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NEUROLOGICAL SEQUELÆ OF SPINAL AND EXTRADURAL ANALGESIA
1066
degree of
accuracy will
t7tiifi rha
mptpr
depend
upon the clinical
use
for
ie intpntit-ii
in the overall maintenance of this disease in The Swann report sketched the lines that should be followed to control the animal disease. Its conscientious implementation would contribute much to the elimination of this troublesome problem.
important man.
J. M. DAVISON G. A. CHEYNE H. M. GIBSON T. LIND.
M.R.C. Reproduction and Growth Unit, Princess Mary Maternity Hospital, Newcastle upon Tyne NE2 3BD.
Enteric Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London N.W.9.
E. S.
ANDERSON, Director.
NEUROLOGICAL SEQUELÆ OF SPINAL AND EXTRADURAL ANALGESIA
SiR,—In
recent years
there has been
an
increase in the
spinal and extradural (lumbar and sacral) analgesia in surgery, obstetrics, and physical medicine. In an effort to determine to what extent these techniques may be associated with neurological sequelae the council of the use
Association of Anaesthetists of Great Britain and Ireland has appointed a small committee to collect details of any such complications. May I appeal through your columns to all workers in whose practices such events occur, and for which records are available, to write to the honorary secretary of the " Association for a neurological sequelae form, which should be completed as fully as possible and returned. It is important that all cases are reported, no matter how minor the neurological deficit that has occurred and irrespective of whether this deficit is thought to be actually caused by the procedure or just associated with it. The information about individual cases will be regarded If this project as strictly confidential by the committee. results in the collection of interesting and significant facts, "
the results will be Room
published.
126,
Tavistock House North, Tavistock Square, London WC1H 9HR.
J. ALFRED LEE, President, Association of Anæsthetists of Great Britain and Ireland.
SALMONELLOSIS IN LIVESTOCK
SiR,—There is a slight error in Dr. Farr’s letter of 29 (p. 968). Human salmonellosis as such is not notifiable, but food-poisoning is, and about two-thirds of this is caused by salmonellx. In effect, the apparent notification anomaly makes little difference to the study of human salmonellosis, because of the full coverage of this disease in man. There is a continuous exchange of information about salmonellosis between bacteriologists, clinicians,
April
and medical officers of health. The Public Health Laboratory Service plays an important part, both in carrying out field and laboratory investigations, and in circulating data about human salmonella infections at the local and national level. It also collaborates with the Animal Health Division of the Ministry of Agriculture, again at the local and national level, in correlating human infection with its animal sources. I understand that legislation is pending which will make animal communicable diseases such as salmonellosis notifiable. But this will not contribute materially to the elimination of animal salmonellosis unless it is backed by implementation of the Swann Committee1 recommendations on the creation of veterinary equivalents of medical officers of health, and the general improvement and expansion of facilities for the laboratory and epidemiological study of infectious diseases in animals. Livestock are the reservoir of human salmonellosis, and if the animal infection can be eliminated, or at least substantially reduced, human infection will dwindle commensurately, because human-to-human spread is un1.
COFFEE AND BLADDER CANCER
of
Joint Committee on the Use of Antibiotics in Animal Husbandry and Veterinary Medicine. Cmnd. 4190. H.M. Stationery Office, 1969.
