- Email: [email protected]
HYPERBILIRUBINÆMIA IN PREMATURE INFANTS
1195 the premature, 12 of whom had exchange transfusions; I believe they were the first reported cases of hyperbilirubinaEmia in the premature so treated. It was considered that vitamin K was not of xtiological importance in the production of hyperbilirubinasmia in the premature. From the study it was evident that hyperbilirubinxmia in the premature was more likely to occur in the infant of low gestation age, who was oedematous, and feeble at birth; attention was also drawn to the occurrence of hyperbilirubineemia in the infant of the diabetic mother. Since that time low gestation age and accompanying oedema have been consistently noted in these cases. To date 6 infants of diabetic mothers have had exchange transfusions at the National Maternity Hospital because of hyperbilirubinsmia. Department of Pædiatrics, Royal College of Surgeons
experiments I refer to consist in procuring the implantation of blastocysts in endometrium incubated as organ cultures. If this procedure is to be successful, it is pellucida before placing the blastocysts on the endometrium. This precludes any chance of granulosa cells being included in the explant, yet I can assure Dr. Gordon that both cyto- and syncytiotrophoblast develop in the cultures and that the trophonecessary to dissect off the
zona
blast shows definite invasive tendencies. Department of Anatomy, Charing Cross Hospital Medical School, London, W.C.2.
T. W. GLENISTER
MATERNAL INFLUENZA AND CONGENITAL DEFORMITY
SIR,-Dr. Acheson’s comments (April 30) on the investigation by Dr. Coffey and Professor Jessop are very much to the point, as well as being pointed, albeit in the wrong direction. His statements will help to dispel and dissipate some of the obfuscation and obnubilation that often surround clinical investigations which present
conflicting opinions. There is little with which to quarrel in Dr. Acheson’s remarks,except with respect to the allegation concerning the inference I made, which resulted in my committing an error ". "
"
"
I wish to assure him that I, for my part, made no inferences concerning the findings of Coffey and Jessop, nor, for that matter, concerning those of the Iowa and Los Angeles groups. It was my purpose solely to record faithfully, and so direct attention to, seemingly conflicting views as they were reported in the medical literature. Surely, Dr. Acheson does not feel I erred when I questioned the validity of including in the study patients in whom the diagnosis of influenza was established on the basis of the answer they gave to the query, " Have you had influenza during this pregnancy ?" Dr. Acheson’s precise account of just some of the many factors involved in epidemiological investigations would lead one to assume that he himself would be reluctant to sanction such a technique. Consequently, I fail to understand just where I committed the error to which Dr. Acheson alludes. Perhaps there were other criteria for diagnosis in the Dublin investigation that were not reported. The truth of my original statements (Jan. 9), composed as they were essentially of excerpts from already documented investigations, cannot be denied, any more than Dr. Acheson can deny that the conflict in opinion, as originally reported in the literature, exists. As for his attack on my position in the matter, I simply took no position, having been too thoroughly conditioned by the smoking and cranberry crises to permit myself to draw inferences as to cause and effect relationships. Any implications that are imputed to me must depend for their validity solely on data already reported in the literature. Paradoxically enough, Dr. Acheson in admirable fashion, by delineating so lucidly the complexity of the planning necessary in controlled studies, lends immeasurable strength to my contention that conclusions as to teratogenic effects of disease must be made with the utmost caution. This essentially was the only implication I intended, and pari passu, the only inference that he should have derived from my comments. Dr. Acheson’s comments are indeed welcome, as well as informative, because he himself planned the early stages of the Tlnhlin "1"11r1.r Seaside Memorial Hospital of Long Beach, Long Beach, California.
SIR,-Iagree with the summary of Dr. Corner and her colleagues that the development of hyperbilirubinxmia in premature infants is directly related to the gestation age. reported1 1.
SHEAMUS DUNDON.
