confirmed that the patient had had massive liver-cell necrosis, but did not uncover any evidence of an abnormal immunological state.
of the liver in the intact animal should be more than the liver in an isolated circuit and may well be a more efficient form of " hepatic support " in hepatic coma. S. J. SAUNDERS Liver Clinic and Liver Research Group, J. TERBLANCHE Groote Schuur Hospital and S. C. W. BOSMAN. University of Cape Town, South Africa. The
use
physiological
NOSOCOMIAL OR HOSPITAL? Sir,- read with pleasure and agreement the article by Dr. Ingelfinger (Oct. 5, p. 766) under the general heading The Editor Speaks. He says: " New ideas and new technology require new terms, but their use without appropriate explanation is self-defeating." In the first article in the same issue of The Lancet, the second sentence of the introductory summary A clinical and bacteriological study of 139 infections states: in Zurich, Switzerland, documented most as nosocomial " problems." Nosocomial " is certainly not a new term, but it is probably unfamiliar to many. I take it that " hospital problems " are meant. Would this important article not be made more attractive by the use of the much more familiar term " hospital " ? H. M. WALKER. Midhurst, Sussex. "
AGGRESSION AND THE XXYY ANOMALY SiR,ňThe association of mental defect with the XXY sexchromosome anomaly is well recognised, as is that of antisocial behaviour and unusual height in the XYY anomaly. Mental retardation is usual but not invariable in the latter; but in the XXYY abnormality it is characteristic and often severe, and is commonly accompanied by aggressive or antisocial behaviour. We record here the case of an XXYY male who is mentally retarded and unusually tall, but has no aggressive tendencies, and does simple and useful work. We suggest a reason why the aggressive or antisocial tendencies which seem to be conferred by an extra Y chromosome may be mitigated in such individuals. The patient, aged 19 years, was the youngest of three siblings. The other two (one man in his early thirties, and one woman) are apparently normal. His parents were both aged 36 when he was born, and have normal karyotypes. Because of mental retardation, he attended a special school, and he now works at filling pork-pies in a food factory. At the age of 10 he received some form of endocrine therapy for an undescended right testis, which failed to promote descent. At the age of 18, after attempted orchidopexy, the right testis was removed, but unfortunately not examined histologically. He is 761/2 in. (194 cm.) in height, pubis to sole 391/2 in. (100 cm.), crown to pubis 37 in. (94 cm.), and span 74112 in. (189 cm.). His penis is normal; the remaining testis is small and soft. He has profuse pubic hair, but sparse body and axillary hair; the facial hair is soft and downy, and he shaves infrequently. His scalp hair is fine, and his skin fine-textured. He has a strikingly prominent jaw and a high-arched palate. Urinary excretion of 17-oxosteroids was 3-7 and 3-8 mg. per 24 hours, and the total 17-oxo-
ASTHMATIC BREATHING IN MICE
SIR,-The P-adrenergic blockers (A.R.) sensitise mice to histamine (H.) and serotonin (s.).1 We have investigated whether inhalation of H. or s. induces bronchial asthma in animals treated with A.R. Bradykinin (B.) was also examined, since it is known that A.R. sensitise mice to the action of B. and potentiate its effect in causing asthmatic breathing.22 The accompanying table shows that H., s., and B. all produce asthmatic respiration in mice treated with A.R. Mepyramine maleate, 2-brom-lysergide (B.O.L.), or aspirin inhibit the asthmogenic effect when they are specific antagonists. Atropine has no effect on these asthma inducers. Artificially produced asthmatic breathing in mice can be used as a good model for studying asthmatic respiration, and for testing new drugs for bronchial asthma. Institute of Pharmacology, University Department of Medicine, Medical Faculty, Sarajevo, Yugoslavia. 1.
2.
P. STERN ENISA BA&Sbreve;AGIĆ.
Fishel, C. W., Szentivaniyi, A., Talmage, D. W. Immunology, 1962, 89, 8. Collier, H. D., James, G. W., Piper, P. J. J. Physiol., Lond. 1965, 180, 13P.
