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URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
168
through the saphenofemoral junction does the vein massively dilate. The first change seems to be generalised dilatation of the vein before the valves become incompetent, and this later is the cause of their becoming
incompetent. King’s College Hospital, London, S.E.5.
L. T. COTTON.
somatotrophic bovine hormone. The urine prepared by Albert’s method. These urine also induced mammary development in the prepubertal male A2G mice, either normal or castrated, adrenalectomised, 10 g. of
by
extracts extracts or
were
both (see figure).
de la
Hospital Rivadavia and Instituto de Fisiología Facultad de Ciencias Médicas,
DEL CASTILLO DELIA RADZYMINSKI.
ENRIQUE B.
Buenos Aires.
URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
SIR,-I was interested to read Mr. Ewan Cameron (Sept. 21) on suprapubic intubation for urinary retention. Ideally, the treatment of retention of urine due to simple prostatic obstruction is immediate prostatectomy, but circumstances may prevent this. On this unit, we have for the past year relieved retention of urine by making the suprapubic puncture with a large-bore needle and threading through it into the bladder a length of polyethylene tubing (gauge 2), with a couple of lateral holes cut near the tip with a scalpel blade. For convenience, we have had a number of sets made up comprising a needle and a length of polyethylene tubing presterilised and wrapped in a towel. One complication of this method is extravasation of urine into the space of Retzius if the tubing slips out as the bladder empties. This can be prevented by passing a long length of tubing into the bladder where it coils up, much in the manner of wiring introduced into an aneurysm. Necessarily, a tube of smaller gauge than the introducing needle must be used, and small lumen tubes are liable to become blocked by urinary debris. Furthermore, the puncture wound in the bladder is larger than the tube used for drainage which makes extravasation possible. But as subsequent suprapubic operation shows, this does not happen. To overcome these disadvantages we now introduce a larger tube by means of a needle placed within the lumen with the point projecting just beyond the end of the tube in the manner of the’‘ Braunula’disposable intravenous cannula (Melsungen). For this purpose we use a Gibbon catheter with the tip cut off and a needle thrust through the wall of the catheter. Department of Surgery, L. F. TINCKLER, University of Singapore. GROWTH HORMONE IN HUMAN URINE
SIR,-We read with interest the important contribution1 by Dr. Salinas and his colleagues demonstrating somatotrophic activity in human urine. In 1961 we reported2 work on the somatotrophic activity of human our menopausal urine. We used in our biological test tibial cartilage of hypophysectomised rats. The cartilage growth produced by an extract
of 8 hours’ output of urine
was
1. Lancet, 1963, ii, 302. 2. Rev. Soc. argent. Biol.
similar
to
that produced
1961, 37, 250.
ANTIDEPRESSANT DRUGS
SIR,-I should like (Dec. 7).
to express a
In this country, mental illnesses are still regarded as rather disgraceful and it is, therefore, worth trying drugs to retain respectability. The clinic which I direct is a hundred miles from the nearest psychiatric bed, and where E.c.T. is given to an outpatient or domiciliary basis, many cases must be excluded because of the risk. It is my experience that, where one antidepressant drug does not work, another will and I am always reluctant to admit defeat and begin E.c.T. In this way, a patient is allowed to have nerves that responded to pills rather than a mental illness that needed shock treatment. These patients are a great help in enabling us to see other patients early and allowing us to approach the ideal of community psychiatry. Mental Health Clinic, Prince Albert, Saskatchewan.
R. E. JENKINS.
TOXIC EFFECTS OF MONOAMINE-OXIDASE INHIBITORS
SIR,-Dr. Linford Rees and Dr. Pare (Dec. 14) comthe possible dangers of antidepressant drugs of
ment on
the monoamine-oxidase inhibitor type, pointing out that the incidence of jaundice attributed to them may have been exaggerated, and that it is a matter for the individual doctor to decide when to prescribe a monoamine-oxidase inhibitor for his depressed patients. It is alarming that a therapeutically valuable drug such as ’Drazine ’ has been withdrawn from use, and that iproniazid, still the most effective monoamine-oxidase inhibitor is threatened with a similar fate. Surely it is not so much the danger of these drugs that give rise to concern as the dangers of doctors prescribing them without proper understanding or appreciation of the drugs or the condition they are attempting to treat. A depressive illness represents a breakdown in a patient’s " internal environment", and it is to a lesser or greater extent the result of his inability to adapt to certain external stresses. A monoamine-oxidase inhibitor may quickly restore internal stability, break a vicious circle, and allow the Datient to cone with and brin? about necessary adjustments in his external. environment. Psychotherapy will speed up and reinforce these adjustments and shorten the time required for drugs. When adaptation is not possible, the drugs may need to be given for longer periods. It seems important that practitioners prescribing these drugs for depressive states should recognise this principle and assess the factors involved far as they are able, and should know the side-effects and possible dangers of the drugs they use. Only then can they weigh fairly all the as
Left: Mammary gland of A,G control male mouse.
