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CONGENITAL MALFORMATIONS AND REFUSED TERMINATION
1123 normal
G.G.T.P.
activities had been
taking
a
wide range of
drugs, including phenothiazines, tricyclic antidepressants, lithium salts, nitrazepam, chlordiazepoxide, and diazepam. Of the 20 alcoholic patients with raised G.G.T.P. activities but without any history of barbiturate ingestion, 9 gave normal results in standard tests for liver function, but the remainder showed some increases in serum alkaline
phosphatase or glutamic-oxaloacetic and/or glutamicpyruvic transaminase. Raised serum-G.G.T.P. levels fall steadily when alcohol and/or barbiturates are withdrawn, except in patients with persistently abnormal results from other liver-function tests. It appears, therefore, that there is a substantial group of alcoholics with no recognised cause for high serumG.G.T.P. levels, since we have found in them no history of recent anticonvulsant therapy or barbiturate intake nor evidence of liver damage revealed by changes in the other serum enzymes which were estimated. Work is continuing in an attempt to establish the significance of these findings and it is hoped to publish the results elsewhere in the near future. St. Bernard’s
Hospital, Southall,
Middlesex.
PREVIOUSLY UNDESCRIBED INTRAEPITHELIAL DEPOSITS IN MEMBRANOUS GLOMERULONEPHRITIS SIR,-Membranous glomerulonephritis is characterised by diffuse thickening of peripheral capillary walls of the glomeruli with slight increase of mesangial matrix and slight hypercellularity in hsEmatoxylin-and-eosin preparations.! The Jones silver stain demonstrates silver-positive
spikes projecting from the glomerular basement membrane.2 Subepithelial deposits associated with projections from the lamina densa have been described.l,3 We wish to report a lesion previously undescribed in fine structural studies of membranous glomerulonephritis. A 5-year-old White boy presented Hospital at age 3 years 8 months with
at an
Fitzsimons General 18-month history of
J. SPENCER-PEET D. WOOD M. M. GLATT.
CONGENITAL MALFORMATIONS AND REFUSED TERMINATION
SiR,-It has been suggested 1-3 that attempted abortion drugs may play some part in the etiology of certain congenital skeletal defects. We have therefore tried to discover the outcome of pregnancies in women refused a termination at this hospital. From May, 1968, to June, 1971, there were 1273 requests for termination of pregnancy, and 225 (18%) were refused by one or more of the consultant gynxcologists. Inquiries from general practitioners and local executive councils failed to trace 26 of these patients. In the remaining 199 patients the outcome was found by contacting general practitioners and examining obstetric records. The results
with
were as
Fig. 1-Typical early membranous glomerulonephritis. Mild basement-membrane thickening with numerous silverpositive projections (spikes). Jones silver stain ( x 860).
follows:
at 30 weeks, the mother having genitourinary gonococcal infection and gonococcal
One stillbirth occurred a severe
arthritis. The other stillbirth occurred after a severe antepartum haemorrhage in a pregnancy already complicated by placental insufficiency. In both cases necropsy revealed no congenital abnormalities. Of the abnormal infants, one was a trisomy-21 mongol who died at the age of two months because of congenital heart-disease, the second had an umbilical hernia which resolved without operation, and the third had a large facial cavernous haemangioma. We have therefore not observed an increased frequency of congenital malformations in the offspring of women refused a termination. This in no way excludes attempted abortion as being responsible for congenital deformities. Indeed aminopterin is known to be teratogenic when used in this way,4 and it is reasonable to be concerned about other drugs when taken in large doses in an attempt to procure an abortion. General Hospital, Bristol BS1 6SY. 1. 2. 3. 4.
T. J. DAVID D. G. J. BATTIN.
Papp, Z., Gardó, S. Lancet, 1971, i, 753. Gardner, L. I., Assemany, S. R., Neu, R. L. ibid. 1971, ii, 98. Kučera, J. ibid. Jan. 29, 1972, p. 260. Warkany, J. Congenital Malformations. Chicago, 1971.
Fig. 2-Electron micrograph illustrating epithelial deposit (D). Osmium-tetroxide fixation, uranyl-acetate and lead-citrate stains
(reduced tofrom x 9000).
microscopic haEmaturia and proteinuria. Renal biopsy at that time demonstrated diffuse increase in mesangial matrical material and slight glomerular hypercellularity. The Jones silver stain demonstrated subepithelial deposits of silver-positive material in the basement membrane of peripheral capillary walls (fig. 1). Tubules and interstitium were unremarkable. Biopsy 8 months later revealed similar changes by light microscopy. The patient is now in remission. 1. 2. 3.
Rosen, S. Hum. Path. 1971, 2, 209. Jones, D. Am.J. Path. 1957, 33, 313. Mostofi, F. K., Antonvych, T. A., Limas, E. Hum. Path. 1971, 2, 233.
