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PERIPHERAL VASCULAR DISEASE TREATED BY AMNION IMPLANTATION
1294 In this sample of 131 tumours, "1.2 with 3 degrees of freedom for deviation from the expectation in a diploid population was 14’91, with p < 0’01. The "1.2(,) for deviation from the trisomic Other tumours in expectation was only 5’77 with p < 0’2. children (259 in number, mainly leukaemias and sarcomas) showed a normal blood-group distribution ((,)==3’19, ’
P=0-4). In a survey of many kinds of tumour such results might arise in an entirely fortuitous way. That that explanation is not appropriate in this instance is shown by corroborative evidence from a much larger survey by Yates and Pearce2 of astrocytic gliomas. The situation was somewhat complicated by the restriction of the anomalous blood-group distribution to cases diagnosed since 1945, but Steward’s sample was also of recent date (1953-58). Yates and Pearce found a large excess of A over 0 and also an excessive number of ABs. For the 309 astrocytic gliomas since 1945 the deviation from the control blood-group distribution was highly significant (x2e=17·9, P < 0’001), whereas there was good agreement with trisomic expectation (x2a=6·3, p=0’l). It was also found (Steward, personal communication) that 51 survivors of retinoblastoma (the only malignant tumour of ectodermal type with a high survival-rate) showed an excess of group A, though the X2 was not significant. If trisomics for any chromosome survived to birth they would be likely to have a severe disability which would appear early in life if not congenitally, like children’s tumours. In addition, trisomics for the ABO chromosome would have the same blood-group distribution as children with ectodermal tumours. If a trisomic were fertile, he would be expected to pass the extra chromosome to half his offspring, and the condition would then be inherited like a dominant gene mutation. When retinoblastoma is familial it is in fact transmitted in this way.
Thus it would
desirable to establish by direct cytological observation whether children with gliomas or other ectodermal tumours are trisomics. If they should prove to be so it would be natural to conclude that the trisomic chromosome was the one carrying the ABO locus, and we should have achieved for the first time the identification of a human autosome with a genetic marker. seem
I wish to thank Dr. J. K. Steward and Dr. P. 0. Yates for their assistance with data and criticism of the manuscript.
Cytogenetics Laboratory,
Christie Hospital and Holt Radium Institute, Manchester.
A. J. BATEMAN.
PERIPHERAL VASCULAR DISEASE TREATED BY AMNION IMPLANTATION
SIR,-In
your issue of March 12 you published a by Mr. Troensegaard-Hansen on amnion
further article
I am surprised that there has been no in your correspondence columns on this procedure, as I have come to regard it as one of those rare gems in the catalogue of surgery of which it may truly be said that it never does any harm and may do a great deal of good. I have carried out amnion implants in some fifteen cases during the past nine years with the result that one third have been " excellent ", one third " improved ", and one third " no change ". The cases were nearly all referred because the physician or surgeon in charge had failed to produce improvement by any other means, and the degree of severity varied between group II and group III.
implantation. comment
It has been said that because the modus operandi of the procedure is not understood it should not be taken seriously; but I, personally, believe that patients should have the chance of benefiting from any otherwise harmless treatment whether it actually works by auto-hypnosis or a general hormonic
reshuffle1 I have also used amnion 2.
as a
surface
dressing
Yates, P. O., Pearce, K. M. Lancet, Jan. 23, 1960,
on
p. 194.
many
occasions and find that in selected cases it is both quicker and better than Thiersch grafting. I think, however, that the most important single factor in its use either superficially or by implantation is the selection and preparation of the membrane itself, and unless this is carried out strictly according to the technique formerly described by Troensegaard-Hansen then results will be disappointing. I do, on the other hand, differ from him in operative technique in so far as all my implants have been carried out through a half-inch incision under local anxsthesia in outpatients. JOHN E. BUCK. London, W.1. OTOTOXICITY OF NEOMYCIN AEROSOL
SIR,-Iwas disturbed to read Mr. Fuller’s report of May 7 of ototoxicity due to neomycin aerosol therapy in two children. Dr. Young’s letter of May 28 is certainly reassuring. I have used neomycin aerosol inhalations for nearly 100 patients with chronic respiratory infection in the past 3 years, and some of these have continued the treatment for more than a year. The effect on the infection appears to have been less definite in many patients than that obtained with oral tetracycline treatment, but there has been no evidence as yet of ototoxicity, and I had come to regard the treatment (perhaps prematurely) as safe in this respect. I should like, however, to take this opportunity of
reporting a case of severe ototoxicity following weekly intrapleural neomycin instillations (1 g. dose) in a patient with a bronchopleural fistula and secondarily infected tuberculous empyema. The tinnitus was first reported after the 4th week. It would appear that considerable absorption of neomycin had occurred from the pleural SDace.
