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TISSUE THERAPY IN ANIMALS
373
THE SMELL OF "ACETONE" SIR,-Professor Moncrieff (Aug. 6, p. 275) mentions that he cannot smell " acetone "; nor can I, although I have seen many cases of severe diabetic ketosis. However I can, and I am sure Professor Moncrieff can also, smell pure chemical acetone. It is clear therefore that what clinicians call " acetone " in the breath of patients with diabetic ketosis is not acetone. Is it acetoacetic acid, p-hydroxybutyric acid, or another substance not yet
identified ? The subject is important, for many people think they smell "acetone " and try to rely clinically on their alleged ability. In my experience about 50% of people cannot smell " acetone " and the fact should be generally can
realised. Mayday Hospital,
G. P. BAKER.
Thornton Heath.
ARTERIAL AUSCULTATION SIR,-In the course of a much smaller experience I have found the systolic carotid bruit to be less specific than reported in your issue of July 30 by Professor Peart and Professor Rob, who state that they had never heard it in a case of complete internal-carotid occlusion. I have encountered this sign on four occasions in the presence of complete internal-carotid occlusion, in each case there being demonstrable stenosis of the external carotid. A further patient, with bilateral intermittent symptoms, had stenosis of the right internal and the left external carotid. The bruit was on the left. This is of more than theoretical interest, for if these patients had been operated on without angiography the results would have been disappointing and even hazardous. Regrettably, it seems that the stethoscope cannot replace the unpleasant and potentially dangerous carotid angiography in the accurate diagnosis of carotid-artery disease. The Derbyshire Royal Infirmary, W. B. MATTHEWS. Derby.
TISSUE THERAPY IN ANIMALS
SiR,—Tissue therapy was first tried in human beings by Filatov,l who made extensive tests with various tissues (homogenous and heterogenous); Troensegaard-Hansen2 implanted human placenta in peripheral vascular disease; and Lahiri3 reviewed the possibilities of tissue therapy and its application in India. As far as I am aware, tissue therapy has never been tried in animal diseases. The trials recorded here were made on various species of domestic animals at the
Bengal Veterinary College Hospital. Skin was the only tissue used. Skins were obtained aseptically from live and recently dead animals (5 hours after death). They were immediately transferred to sterile petri dishes and kept at 4-5°C in a refrigerator. After 7 days they were removed and sterilised at 120°C for one hour. A 1-in.-deep
skin incision was made in the diseased animal’s chest wall behind the point of the elbow, and a pocket made by blunt dissection. 7 c.cm. of skin in small squares was introduced after removing the subcutaneous fat of the donor. The whole operation was done with all possible aseptic precautions. The following were some of the conditions which were treated in this way: (1) Hump sore in a bull (possibly stephanofilariasis): one implantation was given and a large sore disappeared within three months. Normal skin and hair grew
on
the affected
area.
(2) Cutaneous rinderpest in a calf with concurrent coccidiosis. 80% of the nodules on the skin disappeared within 48 hours. The 1. 2. 3.
Filatov, V. P. Tissue Therapy. Moscow, 1955. Troensegaard-Hansen, E. Brit. med. J. 1956, ii, 262. Lahiri, S. C. Antiseptic, 1958, 55, 833.
to coccidial infection became normal in colour after 72 hours.’Dermatitis on the dewlap region assumed the normal colour of skin within 8 days. (3) Buffalo with extensive skin lesions (exudative dermatitis). Oozing lesions became dry within 6 days. Cicatricial tissues appeared with progressive epithelialisation. Spotted pigmentation started covering the affected areas within 12 days. (4) Cutaneous habronemiasis in a horse: a weeping granulomatous area dried up and cicatricial tissue appeared within 7 days. Sympathetic swelling of the joint above and below was considerably reduced by the 5th day. (5) Non-specific eczema in a dog: the lesion dried up within 4 days and new skin appeared within 12 days. (6) Follicular mange in a dog with extensive corrugated angry exudative lesion, extreme irritation on one side of the face including the external ear, and a widespread skin lesion. Much improvement within 3 days of implantation. Swelling in the mouth disappeared completely and oozing stopped.
bloody stool due
A detailed elsewhere.
account
of this work will be
Department of Veterinary Surgery, Bengal Veterinary College, Belgachia, Calcutta, India.
published
D. K, RAY.
ABDOMINAL DECOMPRESSION IN LABOUR
SIR,-We were very interested to read Professor Heyns’ comments (July 9) on our apparatus. I think he would agree with us that there are many ways of achieving abdominal decompression and the ideal method may not yet have been found.
