1364 in the groups with and without
postoperative pulmonary com-
PROLACTIN RISE AFTER FALL IN BLOOD-PRESSURE
plications. We believe that atelectasis is a gradual continuous process secondary to peroperative and postoperative factors affecting the ratio of closing volume to functional residual capacity of the lung. When "microatelectases" develop to a certain point they can be demonstrated by X-ray. This view is only partly in accord with your editorial (Nov. 5, p. 965); postoperative accumulation of sputum in the bronchioli is a common yet different cause of postoperative atelectasis. Department of Anaesthesia, Gentofte Hospital, DK 2900 Hellerup, Denmark
Department of Anæsthesia,
Rigshospitalet, Copenhagen
BENT HUSUM ERIK JACOBSEN
POLYGLYCOLIC ACID SUTURES
SIR,-The
trial of wound closure with silk or polyglycolic (P.G.A.) sutures reported from the Luton and Dunstable Hospital (Dec. 10, p. 1216) demonstrates that P.G.A. is superior to silk for skin closure. But before we all rush to change to acid
should wait for the results of a trial comparwith synthetic suture materials because silk is more irritant to the tissues than are synthetics such as polyamides, polyesters, and polyolefins.l.2 P.G.A. sutures we
ing
P.G.A.
Bridgend General Hospital, Bridgend, Mid Glamorgan
A. W. FOWLER
SIR,-Dr Gawel (Oct. 15, p. 281) reported that plasma-prolactin rises after the fall in blood-pressure induced by adrenaline. We report here that when blood-pressure in hypertensive patients falls after an intravenous injection of clonidine, prolactin rises at the same time. Neurotransmitters are known to control the secretion of hypothalamic-anterior pituitary hormones.’ We have recently reported that intravenous clonidine increases the plasma-thyroid-stimulating hormone in hypertensive patients.2 In subjects with normal blood-pressure, clonidine produced no changes.3-4 Thyroid-stimulating-hormone does not seem to be raised by direct stimulation of ot-adrenoceptors within the hypothalamus but by an adaptive response to hypotension since the hypotensive drug diazoxide, which acts exclusively by a peripheral myolytic mechanism,5has a similar effect. We found that in four patients (two males, two females; mean age 46.5 years) with essential hypertension without Müller, E. E., Nistico’, G., Scapagnini, U. Neurotransmitters and Anterior Pituitary Function. New York, 1977. 2. Pata, P., Ciolino, F., Trimarchi, F., Consolo, F., Rotiroti, D., Bronzetti, B., Nistico’, G. Unpublished. 3. Lal, S., Tolis, G., Martin, J. B., Brown, G. M., Guyda, A. J. clin. Endocr. Metab. 1975, 41, 827. 4. Ferrari, C., Beck-Peccoz, P., Paracchi, A., Rondena, M., Ambrosi, B., Travaglini, P., Spada, A., Faglia, G. in XVI Congress Ital. Soc. Endocr. p. 103.Bari, 1976. 5. Meyers, F. H., Jawetz, E., Goldfien, A. Review of Medical Pharmacology. Los Altos, 1976. 6. Nistico’, G., Preziosi, P. Int. J. clin. Pharmac. 1977, 15, 23. 1.
LEGIONNAIRES’ DISEASE IN LONDON
S!R,—Your editorial of Dec. 17 draws attention to legionnaires’ disease as a cause of severe pneumonia not responding to standard antibiotics. We report here the first case occurring in London. A 45-year-old Scottish alcoholic man was admitted on Nov. 20, 1977, with a 5-day history of a "flu-like" illness. He had continued to work up until the day of admission. On clinical and radiological examination there was evidence of severe bilateral pneumonia, and, despite treatment with penicillin, flucloxacillin, ampicillin, gentamicin, metronidazole, and intermittent positive-pressure ventilation, he deteriorated. Legionnaires’ disease was suspected on the fifth day. Bloodsamples taken on the third and sixth day gave fluorescent antibody titre against legionnaires’ bacillus of 1/512 and 1/4096, respectively (Center for Disease Control, Atlanta, Georgia). Erythromycin was started on the fifth day but the patient died 3 days later. Alcoholism and ischsemic heart-disease contributed to the fatal outcome. The only reports of legionnaires’ disease contracted in England so far have come from Nottingham (Dec. 10, p. 1225). Our patient had not been abroad recently and had come to London from Scotland 5 weeks before presentation. As the incubation period is thought to be less than a week, it is likely that this patient acquired legionnaires’ disease in London. We therefore believe that other cases of this disease may be occurring in South-East England. This case will be reported in greater detail elsewhere. We thank Prof. A. F. Lant for permission to report the case.
Departments of Medicine and Therapeutics and Clinical Microbiology, Westminster Medical School, St Stephen’s Hospital, London SW10 9TH
1. 2.
R. F. U. ASHFORD M. E. EDMONDS D. C. SHANSON
Dettinger, G. B., Bowers, W. F. Surgery, 1957, 42, 325. Britt, C. I., Miller, E. M., Felder, M. E., Sirak, H. D. Ann. Surg. 1961, 153, 52.
