- Email: [email protected]
SMOKING AND FRUSEMIDE DIURESIS
527
mortality. We have continued to use parenteral betamethasone in our conservative regimen for treating tetanus. May I make the following suggestions for optimal prophylaxis in underdeveloped communities ? Here we treat some 350 cases of tetanus annually. Women account for 22%, neonates 34%, and all children up to 15 years 33% of all cases. If, in the first instance, only children and women between 15 and 40 years (60-70% of the population) were adequately inoculated with toxoid (three injections), in 9 months the incidence of tetanus would be reduced by 89%. Reckoning on communicated antepartum immunity still being effective for 5 years, after the first round of inoculations (and subsequently at 5-year intervals) all that would be needed would be a single inoculation to children in the 5-10 age-bracket, about 13% of the population. The rest of the population could reasonably be protected by the giving of a booster toxoid injection in the event of injury or pregnancy. In due course the adult male population would also be covered, further reducing the incidence of tetanus. A slower but equally effective programme would be to inoculate only pregnant women at first, then give booster doses to children of 5-10 years at 5-year intervals. The efficacy of this depends, of course, on how long antepartum induced immunity lasts in the child. We have had no
CORTICOTROPHIN-INDUCED GROWTH-HORMONE RELEASE SiR,-After Zahnd et al. reported the stimulatory effect of pl-24 corticotrophin on growth-hormone secretion,1 Ikkos et al.2 showed that this effect is independent of the presence of normal amounts of cortisol (hydrocortisone) in the blood. Both groups used a standard dose of 1 mg. We present here data showing that lower doses of W-24 corticotrophin have a pronounced and specific effect which is not suppressed by
glucose. 14 healthy
adults were investigated, 9 during a constant infusion of physiological saline, and 5 with high and almost constant hyperglycaamia induced by infusion of 10% glucose solution. 12 were men and 2 were women (both women were in the hyperglycxmia group). After a PLASMA-GROWTH-HORMONE PEAK VALUES AFTER INTRAVENOUS INJECTION OF 05 mg.
(ng./ml.) BEFORE AND p 1-24 CORTICOTROPHIN
incidence of tetanus in children who were immunised in Such a programme would not, of course, be foolproof, but it would considerably reduce the number of people to be inoculated. I would appreciate information and observations on this tonic from vour readers. utero.
Duncan Hospital, North Bihar, India.
R. K. M. SANDERS.
SMOKING AND FRUSEMIDE DIURESIS SIR,-More than 50 years ago, nicotine was shown to have an antidiuretic effect,’ which is due to the release of antidiuretic hormone.2 Smoking or nicotine injection inhibits or postpones diuresis induced by water, alcohol, or intravenous glucose solution.2,3 For this reason it seemed interesting to study whether smoking would inhibit the diuresis produced by a diuretic drug. Healthy medical students, after slight fasting and restriction of fluid intake, received 40 mg. of frusemide orally along with 330 ml. of lemon soda. Smoking of one cigarette at the beginning of the experiment, or six cigarettes (one every 30 minutes) during the experiment, did affect the total 3-hour urine volume but seemed to delay somewhat the peak diuresis. The total 3-hour diuresis induced by frusemide in non-smokers and without cigarettes (+S.E.) was 1093+65 ml. (22 men and 5 women). After six cigarettes the value in temporary smokers was 909+79 ml. (6 men) which is significantly less than the corresponding figure 1361::L 85 ml. (12 men and 3 women) in routine smokers (more than ten cigarettes daily). 2 non-smokers took part in an additional experiment in which the 4-hour urine volume was measured after 40 mg. of frusemide and 330 ml. of fluid. This was then repeated a few days later, the subjects smoking three cigarettes in the first half-hour. Smoking substantially reduced the urine-flow for the first 30-60 minutes but, if anything, increased the total 4-hour urine volume. The results indicate that moderate smoking is unlikely to have any important effect on the total urine volume excreted after administration of frusemide. P. J. NEUVONEN H.I. VAPAATALO of University Department Pharmacology, M. K. PAASONEN. Helsinki. not
period of at least 30 minutes, 0-5 mg. W-24 corticotrophin was injected through the tubing over 2-4 minutes. In the saline group there was no change in blood-sugar. Plasma-growth-hormone peak values before and after corticotrophin are shown in the accompanying table. 30-60 minutes after corticotrophin, growth-hormone levels were notably higher than in the control period in all but one control
differences between control and postlevels were statistically significant (p < 0.01 for saline group; P<0-05 for hyperglycaemia group). The peak growth-hormone values for the hyperglyca:mia group were not significantly different from those in the saline group (p < 04). Though the physiological meaning of these results is not clear, there is no doubt that pl-24 corticotrophin has a stimulatory effect on growth-hormone secretion. Glucose has been shown to inhibit growth-hormone secretion at the hypothalamic levelso the lack of suppression by glucose in our series suggests that exogenous corticotrophin exerts its effect through pathways different from those involved during hypoglycaemia and after other stressful stimuli. Further investigations are needed to show whether (31-z’ corticotrophin, or part of its molecule, acts directly at
subject.
