1263 supports this contention. We recommend the use of water less cold that 4°C, and we emphasise the importance of electrocardiographic monitoring of patients during the diving reflex.
avoided by starting each treatment with clomiphene only after spontaneous or induced menstruation and by asking a patient to visit her doctor before a new course of clomiphene so that pregnancy can be excluded.
ence
Department of Obstetrics and Gynæcology, University of Oulu, 90220 Oulu 22,
Department of Medicine,
OLAVI YLIKORKALA
Finland.
SIDE-EFFECTS OF INTRAVENOUS CORYNEBACTERIUM PARVUM parvum in the therapy of human malignancy makes of interest an observation in two out of ten patients with advanced malignancy receiving C. parvum given slowly intravenously in a dose of 7.5mg/m2. Both patients had recent surgical scars (for mastectomy and laparotomy) which had healed and required no further dressing for some weeks before immunotherapy. On the second day after C. parvum therapy, both wounds developed exudative granulation tissue which required dressings, but both wounds healed again within 10 days. One of these patients was given C. parvum a second time and the wound again broke down and healed at the same tempo as on the first occasion, despite considerably less systemic reaction to the vaccine. This objective evidence of the stimulation of an inflammatory reaction may encourage the hope that C. parvum in this dosage and by this route is effective.
ynebacterium
D. N. H. HAMILTON
VENTRICULAR TACHYCARDIA CAUSED BY THE DIVING REFLEX
SIR,—Dr Wildenthal and his colleagues’ described the use of the diving reflex to terminate paroxysmal atrial tachycardia. The safety of the technique has been emphasised.2 We were unable to terminate a paroxysm of atrial tachycardia in a 50-year-old woman by either carotid-sinus massage or the Valsalva manoeuvre. We then immersed her face in a pail of water at 4°C. After 20 seconds ventricular tachycardia occurred and ended as soon as her face was pulled out (see figure, a). A repeat test had the same result (b). Subsequently, she was treated with intravenous digoxin and reverted to sinus
rhythm. Others3 have
a temperature of 4°C may be too considerable catecholamine discharge, with consequent risk of ventricular dysrhythmias. Our experi-
SIR,—As I was amongst the first to stop transfusing dialysis patients,’ permit me to comment on your editorial of Nov. 15 (p. 959). The basic stimulus to stop blood-transfusion in 1966 was to facilitate home dialysis. Two groups published their "no transfusion" results in 196723 and, apart from the benefits of avoiding the suppression of endogenous erythropoietin secretion and the potential risk of transmission of hepatitis, the only other reason given for "no transfusion" was the avoidance of iron overload. A further benefit was that, in many patients not transfused, the mean haemoglobin levels were higher than in the transfusion era, particularly if iron deficiency was corrected. Today, many dialysis patients are maintained with haemoglobin levels which were never achieved during the transfusion era. It seems odd, therefore, that you should choose to ignore these historical reasons for the suppression of blood-transfusions, and give priority to an unreferenced anecdotal justification relating to transplantation, which arose later and cer-
tainly by "post-hoc" reasoning. I
am
in
no
way competent to
judge
whether transfusions
improve or reduce cadaver-transplant survivals. It is interesting to note, however, that Terasaki4 derived his non-transfused series of cadaver-transplant patients from a nation-wide questionnaire and his control series of transfused patients came exclusively from Los Angeles. In addition, no effort was
graft failures from technical or non-imIn view of this disparity between the sources of his two populations and the possibility of non-immunological factors influencing these results, perhaps one should pay more than passing attention to the opposing view-namely, the E.D.T.A.’s Registration Committee’s report in Copenhagen 1975,5 which found that transfusion adversely affects cadaver-kidney transplant survival. I feel, therefore, that the evidence to date does not justify an increase in transfusion habits in dialysis units, a conclusion made
to
eliminate
munological
causes.
thought that
low, since it results in
1.
Division of Cardiology, West Virginia University Hospital, Morgantown, West Virginia 26506, U.S.A.
PRETRANSPLANT BLOOD-TRANSFUSION
SIR,-The increasing interest in the use of intravenous Cor-
Department of Surgery, Western Infirmary, Glasgow G11 6NT
PATRICK CONDRY ABNASH JAIN ROBERT MARSHALL ALLEN BOWYER
a
Wildenthal, K., Leshin, S. J., Atkins, J. M., Skelton, C.
12. 2. Emergency Medicine, August, 1975, p. 64. 3. Hunt, N. G., Whitaker, D. K., Wilmott, N.
Electrocardiogram showing
L. Lancet, 1975,
i,
J. Lancet, 1975, i, 572
ventricular
tachycardia starting
on
1. Shaldon, S. Lancet, 1967, ii, 783. 2. Verroust, P. J., Curtis, Wing, A. J., Eastwood, J. B., Storey, J., Edwards, M. S., de Wardener, H. E. Proc. Eur. Dial. Transplant Ass.
J. R.,
1967, 4, 12. Crockett, R. E., Baillod, R. A., Lee, B. N., Moorhead, J. F., Stevenson, C.M., Varghese, Z., Shaldon, S. ibid p. 17. 4. Opelz, G., Terasaki, P. I. Lancet, 1974, ii, 696. 5. Brunner, F. et al. Proc. Eur. Dial Transplant Ass. (in the press).
