Effect of stasis of blood in varicose veins on erythrocyte fragility,with accompanying studies comparing red cells and other blood elements with cubital vein blood

1. Blood from varicose veins was compared with cubital vein blood in 20 patientsin order to determine whether or not the degree of stasis present in varicose veinswould increase red cell fragility. Corollary studies consisted of comparative determinations of red cells, hemoglobin, packed cell volume, white blood cells,platelets and serum proteins.

2. There was no increase in red cell fragility in the varicose vein specimen, indicating that the theory that minor degrees of intravascular erythrostasis contribute substantially to some of the hemolytic anemias is untenable.

3. There was a small but statistically significant elevation in red cells per cu.mm. in varicose vein blood as compared with blood from cubital veins. There wasa suggestive, but not significant, increase in packed cell volume and serum proteinin the varicose vein samples. The evidence indicates a mild degree of hemoconcentration.

4. White cells, platelets and hemoglobin determinations were found to have thesame values in varicose vein blood as in blood from the cubital vein.

     

Entrainment Onset in Atrioventricular Reciprocating Tachycardia: Value in Bypass Tract Localization and Relationship to the Preexcitation Index

The timing of entrainment onset has been shown to correlate with the conduction time to critical elements of a tachycardia circuit in a pacemaker model of reentrant ventricular tachycardia (VT). The utility of this method in evaluating clinical reentrant tachycardias was there/ore evaluated in 24 patients with symptomatic Wolff-Parkinson-White syndrome and single bypass tracts (left free wall in 17, posteroseptal in 5, anteroseptal in 1, and right free wall in 1). Right ventricular apex (RVA) pacing during orthodromic atrioventricular reentrant tachycardia (oAVRT) at 10–70 msec less than tachycardia cycle length demonstrated concealed entrainment of the tachycardia in all patients studied. An entrainment index (EI), defined as the minimal prematurity of the ventricular stimulus that first resulted in atrial reset, was calculated from multiple entrainments in each patient. The El was 121 ± 25, 83 ± 19, and 55 msec for left free wall, septal, and right free-wall bypass tracts, respectively (P = 0.004 for difference between left free wall and septal). A corrected EI, derived by subtracting the amount of atrial reset from the EI, gave values of 108 ± 22 and 71 ± 17 msec for left free wall and septal bypass tracts (P = 0.001). These values were compared to the preexcitation index (PI) by linear regression analysis in these patients. The PI correlated closely with both the EI and the corrected EI (r = 0.90 and 0.93, respectively), but the PI could only be derived in 12/17 (71%) left free-wall tachycardias versus the El in 17/17 (100%) (P < 0.05). Thus, the timing of entrainment onset can be used to calculate a relative conduction time to the tachycardia circuit in oAVRT, thus localizing the bypass tract. This may prove useful in localizing critical components of the reentrant circuit in other clinical tachycardias.     

Extent and nature of transitions of route among heroin addicts in treatment—preliminary data from the Drug Transitions Study

Preliminary data are presented here from a study of drug transitions in the UK. These support the contention that differences in route of administration are likely to be reflected in differing patterns of drug use, and associated with differing health risks for the individual drug user. Heroin ‘chasers’ were found to have robust and long-term patterns of heroin use and could not merely be considered as pre-injectors. They were also younger. No differences were found in the typical daily doses prior to entering treatment between chasers and injectors. Subjects who usually ‘chased the dragon’ but who would also inject were less likely to have shared injecting equipment in the past. Transitions between different routes of use were found in most directions. However, changes from ‘chasing’ to injection were most common. Year of initiation into heroin use was also related to initial route of use.     

Human Botulism Caused by Clostridium Botulinum Type E: The Birmingham Outbreak

Four elderly patients developed botulism following ingestionof tinned Alaskan salmon contaminated with Clostridium botulinumtype E. Severe skeletal muscle paralysis, occurring within 18hours in peripheral, respiratory and facial, extrinsic ocularand pharyngeal muscles, resulted in progressive respiratoryfailure, ptosis, loss of eye movements, dysphonia and dysphagia.In addition, the development of intestinal ileus, loss of vagalcardiac control, hypotension and lack of vasomotor responseto either postural change, stimulation by cold or the Valsalvamanoeuvre indicated dysfunction of both parasympathetic andsympathetic nervous systems. Sensation was unimpaired and noalteration of consciousness occurred despite the presence ofextensive abnormal delta activity in the EEGs of all patients. The diagnosis of botulism was confirmed by demonstration ofCl. botulinum type E toxin in the serum of all four patientsand in salmon remnants from the suspect tin, in which Cl. botuilnumtype E spores were also identified. Standard supportive intensive care and antitoxin therapy werecomplemented by the use of a novel neuromuscular blockade antagonist,4-aminopyridine. This agent was shown by electromyography tobe effective in restoring neuromuscular transmission and, clinically,to produce almost complete reversal of peripheral paralysis.However, this effect was transient and there was no detectableeffect on respiratory muscle. Administration of 4-aminopyridineby constant infusion produced sustained improvement in peripheralmuscle power, but there was no additional effect on respiratorymuscle, and convulsive phenomena occurred following treatment.Despite these latter problems, 4-aminopyridine produced a greaterresponse in peripheral muscle than might have been expectedwith guanidine and further studies, possibly with less neurotoxicanalogues, are indicated.     

Failure to Demonstrate Dosage of U Antigen

Abstract. Tests in which 11 examples of anti-U were used in titration studies against the red blood cells of 9 obligate Uu heterozygotes, from 4 unrelated families, and random Negro and Caucasian donors (many of whom were of the presumptive UU genotype) have failed to demonstrate any dosage of the U antigen.     

The development of a hypnotherapy service for children

In September 1988, a Pain and Symptom Management Team was set up to offer hypnotherapy as part of the treatment of pain, discomfort and anxiety. Children are taught self-hypnotherapy skills. Of the first 51 cases referred, 36 were taken on for hypnotherapy and after two to three sessions 29 were rated as improved or much improved. An account is given of the approach of the team and of some of the possible pitfalls.     

Proficiency testing in immunohaematology in Ontario,Canada, 1977–1979

Summary. An analysis of the results of a compulsory proficiency testing programme in immunohaematology is presented. Error rates have been calculated for the determination of ABO and Rh(D) groups, the direct antiglobulin test and antibody detection according to defined criteria. The introduction of proficiency testing has been associated with alterations in error rates for some determinations. An educational programme introduced for laboratories with poor performance has proved effective in improving their results in the proficiency testing programme.