Intravenous sclerosing solutions.
12 Jul 1930-BMJ (BMJ Group)-Vol. 2, Iss: 3627, pp 59-60
TL;DR: In those cases which I have indicatedabove where no changp takes place after injection the're is one infallible method of treatment, wihich is known as the " twin 1ijectioln."
Abstract: Late Loeal Ef#ects.-These conisist prinicipally of ecehymoses anid gangrene of the vein, and ulcer;, of these, the n-ot coelni_ a by far is t!e '' in jection ulcer,'' which is due ill illost cases to the lel)osition of tlhe solttioni in the tissues r,oun1d. tile veini. It is serious and painful, anrd four to six mlolnthis elapse before a c-ure is effected. No case of injectilon ulcer shiould ever occur; it is in all cases due to cairelessness ini tlhe administration of the injection. In. most cases the operator has entered the veill S1nCeVssfallv, bu:t in the courise of injection, througl a mionieiitarv unsteadiness or movement of the patielit, the veini has beeni penetrated and the so)luitioni deposited in tlie sutrro.ola(liiiig tissiues. Th-:is should niever happen if the precautiou of witlhdrawvhX:;g the pluniger of the syringe in nio-nents, of d-ou-bt has been observed. The last late local eNect is the complete thlromiibosis and grad(lal eliniination of the vein. This takes somie three to twelve inonltis to occur, tlle veini gradually becominig har(l ai(l cor-d-like to the touch. Over the boniy surfaces the process is slow, but in. the thigh it is mRuch quieker, and as a genieral rule it imiay be stated that th-e vein shauld be pxractically obliterated in twelve moniths' timle. There is. only one im-iportant late general effect-pulmonary embolism. This is a very rare occurrenice; in somei teai tlhousand cases treatedl at the Waterloo Hospital tbere lias so far beeii no record of such a sequel. Yet t1ere is a chance that this may occuLr, since there aire recor(ls in the miedical literature of maniy cases. In those cases which I have indicatedabove where no changp takes place after injection the're is one infallible method of treatment, wihich is known as the \" twin 1ijectioln.\" Tt is generally necess,ary to makie use of this when the veins are very lairge with extensive varicasity. The selected v-eini rec-eives simultaneous iinjeetions of 4 c(,Ill. cf lithiumii anid 2 c.cm. of quinine urethane solution, the sites of hj,ection being 3 to 5 inches apart. It is pos.sible to, do this -singie-handed by injecting the lithium first and ttLe quininimmediately afterwards, but in actual practice it is much moi-e satisf.actory to have assistance for one of the injections. The qutinin-e must never be injected first, because, if this is done, wh-lien the litlhium is being injected and the barrel of the syringe is beintg pulled out, there is a great likel-ihod of withd-awing some of the quinine from the vein, and this immnnediately causes clotting ini the syringe. This twini injection 'invariably caluses clottiiig, but it must, be emnphasized againi tllat it should not be eilul)loyed unless the veinis are veiry large. Othier solutioins have beeni tried by us., b-uit have been abandone-d for varioXs reasons. Pu're carbolic (9S per cent.) is a sticky solntion; it spoils the syringe, the dose of 1-3r is-difficult to assess owing to the stickiniess, and it cauises peirivenitis, anid, occasiaonally, haeni-aturia. Alcolhol (50-100 per cent.) in a dose of 1-5 nt is too, painful. Socliumiii citrate (20-50 per cenit.) has been given in doses of 0.5 to 4 c.ci., buit the results proved unreliable. Sodium salicylate (20-S5 per cent.) in a dose of 1-4 nl was also -unreliable; about 60 per cent. of results are good if this solu:ition is used exclusively. In a nutimber of hospital cases there is severe varicose vein ulceration. If the ulcer is very large the limnb slhould always be x-rayed in orderto deterniino wulheth1el or not there is any periostitis. Should the bo-ne be invol-e(l the ulcer will naturally take longer to heal under treatmenit. In all cases a Wlassermiann test should be performed. Trcatm ci t of Var icose Ulcer. If n1o -eins aIre visible ULTnna's paste bandage should be applied onice a week. Whhere veins are presenit they slhoul le injected weeklyi-n additioni to the use of the bandage. In severe cases the base of the ulcer should be injected witlh quiniilne urethanle. Two sites are selected an(l into each 2-5pnl of quinine is. injected at an oblique angle, the one frolm above the atlher fromi belo.w. In this way a sihall \" island \" of the ulcer is cut off anid heals,; our metlhod i-s to attack and heal a series of \" islands \" unitil the entire surface of the ulcer is. healed. I-n very smlall ulcers 2per cen1t. tannlic acid solutionl on lint is applied to thle part every fourl hours. This forms a crust over the sulrface of thle ullcer aiid stimlulates hlealinlg under the crust. The treatmnent of an \" injection nlcer '> isas follows. For the first few days hot forentations are applied. They are followed by pure hydrogen peroxide, and theni by the application of calamiine lotion. These ulceirs are very painlful, and the patieiit should be warnied that a cure wvill not occur in less than three to six moniths. The contraindicatioiis to treatmenit aie five in ntumber. (1) Pregnancy; the veins will probably disappear after confinement, and treatment should never be given during pr egO,aIse1Nv. (2) Deep thrombosis. (3) Acute seplti( thromllbo-phlebitis; at least three iiionths mullst be allowed to elapse from the time that all iniflanasnatioii lhas disappeared before treatmenit is attempted. (4) Advanced heart, lun-1g, or kidiiney disease; diabetes; and high blood pressure. (5) If the var icose veini ulcer is very septic it is advisable to clean it up first before injectioni treatment is attempted. We have found fromi experieniee that the following rules ar-e highly imiportanit, if a satisfactory result is to be obtained in. the treatmenit of varlicoseveinls by this mllethod.
