Source PDF Research Articles

PHONOCARDIOGRAPHY IN ACYANOTIC CONGENITAL HEART DISEASE

The phonocardiographic data in 210 cases of acyanotic congenital heart disease were studied, with particular reference to correlation of phonocardiograms with auscultatory findings noted at the bedside and with physiologic data (such as blood pressure and flow) obtained by cardiac catheterization or during surgical procedures. Examples of a wide variety of lesions are presented and discussed. Congenital cardiac lesions are manifested by certain characteristic murmurs and sounds which are modified in a predictable manner by the physiologic disturbances secondary to the cardiac defect (such as pulmonary hypertension of varying degrees). Although the lesions often can be diagnosed by auscultation alone, the correlations in this study indicate that phonocardiography is more precise than the ear in gauging the degree of the secondary disturbances. [See Fig. in Source Pdf.] As shown by representative tracings included in this report, phonocardiography records fine changes in the timing, configuration, duration, intensity and localization of cardiac sounds and murmurs which cannot always be detected by auscultation. The use of phonocardiography as an adjunct to auscultation results in more accurate assessment of the lesions of congenital heart disease and a greater understanding of the associated physiologic changes. This ultimately leads to a more rational basis for decisions which the physician must make regarding definitive treatment. With experience in correlating auscultatory and phonocardiographic findings, the physician often can improve his auscultatory accuracy but he can never equal the refinement of a good graphic recording.

CALORIC AND PROTEIN INTAKES OF CHILDREN BETWEEN 1 AND 18 YEARS OF AGE

CALORIC AND PROTEIN INTAKES OF CHILDREN BETWEEN 1 AND 18 YEARS OF AGE

TECHNIQUE FOR INSERTION OF PLASTIC CATHETER INTO SAPHENOUS VEIN

FOR THE sure delivery of fluid into the blood stream of a patient, it sometimes becomes necessary to place a plastic tube in a selected vein. This procedure can be accomplished by anyone who possesses a moderate knowledge of anatomy and sterile technique and is familiar with the apparatus involved. In infants and obese children the isolation and catheterization of a suitable vein is more difficult.[See FIG. 1., FIG. 2. in Source PDF] On most pediatric services it is the responsibility of the pediatric resident staff to perform such "cutdown" procedures, when indicated. In many community hospitals this task falls to the lot of the busy attending pediatrician. In the middle of the night, with a tiny patient in profound shock, the insertion of a catheter into a vein may be a demanding assignment. In such a situation the attempts of the uninitiated are [See FIG 3 In Source PDF] usually characterized by a generous incision, with much spreading and dissection of the tissues. This invites infection; in addition, any significant delay may be costly. A saphenous vein "cutdown" is frequently used in conjunction with major operative procedures at the Children's Medical Center. Saphenous phlebitis is rare, and its occurrance in a child does not have the more serious connotation that it does in the adult. Under the stimulus of good-humored chiding by the senior residents, each incoming junior house officer acquires a flare in the art of cannulating veins. The time elapsing from preparation of the skin to bandaging averages under 5 minutes. The factors responsible for such rapidity are: an anesthetized patient, repetition of a routine, and an exact knowledge of the anatomy involved. Four anatomic characteristics make the saphenous vein ideal for cannulation under direct vision (Fig. 2). These are: 1) its constancy (one can depend upon its presence just anterior to the medial malleolus); 2) it is the only structure of importance in this location (there are no arteries or tendons in the space immediately anterior to the malleolus; the tiny saphenous nerve should offer no confusion, and its division is of no great moment); 3) the vein lies on tough periosteum; and 4) its elasticity allows it to be withdrawn from a short incision without danger of rupture. Each of these facts serves importantly in the delivery of the vein, which, after all, is the key to the "cutdown" procedure.

