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RAPID AND SIMULTANEOUS DETECTION OF SYPHILIS AND AUSTRALIA-ANTIGEN-POSITIVE BLOOD
880
pink frothy sputum started and the patient became deeply cyanosed. Endotracheal intubation and mechanical ventilation with P.E.E.P. resulted in dramatic improvement (see table). One of the prerequisites in the application of this method is the frequent monitoring of the arterial blood gases and pH, preferably via an indwelling arterial catheter. J. R. VAN HAERINGEN Respiratory Care Unit, J. W. KLEINE University Hospital, H. J. SLUITER. The Netherlands. Groningen,
guide it, would decide the issue better than the use of a gross dilatatory force. Hitherto benefit has been reported only by patients in whom there was pre-existing pain due to anal spasm; such In all cases with classical a benefit was not unexpected. third-degree piles, haemorrhoidectomy had to be carried out
of
later.
Surely the issue is not manual dilatation versus hasmorrhoidectomy, but manual dilatation versus outpatient phenol injection requiring no anxsthetic at all. Where the Lord technique succeeds it presumably does so by fibrosis following extensive submucous hxmatoma absorption. Where the Lord technique fails is, in Osler’s words, the "
RAPID AND SIMULTANEOUS DETECTION OF SYPHILIS AND AUSTRALIA-ANTIGENPOSITIVE BLOOD
demonstration of the lesion ". Gravesend and North Kent Hospital,
Gravesend,
SIR,-The paper of Dr. Bdnffer1 prompted our interest. hospital is in a mountain village where blood-bank
FELIX E. WEALE.
Kent.
Our
meagre. We often obtain blood for transfusion from the patients’ families, and there is little time to examine the blood for the dangerous infective agents, resources are
DROWNING
timely editorial (Sept. 30, p. 691) you importance of early recognition and treatment secondary or near drowning. You stated that in the more severe cases intermittent positive-pressure ventilation is required, in which high pressures are often mandatory and frequent suction will be necessary. We should like to make a plea for the application of positive end-expiratory pressure (P.E.E.P.)1 at an early state of this mechanical ventilation. Since Asbaugh et al.l recorded their results with this method in what they called " acute respiratory distress in adults ", many reports have confirmed the efficacy of this method in respiratory-distress syndromes of widely varying aetiology. We have treated several a few with the nearwith this method, including patients drowning syndrome. The immediate effect is always gratifying: hypoxaemia is corrected, the abundant outpouring of exudate with the need for frequent suction is abolished, and the patient accepts the respirator without fighting and without heavy sedation. We should like to illustrate this point by the data about our last case of neardrowning (see accompanying table). This 8-year-old boy was lifted from the bottom of a canal by frogmen, who immediately started resuscitation. On arrival at the hospital his airways were free, but about 15 minutes later outpouring SIR,-In
your
the of the
emphasised
Treponema pallidum and hepatitis virus. Counter electrophoresis is convenient to this situation, because the method is simple and provides results within an hour. We have used this method for detecting Australia antigen. We used 0-8% agar plates in 0-05M barbiturate buffer, pH 8-6, 1 mm. thick. Three wells in a row had a diameter of 3 mm. and lay 10 mm. from each other. The serum sample was put in the central well, Reiter protein in the anodal well, and anti-Australia antibody in the cathodal well. 3 mA current per cm. width of the gel was applied for 60 minutes. Positive sera showed precipitating line between the wells (see figure). This test is advisable to detect the agents rapidly and simultaneously, though the sensitivitv is
satisfactorv.
not so
Saku Central Hospital, Minamisaku Usuda,
KIMIO FUJITA MATSUO TAKAHASHI.
Nagano, Japan. 1.
Asbaugh, D. G., Bigelow, D. B., Petty, T. L., Levine, B. E. Lancet, 1967, ii, 319. TREATMENT
OF I
8-YEAR-OLD
BOY I
BY
POSITIVE I
* Time of arrival at the respiratory-care unit; mask ventilation with t Oxygen concentration in inspiratory air. t Z.E.E.P. =Zero end-expiratory pressure. § ’ Ventimask’.
