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VITAMIN-C DEFICIENCY AND ULCERATION OF FACE
1382 In separate publications, details of the A.I.C. determinationand further clinical resultswill be presented. We are grateful to Mr. Sigmund Lasker for bringing the A.I.C. work of the Russian investigators to our attention. These studies were supported in part by grants from the National Institutes of
Health, Bethesda, Maryland. Hæmatology and Nutrition Laboratory, Department of Pediatrics, New York Medical College, New York.
A. LEONARD LUHBY JACK M. COOPERMAN.
THE SHATTERED DENTAL PLATE
SIR,-A patient was admitted to the casualty departrecently with multiple injuries after a car accident. He had a stove-in chest, closed head injury with brain damage, and multiple lacerations about the face, the inside of the mouth, and the right leg. His condition was critical and oxygen was given. As soon as intubation was performed and assisted ventilation began, he was transment
ferred
to
the intensive-care unit.
A tracheostomy was performed; and automatically assisted ventilation was instituted under muscle-relaxant cover, using a Barnet ventilator, and adjusted according to blood biochemical levels. During the next two weeks copious secretions were removed from the trachea. On the fourteenth day a jagged fragment of dental plate, 2-5 cm. by 1-5 cm., appeared at the tracheostomy and was removed. After this, his level of consciousness and respiratory function steadily improved. The tracheostomy tube was removed five days later. X-rays of the chest, taken each day from the time of admission showed no evidence that respiratory inefficiency was due to any local cause other than damage to the chest wall.
The
problem of the shattered dental plate is becoming increasingly common in patients with depressed levels of consciousness because many of these plates cannot be detected radiologically. Since radio-opaque denture material is available, it seems advisable to recommend that it be used in all dental plates. Glasgow Royal Infirmary, Glasgow.
VITAMIN-C DEFICIENCY AND ULCERATION OF FACE
SIR,-The following Homoeopathic Hospital vitamin-C deficiency.
illustrates
the Royal London unusual effect of
an
A woman of 78, not showing any other signs of illness, except for glaucoma, developed an ulcer on her left cheek in 1958. She attended another hospital where a biopsy was carried, out, the report being: " The section of skin includes a simple inflammatory ulcer lined at the edge by attenuated squamous epithelium with abundant inflammatory granulation tissue at its base. The small ulcer crater is plugged with serocellular keratinous debris." The treatment at the Royal London Homoeopathic Hospital consisted of homoeopathic medicines, given internally, and external applications of antibiotics. These were matched with results from swabs, which showed Staphylococcus aureus and In addition eusol dressings and Friedlander’s bacillus. ’Vioform’ ointment were employed. Although the ulcer showed some signs of healing at times, it broke down consistently and, in fact, became larger. On June 4, 1962, the vitamin-C excretion in the urine over 24 hours was found to be only 1 mg. per 100 ml. The patient was given vitamin C 1 g. t.d.s. and the ulcer started healing. On June 14 the vitamin-C value had risen to 22 mg. per 100 ml. The healing of the ulcer was complete by the middle of July, and the condition has remained satisfactory since. Throughout the whole period of observation, no signs of scurvy were observed; and the patient’s diet was not apparently deficient in vitamin C. Royal London Homœopathic Hospital, E. K. LEDERMANN. London, W.C.1.
NEONATAL
JAUNDICE SIR,-Dr. With (Nov. 10) raises an interesting, but in my opinion untenable, objection to the use of standard bilirubin-in-plasma preparations. His point is that "
SHEDDEN ALEXANDER.
case seen at
bilirubin in natural sera " consists of an unknown mix-
of bilirubin and various conjugates, the extinction of which may be significantly dissimilar. There of is, course, some indirect evidence strongly suggesting that the chromogenic properties of albumin-bound bilirubin and bilirubin esters are not dissimilar. For example, both my own observations on neonatal plasmaand those of Chiamori et al. have led to this conclusion. ture
SOYA-BEAN PHOSPHOLIPID IN THE THROMBOPLASTIN-GENERATION TEST
constants
SIR,-Dr. Clarke (Sept. 15) writes that he has had unsatisfactory results withLipostabil ’. I have used ’Asolectin ’,7 a phospholipid from soya, with very good results. A possible reason for Dr. Clarke’s failure is the use of saline solution as a diluent for lipostabil. I have conTHROMBOPLASTIC ACTIVITY OF ASOLECTIN
Reagent volumes ==0’2 ml. Substrate volumes ==0’1 ml.