A GUIDE FOR INTRODUCING CATHETERS WHEN CANNULATING SMALL VESSELS

THE INTRODUCTION of a catheter into a vein or artery in the pediatric age group is often difficult because of the small size of the vessels. A guide is herein described which greatly facilitates the insertion of a catheter. This instrument both dilates the vessel and guides the placement. The guide is a curved probe tapering to a point, with a groove on its underside and a phlange on one end to facilitate its manipulation (Fig. 1, A). It is fashioned from 23 gauge. #316 stainless steel. Several sizes are made for the various sized catheters. The inside diameters of the guide vary from ⅛ to 3/64 of an inch and the length is 1½ inches. The phlange measures 1 by ¾ inches. The technique of catheter introduction is as follows: a small longitudinal incision is made in a previously isolated vessel, the pointed end of the guide is then inserted and threaded up the vessel for a distance of two to eight millimeters. With one hand holding the guide in place, the catheter is slipped along the groove in the underside of the guide and into the vessel (Fig. 1, B). Once the catheter is in place, the guide is withdrawn. Advantages of the guide are its structural simplicity and the speed with which [SEE FIG I IN SOURCE PDF] catheters can be inserted or replaced. No forceps or hemostats are needed. Catheters can now be readily inserted into small vessels. There is little trauma to the vessel aside from the initial incision. The latter becomes important when vessels are repaired following catheterization. Such is the case for all retrograde arterial catheterizations. In addition to its use during cardiac catheterization, the guide should make easy the insertion of plastic tubing for exchange transfusion and in exposure of veins for intravenous therapy, especially in infants.

STUDIES OF RESPIRATORY PHYSIOLOGY IN CHILDREN

Tidal volume, respiratory rate and lung volumes have been measured in 64 patients with cystic fibrosis of the pancreas while lung compliance and resistance were measured in 42 of these. Serial studies of lung volumes were done in 43. Tidal volume was reduced and the respiratory rate increased only in the most severely ill patients. Excluding the three patients with lobectomies, residual volume and functional residual capacity were found to be significantly increased in 46 and 21%, respectively. These changes correlated well with the roentgenographic evaluation of emphysema. Vital capacity was significantly reduced in 34% while total lung capacity was, on the average, relatively unchanged. Seventy per cent of the 61 patients had a signficantly elevated RV/TLC ratio. Lung compliance was significantly reduced in only the most severely ill patients but resistance was significantly increased in 35% of the patients studied. The serial studies of lung volumes showed no consistent trends among the groups of patients in the period between studies. However, 10% of the surviving patients showed evidence of significant improvement while 15% deteriorated. [See Fig. 8. in Source Pdf.] Although there were individual discrepancies, there was a definite correlation between the clinical evaluation and tests of respiratory function, especially the changes in residual volume, the vital capacity, RV/ TLC ratio and the lung compliance and resistance.

Longitudinal observations of biological deviations in a schizophrenic infant.

The longitudinal observations made on this child, who is clinically schizophrenic at 5½ years, show that the normal progress of neurological and physiological maturation [refer Source PDF] was disrupted as early as 1 month of age. Biological development differed significantly from the other infants studied by the author, from norms of growth and development previously established on hundreds of children by Gesell and others, and from the usual forms of retarded or precocious development. The following deviations were discussed: 1. The presence of an abnormal torpid state in the first months of life, 2. A severe but transient lag and disorganization in postural-locomotor development, and 3. Physiological disturbances which paralleled the transient neurological disturbances, including retarded physical growth and autonomic instability. These biological manifestations antedated the anxiety and psychological symptoms, and appeared to be intimately related to the later clinical manifestations of schizophrenia. A preliminary study such as this raises more questions than it answers. We plan to study a much larger number of infants to determine the critical limits beyond which erratic development may be the first sign of schizophrenia, as distinguished from the spectrum of relatively benign individual variations; and to study how different patterns of maternal care and early physiological support can modify this development. The capacity of different individuals to maintain psychological integrity in the face of stress is often attributed to elusive qualities we summarize as ego strength. It would appear that there is a related variation in the capacity for integration in the early neurophysiological development of infants. Differences in the growing organization of alertness and muscle tonus, the progression of postural control, physical growth and autonomic stability lend themselves to quantitative measurement and analysis. We believe that further study of these individual differences in early neurological integration should increase our understanding of the factors making for mental health and disease.

