Points from Letters: Causes of Rib Fracture

Abstract

CORRESPONDENCE MICAL JONALview of the present lack of information as to their usefulness. But it should be appreciated that the diet and water consumed by many persons has involved for a long time an intake of fluorine similar in form and quantity to that which might arise from the use of fluoride tablets in fluorine-free areas. It is suggested, therefore, that emphasis should be placed, on the pursuit of practical trials-of which so far there are few signs in Britain.-I am, etc., Didcot, Berks. J. M. FLETCHER. REFERENCES 1 Bromehead, C. N., et al., Lancet, 1943. 1, 490. 2 Weaver, R., Proc. R. Soc. Med., 1948, 41, 284. Blood, 1948, 8, 892. Retaining Patency of Veins SIR,-At the University obstetrics and gynaecological clinic in Budapest the following method is used when giving transfusions in order to ensure that the vein remains patent.The wall of the vein is gripped with fine artery forceps; a thin thread is led under the vein, and when the needle is inserted.in the vein the thread serves to fix it in position. When the transfusion is finished the wall of the vein just distal to the needle is gripped with artery forceps. The thread is cut and the needle is removed. The puncture wound in the wall of the vein can now be seen, and it is seized with a pair of fine Pdan's forceps and undertied with a very fine catgut. On removal of the distal pair of forceps the circulation commences without any bleeding from the ligatured part. The wound of the skin is closed with two or three stitches.Thrombosis rarely occurs in the ligatured vein, because the undertying secures contact of intima with intima, and the vein reacts as if the wall had been very finely sutured. Before removing the needle we inject heparin into the vein to avoid thrombosis due to injury of the vessel. On one occasion the same vein was used to give five transfusions to a patient in three days.In so far as large veins are concerned our method is not a new one, because it has been applied in surgical institutes for closing the wounds of big vessels, but it is worth considering in the case of small veins. When blood transfusions are necessary every little vein may possess vital importance, and therefore they must be treated with caution. According to our experience this method seems to fulfil the best requirements.--I am, etc., Budapest.GEORGES TARJAN. POINTS FROM LETTERS Causes of Rib FractureDr. JAMES T. HAROLD (London, S.W.5) writes: Your issue of Jan. 22 contains references to several unusual causes of rib fracture. Some years ago I encountered another unusual cause. A young female stated that she had once sustained a fractured rib. Knowing her prowess as a huntress I thought it might have been acquired through horse-riding: but this noble animal was not to blame. It transpired that after some months' estrangement from her boy friend she had met him again, was lovingly embraced, and soon after experienced what she described as " a sharp pleuritic pain in the chest." Medical opinion was nonplussed for three days, when an x-ray reveale...