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TREATMENT OF MALIGNANT EFFUSION
144
influenza produces dramatic epidemics, it in total much less illness than non-influenzal virus respiratory diseases such as those due to adenovirus and parainfluenza and respiratory syncytial viruses, against which vaccines have not yet been devised. The best hope of controlling these infections, and influenza, may lie in the discovery of antiviral agents that need not be given long ahead of the virus infection and which will be effective regardless of the serotype of the infecting virus.
Although
causes
high concentrations of radioactive phosphorus-32 in the serum
Despite the encouraging report of Walter and his colleagues, many clinicians will still favour a chemotherapeutic method as the first line of attack, because cytotoxic drugs are much easier to handle than radioactive isotopes. LESSENING THE HANDICAPS OF CHILDREN
of children, from birth or later, have a mental handicap arising from physical damage or abnormalityfor example, injuries during delivery, spina bifida, or the results of meningitis. The new Mental Health Act makes local health authorities responsible for seeing that these children can get whatever help and care they need. In some, of course, the brain is so seriously harmed that their only need is good nursing. But many, though they may lack enough intelligence to go to a school for the educationally subnormal, are at least able to recognise their relatives, to enjoy outings, and perhaps to understand what is said to them. Where this is so, parents have often been greatly disappointed to find no kind of training offered by which their child would learn to develop and use what intelligence remains to him. Some local authorities and voluntary organisations are providing care in the daytime; and for many handicapped children this is the ideal arrangement. The centres can be run on modified nursery lines, the children being put on the floor, or in their chairs, to play, and encouraged to walk, talk, and feed themselves. Expert physiotherapy and speech therapy should be provided. If these children can be taught to talk, can learn to walk, or can be brought to dress or feed themselves and keep themselves clean, this will make a big difference afterwards; and in merely financial terms the cost of training will later be repaidperhaps many times over-because the patient will be so much easier to look after. The value of training to these children, and the progress that can be made, is discussed by Quibell et al.1 in their account of work with severely handicapped children at the Chailey Heritage Hospital School. Without underestimating the need of children for their parents’ affection, or the wonderful achievements of some families in face of difficulties, it remains true that some children are better admitted to a small residential unit where they can get regular attention from nurses and doctors and where expert training is possible. Some of the children at the Chailey Heritage Hospital School had very discouraging backgrounds-never going home for the holidays and never having visitors. Yet they showed substantial improvement. The success attained is attributed by Quibell et al. partly to the policy (not so rare in many long-stay paediatric hospitals) of meeting the needs of the children on the spot, " including having personal relations with individual members of staff, a generally stimulating daily programme ", and of maintaining active links with the families so far as possible. The necessity for doing more than is generally done at present is evident from the fact that, at one hospital which has a hundred such children on its books, the staff estimate that two-thirds would profit from training if they only could get it. A
TREATMENT OF MALIGNANT EFFUSION
CLINICIANS
often in doubt about the best method of effusions secondary to malignant disease. There are two main methods of direct attackto instil chemotherapeutic substances or radioactive isotopes into the fluid-containing cavity. Many different cytotoxic substances have been used,12 mostly of the alkylating group, such as nitrogen mustard. The effective dose for nitrogen mustard (HN2) is now established and the side-effects are well appreciated. While this direct instillation of a chemotherapeutic substance is safe and simple, it does have side-effects, such as nausea, vomiting, and occasional depression of haemopoiesis.’ The nausea and vomiting attributable to instillation of nitrogen mustard can be alleviated by antiemetic drugs or by using alkylating agents less likely to cause nausea and vomiting-for example, thiotepa. With full doses, are
treating patients with