PRIMARY ALDOSTERONISM IN A 9-YEAR-OLD CHILD

Primary aldosteronism has provoked a great deal of interest since first described. Many recent reviews of this subject have been published. Consequently the literature is not reviewed extensively here. [See FIG. 8, FIG. 9, FIG. 10 In Source PDF] Hypertension in the pediatric age period is exceedingly important because this diagnosis implies a rather poor prognosis. However, an individual with primary aldosteronism has a form of hypertension which is curable, making the diagnosis of this discase imperative. In this particular case, a 9-year-old boy was seen for a routine school examination at which time hypertension was discovered. The diagnostic procedures were designed for the consideration of disorders of the central nervous system, kidneys, ability for psychologic adjustment, cardiovascular system and, finally, of the endocrine system. In this patient there were coexistent findings of pyelonephritis and primary aldosteronism. From all the evidence presented, it is reasonable to conclude that there was hypersecretion of aldosterone by the adrenal glands of this boy since early infancy. Hypokalemia is associated with increased secretion of aldosterone and has also been shown to predispose the individual to pyelonephritis. Also it is well known that, in the presence of hypokalemia, the kidney is unable to concentrate urine. In view of the facts that the major histopathologic effects of hypokalemia are seen in the collecting tubule and concentration of urine occurs in this part of the nephron, it is possible to assume a direct association. Since surgery, hypokalemia has disappeared and with it so has the polyuria. There has also been improvement in renal concentrating ability, glomerular filtration rate and urea clearance. The renal plasma flow and the ability of the kidney to respond to vasopressin have not yet improved. It is possible that there exists permanent scarring of the kidney and that this is reflected [See FIG. 11. In Source PDF] in depressed renal plasma flow. Similar to the well-documented study of van Buchem and co-workers, who studied an adolescent with primary aldosteronism, there was no evidence of muscular weakness in this case associated with the hypokalemia. Because only a subtotal adrenalectomy was performed, the patient is leading a completely normal life free of medication and the dangers attendant to adrenal insufficiency. Rough measurement of the urinary excretion of other steroid compounds indicates that they are present in amounts expected for the normal child. He has had mild infections since discharge; during none of these has the patient required therapeutic support. Because of the viability of the remaining adrenal tissue it is expected that he will pass through a normal pubescence and adolescence. Finally, it is standard procedure during the investigation of an individual with hypertension to test for the presence of pheochromocytoma. Since 1932, in this hospital there has not been one pheochromocytoma discovered in an individual below the age of 14 years. It is our opinion that it certainly is equally as important to consider seriously the possibility of primary aldosteronism in every child admitted to the hospital with a diagnosis of essential hypertension, because hypertension in children due to primary aldosteronism, as shown in the present report, is a curable disease.

Marsilid (iproniazid) and electroshock.

Marsilid (iproniazid), so far, is the only drug with powerful anti-depressive properties. Twenty-five out of 32 patients derived benefit from the drug. It is helpful [See TABLE-1 in source PDF] in depressive syndromes in which somatization and retardation predominate, particularly so, if strong neurotic features are present. In one severe chronic schizophrenic syndrome Marsilid had a powerful euphorizing, unblocking effect. It is ineffective in most agitated depressions. It requires considerable length of time before exerting effect. Half of the successfully treated patients relapsed and had to be kept on maintenance therapy. Toxic features are of considerable degree and frequency. Fifteen out of 32 patients showed serious complications, among them 7 cases of liver damage. The well-known minor complications occurred in the vast majority of patients. Indications for electroshock and Marsilid will rarely overlap since depressions with neurotic features were never a first choice indication for electroshock, ...

Electrocardiography as a routine admission procedure in a large neuropsychiatric hospital: an evaluation.

