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SORBITOL DEHYDROGENASE IN MUSCLE DISEASE
673 The driving the anxsthetic gas oxygen, conveys gas, compressed mixture through an antistatic rubber hose (internal diameter 8-10 mm.) to the nearest ventilation channel or along floor or ceiling and through an opening in an outer wall. This ejector flowmeter may be mounted on any anaesthetic machine. It is independent of national standard dimensions and can be attached to all current anaesthetic circuits, including those with an anxsthesia respirator. The float secures visual control of proper flowmeter function. The evacuation capacity is adjustable up to 15 1. per min. and the full capacity is 20-25 1. per min. The consumption of driving gas is about 6-8 1. per min., depending on the driving gas pressure. This elimination of anxsthetic gases involves no explosion risk. Such instruments have been in use in our department for more than a year and they have worked satisfactorily.
meter-for instance, air
excess
Department of Anæsthetics, Odense University Hospital, 5000
Odense,
anaesthetic gas.
or
Denmark.
SØREN
JØRGENSEN.
SORBITOL DEHYDROGENASE IN MUSCLE DISEASE
SIR,-In patients with Duchenne type muscular dystrophy serum enzymes come from affected skeletal muscles. Several lines of evidence support this view: (a) the serum level of predominantly muscle-specific enzymes such as creatine kinase (C.K.) shows several hundredfold increase at early stages of the disease,! (b) only the muscle-type C.K. isoenzyme is detectable in the serum,2 and (c) the lack of rise in serum of certain liver-specific enzymes such as fructose-1-phosphate aldolase,33 sorbitol dehydrogenase (S.D.H.),4 and 5-nucleotidase5 in this disorder. However, Kleine 6 has reported increased levels of serum-s.D.H. in Duchenne muscular dystrophy and suggested that the liver is also affected in this disorder, since abnormal serum S.D.H. levels have been noted by other workers in patients with liver diseases.?’8 In view of the conflicting reports we decided to reinvestigate serum-s.D.H. in patients with Duchenne muscular dystrophy and in certain selected myopathies and neuropathies. Serum s.D.H. was assayed in " tris " buffer at pH 7-4 by Gerlach’s method.9 The range of activity in 93 normal sera was 0-6 ;,mole N.A.D.H. oxidised per litre per minute at 25 °C (i.u.). None of the 21 patients, ranging in age from 1 to 16 years, with Duchenne muscular dystrophy showed abnormal values. Serum-c.K. in this group of patients ranged from 7440 i.u. for the 1-year-old to 267 i.u. for the 16-year-old (normal level is less than 60 LV.). Thirtythree patients with other forms of muscular dystrophies, twenty-five patients with polymyositis and dermatomyositis, and nine patients with spinal muscular atrophy had values in the normal range. One 47-year-old man with biliary cirrhosis had abnormal serum S.D.H. (8 l.u.). We cannot explain the contradictory results obtained by Kleine.6s However, our results accord with those obtained by Schmidt et al. and are supported by the studies of Rosalki and Thomson.10who found no increase in serum Ebashi, S., Toyokura, Y., Sugita, H. J. Biochem. 1959, 46, 103. Vassella, F., Richterich, R., Rossi, E. Pediatrics, 1965, 35, 322. Dreyfus, J. C., Schapira, G. Biochemistry of Hereditary Myopathies; p. 65. Springfield, Illinois, 1962. 4. Schmidt, E., Schmidt, F. W., Horn, H. D., Gerlach, U. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer); p. 690. New York, 1963. 5. Chowdhury, S. R., Pearson, C. M., Fowler, W. M., Griffith, W. H. Proc. Soc. exp. Biol. Med. 1962, 109, 227. 6. Kleine, T. O. Climca chim. Acta, 1970, 29, 227. 7. Gerlach, U. Klin. Wschr. 1959, 37, 93. 8. Asada, M., Galambos, J. T. Gastroenterology, 1963, 44, 578. 9. Gerlach, U. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer ; p. 761. New York, 1963. 10. Rosalki, S. B., Thomson, W. H. S. Clinica chim. Acta, 1971, 33, 264. 1. 2. 3.
y-glutamyl transpeptidase, another liver-specific enzyme, patients with Duchenne type dystrophy and related myopathies. in
This work was supported by grants from the Muscular DysAssociations of America, Inc. and the U.S. Public Health Service (GM 15759).
trophy
Department of Medicine, U.C.L.A. School of Medicine, Los Angeles, California 90024, U.S.A.
NIRMAL C. KAR CARL M. PEARSON.
