- Email: [email protected]
PHENYLBUTAZONE IN SUPERFICIAL PHLEBITIS
739 INFUSION NEEDLES
SiR,-As
a
house-surgeon whose patients specialise
in small veins and whose " drips " occasionally exhibit a poor sense of occasion, in not knowing when not to stop, I would prefer a smaller needle for use with the
giving-set.
makeshift syringe needle, when used for the same purpose, seems less likely to cause thrombosis, and the standard giving-set needle is cruelly oversize, except perhaps for giving blood. Even
a
St. James’s
Hospital,
DAVID FURNISS.
Leeds, 9.
PEDICULOSIS CAPITIS
SIR,—In their article of Feb. 23, Dr. Nelson and Mr. Cromie refer to reinfestation taking place mainly in the family circle. It would be interesting to have details of the treatment given to these cases in the first instance. It is commonly supposed that preparations such as dicophane application B.P. C. need only be left in contact with the hair for 24 hours ;in fact the directions given in the National Formulary include the sentence " Do not wash the hair during the next 24 hours." This is too short a period and at least 7 days contact should be allowed. None of the residual insecticides is effective against nits and it is only by allowing time for the nymphs to hatch and come into contact with the
insecticide that a complete kill can be ensured. Our experience in the Army is summed up in the following passage from the Manual of Army Health, 1954 : " The most efficient method of treating head lice is to apply insecticide and leave it there for a week ; the hair should not be washed during this period." W. M. McCUTCHEON. a
persistent
in the same way, having excluded any possibility of bloodgroup incompatibility. It should be emphasised that this use of chlorpheniramine maleate was reserved only for those who had had such transfusion reactions. curing the period under consideration, 90 bottles of blood containing chlorpheniramine maleate were administered, and of these 88 were accompanied by a perfectly uneventful course, The other 2 produced with no sign of reaction whatever. febrile reactions of 99-8°F and 1002°F respectively, but neither patient had a rigor. The first patient was not again transfused, and the second, after 2 transfusions of washed red cells in saline, which gave no reaction, was later successfully transfused with whole blood, again accompanied by chlorpheniramine maleate.
While this small series cannot pretend to be anything than a limited examination of the problem, it nevertheless suggests that chlorpheniramine maleate can make it possible to transfuse patients who might otherwise Such results are in prove resistant to such therapy. accordance with those of Simon and others.2-7 more
I am grateful to the clinicians of Westminster Hospital for their most helpful cooperation in collecting this series, as well as to Messrs. Allen & Hanburys for the provision of chlorpheniramine maleate in the form of ’Piriton Maleate ’ 10 mg.
ampoules. John Burford Carlill Pathological Laboratories. Westminster School of Medicine. London, S.W.1.
K. GOLDSMITH.
PHENYLBUTAZONE IN SUPERFICIAL PHLEBITIS SIR,—I should like to draw attention to the remarkable effect of phenylbutazone in cases of superficial thrombophlebitis. In a series of 23 cases results have been highly gratifying, and it has been possible to reduce very
considerably the length of the illness. The patients treated can be divided
into two groups.
patients had acute superficial phlebitis without ulceration. The effect of phenylbutazone in these cases was dramatic. Pain relief was quickly obtained, and inflammation subsided rapidly. All cases cleared up within five days, and patients were ambulant soon after treatment began. 8 patients were subject to periodic mild attacks of superficial thrombophlebitis, leading to shallow but painful ulceration of the leg. Such cases previously took four to six weeks to heal, but with phenylbutazone they cleared up within ten days. 15
REACTIONS AFTER TRANSFUSION SIR,-In a leading article in 19551 you noted that 1-2% of all patients transfused with blood were liable to reactions other than those due to mistakes in bloodgrouping or cross-matching techniques. You added that
1-2% of recipients had urticarial and other allergic reactions, while 2-5% had febrile reactions ;; and you remarked that different workers had sought in various ways to reduce the frequency of the reactions, either by sedation or by giving an anti-histamine. The choice of anti-histamine and the mode of administration are still undecided. Since reading your leader, I have always advised that patients to be transfused, other than under a general anaesthetic, be given a sedative and oral antihistamine, the choice of drugs used being governed by The routine the wishes of the clinician concerned. for all cross-matches technique performed under my direction has included the use of a saline and albumin technique at room-temperature, as well as saline, albumin, and indirect anti-globulin techniques at 37°C. Moreover, a smear of the blood to be given has always been stained with methylene-blue and examined microscopically to exclude any possible infection of the bottle concerned. Over
a
period during
which 2295
pints
of blood
were
administered, 16 patients had rigors, 4 pyrexial reactions of over 100°F, and 2 urticaria. Checks of the group, the crossmatch tests, and the in the bottle of blood
possibility on
of infection
or
haemolysis
laboratory were all treated at the beginning
return to the
invariably negative. 2 patients, both of the period under review, had had two reactions at the commencement of a transfusion, despite the transfusion of
fresh blood, sedation, and the administration of an antihistamine. It was decided to treat these patients with chlorpheniramine maleate, 10 mg. to be introduced into each bottle immediately before use. This technique enabled us to transfuse these cases repeatedly (3 times and 4 times respectively) without further incident. It was decided thereafter to transfuse all patients who had previously had a transfusion reaction 1. Lancet, 1955, ii, 180.