ASTHMOGENIC EFFECT ON MICE OF INHALATION OF ABSENCE OF
1%
P-ADRENERGIC
genic steroids 6-6 and 6-9 mg. per 24 hours. The urinary excretion of gonadotrophins was 63 human menopausal gonadotrophin units per day, which is strikingly raised. Bone-age was estimated as 17 years. Buccal smears were chromatin positive, His karyosome 10% of nuclei showing a single Barr body. was studied in fifty-three metaphase preparations from a type peripheral-blood-lymphocyte culture; all showed 48 chromosomes, with 46 autosomes and an XXYY sex-chromosome
constitution (Dr. F. G. J. Hayhoe). In view of the tendency of XYY and XXYY males to be unusually tall, the possibility that the YY state might be associated with an increased level of circulating growth hormone (H.G.H.) was considered. The plasma H.G.H. was kindly assayed by Dr. D. Wright of the Royal Postgraduate Medical School, and found to be normal. Despite his XXYY chromosomal complement, the patient was affable and cooperative, and had given no more trouble at home than the average adolescent. This contrasts with the finding of Casey et aLl of an unexpectedly high incidence of XXYY males in institutions for the mentally subnormal of persistently violent or aggressive behaviour. Ellis et a1,2 described an XXYY male who was said to be affable and could 1. Casey, M. D., Cegall, L. J., Street, D.R.K., Blank, C. E. Nature, 2.
Lond. 1966, 209, 641. Ellis, J. R., Miller, O. J., Penrose, L. S., Scott, G. E. B. Ann. hum. Genet. 1961, 25, 145.
SOLUTIONS OF BLOCKERS
HISTAMINE, SEROTONIN,
(A.R.)
AND BRADYKININ IN PRESENCE OR
AND ASTHMA ANTAGONISTS
l.P.=int]’aperitoneally. O= no protection-i.e., asthmatic breathing develops. * No asthma antagonist. fNoA.R.
-=protection.
of the liver in the intact animal should be more than the liver in an isolated circuit and may well be a more efficient form of " hepatic support " in hepatic coma. S. J. SAUNDERS Liver Clinic and Liver Research Group, J. TERBLANCHE Groote Schuur Hospital and S. C. W. BOSMAN. University of Cape Town, South Africa. The
use
physiological
NOSOCOMIAL OR HOSPITAL? Sir,- read with pleasure and agreement the article by Dr. Ingelfinger (Oct. 5, p. 766) under the general heading The Editor Speaks. He says: " New ideas and new technology require new terms, but their use without appropriate explanation is self-defeating." In the first article in the same issue of The Lancet, the second sentence of the introductory summary A clinical and bacteriological study of 139 infections states: in Zurich, Switzerland, documented most as nosocomial " problems." Nosocomial " is certainly not a new term, but it is probably unfamiliar to many. I take it that " hospital problems " are meant. Would this important article not be made more attractive by the use of the much more familiar term " hospital " ? H. M. WALKER. Midhurst, Sussex. "
AGGRESSION AND THE XXYY ANOMALY SiR,ňThe association of mental defect with the XXY sexchromosome anomaly is well recognised, as is that of antisocial behaviour and unusual height in the XYY anomaly. Mental retardation is usual but not invariable in the latter; but in the XXYY abnormality it is characteristic and often severe, and is commonly accompanied by aggressive or antisocial behaviour. We record here the case of an XXYY male who is mentally retarded and unusually tall, but has no aggressive tendencies, and does simple and useful work. We suggest a reason why the aggressive or antisocial tendencies which seem to be conferred by an extra Y chromosome may be mitigated in such individuals. The patient, aged 19 years, was the youngest of three siblings. The other two (one man in his early thirties, and one woman) are apparently normal. His parents were both aged 36 when he was born, and