SELECTION FOR MEDICAL SCHOOLS
SIR,-Mr Berrey’sletter1 underlines the growing number of women medical-school applicants in the United Kingdom, their higher grade levels on admission and greater proportion of accepted candidates, and the anomalies of selection criteria based on personal interviews. The United States experience is comparable on all scores, but the 10-9% of female applicants in 1970-712 is small compared with Britain’s 29-5°o. Where professional prestige and economic rewards remain high, as they do in the U.S., the most gifted men will seek to enter. Where, as in the Soviet Union, superior males are directed, or self-directed, to the physical sciences and other areas, women form the major body of physicians and dentists, with low income and prestige. However rich the rewards in American medicine, American women are hardly pressing against the gates, and though women in dentistry urge women to enter the professionfewer than 2% of American dentists are women.
Girls do well in school and nearly all women applicants have proved superior academic ability, whereas many unsuitable males make only perfunctory application. According to psychologist Bruno Bettelheimbecause of early teacher enchantment, girls are stimulated to success and a positive image of themselves and the learning process, while boys, immature, often reprimanded, and plagued by physical defects and learning difficulties, are hindered by
negative images. Yet empirical observation reveals a greater number of high i.Q. males and a conspicuously greater success on standard tests in college scholarship competitions, despite the male maturational lag. Feminine verbal skill serves as a school support through puberty, but this superiority disappears by the second American college year as boys 6 come to full maturity. Female applicants to medical schools are undoubtedly superior students. They will need this margin. The female drop-out rate is high in graduate programmes, 7 , possibly because of disenchantment with the work itself, the distractions of delayed marriage or of marriage and motherhood, and the fears, insecurities, and depressions induced by menstrual phases.9-11 With the fittest surviving, women will go into the professions in increasing numbers. However, the cost of training a physician (estimated at S100,000 in the U.S.) counsels’ justification of the investment. The Lancet 12 emphasised the greater number of children born to medical 1. Berrey, P. Lancet, 1972, ii, 1310. 2. J. Am. med. Ass. 1971, 218, 1217. 3. Los Angeles Times, April 27, 1970. 4. Ladies Home Journal, February, 1973. 5. Terman, L. M., et al. Genetic Studies of Genius; vol. I. Stanford, 1925. 6. Rubin-Rabson, Grace. Am. Psychol. 1971, 26, 205. 7. Lunneborg, Patricia W. J. counsel. Psychol. 1969, 16, 463. 8. Johnson, D. C., Hutchins, E. B. J. med. Educ. 1966, special issue,
p. 41. 9. Knox, Wilma J. Am. Psychol. 1970, 25, 1026. 10. Hirschhorn, Theodora. J. emotion. Educ. 1970, 10, 133. 11. Spiegel, Rose. Rvta Psicoan. Psiquuiat. Psicol. 1969, 11, 47. 12. Lancet, 1966, i, 1308.
meter-for instance, air
excess
Department of Anæsthetics, Odense University Hospital, 5000
Odense,
anaesthetic gas.
or
Denmark.
SØREN
JØRGENSEN.
SORBITOL DEHYDROGENASE IN MUSCLE DISEASE
SIR,-In patients with Duchenne type muscular dystrophy serum enzymes come from affected skeletal muscles. Several lines of evidence support this view: (a) the serum level of predominantly muscle-specific enzymes such as creatine kinase (C.K.) shows several hundredfold increase at early stages of the disease,! (b) only the muscle-type C.K. isoenzyme is detectable in the serum,2 and (c) the lack of rise in serum of certain liver-specific enzymes such as fructose-1-phosphate aldolase,33 sorbitol dehydrogenase (S.D.H.),4 and 5-nucleotidase5 in this disorder. However, Kleine 6 has reported increased levels of serum-s.D.H. in Duchenne muscular dystrophy and suggested that the liver is also affected in this disorder, since abnormal serum S.D.H. levels have been noted by other workers in patients with liver diseases.?’8 In view of the conflicting reports we decided to reinvestigate serum-s.D.H. in patients with Duchenne muscular dystrophy and in certain selected myopathies and neuropathies. Serum s.D.H. was assayed in " tris " buffer at pH 7-4 by Gerlach’s method.9 The range of activity in 93 normal sera was 0-6 ;,mole N.A.D.H. oxidised per litre per minute at 25 °C (i.u.). None of the 21 patients, ranging in age from 1 to 16 years, with Duchenne muscular dystrophy showed abnormal values. Serum-c.K. in this group of patients ranged from 7440 i.u. for the 1-year-old to 267 i.u. for the 16-year-old (normal level is less than 60 LV.). Thirtythree patients with other forms of muscular dystrophies, twenty-five patients with polymyositis and dermatomyositis, and nine patients with spinal muscular atrophy had values in the normal range. One 47-year-old man with biliary cirrhosis had abnormal serum S.D.H. (8 l.u.). We cannot explain the contradictory results obtained by Kleine.6s However, our results accord with those obtained by Schmidt et al. and are supported by the studies of Rosalki and Thomson.10who found no increase in serum Ebashi, S., Toyokura, Y., Sugita, H. J. Biochem. 1959, 46, 103. Vassella, F., Richterich, R., Rossi, E. Pediatrics, 1965, 35, 322. Dreyfus, J. C., Schapira, G. Biochemistry of Hereditary Myopathies; p. 65. Springfield, Illinois, 1962. 4. Schmidt, E., Schmidt, F. W., Horn, H. D., Gerlach, U. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer); p. 690. New York, 1963. 5. Chowdhury, S. R., Pearson, C. M., Fowler, W. M., Griffith, W. H. Proc. Soc. exp. Biol. Med. 1962, 109, 227. 6. Kleine, T. O. Climca chim. Acta, 1970, 29, 227. 7. Gerlach, U. Klin. Wschr. 1959, 37, 93. 8. Asada, M., Galambos, J. T. Gastroenterology, 1963, 44, 578. 9. Gerlach, U. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer ; p. 761. New York, 1963. 10. Rosalki, S. B., Thomson, W. H. S. Clinica chim. Acta, 1971, 33, 264. 1. 2. 3.
