285 crises; others treated themselves with remedies for colds
or
in-
fluenza (1 took a tablet containing pseudoephedrine and died); others took tricyclic antidepressants as well as their M.A.O.I.s, and 2 of these died. With other people there were problems with the M.A.o.l. itself. The patients may experience no antidepressant effect to start with and may take more than the prescribed dose to gain benefit (this happens with tricyclic drugs too). Patients on certain M.A.O.I.S can become very self-centred, often to the exclusion of any awareness of the emotions of others; several marriages have broken up in this way. Some M.A.O.i.s have withdrawal symptoms and patients finding themselves "hooked" may become suicidally depressed at the prospect of having to take pills indefinitely. I can only go on what the clients tell us when they seek our help, and it could well be that the prescribing doctor did issue warnings about the hazards of this class of drug. All the same it may be worth drawing attention to the need for both patient and doctor to be aware of all the risks. This means comprehensive instructions about avoiding certain foods and self-treatment. The patients must be told to inform all doctors, dentists, or.psychologists he consults that he is on M.A.O.I. treatment. He should .be aware of the dangers of taking more tablets than the number prescribed. Wives or husbands must be prepared for andperhaps helped to cope with possible personality changes that may put pressure on marriages, and patient and spouse must be aware of the possibility of dependence in some cases.
Perhaps more consideration needs to be given to trying out other drug regimens before resorting to M.A.O.I.S. We often find that patients who do not respond or even react adversely to, say, amitriptyline will respond to, say, nortriptyline/fluphenazine. St Albans
Drugs Information and Advisory Service,
17c Alma Road, St Albans, Hertfordshire AL1 3AR
STEPHEN P. WRIGHT
POLYMORPHONUCLEAR LEUCOCYTE FUNCTION AFTER STORAGE
SIR,—It is generally assumed that the function of human polymorphonuclear leucocytes (P.M.N.) must be tested within a few hours of bleeding the patient. Using radiometric assay techniques developed in this laboratory for measuring phagocytosis and intracellular killing1,2 we have tested this assumption.
had
not
tionally yield.
been stored (see table). After 48 h P.M.N. were funcintact although there was a pronounced reduction in
Blood specimens intended for assessment of P.M.N. function thus be kept overnight or even sent through the post.
can
Department of Immunology, St. Mary’s Hospital Medical School, London W2 1PG
C. G. BRIDGES M. YAMAMURA H. VALDIMARSSON
METASTATIC ADENOCARCINOMA FROM ŒSOPHAGEAL COLONIC INTERPOSITION SIR,—Colonic interposition is a corrective measure for oesophageal obstruction caused by carcinoma, chemical burns, reflux resophagitis, or congenital anomalies.’’3 We describe here a case of metastatic adenocarcinoma from a tumour in the interposed colon. A 51-year-old man was admitted to hospital for discomfort in the upper thorax and the arms of 2 months’ duration. He had no significant medical history except for the insertion of a right colonic interposition for oesophageal strictures resulting from the ingestion of lye 11 years previously. 6 months before admission he noted the. gradual onset of malaise, fatigue, weakness, anorexia, weight loss, and a non-tender nodule on the sternum which had gradually enlarged without any attendant symptoms. He was emaciated and in no acute distress; normal pulse, respiration, and blood-pressure. There was a 6x6 cm, hard, non-moveable nodule over the sternum and palpable nodes (1 cm) in both axilla: but none in the neck or supraclavicular area. There was no evidence of superior vena cava syndrome nor hepatojugular reflux. Cardiac examination revealed aI/vI systolic murmur at the apex. Pulmonary examination showed no rhonchi, rales, or changes in fremitus. The epigastrium had a hard, palpable, non-tender mass approximately 10 cm in diameter. Stool was negative for occult blood. White-cell-count was 13 000/µl, hxmatocrit 30%, and platelet-count 137 000/µl. Clotting tests, electrolytes, urea, uric acid, creatinine, and calcium were normal. His total bilirubin was 2 mg/dl (direct 1 3). His serum-alkaline-phosphatase was 1800 mU/ml (normal 14-103). Chest X-ray showed no defects. Gastrointestinal X-rays showed the colonic interposition but did not reveal any abnormalities there or in the stomach, duodenum, or colon. Isotope studies revealed multiple defects in the liver and increased uptake in the sternum. Biopsy of the sternal nodule revealed metastatic adenocarcinoma. Endoscopy demonstrated a friable mass in the colonic interposition 30 cm from the incisors.