May we are
we
still
on some points that he raised ? Firstly, quite sure from where Professor Heyns takes recordings. In published photographs of his
take issue not
his pressure apparatus the pressure-gauge is seen to be connected to the suction line. We measure our pressures with a completely separate tube leading from under the cage and submit that these must be the true pressure readings. If measured from the suction line, the pressures are very considerably lower than they are within the suit-e.g., a pressure of -100 mm. Hg is easily obtained in the suction line while the suit pressure is only -40 mm. Until we are sure what pressure is being measured, it is very difficult to draw comparisons. The main reason for limiting patients to a maximum decompression of -50 mm. has been our experience that the abdomen is moved maximally (i.e., is touching the front of the cage as shown in our photograph) at around -40 mm., and increasing the negative pressure seems illogical. We would not stop the patient if she thought it helpful. We have used a back plate (which can easily be fitted to our cage) and find that although this stops the patient being lifted forward from the bed, the maximal abdominal movement still occurs at the same pressure-i.e., around -40 mm. Hg. It has been said of our apparatus that most, if not all, the abdominal movement is due to this forward lifting of the patient (which is of course more marked in light patients). Our experiments with a back plate show that this is not so, but such a plate may have a place in patients of light build. In all our experience so far we have never seen a bag burst, in spite of pressures up to -80 mm. Hg being used. This we attribute to the fact that no large area of polyethylene is left unsupported when the patient is in position (it is quite easy to burst bags experimentally at -30 mm. Hg if large areas are allowed to bulge). Moreover we have taken especial care to ensure smooth surfaces in our cages and to see that the bag is not damaged during the setting up of the patient within the apparatus. The bandage seal round the thighs is tied only lightly and certainly does not cause venous congestion. We find Professor Heyns’ ideas on the nature of the pain of labour very interesting and feel sure that more work on the effects of abdominal decompression will elucidate some aspects of this difficult problem. Department of Obstetrics and
Gynæcology,
University of Edinburgh.
D. B. SCOTT J. D. O. LOUDON.
THE SMELL OF "ACETONE" SIR,-Professor Moncrieff (Aug. 6, p. 275) mentions that he cannot smell " acetone "; nor can I, although I have seen many cases of severe diabetic ketosis. However I can, and I am sure Professor Moncrieff can also, smell pure chemical acetone. It is clear therefore that what clinicians call " acetone " in the breath of patients with diabetic ketosis is not acetone. Is it acetoacetic acid, p-hydroxybutyric acid, or another substance not yet
identified ? The subject is important, for many people think they smell "acetone " and try to rely clinically on their alleged ability. In my experience about 50% of people cannot smell " acetone " and the fact should be generally can
realised. Mayday Hospital,
G. P. BAKER.
Thornton Heath.
ARTERIAL AUSCULTATION SIR,-In the course of a much smaller experience I have found the systolic carotid bruit to be less specific than reported in your issue of July 30 by Professor Peart and Professor Rob, who state that they had never heard it in a case of complete internal-carotid occlusion. I have encountered this sign on four occasions in the presence of complete internal-carotid occlusion, in each case there being demonstrable stenosis of the external carotid. A further patient, with bilateral intermittent symptoms, had stenosis of the right internal and the left external carotid. The bruit was on the left. This is of more than theoretical interest, for if these patients had been operated on without angiography the results would have been disappointing and even hazardous. Regrettably, it seems that the stethoscope cannot replace the unpleasant and potentially dangerous carotid angiography in the accurate diagnosis of carotid-artery disease. The Derbyshire Royal Infirmary, W. B. MATTHEWS. Derby.
