GLUCAGON IN DIPHTHERITIC MYOCARDITIS

GLUCAGON IN DIPHTHERITIC MYOCARDITIS

322 ment, but you, Sir, are well placed to insist on the vital connection between hostels and jobs. Unless the Depart ment of Employment and Productiv...

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322 ment, but you, Sir, are well placed to insist on the vital connection between hostels and jobs. Unless the Depart ment of Employment and Productivity wakes up to its duty here, we are going to find ourselves with a large group of expensively educated but frustrated people. The Old House, Englefield Green,

Surrey.

IRIS CAWLEY, Chairman, Slough Society for Menally Handicapped Children.

UNSATURATED FAT AND CANCER SIR,-My attention was arrested by the observation of Professor Pearce and Dr. Dayton1 that a diet high in unsaturated fatty acids was associated with an increased incidence of malignant disease in human beings. I was reminded of a paper by Lane et awl. showing that subcutaneous injection of lard or vegetable oil browned by heating caused the growth of malignant tumours in rats, and of a report by Sugai et awl. that the feeding of polyunsaturated vegetable oil together with unheated vegetable oil increased the incidence of malignant tumours in rats exposed to 2-acetylaminofluorene. It would be interesting to know to what extent the polyunsaturated fats fed to the men reported in the investigation by Pearce and Dayton were used for frying-particularly deep frying, when the fat is often re-used a number of times. Canadian Forces Institute of Environmental Medicine, Toronto 305, Ontario, Canada.

P. D. NEWBERRY.

GLUCAGON IN DIPHTHERITIC MYOCARDITIS SiR,-Glucagon has been shown to have an inotropic and chronotropic action on the heart, and to enhance atrioventricular conduction velocity without increasing ventricular automaticity. 4-6 It has been used with good results, and without serious side-effects, in patients with congestive heart-failure. 7-9 This drug has been evaluated clinically at this hospital in five children with diphtheritic myocarditis and severe congestive heart-failure. In each case the diagnosis was based on a history of diphtheria with positive throat cultures, and significant electrocardiographic abnormalities -namely, left bundle-branch block in two, right bundlebranch block in one, supraventricular tachycardia with ischxmic changes and low voltage in one, and ventricular tachycardia in one. In addition, all the patients had other clinical signs of myocarditis and severe congestive heartfailure. The ages were 5-7 years. The patients were all placed on a cardiac monitor, and blood-pressure and respiratory rate were recorded every hour. Three patients had previously received digitalis. The glucagon solutions (Eli Lilly & Co.) were freshly prepared and used within one hour. The dosage of glucagon was 1 mg. initially, followed by 0-5-1-5 mg. per hour intravenously in 5% dextrose in water with added potassium chloride. Serum glucose, sodium, potassium, and chloride were determined initially, and repeated at 8-12-hourly intervals. The infusion of glucagon was continued for 8-48 hours. Nausea and vomiting were frequently observed after the initial dose, but these were controlled by reducing the 1. 2. 3.

4. 5. 6. 7. 8. 9.

rate

of infusion.

Pearce, M. L., Dayton, S. Lancet, 1971, i, 464. Lane, A., Blickenstaff, D., Ivy, A. C. Cancer, 1950, 3, 1044. Sugai, M., Witting, L. A., Tsuchiyama, H., Kummerow, F. A. Cancer Res. 1962, 22, 510. Glick, G., Parmley, W. W., Wechsler, A. S., Sonnenblick, E. H. Circulation Res. 1968, 22, 789. Lucches, B. R. ibid. p. 777. Steiner, C., Wit, A., Damato, A. N. ibid. 1969, 24, 167. Vander, C. R., Reynolds, E. W. Am. Heart J. 1970, 79, 481. Brogan, E., Kozonis, M. C., Overy, D. C. Lancet, 1969, i, 482. Wilcken, D. E. L., Lvoff, R. ibid. 1970, i, 1315.

In general, except for an increase in the pulse-rate and slight improvement of the pulse quality, no other changes There were no substantial changes in the were noted. blood-pressure, and the congestive heart-failure did not significantly improve as judged by the size of the liver and patient’s general condition. In one case, the central venous pressure before administration of glucagon was 29 cm. of water; 18 hours later, after 20 mg. of the drug, it was 23 cm. The liver size and the general condition were unchanged. There were no significant changes in the serum-electrolytes. None of the patients survived. They gradually deteriorated and died 8-56 hours after admission. Necropsy was performed in three cases, and the findings were consistent with diphtheritic myocarditis. It is well known that diphtheritic myocarditis, particularly when associated with heart-block, carries an extremely poor prognosis. 10-12 Experience at this institution 13 has shown that, despite vigorous medical treatment, including steroids and digitalis, the mortality-rate is very high. The failure of glucagon to produce clinical improvement in this series probably reflects the extensive myocardial and conduction-system damage present in these patients. Ahari Children’s Hospital Medical Center,

Tehran,

Iran.

IRAJ ARYANPUR.

HEPATIC BLOOD-FLOW IN CIRRHOSIS SiR,-We have measured hepatic blood-flow in 26 normal individuals and 78 patients with cirrhosis, of whom 26 had previously had operations for portal-systemic anastomosis. We used the method of Halpern et al.,14 with colloidal heat-denatured human serum albumin labelled with 1311. The following results were obtained:

The hepatic blood-flow was significantly reduced in the cirrhosis patients, and those with shunts had a still greater reduction. There were no significant sex differences except in the normal group. There were no significant differences in blood-flow between patients with end-to-side anastomosis and those with side-to-side or splenorenal shunts. The blood-flow was measured again a year later in 31 of the patients with cirrhosis (15 shunted, 16 unshunted) and was found to be unchanged. The results in 9 patients who died in the year after the first test were not significantly different from those of the other patients. A very high inverse correlation was found between 45-minute bromsulphthalein retention (?< 0-001), and a lesser correlation (p < 0-05) with conjugated bilirubin, gamma-globulins, and A direct correlation was observed with albumin age. (P<0-01), prothrombin-time, and total proteins (P<0-05). The following were not correlated with hepatic blood-flow: blood urea nitrogen, glucose, unconjugated bilirubin, alkaline phosphatase, serum glutamic oxaloacetic and glutamicpyruvic transaminase, alphal} alpha2, and beta globulin, heematocrit, arterial pressure, and pulse-rate. Ospedale Maggiore di Milano, Ospedale Policlinico, and Institute of Medical Pathology, University of Milan,

Italy.

P. F. CROSTI C. A. GIOVANNELLI U. BARDI P. L. VIGO.

Boyer, N. H. Weinstein, L. New Engl. J. Med. 1948, 239, 913. Begg, N. Lancet, 1937, i, 856. Claman, H. N. Am. J. Cardiol. 1962, 9, 790. Aryanpur, I., Roohie, P., Raafat, F., Aghighi, Y., Moazzami, R. Paper to be presented at 13th International Congress of Pediatrics, Vienna, September, 1971. 14. Halpern, B., Biozzi, G., Benacerraf, B., Stiffel, C., Hillemand, B. C.r. Séanc. Soc. Biol., Paris, 1956, 150, 1307. 10. 11. 12. 13.