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PHOTOTHERAPY FOR JAUNDICE
1003
with the hypothesis of Weatherall and Brown that the disorder is congenital and derives from a proliferation of a stem-cell line in which the normal process of differentiation has not occurred. University Pædiatrics Clinic, Perugia, Italy.
ANTONIO CAO.
EFFECT OF CYSTIC-FIBROSIS SWEAT ON SODIUM REABSORPTION BY THE NORMAL SWEAT-GLAND
SiR,—The increased sodium concentration in the sweat of children with cystic fibrosis of the pancreas (c.F.) is, to the investigator, one of the most important manifestations of this genetic defect.1,2It has lately been shown that the coil of the c.F. sweat-gland secretes a normal volume of primary sweat isotonic with plasma but that during passage through the sweat-gland duct the net reabsorption-rate of sodium is lower than normal; the final sweat is thus sodium-rich. The underlying defect must therefore be in the epithelial cells of the gland duct.3-5 Recent data indicate that the sweat and mixed mouth saliva of c.F. patients contain a humoral agent which inhibits net sodium reabsorption in the rat parotid. 6, We have conducted an experiment to determine whether this humoral factor has an action on normal human sweat-glands. We chose the single sweat-gland for our investigations. Using a micropuncture technique and sweat collection under mineral Oil,3,SC.F. sweat was perfused for 7 minutes into the duct of a normal finger sweat-gland. After pilo-
similar. Sweat from normal subjects with a sodium concentration raised to c.F. levels served as controls (open circles in figure). The sodium concentrations were 62-0 ±18-0 meq. per 1. after perfusion with c.F. sweat (n==14), and 200J=7-0 meq. per 1. after perfusion with control sweat (n=8). Potassium was 19-9 Jr 5-0 meq. per 1. (c.F.) and 9-0 ±5 5 meq. per 1. (controls). In contrast to retrograde perfusion, subcutaneous infiltration of normal glands with C.F. sweat had no effect on sodium or potassium secretion. The results clearly demonstrate the humoral transducibility of the C.F. electrolyte defect. They strongly support the view that c.F. sweat contains a sodium-transport inhibiting factor. We suspect that this factor is produced by the sweat-glands themselves rather than a substance in blood or interstitial fluid. D. KAISER
E. DRACK E. ROSSI.
University Department of Pediatrics, Berne, Switzerland.
PHOTOTHERAPY FOR
JAUNDICE
SIR,-Dr. Barrie’s ingenious phototherapy unit (April 18, p. 835), improvised from an X-ray viewing box, may stimulate other pxdiatricians to use this method of treatment for neonatal jaundice. However, the evidence quoted for its effectiveness in one case is not convincing, since the fall in serum-bilirubin concentration could have occurred naturally or as a result of phenobarbitone administration. Using a purpose-made unit, we have obtained similar encouraging results in many individual cases, but only by a controlled clinical trial was the effectiveness of photo-
therapy proved.2 Your editorial in the same issue (p. 825) mentions that phototherapy units are commercially available in the U.S.A. They are also obtainable in Britain * and in our experience are useful acquisitions for neonatal departments. We are surprised that this method of treatment has been so long gaining acceptance in this country. Lest excessive caution be
we recommend read the balanced and authoritative account of phototherapy by Behrman and Hsia.3 St. John’s Hospital, C. B. M. WARREN. Chelmsford. University Department of Chemical Pathology, P. M. G. BROUGHTON. Leeds.
now
intending
Sodium concentrations in the sweat of single sweat-glands, plotted as a function of flow-rate, after retrograde perfusion with C.F. sweat (.) and sodium-rich control sweat (0).
replaced by overenthusiasm, users
to
Sant’Agnese, P. A., Darling, R. C., Perera, G. A., Shea, E. Pediatrics, Springfield, 1953, 12, 549. 2. di Sant’Agnese, P. A., Talamo, R. C. New Engl. J. Med. 1967, 277,
HYPOTHERMIA IN THE ELDERLY note on the work of Birmingham medical students on hypothermia in the elderly (April 11, p. 791) prompts us to comment on the results of our small similar survey on the elderly in Lambeth, London, in the winter of 1965-66. We thought that mercury thermometers might produce unreliable readings and therefore built, with the help of Prof. W. I. Cranston of St. Thomas’s Hospital, an electrical thermometer using a thermistor which could record mouth temperatures continuously without removal from the mouth. It was accurate to 0-03°C. This indicated when the oral temperature was stable and, particularly, could detect any covert mouth-breathing, which we found caused rapid cooling.