The routine use of the electrocardiogram on admission of patients to a large neuropsychiatric hospital has been found to be of considerable value. It has demonstrated a large number of patients (16.6%) to have significant electrocardiographic abnormalities. This has made possible, at a very early stage, the following appropriate measures: 1. Proper treatment of the cardiac, or related, disorder. 2. Rapid evaluation of eligibility for desirable neuropsychiatric therapeutic regime, especially shock therapy. 3. Proper occupational therapy. 4. Realistic rehabilitation planning. It should further be mentioned that only a small percentage of these patients were suspected of cardiac abnormalities after clinical examination and other laboratory tests. The procedure of taking routine electrocardiograms on all patients admitted to a neuropsychiatric hospital is highly recommended. [SEE TABLE 1 IN SOURCE PDF]

A SIMPLE METHOD FOR OBTAINING VENOUS BLOOD FROM SMALL INFANTS

OBTAINING samples of venous blood from small infants presents a problem even to the experienced pediatrician. A method providing least trauma for baby and doctor is always desired. A simple technique for obtaining samples of venous blood from premature and small infants was described by Banus in 1957. A modification of his technique has been adopted in the present technique which employs simpler equipment and easily allows obtaining volumes of blood from 5 to 10 ml. EQUIPMENT (Figs. Ia and Ib) Polyethylene catheter with attached No. 23-gauge needle (modified Murphy-Gardner set). Plastic needle-adapter. No. 20-22 gauge needle. Hemostat. Vacuum test tube. PROCEDURE The polyethylene catheter is connected to [See Fig. 1a,1b in Source Pdf] the plastic needle-adapter and the latter to a No. 20-22 gauge needle (Fig. lb). The catheter is clamped with the hemostat, which will maintain a good vacuum, and the needle inserted through the center of the rubber plug of the vacuum-containing test tube. A scalp vein is entered against the blood flow. As this is done the blood will flow several millimeters into the catheter. The hemostat is then released, permitting blood to flow through the polyethylene catheter into the test tube by means of the vacuum existing in the system. The polyethylene catheter and needle may be rinsed with heparin before assembling, in order to prevent clotting when large volumes of blood are required. Scalp veins are preferred to other peripheral veins, because the needle can be held firmly while in such a superficial vein, assuring a good flow of blood. COMMENT This technique has several distinct advantages over the more commonly used methods of venipuncture. Minimal equipment, which for the most part is inexpensive and disposable, is needed. There is less trauma to the infant than by standard procedures for blood-letting. With very little experience the technique can be performed with facility. Because suction is evenly controlled, the plasma obtained is usually free of hemolysis. There is almost no exposure to air with this system, so that blood for determination of carbon dioxide can be collected with accuracy, providing oil is added to the tube immediately after collecting the blood. The polyethylene catheter can be clamped during the procedure, and the collecting tubes can be changed, should both clotted and non-coagulated specimens be desired.

Circulatory and Pulmonary Effects of Acute Central Vascular Engorgement in Normal Subjects

1. Brief, acute central vascular and pulmonary engorgement has been produced in normal subjects by inflation of an aviator's g-suit and by submersion in water while breathing against atmospheric pressure. 2. G-suit inflation (2 psi) produced an increase in central venous pressure of 26.8-7.8 cm H2O and a decrease in pulmonary compliance from .217-.048 to .093-.136 L per cm H2O. A similar compliance change occurred with submersion. [SEE CHART III IN SOURCE PDF] 3. On maintaining g-suit pressure or submersion for two minutes, central venous pressure and compliance showed a progressive but incomplete return toward control levels. 4. Infusion of norepinephrine or immersion of an arm in ice water during g-suit inflation prevented the return of central venous pressure and pulmonary compliance toward control levels. 5. It is suggested that the compliance changes induced by these procedures depend partially on the degree of central vascular engorgement and that under the experimental conditions this in turn is partially dependent on peripheral venous tone.

