291
Our patient shows that this procedure is possible after intravenous administration of alteplase. It should be noted that he received a total dose of 30 mg and not the usual 50 mg over two bourse Although we report only one case, thrombolysis is often the first step in the management of acute PE with circulatory instability, and surgical embolectomy is the only alternative should this treatment fail. We need to emphasise that providing a short half-life fibrinolytic agent such as alteplase is used, thrombolysis does not necessarily contraindicate subsequent pulmonary embolectomy.
important contribution of Bruno Fleischer, clinician, deserves better recognition. Warneford Hospital, Oxford OX3 7JX, UK
an
astute
T. R. DENING
Department of Psychiatry,
University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge 1.
G. E. BERRIOS
Obituary of Richard Fleischer. Munchen Med Wochenschr 1909; 56: 1285-86.
2. Fischer I. Biographisches Lexikon der hervorragenden Ärzte der letzten fünfzig
Medical Clinic, Department of Anaesthesiology, and Centre for Medical and Surgical Admissions, Hôpital Cantonal Universitaire, 1211 Geneva 4, Switzerland
PHILIPPE JOLLIET CLAUDE MAGNIN
PIERRE-FRANÇOIS UNGER
1. The urokinase
pulmonary embolism trial (UPET): a national cooperative study. Circulation 1973; 47 (suppl II). 2 Urokinase-streptokinase pulmonary embolism trial (USPET), phase II results: a co-operative study. JAMA 1974; 229: 1606-13. 3. Miller GA, Hall RJ. Pulmonary embolectomy: their place in the treatment of acute massive pulmonary embolism. Am Heart J 1977; 93: 568-74. 4. Marder V, Sherry S. Thrombolytic therapy: current status. N Engl J Med 1988; 318: 1512-20, 1585-95. 5. Verstraete M, Miller GA. Intravenous and
plasminogen activator
The
intrapulmonary recombinant tissue-type acute massive pulmonary embolism.
Jahre:
Vol I. Berlin Urban & Schwarzenberg, 1932: 416-17. 3. Fleischer R. Ueber eine neue Form von Haemoglobinurie beim Menschen. Berl Klin Wochenschr 1881; 18: 691. 4. Anon. Death notice of Bruno Fleischer Dtsch Med Wochenschr 1965; 90: 1195. 5. Fleischer B. Zwei weiterer Falle von grunlicher Verfarbung der Kornea. Klin Monatssbl Augenheilk 1903; 41: 489-91. 6. Fleischer B. Uber eine der ’Pseudosklerose’ nahestehende bisher unbekannte Krankheit (gekennzeichnet durch Tremor, psychische Storungen, braunliche Pigmentierung bestimmter Gewebe, insbesondere auch der Hornhautperipherie, Lebercirrhose). Dtsch Z Nervenheilk 1912; 44: 179-201. 7. Wilson SAK. Progressive lenticular degeneration: a familial nervous disease associated with cirrhosis of the liver. Brain 1912; 34: 295-509. 8 Fleischer B, Gerlach W. Zur Frage der Silberpigmentierung des KayserFleischerschen Hornhautringes. Klin Wochenschr 1934; 13: 255. 9. Fleischer B. Zur Frage des Hamosiderinrings bei Keratokonus. Klin Monatssbl Augenheilk 1916; 57: 353-61.
in the treatment of Circulation 1988; 77: 353-60.
Gray HH, Morgan JM. Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases. Br Heart J 1988; 60: 196-200. 7. Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg 1986; 92: 442-45. 8. Alpert JS, Smith RE. Treatment of massive pulmonary embolism: the role of pulmonary embolectomy. Am Heart J 1975; 89: 413-18. 9 Masters RG, Koshal A. Ongoing role of pulmonary embolectomy. Can J Cardiol 1988; 6.