Effect of intravenous injection of clonidine on systolic and diastolic blood pressure and plasma-prolactin in hypertensive
patients. Mean values and
from baseline (P
postoperative pulmonary com-
PROLACTIN RISE AFTER FALL IN BLOOD-PRESSURE
plications. We believe that atelectasis is a gradual continuous process secondary to peroperative and postoperative factors affecting the ratio of closing volume to functional residual capacity of the lung. When "microatelectases" develop to a certain point they can be demonstrated by X-ray. This view is only partly in accord with your editorial (Nov. 5, p. 965); postoperative accumulation of sputum in the bronchioli is a common yet different cause of postoperative atelectasis. Department of Anaesthesia, Gentofte Hospital, DK 2900 Hellerup, Denmark
Department of Anæsthesia,
Rigshospitalet, Copenhagen
BENT HUSUM ERIK JACOBSEN
POLYGLYCOLIC ACID SUTURES
SIR,-The
trial of wound closure with silk or polyglycolic (P.G.A.) sutures reported from the Luton and Dunstable Hospital (Dec. 10, p. 1216) demonstrates that P.G.A. is superior to silk for skin closure. But before we all rush to change to acid
should wait for the results of a trial comparwith synthetic suture materials because silk is more irritant to the tissues than are synthetics such as polyamides, polyesters, and polyolefins.l.2 P.G.A. sutures we
ing
P.G.A.
Bridgend General Hospital, Bridgend, Mid Glamorgan
A. W. FOWLER
SIR,-Dr Gawel (Oct. 15, p. 281) reported that plasma-prolactin rises after the fall in blood-pressure induced by adrenaline. We report here that when blood-pressure in hypertensive patients falls after an intravenous injection of clonidine, prolactin rises at the same time. Neurotransmitters are known to control the secretion of hypothalamic-anterior pituitary hormones.’ We have recently reported that intravenous clonidine increases the plasma-thyroid-stimulating hormone in hypertensive patients.2 In subjects with normal blood-pressure, clonidine produced no changes.3-4 Thyroid-stimulating-hormone does not seem to be raised by direct stimulation of ot-adrenoceptors within the hypothalamus but by an adaptive response to hypotension since the hypotensive drug diazoxide, which acts exclusively by a peripheral myolytic mechanism,5has a similar effect. We found that in four patients (two males, two females; mean age 46.5 years) with essential hypertension without Müller, E. E., Nistico’, G., Scapagnini, U. Neurotransmitters and Anterior Pituitary Function. New York, 1977. 2. Pata, P., Ciolino, F., Trimarchi, F., Consolo, F., Rotiroti, D., Bronzetti, B., Nistico’, G. Unpublished. 3. Lal, S., Tolis, G., Martin, J. B., Brown, G. M., Guyda, A. J. clin. Endocr. Metab. 1975, 41, 827. 4. Ferrari, C., Beck-Peccoz, P., Paracchi, A., Rondena, M., Ambrosi, B., Travaglini, P., Spada, A., Faglia, G. in XVI Congress Ital. Soc. Endocr. p. 103.Bari, 1976. 5. Meyers, F. H., Jawetz, E., Goldfien, A. Review of Medical Pharmacology. Los Altos, 1976. 6. Nistico’, G., Preziosi, P. Int. J. clin. Pharmac. 1977, 15, 23. 1.
LEGIONNAIRES’ DISEASE IN LONDON
S!R,—Your editorial of Dec. 17 draws attention to legionnaires’ disease as a cause of severe pneumonia not responding to standard antibiotics. We report here the first case occurring in London. A 45-year-old Scottish alcoholic man was admitted on Nov. 20, 1977, with a 5-day history of a "flu-like" illness. He had continued to work up until the day of admission. On clinical and radiological examination there was evidence of severe bilateral pneumonia, and, despite treatment with penicillin, flucloxacillin, ampicillin, gentamicin, metronidazole, and intermittent positive-pressure ventilation, he deteriorated. Legionnaires’ disease was suspected on the fifth day. Bloodsamples taken on the third and sixth day gave fluorescent antibody titre against legionnaires’ bacillus of 1/512 and 1/4096, respectively (Center for Disease Control, Atlanta, Georgia). Erythromycin was started on the fifth day but the patient died 3 days later. Alcoholism and ischsemic heart-disease contributed to the fatal outcome. The only reports of legionnaires’ disease contracted in England so far have come from Nottingham (Dec. 10, p. 1225). Our patient had not been abroad recently and had come to London from Scotland 5 weeks before presentation. As the incubation period is thought to be less than a week, it is likely that this patient acquired legionnaires’ disease in London. We therefore believe that other cases of this disease may be occurring in South-East England. This case will be reported in greater detail elsewhere. We thank Prof. A. F. Lant for permission to report the case.
Departments of Medicine and Therapeutics and Clinical Microbiology, Westminster Medical School, St Stephen’s Hospital, London SW10 9TH
1. 2.
R. F. U. ASHFORD M. E. EDMONDS D. C. SHANSON
Dettinger, G. B., Bowers, W. F. Surgery, 1957, 42, 325. Britt, C. I., Miller, E. M., Felder, M. E., Sirak, H. D. Ann. Surg. 1961, 153, 52.
Effect of intravenous injection of clonidine on systolic and diastolic blood pressure and plasma-prolactin in hypertensive
patients. Mean values and
from baseline (P