END-EXPIRATORY I
PRESSURE I
oxygen was administered in the ambulance
pink frothy sputum started and the patient became deeply cyanosed. Endotracheal intubation and mechanical ventilation with P.E.E.P. resulted in dramatic improvement (see table). One of the prerequisites in the application of this method is the frequent monitoring of the arterial blood gases and pH, preferably via an indwelling arterial catheter. J. R. VAN HAERINGEN Respiratory Care Unit, J. W. KLEINE University Hospital, H. J. SLUITER. The Netherlands. Groningen,
guide it, would decide the issue better than the use of a gross dilatatory force. Hitherto benefit has been reported only by patients in whom there was pre-existing pain due to anal spasm; such In all cases with classical a benefit was not unexpected. third-degree piles, haemorrhoidectomy had to be carried out
of
later.
Surely the issue is not manual dilatation versus hasmorrhoidectomy, but manual dilatation versus outpatient phenol injection requiring no anxsthetic at all. Where the Lord technique succeeds it presumably does so by fibrosis following extensive submucous hxmatoma absorption. Where the Lord technique fails is, in Osler’s words, the "
RAPID AND SIMULTANEOUS DETECTION OF SYPHILIS AND AUSTRALIA-ANTIGENPOSITIVE BLOOD
demonstration of the lesion ". Gravesend and North Kent Hospital,
Gravesend,
SIR,-The paper of Dr. Bdnffer1 prompted our interest. hospital is in a mountain village where blood-bank
FELIX E. WEALE.
Kent.
Our
meagre. We often obtain blood for transfusion from the patients’ families, and there is little time to examine the blood for the dangerous infective agents, resources are
DROWNING
timely editorial (Sept. 30, p. 691) you importance of early recognition and treatment secondary or near drowning. You stated that in the more severe cases intermittent positive-pressure ventilation is required, in which high pressures are often mandatory and frequent suction will be necessary. We should like to make a plea for the application of positive end-expiratory pressure (P.E.E.P.)1 at an early state of this mechanical ventilation. Since Asbaugh et al.l recorded their results with this method in what they called " acute respiratory distress in adults ", many reports have confirmed the efficacy of this method in respiratory-distress syndromes of widely varying aetiology. We have treated several a few with the nearwith this method, including patients drowning syndrome. The immediate effect is always gratifying: hypoxaemia is corrected, the abundant outpouring of exudate with the need for frequent suction is abolished, and the patient accepts the respirator without fighting and without heavy sedation. We should like to illustrate this point by the data about our last case of neardrowning (see accompanying table). This 8-year-old boy was lifted from the bottom of a canal by frogmen, who immediately started resuscitation. On arrival at the hospital his airways were free, but about 15 minutes later outpouring SIR,-In
your
the of the
emphasised
Treponema pallidum and hepatitis virus. Counter electrophoresis is convenient to this situation, because the method is simple and provides results within an hour. We have used this method for detecting Australia antigen. We used 0-8% agar plates in 0-05M barbiturate buffer, pH 8-6, 1 mm. thick. Three wells in a row had a diameter of 3 mm. and lay 10 mm. from each other. The serum sample was put in the central well, Reiter protein in the anodal well, and anti-Australia antibody in the cathodal well. 3 mA current per cm. width of the gel was applied for 60 minutes. Positive sera showed precipitating line between the wells (see figure). This test is advisable to detect the agents rapidly and simultaneously, though the sensitivitv is
satisfactorv.
not so
Saku Central Hospital, Minamisaku Usuda,
KIMIO FUJITA MATSUO TAKAHASHI.
Nagano, Japan. 1.
Asbaugh, D. G., Bigelow, D. B., Petty, T. L., Levine, B. E. Lancet, 1967, ii, 319. TREATMENT
OF I
8-YEAR-OLD
BOY I
BY
POSITIVE I
* Time of arrival at the respiratory-care unit; mask ventilation with t Oxygen concentration in inspiratory air. t Z.E.E.P. =Zero end-expiratory pressure. § ’ Ventimask’.
END-EXPIRATORY I
PRESSURE I
oxygen was administered in the ambulance