4: 347-51
Eponymous confusion
over
Bruno Fleischer
SrR,-The Kayser-Fleischer ring, a greenish-brown pigmentation cornea found in Wilson’s disease, is one of the more specific physical signs in clinical medicine. It is named after two German ophthalmologists, Bernard Kayser and Bruno Fleischer. Accounts of Kayser (1869-1954) in medical dictionaries and books of of the
eponyms are in agreement, but Fleischer has suffered from a case of mistaken identity. Richard Fleischer was a physician, born in 1848. He studied in Berlin, Jena, and Wurzburg, and worked in Berlin, Heidelberg, and Jena, before moving to Erlangen in 1877. He became professor of medicine in Erlangen in 1886 and retired to Munich in 1903. He died in 1909. His best-known paper decribed march
haemoglobinuria.3 Bruno Fleischer, ophthalmologist, was born in Stuttgart in 1874. He studied in Tubingen, Geneva, and Berlin, and from 1898 worked in Tubingen, becoming a professor in 1909. He moved to Erlangen in 1920 and died there in 1965, aged 90. His first account of the corneal ring appeared in 1903.5 His contribution went beyond that of Kayser because he recognised that the ring was a marker for a particular neuropsychiatric disorder associated with cirrhosis.6 Unfortunately for him, this breakthrough was overshadowed by the work of Kinnier Wilson.’ He published a final paper on the Kayser-Fleischer ring in 1934, and also described corneal pigmentation in keratoconus.9 Most medical dictionaries erroneously attribute the description of corneal rings to Richard Fleischer. Seven out of nine large medical dictionaries and collections of eponyms published in the past 15 years and surveyed in two libraries were wrong. Five volumes made an incorrect attribution to Richard Fleischer, and the other two described Bruno Fleischer as a Munich physician who died in 1904. The seven offending texts were the Faber, Blakiston Gould (4th ed), Stedman (24th ed), Dorland (27th ed), and Churchill medical dictionaries, the International Dictionary of Medicine and Biology, and Lourie’s Medical Eponyms. Two dictionaries (Butterworth and Webster) correctly identified Bruno Fleischer (as bom in 1874), but neither included the date of his death.
Prenatal
sex
determination
SiR,—Dr Lo and colleagues (Dec 9, p 1363) examine peripheral blood samples from 19 pregnant women of various gestational ages. With amplification of a 149 bp fragment1 of a Y-specific repeat sequence, pHY10,2 of the DYZ1 family they detected a Y-specific signal in all 12 women who bore a male fetus but in none of 7 women who bore a female fetus. There are controversial results by two groups3,4 who used the same 149 bp fragment and failed to detect such a Y-specific signal, although a dual amplification system was not used. Some women seemed to show a positive signal when the 149 bp fragment was amplified.s Lo et al report 1 false-positive in a non-pregnant woman. A repeating unit of the DYZfamily consists of segments with autosomal homologies interspersed with different Y-specific segments.6 We have identified a Y-specific 1024 bp B segment within the pHY 10 fragment. On the other hand, a 323 bp E segment which spans the 149 bp segment proved not to be Y-specific and showed homology with autosomal sequences. The E segment was detected in 2 of 20 controls (unpublished). Lo et al examined only 3 female volunteers with their dual amplification technique. They attributed their false-positive result to contamination by male DNA. An alternative interpretation could be the presence of autosomal sequence(s) homologous to the 149 bp sequence on the
pHYlO. We believe that a larger number of female volunteers should be examined by the dual amplification technique before this method is used diagnostically, to avoid false-positive results. We are attempting to detect with the B segment a Y-specific signal in women who bear male fetuses. Department of Congenital Abnormalities Research, National Children’s Medical Research Centre,
Setagaya-ku, Tokyo, 154 Japan
1.
YASUO NAKAGOME SHIGEO NAGAFUCHI YUTAKA NAKAHORI
Kogan SC, Doherty M, Gitchier J. An improved method for prenatal diagnosis of genetic diseases by analysis of amplified DNA sequences. N Engl J Med 1987; 317:
985-90. 2. Nakahon Y, Mitani K, Yamada M, Nakagome Y. A human Y chromosome specific repeated DNA family (DYZ1) consists of a tandem array of pentanucleotides. Nucleic Acids Res 1986; 14: 7569-80
3. Adinolfi M, Camporese C, Carr T. Gene amplification to detect fetal nucleated cells in pregnant women Lancet 1989; ii: 328-29. 4. Schwinger E, Hillers M, Vosberg HP. No identification of Y-chromosomal DNA in blood from pregnant women bearing a male fetus? Am J Hunt Genet 1989; 45: A268. 5. Handyside AH, Pattinson JK, Penketh RJA, et al. Biopsy of human preimplantation embryos and sexing by DNA amplification. Lancet 1989; i: 347-49 6 Smith KD, Young KE, Talbot CC Jr, Schmeckpeper BJ. Repeated DNA of the human Y chromosome. Development 1987 (suppl): 77-92.
