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THE DEMONSTRATION OF LYMPHATIC VESSELS
1371
PRELIMINARY COMMUNICATION-MEDICAL SOCIETIES
Summary A
case
of acute virus
Medical Societies
pneumonia in a laboratory worker
is
reported. The properties of the virus isolated absorption tests on the patient’s serum,
from sputum, and skin tests
indicated that infection was due to the agent causing ,eiizo6tic abortion in ewes. This virus had been used by the patient for experimental work during three weeks before the illness and has not previously been recorded as a cause of human disease. I am indebted to Prof. Clifford Wilson and Dr. D. G. Abrahams for the clinical notes. REFERENCES
Baker, J. A. (1944) J. exp. Med. 79, 159. Barwell, C. F. (1952) Brit. J. exp. Path. 33, 268. Bedson, S. P., Barwell, C. F., King, E. J., Bishop, L. W. J. (1949) J. clin. Path, 2, 241. - May, H. B. (1945) Lancet, ii, 394. Dickinson, L., Inkley, G. W. (1951) Nature, Lond. 168, 37. Giroud, P., Jadin, J. (1954) Bull. Soc. Path. exot. 47, 578. Roger, F., Dumas, N., Vouilloux, P., Sacquet, E. (1954) Ibid, p. 644. Harrop, G. A., Rake, G. W., Shaffer, M. F. (1941) Trans. Amer. climat. (clin.) Ass. 56, 154. Monsur, K. A., Barwell, C. F. (1951) Brit. J. exp. Path. 32, 414. Stamp, J. T., McEwen, A. D., Watt, J. A. A., Nisbet, D. I. (1950) Vet. Rec. 62, 251. -
Preliminary
Communication
THE DEMONSTRATION OF LYMPHATIC
VESSELS
lymphatic drainage from tissues can be studied by injecting some material which will be visible in the vessels when the tissues are removed at operation or biopsy. Ideally the material injected should be (a) nontoxic, (b) diffusible on interstitial injection and readily taken into lymphatics, (c) rapidly removed, without -causing local or general stain, when injected into living subcutaneous tissues, and (d) easily visible and nondiffusible in the fixed specimen. THE
Substances in common use do not fulfil all these criteria : thus Evans blue and patent blue tend to fade from lymphatics during mass clearing ; pontamine skyblue is more permanent, which though an advantage histologically is a disadvantage clinically ; and particulate dyes tend to remain in the tissues and enter lymphatics
poorly. A new method has therefore been devised for the tlemonstration of lymphatic vessels in the breast. A diffusible solution containing free iron is injected into the interstitial tissues, from which it is taken up by lymphatics. When the breast has been removed, the iron is precipitated in the vessels and nodes by fixation in isotonic acid-potassium-ferrocyanide/formol saline solution, forming a permanent, particulate, and easily visible prussian blue. Various iron-containing solutions have been used, including iron dextran similar to that given A small by injection for iron-deficiency anaemia. the of blue added to quantity injection displays patent the vessels during operation, and a radio-opaque addition provides. for radiographic record of the specimen. Post mortem, injected iron can be made to enter the lymphatic vessels by massage, and its use has the advantage of avoiding extensive skin staining by dye. Iron-containing compounds of high molecular weight, suitable for the biopsy study of superficial lymphatic vessels, are at present under investigation with Mr. David Crockett, F.R.C.S. R. T. TURNER-WARWICK Middlesex Hospital, B.M., B.Sc. Oxfd, F.R.C.S., M.R.C.P. London, W.1
HEBERDEN SOCIETY THE annual meeting of this society was held in London on Nov. 25 and 26, under the presidency of Prof. R. E. TUNBRIDGE.