A Nasal Aspirator for Home Use

A nasal aspirator is now available based upon the Venturi principle of water pressure suction. By means of simple adaptors this apparatus may be easily attached to kitchen water faucets in more than than 90% of homes. It has a long plastic hose and plastic, bulb-type nasal tip designed to fit securely in the ostia of the nose. The nasal tip has a safety vent on time side so that pressure can be controlled easily by the finger.[See figure in source pdf.] This aspirator is inexpensive.

Specific behavioral changes produced by chlorpromazine in chronic schizophrenia.

Results of this and other studies employing objective test measurements suggest that widely observed even radical alterations in behavior are not usually accompanied by commensurate changes in the psychological test performance. The dilemma faced by those interested in objective measurement is whether psychological tests are generally insensitive to change; or whether the behavioral changes are relatively superficial, while the psychological tests measure the more stable aspects of the personality? Reports of change in the literature especially in chronic psychotic patients is so prelevant that something must happen to these patients however exaggerated the claim. It is very possible that psychologists persist in applying the wrong measuring techniques and that new methods will have to be developed. At present behavior rating scales probably provide a more sensitive index of change than most psychological tests. It is also possible, however, that changes resulting from chlorpromazine are relatively superficial. In very few studies are claims of a remission in the psychotic process substantiated by objective evidence. In this study, for example, there appeared to be an alleviation of some of the more objective symptoms but in no case could a patient [see Fig. 1. in source PDF] Fig. 1. Example of the Hospital Management Picture Frustration Test. (Modification by Moss of the Rosenzweig Picture-Frustration Study, Adult Form. Copyright 1948, made with the author's permission. be regarded as without psychosis at the conclusion of the experiment. While medication was administered for a relatively short period, it is common clinical experience that the psychological reaction to seeming tolerance develops so that in this respect the design of the present study should maximize finding psychological alterations. A 14-month followup survey also revealed that in spite of continued tranquilizing medication of one type or another, only one of the patients (number 7, Table 1) is on convalescent leave at present and none has been discharged. Enthusiasm for psychopharmacological treatment should be tempered by a more realistic appraisal of the limitations of these agents.

Device for Urine Collections

The recent appearance of several articles showing more or less complex devices for collecting urine from baby boys prompts me to describe a simple and effective technique; this system was devised and used for 2 years at Travis Air Force Base Hospital and has been used on the infants' ward at the University of California Medical [See FIG. 1. in Source Pdf] Center for 1½ years. The components can be found in any hospital; the apparatus can be assembled and affixed in 10 minutes; it does not leak; no skin irritation has been noted, even with 4-day collection periods; and it can be washed, stored and re-used indefinitely. (See Fig. 1.)

Psycho-physiologic evaluation of phenyltoloxamine, a new phrenotropic agent; a comparative study with reserpine and placebo.

