- Email: [email protected]
POLYETHYLENE AS COVERSLIPS
1027 I know no evidence that patients with the Marfan syndrome have an increased frequency of bicuspid aortic valve. Perhaps practical significance of recognising an association between bicuspid valve and Erdheim’s disease (if it exists) lies in its implications for surgical management. When the first part of the aorta is dilated in a case of bicuspid aortic valve, it may not be adequate merely Even though the degree of to replace the aortic valve. dilatation in the aorta may not be sufficient to warrant a further procedure under the ordinary criteria, the suggested association may make wrapping of the aorta indicated also in such cases. Johns Hopkins Hospital, VICTOR A. MCKUSICK. Baltimore, Maryland 21205, U.S.A.
between blood and effusion fluid. Under certain circumthis pool of digoxin could serve as an extra source, leading to acute intoxication, despite initial low plasmadigoxin values. stances
Department of Biological Chemistry, University of Athens, Goudi, Athens 609, Greece. Department of Cardiology, King Paul Hospital,
TH. LIVANOU.
EU. VORIDIS K. KAPLANIDIS.
Athens.
Department of Biological Chemistry,
C. J. MIRAS.
University of Athens.
Diary of the Week POLYETHYLENE AS COVERSLIPS the suggestion that polyethylene be used as slides for microscopical work, I have started using it as coverslips in my clinic for routine blood-counts and microscopical examination of urine and fseces. The polyethylene films are advantageous in that they can be cut into any size and also can be easily disposed of. The glass coverslips are expensive, easily breakable, and available only in fixed sizes.
SIR,-Prompted by
can
Rathika, Kumbakonam,
R.
India.
MAY
7
to
13
8th
Monday,
ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 OHS 6 P.M. Dr. A. G. Doughty: An Epidural Service for Obstetrics. INSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London W.C.2 4.30 P.M. Dr. Rodney Grahame: Cutaneous and Joint Disease. WRIGHT-FLEMING INSTITUTE, St. Mary’s Hospital Medical School, London W2 1PG 5 P.M. Prof. D. J. Weatherall: Abnormal Hxmoglobin Synthesis.
NATARAJAN. 9th
Tuesday, DIGITALIS TOXICITY
ROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London WC2A 3PN 5 P.M. Mr. Denis Burkitt: Epidemiology and Causation of Bowel. Cancer. (Walker prize lecture.)
SIR,-Since the development of
a sensitive radiothe measurement of digoxin, several been made of serum or plasma digoxin concentrations with clinical and electrocardiographic signs of intoxication. Most of this work either supports o demonstrates a good relationship between plasma-digoxin concentration and clinical signs of intoxication.1-4 There is, however, an overlap of serum-digoxin levels in nontoxic and toxic patients, and this critical point coincides with the physician’s difficulty in selecting treatment for a particular patient. Therefore, the study of the relationship of circulating-digoxin levels and various factors which may predispose to digitalis toxicity is very important. Among factors affecting individual tolerance 5-8 chronic lung disease with hypoxia, renal insufficiency, and myocardial infarction have been judged the most significant. It is generally accepted that pleural effusion, ascites, and even oedema may contribute to digitalis intoxication by a mechanism which, to our knowledge, has not yet been experimentally tested. In our studies, on 12 patients, using 125I_labelled 3-0-succinyl digoxigenin as antigen for the radioimmunoassay, we were able to detect up to 6 ng. per ml. digoxin in the pleural fluid, 30 minutes to 6 hours after an intravenous injection of 1 mg. of digoxin. On the other hand, digoxin was detected in the blood, in a concentration up to 6 ng. per ml., after an intrapleural or intraperitoneal injection of 1 mg. of digoxin. This shows a digoxin flow
immunoassay for comparisons have
1. 2. 3. 4. 5. 6.
7. 8.
Chamberlain, D. A., White, R. D., Howard, M. R., Smith, T. W. Br. med. J. 1970, iii, 429. Smith, T. W., Haber, E. J. clin. Invest. 1970, 49, 2377. Evered, D. C., Chapman, C. Br. Heart J. 1971, 33, 540. Huffman, D., Azarnoff, D. L. Lancet, March 25, 1972, p. 695. Hargreave, F. E. Br. med. J. 1965, ii, 943. Doherty, J. E., Perkins, W. H., Flanagan, W. J. Ann. intern. Med. 1967, 66, 116. Binnion, P. F., Morgan, L. M., Stevenson, H. M., Flecher, E. Br. Heart J. 1969, 31, 636. Surawicz, B., Mortelmans, S. in Digitalis; p. 127. New York, 1969.
