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PORTABLE CONTAINER FOR AMPOULES OF VARIOUS SIZES
1390
infection officer would achieve nothing, would add confusion to a difficult problem, and would constitute another memorial to the ancient cult of " passing the buck ". JOHN HUTCHISON Stobhill General Hospital, JOHN S. STEVENSON. Glasgow, N.1. UNUSUAL URINE PROTEIN IN MYELOMATOSIS SIR,—Cummings 1reported three bands in the gammaglobulin region of urine proteins in a case of myelomatosis. We have observed two bands in this region in case 2
(see accompanying figure), although myelomatosis
from both girls were also taken but unfortunately the person to whom they were entrusted for analysis died suddenly and they cannot be traced. Dr. Bullough reports4 a similar case in which he used edrophonium before neostigmine, which makes me think that the risk of prolonging the apnoea by the use of anticholinesterases is not so great as is generally believed; in fact, as Dr. Bullough suggests, if the action of suxamethonium is prolonged neostigmine will do nothing
but
good. J. SHEGOG RUDDELL.
gener-
NOT SO MUTE
SIR,-With reference to your note of March 29 (p. 700), we cannot resist the temptation to point out that American proctologists have not been quite so mute as you believe. They have three outlets already: (1) Transactions of the Arnericari 11’roctological Association, St. Louis. (1889) ) (2) Proctologv (and Allied SuhJects), Chicago. (1936(3) American Journal of Proctology (International Academy of ) Proctology). (1950And now there is a fourth. Librarians have long wished that the unnecessary proliferation of medical journals would cease. M. DOREEN E. FRASER University of British Columbia, Biomedical Librarian.
Vancouver.
Serum and urine b, urine.
proteins in
2
cases
of
myelomatosis:
a, serum;
serum- and urine-protein patterns as in case 1. The smears from the sternal bone-marrow in case 2 showed numerous plasma cells and " grape cells ", as
ally gives
cit-qc-rihf-(i hv Stich
ft
PORTABLE CONTAINER FOR AMPOULES OF VARIOUS SIZES SiR,ńThe ampoule container in the accompanying illustration was designed primarily for the anxsthetist. It enables him to have ampoules of various drugs immediately accessible, and has the advantage that when ampoules have been used the empty space is apparent; the drug used can be replaced, so that the necessary drugs are always available. The container, which is made of pressed steel, is about 12 in. long, 4 in. wide, and 4 in. in depth. It can be opened at eitherside,
al_22
Biochemistry Department, Madras Medical College, Madras, India.
NINAN VERGHESE.
REVERSAL OF SUXAMETHONIUM PARALYSIS WITH NEOSTIGMINE I reporteda case of reversal of suxa1952 SIR,-In methonium-chloride paralysis with neostigmine. Since then I have not had a case of prolonged apnoea until last month, when I ansesthetised two sisters, aged 9 years and 7 years, for tonsillectomy. Both children received premedication of ’Omnopon’ and scopolamine appropriate for their weight; both were induced with hexobarbitone and suxamethonium bromide, and maintained on N2O and O2, The younger child at the end of her tonsillectomy, unlike her sister, was not breathing spon-
taneously. During
the next half-hour she was given nalorphine, nikethamide, and methyl phenidate (’Ritalin’), with no
response. By this time it was established in my mind that the apncea was due to the suxamethonium bromide solely, so I gave her gr. 1/100 of atropine followed by 25 mg. neostigmine with almost immediate return of respirations, and no relapse. The relaxant was sent to the manufacturers who reported that it was normal in strength and quality. Specimens of serum 1. Cummings, A. L. Lancet, 1957, i, 598. 2. Stich, M. H., Swiller, A. I., Morrison, M.
25, 601. 3. Lancet, 1952, ii, 341.
Container for
that the
ampoules.
ensuring ampoules easy to remove. It holds twelve 2 ml. ampoules, eighteen of 1 ml., and two each of 4 ml., 10 ml., and 20 ml.-a total of 36 ampoules. are
is made by Luckham Ltd., 591/3, Kingston Road, I am indebted to the photographic department of the Institute of Orthopaedics, 234, Great Portland Street, for the illustration. The
case
London, S.W.20.
G. K. T. ROCHE.
Amer. J. clin. Path. 1955, 4. ibid.