Phenyltoloxamine produced predominantly a sedative-hypnotic pattern. Physiologically, there was a slight increase of respiration, decrease in muscle tension, lowering of the systolic (but not diastolic) blood pressure, marked pupillary constriction. Pulse rate and finger skin temperature were not significantly affected. Significant impairment of psychomotor functions occurred at peak of the drug action, and was manifested by a decrease in rate of motor activity discharge and impairment of visuomotor coordination and steadiness. The speed of mental processes was not impaired, but accuracy was somewhat decreased. Learning of competitive paired associate material was improved. The Ss. were aware of the marked effects of the drugs at the peak of drug action, usually 4-5 hours after ingestion. They experienced this as unpleasant because of the degree of sedation and impairment of motor function. The marked sedative and soporific effect approached hypnotic proportions and was associated with slowing of speech, impaired voluntary motor control and coordination, and subjective feelings of slowed thinking, disrupted concentration, a loss of ability to study and lethargy as well as reduction in anxiety. The peak action, at 4-5 hours after ingestion of the drug, was achieved with a relatively abrupt onset and cessation. Many of the Ss. reported a sense of relaxation and an increase in the capacity to do mental work which came after peak action and continued for another 4-8 hours. During the peak action of drug there was some decrease in rapport, a lessening of emotional responsiveness, and a decrease in the quality of verbal associations. Reserpine produced predominantly vegetative effects with only slight effect on state of consciousness and motor activity. The rate of respiration decreased, a rise in finger skin temperature was recorded, muscle tension increased and diastolic blood pressure decreased without change in systolic pressure. Pupils were slightly constricted. Psychomotor test performance was slightly increased, but mental speed remained unaffected. Accuracy of serial addition was slightly increased. Competitive paired associate learning was greatly impaired. While the Ss. were, according to the psychiatrist's observations, mildly sedated, inhibited in facial expressiveness, and slowed in overall psychomotor reactivity, they frequently reported that they felt "no change". The visceral discomforts attracted their attention more frequently. This apparent lack of awareness of the changes in their behavior noted by the psychiatrist is similar to the quality of the drug action called "indifference" by Denniker(17) and "isolation from environment" by Berger(18). Three Ss. reported feelings of depression. The effects on rapport and verbal associations were variable. Sedation effects occurred at early hours and were followed in 8 to 18 hours by awareness of uncomfortable visceral symptoms. Following the administration of placebo the Ss. reported a reduction of anxiety, an increase in relaxation, a slight increase in respiration and a slight decrease of muscle tension. Psychomotor performance and accuracy in mental function were increased, probably caused by a combination of practice and relaxation. When competitive associate learning after placebo was compared with learning under the other agents, it was noted that associative learning was facilitated under phenyltoloxamine and retarded with reserpine. As the placebo day progressed, the subjects reported mild sedation and relaxation, but were able to study and read. This was associated with a concomitant improvement in rapport, emotional expressiveness and verbal associations. Many investigators have similarly reported such changes subsequent to the administration of a placebo. The "drug action profiles" (characteristic pattern of action) of the three agents are shown in Fig. 4.[see source PDF for figure 4.]

PHENYLPYRUVIC OLIGOPHRENIA

PHENYLPYRUVIC OLIGOPHRENIA is an inherited disease characterized by mental deficiency and urinary excretion of phenylpyruvic acid. Patients with this disorder are unable to carry out a particular enzymatic step in the metabolism of phenylalanine; this reaction is the conversion of phenylalanine to tyrosine:[see equation in source pdf]. These individuals therefore appear to be human mutants, analogous to mutants such as those which have been induced in Neurospora crassa and Escherichia coli. However, in contrast to the enzymatic defect in certain mutant microorganisms, which is often recognizable in terms of a specific nutritional requirement, the metabolic block in phenylpyruvic oligophrenia is associated with a relatively complex picture. Phenyipyruvic oligophrenia is a recessive trait; it has been estimated that the gene is carried by approximately 0.5 to 1% of the population. Although most patients with this disease exhibit markedly reduced mental capacity, a few show only moderate retardation. A high percentage of patients with phenylketonuria have fair skin, blue eyes and blond hair. About 25% of patients with phenylpyruvic oligophrenia have experienced seizures, and many of these patients have been reported to show abnormal electroencephalograms. Several necropsies have revealed evidence of abnormal myelination; on the other hand, other postmortem studies have been described as essentially negative. Patients with phenylpyruvic oligophrenia may excrete as much as 1 to 2 gm each of phenylpyruvic acid and phenyllactic acid per day; these compounds are not usually detectable in normal urine (Fig. 1). Urinary excretion of phenylalanine, normally no more than about 30 mg/day, may be as high as 1 gm/day in phenylpyruvic oligophrenia.

Patient privileges in mental hospitals.