TtttmtQrB7 lf7F*1 Service d’Endocrinologie et de Métabolisme, Laboratoire de radio-immunologie, Hôpital Cochin, Paris 14e. 1.
1. 2. 3.
Motzfeldt, K. J. exp. Med. 1917, 25, 153. Burn, J. H., Truelove, L. H., Burn, S. Br. med. J. 1945, i, 403. Larson, P. S., Haag, H. B., Silvette, H. Tobacco: Experimental and Clinical Studies; p. 264. Baltimore, 1961.
The
corticotrophin
2.
P. PANDOS G. STRAUCH H. BRICAIRE.
Zahnd, G. R., Nadeau, A., von Muhlendahl, K. E. Lancet, 1969, ii, 1278. Ikkos, D., Pantelakis, S., Katsichtis, P., Velentzas, C. ibid. 1970, i,
1401. 3. Blanco, S., Schalch, D. S.,
Reichlin, S. Fedn. Proc. 1966, 25, 191.
mortality. We have continued to use parenteral betamethasone in our conservative regimen for treating tetanus. May I make the following suggestions for optimal prophylaxis in underdeveloped communities ? Here we treat some 350 cases of tetanus annually. Women account for 22%, neonates 34%, and all children up to 15 years 33% of all cases. If, in the first instance, only children and women between 15 and 40 years (60-70% of the population) were adequately inoculated with toxoid (three injections), in 9 months the incidence of tetanus would be reduced by 89%. Reckoning on communicated antepartum immunity still being effective for 5 years, after the first round of inoculations (and subsequently at 5-year intervals) all that would be needed would be a single inoculation to children in the 5-10 age-bracket, about 13% of the population. The rest of the population could reasonably be protected by the giving of a booster toxoid injection in the event of injury or pregnancy. In due course the adult male population would also be covered, further reducing the incidence of tetanus. A slower but equally effective programme would be to inoculate only pregnant women at first, then give booster doses to children of 5-10 years at 5-year intervals. The efficacy of this depends, of course, on how long antepartum induced immunity lasts in the child. We have had no
CORTICOTROPHIN-INDUCED GROWTH-HORMONE RELEASE SiR,-After Zahnd et al. reported the stimulatory effect of pl-24 corticotrophin on growth-hormone secretion,1 Ikkos et al.2 showed that this effect is independent of the presence of normal amounts of cortisol (hydrocortisone) in the blood. Both groups used a standard dose of 1 mg. We present here data showing that lower doses of W-24 corticotrophin have a pronounced and specific effect which is not suppressed by
glucose. 14 healthy
adults were investigated, 9 during a constant infusion of physiological saline, and 5 with high and almost constant hyperglycaamia induced by infusion of 10% glucose solution. 12 were men and 2 were women (both women were in the hyperglycxmia group). After a PLASMA-GROWTH-HORMONE PEAK VALUES AFTER INTRAVENOUS INJECTION OF 05 mg.
