- Email: [email protected]
THE TOXOPLASMA DYE TEST IN IDIOPATHIC RETROPERITONEAL FIBROSIS
602 call for more elaborate assays based on solvent extraction of the urinary drug derivatives and subsequent determination
by spectrophotometry. Veterans Administration Hospital, Palo Alto, California.
FRED M. FORREST IRENE S. FORREST.
mean increase in plasma-ammonia after clopamide 2’1±5’1%. This difference was not significant (t=042; p>0’6). In practice treatment with saluretics is usually continued for more than three days, so the effect on plasma-ammonia
The
was
may be much greater than these results suggest.
EFFECT OF CLOPAMIDE AND HYDROCHLOROTHIAZIDE ON PLASMA-AMMONIA Snt,—Hyperammonaemia has an important role in hepatic coma. A raised plasma-ammonia is often seen in patients with hepatic cirrhosis and ascites. Saluretics are used in the treatment of fluid retention in liver disease in preference to paracentesis, which results in considerable loss of protein. An ideal saluretic for this purpose would cause no rise in plasma-ammonia. These considerations prompted us to measure plasma-ammonia levels after administration of clopamide (’ Brinaldix ’). For comparison, similar investigations were done with the widely used saluretic, hydrochlorothiazide. 34 experiments were carried out in 21 patients-16 men and 5 women-with pathological fluid retention. Their ages ranged from 52 to 81 years. In 14 the underlying disease was cirrhosis of the liver, and in 7 it was cor pulmonale associated with severe right-heart failure. Our own previous studies have shown that patients with EFFECTS OF HYDROCHLOROTHIAZIDE AND CLOPAMIDE ON PLASMAAMMONIA
Moreover,
published reports, the ammonia content of arterial blood is always higher than that of venous blood. Patients with raised blood-ammonia may develop ammonia encephalopathy after treatment with hydrochlorothiazide. Thus, for patients with fluid retention and hyperammonaemia, clopamide seems to be a more suitable
according
to
saluretic. 3rd Department of Medicine,
ISTVÁN SZÁM
Municipal János Hospital, Budapest 12, Hungary.
ÁGNES VASS ILDIKÓ WEIN.
THE TOXOPLASMA DYE TEST IN IDIOPATHIC RETROPERITONEAL FIBROSIS SiR-Hooper 6 and Kalderon et al. described patients with acquired toxoplasmosis who had some fibrosis in the retroperitoneal tissues. In the course of a retrospective study8 the toxoplasma dye test has been done on the sera of fourteen patients at widely differing stages of idiopathic retroperitoneal fibrosis. With one exception (a patient who was atypical in some respects-e.g., in having a low erythrocyte-sedimentation rate) the patients with negative tests (titres of less than 1/8) were the five who had had the disease for more than 4 years. The results in the 6 patients with positive tests were as follows: Duration of Disease (yr.) Toxoplasma Dye Test Titre 1/512 1/1024 1/32 1/32 1/64 1/8 1/8 1/256
1 1
118 3
31/s Many
Many Many
equivocal, and it is important to note that histological study of tissue from forty-six patients with the disease has not revealed any evidence of typical toxoplasmosis; but in view of the slightly raised proportion of positive titres it would be interesting to repeat the test in other patients with idiopathic retroperitoneal fibrosis. The significance of these results is
cor pulmonale and severe right-heart failure have significantly raised plasma-ammonia levels.12 All 21 patients had raised plasma-ammonia levels before treatment with saluretics. Plasma-ammonia was determined by a modified Fenton ion-exchange procedure. 34 By this method the normal plasma-ammonia range is 7-28 tLg. per 100 ml. (mean 19’2 g. per 100 ml.). Fasting venous-blood samples were taken in the morning. Clopamide and hydrochlorothiazide were administered for three-day periods. The doses were 100 mg. hydrochlorothiazide, and 40 mg. clopamide, daily; and treatment with the two preparations was alternated-i.e., half the patients received hydrochlorothiazide first, and the other half had clopamide first. After each three-day treatment period a drug-free period of three days was allowed. Plasma-ammonia increases were only regarded as significant if they exceeded 5 g. per 100 ml. A significant increase in plasma-ammonia was found in 11 out of 16 experiments after administration of hydrochlorothiazide, and in only 5 out of 18 experiments after clopamide. The results are shown in the accompanying table. After hydrochlorothiazide the plasma-ammonia increased on average by 18-9:E7.5% of the pretreatment value. This increase was significant (t=O.42; p<0-05).
