- Email: [email protected]
PAROXYSMAL TACHYCARDIA IN INFANCY
106
degenerative disorders of middle age sufficiently to prolong life. Publicity in cancer is a common subject of correspondence, but less is heard of appears to retard the
the cardiovascular and renal troubles which we associate with overweight and which in men cause more than four times as many deaths as cancer. Indped, cardiovascular and renal causes account for over half the deaths among men over 45 years of age; .and a useful and simple remedy, at least in so far as normal expectation of life is desirable, appears to be within the grasp of perhaps the majority who need it. Weight reduction as a preventive remedy is either too little appreciated or too much disliked ! R. W.PARNELL. E. PARNELL. Institute of Social Social Medicine, Medicine, Oxford. PAROXYSMAL
TACHYCARDIA
IN INFANCY
SIR,—Dr. Edmunds in his article of Dec. 15 comes to the conclusion that paroxysmal tachycardia occurs in infancy more often without than with an underlying infection. It should, however, be remembered that infection in infancy is often present without gross clinical signs. It will be found that in some of the reported cases of idiopathic paroxysmal tachycardia signs of upper respiratory infection or of transitory gastro-intestinal upset are mentioned ; and this, although inconspicuous, might have been the cause of the heart paroxysm. Walker Gate Hospital, C. NEUBAUER. Newcastle upon Tyne. upon Tyne. THE TIME OF DEATH
SIR,-Dr. Morgan’s letter (Dec. 29) describes his father’s observations of apparently normal heart-beats occurring during the first hour after hanging. Miss Dobson’s interesting extracts (Dec. 29) from the Annals of the Barber-surgeons give instances of recovery after unsuccessful hanging. Her extracts from William Clift’s Diaries describe contractions of the right auricle during the hours after execution ; but no contractions were seen in the left auricle or the ventricles, and the auricular contractions could not have maintained any useful circulation. Hanging kills either by strangulation, causing cerebral anoxia, or by dislocation of the neck with destruction of the medullary vital centres. Survival is quite likely to follow inefficient strangulation, but after destruction of the medullary centres long survival is impossible, whether they are destroyed by the trauma of judicial hanging or by anoxia, as in cardiac arrest on the operating-table. In a personal case of cardiac arrest the time of death was in much doubt, for the heart survived long after the rest of the patient was dead. first
seven
The patient was a fat, healthy, black woman of about 45. At about 2 P.M. thyroidectomy was started under endotracheal anaesthesia for a non-toxic nodular goitre. During elevation of the skin-flaps the blood was seen to be deeply cyanosed, and during exposure of the first lateral lobe respiration and heart action ceased. Three minutes were spent giving artificial respiration and ineffective intravenous stimulants. Cardiac massage was then started through an epigastric incision, and adrenaline was injected into the heart. After some ten minutes’ massage the heart began to beat, at first irregularly and later regularly ; but when massage was stopped the heart-beat became feeble and failed. Massage was therefore continued, synchronously with the heart-beat, and an intravenous adrenaline drip was set up. The heart responded well and was soon beating steadily, with the blood-pressure mm. Hg, depending on varying between 90/60 and the speed of the adrenaline drip. Artificial respiration by bag compression was continued until 8 P.M., but in spite of respiratory stimulants spontaneous respiration never occurred. The patient was then transferred to an iron lung. Kext morning at 10 A.M. the pulse-rate was about 140 per min., regular and easily felt at the wrist. Consciousness had never been regained, and corneal reflexes were absent. The patient’s temperature was about 103F, but since she was in an iron lung in a tropical climate this was of doubtful significance. There was a distinct and unmistakable smell of decomposition which was apparent even outside the patient’s
180/110
including
It was obvious to all, the-patient’s relatives, that " life " was being maintained artificially. On removing the patient from the iron lung respiration did not start and the heart-beat became progressively feehier, ceasing after about four minutes. room.
patient’s brain died at about 2.15 P.M. on the day operation. Her body began to decay during the following night. Her heart died at 10 A.M. next day. This
of
When did this death ?
patient
die . Is there
Alresford, Hants.
a
moment of
AUBREY LEACOCK.
a progressive and gradual In if the cats, process. blood-supply to the brain is completely shut off, death of the central nervous system takes place from above downwards. The activity of the cortex cannot be reawakened if the arteries have been closed for 5 minutes. If the blood-pressure has been nil for 10 minutes the pontine centres (e.g., pneumotaxic centre) cannot be revived ; after 15 minutes the medul. lary centres (e.g., apneustic, expiratory, and gasping centres) cannot be restored. Cardiac action, on the other hand, can be revived after several hours of quiescence and may raise the blood-pressure almost up to normal if artificial respiration is maintained. From these facts itappears that it is valueless to continue artificial respiration if it is certain that the blood-supply to the brain has been completely shut off for more than 5 minutes. The pulse and respiration may be re-established, but the forebrain cannot be revived. THOMAS LUMSDEN. Stocking-Pelham, Herts.