(ng./ml.) BEFORE AND p 1-24 CORTICOTROPHIN
incidence of tetanus in children who were immunised in Such a programme would not, of course, be foolproof, but it would considerably reduce the number of people to be inoculated. I would appreciate information and observations on this tonic from vour readers. utero.
Duncan Hospital, North Bihar, India.
R. K. M. SANDERS.
SMOKING AND FRUSEMIDE DIURESIS SIR,-More than 50 years ago, nicotine was shown to have an antidiuretic effect,’ which is due to the release of antidiuretic hormone.2 Smoking or nicotine injection inhibits or postpones diuresis induced by water, alcohol, or intravenous glucose solution.2,3 For this reason it seemed interesting to study whether smoking would inhibit the diuresis produced by a diuretic drug. Healthy medical students, after slight fasting and restriction of fluid intake, received 40 mg. of frusemide orally along with 330 ml. of lemon soda. Smoking of one cigarette at the beginning of the experiment, or six cigarettes (one every 30 minutes) during the experiment, did affect the total 3-hour urine volume but seemed to delay somewhat the peak diuresis. The total 3-hour diuresis induced by frusemide in non-smokers and without cigarettes (+S.E.) was 1093+65 ml. (22 men and 5 women). After six cigarettes the value in temporary smokers was 909+79 ml. (6 men) which is significantly less than the corresponding figure 1361::L 85 ml. (12 men and 3 women) in routine smokers (more than ten cigarettes daily). 2 non-smokers took part in an additional experiment in which the 4-hour urine volume was measured after 40 mg. of frusemide and 330 ml. of fluid. This was then repeated a few days later, the subjects smoking three cigarettes in the first half-hour. Smoking substantially reduced the urine-flow for the first 30-60 minutes but, if anything, increased the total 4-hour urine volume. The results indicate that moderate smoking is unlikely to have any important effect on the total urine volume excreted after administration of frusemide. P. J. NEUVONEN H.I. VAPAATALO of University Department Pharmacology, M. K. PAASONEN. Helsinki. not
period of at least 30 minutes, 0-5 mg. W-24 corticotrophin was injected through the tubing over 2-4 minutes. In the saline group there was no change in blood-sugar. Plasma-growth-hormone peak values before and after corticotrophin are shown in the accompanying table. 30-60 minutes after corticotrophin, growth-hormone levels were notably higher than in the control period in all but one control
differences between control and postlevels were statistically significant (p < 0.01 for saline group; P<0-05 for hyperglycaemia group). The peak growth-hormone values for the hyperglyca:mia group were not significantly different from those in the saline group (p < 04). Though the physiological meaning of these results is not clear, there is no doubt that pl-24 corticotrophin has a stimulatory effect on growth-hormone secretion. Glucose has been shown to inhibit growth-hormone secretion at the hypothalamic levelso the lack of suppression by glucose in our series suggests that exogenous corticotrophin exerts its effect through pathways different from those involved during hypoglycaemia and after other stressful stimuli. Further investigations are needed to show whether (31-z’ corticotrophin, or part of its molecule, acts directly at
subject.
TtttmtQrB7 lf7F*1 Service d’Endocrinologie et de Métabolisme, Laboratoire de radio-immunologie, Hôpital Cochin, Paris 14e. 1.
1. 2. 3.
Motzfeldt, K. J. exp. Med. 1917, 25, 153. Burn, J. H., Truelove, L. H., Burn, S. Br. med. J. 1945, i, 403. Larson, P. S., Haag, H. B., Silvette, H. Tobacco: Experimental and Clinical Studies; p. 264. Baltimore, 1961.
The
corticotrophin
2.
P. PANDOS G. STRAUCH H. BRICAIRE.
Zahnd, G. R., Nadeau, A., von Muhlendahl, K. E. Lancet, 1969, ii, 1278. Ikkos, D., Pantelakis, S., Katsichtis, P., Velentzas, C. ibid. 1970, i,
1401. 3. Blanco, S., Schalch, D. S.,
Reichlin, S. Fedn. Proc. 1966, 25, 191.