Szám, I., Vass, Á., Wein, I. Proceedings of the Tenth International Congress of Internal Medicine; p. 54. Warsaw, 1968. 2. Szám, I., Vass, Á., Wein, I. Orv. Hetil. 1969, 110, 1842. 3. Fenton, J. C. B. Clin. Chim. Acta, 1962, 7, 163. 4. Fenton, J. C. B., Williams, A. H. J. clin. Path. 1968. 21, 14. 1.
I am grateful for the help of Dr. G. B. Health Laboratory Service, Leeds.
University Department of Pathology, Cambridge.
Ludlam, of the Public
M. J. MITCHINSON.
A PROBLEM IN PERITONEAL DIALYSIS SIR,-A rather unusual problem, encountered during the course of a recent peritoneal dialysis, led us to resort to an unorthodox remedy which proved successful. We should like to record this experience for the benefit of those who may be faced with a similar situation. A 45-year-old man undergoing peritoneal dialysis had profuse intra-abdominal bleeding when the anterior abdominal wall was pierced by the peritoneal catheter. Slight shock responded promptly to blood-transfusion, but the peritoneal fluid showed no sign of running clear. Serial samples in glass tubes remained heavily bloodstained and clotted in a semi-solid gel. Before long, drainage ceased from the peritoneal cavity, though it was still possible to Stahl, I. Ann. intern. Med. 1963, 58, 1. Hooper, A. D. Archs Path. 1957, 64, 1. Kalderon, A. E., Kikkawa, Y., Bernstein, J. Archs int. Med. 1964, 114, 95. 8. Mitchinson, M. J. M.D. thesis, University of Cambridge, 1969. 5. 6. 7.
by spectrophotometry. Veterans Administration Hospital, Palo Alto, California.
FRED M. FORREST IRENE S. FORREST.
mean increase in plasma-ammonia after clopamide 2’1±5’1%. This difference was not significant (t=042; p>0’6). In practice treatment with saluretics is usually continued for more than three days, so the effect on plasma-ammonia
The
was
may be much greater than these results suggest.
EFFECT OF CLOPAMIDE AND HYDROCHLOROTHIAZIDE ON PLASMA-AMMONIA Snt,—Hyperammonaemia has an important role in hepatic coma. A raised plasma-ammonia is often seen in patients with hepatic cirrhosis and ascites. Saluretics are used in the treatment of fluid retention in liver disease in preference to paracentesis, which results in considerable loss of protein. An ideal saluretic for this purpose would cause no rise in plasma-ammonia. These considerations prompted us to measure plasma-ammonia levels after administration of clopamide (’ Brinaldix ’). For comparison, similar investigations were done with the widely used saluretic, hydrochlorothiazide. 34 experiments were carried out in 21 patients-16 men and 5 women-with pathological fluid retention. Their ages ranged from 52 to 81 years. In 14 the underlying disease was cirrhosis of the liver, and in 7 it was cor pulmonale associated with severe right-heart failure. Our own previous studies have shown that patients with EFFECTS OF HYDROCHLOROTHIAZIDE AND CLOPAMIDE ON PLASMAAMMONIA
Moreover,
published reports, the ammonia content of arterial blood is always higher than that of venous blood. Patients with raised blood-ammonia may develop ammonia encephalopathy after treatment with hydrochlorothiazide. Thus, for patients with fluid retention and hyperammonaemia, clopamide seems to be a more suitable
according
to
saluretic. 3rd Department of Medicine,
ISTVÁN SZÁM
Municipal János Hospital, Budapest 12, Hungary.