The Hartley Hospital, Colne, Lancs.
W. H. HELM.
SOME UNCRITICISED ASSUMPTIONS IN PSYCHIATRIC THOUGHT
SIR,- In his article of March 19 Dr. McConaghy helps the unrecognised sadism which is the basis of the dynamic method of psychiatry. We are shown how the patient is subjected to continuous " interpretations ", really nothing but criticisms of the patient’s character and whole way of life, which effectively destroy his to expose
self-confidence as well as stimulate a resentment towards the therapist, which cannot be expressed without embarrassment, because the therapist seems not to be attacking the patient’s in an objective fashion. character, but only helping the patient The psychiatrist is shown to be a " passive-aggressive " type, unaware of his own aggressions, and unable to assume any responsibility for generating hostility in the patient, all of which, he assumes, misguidedly, is merely a reflection of unresolved childhood conflicts. Dr. McConaghy’s deftly written article is valuable in that it demonstrates how a therapeutic method can be, and certainly often is, made to serve destructive ends in the hands of the wrong type of person. That psychoanalytic methods are intrinsically the expression of " passive aggression " is Dr. McConaghy’s main point, however, and this assertion cannot really be taken seriously. All psychiatric training centres recognise as clearly as Dr. McConaghy that persons with hostile or defensive characteristics should be discouraged from the practice of psychiatry. Furthermore, it is a wellestablished principle of dynamic psychiatry that interpretations cannot be effective if the patient experiences them as criticisms or if they are forced upon him. In fact, the ideal situation for psychotherapy is one in which, in an accepting atmosphere, for most patients a novelty, the patient becomes able to discover his own blind spots unaided. Dr. McConaghy’s article is entertaining to read but, unfbr-
P=0-4). In a survey of many kinds of tumour such results might arise in an entirely fortuitous way. That that explanation is not appropriate in this instance is shown by corroborative evidence from a much larger survey by Yates and Pearce2 of astrocytic gliomas. The situation was somewhat complicated by the restriction of the anomalous blood-group distribution to cases diagnosed since 1945, but Steward’s sample was also of recent date (1953-58). Yates and Pearce found a large excess of A over 0 and also an excessive number of ABs. For the 309 astrocytic gliomas since 1945 the deviation from the control blood-group distribution was highly significant (x2e=17·9, P < 0’001), whereas there was good agreement with trisomic expectation (x2a=6·3, p=0’l). It was also found (Steward, personal communication) that 51 survivors of retinoblastoma (the only malignant tumour of ectodermal type with a high survival-rate) showed an excess of group A, though the X2 was not significant. If trisomics for any chromosome survived to birth they would be likely to have a severe disability which would appear early in life if not congenitally, like children’s tumours. In addition, trisomics for the ABO chromosome would have the same blood-group distribution as children with ectodermal tumours. If a trisomic were fertile, he would be expected to pass the extra chromosome to half his offspring, and the condition would then be inherited like a dominant gene mutation. When retinoblastoma is familial it is in fact transmitted in this way.
Thus it would
desirable to establish by direct cytological observation whether children with gliomas or other ectodermal tumours are trisomics. If they should prove to be so it would be natural to conclude that the trisomic chromosome was the one carrying the ABO locus, and we should have achieved for the first time the identification of a human autosome with a genetic marker. seem
I wish to thank Dr. J. K. Steward and Dr. P. 0. Yates for their assistance with data and criticism of the manuscript.
Cytogenetics Laboratory,
Christie Hospital and Holt Radium Institute, Manchester.