DEATHS FROM LUNG CANCER
SiR,ŁThe number of deaths from lung cancer for 1958, published recently, was 19,820, including 17,040 males. The 1948 figures for " respiratory cancer " were 9465 males and 2158 females. It seems that the male-tofemale ratio has considerably increased. If smoking is the cause and if it is accepted that more women are now smoking than used to, one would expect this ratio to decrease instead of increase. What have the statisticians to say ? S. HULME. Sutton, Surrey. CRYPTOGENIC LIVER ABSCESS
SIR,-Iwas very interested to read Dr. Stokes’ paper of Feb. 13. In England the population may normally be " presumed to be not at risk of amoebic infection, but conditions here are the reverse because amoebic infection is so widespread. It is my impression that in the many liver abscesses seen, the non-amoebic pyogenic abscess is by no means uncommon. The amoebic and non-amoebic varieties of abscess are distinguished by the naked-eye characteristics of the pus, since amoeba: are usually not recovered even from known amoebic abscesses, and cultures have been negative even from clearcut pyogenic abscesses-possibly because of antibiotic treatment given before drainage. I have operated on 3 such cases during the past five years "
in which the pus was distinctly white or whitish yellow and therefore left no doubt that the abscesses were non-amoebic. There was no history or other evidence of infection in the area of drainage of the portal vein, and all the patients recovered after drainage and antibiotic treatment. All were " solitary " abscesses, so that a single liver abscess is by no means synonymous with amoebic abscess, as stated in some textbooks. A healthy Englishman, an athletic outdoor type of 50, developed
right upper abdominal pain with severe toxaemia and congestion right lung base. He had a corresponding leucocytosis. Treatment with emetine, penicillin, and, later, broad-spectrum antibiotics did not bring remission. Drainage through the bed of the 12th rib led to an abscess cavity about 2 in. x 2 in. containing white sterile pus. A smear showed only pus cells, no organisms. While convalescing, he had a brisk mel2ena, which needed a blood-transfusion. Subsequent radiological examination of the gastrointestinal tract, and cholecystographic and urographic studies showed no abnormality. Frequent stool examinations were negative for ova or cysts throughout the illness. He made a complete recovery, and rejected the advice to leave the country, given on the suspicion that he may have contracted a tropical " disease and that stay in the tropics may be prejudicial to acute
of the
"
GEORGE X. TRIMBLE.
HYPERBILIRUBINÆMIA IN PREMATURE INFANTS
In 1956 I
in Ireland Medical School, National Maternity Hospital, Dublin.
22 cases of hyperbilirubinxmia in J. Irish med. Ass. 1956, 38, 99.
his health. He has been well without any trace of recurrence of bowel or other symptoms almost five years after his illness.
This patient suffered from a clearcut acute infection resulting in a pyogenic liver abscess, and a haemorrhage from the bowel. Could he have had a silent ulcer of the terminal ileum, which led to a metastatic liver abscess, and later haemorrhage ? My colleagues and I have seen a number of cases of solitary ulcers in the terminal ileum which have presented for the first time
experiments I refer to consist in procuring the implantation of blastocysts in endometrium incubated as organ cultures. If this procedure is to be successful, it is pellucida before placing the blastocysts on the endometrium. This precludes any chance of granulosa cells being included in the explant, yet I can assure Dr. Gordon that both cyto- and syncytiotrophoblast develop in the cultures and that the trophonecessary to dissect off the
zona
blast shows definite invasive tendencies. Department of Anatomy, Charing Cross Hospital Medical School, London, W.C.2.
T. W. GLENISTER
MATERNAL INFLUENZA AND CONGENITAL DEFORMITY
SIR,-Dr. Acheson’s comments (April 30) on the investigation by Dr. Coffey and Professor Jessop are very much to the point, as well as being pointed, albeit in the wrong direction. His statements will help to dispel and dissipate some of the obfuscation and obnubilation that often surround clinical investigations which present
conflicting opinions. There is little with which to quarrel in Dr. Acheson’s remarks,except with respect to the allegation concerning the inference I made, which resulted in my committing an error ". "
"
"
I wish to assure him that I, for my part, made no inferences concerning the findings of Coffey and Jessop, nor, for that matter, concerning those of the Iowa and Los Angeles groups. It was my purpose solely to record faithfully, and so direct attention to, seemingly conflicting views as they were reported in the medical literature. Surely, Dr. Acheson does not feel I erred when I questioned the validity of including in the study patients in whom the diagnosis of influenza was established on the basis of the answer they gave to the query, " Have you had influenza during this pregnancy ?" Dr. Acheson’s precise account of just some of the many factors involved in epidemiological investigations would lead one to assume that he himself would be reluctant to sanction such a technique. Consequently, I fail to understand just where I committed the error to which Dr. Acheson alludes. Perhaps there were other criteria for diagnosis in the Dublin investigation that were not reported. The truth of my original statements (Jan. 9), composed as they were essentially of excerpts from already documented investigations, cannot be denied, any more than Dr. Acheson can deny that the conflict in opinion, as originally reported in the literature, exists. As for his attack on my position in the matter, I simply took no position, having been too thoroughly conditioned by the smoking and cranberry crises to permit myself to draw inferences as to cause and effect relationships. Any implications that are imputed to me must depend for their validity solely on data already reported in the literature. Paradoxically enough, Dr. Acheson in admirable fashion, by delineating so lucidly the complexity of the planning necessary in controlled studies, lends immeasurable strength to my contention that conclusions as to teratogenic effects of disease must be made with the utmost caution. This essentially was the only implication I intended, and pari passu, the only inference that he should have derived from my comments. Dr. Acheson’s comments are indeed welcome, as well as informative, because he himself planned the early stages of the Tlnhlin "1"11r1.r Seaside Memorial Hospital of Long Beach, Long Beach, California.