Our patient shows that this procedure is possible after intravenous administration of alteplase. It should be noted that he received a total dose of 30 mg and not the usual 50 mg over two bourse Although we report only one case, thrombolysis is often the first step in the management of acute PE with circulatory instability, and surgical embolectomy is the only alternative should this treatment fail. We need to emphasise that providing a short half-life fibrinolytic agent such as alteplase is used, thrombolysis does not necessarily contraindicate subsequent pulmonary embolectomy.
important contribution of Bruno Fleischer, clinician, deserves better recognition. Warneford Hospital, Oxford OX3 7JX, UK
an
astute
T. R. DENING
Department of Psychiatry,
University of Cambridge Clinical School, Addenbrooke’s Hospital, Cambridge 1.
G. E. BERRIOS
Obituary of Richard Fleischer. Munchen Med Wochenschr 1909; 56: 1285-86.
2. Fischer I. Biographisches Lexikon der hervorragenden Ärzte der letzten fünfzig
Medical Clinic, Department of Anaesthesiology, and Centre for Medical and Surgical Admissions, Hôpital Cantonal Universitaire, 1211 Geneva 4, Switzerland
PHILIPPE JOLLIET CLAUDE MAGNIN
PIERRE-FRANÇOIS UNGER
1. The urokinase
pulmonary embolism trial (UPET): a national cooperative study. Circulation 1973; 47 (suppl II). 2 Urokinase-streptokinase pulmonary embolism trial (USPET), phase II results: a co-operative study. JAMA 1974; 229: 1606-13. 3. Miller GA, Hall RJ. Pulmonary embolectomy: their place in the treatment of acute massive pulmonary embolism. Am Heart J 1977; 93: 568-74. 4. Marder V, Sherry S. Thrombolytic therapy: current status. N Engl J Med 1988; 318: 1512-20, 1585-95. 5. Verstraete M, Miller GA. Intravenous and
plasminogen activator
The
intrapulmonary recombinant tissue-type acute massive pulmonary embolism.
Jahre:
Vol I. Berlin Urban & Schwarzenberg, 1932: 416-17. 3. Fleischer R. Ueber eine neue Form von Haemoglobinurie beim Menschen. Berl Klin Wochenschr 1881; 18: 691. 4. Anon. Death notice of Bruno Fleischer Dtsch Med Wochenschr 1965; 90: 1195. 5. Fleischer B. Zwei weiterer Falle von grunlicher Verfarbung der Kornea. Klin Monatssbl Augenheilk 1903; 41: 489-91. 6. Fleischer B. Uber eine der ’Pseudosklerose’ nahestehende bisher unbekannte Krankheit (gekennzeichnet durch Tremor, psychische Storungen, braunliche Pigmentierung bestimmter Gewebe, insbesondere auch der Hornhautperipherie, Lebercirrhose). Dtsch Z Nervenheilk 1912; 44: 179-201. 7. Wilson SAK. Progressive lenticular degeneration: a familial nervous disease associated with cirrhosis of the liver. Brain 1912; 34: 295-509. 8 Fleischer B, Gerlach W. Zur Frage der Silberpigmentierung des KayserFleischerschen Hornhautringes. Klin Wochenschr 1934; 13: 255. 9. Fleischer B. Zur Frage des Hamosiderinrings bei Keratokonus. Klin Monatssbl Augenheilk 1916; 57: 353-61.
in the treatment of Circulation 1988; 77: 353-60.
Gray HH, Morgan JM. Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases. Br Heart J 1988; 60: 196-200. 7. Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. J Thorac Cardiovasc Surg 1986; 92: 442-45. 8. Alpert JS, Smith RE. Treatment of massive pulmonary embolism: the role of pulmonary embolectomy. Am Heart J 1975; 89: 413-18. 9 Masters RG, Koshal A. Ongoing role of pulmonary embolectomy. Can J Cardiol 1988; 6.
