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RETURN TO WORK AFTER MYOCARDIAL INFARCTION
823 that 17-methoxyl-oestradiol acts similarly to mstradiol. This is not really justified: Alteration at the C17 position can bring about major changes
assumption is
in some aspects of hormonal activity-for instance, ethinyl cestradiol is a partial condensation product of an acetylene group at this locus and is the most powerful oestrogen known. Testosterone is an androgen; 17-alpha-ethyltestosterone is almost inert; 17-alpha-ethinyltestosterone is a progestin. Parenthetically, the excretion of two other hormones, androsterone and xtiocholanolone, has been shown to be subnormal in women who develop breast cancer.1
With steroids, structural analogy is upon which to balance an important Department of Infectious Disease, Cook County Hospital, Chicago, Illinois 60612, U.S.A.
dangerous point hypothesis. a
ROGER LEWIS.
RETURN TO WORK AFTER MYOCARDIAL INFARCTION and his colleagues (Aug. 28, p. 454) Sin;—Dr. Nagle found that only 50% of males had returned to work 4 months after myocardial infarction. My own figures (Br. Heart I., in the press) are 90% at 3 months, 23% at 1 month, and 56% at 6 weeks from the onset of the infarct. These figures include the time spent in hospital, and have been obtained by adopting the measures recommended by Dr. Nagle. I entirely agree with Dr. Nagle and his colleagues that rehabilitation should start in the early days in hospital, and that " essentially the problem seems to be one of education of hospital staff, general practitioners, employers, relatives, and the patients themselves ". It necessarily follows that the time spent in bed and in hospital must be the minimum, and that any delay, either in hospital or before returning to work, must be anticipated and suitable avoiding action taken. This entails a lot of extra work for the medical and ancillary staff, but results in great social and economic benefits and the virtual eradication of cardiac neurosis. Barnet General Hospital, Barnet, Herts.
takenly identified in many cases; but 20% of our population have amoebiasis, and he will need to produce more evidence in support of his claim. He and I have observed the epidemic in different countries, at different moments, in different populations, from the biological and the social points of view, with different interests and different techniques. What I saw suggests that in some patients Shiga dysentery caused a state of acute amcebiasis or of protracted acute enterocolitis. I still know of no evidence to refute my view. Hospital General " El Retiro ", Managua, D.N., Nicaragua.
CAMILO
VIJIL.
EFFECT OF OXYGEN ON A STIMULATED N.B.T. TEST
SIR,-The nitroblue-tetrazolium (N.B.T.) test was first described by Park et al. as an aid to differential diagnosis of febrile disorders. Increased N.B.T. reduction’ by circulating neutrophils has been reported in association with bacterial infections 2,3and parasitic diseased, 4,5 and in the absence of infection in the neonatal period. 6, In experiments employing an in-vitro phagocytosis system consisting EFFECT OF OXYGEN ON THE REDUCTION OF N.B.T. BY STIMULATED NEUTROPHILS
G. R. ROYSTON.
EPIDEMIC SHIGA DYSENTERY IN CENTRAL AMERICA
SiR,—Dr. Mata’s well-documented report2 throws light the unusual epidemic in Central America, which continues to the present time. When the epidemic began here, on
had no information at the El Retiro Hospital about previous therapeutic trials in Guatemala and El Salvador. Both cities are within an hour’s flight from Managua. How was this possible, in the age of worldwide epidemiological information ? By trial and error we found, within a short time, evidence of drug resistance and of the efficacy of ampicillin (rather slow-acting), trimethoprim/sulphamethoxazole, rifampicin, and nalidixic acid. Our hospital cases led us to suspect that where Entamaeba histolytica and amaebic abscesses were found the disease tended to run a more serious course; thus, there were straightforward cases of Shiga dysentery, cured by adequate therapy within a week, and cases which continued for 4-6 weeks and in which treatment was ineffective until anti-amcebics (such as emetin or metronidazole) were added. In the second type hmmorrhages were severe, there was rectocolitis, the general health was poorer, and most of the patients were males between the ages of 30 and 50. Dr. Mata asserts that E. histolytica was probably miswe
Bulbrook, R. D., Hayward, J. L., Spicer, C. C. Lancet, Aug. 21 1971, p. 395. 2. Mata, L. J., Cáceres, A., Torres, M. F. ibid. 1971, i, 600. 3. Vijil, C. ibid. 1970, ii, 471. 1.