y-glutamyl transpeptidase, another liver-specific enzyme, patients with Duchenne type dystrophy and related myopathies. in
This work was supported by grants from the Muscular DysAssociations of America, Inc. and the U.S. Public Health Service (GM 15759).
trophy
Department of Medicine, U.C.L.A. School of Medicine, Los Angeles, California 90024, U.S.A.
NIRMAL C. KAR CARL M. PEARSON.
SELECTION FOR MEDICAL SCHOOLS
SIR,-Mr Berrey’sletter1 underlines the growing number of women medical-school applicants in the United Kingdom, their higher grade levels on admission and greater proportion of accepted candidates, and the anomalies of selection criteria based on personal interviews. The United States experience is comparable on all scores, but the 10-9% of female applicants in 1970-712 is small compared with Britain’s 29-5°o. Where professional prestige and economic rewards remain high, as they do in the U.S., the most gifted men will seek to enter. Where, as in the Soviet Union, superior males are directed, or self-directed, to the physical sciences and other areas, women form the major body of physicians and dentists, with low income and prestige. However rich the rewards in American medicine, American women are hardly pressing against the gates, and though women in dentistry urge women to enter the professionfewer than 2% of American dentists are women.
Girls do well in school and nearly all women applicants have proved superior academic ability, whereas many unsuitable males make only perfunctory application. According to psychologist Bruno Bettelheimbecause of early teacher enchantment, girls are stimulated to success and a positive image of themselves and the learning process, while boys, immature, often reprimanded, and plagued by physical defects and learning difficulties, are hindered by
negative images. Yet empirical observation reveals a greater number of high i.Q. males and a conspicuously greater success on standard tests in college scholarship competitions, despite the male maturational lag. Feminine verbal skill serves as a school support through puberty, but this superiority disappears by the second American college year as boys 6 come to full maturity. Female applicants to medical schools are undoubtedly superior students. They will need this margin. The female drop-out rate is high in graduate programmes, 7 , possibly because of disenchantment with the work itself, the distractions of delayed marriage or of marriage and motherhood, and the fears, insecurities, and depressions induced by menstrual phases.9-11 With the fittest surviving, women will go into the professions in increasing numbers. However, the cost of training a physician (estimated at S100,000 in the U.S.) counsels’ justification of the investment. The Lancet 12 emphasised the greater number of children born to medical 1. Berrey, P. Lancet, 1972, ii, 1310. 2. J. Am. med. Ass. 1971, 218, 1217. 3. Los Angeles Times, April 27, 1970. 4. Ladies Home Journal, February, 1973. 5. Terman, L. M., et al. Genetic Studies of Genius; vol. I. Stanford, 1925. 6. Rubin-Rabson, Grace. Am. Psychol. 1971, 26, 205. 7. Lunneborg, Patricia W. J. counsel. Psychol. 1969, 16, 463. 8. Johnson, D. C., Hutchins, E. B. J. med. Educ. 1966, special issue,
p. 41. 9. Knox, Wilma J. Am. Psychol. 1970, 25, 1026. 10. Hirschhorn, Theodora. J. emotion. Educ. 1970, 10, 133. 11. Spiegel, Rose. Rvta Psicoan. Psiquuiat. Psicol. 1969, 11, 47. 12. Lancet, 1966, i, 1308.