TL;DR: White bodies form when platelets rapidly form a haemostatic plug outside the vessel and others adhere to its endothelial lining at the site of injury to form platelet clumps or ‘white bodies’ which embolize intermittently in the blood stream.
Abstract: WHEN an artery of the cerebral cortex of an anaesthetized rabbit is pinched with a pair of fine forceps so that it bleeds briefly, some platelets rapidly form a haemostatic plug outside the vessel and others adhere to its endothelial lining at the site of injury to form platelet clumps or ‘white bodies’ which embolize intermittently in the blood stream. The formation and embolization of white bodies may go on for several hours1–3.
TL;DR: In this paper, an geographisch und milieumasig geeignetem Material gezeigt, das in Sudosteuropa in landlichen Gebieten keine penicillinresistenten Staphylokokken vorkommen, and das dagegen in Grosstadten, vor allem im Krankenhausmilieu dieselben hohen Prozentsatze zu finden sind, wie sie von englischen Autoren fur die dortigen ents
Abstract: Es wird an geographisch und milieumasig geeignetem Material gezeigt, das in Sudosteuropa in landlichen Gebieten keine penicillinresistenten Staphylokokken vorkommen, das dagegen in Grosstadten, vor allem im Krankenhausmilieu dieselben hohen Prozentsatze zu finden sind, wie sie von englischen Autoren fur die dortigen entsprechenden Verhaltnisse gefunden wurden. Ebenso wird eine eingehende Analyse der resistenten Mikrokokken aus denselben Gegenden und Verhaltnissen gebracht. Es zeigt sich, das die Verteilung der resistenten Stamme ganz anders ist, als bei den Staphylokokken. Die Grunde dafur werden untersucht.
TL;DR: None of the studies published since 1965 have provided convincing evidence that beta blockers are useful following myocardial infarction, and the analysis of several of the published trials has been made difficult by a lack of data.
Abstract: In 1965 Snow reported a clinical trial in which treatment with propranolol significantly reduced mortality following myocardial infarction. Unfortunately the design of this trial was inadequate by modern standards, and the results must be discounted. None of the studies published since then have provided convincing evidence that beta blockers are useful following myocardial infarction. Survival after a myocardial infarction depends principally upon the amount of heart muscle that has been destroyed, and it is probably unreasonable to expect any treatment to reduce mortality by more than 20 or 30 %. In patients who survive an infarction for more than 48 hours, the expected fatality rate in the next year is approximately 15 %. To detect a reduction of this mortality to 10%, 2300 patients would be needed in the trial. The analysis of several of the published trials has been made difficult by a lack of data, the failure on the part of authors and journal editors to agree on a common method of presenting results, and disagreement as to whether results should be analysed on an «all patients – intention to treat» basis or by considering only «clinical effectiveness» among patients who remained on treatment. Examples of these problems will be given, together with a suggested scheme for data presentation. The 95 % confidence intervals of all the randomised and double blind studies of beta blockers after myocardial infarction show that by «intention to treat» analysis, none demonstrate a statistically significant reduction in mortality among treated patients. Only the practolol trial was of a reasonable size, but even here total mortality was not significantly reduced; the result is in any case of only theoretical interest. The trials showing a reduction of mortality in association with alprenolol treatment are not convincing, and the stratified trial design of one of these may have given misleading results because of the relatively small number of patients involved.
TL;DR: It is concluded that a protective effect on sudden death in myocardial infarction survivors is related to beta-blockade, and high dose oxprenolol treatment might be deleterious to some patients with more enhanced coronary heart disease.
Abstract: The European Infarction Study (EIS) was a multicentre, double-blind, randomized study comparing the effect on survival, cardiac mortality and non-fatal cardiac events of oxprenolol slow release 160 mg b.i.d. with placebo in 1741 patients aged 35 to 69 years surviving acute myocardial infarction. During the one year follow-up there was a 30% difference in the cumulative mortality rate in favor of placebo. In the oxprenolol group the mortality was noted to be higher in patients who were 65–69 years of age. In general, there was a higher incidence of fatal reinfarctions and of sudden death in those, who discontinued study medication.