of whole blood with Pseudomonas ceruginosa, stimulation of the neutrophils causes a considerable increase in N.B.T. reduction after 1 hour’s incubation at 37 °C with the test organism. By contrast the N.B.T. reduction by unstimulated neutrophils remains unchanged." With the same experimental conditions, the tests were repeated on blood-samples from 6 healthy newborn infants and 6 adults. Each bloodsample was transferred into 2 capped plastic tubes. One was maintained in a oxygen-rich atmosphere (obtained by flushing the test-tube with oxygen for the whole period of incubation), the other was incubated without added oxygen and served as a control. The accompanying table shows that the N.B.T.-reducing activity of stimulated neutrophils was significantly lower in the blood-samples treated with oxygen than in the controls. Resting unstimulated neutrophils, whether treated with oxygen or not, did not show any significant difference in the rate of N.B.T. reduction. 1. 2. 3. 4. 5. 6. 7. 8.
Park, B. H., Fikrig, S. M., Smithwick, E. M. Lancet, 1968, ii, 532. Feigin, R. D., Shackelford, P. G., Choi, S. C., Flake, K. K., Franklin, F. A., Eisenberg, C. S. J. Pediat. 1971, 78, 230. Matula, G., Peterson, P. Y. J. clin. Invest. 1970, 49, 62a. Andersen, B. R. Lancet, Aug. 7, 1971, p. 317. Chretien, J. H., Garagusi, V. F. ibid. Sept. 4, 1971, p. 549. Park, B. H., Holmes, B., Rodey, G. E., Good, R. A. ibid. 1969, i, 157. Cocchi, P., Mori, S., Becattini, A. ibid. 1969, ii, 1426. Cocchi, P., Mori, S., Becattini, A. Acta pœdiat. scand. 1971, 60, 475.
assumption is
in some aspects of hormonal activity-for instance, ethinyl cestradiol is a partial condensation product of an acetylene group at this locus and is the most powerful oestrogen known. Testosterone is an androgen; 17-alpha-ethyltestosterone is almost inert; 17-alpha-ethinyltestosterone is a progestin. Parenthetically, the excretion of two other hormones, androsterone and xtiocholanolone, has been shown to be subnormal in women who develop breast cancer.1
With steroids, structural analogy is upon which to balance an important Department of Infectious Disease, Cook County Hospital, Chicago, Illinois 60612, U.S.A.
dangerous point hypothesis. a
ROGER LEWIS.
RETURN TO WORK AFTER MYOCARDIAL INFARCTION and his colleagues (Aug. 28, p. 454) Sin;—Dr. Nagle found that only 50% of males had returned to work 4 months after myocardial infarction. My own figures (Br. Heart I., in the press) are 90% at 3 months, 23% at 1 month, and 56% at 6 weeks from the onset of the infarct. These figures include the time spent in hospital, and have been obtained by adopting the measures recommended by Dr. Nagle. I entirely agree with Dr. Nagle and his colleagues that rehabilitation should start in the early days in hospital, and that " essentially the problem seems to be one of education of hospital staff, general practitioners, employers, relatives, and the patients themselves ". It necessarily follows that the time spent in bed and in hospital must be the minimum, and that any delay, either in hospital or before returning to work, must be anticipated and suitable avoiding action taken. This entails a lot of extra work for the medical and ancillary staff, but results in great social and economic benefits and the virtual eradication of cardiac neurosis. Barnet General Hospital, Barnet, Herts.
takenly identified in many cases; but 20% of our population have amoebiasis, and he will need to produce more evidence in support of his claim. He and I have observed the epidemic in different countries, at different moments, in different populations, from the biological and the social points of view, with different interests and different techniques. What I saw suggests that in some patients Shiga dysentery caused a state of acute amcebiasis or of protracted acute enterocolitis. I still know of no evidence to refute my view. Hospital General " El Retiro ", Managua, D.N., Nicaragua.
