- Email: [email protected]
URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
785 control series and in a subpopulation with fundal cancer. He also concludes that there is a genetic factor common to carcinoma of the body of the uterus, diabetes mellitus, and the determination of the menopausal age. The hypothesis that the menopausal age is under genetic control, could readily be tested by twins studies, but we have been unable to trace any. If the overall distribution of the menopausal age is, in fact, an aggregate of multiple distributions, it follows that each specific distribution must be very It is, therefore, quite possible that some of sharply the " structure " in the figure is genuine and is not entirely due to memory bias or statistical excursions. In contrast to the menarche, there is no indication 24-26 that the age of peak onset (50) of the menopause has recently undergone a secular change, or that it is affected by ordinary environmental factors. Should these aspects be confirmed by future studies, we shall have to explain how the timing mechanism (a) is genetically determined; (b) produces a very sharp peak in the age-distribution ; and (c) is more or less unaffected by secular change or ordinary environmental differences. The only system we have so far identified to which such properties can be attributed is the lymphoid system, although there may well be others. It could, therefore, be argued that the onset of the menopause depends upon the accumulation in one, or more probably in a few, stem cells of a total of around 80(?) somatic mutations and the generation of one or a few forbidden clones of lymphocytes. The latent period 17 would need to be short, or generally constant, to within about a year. According to Burwell,27 the primary function of lymphoid tissue is related-to morphostasis and on this theory, any tissue that is in any way subject to mitotic control by lymphocytes, may under appropriate conditions be susceptible to autoimmune attack." 2’ 28 We may suspect that many autoimmune diseases and conditions remain to be discovered. The possibility should, therefore, be borne in mind that the menopause may be induced by an autoimmune process. P. R. J. BURCH
peaked.
The General Infirmary at Leeds.
N. R. ROWELL.
WRAPPING OF STERILISED ARTICLES SIR,-The letter of Professor Cunliffe and his colleagues (Sept. 14) is a timely warning to those who supply or use
condition, and no amount of financial expediency can justify deviation from this aim. To this end the bacteriologist, the packaging expert, and the consumer (i.e., clinician and nurse) must cooperate to produce the right article so that our patients will not be harmed. Department of Pathology, Ruchill
Hospital, Glasgow.
R. J. FALLON.
URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
SIR,-Iwas very interested to read the article by Mr. Cameron (Sept. 21). We have also been impressed with a similar technique, but we have also found the " Bardic Intracath " very satisfactory for paracentesis abdominis, since it has the advantages over the old trocar and cannula method of (a) " non-touch " of components entering the peritoneal cavity, (b) much more comfortable, and (c) when connected to a Bardic bag via the distal drip chamber and tubing of a disposable giving-set a real closed system of drainage is produced, and rate of drain-off is also easily controlled. Willesden General Hospital, London, N.W.10.
JOHN R. MAYER.
REGIONAL CURARISATION
SIR,-Professor Jones (Sept. 7) is advocating the use of a dangerous sledgehammer to crack a non-existent peanut. With adequate and yet not excessive general ansthesia, practically no relaxation is needed for surgery of the
knee-joint. Even assuming that it were necessary, enough relaxation can easily be obtained safely by intravenous injection of doses adequate for -the purpose, but short of " complete curarisation ", before the application of the tourniquet. Only those who were convinced by Beecher and Todd1 and have believed their conclusions in spite of the overwhelming mass of evidence opinion to the contrary, can possibly believe that the asphyxial risks " accompanying the small dose of gallamine necessary (if any) are greater than the risks of intra-arterial injection. This novel technique Professor Jones is advocating for " a " relatively inexperienced anarsthetist even " under field conditions, as it were, giving open drop ether or chloroform ". It is fortunate that the human body has two of its own hxmodialysing devices known as the kidneys, so we can, except in renal failure, expect normal doses of even intravenously injected agents to be adequately excreted. Even if we assume that a relaxant is necessary, and that " " total-body curarisation carries inherent and unjustifiable risk, it would still be possible to perform regional curarisation more simply and safely by suitably diluting the calculated dose of gallamine and injecting intravenously after application of the tourniquet and exsanguination. I have followed Holmes’ technique of regional intravenous analgesia2 in the arm with very satisfactory results and have on a few occasions modified it by the additional injection of 12-5-25 mg. of suxamethonium to try to give regional relaxation for the manipulation of fractures of the forearm.
and
wrapped sterilised articles. All too often little thought has gone into the design of such packs, or an obviously second-rate article has been chosen on the grounds of economy. The examples chosen by Cunliffe et al. are apt, and perhaps if a bacteriologist had been asked to comment on them in the design stage they would not have been produced. One of the difficulties is that most people cannot visualise the widespread distribution of bacteria. At a meeting of the Central Sterilising Club in Bristol in 1961 I was able to show how this difficulty may be overcome. If a pack is sprayed lightly with fluorescent powder it can be shown that, even although it may appear quite clean and dustfree when examined in ordinary light, examination under ultraviolet light (U.V.L.) will show the pack to be quite heavily contaminated. When such a pack is opened under u.v.L., dust particles can be seen to settle on the contents, particularly if the pack is torn open rather than opened in other ways. This simple experiment (which has great educative value for anyone concerned with the design and I think that to encourage frequent femoral and subuse of wrapped sterilised articles) demonstrates quite clavian arterial by inexperienced anaesthetists, dramatically the danger of the single-wrapped pack so who would be puncture better employed learning the normally rightly condemned by Hare and his colleagues.29 accepted methods of introducing normal clinical doses The final point which Cunliffe et al. make is most of relaxants into the circulation, is quite wrong. important. If we are to take the trouble to sterilise articles Royal Hobart Hospital, it is most important to get them to the patient in a sterile Hobart, F. W. ROBERTS. Tasmania. 27. 28. 29.