PHAGOCYTOSIS AND INTRACELLULAR KILLING BEFORE AND AFTER STORAGE
Necropsy
showed adenocarcinoma of the colonic
interposi-
tion, which was eroding into the sternum and soft tissue of the chest, and metastases in lungs, peritoneum, thoracoabdominal
lymph-nodes, thoracic vertebræ and ribs. The usual problems associated with
colonic interpositions gangrene of the colonic segment, anastomotic leakage, regurgitation, substernal discomfort, halitosis, and belching.2 Patients with such prostheses should be carefully evaluated if they present with metastatic adenocarcinoma of unknown aetiology even though usual gastrointestinal X-rays are normal, as in our patient. are
*=% inhibition of 3H-uridine uptake.
Endocrine Metabolism
=%51Cr release.
Heparinised blood (40 units/ml) or acid-citrate-dextrosetreated buffy coat samples were kept for 24 and 48 h at room temperature (10-20°C) or at 4°C. P.M.N. were then isolated by sedimenting erythrocytes with dextran 110. Phagocytosis and intracellular killing were examined using Candida albicans. In blood-samples kept for 24 h the yield and functional activity of P.M. N. was scarcely different from that in samples which
Unit,
University of Rochester, Rochester General Hospital, Rochester, 14621, U.S.A.
Department of Medicine, Georgetown University, and Veterans Administration Hospital,
Washington, D.C.
ANGELO A. LICATA PETER FECANIN ROBERT GLOWITZ
1.
Hanna, E. A., Harrison, A. W., Derrick, J. R. Ann. thorac. Surg. 1967, 3,
2.
Postlethwait, R. W., Sealy, W. C., Dillon, M. L., Young, W. G. ibid. 1971, 12, 89.
3.
Stephens, H. B. Am. J. Surg. 1971, 122, 217.
111. 1. Yamamura, M., Boler, J., Valdimarsson, H. J. immun. Methods, 1976, 227. 2. Yamamura, M., Boler, J., Valdimarsson, H. ibid. 1977, 14, 19.
13,
or
in-
fluenza (1 took a tablet containing pseudoephedrine and died); others took tricyclic antidepressants as well as their M.A.O.I.s, and 2 of these died. With other people there were problems with the M.A.o.l. itself. The patients may experience no antidepressant effect to start with and may take more than the prescribed dose to gain benefit (this happens with tricyclic drugs too). Patients on certain M.A.O.I.S can become very self-centred, often to the exclusion of any awareness of the emotions of others; several marriages have broken up in this way. Some M.A.O.i.s have withdrawal symptoms and patients finding themselves "hooked" may become suicidally depressed at the prospect of having to take pills indefinitely. I can only go on what the clients tell us when they seek our help, and it could well be that the prescribing doctor did issue warnings about the hazards of this class of drug. All the same it may be worth drawing attention to the need for both patient and doctor to be aware of all the risks. This means comprehensive instructions about avoiding certain foods and self-treatment. The patients must be told to inform all doctors, dentists, or.psychologists he consults that he is on M.A.O.I. treatment. He should .be aware of the dangers of taking more tablets than the number prescribed. Wives or husbands must be prepared for andperhaps helped to cope with possible personality changes that may put pressure on marriages, and patient and spouse must be aware of the possibility of dependence in some cases.
Perhaps more consideration needs to be given to trying out other drug regimens before resorting to M.A.O.I.S. We often find that patients who do not respond or even react adversely to, say, amitriptyline will respond to, say, nortriptyline/fluphenazine. St Albans
Drugs Information and Advisory Service,
17c Alma Road, St Albans, Hertfordshire AL1 3AR
STEPHEN P. WRIGHT
POLYMORPHONUCLEAR LEUCOCYTE FUNCTION AFTER STORAGE
SIR,—It is generally assumed that the function of human polymorphonuclear leucocytes (P.M.N.) must be tested within a few hours of bleeding the patient. Using radiometric assay techniques developed in this laboratory for measuring phagocytosis and intracellular killing1,2 we have tested this assumption.
had
not
tionally yield.
been stored (see table). After 48 h P.M.N. were funcintact although there was a pronounced reduction in
Blood specimens intended for assessment of P.M.N. function thus be kept overnight or even sent through the post.