Figures represent clotting-time in seconds samples of incubation mixture.
of substrate
plasma added
to
firmed that asolectin diluted with saline solution gives abnormally prolonged times in the thromboplastingeneration test. On the other hand, a ’Veronal ’-acetate buffer solution at pH 7-4 has given consistently good results (see accompanying table). The same might happen with lipostabil if the buffered diluent were employed. Departamento de Laboratorio Clinico, Escuela de Post-Graduados, Facultad de Medicina, JUSTO AZNAR LUCEA. Pamplona, Spain. 6. Luhby, A. L., Cooperman, J. M., Singer, H., Lasker, S., Fox, C. L., Jr. Unpublished data. 7. Associated Concentrates Inc., 32-30 61st Street, Woodside 77, Long Island, N.Y., U.S.A.
consideration of the absorptivities of the is perhaps even more pertinent to the problem of standardisation. During the analysis of icteric plasma from patients with hepatitis by the procedure of Jendrassik and Grof, the introduction of strong alkali results in partial hydrolysis of the dipyrrolazo pigments of conjugated bilirubin into those of unconjugated bilirubin. No conversion of conjugated into unconjugated " azobilirubin " occurs in the method of Lathe and Ruthven which neverthless gives the same results as those obtainable by Jendrassik and Grof’s method. The simplest explanation for this is that the extinction coefficients of the azo pigments of conjugated and unconjugated bilirubin are the same. A balance between small amounts of pigments, some more and some less chromogenic than azobilirubin, is possible but unlikely. But, in either case, the use of bilirubin-in-plasma will serve as a satisfactory standard. The peroxidative effect of haem pigments on plasma-bilirubin was first expounded by Professor Lemberg,3 and its prevention by the addition of 30 mg. ascorbic acid per 100 ml. serum has recently been recommended 41 by me. Michaelsson * has independently suggested the use of ascorbic
However,
respective
a
azo
pigments
1. Watson, D. Clin. chim. Acta, 1961, 6, 737. 2. Chiamori, N., Henry, R. J., Golub, O. J. ibid. p. 1. 3. Lemberg, R. Aust. J. exp. biol. med. Sci. 1942, 20, 111. 4. Rogers, J. A., Watson, D. J. clin. Path. 1961, 14, 271. 5. Watson, D. Clin. Chem. 1961, 7, 603. 6. Michaëlsson, M. Scand. J. clin. Lab. Invest. 1961, suppl.
56, pp. 39, 45.
Health, Bethesda, Maryland. Hæmatology and Nutrition Laboratory, Department of Pediatrics, New York Medical College, New York.
A. LEONARD LUHBY JACK M. COOPERMAN.
THE SHATTERED DENTAL PLATE
SIR,-A patient was admitted to the casualty departrecently with multiple injuries after a car accident. He had a stove-in chest, closed head injury with brain damage, and multiple lacerations about the face, the inside of the mouth, and the right leg. His condition was critical and oxygen was given. As soon as intubation was performed and assisted ventilation began, he was transment
ferred
to
the intensive-care unit.
A tracheostomy was performed; and automatically assisted ventilation was instituted under muscle-relaxant cover, using a Barnet ventilator, and adjusted according to blood biochemical levels. During the next two weeks copious secretions were removed from the trachea. On the fourteenth day a jagged fragment of dental plate, 2-5 cm. by 1-5 cm., appeared at the tracheostomy and was removed. After this, his level of consciousness and respiratory function steadily improved. The tracheostomy tube was removed five days later. X-rays of the chest, taken each day from the time of admission showed no evidence that respiratory inefficiency was due to any local cause other than damage to the chest wall.
The
problem of the shattered dental plate is becoming increasingly common in patients with depressed levels of consciousness because many of these plates cannot be detected radiologically. Since radio-opaque denture material is available, it seems advisable to recommend that it be used in all dental plates. Glasgow Royal Infirmary, Glasgow.