have normal karyotypes. Because of mental retardation, he attended a special school, and he now works at filling pork-pies in a food factory. At the age of 10 he received some form of endocrine therapy for an undescended right testis, which failed to promote descent. At the age of 18, after attempted orchidopexy, the right testis was removed, but unfortunately not examined histologically. He is 761/2 in. (194 cm.) in height, pubis to sole 391/2 in. (100 cm.), crown to pubis 37 in. (94 cm.), and span 74112 in. (189 cm.). His penis is normal; the remaining testis is small and soft. He has profuse pubic hair, but sparse body and axillary hair; the facial hair is soft and downy, and he shaves infrequently. His scalp hair is fine, and his skin fine-textured. He has a strikingly prominent jaw and a high-arched palate. Urinary excretion of 17-oxosteroids was 3-7 and 3-8 mg. per 24 hours, and the total 17-oxo-
ASTHMATIC BREATHING IN MICE
SIR,-The P-adrenergic blockers (A.R.) sensitise mice to histamine (H.) and serotonin (s.).1 We have investigated whether inhalation of H. or s. induces bronchial asthma in animals treated with A.R. Bradykinin (B.) was also examined, since it is known that A.R. sensitise mice to the action of B. and potentiate its effect in causing asthmatic breathing.22 The accompanying table shows that H., s., and B. all produce asthmatic respiration in mice treated with A.R. Mepyramine maleate, 2-brom-lysergide (B.O.L.), or aspirin inhibit the asthmogenic effect when they are specific antagonists. Atropine has no effect on these asthma inducers. Artificially produced asthmatic breathing in mice can be used as a good model for studying asthmatic respiration, and for testing new drugs for bronchial asthma. Institute of Pharmacology, University Department of Medicine, Medical Faculty, Sarajevo, Yugoslavia. 1.
2.
P. STERN ENISA BA&Sbreve;AGIĆ.
Fishel, C. W., Szentivaniyi, A., Talmage, D. W. Immunology, 1962, 89, 8. Collier, H. D., James, G. W., Piper, P. J. J. Physiol., Lond. 1965, 180, 13P.
ASTHMOGENIC EFFECT ON MICE OF INHALATION OF ABSENCE OF
1%
P-ADRENERGIC
genic steroids 6-6 and 6-9 mg. per 24 hours. The urinary excretion of gonadotrophins was 63 human menopausal gonadotrophin units per day, which is strikingly raised. Bone-age was estimated as 17 years. Buccal smears were chromatin positive, His karyosome 10% of nuclei showing a single Barr body. was studied in fifty-three metaphase preparations from a type peripheral-blood-lymphocyte culture; all showed 48 chromosomes, with 46 autosomes and an XXYY sex-chromosome
constitution (Dr. F. G. J. Hayhoe). In view of the tendency of XYY and XXYY males to be unusually tall, the possibility that the YY state might be associated with an increased level of circulating growth hormone (H.G.H.) was considered. The plasma H.G.H. was kindly assayed by Dr. D. Wright of the Royal Postgraduate Medical School, and found to be normal. Despite his XXYY chromosomal complement, the patient was affable and cooperative, and had given no more trouble at home than the average adolescent. This contrasts with the finding of Casey et aLl of an unexpectedly high incidence of XXYY males in institutions for the mentally subnormal of persistently violent or aggressive behaviour. Ellis et a1,2 described an XXYY male who was said to be affable and could 1. Casey, M. D., Cegall, L. J., Street, D.R.K., Blank, C. E. Nature, 2.
Lond. 1966, 209, 641. Ellis, J. R., Miller, O. J., Penrose, L. S., Scott, G. E. B. Ann. hum. Genet. 1961, 25, 145.
SOLUTIONS OF BLOCKERS
HISTAMINE, SEROTONIN,
(A.R.)
AND BRADYKININ IN PRESENCE OR
AND ASTHMA ANTAGONISTS
l.P.=int]’aperitoneally. O= no protection-i.e., asthmatic breathing develops. * No asthma antagonist. fNoA.R.
-=protection.