Wednesday,
10th
ROYAL COLLEGE OF SURGEONS OF ENGLAND 5 P.M. Dr. Denis Dooley: A Dissection of
Anatomy. (Arris and Gale-
lecture.) ROYAL POSTGRADUATE MEDICAL SCHOOL 2 P.M. Dr. A. Stevens: Histochemistry in Exfoliative
Cytology
Diagnosis. INSTITUTE OF CHILD HEALTH, 5.30
P.M.
30 Guilford Street, London W.C.1 Dr. A. P. Mowat: The Neonatal Hepatitis Syndrome-An.
Epidemiological Syndrome. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Mr. G. L. W. Bonney, Mr. P. M. Yeoman: Brachial Plexus. Injuries-Diagnosis and Prognosis. 8.15 P.M. Mr. P. M. Yeoman: Brachial Plexus Injuries-Surgical. Management. Dr. D. A. Brewerton: Resettlement. INSTITUTE OF PSYCHIATRY, De Crespigny Park, Denmark Hill, London S.E.5 5.30 P.M. Dr. E. H. Hare: Social Class and Mental Illness-a Reviewand a New Study. ROYAL FREE HOSPITAL, Gray’s Inn Road, London W.C.1 5.15 P.M. Dr. L. W. Powell (Brisbane): Heemochromatosis. MANCHESTER MEDICAL SOCIETY 5 P.M. (Medical School.) Pathology. Dr. A. J. Zuckerman: Recent’ Advances in Human Viral Hepatitis. UNIVERSITY OF DUNDEE 5 P.M. Prof. G. Meyer-Schwickerath (Essen): Treatment of Diabetic.
Retinopathy.
Thursday, llth ROYAL COLLEGE
OF PHYSICIANS OF LONDON, 11 St. Andrew’s Placer Regent’s Park, NW1 4LE 5 P.M. Dr. J. M. Malins: The Impact of Insulin on Clinical Medicine(Bertram Louis Abrahams lecture.) ST. MARY’S HOSPITAL MEDICAL SCHOOL, London W2 1PG 5.15 P.M. Prof. J. K. Dennis: Abortion, Contraception, Sex Education, -Is the Order Reversed ? (Aleck Bourne lecture.)
UNIVERSITY OF ABERDEEN 5 P.M. Prof. D. J. Weatherall:
Haemoglobin and its Abnormalities
(Davidson lecture.)
Friday, 12th ROYAL POSTGRADUATE MEDICAL SCHOOL 11 A.M. Mr. I. W. MacPhee: From Here to Eternity-Thoughts on, the Treatment of Malignant Disease.
between blood and effusion fluid. Under certain circumthis pool of digoxin could serve as an extra source, leading to acute intoxication, despite initial low plasmadigoxin values. stances
Department of Biological Chemistry, University of Athens, Goudi, Athens 609, Greece. Department of Cardiology, King Paul Hospital,
TH. LIVANOU.
EU. VORIDIS K. KAPLANIDIS.
Athens.
Department of Biological Chemistry,
C. J. MIRAS.
University of Athens.
Diary of the Week POLYETHYLENE AS COVERSLIPS the suggestion that polyethylene be used as slides for microscopical work, I have started using it as coverslips in my clinic for routine blood-counts and microscopical examination of urine and fseces. The polyethylene films are advantageous in that they can be cut into any size and also can be easily disposed of. The glass coverslips are expensive, easily breakable, and available only in fixed sizes.
SIR,-Prompted by
can
Rathika, Kumbakonam,
R.
India.
MAY
7
to
13
8th
Monday,
ROYAL POSTGRADUATE MEDICAL SCHOOL, Hammersmith Hospital, London W12 OHS 6 P.M. Dr. A. G. Doughty: An Epidural Service for Obstetrics. INSTITUTE OF DERMATOLOGY, St. John’s Hospital for Diseases of the Skin, Lisle Street, Leicester Square, London W.C.2 4.30 P.M. Dr. Rodney Grahame: Cutaneous and Joint Disease. WRIGHT-FLEMING INSTITUTE, St. Mary’s Hospital Medical School, London W2 1PG 5 P.M. Prof. D. J. Weatherall: Abnormal Hxmoglobin Synthesis.
NATARAJAN. 9th
Tuesday, DIGITALIS TOXICITY
ROYAL COLLEGE OF SURGEONS OF ENGLAND, Lincoln’s Inn Fields, London WC2A 3PN 5 P.M. Mr. Denis Burkitt: Epidemiology and Causation of Bowel. Cancer. (Walker prize lecture.)