TISSUE THERAPY IN ANIMALS
SiR,—Tissue therapy was first tried in human beings by Filatov,l who made extensive tests with various tissues (homogenous and heterogenous); Troensegaard-Hansen2 implanted human placenta in peripheral vascular disease; and Lahiri3 reviewed the possibilities of tissue therapy and its application in India. As far as I am aware, tissue therapy has never been tried in animal diseases. The trials recorded here were made on various species of domestic animals at the
Bengal Veterinary College Hospital. Skin was the only tissue used. Skins were obtained aseptically from live and recently dead animals (5 hours after death). They were immediately transferred to sterile petri dishes and kept at 4-5°C in a refrigerator. After 7 days they were removed and sterilised at 120°C for one hour. A 1-in.-deep
skin incision was made in the diseased animal’s chest wall behind the point of the elbow, and a pocket made by blunt dissection. 7 c.cm. of skin in small squares was introduced after removing the subcutaneous fat of the donor. The whole operation was done with all possible aseptic precautions. The following were some of the conditions which were treated in this way: (1) Hump sore in a bull (possibly stephanofilariasis): one implantation was given and a large sore disappeared within three months. Normal skin and hair grew
on
the affected
area.
(2) Cutaneous rinderpest in a calf with concurrent coccidiosis. 80% of the nodules on the skin disappeared within 48 hours. The 1. 2. 3.
Filatov, V. P. Tissue Therapy. Moscow, 1955. Troensegaard-Hansen, E. Brit. med. J. 1956, ii, 262. Lahiri, S. C. Antiseptic, 1958, 55, 833.
to coccidial infection became normal in colour after 72 hours.’Dermatitis on the dewlap region assumed the normal colour of skin within 8 days. (3) Buffalo with extensive skin lesions (exudative dermatitis). Oozing lesions became dry within 6 days. Cicatricial tissues appeared with progressive epithelialisation. Spotted pigmentation started covering the affected areas within 12 days. (4) Cutaneous habronemiasis in a horse: a weeping granulomatous area dried up and cicatricial tissue appeared within 7 days. Sympathetic swelling of the joint above and below was considerably reduced by the 5th day. (5) Non-specific eczema in a dog: the lesion dried up within 4 days and new skin appeared within 12 days. (6) Follicular mange in a dog with extensive corrugated angry exudative lesion, extreme irritation on one side of the face including the external ear, and a widespread skin lesion. Much improvement within 3 days of implantation. Swelling in the mouth disappeared completely and oozing stopped.
bloody stool due
A detailed elsewhere.
account
of this work will be
Department of Veterinary Surgery, Bengal Veterinary College, Belgachia, Calcutta, India.
published
D. K, RAY.
ABDOMINAL DECOMPRESSION IN LABOUR
SIR,-We were very interested to read Professor Heyns’ comments (July 9) on our apparatus. I think he would agree with us that there are many ways of achieving abdominal decompression and the ideal method may not yet have been found.
May we are
we
still
on some points that he raised ? Firstly, quite sure from where Professor Heyns takes recordings. In published photographs of his
take issue not
his pressure apparatus the pressure-gauge is seen to be connected to the suction line. We measure our pressures with a completely separate tube leading from under the cage and submit that these must be the true pressure readings. If measured from the suction line, the pressures are very considerably lower than they are within the suit-e.g., a pressure of -100 mm. Hg is easily obtained in the suction line while the suit pressure is only -40 mm. Until we are sure what pressure is being measured, it is very difficult to draw comparisons. The main reason for limiting patients to a maximum decompression of -50 mm. has been our experience that the abdomen is moved maximally (i.e., is touching the front of the cage as shown in our photograph) at around -40 mm., and increasing the negative pressure seems illogical. We would not stop the patient if she thought it helpful. We have used a back plate (which can easily be fitted to our cage) and find that although this stops the patient being lifted forward from the bed, the maximal abdominal movement still occurs at the same pressure-i.e., around -40 mm. Hg. It has been said of our apparatus that most, if not all, the abdominal movement is due to this forward lifting of the patient (which is of course more marked in light patients). Our experiments with a back plate show that this is not so, but such a plate may have a place in patients of light build. In all our experience so far we have never seen a bag burst, in spite of pressures up to -80 mm. Hg being used. This we attribute to the fact that no large area of polyethylene is left unsupported when the patient is in position (it is quite easy to burst bags experimentally at -30 mm. Hg if large areas are allowed to bulge). Moreover we have taken especial care to ensure smooth surfaces in our cages and to see that the bag is not damaged during the setting up of the patient within the apparatus. The bandage seal round the thighs is tied only lightly and certainly does not cause venous congestion. We find Professor Heyns’ ideas on the nature of the pain of labour very interesting and feel sure that more work on the effects of abdominal decompression will elucidate some aspects of this difficult problem. Department of Obstetrics and
Gynæcology,
University of Edinburgh.
D. B. SCOTT J. D. O. LOUDON.