however, haematological complications
are
occasionally
unavoidable. The alternative is a radioactive substance, and radioactive gold (198Au) in colloidal form has long been the accepted agent. The disadvantage of handling a radioactive substance is partly - offset by less hasmopoietic depression, since little of the instilled substance escapes from the cavity and the effect of the irradiation is therefore mostly local. Walter et a1.3 have investigated colloidal yttrium-90 silicate in the treatment of malignant effusions and have made a good case for selecting this compound. They mention the disadvantages of radioactive colloidal gold, one being the gamma-rays from this isotope, which contribute little to the local tissue effect but add to handling and protection difficulties. Other radioactive yttrium compounds, amongst which is the chloride, have been investigated and tried clinically in the United States,4 but the silicate has been shown to be less toxic in animal experiments. Walter et al.3 have demonstrated that radioactive colloidal yttrium silicate is effective: in 9 out of 15 patients with malignant effusions, palliation was good for periods from five to nineteen months. This effect compares favourably with the results of instilling radioactive colloidal gold and nitrogen mustard. The other pure beta-emitters which have been investigated are colloidal chromic radiophosphate5and colloidal zirconium radiophosphate.7 These compounds are imperfectly retained in the abdominal and pleural cavities and release free phosphate ions, giving rise to Ann. N.Y. Acad. Sci. 1958, 68, 1091. Levison, V. B. Brit. med. J. 1961, i, 1143. Walter, J., Jones, J. C., Fisher, M. Brit. J. Radial. 1961, 34, 337. Siegel, E. P., Hart, H. E., Brothers, M., Spencer, H., Laszio, D. J. Amer. med. Ass. 1956, 161, 499. 5. Andrews, G. A. United States Atomic Energy Commission Report ORINS, 1956, 12, 241. 6. Andrews, G. A., Kniseley, R. M., Palmer, E. L., Kretchmar, A. L. International Conference on Peaceful Uses of Atomic Energy; vol. 10, p. 122. New York, 1956. 7. British Empire Cancer Campaign 34th annual report, 1956, p. 174.
1. 2. 3. 4.
Weisberger, A. S.
and urine.
NUMBER
___
A. C. MUNRO, i.M.s.j director of medical services in India from 1941 to 1943, died on July 6 at the age of 75. 1. Quibell, E. P., Stephen, E., Whatley, E. Arch. Dis. Childh. 1961, 36, 58.
Major-General
influenza produces dramatic epidemics, it in total much less illness than non-influenzal virus respiratory diseases such as those due to adenovirus and parainfluenza and respiratory syncytial viruses, against which vaccines have not yet been devised. The best hope of controlling these infections, and influenza, may lie in the discovery of antiviral agents that need not be given long ahead of the virus infection and which will be effective regardless of the serotype of the infecting virus.
Although
causes
high concentrations of radioactive phosphorus-32 in the serum
Despite the encouraging report of Walter and his colleagues, many clinicians will still favour a chemotherapeutic method as the first line of attack, because cytotoxic drugs are much easier to handle than radioactive isotopes. LESSENING THE HANDICAPS OF CHILDREN
of children, from birth or later, have a mental handicap arising from physical damage or abnormalityfor example, injuries during delivery, spina bifida, or the results of meningitis. The new Mental Health Act makes local health authorities responsible for seeing that these children can get whatever help and care they need. In some, of course, the brain is so seriously harmed that their only need is good nursing. But many, though they may lack enough intelligence to go to a school for the educationally subnormal, are at least able to recognise their relatives, to enjoy outings, and perhaps to understand what is said to them. Where this is so, parents have often been greatly disappointed to find no kind of training offered by which their child would learn to develop and use what intelligence remains to him. Some local authorities and voluntary organisations are providing care in the daytime; and for many handicapped children this is the ideal arrangement. The centres can be run on modified nursery lines, the children being put on the floor, or in their chairs, to play, and encouraged to walk, talk, and feed themselves. Expert physiotherapy and speech therapy should be provided. If these children can be taught to talk, can learn to walk, or can be brought to dress or feed themselves and keep themselves clean, this will make a big difference afterwards; and in merely financial terms the cost of training will later be repaidperhaps many times over-because