PREMEDICATION FOR GASTROINTESTINAL ENDOSCOPY

PREMEDICATION FOR GASTROINTESTINAL ENDOSCOPY

270 and a Y, thus excluding any possibility that the dividing The result of sexcells were maternal lymphocytes. chromatin counts also determined that ...

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270 and a Y, thus excluding any possibility that the dividing The result of sexcells were maternal lymphocytes. chromatin counts also determined that the fetus was male. On restudying previous sex-chromatin preparations, we found one division in another case, but this was of pool quality and we could not identify individual chromosomes. We are at present using various techniques in an attempt to accumulate divisions from uncultured amniotic fluid cells. A prenatal diagnosis obtained in this way would obviously provide a quick result and have the added advantage of eliminating problems encountered during culture. Area Cytogenetic Unit, St. Ebba’s Hospital, SARAH QUAYLE Hook Road, R. G. CHITHAM. Epsom, Surrey. Kingston Hospital, IAN CRAFT. Kingston, Surrey.

(Jan. 21, p. 203) that caution is needed in the application of the technique we described (Dec. 11, p. 1319) of obtaining karyotypes without culture. However, we have now successfully obtained further karyotypes directly from amniotic cells in SIR,-We

agree with Dr. Hamerton

of 3 fresh samples. Mitoses were found in all three (4, 5, and 286 metaphases per sample respectively). 2 of the 3 cases yielded a clear male karyotype, leaving no doubt we were dealing with fetal chromosomes. The karyotype in one of these was confirmed by cell culture of fetal tissue after abortion (the mother was a certain carrier of the gene for X-linked muscular dystrophy) and of the 2

further study of peptic-ulcer therapy under endo30 patients each had 4 endoscopic examinacontrol, scopic tions during a period of four months. No patient failed to attend for follow-up endoscopy, although 4 other patients In

a

failed to complete the study for other reasons. We feel that such a high degree of patient acceptability of endoscopy, and its favourable comparison with two wellestablished routine procedures, is due mainly to the degree of amnesia induced by the premedication with diazepam. Department of Medicine, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW.

P. BROWN P. R. SALMON A. E. READ.

ANCROD VERSUS HEPARIN IN TREATMENT OF DEEP-VEIN THROMBOSIS Dr. J. A. DAVIES and his colleagues write: " We regret we omitted to acknowledge in our paper (Jan. 15, p. 113) the generous financial support given to one of us (J. A. D.) by Kabi Pharmaceuticals (G.B.) Ltd. and the provision of ancrod and the perfusion pumps by T.C.L. (Park Royal) Ltd. Without this help, this trial would have been impossible."

out

cases

other We

by culture of amniotic cells. are indebted to the Obstetric Department of St.

Hospital

for

supplying the

amniotic

Thomas’s

Cytogenetics Unit,

D. T. HUGHES ELIZABETH RINK.

PREMEDICATION FOR GASTROINTESTINAL ENDOSCOPY SIR,-We agree with the conclusion of Dr. Ludlam and Dr. Bennett (Dec. 25, p. 1397) that diazepam is a safe and suitable premedication for gastrointestinal endoscopy. Its short duration of action makes it especially suitable for

outpatient endoscopy,

an

important consideration, since,

in a recent series of 200 consecutive examinations of the duodenal bulb, 134 (67%) were carried out as an out-

patient.I We prefer to give diazepam as an undiluted solution intravenously at a rate of 2-5 mg. (0-5 ml.) every 30 seconds until ptosis or dysarthria develops. It should be stressed that after intravenous diazepam patients should be advised not to

likely

drive for the rest of that be impaired.

day,

as

their

judgment is

to

In our own series,l patient acceptability was assessed by postal questionary in 50 patients, who were asked in addition to compare any experiences they may have had of fibre-optic duodenoscopy with barium meal and with gastric-function studies. Of 40 replies, only 1 patient found the examination painful, and he was the single patient who would not have been willing to have the examination repeated. Patients’ comparative impressions of duodenoscopy with a

other examinations

1. 2.

Vasectomy Bill The National Health Service (Family Planning) AmendBill was given a second reading in the House of Commons on Jan. 21. Introducing the Bill, Mr. PHILLIP WHITEHEAD said that it sought to amend the Act by including vasectomy among the local authorities’ family-planningclinic and domiciliary services; the local health authority would be empowered, subject to the approval of the Minister, to recover such charges as were considered reasonable for the vasectomy counselling and operation, having regard to the means of the patient. The problem of overpopulation was one reason why the Government should support all kinds of family planning, and it was to be hoped that the day would soon come when all family-planning services would be provided free on the National Health Service. Vasectomy was cheap, simple, and, properly carried out and checked, 100% reliable. In 1969 about 20,000 women were sterilised, as opposed to about 2000 men, although female sterilisation required a stay in hospital and an internal operation, and was more expensive and carried a greater risk than vasectomy. Psychiatric counselling was, however, essential for those considering vasectomy, and the Family Planning Association, with 17 clinics for vasectomy operations, which would be largely integrated with the local-authority family-planning service if the Bill became law, was scrupulously careful in screening its cases. All applicants were told that the operation must be considered irreversible, and both husband and wife, and the general practitioner, had to sign the consent form. The total fee charged by the Family Planning Association was E15.50, while private surgeons charged anything from E30 to E70 for those who could afford to avoid the waiting-list, which was now considerable. Vasectomy on the National Health Service was being turned down even in cases where really serious medical or social grounds existed for the operation; it was astonishing that vasectomy was not included among local-authority family-planning facilities. The central issue of principle raised by the Bill was whether vasectomy should be supported as a form of birth control as well as a preventive operation carried out where there might be threat to life. No F.P.A. clinic would counsel vasectomy for a single man or for one enmeshed in a troubled or unstable relationship, but for the couple who regarded their family as completed, vasectomy could be as ment

specimens.

Morbid Anatomy Department, and M.R.C. Clinical Genetics Research Unit, Institute of Child Health, London W.C.1.

Parliament

were:

Salmon, P. R., Brown, P., Htut, T., Read, A. E. Gut (in the press). Main, D. M. G. in Diazepam in Anæsthesia. Bristol, 1967.