SIR,-An epidemiological study by Dr. Philip Cole1 suggests an association between coffee drinking and bladderrisk. Fraumeni and his colleagues2 and Dunham and associates,3 upon recomputation of their data using the statistical methods employed by Dr. Cole, also found an association in Negro women between coffee drinking and bladder cancer. However, a lack of dose/response relationship and other inconsistencies were noted by both groups, which led Fraumeni and his colleagues to the conclusion that the association was probably non-causal. We submit our observations on bladder pathology in rats, which are part of a study undertaken to define the chronic toxic and oncogenic potential of instant coffee. Instant-coffee solids were administered for 2 years to Sprague-Dawley male and female rats, starting as 21-dayold weanlings. The instant coffee was incorporated into Wayne Laboratory Chow at a concentration of 5-0%. The caffeine content of the instant coffee was 3-6%, thus providing a dietary concentration of 0-18% caffeine. The instant-coffee level was chosen on the basis of preliminary studies undertaken to define the maximum dose accepted by the rat without obvious food refusal. On a weight basis, the rats consumed the equivalent of a man drinking 85 cups of strong coffee daily (150 ml. cups, each cup containing 2-2 g. instant-coffee solids and 79 mg. caffeine, or a total of 6-7 g. caffeine). 144 males and 144 females A basic-diet control group were used as test animals. contained 41 males and 41 females. Necropsies and histopathological examinations were conducted in all animals which died during the study and in survivors killed after 2 years. The bladders of 94 males and 99 females in the test group and 29 males and 29 females in the control group were examined. None of the urinary bladders of animals examined showed abnormalities related to the coffee diet. Only coincidental bladder changes were noted, and in no case was a tumour found. Hyperplasia of the bladder epithelium was not seen, and only 1 rat, a control, had bladder stones. Persistent hyperplasia and bladder calculi have been implicated as predisposing factors in bladder-tumour induction.4 Thus, no instant-coffee-related bladder tumours were noted in rats which had been fed diets containing as much as 5% instantcoffee solids over the major portion of the lifespan at a dosage level equivalent to the consumption, by a man, of cancer
85 cups per day. We must conclude that the association between coffee consumption and bladder cancer suggested by Dr. Cole and
Dr. Fraumeni is not supported by the results obtained from long-term feeding experiments in rats. Corporate Research Department, General Foods Corporation, Technical Center, White Plains, New York 10625, U.S.A. 1. 2. 3. 4.
BENJAMIN R.
ZEITLIN.
Cole, P. Lancet, 1971, i, 1335. Fraumeni, J. F., Scotto, J., Dunham, L. J. ibid. 1971, ii, 1204. Dunham, L. J., Rabson, A. S., Stewart, H. L., Frank, A. S. Young, J. L., Jr. J. natn. Cancer Inst. 1971, 41, 683. British Industrial Biological Research Association (B.I.B.R.A.). Counting " Lumps " in the Rodent Bladder; vol. 10, no. 7, p. 317, 1971.
degree of
accuracy will
t7tiifi rha
mptpr
depend
upon the clinical
use
for
ie intpntit-ii
in the overall maintenance of this disease in The Swann report sketched the lines that should be followed to control the animal disease. Its conscientious implementation would contribute much to the elimination of this troublesome problem.
important man.
J. M. DAVISON G. A. CHEYNE H. M. GIBSON T. LIND.
M.R.C. Reproduction and Growth Unit, Princess Mary Maternity Hospital, Newcastle upon Tyne NE2 3BD.
Enteric Reference Laboratory, Central Public Health Laboratory, Colindale Avenue, London N.W.9.
E. S.
ANDERSON, Director.
NEUROLOGICAL SEQUELÆ OF SPINAL AND EXTRADURAL ANALGESIA
SiR,—In
recent years
there has been
an
increase in the
spinal and extradural (lumbar and sacral) analgesia in surgery, obstetrics, and physical medicine. In an effort to determine to what extent these techniques may be associated with neurological sequelae the council of the use
Association of Anaesthetists of Great Britain and Ireland has appointed a small committee to collect details of any such complications. May I appeal through your columns to all workers in whose practices such events occur, and for which records are available, to write to the honorary secretary of the " Association for a neurological sequelae form, which should be completed as fully as possible and returned. It is important that all cases are reported, no matter how minor the neurological deficit that has occurred and irrespective of whether this deficit is thought to be actually caused by the procedure or just associated with it. The information about individual cases will be regarded If this project as strictly confidential by the committee. results in the collection of interesting and significant facts, "
the results will be Room
published.
126,
Tavistock House North, Tavistock Square, London WC1H 9HR.