1957, ii, 804.
infection officer would achieve nothing, would add confusion to a difficult problem, and would constitute another memorial to the ancient cult of " passing the buck ". JOHN HUTCHISON Stobhill General Hospital, JOHN S. STEVENSON. Glasgow, N.1. UNUSUAL URINE PROTEIN IN MYELOMATOSIS SIR,—Cummings 1reported three bands in the gammaglobulin region of urine proteins in a case of myelomatosis. We have observed two bands in this region in case 2
(see accompanying figure), although myelomatosis
from both girls were also taken but unfortunately the person to whom they were entrusted for analysis died suddenly and they cannot be traced. Dr. Bullough reports4 a similar case in which he used edrophonium before neostigmine, which makes me think that the risk of prolonging the apnoea by the use of anticholinesterases is not so great as is generally believed; in fact, as Dr. Bullough suggests, if the action of suxamethonium is prolonged neostigmine will do nothing
but
good. J. SHEGOG RUDDELL.
gener-
NOT SO MUTE
SIR,-With reference to your note of March 29 (p. 700), we cannot resist the temptation to point out that American proctologists have not been quite so mute as you believe. They have three outlets already: (1) Transactions of the Arnericari 11’roctological Association, St. Louis. (1889) ) (2) Proctologv (and Allied SuhJects), Chicago. (1936(3) American Journal of Proctology (International Academy of ) Proctology). (1950And now there is a fourth. Librarians have long wished that the unnecessary proliferation of medical journals would cease. M. DOREEN E. FRASER University of British Columbia, Biomedical Librarian.
Vancouver.
Serum and urine b, urine.
proteins in
2
cases
of
myelomatosis:
a, serum;
serum- and urine-protein patterns as in case 1. The smears from the sternal bone-marrow in case 2 showed numerous plasma cells and " grape cells ", as
ally gives
cit-qc-rihf-(i hv Stich
ft
PORTABLE CONTAINER FOR AMPOULES OF VARIOUS SIZES SiR,ńThe ampoule container in the accompanying illustration was designed primarily for the anxsthetist. It enables him to have ampoules of various drugs immediately accessible, and has the advantage that when ampoules have been used the empty space is apparent; the drug used can be replaced, so that the necessary drugs are always available. The container, which is made of pressed steel, is about 12 in. long, 4 in. wide, and 4 in. in depth. It can be opened at eitherside,
al_22
Biochemistry Department, Madras Medical College, Madras, India.
NINAN VERGHESE.
REVERSAL OF SUXAMETHONIUM PARALYSIS WITH NEOSTIGMINE I reporteda case of reversal of suxa1952 SIR,-In methonium-chloride paralysis with neostigmine. Since then I have not had a case of prolonged apnoea until last month, when I ansesthetised two sisters, aged 9 years and 7 years, for tonsillectomy. Both children received premedication of ’Omnopon’ and scopolamine appropriate for their weight; both were induced with hexobarbitone and suxamethonium bromide, and maintained on N2O and O2, The younger child at the end of her tonsillectomy, unlike her sister, was not breathing spon-
taneously. During
the next half-hour she was given nalorphine, nikethamide, and methyl phenidate (’Ritalin’), with no
response. By this time it was established in my mind that the apncea was due to the suxamethonium bromide solely, so I gave her gr. 1/100 of atropine followed by 25 mg. neostigmine with almost immediate return of respirations, and no relapse. The relaxant was sent to the manufacturers who reported that it was normal in strength and quality. Specimens of serum 1. Cummings, A. L. Lancet, 1957, i, 598. 2. Stich, M. H., Swiller, A. I., Morrison, M.
25, 601. 3. Lancet, 1952, ii, 341.
Container for
that the
ampoules.
ensuring ampoules easy to remove. It holds twelve 2 ml. ampoules, eighteen of 1 ml., and two each of 4 ml., 10 ml., and 20 ml.-a total of 36 ampoules. are
is made by Luckham Ltd., 591/3, Kingston Road, I am indebted to the photographic department of the Institute of Orthopaedics, 234, Great Portland Street, for the illustration. The
case
London, S.W.20.
G. K. T. ROCHE.
Amer. J. clin. Path. 1955, 4. ibid.
1957, ii, 804.