SIR,-Iagree with the summary of Dr. Corner and her colleagues that the development of hyperbilirubinxmia in premature infants is directly related to the gestation age. reported1 1.
SHEAMUS DUNDON.
DEATHS FROM LUNG CANCER
SiR,ŁThe number of deaths from lung cancer for 1958, published recently, was 19,820, including 17,040 males. The 1948 figures for " respiratory cancer " were 9465 males and 2158 females. It seems that the male-tofemale ratio has considerably increased. If smoking is the cause and if it is accepted that more women are now smoking than used to, one would expect this ratio to decrease instead of increase. What have the statisticians to say ? S. HULME. Sutton, Surrey. CRYPTOGENIC LIVER ABSCESS
SIR,-Iwas very interested to read Dr. Stokes’ paper of Feb. 13. In England the population may normally be " presumed to be not at risk of amoebic infection, but conditions here are the reverse because amoebic infection is so widespread. It is my impression that in the many liver abscesses seen, the non-amoebic pyogenic abscess is by no means uncommon. The amoebic and non-amoebic varieties of abscess are distinguished by the naked-eye characteristics of the pus, since amoeba: are usually not recovered even from known amoebic abscesses, and cultures have been negative even from clearcut pyogenic abscesses-possibly because of antibiotic treatment given before drainage. I have operated on 3 such cases during the past five years "
in which the pus was distinctly white or whitish yellow and therefore left no doubt that the abscesses were non-amoebic. There was no history or other evidence of infection in the area of drainage of the portal vein, and all the patients recovered after drainage and antibiotic treatment. All were " solitary " abscesses, so that a single liver abscess is by no means synonymous with amoebic abscess, as stated in some textbooks. A healthy Englishman, an athletic outdoor type of 50, developed
right upper abdominal pain with severe toxaemia and congestion right lung base. He had a corresponding leucocytosis. Treatment with emetine, penicillin, and, later, broad-spectrum antibiotics did not bring remission. Drainage through the bed of the 12th rib led to an abscess cavity about 2 in. x 2 in. containing white sterile pus. A smear showed only pus cells, no organisms. While convalescing, he had a brisk mel2ena, which needed a blood-transfusion. Subsequent radiological examination of the gastrointestinal tract, and cholecystographic and urographic studies showed no abnormality. Frequent stool examinations were negative for ova or cysts throughout the illness. He made a complete recovery, and rejected the advice to leave the country, given on the suspicion that he may have contracted a tropical " disease and that stay in the tropics may be prejudicial to acute
of the
"
GEORGE X. TRIMBLE.
HYPERBILIRUBINÆMIA IN PREMATURE INFANTS
In 1956 I
in Ireland Medical School, National Maternity Hospital, Dublin.
22 cases of hyperbilirubinxmia in J. Irish med. Ass. 1956, 38, 99.
his health. He has been well without any trace of recurrence of bowel or other symptoms almost five years after his illness.
This patient suffered from a clearcut acute infection resulting in a pyogenic liver abscess, and a haemorrhage from the bowel. Could he have had a silent ulcer of the terminal ileum, which led to a metastatic liver abscess, and later haemorrhage ? My colleagues and I have seen a number of cases of solitary ulcers in the terminal ileum which have presented for the first time