1287. 3. Schulz, I., di Sant’Agnese, P. A., Orloff, J., Froemter, E., Ulrich, K. J. Fedn. Proc. 1967, 26, 287. 4. Slegers, J. F. G. Dermatologica, 1963, 127, 242. 5. Emrich, H. M., Stoll, E., Friolet, B., Colombo, J. P., Richterich, R., Rossi, E. Pediat. Res. 1968, 2, 464. 6. Mangos, J. A., McSherry, N. R. Science, N.Y. 1967, 158, 135. 7. Mangos, J. A., McSherry, N. R. Pediat. Res. 1968, 2, 378. 8. Gertz, K. H. Pflügers Arch. ges. Physiol. 1963, 276, 336.
From: Stanley Cox Medical Equipment, Rank Precision Industries Ltd., Bessemer Road, Welwyn Garden City, Herts; and Air-Shields (U.K.) Ltd., Towerfield Estate, Shoeburvness. Southend-on-Sea. Essex. 1. Warren, C. B. M., Broughton, P. M. G. Lancet, 1968, i, 422. 2. Broughton, P. M. G., Rossiter, E. J. R., Warren, C. B. M., Goulis, G., Lord, P. S. Archs dis. Childh. 1965, 40, 666. 3. Behrman, R. E., Hsia, D. Y. Y. J. Pediat. 1969, 75, 718.
carpine stimulation the first 5-minute sample was discarded, and then the sweat from the perfused gland was collected for 40-80 minutes. The analyses for sodium and potassium were done on an ultra micro flame-photometer, which permitted determination of both ions together in a volume of less than 0-3 nl. (10-6 ml.). The results were as follows. At all flow-rates, and over the whole period of time, there was a significant increase in the sweat-sodium concentration (see accompanying figure, dark circles). The effect on potassium was 1. di
SIR,-Your
with the hypothesis of Weatherall and Brown that the disorder is congenital and derives from a proliferation of a stem-cell line in which the normal process of differentiation has not occurred. University Pædiatrics Clinic, Perugia, Italy.
ANTONIO CAO.
EFFECT OF CYSTIC-FIBROSIS SWEAT ON SODIUM REABSORPTION BY THE NORMAL SWEAT-GLAND
SiR,—The increased sodium concentration in the sweat of children with cystic fibrosis of the pancreas (c.F.) is, to the investigator, one of the most important manifestations of this genetic defect.1,2It has lately been shown that the coil of the c.F. sweat-gland secretes a normal volume of primary sweat isotonic with plasma but that during passage through the sweat-gland duct the net reabsorption-rate of sodium is lower than normal; the final sweat is thus sodium-rich. The underlying defect must therefore be in the epithelial cells of the gland duct.3-5 Recent data indicate that the sweat and mixed mouth saliva of c.F. patients contain a humoral agent which inhibits net sodium reabsorption in the rat parotid. 6, We have conducted an experiment to determine whether this humoral factor has an action on normal human sweat-glands. We chose the single sweat-gland for our investigations. Using a micropuncture technique and sweat collection under mineral Oil,3,SC.F. sweat was perfused for 7 minutes into the duct of a normal finger sweat-gland. After pilo-
similar. Sweat from normal subjects with a sodium concentration raised to c.F. levels served as controls (open circles in figure). The sodium concentrations were 62-0 ±18-0 meq. per 1. after perfusion with c.F. sweat (n==14), and 200J=7-0 meq. per 1. after perfusion with control sweat (n=8). Potassium was 19-9 Jr 5-0 meq. per 1. (c.F.) and 9-0 ±5 5 meq. per 1. (controls). In contrast to retrograde perfusion, subcutaneous infiltration of normal glands with C.F. sweat had no effect on sodium or potassium secretion. The results clearly demonstrate the humoral transducibility of the C.F. electrolyte defect. They strongly support the view that c.F. sweat contains a sodium-transport inhibiting factor. We suspect that this factor is produced by the sweat-glands themselves rather than a substance in blood or interstitial fluid. D. KAISER
E. DRACK E. ROSSI.
University Department of Pediatrics, Berne, Switzerland.