CAMILO
VIJIL.
EFFECT OF OXYGEN ON A STIMULATED N.B.T. TEST
SIR,-The nitroblue-tetrazolium (N.B.T.) test was first described by Park et al. as an aid to differential diagnosis of febrile disorders. Increased N.B.T. reduction’ by circulating neutrophils has been reported in association with bacterial infections 2,3and parasitic diseased, 4,5 and in the absence of infection in the neonatal period. 6, In experiments employing an in-vitro phagocytosis system consisting EFFECT OF OXYGEN ON THE REDUCTION OF N.B.T. BY STIMULATED NEUTROPHILS
G. R. ROYSTON.
EPIDEMIC SHIGA DYSENTERY IN CENTRAL AMERICA
SiR,—Dr. Mata’s well-documented report2 throws light the unusual epidemic in Central America, which continues to the present time. When the epidemic began here, on
had no information at the El Retiro Hospital about previous therapeutic trials in Guatemala and El Salvador. Both cities are within an hour’s flight from Managua. How was this possible, in the age of worldwide epidemiological information ? By trial and error we found, within a short time, evidence of drug resistance and of the efficacy of ampicillin (rather slow-acting), trimethoprim/sulphamethoxazole, rifampicin, and nalidixic acid. Our hospital cases led us to suspect that where Entamaeba histolytica and amaebic abscesses were found the disease tended to run a more serious course; thus, there were straightforward cases of Shiga dysentery, cured by adequate therapy within a week, and cases which continued for 4-6 weeks and in which treatment was ineffective until anti-amcebics (such as emetin or metronidazole) were added. In the second type hmmorrhages were severe, there was rectocolitis, the general health was poorer, and most of the patients were males between the ages of 30 and 50. Dr. Mata asserts that E. histolytica was probably miswe
Bulbrook, R. D., Hayward, J. L., Spicer, C. C. Lancet, Aug. 21 1971, p. 395. 2. Mata, L. J., Cáceres, A., Torres, M. F. ibid. 1971, i, 600. 3. Vijil, C. ibid. 1970, ii, 471. 1.
of whole blood with Pseudomonas ceruginosa, stimulation of the neutrophils causes a considerable increase in N.B.T. reduction after 1 hour’s incubation at 37 °C with the test organism. By contrast the N.B.T. reduction by unstimulated neutrophils remains unchanged." With the same experimental conditions, the tests were repeated on blood-samples from 6 healthy newborn infants and 6 adults. Each bloodsample was transferred into 2 capped plastic tubes. One was maintained in a oxygen-rich atmosphere (obtained by flushing the test-tube with oxygen for the whole period of incubation), the other was incubated without added oxygen and served as a control. The accompanying table shows that the N.B.T.-reducing activity of stimulated neutrophils was significantly lower in the blood-samples treated with oxygen than in the controls. Resting unstimulated neutrophils, whether treated with oxygen or not, did not show any significant difference in the rate of N.B.T. reduction. 1. 2. 3. 4. 5. 6. 7. 8.
Park, B. H., Fikrig, S. M., Smithwick, E. M. Lancet, 1968, ii, 532. Feigin, R. D., Shackelford, P. G., Choi, S. C., Flake, K. K., Franklin, F. A., Eisenberg, C. S. J. Pediat. 1971, 78, 230. Matula, G., Peterson, P. Y. J. clin. Invest. 1970, 49, 62a. Andersen, B. R. Lancet, Aug. 7, 1971, p. 317. Chretien, J. H., Garagusi, V. F. ibid. Sept. 4, 1971, p. 549. Park, B. H., Holmes, B., Rodey, G. E., Good, R. A. ibid. 1969, i, 157. Cocchi, P., Mori, S., Becattini, A. ibid. 1969, ii, 1426. Cocchi, P., Mori, S., Becattini, A. Acta pœdiat. scand. 1971, 60, 475.