VITAMIN-C DEFICIENCY AND ULCERATION OF FACE
SIR,-The following Homoeopathic Hospital vitamin-C deficiency.
illustrates
the Royal London unusual effect of
an
A woman of 78, not showing any other signs of illness, except for glaucoma, developed an ulcer on her left cheek in 1958. She attended another hospital where a biopsy was carried, out, the report being: " The section of skin includes a simple inflammatory ulcer lined at the edge by attenuated squamous epithelium with abundant inflammatory granulation tissue at its base. The small ulcer crater is plugged with serocellular keratinous debris." The treatment at the Royal London Homoeopathic Hospital consisted of homoeopathic medicines, given internally, and external applications of antibiotics. These were matched with results from swabs, which showed Staphylococcus aureus and In addition eusol dressings and Friedlander’s bacillus. ’Vioform’ ointment were employed. Although the ulcer showed some signs of healing at times, it broke down consistently and, in fact, became larger. On June 4, 1962, the vitamin-C excretion in the urine over 24 hours was found to be only 1 mg. per 100 ml. The patient was given vitamin C 1 g. t.d.s. and the ulcer started healing. On June 14 the vitamin-C value had risen to 22 mg. per 100 ml. The healing of the ulcer was complete by the middle of July, and the condition has remained satisfactory since. Throughout the whole period of observation, no signs of scurvy were observed; and the patient’s diet was not apparently deficient in vitamin C. Royal London Homœopathic Hospital, E. K. LEDERMANN. London, W.C.1.
NEONATAL
JAUNDICE SIR,-Dr. With (Nov. 10) raises an interesting, but in my opinion untenable, objection to the use of standard bilirubin-in-plasma preparations. His point is that "
SHEDDEN ALEXANDER.
case seen at
bilirubin in natural sera " consists of an unknown mix-
of bilirubin and various conjugates, the extinction of which may be significantly dissimilar. There of is, course, some indirect evidence strongly suggesting that the chromogenic properties of albumin-bound bilirubin and bilirubin esters are not dissimilar. For example, both my own observations on neonatal plasmaand those of Chiamori et al. have led to this conclusion. ture
SOYA-BEAN PHOSPHOLIPID IN THE THROMBOPLASTIN-GENERATION TEST
constants
SIR,-Dr. Clarke (Sept. 15) writes that he has had unsatisfactory results withLipostabil ’. I have used ’Asolectin ’,7 a phospholipid from soya, with very good results. A possible reason for Dr. Clarke’s failure is the use of saline solution as a diluent for lipostabil. I have conTHROMBOPLASTIC ACTIVITY OF ASOLECTIN
Reagent volumes ==0’2 ml. Substrate volumes ==0’1 ml.
Figures represent clotting-time in seconds samples of incubation mixture.
of substrate
plasma added
to
firmed that asolectin diluted with saline solution gives abnormally prolonged times in the thromboplastingeneration test. On the other hand, a ’Veronal ’-acetate buffer solution at pH 7-4 has given consistently good results (see accompanying table). The same might happen with lipostabil if the buffered diluent were employed. Departamento de Laboratorio Clinico, Escuela de Post-Graduados, Facultad de Medicina, JUSTO AZNAR LUCEA. Pamplona, Spain. 6. Luhby, A. L., Cooperman, J. M., Singer, H., Lasker, S., Fox, C. L., Jr. Unpublished data. 7. Associated Concentrates Inc., 32-30 61st Street, Woodside 77, Long Island, N.Y., U.S.A.
consideration of the absorptivities of the is perhaps even more pertinent to the problem of standardisation. During the analysis of icteric plasma from patients with hepatitis by the procedure of Jendrassik and Grof, the introduction of strong alkali results in partial hydrolysis of the dipyrrolazo pigments of conjugated bilirubin into those of unconjugated bilirubin. No conversion of conjugated into unconjugated " azobilirubin " occurs in the method of Lathe and Ruthven which neverthless gives the same results as those obtainable by Jendrassik and Grof’s method. The simplest explanation for this is that the extinction coefficients of the azo pigments of conjugated and unconjugated bilirubin are the same. A balance between small amounts of pigments, some more and some less chromogenic than azobilirubin, is possible but unlikely. But, in either case, the use of bilirubin-in-plasma will serve as a satisfactory standard. The peroxidative effect of haem pigments on plasma-bilirubin was first expounded by Professor Lemberg,3 and its prevention by the addition of 30 mg. ascorbic acid per 100 ml. serum has recently been recommended 41 by me. Michaelsson * has independently suggested the use of ascorbic
However,
respective
a
azo
pigments
1. Watson, D. Clin. chim. Acta, 1961, 6, 737. 2. Chiamori, N., Henry, R. J., Golub, O. J. ibid. p. 1. 3. Lemberg, R. Aust. J. exp. biol. med. Sci. 1942, 20, 111. 4. Rogers, J. A., Watson, D. J. clin. Path. 1961, 14, 271. 5. Watson, D. Clin. Chem. 1961, 7, 603. 6. Michaëlsson, M. Scand. J. clin. Lab. Invest. 1961, suppl.
56, pp. 39, 45.