SIR,—Death is always
,
ELECTROPHORESIS OF SERUM LIPOPROTEINS ON FILTER-PAPER
SIR,—The need for better knowledge of normal and pathological patterns of serum lipoproteins is now of ultracentrifugal recognised. Nevertheless the methods3-6 2 and are too complex alcohol fractionation analysis 1 for general use. Micro-electrophoresis on filter-paper is a simple method for effective separation of various lipoproteins of the serum. I have adopted the combination of the method of Durrum and of Cremer and Tiselius proposed by Flynn and de Mayo.7
After " standard " electrophoresis the dried strip of filterpaper (36 x 6 cm.) is cut longitudinally into two strips; one is stained with bromophenol-blue ; the other is stained by immersion in a solution of Sudan ill in 50% ethyl alcohol for 30 min. at 40°C, then washed thoroughly first in 50% ethyl alcohol and subsequently in distilled water. The ai and &bgr;1 lipoproteins appear as rather sharply differ. entiated bands. For a semiquantitative determination one cuts the strip serially, elutes the absorbed colour in alcoholether (3 : 1), then reads photometrically the optical densities at 540 m, ; by plotting optical densities against the distance along the strip a curve is obtained which represents the electrophoretic distribution of lipoproteins as well as their approxi. mate relative concentration. Comparison with the results of the chemical determination of cholesterol in the serial sections of strip has shown a fairly close correlation : in normal sera 60-75% of the colour absorbed and of the total cholesterol appear in the &bgr;1 band ; the oc3L band contains nearly all the other lipidic constituents as evidenced by Sudan ill absorption and by cholesterol determination.
This method has been applied to normal and pathosera ; further development is in progress. ANGELO FASOLI. Medical Clinic, University of Milan.
logical
1. Gofman, J. W, Lindgren, F. T., Elliott, H. J. biol. Chem. 1949, 179, 973. 2. Goldwater, W. H., Randolph, M. L., Suavely, J. R., Turner. R. H., Unglaunb, W. G. Fed. Proc. 1950, 9, 178. 3. Pearsall, H. R., Chanutin, A. Amer. J. Med. 1949, 7, 297. 4. Fasoli, A., Bonelli, M. Arch. Sci. biol., Napoli, 1950, 34, 161. 5. Fasoli, A. Ibid (in the press). 6. Lever, W. F., Gurd, F. R. N., Uroma. E., Brown, R. K., Barnes, B.A., Schmid, K., Schultz, E. L. J. clin. Invest. 1951, 30, 99. 7. Flynn, F. V., de Mayo, P. Lancet, 1951, ii, 235.
degenerative disorders of middle age sufficiently to prolong life. Publicity in cancer is a common subject of correspondence, but less is heard of appears to retard the
the cardiovascular and renal troubles which we associate with overweight and which in men cause more than four times as many deaths as cancer. Indped, cardiovascular and renal causes account for over half the deaths among men over 45 years of age; .and a useful and simple remedy, at least in so far as normal expectation of life is desirable, appears to be within the grasp of perhaps the majority who need it. Weight reduction as a preventive remedy is either too little appreciated or too much disliked ! R. W.PARNELL. E. PARNELL. Institute of Social Social Medicine, Medicine, Oxford. PAROXYSMAL
TACHYCARDIA
IN INFANCY
SIR,—Dr. Edmunds in his article of Dec. 15 comes to the conclusion that paroxysmal tachycardia occurs in infancy more often without than with an underlying infection. It should, however, be remembered that infection in infancy is often present without gross clinical signs. It will be found that in some of the reported cases of idiopathic paroxysmal tachycardia signs of upper respiratory infection or of transitory gastro-intestinal upset are mentioned ; and this, although inconspicuous, might have been the cause of the heart paroxysm. Walker Gate Hospital, C. NEUBAUER. Newcastle upon Tyne. upon Tyne. THE TIME OF DEATH
SIR,-Dr. Morgan’s letter (Dec. 29) describes his father’s observations of apparently normal heart-beats occurring during the first hour after hanging. Miss Dobson’s interesting extracts (Dec. 29) from the Annals of the Barber-surgeons give instances of recovery after unsuccessful hanging. Her extracts from William Clift’s Diaries describe contractions of the right auricle during the hours after execution ; but no contractions were seen in the left auricle or the ventricles, and the auricular contractions could not have maintained any useful circulation. Hanging kills either by strangulation, causing cerebral anoxia, or by dislocation of the neck with destruction of the medullary vital centres. Survival is quite likely to follow inefficient strangulation, but after destruction of the medullary centres long survival is impossible, whether they are destroyed by the trauma of judicial hanging or by anoxia, as in cardiac arrest on the operating-table. In a personal case of cardiac arrest the time of death was in much doubt, for the heart survived long after the rest of the patient was dead. first
seven
The patient was a fat, healthy, black woman of about 45. At about 2 P.M. thyroidectomy was started under endotracheal anaesthesia for a non-toxic nodular goitre. During elevation of the skin-flaps the blood was seen to be deeply cyanosed, and during exposure of the first lateral lobe respiration and heart action ceased. Three minutes were spent giving artificial respiration and ineffective intravenous stimulants. Cardiac massage was then started through an epigastric incision, and adrenaline was injected into the heart. After some ten minutes’ massage the heart began to beat, at first irregularly and later regularly ; but when massage was stopped the heart-beat became feeble and failed. Massage was therefore continued, synchronously with the heart-beat, and an intravenous adrenaline drip was set up. The heart responded well and was soon beating steadily, with the blood-pressure mm. Hg, depending on varying between 90/60 and the speed of the adrenaline drip. Artificial respiration by bag compression was continued until 8 P.M., but in spite of respiratory stimulants spontaneous respiration never occurred. The patient was then transferred to an iron lung. Kext morning at 10 A.M. the pulse-rate was about 140 per min., regular and easily felt at the wrist. Consciousness had never been regained, and corneal reflexes were absent. The patient’s temperature was about 103F, but since she was in an iron lung in a tropical climate this was of doubtful significance. There was a distinct and unmistakable smell of decomposition which was apparent even outside the patient’s
180/110
including
It was obvious to all, the-patient’s relatives, that " life " was being maintained artificially. On removing the patient from the iron lung respiration did not start and the heart-beat became progressively feehier, ceasing after about four minutes. room.