Spondylitis
and Heart-disease
Dr. JAMES SHARP had found that of 788 patients attending a clinic for the investigation of cases of spondylitis 25 had disease of the mitral or aortic heart valves. 3 of these, all with pure aortic disease, appeared to have typical ankylosing spondylitis, and Dr. Sharp suggested that the processes in the spine and heart might be related. In at least 7 of the remainder the changes in the heart, spine, and sacro-iliac and limb joints seemed to have resulted from severe attacks of rheumatic fever. The clinical features of these 7 and of 12 further patients, who had the same condition but had not been referred to the spondylitis clinic, were described. 17 of them had permanent change in limb-joints of the type originally described by Jaccoud, and 12 had residual limitation of spinal movement. Radiographically the sacro-iliac joints were commonly involved. The changes in the spine were characterised by alteration in shape and sometimes hypoplasia of the vertebral bodies, narrowing and ossification of multiple
discs without vertebral osteophytosis, apophyseal joint involvement progressing to bony ankylosis, and, occasionally, ossification of spinal ligaments. In its complete form this radiographic picture was recognisably different from that of typical ankylosing spondylitis. Deep X-ray therapy did not appear to be of value for such patients, but they were usually greatly helped by aspirin. The most important measures in their long-term management were the prevention and early treatment of streptococcal infections. Prednisone and Prednisolone
Dr. H. F. WEST opened a discussion on prednisone and prednisolone. The ability of prednisone to suppress the adrenal gland was approximately the same as that of a dose of hydrocortisone equal in therapeutic potency. Dr. OSWALD SAVAGE confirmed the therapeutic effectiveness of the new substances-particularly evident in an improvement in strength of grip. In different from two to ten times as potent patients they proved as cortisone. Dyspepsia was a common toxic effect, but was not invariably worse on the new steroids than on cortisone. Afebrile pneumonia and staphylococcal had occurred during treatment. septicaemia Dr. MALCOLM THOMPSON said that in the United States haemorrhage from the upper or lower alimentary tract was a recognised danger of treatment with the new steroids. After several months of treatment the dose often had to be increased to maintain suppression of the disease, but a change to cortisone was sometimes an effective alternative to this. Dr. G. D. KERSLEY had found prednisolone useful in treating a case of rheumatoid arthritis with heart-failure and oedema. Dr. F. DUDLEY HART had been impressed by the promptness of the response to the new steroids. He felt, however, that the increased incidence of dyspepsia associated with their use outweighed the advantage of their negligible effect on sodium metabolism. Dr. A. ST. J. DIXON commented on the " lift " which a patient experienced when he was transferred from cortisone to one of the new compounds. Dr. E. G. L. BYWATERS stressed that the incidence of side-effects was the crux of the problem, and that it was too early to draw firm conclusions on this.
PRELIMINARY COMMUNICATION-MEDICAL SOCIETIES
Summary A
case
of acute virus
Medical Societies
pneumonia in a laboratory worker
is
reported. The properties of the virus isolated absorption tests on the patient’s serum,
from sputum, and skin tests
indicated that infection was due to the agent causing ,eiizo6tic abortion in ewes. This virus had been used by the patient for experimental work during three weeks before the illness and has not previously been recorded as a cause of human disease. I am indebted to Prof. Clifford Wilson and Dr. D. G. Abrahams for the clinical notes. REFERENCES
Baker, J. A. (1944) J. exp. Med. 79, 159. Barwell, C. F. (1952) Brit. J. exp. Path. 33, 268. Bedson, S. P., Barwell, C. F., King, E. J., Bishop, L. W. J. (1949) J. clin. Path, 2, 241. - May, H. B. (1945) Lancet, ii, 394. Dickinson, L., Inkley, G. W. (1951) Nature, Lond. 168, 37. Giroud, P., Jadin, J. (1954) Bull. Soc. Path. exot. 47, 578. Roger, F., Dumas, N., Vouilloux, P., Sacquet, E. (1954) Ibid, p. 644. Harrop, G. A., Rake, G. W., Shaffer, M. F. (1941) Trans. Amer. climat. (clin.) Ass. 56, 154. Monsur, K. A., Barwell, C. F. (1951) Brit. J. exp. Path. 32, 414. Stamp, J. T., McEwen, A. D., Watt, J. A. A., Nisbet, D. I. (1950) Vet. Rec. 62, 251. -
Preliminary
Communication
THE DEMONSTRATION OF LYMPHATIC
VESSELS
lymphatic drainage from tissues can be studied by injecting some material which will be visible in the vessels when the tissues are removed at operation or biopsy. Ideally the material injected should be (a) nontoxic, (b) diffusible on interstitial injection and readily taken into lymphatics, (c) rapidly removed, without -causing local or general stain, when injected into living subcutaneous tissues, and (d) easily visible and nondiffusible in the fixed specimen. THE