3.
immersion of face in water at 4°C
(a) and returning after repeat test (b).
avoided by starting each treatment with clomiphene only after spontaneous or induced menstruation and by asking a patient to visit her doctor before a new course of clomiphene so that pregnancy can be excluded.
ence
Department of Obstetrics and Gynæcology, University of Oulu, 90220 Oulu 22,
Department of Medicine,
OLAVI YLIKORKALA
Finland.
SIDE-EFFECTS OF INTRAVENOUS CORYNEBACTERIUM PARVUM parvum in the therapy of human malignancy makes of interest an observation in two out of ten patients with advanced malignancy receiving C. parvum given slowly intravenously in a dose of 7.5mg/m2. Both patients had recent surgical scars (for mastectomy and laparotomy) which had healed and required no further dressing for some weeks before immunotherapy. On the second day after C. parvum therapy, both wounds developed exudative granulation tissue which required dressings, but both wounds healed again within 10 days. One of these patients was given C. parvum a second time and the wound again broke down and healed at the same tempo as on the first occasion, despite considerably less systemic reaction to the vaccine. This objective evidence of the stimulation of an inflammatory reaction may encourage the hope that C. parvum in this dosage and by this route is effective.
ynebacterium
D. N. H. HAMILTON
VENTRICULAR TACHYCARDIA CAUSED BY THE DIVING REFLEX
SIR,—Dr Wildenthal and his colleagues’ described the use of the diving reflex to terminate paroxysmal atrial tachycardia. The safety of the technique has been emphasised.2 We were unable to terminate a paroxysm of atrial tachycardia in a 50-year-old woman by either carotid-sinus massage or the Valsalva manoeuvre. We then immersed her face in a pail of water at 4°C. After 20 seconds ventricular tachycardia occurred and ended as soon as her face was pulled out (see figure, a). A repeat test had the same result (b). Subsequently, she was treated with intravenous digoxin and reverted to sinus
rhythm. Others3 have
a temperature of 4°C may be too considerable catecholamine discharge, with consequent risk of ventricular dysrhythmias. Our experi-
SIR,—As I was amongst the first to stop transfusing dialysis patients,’ permit me to comment on your editorial of Nov. 15 (p. 959). The basic stimulus to stop blood-transfusion in 1966 was to facilitate home dialysis. Two groups published their "no transfusion" results in 196723 and, apart from the benefits of avoiding the suppression of endogenous erythropoietin secretion and the potential risk of transmission of hepatitis, the only other reason given for "no transfusion" was the avoidance of iron overload. A further benefit was that, in many patients not transfused, the mean haemoglobin levels were higher than in the transfusion era, particularly if iron deficiency was corrected. Today, many dialysis patients are maintained with haemoglobin levels which were never achieved during the transfusion era. It seems odd, therefore, that you should choose to ignore these historical reasons for the suppression of blood-transfusions, and give priority to an unreferenced anecdotal justification relating to transplantation, which arose later and cer-
tainly by "post-hoc" reasoning. I
am
in
no
way competent to
judge
whether transfusions
improve or reduce cadaver-transplant survivals. It is interesting to note, however, that Terasaki4 derived his non-transfused series of cadaver-transplant patients from a nation-wide questionnaire and his control series of transfused patients came exclusively from Los Angeles. In addition, no effort was
graft failures from technical or non-imIn view of this disparity between the sources of his two populations and the possibility of non-immunological factors influencing these results, perhaps one should pay more than passing attention to the opposing view-namely, the E.D.T.A.’s Registration Committee’s report in Copenhagen 1975,5 which found that transfusion adversely affects cadaver-kidney transplant survival. I feel, therefore, that the evidence to date does not justify an increase in transfusion habits in dialysis units, a conclusion made
to
eliminate
munological
causes.
thought that
low, since it results in
1.
Division of Cardiology, West Virginia University Hospital, Morgantown, West Virginia 26506, U.S.A.
PRETRANSPLANT BLOOD-TRANSFUSION
SIR,-The increasing interest in the use of intravenous Cor-
Department of Surgery, Western Infirmary, Glasgow G11 6NT
PATRICK CONDRY ABNASH JAIN ROBERT MARSHALL ALLEN BOWYER
a
Wildenthal, K., Leshin, S. J., Atkins, J. M., Skelton, C.
12. 2. Emergency Medicine, August, 1975, p. 64. 3. Hunt, N. G., Whitaker, D. K., Wilmott, N.
Electrocardiogram showing
L. Lancet, 1975,
i,
J. Lancet, 1975, i, 572
ventricular
tachycardia starting
on
1. Shaldon, S. Lancet, 1967, ii, 783. 2. Verroust, P. J., Curtis, Wing, A. J., Eastwood, J. B., Storey, J., Edwards, M. S., de Wardener, H. E. Proc. Eur. Dial. Transplant Ass.
J. R.,
1967, 4, 12. Crockett, R. E., Baillod, R. A., Lee, B. N., Moorhead, J. F., Stevenson, C.M., Varghese, Z., Shaldon, S. ibid p. 17. 4. Opelz, G., Terasaki, P. I. Lancet, 1974, ii, 696. 5. Brunner, F. et al. Proc. Eur. Dial Transplant Ass. (in the press).
3.
immersion of face in water at 4°C
(a) and returning after repeat test (b).