SIR,-Since the development of
a sensitive radiothe measurement of digoxin, several been made of serum or plasma digoxin concentrations with clinical and electrocardiographic signs of intoxication. Most of this work either supports o demonstrates a good relationship between plasma-digoxin concentration and clinical signs of intoxication.1-4 There is, however, an overlap of serum-digoxin levels in nontoxic and toxic patients, and this critical point coincides with the physician’s difficulty in selecting treatment for a particular patient. Therefore, the study of the relationship of circulating-digoxin levels and various factors which may predispose to digitalis toxicity is very important. Among factors affecting individual tolerance 5-8 chronic lung disease with hypoxia, renal insufficiency, and myocardial infarction have been judged the most significant. It is generally accepted that pleural effusion, ascites, and even oedema may contribute to digitalis intoxication by a mechanism which, to our knowledge, has not yet been experimentally tested. In our studies, on 12 patients, using 125I_labelled 3-0-succinyl digoxigenin as antigen for the radioimmunoassay, we were able to detect up to 6 ng. per ml. digoxin in the pleural fluid, 30 minutes to 6 hours after an intravenous injection of 1 mg. of digoxin. On the other hand, digoxin was detected in the blood, in a concentration up to 6 ng. per ml., after an intrapleural or intraperitoneal injection of 1 mg. of digoxin. This shows a digoxin flow
immunoassay for comparisons have
1. 2. 3. 4. 5. 6.
7. 8.
Chamberlain, D. A., White, R. D., Howard, M. R., Smith, T. W. Br. med. J. 1970, iii, 429. Smith, T. W., Haber, E. J. clin. Invest. 1970, 49, 2377. Evered, D. C., Chapman, C. Br. Heart J. 1971, 33, 540. Huffman, D., Azarnoff, D. L. Lancet, March 25, 1972, p. 695. Hargreave, F. E. Br. med. J. 1965, ii, 943. Doherty, J. E., Perkins, W. H., Flanagan, W. J. Ann. intern. Med. 1967, 66, 116. Binnion, P. F., Morgan, L. M., Stevenson, H. M., Flecher, E. Br. Heart J. 1969, 31, 636. Surawicz, B., Mortelmans, S. in Digitalis; p. 127. New York, 1969.
Wednesday,
10th
ROYAL COLLEGE OF SURGEONS OF ENGLAND 5 P.M. Dr. Denis Dooley: A Dissection of
Anatomy. (Arris and Gale-
lecture.) ROYAL POSTGRADUATE MEDICAL SCHOOL 2 P.M. Dr. A. Stevens: Histochemistry in Exfoliative
Cytology
Diagnosis. INSTITUTE OF CHILD HEALTH, 5.30
P.M.
30 Guilford Street, London W.C.1 Dr. A. P. Mowat: The Neonatal Hepatitis Syndrome-An.
Epidemiological Syndrome. INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD 6 P.M. Mr. G. L. W. Bonney, Mr. P. M. Yeoman: Brachial Plexus. Injuries-Diagnosis and Prognosis. 8.15 P.M. Mr. P. M. Yeoman: Brachial Plexus Injuries-Surgical. Management. Dr. D. A. Brewerton: Resettlement. INSTITUTE OF PSYCHIATRY, De Crespigny Park, Denmark Hill, London S.E.5 5.30 P.M. Dr. E. H. Hare: Social Class and Mental Illness-a Reviewand a New Study. ROYAL FREE HOSPITAL, Gray’s Inn Road, London W.C.1 5.15 P.M. Dr. L. W. Powell (Brisbane): Heemochromatosis. MANCHESTER MEDICAL SOCIETY 5 P.M. (Medical School.) Pathology. Dr. A. J. Zuckerman: Recent’ Advances in Human Viral Hepatitis. UNIVERSITY OF DUNDEE 5 P.M. Prof. G. Meyer-Schwickerath (Essen): Treatment of Diabetic.
Retinopathy.
Thursday, llth ROYAL COLLEGE
OF PHYSICIANS OF LONDON, 11 St. Andrew’s Placer Regent’s Park, NW1 4LE 5 P.M. Dr. J. M. Malins: The Impact of Insulin on Clinical Medicine(Bertram Louis Abrahams lecture.) ST. MARY’S HOSPITAL MEDICAL SCHOOL, London W2 1PG 5.15 P.M. Prof. J. K. Dennis: Abortion, Contraception, Sex Education, -Is the Order Reversed ? (Aleck Bourne lecture.)
UNIVERSITY OF ABERDEEN 5 P.M. Prof. D. J. Weatherall:
Haemoglobin and its Abnormalities
(Davidson lecture.)
Friday, 12th ROYAL POSTGRADUATE MEDICAL SCHOOL 11 A.M. Mr. I. W. MacPhee: From Here to Eternity-Thoughts on, the Treatment of Malignant Disease.