G.G.T.P.
activities had been
taking
a
wide range of
drugs, including phenothiazines, tricyclic antidepressants, lithium salts, nitrazepam, chlordiazepoxide, and diazepam. Of the 20 alcoholic patients with raised G.G.T.P. activities but without any history of barbiturate ingestion, 9 gave normal results in standard tests for liver function, but the remainder showed some increases in serum alkaline
phosphatase or glutamic-oxaloacetic and/or glutamicpyruvic transaminase. Raised serum-G.G.T.P. levels fall steadily when alcohol and/or barbiturates are withdrawn, except in patients with persistently abnormal results from other liver-function tests. It appears, therefore, that there is a substantial group of alcoholics with no recognised cause for high serumG.G.T.P. levels, since we have found in them no history of recent anticonvulsant therapy or barbiturate intake nor evidence of liver damage revealed by changes in the other serum enzymes which were estimated. Work is continuing in an attempt to establish the significance of these findings and it is hoped to publish the results elsewhere in the near future. St. Bernard’s
Hospital, Southall,
Middlesex.
PREVIOUSLY UNDESCRIBED INTRAEPITHELIAL DEPOSITS IN MEMBRANOUS GLOMERULONEPHRITIS SIR,-Membranous glomerulonephritis is characterised by diffuse thickening of peripheral capillary walls of the glomeruli with slight increase of mesangial matrix and slight hypercellularity in hsEmatoxylin-and-eosin preparations.! The Jones silver stain demonstrates silver-positive
spikes projecting from the glomerular basement membrane.2 Subepithelial deposits associated with projections from the lamina densa have been described.l,3 We wish to report a lesion previously undescribed in fine structural studies of membranous glomerulonephritis. A 5-year-old White boy presented Hospital at age 3 years 8 months with
at an
Fitzsimons General 18-month history of
J. SPENCER-PEET D. WOOD M. M. GLATT.
CONGENITAL MALFORMATIONS AND REFUSED TERMINATION
SiR,-It has been suggested 1-3 that attempted abortion drugs may play some part in the etiology of certain congenital skeletal defects. We have therefore tried to discover the outcome of pregnancies in women refused a termination at this hospital. From May, 1968, to June, 1971, there were 1273 requests for termination of pregnancy, and 225 (18%) were refused by one or more of the consultant gynxcologists. Inquiries from general practitioners and local executive councils failed to trace 26 of these patients. In the remaining 199 patients the outcome was found by contacting general practitioners and examining obstetric records. The results
with
were as
Fig. 1-Typical early membranous glomerulonephritis. Mild basement-membrane thickening with numerous silverpositive projections (spikes). Jones silver stain ( x 860).
follows:
at 30 weeks, the mother having genitourinary gonococcal infection and gonococcal
One stillbirth occurred a severe
arthritis. The other stillbirth occurred after a severe antepartum haemorrhage in a pregnancy already complicated by placental insufficiency. In both cases necropsy revealed no congenital abnormalities. Of the abnormal infants, one was a trisomy-21 mongol who died at the age of two months because of congenital heart-disease, the second had an umbilical hernia which resolved without operation, and the third had a large facial cavernous haemangioma. We have therefore not observed an increased frequency of congenital malformations in the offspring of women refused a termination. This in no way excludes attempted abortion as being responsible for congenital deformities. Indeed aminopterin is known to be teratogenic when used in this way,4 and it is reasonable to be concerned about other drugs when taken in large doses in an attempt to procure an abortion. General Hospital, Bristol BS1 6SY. 1. 2. 3. 4.
T. J. DAVID D. G. J. BATTIN.
Papp, Z., Gardó, S. Lancet, 1971, i, 753. Gardner, L. I., Assemany, S. R., Neu, R. L. ibid. 1971, ii, 98. Kučera, J. ibid. Jan. 29, 1972, p. 260. Warkany, J. Congenital Malformations. Chicago, 1971.
Fig. 2-Electron micrograph illustrating epithelial deposit (D). Osmium-tetroxide fixation, uranyl-acetate and lead-citrate stains
(reduced tofrom x 9000).
microscopic haEmaturia and proteinuria. Renal biopsy at that time demonstrated diffuse increase in mesangial matrical material and slight glomerular hypercellularity. The Jones silver stain demonstrated subepithelial deposits of silver-positive material in the basement membrane of peripheral capillary walls (fig. 1). Tubules and interstitium were unremarkable. Biopsy 8 months later revealed similar changes by light microscopy. The patient is now in remission. 1. 2. 3.
Rosen, S. Hum. Path. 1971, 2, 209. Jones, D. Am.J. Path. 1957, 33, 313. Mostofi, F. K., Antonvych, T. A., Limas, E. Hum. Path. 1971, 2, 233.