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PHENFORMIN (D.B.I.) AND FIBRINOLYTIC ACTIVITY
486 factors concerned with the contractile mechanism of uterine muscle, he has nevertheless been cautious in defining the exact quantitative role of oestrogen in human myometrial disorders. Uterine volume is another factor which may be important in determining the state of myometrial function after fcetal death. Csapo et al.were able to initiate labour by the intraamniotic injection of 500 ml. of 5% dextrose in water in two cases where considerable reduction of uterine volume had occurred after foetal death, and there is already a certain amount of evidence concerning the basic role of uterine volume in determining the onset of labour in both rabbit and human
pregnancy.2 Queen Charlotte’s Maternity Hospital, London, W.6.
CARL WOOD.
M. H. GHANEM MOUFID H. FAHMI A. TANIOUS.
Alexandria, Egypt.
IATROGENIC " suffix -genic is used indiscriminately to "
SiR,łThe
causing " (atherogenic, carcinogenic, mutagenic, pathogenic, pyrogenic) or " caused by" (agnogenic, cryptogenic, iatrogenic, neurogenic, psychogenic); and there is haemogenic shock ", shock caused not by blood but by loss of it.
mean "
"
AND FIBRINOLYTIC ACTIVITY SiR,łWe would like to report on the effect of phenformin (D.B.I.) on fibrinolytic activity of the blood. Fearnley et al.3 reported that, after injection of 20 units of soluble insulin in 4 diabetic patients, an initial decrease in fibrinolytic activity was followed by a rapid rebound increase when the blood-glucose was at its lowest level. This resulted probably from adrenaline release. On the other hand the same workers later reportedthat sulphonylurea (tolbutamide and chloropropamide) increased the fibrinolytic activity in 7 out of 18 non-diabetics suffering from thromboembolic
PHENFORMIN
significantly affect the fibrinolytic activity either by reduction, as with insulin, or by increase, as with sulphonylurea.
(D.B.I.)
What is worse,
some
of the words
are
used in both
senses.
" Ewing used the termosteogenic ’ to indicate that the tumor is of osseous genesis but other writers use it to mean that it forms bone tissue ... many recent writers prefer to use the non-committal term ’osteosarcoma’." )I In medicine, cause and effect are often hard to distinguish, and it is intolerable that ill-conceived words should increase the confusion. Dr. Arie and Mr. Cronin (Jan. 27) would discard " iatrogenic ", and many pathologists would discard " osteogenic "; I believe that lucidity would be served by our discarding all words of this class-preferably before someone hits on the idea of labelling inherited disorders " genogenic ". Faulkner Hospital, D. M. Boston,
Mass.
JACKSON.
THE FUTURE OF GENERAL PRACTICE
Actual and mean rates of fibrinolysis before and after administration for fifteen days of soluble insulin and 100 mg. phenformin daily to 14 diabetics.
disease. Unlike the effect with insulin, this effect was unrelated to the blood-sugar level. We have determined the fibrin lysed per hour before and after administration of phenformin. The percentage of fibrin lysed after six and twelve hours was estimated by the quantitative method of Bide11.5&a cute; Three and a half hours after a single oral dose of 50 mg. of
phenformin no significant changes in fibrinolytic activity (p < 0.2) or blood-sugar (p < 0.3) was observed in 6 diabetics compared with 4 normal controls. Similarly no significant change in fibrinolytic activity was observed in 14 diabetics. Activity was estimated in 14 diabetics after a fifteen-day course of combined soluble insulin and 100 mg. phenformin (see figure). An insignificant increase in fibrinolytic activity was observed in the 4 patients who had a relatively greater drop in their blood-sugars (34-3% to 22-5%).
experience we have found that the brief long-continued administration of phenformin does not
In this limited or 1.
Csapo, A., Jaffin, H., Kerenyi, T., Lipman, J., Wood, C. published.
To be
2. Csapo, A., Lloyd-Jacob, M. Amer. J. Obstet. Gynec. (in the press). 3. Fearnley, G. R., Vincent, C. T., Chakrabarti, R. Lancet, 1959, ii, 1067. 4. ibid. 1960, ii, 622. 5. Bidwell, E., Biochem. J. 1953, 55, 497.
SIR,-Iwas cheered to read that others share my conviction that general practice is truly a specialty in its own right. The picture of the general practitioner drawn by Dr. Cardew (Feb. 3) and Dr. Stark Murray (Feb. 17) is that of a front-line defender against illness, whether physical or otherwise. This picture is not an abstract one, for such can be found, even in 1962, in many parts of the country. Being a third-rate consultant, or even a junior hospital medical officer, is really a distraction from his proper work, which requires his full attention. To do this work efficiently, he needs two things. First, ability to recognise which patients will be best treated by himself and which will benefit from specialised advice. This ability is necessarily founded upon up-to-date general medical knowledge. It is here that he should gain the invaluable help of his local consultants, year-round seminars being a more effective way to provide him with this knowledge than occasional intensive courses of lectures and case demonstrations. Secondly, he must have full access to all those diagnostic routines which are within his own ability to interpret authoritatively. Such considerations prompt some further comments. Writers, in growing numbers, during the past few years have warned of the danger lest-in the vast machine which is the National Health Service-the primary needs of the patient may be largely overlooked. How good for all our patients it would be if three wise men " could ponder their needs, and how they might be met! Such small " thinking units" have a way of getting to the root of a problem in a way often denied to larger committees. Just how much the patient’s needs can be ignored is vividly shown in the structure and administration of the maternity medical services. The views of the Treasury, the local health authorities, the hospital boards, and, quite often, the consultants are given due weight and consideration. The needs of the person most concerned (the patient) are best understood by the person most intimately known (the general practitioner), yet he it is whose representations are most consistently ignored by officialdom. But these thoughts run quite counter to current trends. 1. Aegerter, E., Kirkpatrick, J. A. Orthopedic Diseases; p. 449, Philadelphia, 1958. "
pregnancy.2 Queen Charlotte’s Maternity Hospital, London, W.6.