A. J. BATEMAN.
PERIPHERAL VASCULAR DISEASE TREATED BY AMNION IMPLANTATION
SIR,-In
your issue of March 12 you published a by Mr. Troensegaard-Hansen on amnion
further article
I am surprised that there has been no in your correspondence columns on this procedure, as I have come to regard it as one of those rare gems in the catalogue of surgery of which it may truly be said that it never does any harm and may do a great deal of good. I have carried out amnion implants in some fifteen cases during the past nine years with the result that one third have been " excellent ", one third " improved ", and one third " no change ". The cases were nearly all referred because the physician or surgeon in charge had failed to produce improvement by any other means, and the degree of severity varied between group II and group III.
implantation. comment
It has been said that because the modus operandi of the procedure is not understood it should not be taken seriously; but I, personally, believe that patients should have the chance of benefiting from any otherwise harmless treatment whether it actually works by auto-hypnosis or a general hormonic
reshuffle1 I have also used amnion 2.
as a
surface
dressing
Yates, P. O., Pearce, K. M. Lancet, Jan. 23, 1960,
on
p. 194.
many
occasions and find that in selected cases it is both quicker and better than Thiersch grafting. I think, however, that the most important single factor in its use either superficially or by implantation is the selection and preparation of the membrane itself, and unless this is carried out strictly according to the technique formerly described by Troensegaard-Hansen then results will be disappointing. I do, on the other hand, differ from him in operative technique in so far as all my implants have been carried out through a half-inch incision under local anxsthesia in outpatients. JOHN E. BUCK. London, W.1. OTOTOXICITY OF NEOMYCIN AEROSOL
SIR,-Iwas disturbed to read Mr. Fuller’s report of May 7 of ototoxicity due to neomycin aerosol therapy in two children. Dr. Young’s letter of May 28 is certainly reassuring. I have used neomycin aerosol inhalations for nearly 100 patients with chronic respiratory infection in the past 3 years, and some of these have continued the treatment for more than a year. The effect on the infection appears to have been less definite in many patients than that obtained with oral tetracycline treatment, but there has been no evidence as yet of ototoxicity, and I had come to regard the treatment (perhaps prematurely) as safe in this respect. I should like, however, to take this opportunity of
reporting a case of severe ototoxicity following weekly intrapleural neomycin instillations (1 g. dose) in a patient with a bronchopleural fistula and secondarily infected tuberculous empyema. The tinnitus was first reported after the 4th week. It would appear that considerable absorption of neomycin had occurred from the pleural SDace.
The Hartley Hospital, Colne, Lancs.
W. H. HELM.
SOME UNCRITICISED ASSUMPTIONS IN PSYCHIATRIC THOUGHT
SIR,- In his article of March 19 Dr. McConaghy helps the unrecognised sadism which is the basis of the dynamic method of psychiatry. We are shown how the patient is subjected to continuous " interpretations ", really nothing but criticisms of the patient’s character and whole way of life, which effectively destroy his to expose
self-confidence as well as stimulate a resentment towards the therapist, which cannot be expressed without embarrassment, because the therapist seems not to be attacking the patient’s in an objective fashion. character, but only helping the patient The psychiatrist is shown to be a " passive-aggressive " type, unaware of his own aggressions, and unable to assume any responsibility for generating hostility in the patient, all of which, he assumes, misguidedly, is merely a reflection of unresolved childhood conflicts. Dr. McConaghy’s deftly written article is valuable in that it demonstrates how a therapeutic method can be, and certainly often is, made to serve destructive ends in the hands of the wrong type of person. That psychoanalytic methods are intrinsically the expression of " passive aggression " is Dr. McConaghy’s main point, however, and this assertion cannot really be taken seriously. All psychiatric training centres recognise as clearly as Dr. McConaghy that persons with hostile or defensive characteristics should be discouraged from the practice of psychiatry. Furthermore, it is a wellestablished principle of dynamic psychiatry that interpretations cannot be effective if the patient experiences them as criticisms or if they are forced upon him. In fact, the ideal situation for psychotherapy is one in which, in an accepting atmosphere, for most patients a novelty, the patient becomes able to discover his own blind spots unaided. Dr. McConaghy’s article is entertaining to read but, unfbr-