Right: Mammary gland
of
AG prepubertal
treated with 8-hour extract of pausal urine. mouse
contrary view to that of
Dr. Rishi
meno-
through the saphenofemoral junction does the vein massively dilate. The first change seems to be generalised dilatation of the vein before the valves become incompetent, and this later is the cause of their becoming
incompetent. King’s College Hospital, London, S.E.5.
L. T. COTTON.
somatotrophic bovine hormone. The urine prepared by Albert’s method. These urine also induced mammary development in the prepubertal male A2G mice, either normal or castrated, adrenalectomised, 10 g. of
by
extracts extracts or
were
both (see figure).
de la
Hospital Rivadavia and Instituto de Fisiología Facultad de Ciencias Médicas,
DEL CASTILLO DELIA RADZYMINSKI.
ENRIQUE B.
Buenos Aires.
URINARY RETENTION MANAGED WITHOUT URETHRAL CATHETERISATION
SIR,-I was interested to read Mr. Ewan Cameron (Sept. 21) on suprapubic intubation for urinary retention. Ideally, the treatment of retention of urine due to simple prostatic obstruction is immediate prostatectomy, but circumstances may prevent this. On this unit, we have for the past year relieved retention of urine by making the suprapubic puncture with a large-bore needle and threading through it into the bladder a length of polyethylene tubing (gauge 2), with a couple of lateral holes cut near the tip with a scalpel blade. For convenience, we have had a number of sets made up comprising a needle and a length of polyethylene tubing presterilised and wrapped in a towel. One complication of this method is extravasation of urine into the space of Retzius if the tubing slips out as the bladder empties. This can be prevented by passing a long length of tubing into the bladder where it coils up, much in the manner of wiring introduced into an aneurysm. Necessarily, a tube of smaller gauge than the introducing needle must be used, and small lumen tubes are liable to become blocked by urinary debris. Furthermore, the puncture wound in the bladder is larger than the tube used for drainage which makes extravasation possible. But as subsequent suprapubic operation shows, this does not happen. To overcome these disadvantages we now introduce a larger tube by means of a needle placed within the lumen with the point projecting just beyond the end of the tube in the manner of the’‘ Braunula’disposable intravenous cannula (Melsungen). For this purpose we use a Gibbon catheter with the tip cut off and a needle thrust through the wall of the catheter. Department of Surgery, L. F. TINCKLER, University of Singapore. GROWTH HORMONE IN HUMAN URINE
SIR,-We read with interest the important contribution1 by Dr. Salinas and his colleagues demonstrating somatotrophic activity in human urine. In 1961 we reported2 work on the somatotrophic activity of human our menopausal urine. We used in our biological test tibial cartilage of hypophysectomised rats. The cartilage growth produced by an extract
of 8 hours’ output of urine
was
1. Lancet, 1963, ii, 302. 2. Rev. Soc. argent. Biol.
similar
to
that produced
1961, 37, 250.
ANTIDEPRESSANT DRUGS
SIR,-I should like (Dec. 7).
to express a
In this country, mental illnesses are still regarded as rather disgraceful and it is, therefore, worth trying drugs to retain respectability. The clinic which I direct is a hundred miles from the nearest psychiatric bed, and where E.c.T. is given to an outpatient or domiciliary basis, many cases must be excluded because of the risk. It is my experience that, where one antidepressant drug does not work, another will and I am always reluctant to admit defeat and begin E.c.T. In this way, a patient is allowed to have nerves that responded to pills rather than a mental illness that needed shock treatment. These patients are a great help in enabling us to see other patients early and allowing us to approach the ideal of community psychiatry. Mental Health Clinic, Prince Albert, Saskatchewan.
R. E. JENKINS.
TOXIC EFFECTS OF MONOAMINE-OXIDASE INHIBITORS
SIR,-Dr. Linford Rees and Dr. Pare (Dec. 14) comthe possible dangers of antidepressant drugs of
ment on
the monoamine-oxidase inhibitor type, pointing out that the incidence of jaundice attributed to them may have been exaggerated, and that it is a matter for the individual doctor to decide when to prescribe a monoamine-oxidase inhibitor for his depressed patients. It is alarming that a therapeutically valuable drug such as ’Drazine ’ has been withdrawn from use, and that iproniazid, still the most effective monoamine-oxidase inhibitor is threatened with a similar fate. Surely it is not so much the danger of these drugs that give rise to concern as the dangers of doctors prescribing them without proper understanding or appreciation of the drugs or the condition they are attempting to treat. A depressive illness represents a breakdown in a patient’s " internal environment", and it is to a lesser or greater extent the result of his inability to adapt to certain external stresses. A monoamine-oxidase inhibitor may quickly restore internal stability, break a vicious circle, and allow the Datient to cone with and brin? about necessary adjustments in his external. environment. Psychotherapy will speed up and reinforce these adjustments and shorten the time required for drugs. When adaptation is not possible, the drugs may need to be given for longer periods. It seems important that practitioners prescribing these drugs for depressive states should recognise this principle and assess the factors involved far as they are able, and should know the side-effects and possible dangers of the drugs they use. Only then can they weigh fairly all the as
Left: Mammary gland of A,G control male mouse.
Right: Mammary gland
of
AG prepubertal
treated with 8-hour extract of pausal urine. mouse
contrary view to that of
Dr. Rishi
meno-