CARL WOOD.
M. H. GHANEM MOUFID H. FAHMI A. TANIOUS.
Alexandria, Egypt.
IATROGENIC " suffix -genic is used indiscriminately to "
SiR,łThe
causing " (atherogenic, carcinogenic, mutagenic, pathogenic, pyrogenic) or " caused by" (agnogenic, cryptogenic, iatrogenic, neurogenic, psychogenic); and there is haemogenic shock ", shock caused not by blood but by loss of it.
mean "
"
AND FIBRINOLYTIC ACTIVITY SiR,łWe would like to report on the effect of phenformin (D.B.I.) on fibrinolytic activity of the blood. Fearnley et al.3 reported that, after injection of 20 units of soluble insulin in 4 diabetic patients, an initial decrease in fibrinolytic activity was followed by a rapid rebound increase when the blood-glucose was at its lowest level. This resulted probably from adrenaline release. On the other hand the same workers later reportedthat sulphonylurea (tolbutamide and chloropropamide) increased the fibrinolytic activity in 7 out of 18 non-diabetics suffering from thromboembolic
PHENFORMIN
significantly affect the fibrinolytic activity either by reduction, as with insulin, or by increase, as with sulphonylurea.
(D.B.I.)
What is worse,
some
of the words
are
used in both
senses.
" Ewing used the termosteogenic ’ to indicate that the tumor is of osseous genesis but other writers use it to mean that it forms bone tissue ... many recent writers prefer to use the non-committal term ’osteosarcoma’." )I In medicine, cause and effect are often hard to distinguish, and it is intolerable that ill-conceived words should increase the confusion. Dr. Arie and Mr. Cronin (Jan. 27) would discard " iatrogenic ", and many pathologists would discard " osteogenic "; I believe that lucidity would be served by our discarding all words of this class-preferably before someone hits on the idea of labelling inherited disorders " genogenic ". Faulkner Hospital, D. M. Boston,
Mass.
JACKSON.
THE FUTURE OF GENERAL PRACTICE
Actual and mean rates of fibrinolysis before and after administration for fifteen days of soluble insulin and 100 mg. phenformin daily to 14 diabetics.
disease. Unlike the effect with insulin, this effect was unrelated to the blood-sugar level. We have determined the fibrin lysed per hour before and after administration of phenformin. The percentage of fibrin lysed after six and twelve hours was estimated by the quantitative method of Bide11.5&a cute; Three and a half hours after a single oral dose of 50 mg. of
phenformin no significant changes in fibrinolytic activity (p < 0.2) or blood-sugar (p < 0.3) was observed in 6 diabetics compared with 4 normal controls. Similarly no significant change in fibrinolytic activity was observed in 14 diabetics. Activity was estimated in 14 diabetics after a fifteen-day course of combined soluble insulin and 100 mg. phenformin (see figure). An insignificant increase in fibrinolytic activity was observed in the 4 patients who had a relatively greater drop in their blood-sugars (34-3% to 22-5%).
experience we have found that the brief long-continued administration of phenformin does not
In this limited or 1.
Csapo, A., Jaffin, H., Kerenyi, T., Lipman, J., Wood, C. published.
To be
2. Csapo, A., Lloyd-Jacob, M. Amer. J. Obstet. Gynec. (in the press). 3. Fearnley, G. R., Vincent, C. T., Chakrabarti, R. Lancet, 1959, ii, 1067. 4. ibid. 1960, ii, 622. 5. Bidwell, E., Biochem. J. 1953, 55, 497.
SIR,-Iwas cheered to read that others share my conviction that general practice is truly a specialty in its own right. The picture of the general practitioner drawn by Dr. Cardew (Feb. 3) and Dr. Stark Murray (Feb. 17) is that of a front-line defender against illness, whether physical or otherwise. This picture is not an abstract one, for such can be found, even in 1962, in many parts of the country. Being a third-rate consultant, or even a junior hospital medical officer, is really a distraction from his proper work, which requires his full attention. To do this work efficiently, he needs two things. First, ability to recognise which patients will be best treated by himself and which will benefit from specialised advice. This ability is necessarily founded upon up-to-date general medical knowledge. It is here that he should gain the invaluable help of his local consultants, year-round seminars being a more effective way to provide him with this knowledge than occasional intensive courses of lectures and case demonstrations. Secondly, he must have full access to all those diagnostic routines which are within his own ability to interpret authoritatively. Such considerations prompt some further comments. Writers, in growing numbers, during the past few years have warned of the danger lest-in the vast machine which is the National Health Service-the primary needs of the patient may be largely overlooked. How good for all our patients it would be if three wise men " could ponder their needs, and how they might be met! Such small " thinking units" have a way of getting to the root of a problem in a way often denied to larger committees. Just how much the patient’s needs can be ignored is vividly shown in the structure and administration of the maternity medical services. The views of the Treasury, the local health authorities, the hospital boards, and, quite often, the consultants are given due weight and consideration. The needs of the person most concerned (the patient) are best understood by the person most intimately known (the general practitioner), yet he it is whose representations are most consistently ignored by officialdom. But these thoughts run quite counter to current trends. 1. Aegerter, E., Kirkpatrick, J. A. Orthopedic Diseases; p. 449, Philadelphia, 1958. "