This series is admittedly not large enough for statistical with similar cases admitted to hospital for conservative treatment, but the results are so striking that I feel they should be made known at once. A wider trial seems highly desirable.
comparison
Dudley Road Hospital, Birmingham.
R. O. GILLHESPY.
GOVERNMENT AND PROFESSION
SIR,—In his letter last week, my neighbour, Dr. John
Fry, deplores the manner in which the profession’s claim has been presented. I agree.that the claim should have been associated with an expressed desire to examine defects in the existing service. He does not, however, stress sufficiently the fundamental defect in the scheme from which the present weaknesses spring, nor do the remedies he suggests all appear pertinent to the issue. The defects arise, as far as general practitioners are concerned, from the fact that the majority are attempting, valiantly if inadequately, to stretch old conditions of practice to meet the demands of a new age-an age that is characterised by an increased understanding of the individual in health and disease together with a changed sociological outlook that demands the national application of this knowledge. The family doctor’s increased area of responsibility is indicated by the widely W. G. Ann. Allergy, 1954, 12, 182. Frankel, D. B., Weidner, N. Ibid, 1953, 11, 204. Offenkrantz, F. M., Margolin, S., Jackson, D. J. med. Soc. N.J. 1953, 50, 253. 5. Tuft, L. In Current Therapy. Philadelphia, 1954 ; p. 564. 6. Wilhelm, R. E. J. Mich. med. Soc. 1954, 53, 651. 7. Winter, C. C., Taplin, G. V. Ann. Allergy, 1954, 12, 717.
2. 3. 4.
Simon, S. W., Eckman,
SiR,-As
a
house-surgeon whose patients specialise
in small veins and whose " drips " occasionally exhibit a poor sense of occasion, in not knowing when not to stop, I would prefer a smaller needle for use with the
giving-set.
makeshift syringe needle, when used for the same purpose, seems less likely to cause thrombosis, and the standard giving-set needle is cruelly oversize, except perhaps for giving blood. Even
a
St. James’s
Hospital,
DAVID FURNISS.
Leeds, 9.
PEDICULOSIS CAPITIS
SIR,—In their article of Feb. 23, Dr. Nelson and Mr. Cromie refer to reinfestation taking place mainly in the family circle. It would be interesting to have details of the treatment given to these cases in the first instance. It is commonly supposed that preparations such as dicophane application B.P. C. need only be left in contact with the hair for 24 hours ;in fact the directions given in the National Formulary include the sentence " Do not wash the hair during the next 24 hours." This is too short a period and at least 7 days contact should be allowed. None of the residual insecticides is effective against nits and it is only by allowing time for the nymphs to hatch and come into contact with the
insecticide that a complete kill can be ensured. Our experience in the Army is summed up in the following passage from the Manual of Army Health, 1954 : " The most efficient method of treating head lice is to apply insecticide and leave it there for a week ; the hair should not be washed during this period." W. M. McCUTCHEON. a
persistent
in the same way, having excluded any possibility of bloodgroup incompatibility. It should be emphasised that this use of chlorpheniramine maleate was reserved only for those who had had such transfusion reactions. curing the period under consideration, 90 bottles of blood containing chlorpheniramine maleate were administered, and of these 88 were accompanied by a perfectly uneventful course, The other 2 produced with no sign of reaction whatever. febrile reactions of 99-8°F and 1002°F respectively, but neither patient had a rigor. The first patient was not again transfused, and the second, after 2 transfusions of washed red cells in saline, which gave no reaction, was later successfully transfused with whole blood, again accompanied by chlorpheniramine maleate.