The literature reports many changes in mental hospital philosophy and attitudes that reflect on security practices. Since these practices appear to have a direct bearing on requirements for physical facilities, the Architectural Study Project sought to (a) assess the extent and degree of privilege and responsibility permitted to patients in the various types of mental hospitals in this country (b) to establish a base line in reference to security practices in order to detect future changes and trends; and (c) to identify some of the factors which might be related to security practices in mental hospitals. [Refer Source Pdf for the Table 5] A mail questionnaire sent to all public mental hospitals in the United States, Canada, Hawaii and Puerto Rico, resulted in information from 94% of the hospitals which also contained about 94% of all beds in all public mental hospitals. Analysis of the data showed that 12.8% of all the patients in all the hospitals are on open wards, 22.3% are privileged, 45.8% are semi-privileged and 31.9% are non-privileged. State, VA, county, Canadian and Hawaiian hospitals appear to differ significantly in their patient privileges practices. VA hospitals appear to have the smallest proportion of non-privileged patients and semi-privileged patients. Except for the one Hawaiian hospital, the VA hospitals also have the largest percentage of privileged patients with county hospitals in second place. Hospitals which are primarily or entirely for the criminally insane have the lowest privilege rate. Canadian and state hospitals are fairly similar in their practices. Variation in patient privilege practices within each hospital group seems to be related to size of the hospital. Doctor-patient ratios and recency of hospitals do not seem to be related to privilege practices except in VA hospitals where hospitals established after 1946 showed higher percentages of open ward patients than those established prior to this date. Geriatric, medical-surgical and tuberculosis services show a generally lower privilege level than the rest of the services in mental hospitals. The trend of present day psychiatric thinking and practice is toward the open hospital. Yet the data presented here shows that there is still a very long way to go. It would be of utmost importance to determine those factors that bear upon this issue. This study did not attempt to discover the role of staff attitudes in security practices but evidence is available (Greenblatt (2), Stanton (6), our study (4)) that this may be a key factor.

The effect of cetadiol on delirium tremens, alcoholic hallucinosis, and alcohol withdrawal.

Cetadiol does not have a tranquilizing or sedating effect on patients suffering from delirium tremens or alcoholic hallucinosis. It does not shorten the course of delirium tremens. The placebo used in this study is as effective as Cetadiol in relieving symptoms of alcohol withdrawal. [See Source PDF for table 1]

DISORDERS ASSOCIATED WITH THE METABOLISM OF PHENYLALANINE AND TYROSINE

DISORDERS ASSOCIATED WITH THE METABOLISM OF PHENYLALANINE AND TYROSINE

MODIFIED METHOD OF PREPARING CONCENTRATED SMEARS OF BONE MARROW

THE FOLLOWING brief communication concerns a method of obtaining bone marrow smears which are practically devoid of dilution with cells from the peripheral blood. In the authors' experience bone marrow particles are not usually obtained from small infants and children. Therefore it has not been possible to make use of the standard technique of aspiration of the bone marrow into a heparinized syringe, placing the aspirate on a watchglass, and then selecting a particle of bone marrow for smear or imprint. Neither has the alternative method of centrifuging heparinized marrow in Wintrobe hematocrit tubes proved satisfactory, because the small quantity of marrow generally taken from infants is insufficient to fill a Wintrobe tube. Another difficulty is in separating the buffy coat from the erythrocyte layer in the Wintrobe tube. [SEE FIG. 1 IN SOURCE PDF] METHOD The present method consists of expelling two or three small drops of bone marrow from the aspirating syringe on to a glass slide; this is transferred by means of capillary attraction into a micro-hematocrit tube. The micro-hematocrit tube is heat-sealed as in the determination of the micro-hematocrit of peripheral blood. The tube is centrifuged for 5 minutes at high speed, and then broken at the interface of the erythrocytes and buffy coat. This is accomplished by the use of an ordinary metal file such as is used for cutting glass vials. The buffy coat with the supernatant plasma is expelled on to a coverslip, smeared and stained in the usual manner (Fig.1). This method has proved useful in providing a concentrated preparation of marrow cells and in yielding a more informative picture of the activity of the bone marrow than has been available with the use of ordinary smears.