1550
Sixth
sense
StR,—What are those waves of communication, that extra sense yet understood? Something remarkable happened to me about ten years ago. Two elderly sisters had a house built near part of our garden. I had objected to the planning permission and then had required the plans to be modified, causing the sisters to see me as a hostile incompatible, and no neighbourliness existed. When our doctor told me that one of them had been admitted to hospital, we thought I should show some support by visiting her. I found her recovering, soon to return home. We talked pleasantly and the clouds of strangers and antagonism drifted away. The following Sunday morning, when crossing the hall to the kitchen to make tea, a presentiment of doom beset me and I feared we had been burgled. When I opened the kitchen door all appeared normal but then there seemed to be a curious descending dark shimmer in the far part of the kitchen, immediately gone-but I not
knew it was death and female. I thought some catastrophe to one of our daughters-in-law. Disturbed by these suppositions and deciding not to tell my wife, I made the tea and took the tray to the bedroom. As I reached the bedroom, the doorbell rang and I was not surprised to see the village policeman who said he would be grateful for my help. He had to tell the lady along the road that her sister had died suddenly and could I assist him with the awful task? This we did together, and he came in for a cup of tea; as we sat I told him of my astonishing experience. He said that he had been on his way to tell our neighbour that her sister was very ill but that when almost here a message had come through on his car telephone that she had just died-and it had been then that he thought he should seek my help. My monition must have been as she was actually dying. Was she trying to recruit my help for her sister-was that the cry? My wife and I did have to support the sister, a woman we did not know who had a considerable disability. She is now dead and I can record this without causing her distress. As a neurosurgeon my mind has been pragmatically directed and I had had no interest in telepathy or extrasensory perception. Here was the reception of information from a source I did not know nor comprehend when it declared its nature, female death. Finding out what you do not know from what you do is a logical concept but I did not know the people involved, except the fragmentary meeting at the hospital, nor had any thoughts persisted in my mind. For me to have received such a message remains astonishing. It would be valuable if declared telepathic communicators could be investigated by scanning and electroencephalography to find which areas of the brain are involved with inception, reception, and onward conscious recognition. There was a message in my mind. How it reached there is not defined; although at first confused with fear, it was so very clear. 6 Chad Road,
Edgbaston, Birmingham B153EN,
UK
J. M. SMALL
Small-bowel enteroscopy and NSAID ulceration S!R,—The development of small-bowel enteroscopy has provided a useful method of detecting otherwise occult small-bowel lesions. We welcome Dr Lewis’ observations (May 4, p 1093) on our paper about small-bowel ulceration diagnosed by small-bowel enteroscopy in patients with rheumatoid arthritis who receive non-steroidal anti-inflammatory drugs (NSAIDs). He suggests that some of the abnormalities that we observed could have been due to enteroscope trauma. We have now examined 102 patients with this technique, 60 of whom had rheumatoid arthritis and were taking regular NSAIDs. Red spot lesions were seen only in rheumatoid patients on regular NSAIDs and were found in none of the remaining 42 patients. Erosions were observed at all sites around the bowel circumference, but infrequently on the valvulae conniventes. 33 of 60 (56%) patients with rheumatoid arthritis have had small-bowel lesions whereas only 27% of patients not on NSAIDs have had such abnormalities. The figure for patients not on NSAIDs compares closely with the experience of others.1 Our findings of NSAID-
induced small-bowel lesions agree with previous radioisotope studies in which small-bowel damage was estimated to occur in 70% of patients receiving long-term NSAIDs.1We wonder how many of Lewis’ patients had rheumatoid arthritis and were taking long-term NSAIDs. If he examines these patients he may find a similar frequency of small-bowel lesions to our own. A. J. MORRIS Royal Infirmary, Glasgow G31 2ER, UK J. F. MACKENZIE bleeding of obscure origin: role of small bowel enteroscopy. Gastroenterology 1988; 94: 1117-20. 2. Bjarnason I. Non-steroidal anti-inflammatory drug induced small intestinal inflammation in man. In: Pounder RE, ed. Recent advances in gastroenterology 7. Edinburgh. Churchill Livingstone, 1988: 23-47. 1. Lewis BS, Waye JD. Chronic gastrointestinal
Alcoholism treatment according to the Minnesota model SiR,—The author of the review of the debate about the ethics and of private treatment for alcohol abuse (Feb 16, p 422) was
outcome
troubled because "the claims made for the Minnesota model have been subjected to comparative studies, and their success remains unproven by conventional standards". We have completed a randomised clinical trial in 141 employed alcoholics comparing treatment according to the Minnesota model with a more standard form of inpatient therapy.’ Follow-up was bimonthly for one year. During each follow-up visit a blood sample was taken for the measurement of erythrocyte mean cell volume (MCV) and y-glutamyltransferase (GGT) activity. Alcohol consumption was assessed by structured interview. Outcome was based on the combined information of MCV, GGT, and admitted alcohol intake. Our results showed that the one year total abstinence rate was 14% for the Minnesota-type treatment and 1 ’9% for the "standard treatment" (p < 005). The corresponding rates for controlled drinking were 17% (Minnesota model) and 8% ("standard treatment"; difference not significant). Although the abstinence rate was low, treatment according to the Minnesota model achieved a better one year abstinence rate than standard Finnish treatment. All clinical trials on alcoholism treatment should adopt laboratory markers for alcoholism as part of their outcome evaluation.