Burwell, R. G. Lancet, July 13, 1963, p. 69. Burwell, R. G. To be published. Hare, R., Helliwell, P. J., Shooter, R. A. Lancet, 1961, i, 774.
1. 2.
Beecher, H. K., Todd, D. P. Ann. Surg. 1954, 140, Holmes, C. McK. Lancet, 1963, i, 245.
2.
peaked.
The General Infirmary at Leeds.
N. R. ROWELL.
WRAPPING OF STERILISED ARTICLES SIR,-The letter of Professor Cunliffe and his colleagues (Sept. 14) is a timely warning to those who supply or use
condition, and no amount of financial expediency can justify deviation from this aim. To this end the bacteriologist, the packaging expert, and the consumer (i.e., clinician and nurse) must cooperate to produce the right article so that our patients will not be harmed. Department of Pathology, Ruchill
Hospital, Glasgow.
R. J. FALLON.
URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
SIR,-Iwas very interested to read the article by Mr. Cameron (Sept. 21). We have also been impressed with a similar technique, but we have also found the " Bardic Intracath " very satisfactory for paracentesis abdominis, since it has the advantages over the old trocar and cannula method of (a) " non-touch " of components entering the peritoneal cavity, (b) much more comfortable, and (c) when connected to a Bardic bag via the distal drip chamber and tubing of a disposable giving-set a real closed system of drainage is produced, and rate of drain-off is also easily controlled. Willesden General Hospital, London, N.W.10.
JOHN R. MAYER.
REGIONAL CURARISATION
SIR,-Professor Jones (Sept. 7) is advocating the use of a dangerous sledgehammer to crack a non-existent peanut. With adequate and yet not excessive general ansthesia, practically no relaxation is needed for surgery of the
knee-joint. Even assuming that it were necessary, enough relaxation can easily be obtained safely by intravenous injection of doses adequate for -the purpose, but short of " complete curarisation ", before the application of the tourniquet. Only those who were convinced by Beecher and Todd1 and have believed their conclusions in spite of the overwhelming mass of evidence opinion to the contrary, can possibly believe that the asphyxial risks " accompanying the small dose of gallamine necessary (if any) are greater than the risks of intra-arterial injection. This novel technique Professor Jones is advocating for " a " relatively inexperienced anarsthetist even " under field conditions, as it were, giving open drop ether or chloroform ". It is fortunate that the human body has two of its own hxmodialysing devices known as the kidneys, so we can, except in renal failure, expect normal doses of even intravenously injected agents to be adequately excreted. Even if we assume that a relaxant is necessary, and that " " total-body curarisation carries inherent and unjustifiable risk, it would still be possible to perform regional curarisation more simply and safely by suitably diluting the calculated dose of gallamine and injecting intravenously after application of the tourniquet and exsanguination. I have followed Holmes’ technique of regional intravenous analgesia2 in the arm with very satisfactory results and have on a few occasions modified it by the additional injection of 12-5-25 mg. of suxamethonium to try to give regional relaxation for the manipulation of fractures of the forearm.
and
wrapped sterilised articles. All too often little thought has gone into the design of such packs, or an obviously second-rate article has been chosen on the grounds of economy. The examples chosen by Cunliffe et al. are apt, and perhaps if a bacteriologist had been asked to comment on them in the design stage they would not have been produced. One of the difficulties is that most people cannot visualise the widespread distribution of bacteria. At a meeting of the Central Sterilising Club in Bristol in 1961 I was able to show how this difficulty may be overcome. If a pack is sprayed lightly with fluorescent powder it can be shown that, even although it may appear quite clean and dustfree when examined in ordinary light, examination under ultraviolet light (U.V.L.) will show the pack to be quite heavily contaminated. When such a pack is opened under u.v.L., dust particles can be seen to settle on the contents, particularly if the pack is torn open rather than opened in other ways. This simple experiment (which has great educative value for anyone concerned with the design and I think that to encourage frequent femoral and subuse of wrapped sterilised articles) demonstrates quite clavian arterial by inexperienced anaesthetists, dramatically the danger of the single-wrapped pack so who would be puncture better employed learning the normally rightly condemned by Hare and his colleagues.29 accepted methods of introducing normal clinical doses The final point which Cunliffe et al. make is most of relaxants into the circulation, is quite wrong. important. If we are to take the trouble to sterilise articles Royal Hobart Hospital, it is most important to get them to the patient in a sterile Hobart, F. W. ROBERTS. Tasmania. 27. 28. 29.
Burwell, R. G. Lancet, July 13, 1963, p. 69. Burwell, R. G. To be published. Hare, R., Helliwell, P. J., Shooter, R. A. Lancet, 1961, i, 774.
1. 2.
Beecher, H. K., Todd, D. P. Ann. Surg. 1954, 140, Holmes, C. McK. Lancet, 1963, i, 245.
2.