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7 September 1968 Correspondence MEDICALJOURNAL

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7 September 1968 Correspondence MEDICALJOURNAL 7 September 1968 Correspondence MEDICAL JOURNAL 617 ion of moderate severity and a-haemolytic plement fixation test. When the investiga- money. The user must decide whether to streptococci were cultured from the blood. tions were repeated 30 days after stopping analyse the cylinders himself or to accept the Br Med J: first published as 10.1136/bmj.3.5618.617-b on 7 September 1968. Downloaded from Six hundred mg. (1 mega unit) of benzylpenicillin penicillin therapy no agglutination could be manufacturer's certificate. If one assumes was given six-hourly by intramuscular injection. demonstrated by either technique. that our analyses gave the " right " values, This was increased to 1,200 mg. six-hourly when on the B.O.C. the temperature did not settle quite to normal. As in the previously reported cases, com- acceptance of the values Even so, low-grade fever persisted, and during paratively high doses of penicillin had been certificates would rarely have caused esti- the seventh week of treatment he developed a administered. The most striking feature of mates of blood-gas tensions to be more than sore throat and generalized muscular pains. our patient was the occurrence of agranulo- 1.0 mm. Hg "wrong." Whether the user There was pronounced neutropenia (total white cytosis on two occasions following penicillin analyses a cylinder or accepts the certificate cells 2,300/c.mm. with 2% neutrophil poly- and the demonstration of leucocyte antibodies it is wise to use the electrodes to compare a morphs), slight anaemia (haemoglobin 11.0 g./ during the second attack. As far as we are fresh cylinder with the old one before the old 100 ml.), and moderate thrombocytopenia (plate- been pre- is completely empty. lets 65,000/c.mm.). Penicillin was stopped, after aware thrombocytopenia has not one which the temperature became normal, symp- viously observed.-We are, etc., These gas mixtures are now available from toms disappeared, and the haematological values M. A. RosSITER. British Oxygen (Special Gases Department, the rapidly returned to normal. I. R. GRAY. British Oxygen Company, Deer Park Road, A second attack of infective endocarditis London S.W.19). We are grateful to Mr. R. C. occurred in December 1966, and a-haemolytic N. K. SHINTON. Warwickshire Postgraduate Heape, Mr. J. Pennington, and Mr. J. H. Scawin streptococci were again cultured from the blood. Medical Centre, for their enthusiastic collaboration. Intramuscular benzylpenicillin was given for Coventry, Warwicks. four days while waiting for sensitivity studies. -We are, etc., His treatment was then changed to phenethicillin REFERENCE E. J. M. CAMPBELL. with probenecid 1 g. l Gray, I. R., Tai, A. R., Wallace, J. G., and I g. six-hourly together Calder, J. H., Lancet, 1964, 2, 110. HELEN M. POPE. six-hourly, because it has previously been shown Department of Medicine, by one of us' that oral therapy is effective and Royal Postgraduate kinder to patients when the organism causing Medical School, infective endocarditis is fully sensitive to peni- Gas Mixtures for Calibration London W.12. cillin. The temperature, which had quickly fallen to normal, rose again during the second SIR,-The accuracy of blood P02 and Pco2 REFERENCE week of treatment. Although serum levels of measurements by the electrode techniques Lloyd, B. B., 7. Physiol. (Lond.), 1958, 143, SP. phenethicillin were high compared with the depends, among other factors, on the accu- sensitivity of the infecting organism it was racy of the gas mixtures used to calibrate the thought wise to* return to parenteral treatment electrodes. As the preparation and analysis with benzylpenicillin. The leucocyte count fell of these calibrating gas mixtures requires slightly during the first three weeks of treatment. the operation of the elec- During the fourth week the patient became quite more skill than with generalized muscular pains, sweat- trodes, most users now purchase their cali- Hereditary Quivering of the Chin unwell, brating gas mixtures. The demand for ing, and sore throat. The pharynx was red, but read your there was no ulceration and no significant numerous individual cylinders of " special" SIR,-I have been interested to bacterial growth from a throat-swab. Haemo- mixtures is now very great; their prepara- leading article (20 July, p. 138) and the globin was 11.1 g./100 ml.; leucocytes 800/ tion, analysis, and delivery are expensive. In ensuing correspondence about hereditary c.mm. with 4% neutrophil polymorphs, platelets our experience three gas mixtures greatly quivering of the chin. I have this condition 275,000/c.mm. Bone marrow showed normo- facilitate blood P02 and Pco2 measurement myself and so has my sister. My father, blastic erythropoiesis but absence of granulo- grandfather, and at least two of his sibs and