not
Research Unit of Alcohol Diseases, University of Helsinki, 00290 Helsinki, Finland
MIKKO SALASPURO LAURI KESO
1. Keso L, Salaspuro M. Inpatient treatment of employed alcoholics: a randomized clinical trial of Hazelden-type and traditional treatment. Alcohol Clin Exp Res 1990; 14: 584-89.
Susceptibility to malignant hyperthermia detected non-invasively SiR,—Malignant hyperthermia (MH), an uncommon clinical syndrome with fever and rhabdomyolysis triggered by anaesthetic agents, is potentially fatal. Presymptomatic diagnosis of MH susceptibility (MHS) has relied until now solely on an in vitro contracture test requiring muscle biopsy. Since MH susceptibility is inherited, a non-invasive test is important. We report here magnetic resonance spectroscopy (31-P MRS) of skeletal muscle in vivo. 23
patients being investigated by biopsy because of a family history of MH were also tested by 31P-MRS. 8 proved to have MHS (4 male, 4 female, mean age 35) and 15 (7 male, 8 female, mean age 31) were MH non-susceptible (MHN) by the in-vitro contracture test.1 None had any clinical illness or specific myopathy on histological examination or were receiving drug therapy. In-vivo MRS was done with a Brucker MSL system with a 2 35 T 35 cm horizontal bore magnet. The calf muscle was placed over a 6 cm diameter surface coil. Fully relaxed 31P-spectra (40MHz) were acquired at rest after completion of 20 single scans at a 20 s pulse repetition rate. The phosphocreatine (PCr) peak was chosen as the chemical shift reference (0 ppm). Typical spectra in MHS and MHN subjects are shown in fig 1. The major finding is a marked signal in the PDE region (3 ppm) in
Sixth
sense
StR,—What are those waves of communication, that extra sense yet understood? Something remarkable happened to me about ten years ago. Two elderly sisters had a house built near part of our garden. I had objected to the planning permission and then had required the plans to be modified, causing the sisters to see me as a hostile incompatible, and no neighbourliness existed. When our doctor told me that one of them had been admitted to hospital, we thought I should show some support by visiting her. I found her recovering, soon to return home. We talked pleasantly and the clouds of strangers and antagonism drifted away. The following Sunday morning, when crossing the hall to the kitchen to make tea, a presentiment of doom beset me and I feared we had been burgled. When I opened the kitchen door all appeared normal but then there seemed to be a curious descending dark shimmer in the far part of the kitchen, immediately gone-but I not
knew it was death and female. I thought some catastrophe to one of our daughters-in-law. Disturbed by these suppositions and deciding not to tell my wife, I made the tea and took the tray to the bedroom. As I reached the bedroom, the doorbell rang and I was not surprised to see the village policeman who said he would be grateful for my help. He had to tell the lady along the road that her sister had died suddenly and could I assist him with the awful task? This we did together, and he came in for a cup of tea; as we sat I told him of my astonishing experience. He said that he had been on his way to tell our neighbour that her sister was very ill but that when almost here a message had come through on his car telephone that she had just died-and it had been then that he thought he should seek my help. My monition must have been as she was actually dying. Was she trying to recruit my help for her sister-was that the cry? My wife and I did have to support the sister, a woman we did not know who had a considerable disability. She is now dead and I can record this without causing her distress. As a neurosurgeon my mind has been pragmatically directed and I had had no interest in telepathy or extrasensory perception. Here was the reception of information from a source I did not know nor comprehend when it declared its nature, female death. Finding out what you do not know from what you do is a logical concept but I did not know the people involved, except the fragmentary meeting at the hospital, nor had any thoughts persisted in my mind. For me to have received such a message remains astonishing. It would be valuable if declared telepathic communicators could be investigated by scanning and electroencephalography to find which areas of the brain are involved with inception, reception, and onward conscious recognition. There was a message in my mind. How it reached there is not defined; although at first confused with fear, it was so very clear. 6 Chad Road,
Edgbaston, Birmingham B153EN,
UK
J. M. SMALL