patient’s brain died at about 2.15 P.M. on the day operation. Her body began to decay during the following night. Her heart died at 10 A.M. next day. This
of
When did this death ?
patient
die . Is there
Alresford, Hants.
a
moment of
AUBREY LEACOCK.
a progressive and gradual In if the cats, process. blood-supply to the brain is completely shut off, death of the central nervous system takes place from above downwards. The activity of the cortex cannot be reawakened if the arteries have been closed for 5 minutes. If the blood-pressure has been nil for 10 minutes the pontine centres (e.g., pneumotaxic centre) cannot be revived ; after 15 minutes the medul. lary centres (e.g., apneustic, expiratory, and gasping centres) cannot be restored. Cardiac action, on the other hand, can be revived after several hours of quiescence and may raise the blood-pressure almost up to normal if artificial respiration is maintained. From these facts itappears that it is valueless to continue artificial respiration if it is certain that the blood-supply to the brain has been completely shut off for more than 5 minutes. The pulse and respiration may be re-established, but the forebrain cannot be revived. THOMAS LUMSDEN. Stocking-Pelham, Herts.
SIR,—Death is always
,
ELECTROPHORESIS OF SERUM LIPOPROTEINS ON FILTER-PAPER
SIR,—The need for better knowledge of normal and pathological patterns of serum lipoproteins is now of ultracentrifugal recognised. Nevertheless the methods3-6 2 and are too complex alcohol fractionation analysis 1 for general use. Micro-electrophoresis on filter-paper is a simple method for effective separation of various lipoproteins of the serum. I have adopted the combination of the method of Durrum and of Cremer and Tiselius proposed by Flynn and de Mayo.7
After " standard " electrophoresis the dried strip of filterpaper (36 x 6 cm.) is cut longitudinally into two strips; one is stained with bromophenol-blue ; the other is stained by immersion in a solution of Sudan ill in 50% ethyl alcohol for 30 min. at 40°C, then washed thoroughly first in 50% ethyl alcohol and subsequently in distilled water. The ai and &bgr;1 lipoproteins appear as rather sharply differ. entiated bands. For a semiquantitative determination one cuts the strip serially, elutes the absorbed colour in alcoholether (3 : 1), then reads photometrically the optical densities at 540 m, ; by plotting optical densities against the distance along the strip a curve is obtained which represents the electrophoretic distribution of lipoproteins as well as their approxi. mate relative concentration. Comparison with the results of the chemical determination of cholesterol in the serial sections of strip has shown a fairly close correlation : in normal sera 60-75% of the colour absorbed and of the total cholesterol appear in the &bgr;1 band ; the oc3L band contains nearly all the other lipidic constituents as evidenced by Sudan ill absorption and by cholesterol determination.
This method has been applied to normal and pathosera ; further development is in progress. ANGELO FASOLI. Medical Clinic, University of Milan.
logical
1. Gofman, J. W, Lindgren, F. T., Elliott, H. J. biol. Chem. 1949, 179, 973. 2. Goldwater, W. H., Randolph, M. L., Suavely, J. R., Turner. R. H., Unglaunb, W. G. Fed. Proc. 1950, 9, 178. 3. Pearsall, H. R., Chanutin, A. Amer. J. Med. 1949, 7, 297. 4. Fasoli, A., Bonelli, M. Arch. Sci. biol., Napoli, 1950, 34, 161. 5. Fasoli, A. Ibid (in the press). 6. Lever, W. F., Gurd, F. R. N., Uroma. E., Brown, R. K., Barnes, B.A., Schmid, K., Schultz, E. L. J. clin. Invest. 1951, 30, 99. 7. Flynn, F. V., de Mayo, P. Lancet, 1951, ii, 235.