myelocyte stage of develop- by spanning the most important range for cytes beyond the both gases; they are 4% C02, 13% 02; his mother also suffered with this. We have ment. Megakaryocytosis was normal. Penicillin by rapid move- was stopped, after which the temperature re- 6% C02, 11% 02; and 10% COa, 7% 02. all found it to be precipitated turned to normal within 24 hours. The leuco- We therefore approached the British Oxygen ments of the eyes such as playing table tennis cyte count rose to 5,500/c.mm. (62% neutrophil Company with the suggestion that they pro- or any ball game or watching birds flying, etc. polymorphs) after three days and remained vide these gas mixtures on loan stock. They It quite frequently occurs during sleep, and I http://www.bmj.com/ normal. After 30 days haemoglobin had risen agreed and undertook to prepare the mixtures have many times been woken up by an attack. to 12.5 g./l00 ml., and apart from,symptoms and, as an It has been most troublesome in childhood well. with a tolerance of ± 0.5% of the heart condition he has remained optional extra service, to supply a certificate and puberty, attacks tending to become in- Serological investigations: Erythrocytes- of analysis stating the composition to frequent and shorter in duration with age, Group 0 rhesus positive, phenotype ccDE. ±0.05%. This note is to draw attention to although different members of the family Direct Coombs test positive. Eluate showed this service and report the agreement between have been affected more badly than others. weak direct agglutination with pooled Group the manufacturers and our own analyses. I am at present trying to compile our com- and would appreciate O red cells suspended in both AB serum and Ten, cylinders of each gas mixture were re- plete family incidence, saline containing 40 mg./ml. benzylpeni- ceived between November 1966 and January being informed by any other affected persons on 25 September 2021 by guest. Protected copyright. cillin at 0' C., 22' C., and 370 C. High titre 1968, and analysed with the Lloyd-Haldane or by their doctors if they have any patients agglutination was found using an indirect apparatus. Each cylinder was analysed in dupli- with this complaint.-I am, etc., Coombs test with broad spectrum antihuman cate. Room air was analysed at each session globulin, antilgG, and antiIgM, again at all and the results were as follows: CO. 0.04%, ROSEMARY J. SIMPSON. three temperatures. Similar results were S.D. 0.022; 0, 20.92%, S.D. 0.028 (n=23). the serum with B.O.C. analysed the cylinders either by gas 14 St. Aubin's Park, obtained by testing patient's chromatography or by the Bone and Wheeler West Hayling, Group 0 cells treated with penicillin. Both absorption technique. All the cylinders supplied Hayling Island, serum and eluate reactions against penicillin- contaned gas mixtures within the specified toler- Hants. treated red cells were inhibited by previous ance of ±0.5%. The comparison between the exposure for 30 minutes to penicillin, IgM certificates supplied by B.O.C. and our analyses or IgG. There was no evidence of blood were as follows: Cerebral Malaria group specificity of the antibody present in the eluate or the serum. Thirty days after SIR,-It was with great interest that the the penicillin was stopped the direct Coombs C02 02 preliminary communication entitled "Use of in Cerebral Malaria," by test was negative and no penicillin red cell Mean difference +0.048 (B.O.C. Dexamethasone antibodies could be demonstrated. Leuco- an iR.P.M.S.) -0.003 Professor A. W. Woodruff and Dr. C. J. S.D. of difference 0.063 0.078 Dickinson (6 July, p. 31), was read at the cytes: There was direct agglutination of two S.E.M. of difference 0.01 is 0.014 out of four leucocyte suspensions. All four Maximum difference 0.22 -0.18 93rd Evacuation Hospital, Long Binh, Viet com- P <0.001 <O.S Nam. suspensions showed agglutination by The reason for this small plement fixation techniques carried out by but significant difference is unknown. During the past 10 months we have been malaria cases Dr. W. J. Jenkins at the N.E. Metropolitan There was no significant difference in the agreement accumulating 50-80 falcipar;An Blood Transfusion Centre (unpublished) for either gas at any of the three nominal ranges. monthly, with 1-2 cerebral malaria cases per Addition of phenethicillin 10 mng./ml. or month. Dexamethasome has been part of the benzyl penicillin 7 mg./ml. caused no change The general use of these gas mixtures in standard treatment, along with intravenous -In th~e strength ofW reactions uising the com- cylinders on loan should save time and quinine. There have been no fatalities re. 618 7 September 1968 Correspondence BRITISH corded. Post-cerebral malaria (? oedema) complete recovery even after five days' deep base in medicine and social work (i.e., health residua have been non-existent (by psycholo- coma, and fully justifies persisting with visitors).
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