can
Department of Immunology, St. Mary’s Hospital Medical School, London W2 1PG
C. G. BRIDGES M. YAMAMURA H. VALDIMARSSON
METASTATIC ADENOCARCINOMA FROM ŒSOPHAGEAL COLONIC INTERPOSITION SIR,—Colonic interposition is a corrective measure for oesophageal obstruction caused by carcinoma, chemical burns, reflux resophagitis, or congenital anomalies.’’3 We describe here a case of metastatic adenocarcinoma from a tumour in the interposed colon. A 51-year-old man was admitted to hospital for discomfort in the upper thorax and the arms of 2 months’ duration. He had no significant medical history except for the insertion of a right colonic interposition for oesophageal strictures resulting from the ingestion of lye 11 years previously. 6 months before admission he noted the. gradual onset of malaise, fatigue, weakness, anorexia, weight loss, and a non-tender nodule on the sternum which had gradually enlarged without any attendant symptoms. He was emaciated and in no acute distress; normal pulse, respiration, and blood-pressure. There was a 6x6 cm, hard, non-moveable nodule over the sternum and palpable nodes (1 cm) in both axilla: but none in the neck or supraclavicular area. There was no evidence of superior vena cava syndrome nor hepatojugular reflux. Cardiac examination revealed aI/vI systolic murmur at the apex. Pulmonary examination showed no rhonchi, rales, or changes in fremitus. The epigastrium had a hard, palpable, non-tender mass approximately 10 cm in diameter. Stool was negative for occult blood. White-cell-count was 13 000/µl, hxmatocrit 30%, and platelet-count 137 000/µl. Clotting tests, electrolytes, urea, uric acid, creatinine, and calcium were normal. His total bilirubin was 2 mg/dl (direct 1 3). His serum-alkaline-phosphatase was 1800 mU/ml (normal 14-103). Chest X-ray showed no defects. Gastrointestinal X-rays showed the colonic interposition but did not reveal any abnormalities there or in the stomach, duodenum, or colon. Isotope studies revealed multiple defects in the liver and increased uptake in the sternum. Biopsy of the sternal nodule revealed metastatic adenocarcinoma. Endoscopy demonstrated a friable mass in the colonic interposition 30 cm from the incisors.
PHAGOCYTOSIS AND INTRACELLULAR KILLING BEFORE AND AFTER STORAGE
Necropsy
showed adenocarcinoma of the colonic
interposi-
tion, which was eroding into the sternum and soft tissue of the chest, and metastases in lungs, peritoneum, thoracoabdominal
lymph-nodes, thoracic vertebræ and ribs. The usual problems associated with
colonic interpositions gangrene of the colonic segment, anastomotic leakage, regurgitation, substernal discomfort, halitosis, and belching.2 Patients with such prostheses should be carefully evaluated if they present with metastatic adenocarcinoma of unknown aetiology even though usual gastrointestinal X-rays are normal, as in our patient. are
*=% inhibition of 3H-uridine uptake.
Endocrine Metabolism
=%51Cr release.
Heparinised blood (40 units/ml) or acid-citrate-dextrosetreated buffy coat samples were kept for 24 and 48 h at room temperature (10-20°C) or at 4°C. P.M.N. were then isolated by sedimenting erythrocytes with dextran 110. Phagocytosis and intracellular killing were examined using Candida albicans. In blood-samples kept for 24 h the yield and functional activity of P.M. N. was scarcely different from that in samples which
Unit,
University of Rochester, Rochester General Hospital, Rochester, 14621, U.S.A.
Department of Medicine, Georgetown University, and Veterans Administration Hospital,
Washington, D.C.
ANGELO A. LICATA PETER FECANIN ROBERT GLOWITZ
1.
Hanna, E. A., Harrison, A. W., Derrick, J. R. Ann. thorac. Surg. 1967, 3,
2.
Postlethwait, R. W., Sealy, W. C., Dillon, M. L., Young, W. G. ibid. 1971, 12, 89.
3.
Stephens, H. B. Am. J. Surg. 1971, 122, 217.
111. 1. Yamamura, M., Boler, J., Valdimarsson, H. J. immun. Methods, 1976, 227. 2. Yamamura, M., Boler, J., Valdimarsson, H. ibid. 1977, 14, 19.
13,