Substances in common use do not fulfil all these criteria : thus Evans blue and patent blue tend to fade from lymphatics during mass clearing ; pontamine skyblue is more permanent, which though an advantage histologically is a disadvantage clinically ; and particulate dyes tend to remain in the tissues and enter lymphatics
poorly. A new method has therefore been devised for the tlemonstration of lymphatic vessels in the breast. A diffusible solution containing free iron is injected into the interstitial tissues, from which it is taken up by lymphatics. When the breast has been removed, the iron is precipitated in the vessels and nodes by fixation in isotonic acid-potassium-ferrocyanide/formol saline solution, forming a permanent, particulate, and easily visible prussian blue. Various iron-containing solutions have been used, including iron dextran similar to that given A small by injection for iron-deficiency anaemia. the of blue added to quantity injection displays patent the vessels during operation, and a radio-opaque addition provides. for radiographic record of the specimen. Post mortem, injected iron can be made to enter the lymphatic vessels by massage, and its use has the advantage of avoiding extensive skin staining by dye. Iron-containing compounds of high molecular weight, suitable for the biopsy study of superficial lymphatic vessels, are at present under investigation with Mr. David Crockett, F.R.C.S. R. T. TURNER-WARWICK Middlesex Hospital, B.M., B.Sc. Oxfd, F.R.C.S., M.R.C.P. London, W.1
HEBERDEN SOCIETY THE annual meeting of this society was held in London on Nov. 25 and 26, under the presidency of Prof. R. E. TUNBRIDGE.
Spondylitis
and Heart-disease
Dr. JAMES SHARP had found that of 788 patients attending a clinic for the investigation of cases of spondylitis 25 had disease of the mitral or aortic heart valves. 3 of these, all with pure aortic disease, appeared to have typical ankylosing spondylitis, and Dr. Sharp suggested that the processes in the spine and heart might be related. In at least 7 of the remainder the changes in the heart, spine, and sacro-iliac and limb joints seemed to have resulted from severe attacks of rheumatic fever. The clinical features of these 7 and of 12 further patients, who had the same condition but had not been referred to the spondylitis clinic, were described. 17 of them had permanent change in limb-joints of the type originally described by Jaccoud, and 12 had residual limitation of spinal movement. Radiographically the sacro-iliac joints were commonly involved. The changes in the spine were characterised by alteration in shape and sometimes hypoplasia of the vertebral bodies, narrowing and ossification of multiple
discs without vertebral osteophytosis, apophyseal joint involvement progressing to bony ankylosis, and, occasionally, ossification of spinal ligaments. In its complete form this radiographic picture was recognisably different from that of typical ankylosing spondylitis. Deep X-ray therapy did not appear to be of value for such patients, but they were usually greatly helped by aspirin. The most important measures in their long-term management were the prevention and early treatment of streptococcal infections. Prednisone and Prednisolone
Dr. H. F. WEST opened a discussion on prednisone and prednisolone. The ability of prednisone to suppress the adrenal gland was approximately the same as that of a dose of hydrocortisone equal in therapeutic potency. Dr. OSWALD SAVAGE confirmed the therapeutic effectiveness of the new substances-particularly evident in an improvement in strength of grip. In different from two to ten times as potent patients they proved as cortisone. Dyspepsia was a common toxic effect, but was not invariably worse on the new steroids than on cortisone. Afebrile pneumonia and staphylococcal had occurred during treatment. septicaemia Dr. MALCOLM THOMPSON said that in the United States haemorrhage from the upper or lower alimentary tract was a recognised danger of treatment with the new steroids. After several months of treatment the dose often had to be increased to maintain suppression of the disease, but a change to cortisone was sometimes an effective alternative to this. Dr. G. D. KERSLEY had found prednisolone useful in treating a case of rheumatoid arthritis with heart-failure and oedema. Dr. F. DUDLEY HART had been impressed by the promptness of the response to the new steroids. He felt, however, that the increased incidence of dyspepsia associated with their use outweighed the advantage of their negligible effect on sodium metabolism. Dr. A. ST. J. DIXON commented on the " lift " which a patient experienced when he was transferred from cortisone to one of the new compounds. Dr. E. G. L. BYWATERS stressed that the incidence of side-effects was the crux of the problem, and that it was too early to draw firm conclusions on this.