J. ALFRED LEE, President, Association of Anæsthetists of Great Britain and Ireland.
SALMONELLOSIS IN LIVESTOCK
SiR,—There is a slight error in Dr. Farr’s letter of 29 (p. 968). Human salmonellosis as such is not notifiable, but food-poisoning is, and about two-thirds of this is caused by salmonellx. In effect, the apparent notification anomaly makes little difference to the study of human salmonellosis, because of the full coverage of this disease in man. There is a continuous exchange of information about salmonellosis between bacteriologists, clinicians,
April
and medical officers of health. The Public Health Laboratory Service plays an important part, both in carrying out field and laboratory investigations, and in circulating data about human salmonella infections at the local and national level. It also collaborates with the Animal Health Division of the Ministry of Agriculture, again at the local and national level, in correlating human infection with its animal sources. I understand that legislation is pending which will make animal communicable diseases such as salmonellosis notifiable. But this will not contribute materially to the elimination of animal salmonellosis unless it is backed by implementation of the Swann Committee1 recommendations on the creation of veterinary equivalents of medical officers of health, and the general improvement and expansion of facilities for the laboratory and epidemiological study of infectious diseases in animals. Livestock are the reservoir of human salmonellosis, and if the animal infection can be eliminated, or at least substantially reduced, human infection will dwindle commensurately, because human-to-human spread is un1.
COFFEE AND BLADDER CANCER
of
Joint Committee on the Use of Antibiotics in Animal Husbandry and Veterinary Medicine. Cmnd. 4190. H.M. Stationery Office, 1969.
SIR,-An epidemiological study by Dr. Philip Cole1 suggests an association between coffee drinking and bladderrisk. Fraumeni and his colleagues2 and Dunham and associates,3 upon recomputation of their data using the statistical methods employed by Dr. Cole, also found an association in Negro women between coffee drinking and bladder cancer. However, a lack of dose/response relationship and other inconsistencies were noted by both groups, which led Fraumeni and his colleagues to the conclusion that the association was probably non-causal. We submit our observations on bladder pathology in rats, which are part of a study undertaken to define the chronic toxic and oncogenic potential of instant coffee. Instant-coffee solids were administered for 2 years to Sprague-Dawley male and female rats, starting as 21-dayold weanlings. The instant coffee was incorporated into Wayne Laboratory Chow at a concentration of 5-0%. The caffeine content of the instant coffee was 3-6%, thus providing a dietary concentration of 0-18% caffeine. The instant-coffee level was chosen on the basis of preliminary studies undertaken to define the maximum dose accepted by the rat without obvious food refusal. On a weight basis, the rats consumed the equivalent of a man drinking 85 cups of strong coffee daily (150 ml. cups, each cup containing 2-2 g. instant-coffee solids and 79 mg. caffeine, or a total of 6-7 g. caffeine). 144 males and 144 females A basic-diet control group were used as test animals. contained 41 males and 41 females. Necropsies and histopathological examinations were conducted in all animals which died during the study and in survivors killed after 2 years. The bladders of 94 males and 99 females in the test group and 29 males and 29 females in the control group were examined. None of the urinary bladders of animals examined showed abnormalities related to the coffee diet. Only coincidental bladder changes were noted, and in no case was a tumour found. Hyperplasia of the bladder epithelium was not seen, and only 1 rat, a control, had bladder stones. Persistent hyperplasia and bladder calculi have been implicated as predisposing factors in bladder-tumour induction.4 Thus, no instant-coffee-related bladder tumours were noted in rats which had been fed diets containing as much as 5% instantcoffee solids over the major portion of the lifespan at a dosage level equivalent to the consumption, by a man, of cancer
85 cups per day. We must conclude that the association between coffee consumption and bladder cancer suggested by Dr. Cole and
Dr. Fraumeni is not supported by the results obtained from long-term feeding experiments in rats. Corporate Research Department, General Foods Corporation, Technical Center, White Plains, New York 10625, U.S.A. 1. 2. 3. 4.
BENJAMIN R.
ZEITLIN.
Cole, P. Lancet, 1971, i, 1335. Fraumeni, J. F., Scotto, J., Dunham, L. J. ibid. 1971, ii, 1204. Dunham, L. J., Rabson, A. S., Stewart, H. L., Frank, A. S. Young, J. L., Jr. J. natn. Cancer Inst. 1971, 41, 683. British Industrial Biological Research Association (B.I.B.R.A.). Counting " Lumps " in the Rodent Bladder; vol. 10, no. 7, p. 317, 1971.