the patient will be so much easier to look after. The value of training to these children, and the progress that can be made, is discussed by Quibell et al.1 in their account of work with severely handicapped children at the Chailey Heritage Hospital School. Without underestimating the need of children for their parents’ affection, or the wonderful achievements of some families in face of difficulties, it remains true that some children are better admitted to a small residential unit where they can get regular attention from nurses and doctors and where expert training is possible. Some of the children at the Chailey Heritage Hospital School had very discouraging backgrounds-never going home for the holidays and never having visitors. Yet they showed substantial improvement. The success attained is attributed by Quibell et al. partly to the policy (not so rare in many long-stay paediatric hospitals) of meeting the needs of the children on the spot, " including having personal relations with individual members of staff, a generally stimulating daily programme ", and of maintaining active links with the families so far as possible. The necessity for doing more than is generally done at present is evident from the fact that, at one hospital which has a hundred such children on its books, the staff estimate that two-thirds would profit from training if they only could get it. A
TREATMENT OF MALIGNANT EFFUSION
CLINICIANS
often in doubt about the best method of effusions secondary to malignant disease. There are two main methods of direct attackto instil chemotherapeutic substances or radioactive isotopes into the fluid-containing cavity. Many different cytotoxic substances have been used,12 mostly of the alkylating group, such as nitrogen mustard. The effective dose for nitrogen mustard (HN2) is now established and the side-effects are well appreciated. While this direct instillation of a chemotherapeutic substance is safe and simple, it does have side-effects, such as nausea, vomiting, and occasional depression of haemopoiesis.’ The nausea and vomiting attributable to instillation of nitrogen mustard can be alleviated by antiemetic drugs or by using alkylating agents less likely to cause nausea and vomiting-for example, thiotepa. With full doses, are
treating patients with
however, haematological complications
are
occasionally
unavoidable. The alternative is a radioactive substance, and radioactive gold (198Au) in colloidal form has long been the accepted agent. The disadvantage of handling a radioactive substance is partly - offset by less hasmopoietic depression, since little of the instilled substance escapes from the cavity and the effect of the irradiation is therefore mostly local. Walter et a1.3 have investigated colloidal yttrium-90 silicate in the treatment of malignant effusions and have made a good case for selecting this compound. They mention the disadvantages of radioactive colloidal gold, one being the gamma-rays from this isotope, which contribute little to the local tissue effect but add to handling and protection difficulties. Other radioactive yttrium compounds, amongst which is the chloride, have been investigated and tried clinically in the United States,4 but the silicate has been shown to be less toxic in animal experiments. Walter et al.3 have demonstrated that radioactive colloidal yttrium silicate is effective: in 9 out of 15 patients with malignant effusions, palliation was good for periods from five to nineteen months. This effect compares favourably with the results of instilling radioactive colloidal gold and nitrogen mustard. The other pure beta-emitters which have been investigated are colloidal chromic radiophosphate5and colloidal zirconium radiophosphate.7 These compounds are imperfectly retained in the abdominal and pleural cavities and release free phosphate ions, giving rise to Ann. N.Y. Acad. Sci. 1958, 68, 1091. Levison, V. B. Brit. med. J. 1961, i, 1143. Walter, J., Jones, J. C., Fisher, M. Brit. J. Radial. 1961, 34, 337. Siegel, E. P., Hart, H. E., Brothers, M., Spencer, H., Laszio, D. J. Amer. med. Ass. 1956, 161, 499. 5. Andrews, G. A. United States Atomic Energy Commission Report ORINS, 1956, 12, 241. 6. Andrews, G. A., Kniseley, R. M., Palmer, E. L., Kretchmar, A. L. International Conference on Peaceful Uses of Atomic Energy; vol. 10, p. 122. New York, 1956. 7. British Empire Cancer Campaign 34th annual report, 1956, p. 174.
1. 2. 3. 4.
Weisberger, A. S.
and urine.
NUMBER
___
A. C. MUNRO, i.M.s.j director of medical services in India from 1941 to 1943, died on July 6 at the age of 75. 1. Quibell, E. P., Stephen, E., Whatley, E. Arch. Dis. Childh. 1961, 36, 58.
Major-General