ÁGNES VASS ILDIKÓ WEIN.
THE TOXOPLASMA DYE TEST IN IDIOPATHIC RETROPERITONEAL FIBROSIS SiR-Hooper 6 and Kalderon et al. described patients with acquired toxoplasmosis who had some fibrosis in the retroperitoneal tissues. In the course of a retrospective study8 the toxoplasma dye test has been done on the sera of fourteen patients at widely differing stages of idiopathic retroperitoneal fibrosis. With one exception (a patient who was atypical in some respects-e.g., in having a low erythrocyte-sedimentation rate) the patients with negative tests (titres of less than 1/8) were the five who had had the disease for more than 4 years. The results in the 6 patients with positive tests were as follows: Duration of Disease (yr.) Toxoplasma Dye Test Titre 1/512 1/1024 1/32 1/32 1/64 1/8 1/8 1/256
1 1
118 3
31/s Many
Many Many
equivocal, and it is important to note that histological study of tissue from forty-six patients with the disease has not revealed any evidence of typical toxoplasmosis; but in view of the slightly raised proportion of positive titres it would be interesting to repeat the test in other patients with idiopathic retroperitoneal fibrosis. The significance of these results is
cor pulmonale and severe right-heart failure have significantly raised plasma-ammonia levels.12 All 21 patients had raised plasma-ammonia levels before treatment with saluretics. Plasma-ammonia was determined by a modified Fenton ion-exchange procedure. 34 By this method the normal plasma-ammonia range is 7-28 tLg. per 100 ml. (mean 19’2 g. per 100 ml.). Fasting venous-blood samples were taken in the morning. Clopamide and hydrochlorothiazide were administered for three-day periods. The doses were 100 mg. hydrochlorothiazide, and 40 mg. clopamide, daily; and treatment with the two preparations was alternated-i.e., half the patients received hydrochlorothiazide first, and the other half had clopamide first. After each three-day treatment period a drug-free period of three days was allowed. Plasma-ammonia increases were only regarded as significant if they exceeded 5 g. per 100 ml. A significant increase in plasma-ammonia was found in 11 out of 16 experiments after administration of hydrochlorothiazide, and in only 5 out of 18 experiments after clopamide. The results are shown in the accompanying table. After hydrochlorothiazide the plasma-ammonia increased on average by 18-9:E7.5% of the pretreatment value. This increase was significant (t=O.42; p<0-05).
Szám, I., Vass, Á., Wein, I. Proceedings of the Tenth International Congress of Internal Medicine; p. 54. Warsaw, 1968. 2. Szám, I., Vass, Á., Wein, I. Orv. Hetil. 1969, 110, 1842. 3. Fenton, J. C. B. Clin. Chim. Acta, 1962, 7, 163. 4. Fenton, J. C. B., Williams, A. H. J. clin. Path. 1968. 21, 14. 1.
I am grateful for the help of Dr. G. B. Health Laboratory Service, Leeds.
University Department of Pathology, Cambridge.
Ludlam, of the Public
M. J. MITCHINSON.
A PROBLEM IN PERITONEAL DIALYSIS SIR,-A rather unusual problem, encountered during the course of a recent peritoneal dialysis, led us to resort to an unorthodox remedy which proved successful. We should like to record this experience for the benefit of those who may be faced with a similar situation. A 45-year-old man undergoing peritoneal dialysis had profuse intra-abdominal bleeding when the anterior abdominal wall was pierced by the peritoneal catheter. Slight shock responded promptly to blood-transfusion, but the peritoneal fluid showed no sign of running clear. Serial samples in glass tubes remained heavily bloodstained and clotted in a semi-solid gel. Before long, drainage ceased from the peritoneal cavity, though it was still possible to Stahl, I. Ann. intern. Med. 1963, 58, 1. Hooper, A. D. Archs Path. 1957, 64, 1. Kalderon, A. E., Kikkawa, Y., Bernstein, J. Archs int. Med. 1964, 114, 95. 8. Mitchinson, M. J. M.D. thesis, University of Cambridge, 1969. 5. 6. 7.