While this small series cannot pretend to be anything than a limited examination of the problem, it nevertheless suggests that chlorpheniramine maleate can make it possible to transfuse patients who might otherwise Such results are in prove resistant to such therapy. accordance with those of Simon and others.2-7 more
I am grateful to the clinicians of Westminster Hospital for their most helpful cooperation in collecting this series, as well as to Messrs. Allen & Hanburys for the provision of chlorpheniramine maleate in the form of ’Piriton Maleate ’ 10 mg.
ampoules. John Burford Carlill Pathological Laboratories. Westminster School of Medicine. London, S.W.1.
K. GOLDSMITH.
PHENYLBUTAZONE IN SUPERFICIAL PHLEBITIS SIR,—I should like to draw attention to the remarkable effect of phenylbutazone in cases of superficial thrombophlebitis. In a series of 23 cases results have been highly gratifying, and it has been possible to reduce very
considerably the length of the illness. The patients treated can be divided
into two groups.
patients had acute superficial phlebitis without ulceration. The effect of phenylbutazone in these cases was dramatic. Pain relief was quickly obtained, and inflammation subsided rapidly. All cases cleared up within five days, and patients were ambulant soon after treatment began. 8 patients were subject to periodic mild attacks of superficial thrombophlebitis, leading to shallow but painful ulceration of the leg. Such cases previously took four to six weeks to heal, but with phenylbutazone they cleared up within ten days. 15
REACTIONS AFTER TRANSFUSION SIR,-In a leading article in 19551 you noted that 1-2% of all patients transfused with blood were liable to reactions other than those due to mistakes in bloodgrouping or cross-matching techniques. You added that
1-2% of recipients had urticarial and other allergic reactions, while 2-5% had febrile reactions ;; and you remarked that different workers had sought in various ways to reduce the frequency of the reactions, either by sedation or by giving an anti-histamine. The choice of anti-histamine and the mode of administration are still undecided. Since reading your leader, I have always advised that patients to be transfused, other than under a general anaesthetic, be given a sedative and oral antihistamine, the choice of drugs used being governed by The routine the wishes of the clinician concerned. for all cross-matches technique performed under my direction has included the use of a saline and albumin technique at room-temperature, as well as saline, albumin, and indirect anti-globulin techniques at 37°C. Moreover, a smear of the blood to be given has always been stained with methylene-blue and examined microscopically to exclude any possible infection of the bottle concerned. Over
a
period during
which 2295
pints
of blood
were
administered, 16 patients had rigors, 4 pyrexial reactions of over 100°F, and 2 urticaria. Checks of the group, the crossmatch tests, and the in the bottle of blood
possibility on
of infection
or
haemolysis
laboratory were all treated at the beginning
return to the
invariably negative. 2 patients, both of the period under review, had had two reactions at the commencement of a transfusion, despite the transfusion of
fresh blood, sedation, and the administration of an antihistamine. It was decided to treat these patients with chlorpheniramine maleate, 10 mg. to be introduced into each bottle immediately before use. This technique enabled us to transfuse these cases repeatedly (3 times and 4 times respectively) without further incident. It was decided thereafter to transfuse all patients who had previously had a transfusion reaction 1. Lancet, 1955, ii, 180.
This series is admittedly not large enough for statistical with similar cases admitted to hospital for conservative treatment, but the results are so striking that I feel they should be made known at once. A wider trial seems highly desirable.
comparison
Dudley Road Hospital, Birmingham.
R. O. GILLHESPY.
GOVERNMENT AND PROFESSION
SIR,—In his letter last week, my neighbour, Dr. John
Fry, deplores the manner in which the profession’s claim has been presented. I agree.that the claim should have been associated with an expressed desire to examine defects in the existing service. He does not, however, stress sufficiently the fundamental defect in the scheme from which the present weaknesses spring, nor do the remedies he suggests all appear pertinent to the issue. The defects arise, as far as general practitioners are concerned, from the fact that the majority are attempting, valiantly if inadequately, to stretch old conditions of practice to meet the demands of a new age-an age that is characterised by an increased understanding of the individual in health and disease together with a changed sociological outlook that demands the national application of this knowledge. The family doctor’s increased area of responsibility is indicated by the widely W. G. Ann. Allergy, 1954, 12, 182. Frankel, D. B., Weidner, N. Ibid, 1953, 11, 204. Offenkrantz, F. M., Margolin, S., Jackson, D. J. med. Soc. N.J. 1953, 50, 253. 5. Tuft, L. In Current Therapy. Philadelphia, 1954 ; p. 564. 6. Wilhelm, R. E. J. Mich. med. Soc. 1954, 53, 651. 7. Winter, C. C., Taplin, G. V. Ann. Allergy, 1954, 12, 717.
2. 3. 4.
Simon, S. W., Eckman,