4: 347-51
Eponymous confusion
over
Bruno Fleischer
SrR,-The Kayser-Fleischer ring, a greenish-brown pigmentation cornea found in Wilson’s disease, is one of the more specific physical signs in clinical medicine. It is named after two German ophthalmologists, Bernard Kayser and Bruno Fleischer. Accounts of Kayser (1869-1954) in medical dictionaries and books of of the
eponyms are in agreement, but Fleischer has suffered from a case of mistaken identity. Richard Fleischer was a physician, born in 1848. He studied in Berlin, Jena, and Wurzburg, and worked in Berlin, Heidelberg, and Jena, before moving to Erlangen in 1877. He became professor of medicine in Erlangen in 1886 and retired to Munich in 1903. He died in 1909. His best-known paper decribed march
haemoglobinuria.3 Bruno Fleischer, ophthalmologist, was born in Stuttgart in 1874. He studied in Tubingen, Geneva, and Berlin, and from 1898 worked in Tubingen, becoming a professor in 1909. He moved to Erlangen in 1920 and died there in 1965, aged 90. His first account of the corneal ring appeared in 1903.5 His contribution went beyond that of Kayser because he recognised that the ring was a marker for a particular neuropsychiatric disorder associated with cirrhosis.6 Unfortunately for him, this breakthrough was overshadowed by the work of Kinnier Wilson.’ He published a final paper on the Kayser-Fleischer ring in 1934, and also described corneal pigmentation in keratoconus.9 Most medical dictionaries erroneously attribute the description of corneal rings to Richard Fleischer. Seven out of nine large medical dictionaries and collections of eponyms published in the past 15 years and surveyed in two libraries were wrong. Five volumes made an incorrect attribution to Richard Fleischer, and the other two described Bruno Fleischer as a Munich physician who died in 1904. The seven offending texts were the Faber, Blakiston Gould (4th ed), Stedman (24th ed), Dorland (27th ed), and Churchill medical dictionaries, the International Dictionary of Medicine and Biology, and Lourie’s Medical Eponyms. Two dictionaries (Butterworth and Webster) correctly identified Bruno Fleischer (as bom in 1874), but neither included the date of his death.
Prenatal
sex
determination
SiR,—Dr Lo and colleagues (Dec 9, p 1363) examine peripheral blood samples from 19 pregnant women of various gestational ages. With amplification of a 149 bp fragment1 of a Y-specific repeat sequence, pHY10,2 of the DYZ1 family they detected a Y-specific signal in all 12 women who bore a male fetus but in none of 7 women who bore a female fetus. There are controversial results by two groups3,4 who used the same 149 bp fragment and failed to detect such a Y-specific signal, although a dual amplification system was not used. Some women seemed to show a positive signal when the 149 bp fragment was amplified.s Lo et al report 1 false-positive in a non-pregnant woman. A repeating unit of the DYZfamily consists of segments with autosomal homologies interspersed with different Y-specific segments.6 We have identified a Y-specific 1024 bp B segment within the pHY 10 fragment. On the other hand, a 323 bp E segment which spans the 149 bp segment proved not to be Y-specific and showed homology with autosomal sequences. The E segment was detected in 2 of 20 controls (unpublished). Lo et al examined only 3 female volunteers with their dual amplification technique. They attributed their false-positive result to contamination by male DNA. An alternative interpretation could be the presence of autosomal sequence(s) homologous to the 149 bp sequence on the
pHYlO. We believe that a larger number of female volunteers should be examined by the dual amplification technique before this method is used diagnostically, to avoid false-positive results. We are attempting to detect with the B segment a Y-specific signal in women who bear male fetuses. Department of Congenital Abnormalities Research, National Children’s Medical Research Centre,
Setagaya-ku, Tokyo, 154 Japan
1.
YASUO NAKAGOME SHIGEO NAGAFUCHI YUTAKA NAKAHORI
Kogan SC, Doherty M, Gitchier J. An improved method for prenatal diagnosis of genetic diseases by analysis of amplified DNA sequences. N Engl J Med 1987; 317:
985-90. 2. Nakahon Y, Mitani K, Yamada M, Nakagome Y. A human Y chromosome specific repeated DNA family (DYZ1) consists of a tandem array of pentanucleotides. Nucleic Acids Res 1986; 14: 7569-80
3. Adinolfi M, Camporese C, Carr T. Gene amplification to detect fetal nucleated cells in pregnant women Lancet 1989; ii: 328-29. 4. Schwinger E, Hillers M, Vosberg HP. No identification of Y-chromosomal DNA in blood from pregnant women bearing a male fetus? Am J Hunt Genet 1989; 45: A268. 5. Handyside AH, Pattinson JK, Penketh RJA, et al. Biopsy of human preimplantation embryos and sexing by DNA amplification. Lancet 1989; i: 347-49 6 Smith KD, Young KE, Talbot CC Jr, Schmeckpeper BJ. Repeated DNA of the human Y chromosome. Development 1987 (suppl): 77-92.