Small-bowel enteroscopy and NSAID ulceration S!R,—The development of small-bowel enteroscopy has provided a useful method of detecting otherwise occult small-bowel lesions. We welcome Dr Lewis’ observations (May 4, p 1093) on our paper about small-bowel ulceration diagnosed by small-bowel enteroscopy in patients with rheumatoid arthritis who receive non-steroidal anti-inflammatory drugs (NSAIDs). He suggests that some of the abnormalities that we observed could have been due to enteroscope trauma. We have now examined 102 patients with this technique, 60 of whom had rheumatoid arthritis and were taking regular NSAIDs. Red spot lesions were seen only in rheumatoid patients on regular NSAIDs and were found in none of the remaining 42 patients. Erosions were observed at all sites around the bowel circumference, but infrequently on the valvulae conniventes. 33 of 60 (56%) patients with rheumatoid arthritis have had small-bowel lesions whereas only 27% of patients not on NSAIDs have had such abnormalities. The figure for patients not on NSAIDs compares closely with the experience of others.1 Our findings of NSAID-
induced small-bowel lesions agree with previous radioisotope studies in which small-bowel damage was estimated to occur in 70% of patients receiving long-term NSAIDs.1We wonder how many of Lewis’ patients had rheumatoid arthritis and were taking long-term NSAIDs. If he examines these patients he may find a similar frequency of small-bowel lesions to our own. A. J. MORRIS Royal Infirmary, Glasgow G31 2ER, UK J. F. MACKENZIE bleeding of obscure origin: role of small bowel enteroscopy. Gastroenterology 1988; 94: 1117-20. 2. Bjarnason I. Non-steroidal anti-inflammatory drug induced small intestinal inflammation in man. In: Pounder RE, ed. Recent advances in gastroenterology 7. Edinburgh. Churchill Livingstone, 1988: 23-47. 1. Lewis BS, Waye JD. Chronic gastrointestinal
Alcoholism treatment according to the Minnesota model SiR,—The author of the review of the debate about the ethics and of private treatment for alcohol abuse (Feb 16, p 422) was
outcome
troubled because "the claims made for the Minnesota model have been subjected to comparative studies, and their success remains unproven by conventional standards". We have completed a randomised clinical trial in 141 employed alcoholics comparing treatment according to the Minnesota model with a more standard form of inpatient therapy.’ Follow-up was bimonthly for one year. During each follow-up visit a blood sample was taken for the measurement of erythrocyte mean cell volume (MCV) and y-glutamyltransferase (GGT) activity. Alcohol consumption was assessed by structured interview. Outcome was based on the combined information of MCV, GGT, and admitted alcohol intake. Our results showed that the one year total abstinence rate was 14% for the Minnesota-type treatment and 1 ’9% for the "standard treatment" (p < 005). The corresponding rates for controlled drinking were 17% (Minnesota model) and 8% ("standard treatment"; difference not significant). Although the abstinence rate was low, treatment according to the Minnesota model achieved a better one year abstinence rate than standard Finnish treatment. All clinical trials on alcoholism treatment should adopt laboratory markers for alcoholism as part of their outcome evaluation.
not
Research Unit of Alcohol Diseases, University of Helsinki, 00290 Helsinki, Finland
MIKKO SALASPURO LAURI KESO
1. Keso L, Salaspuro M. Inpatient treatment of employed alcoholics: a randomized clinical trial of Hazelden-type and traditional treatment. Alcohol Clin Exp Res 1990; 14: 584-89.
Susceptibility to malignant hyperthermia detected non-invasively SiR,—Malignant hyperthermia (MH), an uncommon clinical syndrome with fever and rhabdomyolysis triggered by anaesthetic agents, is potentially fatal. Presymptomatic diagnosis of MH susceptibility (MHS) has relied until now solely on an in vitro contracture test requiring muscle biopsy. Since MH susceptibility is inherited, a non-invasive test is important. We report here magnetic resonance spectroscopy (31-P MRS) of skeletal muscle in vivo. 23
patients being investigated by biopsy because of a family history of MH were also tested by 31P-MRS. 8 proved to have MHS (4 male, 4 female, mean age 35) and 15 (7 male, 8 female, mean age 31) were MH non-susceptible (MHN) by the in-vitro contracture test.1 None had any clinical illness or specific myopathy on histological examination or were receiving drug therapy. In-vivo MRS was done with a Brucker MSL system with a 2 35 T 35 cm horizontal bore magnet. The calf muscle was placed over a 6 cm diameter surface coil. Fully relaxed 31P-spectra (40MHz) were acquired at rest after completion of 20 single scans at a 20 s pulse repetition rate. The phosphocreatine (PCr) peak was chosen as the chemical shift reference (0 ppm). Typical spectra in MHS and MHN subjects are shown in fig 1. The major finding is a marked signal in the PDE region (3 ppm) in