PHOTOTHERAPY FOR
JAUNDICE
SIR,-Dr. Barrie’s ingenious phototherapy unit (April 18, p. 835), improvised from an X-ray viewing box, may stimulate other pxdiatricians to use this method of treatment for neonatal jaundice. However, the evidence quoted for its effectiveness in one case is not convincing, since the fall in serum-bilirubin concentration could have occurred naturally or as a result of phenobarbitone administration. Using a purpose-made unit, we have obtained similar encouraging results in many individual cases, but only by a controlled clinical trial was the effectiveness of photo-
therapy proved.2 Your editorial in the same issue (p. 825) mentions that phototherapy units are commercially available in the U.S.A. They are also obtainable in Britain * and in our experience are useful acquisitions for neonatal departments. We are surprised that this method of treatment has been so long gaining acceptance in this country. Lest excessive caution be
we recommend read the balanced and authoritative account of phototherapy by Behrman and Hsia.3 St. John’s Hospital, C. B. M. WARREN. Chelmsford. University Department of Chemical Pathology, P. M. G. BROUGHTON. Leeds.
now
intending
Sodium concentrations in the sweat of single sweat-glands, plotted as a function of flow-rate, after retrograde perfusion with C.F. sweat (.) and sodium-rich control sweat (0).
replaced by overenthusiasm, users
to
Sant’Agnese, P. A., Darling, R. C., Perera, G. A., Shea, E. Pediatrics, Springfield, 1953, 12, 549. 2. di Sant’Agnese, P. A., Talamo, R. C. New Engl. J. Med. 1967, 277,
HYPOTHERMIA IN THE ELDERLY note on the work of Birmingham medical students on hypothermia in the elderly (April 11, p. 791) prompts us to comment on the results of our small similar survey on the elderly in Lambeth, London, in the winter of 1965-66. We thought that mercury thermometers might produce unreliable readings and therefore built, with the help of Prof. W. I. Cranston of St. Thomas’s Hospital, an electrical thermometer using a thermistor which could record mouth temperatures continuously without removal from the mouth. It was accurate to 0-03°C. This indicated when the oral temperature was stable and, particularly, could detect any covert mouth-breathing, which we found caused rapid cooling.
1287. 3. Schulz, I., di Sant’Agnese, P. A., Orloff, J., Froemter, E., Ulrich, K. J. Fedn. Proc. 1967, 26, 287. 4. Slegers, J. F. G. Dermatologica, 1963, 127, 242. 5. Emrich, H. M., Stoll, E., Friolet, B., Colombo, J. P., Richterich, R., Rossi, E. Pediat. Res. 1968, 2, 464. 6. Mangos, J. A., McSherry, N. R. Science, N.Y. 1967, 158, 135. 7. Mangos, J. A., McSherry, N. R. Pediat. Res. 1968, 2, 378. 8. Gertz, K. H. Pflügers Arch. ges. Physiol. 1963, 276, 336.
From: Stanley Cox Medical Equipment, Rank Precision Industries Ltd., Bessemer Road, Welwyn Garden City, Herts; and Air-Shields (U.K.) Ltd., Towerfield Estate, Shoeburvness. Southend-on-Sea. Essex. 1. Warren, C. B. M., Broughton, P. M. G. Lancet, 1968, i, 422. 2. Broughton, P. M. G., Rossiter, E. J. R., Warren, C. B. M., Goulis, G., Lord, P. S. Archs dis. Childh. 1965, 40, 666. 3. Behrman, R. E., Hsia, D. Y. Y. J. Pediat. 1969, 75, 718.
carpine stimulation the first 5-minute sample was discarded, and then the sweat from the perfused gland was collected for 40-80 minutes. The analyses for sodium and potassium were done on an ultra micro flame-photometer, which permitted determination of both ions together in a volume of less than 0-3 nl. (10-6 ml.). The results were as follows. At all flow-rates, and over the whole period of time, there was a significant increase in the sweat-sodium concentration (see accompanying figure, dark circles). The effect on potassium was 1. di
SIR,-Your