Kenneth L Stuart

Bacteriuria, Prematurity, and the Hypertensive Disorders of Pregnancy

In all age and parity groups the occurrence of prematurity and the hypertensive disorders of pregnancy was higher in bacteriurics than in non-bacteriurics. Prevalence rates for the emergence of the hypertensive disorders of pregnancy rose particularly rapidly with increasing age and parity in bacteriuric subjects. The predictive values of bacteriuria as an index of subsequent clinical pyelonephritis was confirmed. Some of the perinatal mortality and morbidity associated with hypertension and prematurity may be preventable (AU)

Acute Toxic Hypoglycaemia in the Vomiting Sickness of Jamaica

Trial with Gallamine In order to determine whether the abolition of visible muscle fasciculations prevented the muscle pains following suxamethonium a further series was attempted identical with group I (out-patients) except that the injection of suxamethonium was preceded by 40 mg. of gallamine triethiodide. This abolished visible twitching in every case. Of 15 cases examined, 6 (40%) complained of muscle pains. The significance of results based on such a small series is difficult to analyse, but the general impression was that following gallamine the incidence and severity of the muscle pains were diminished, though with this dosage they were not abolished. Further support is given to this suggestion by the finding in 12 in-patient cases (that is, confined to bed for 48 hours after operation), that if a dose of gallamine triethiodide (80 mg.) was given before the administration of suxamethonium there was no case of post-operative muscle stiffness.

Diet, Serum Cholesterol, Protein, Blood Haemoglobin, and Glycosuria in a West Indian Community (St. Kitts, W.I.)

understand how a decision may be influenced by the patients particular circumstances and personality. It might be thought that the large quantity of testosterone given with the thiotepa played a part in producing the responses observed. The possibility cannot be excluded, and it is probable that this substance was partly responsible for the subjective benefit so often seen. If, however, testosterone was also responsible for the objective remissions produced, one would expect some relationship to exist between response to it at a previous stage and subsequent benefit from thiotepa (Table IV): this was not found. On the other hand, the fact that hypophysectomy and thiotepa were effective in similar types of disease suggested an endocrine basis for its action. We have been unable to note any relationship between the clinical outcome of treatment and the dose of drug administered or the marrow depression produced. This may mean either that similar clinical results could be obtained by a reduced dosage, with possibly a smaller mortality, or that our data are inadequate because of the small number of patients. Improved results might be obtained by increasing the maximum dose (285 mg.) of thiotepa in patients who at that level of dosage did not show a serious depression of their blood counts. This would certainly increase the lethal effect of the drug, and in view of the alternative and, as it seems to us, superior methods of treatment, could not be justified. Can the treatment be made safer ? Table III shows that a rapid fall in the blood count to levels necessitating cessation of therapy did not give much information about the ultimate depth of marrow depression. Thus 13 (56%) out of 23 patients able to tolerate doses between 166 and 225 mg. showed eventual severe depression, while those given 226 to 285 mg. showed a similar result. It must be concluded that about half the cases treated will suffer a dangerous degree of marrow depression, and it is difficult either to prevent it or to predict when it will occur. The only way to make treatment safer would be to raise the white-cell and platelet levels at which treatment is stopped. It is likely that this would reduce the number of remissions. We cannot recommend second courses of treatment. The mortality produced (5 deaths out of 13 cases) was high, though it must be admitted that these cases had very advanced disease and were in poor general condition. Summary The results of treatment with thiotepa and testosterone in 46 patients suffering from advanced breast cancer have been presented. The mortality rate was 11%, and an overall remission rate of 37 %, lasting an average of 7.5 months, was obtained. It appeared that premenopausal women with a slowly evolving disease and metastases in bone were more likely to respond to this form of therapy. The hazards and protracted nature of treatment were comparable to those from hypophysectomy, but it was concluded that the results were inferior to those of the operation. We wish to thank Dr. G. A. Lynch for his co-operation in producing the series; Dr. A. T. Barker, whose supervision of in-patients was invaluable; and Dr. G. F. Tinsdale and his staff, who performed many clinico-pathological studies, without which the investigation would have been impossible. We also thank the nursing staffs of the Northern Ireland Radiotherapy Centre and Ward 22 of the Royal Victoria Hospital, Belfast, for carrying out the large amount of work the treatment placed on them. Our appreciation also goes to Mrs. Convey for secretarial help.

Clinical observations on veno-occlusive disease of the liver in Jamaican adults

Aitken, R. S., and Clark-Kenncdy, A. E. (1927). J. Physiol. (Lond.), 64, 17P. Allison, P. R., and Linden, R. J. (1953). Circulation, 7, 669. Armitage, 0. H., and Arnott, W. M. (1949a). J. Physiol. (Lond.), 109, 64. (1949b). Ibid., 109, 70. and Pincock, A. C. (1949). Ibid., 108, 27P. Austrian, R., McClement, J. H., Renzetti, A. D., Donald, K. W., Riley. R. L., and Cournand, A. (1951). Amer. J. Med., 11, 667. Aviado, D. M., Cerletti, A., Alanis, J., Bulle, P. H., and Schmidt, C. F. (1952). Amer. J. Physiol., 169, 460. Barcroft, J. (1934). Features in the Architecture of Physiological Function. Cambridge Univ. Press, Cambridge. Bjdrk, V. 0. (1954). Acta chir. scand., 107, 466. Bloomer, W. E., Harrison, W., Lindskog. G. F., and Liebow, A. A. (1949). Amer. J. Physiol., 157, 317. Bohr, C. (1909). Skand. Arch. Physiol., 22, 221. Bradford, J. R., and Dean, H. P. (1894). J. Physiol. (Lond.), 16, 34. Brenner, 0. (1935). Arch. Intern. Med., 56, 211, 457, 724, 976. 1189. Briscoe, W. A., Becklade, M. R., and Rose, T. F. (1951). Clin. Sci., 10, 37. Burton, A. C. (1951). Amer. J. Physiol., 164, 319. Churchill, E. D., and Cope, 0. (1929). J. exp. Med., 49, 531. Cockett, F. B., and Vass, C. C. N. (1951). Thorax, 6. 268. Cohn, J. E., Carroll, D. G., Armstrong, B. W., Shepard, R. H., and Riley, R. L. (1954). J. appl. Physiol., 6, 588. Comroe. J. H., and Fowler, W. S. (1951). Amer. J. Med., 10, 408. Cournand, A. (1950). Circulation, 2, 641. and Ranges, H. A. (1951). Proc. Soc. exp. Biol. (N.Y.), 46, 462.

Pernicious Anaemia in Jamaica

Megaloblastic anaemias arecommon in tropical countries and usually have a background of nutritional deficiency. In Jamaica megaloblastic anaemia of infancy is extremely common (Maclver and Back, 1960a, 1960b), and is due to a nutritional deficiency of folic acid. On the other hand, megaloblastic anaemia of pregnancy is rather rare. In Trinidad, Habib (1960) has reported several cases of megaloblastic anaemia in adult males-strict Hindus-apparently due to a primary nutritional deficiency of vitamin 12 Classical Addisonian perhnicious anaemia is known to occur in the negro, but there is still some debate on its relative frequency in comparison with other races. It is well