1269 within monocytes

at

corticosteroids, and

24 h. All of

we can

Ganguly’s patients were on confirm’ their assumption that cor-

ticosteroids do not influence lysosomal enzyme levels. Royal Free Hospital, London NW3 2QG

A. S. MEE D. P. JEWELL

suggest that o,p’-DDD in this case decreased uricxmia by inthe renal elimination of uric acid, but we cannot decide on the mechanism of this effect: a decrease in reabsorp-

creasing tion

or an

increase in

urate

secretion.

GÉRARD REACH

Hôpital Broussais, Paris, France

INCREASED URATE EXCRETION AFTER o,p’-DDD SIR,-We have observed a uricosuric effect of 2,2-bis (2-chlorophenyl-4-chlorophenyl)-1, 1-dichloroethane (o,p’-DDD) in a with Cushing’s disease. A 34-year-old woman was admitted with raised blood-pressure, hirsutism, and characteristic facies. Plasma-cortisol circadian rhythm was abolished. 24 h urinary free-cortisol excretion was 800 ;g. A standard dexamethasone suppression test was negative but plasma-corusol decreased significantly after 8 mg of dexamethasone on two consecutive days. Nephrotomography showed two enlarged . adrenal glands, which were confirmed by 19-iodocholesterol . adrenal scan. Before treatment, serum-uric-acid was 214-250 mol/1 100 ,-tmol/4=1.68 mg/dl and urinary uric acid was 35-865 mmol/24 h. During this control period, urate renal clearance, calculated on a 24 h basis, was 12-7±1’6 ml/mm (mean + S.D., 9 determinations). Investigations with dexamethasone or spironolactone did not change these tests. o,p’-DDD therapy was begun (12 g/day). After 1 day of treatment, urate renal clearance was 29.2 ml/min (see figure’,. Urate values decreased progressively to 89 ;j.mol/I after 10 days, then remained unchanged for 4 weeks. To eliminate possible interference between o,p’-DDD or one of its metabolites and the standard colorimetric assay, it was verified on plasma taken during therapy that the same result was obtained with a specific uricase method. During therapy, urate renal clearance was 33.4±8.1 ml/min (mean+s.D., 12 determinations). No significant change in plasma-creatinine, creatnine renal clearance, or fractional phosphate extraction was observed. When o,p’-DDD was stopped, uricoemia increased rapidly and was 184 mol/1 1 week later. The urate renal clearance simuldecreased to 17.2 ml/min. When o,p’-DDD was given again, urate renal clearance greatly increased and urate values again decreased. We are not aware of any other studies of o,p’-DDD influence on urate excretion. Uric-acid excretion is dependent both on reabsorption and secretion by the renal tUbule.2 We

patient

taneously

2.

Steele, T. H. New Engl. J. Med. 1971, 284, 1193.

IBN-AL-NAFIS AND THE PULMONARY CIRCULATION

SIR,-Dr Al-Daggagh (May 27, p. 1148) seeks to secure for Ibn Al-Nafis credit for the discovery of the pulmonary circulation. But it is difficult to establish the case. He agrees that IbnAl-Nafis read and esteemed Galen. Galen’s own writings affirm the existence of the pulmonary circulation, and as Siegel remarks, "The only merit in Ibn-an-Nafis’ chapter consists inhaving revived the Galenic idea of blood flow through the lungs."’ No doubt Galen never arrived at anything resembling present-day understanding of the pulmonary circulation, in which a whole right-heart output traverses the lungs-a measured amount in unit time, with defined consequences for function. To Galen the flow might have seemed a dnbble, or even occasional or intermittent; we cannot tell. The discovery of the pulmonary circulation was not a stepwise event-not "now we know all about it, yesterday we knew nothing". A serious claimant to a share of the discovery must have discerned some new feature of the story, or have provided some experimental evidence. On these criteria, where does Ibn Al-Nafis stand? Department of Physiology, Medical School, Edinburgh EH8 9AG

JOHN FORRESTER

CENTRAL CERVICAL CORD SYNDROME AFTER HEADING A FOOTBALL

SIR,-Hyperextension of the cervical spine can, by leading vascular injury, give rise to the "central cervical cord syndrome",z characterised by greater weakness in the upper limbs than in the lower, retention of urine, impairment of sensation below the lesion, and pain and exquisite sensitivity in the derto a

matomes

of the lesion.

fit-looking 34-year-old man who often takes part in tacplaying football on a wet pitch in December, 1976. He suddenly saw the ball arriving high from A tory

tournaments was

afar, jumped, and headed it; he

then fell to the ground, and when he tried to get up he could move neither arms nor legs. Two or three minutes later, being able to get up, he went to hospital; an X-ray of the cervical spine revealed simply lack of the normal cervical lordosis. On the ensuing days the patient noticed a moderate burning pain at the ulnar edge-of the left hand and a mild weakness in the movements of the same hand. 15 days later, when we saw him, he had slight weakness of the left arm and leg with increased stretch reflexes and exhaustive foot clonus, mild weakness of the intrinsic muscles of the left hand, and a hypersensitive area along the ulnar edge of the left hand. 1 month later the same signs and symptoms were present, and more than a year later the patient often complains of a mild tickling pain in the ulnar edge of the hand. Our patient had a mild central cord syndrome at c7-8. This unusual football injury was due partly to the weight of the soaked ball and partly to the player’s insufficient muscular preparation. Neurological Institute, Catholic University, 00168 Rome, Italy

Effects of o,p’-DDD therapy. -o-urate renal clearance; —W—serum-uric-acid.

FRANCOIS ELKIK CHRISTIAN PARRY PIERRE CORVOL PAUL MILLIEZ

1. 2.

CIRIACO SCOPPETTA MARIA LUIGIA VACCARIO

Siegel, R. E. Galen’s System of Physiology and Medicine, p 69. Basle, Hopkins, A., Rudge, P. J. Neurol. Neurosurg. Psychiat. 1973, 36, 637.

1968.

Ibn-Al-Nafis and the pulmonary circulation.

1269 within monocytes at corticosteroids, and 24 h. All of we can Ganguly’s patients were on confirm’ their assumption that cor- ticosteroids do...
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