Upload
tranngoc
View
216
Download
0
Embed Size (px)
Citation preview
504
erytheinato-papular rash, mainly over trunk and face,in his 2 cases.The 125 cases of lymphocytic meningo-encephalitis
reported by Lyle (1956b) were similar to our cases, inparticular in C.S.F. findings. 48 of his patients, however,had acute and severe myalagia ; and though only 24had much neck stiffness, 68 had neurological abnormalitiesnot encountered in our series. Some of Lyle’s cases alsohad hepatitis or abnormal liver-function tests. The diseaseas seen by us did not usually conform to McAlpine’s(1947) criteria of encephalitis (nystagmus, photophobia,and neck stiffness after fever and headache), as did thecases described by Lyle.
Our series bears most resemblance to 24 cases described
by Karzon et al. (1956) in the U.S.A., which was called" seasonal aseptic meningitis." The causal agent isolatedfrom Karzon’s patients was Echo virus strain 6. Onsetin July, household aggregation, and age-incidence wereall similar to those observed here. The preponderanceof males and the short duration of the epidemic describedby Karzon might be accounted for by the localisedoutbreak in a closed community.There is little similarity between the condition described
here and the outbreak at the Royal Free Hospital in 1955.
Summary and Conclusions100 patients suffering from an aseptic meningitis were
admitted to the Leicester Isolation Hospital betweenJuly 4 and Nov. 23, 1956. The main clinical featuresof the disease were acute onset, headache, pyrexia,vomiting, neck and back rigidity, and occasionally arubelliform rash and photophobia. A predominantlylymphocytic pleocytosis was found in the c.s.F. of mostpatients. Adenopathy was not a feature of the disease.All patients recovered without specific treatment, andwith no serious sequelae. A cytopathogenic virus relatedto Echo virus type 9 was isolated from feces, C.S.F.,and throat swabs in several cases. It is concluded thatthis essentially benign disease is probably not identicalwith Lyle’s lymphocytic meningo-encephalitis, but showsclinical similarity with cases described by Karzon andby Dodd.
ADDENDUM
Since the present survey was concluded, more cases ofM.v.o., some of increased severity, have been admitted tothis hospital. Monthly incidence is on the decline.
I wish to thank Dr. J. C. H. Mackenzie, consultant andphysician-superintendent, for permission to publish this
paper and for his helpful criticism ; Dr. N. S. Mair and Dr.H. J. Mair for help and advice on virology : and Dr. J. P.Anderson and Dr. J. R. Barton for the use of some of theircase-notes.
BIBLIOGRAPHY
Boissard, G. P. B., Stokes, L. J., Macrae, A. D., MacCallum, F. O.(1957) Lancet, i, 500.
Dodd, W. (1956) Cited in Ibid, 1956, ii, 947.Eastwood, N. B. (1956) Practitioner, 177, 39.Hesling, G. (1956) Lancet, ii, 993.Karzon, O. T., Barron, A. L., Winkelstein, W. jun., Cohen, S.
(1956) J. Amer. med. Ass. 162, 1298.Kelly, F. E. B. (1956) Practitioner, 177, 39.Lancet (1956) ii, 838.Lyle, W. H. (1956a) Ibid, p. 1042.
— (1956b) Ibid, p. 1158.McAlpine, O. (1947) Proc. R. Soc. Med. 40, 929.Pickles, W. N. (1956) Lancet, ii, 1046.
"... Would any one of us, taken with a grievous illness farfrom home, care to be nursed by a keen diagnostician, anamateur microscopist or an earnest student of pathology ?What we want is a nurse who loves nursing, and the sicker weare the more we long for someone who can combine wife, sisterand mother rather than an efficient technician, however wellintentioned. Knowledge of sick people is gained by being withsick people and though this knowledge once acquired can begreatly enhanced by book learning, that learning itself cannot be a substitute for the bedside experience. The fine artsof nursing are only unimposing to those who have neverthemselves been gravely ill."-Dr. JOHN ZERNY and Dr.HUMPHRY OSMOND, Canad. 7red. Ass. J. 1956, 752, 75.
METABOLIC EFFECTS OF CARBUTAMIDE
IN SELECTED DIABETICS
P. A. BASTENIEM.D. Brussels
PROFESSOR OF CLINICAL MEDICINE
R. DE MEUTTERM.D. Brussels
ASSISTANT
V. CONARDM.D. Brussels
SENIOR ASSISTANT
J. R. M. FRANCKSONM.D. Brussels
ASSISTANT
T. C. DEMANETM.D. Brussels
ASSISTANT
From the University Department of Medicine, St. Pierre Hospital,Brussels
THE mechanism whereby certain sulphonamides exerta hypoglycsemic and (in certain diabetics) an anti.diabetic effect remains a matter of debate.The following explanations have been suggested:
inhibition or destruction of glucagon-secreting a cells(Franke and Fuchs 1955, Mellinghoff 1955, YouHolt et al. 1955, Ferner and Runge 1956) ; insulinsparing action (Kinsell et al. 1956, Mohnicke 1956);inhibition of insulinase (Mirsky 1956, Mirsky et al. 1956);increased production of insulin (Gepts et al. 1955,1956, Loubatieres 1955, Ashworth and Haist 1956);depression of gluconeogenesis by a direct effect on thepituitary gland and the adrenal cortex ; and increasedpermeability of the cells to glucose, possibly due torelease of an inhibitor of hexokinase (Best 1956).
Although none of these hypotheses has been proved,in-vitro experiments have shown that hypoglycsemicdrugs reduce the activity of certain enzyme systems inthe liver (Clarke et al. 1956, Hawkins et al. 1956,Mohnicke and Knitsch 1956).Many diabetics have already been treated with oral
sulphonamide, but the results show that sulphonamideis isno substitute for insulin and is only effective in "thosesubjects who possess a source of appreciable amounts ofendogenous insulin
" (Wrenshall and Best 1956).Only a few clinical studies concerned with metabolic
investigations have been published. We report heresuch studies made on diabetics treated with carbutamideB.Z.55 ’).
Material
18 patients were kept in hospital for a few weeks on a
Fig. 1-.Intravenous glucose-tolerancecurve in healthy people : a, mean ofobserved values ; b, semilogarithmicline derived from a.
1500-calorie diet
(carbohydrates180 g., fats 50 g.,and proteins 80 g.),Afterwards theywere under ambula-tory control with aslightly more liberaldiet. Gross over-weight was reducedbefore the start oftreatment. Duringthe treatment the
patients maintainedtheir weight. After1-3 months’ treat,ment the patientswere readmitted forcontrol metabolicstudies.
16 of these pati-ents, aged 42-82,had diabetes of themiddle-age onset
type ; they had or