- Email: [email protected]
PLEOCYTOSIS AFTER IRON DEXTRAN INJECTION
1428 to go he could be discharged. The second patient is a married man of 44 who was subject to attacks of violent mania which necessitated his detention in a locked ward. His periods of normality were short but he never had any depressive episodes. He was started on lithium carbonate during a period of normality 10 months ago, since when no further attacks of mania have occurred. He has been discharged on regular lithium, and he is supporting his wife and children. In this case also, no adverse side-effects have so far been encountered.
somewhere
A. W.
J. HOUGHTON.
DERMATOGLYPHICS IN PARTIAL C TRISOMIES SIR,-Dr. Hall (April 20, p. 860) expresses interest regarding " unpublished cases of fingertip patterns with six arches in persons without E trisomy ". We have recently observed a 7-year-old girl with oligophreny and most of the somatic aspects of the osteodystrophy of Albright, type n, or pseudopseudohypoparathyroidism (round facies, dwarfism below 3rd percentile with overweight, and short distal-phalanges with a very high nail-index). The distal phalanx of the fingers and toes were very small (in the 1st digit the size was roughly that of a 21/2-year old), and the nails also were very short. The nail-index was greater than 5 (normal 1-1-1-4 1). Remarkably 20 arches were present on the fingers and toes. As a child she had had many convulsions. The clinical features of her mother and 4 uncles also were suggestive of this syndrome. They were oligophrenic and epileptic. They were not cooperative, however. The dermatoglyphics of the patient’s parents were examined : the mother had 9 loops and 1 whorl, and the father 8 loops, 1 whorl, and 1 arch. The child had a normal 46, XX karyotype; a clearly marked satellite was seen on one of the G chromosomes in 6 of 7 karyotypes. Forbes2 has noted
an
pseudohypoparathyroidism
increased incidence of arches in and
pseudopseudohypoparathy-
increased number of arches, although not pathognomonic or an essential feature, can be a valuable aid in the diagnosis of the osteodystrophy of Albright, types i and 11. One could imagine that the triad of short distal phalanges, hypoplasia of the nails, and increased number of arches on the fingers and toes, are related to one another, all three occurring as a result of deficient embryonic development in this area.
roidism. We suggest also that
Maria Roepaan Institute for Mental Defectives, Ottersum, The Netherlands.
an
"
Department of Medical Genetics, City of Hope Medical Center, Duarte, California.
DAVID E. COMINGS.
PLEOCYTOSIS AFTER IRON DEXTRAN INJECTION SIR,-Recently an irritable, febrile (temperature 105°F, 406C), Caucasian, 10-month-old girl was admitted to our The previous evening she had been in her usual hospital. " good " health except for iron-deficiency anaemia (Hb 4-4 g. per 100 ml., white blood-cells [W.B.C.] 14,000), for which she C.S.F., AND TEMPERATURE RECORDINGS, AFTER INJECTION OF IMFERON IN A 10-MONTH-OLD GIRL
FINDINGS IN BLOOD AND
INTRAAtL’SCL’LAR
P. H. JONGBLOET C. VAN KEMPEN.
SIR,-Dr. Verbov (May 18, p. 1090) in reply to Dr. Hall’s request for information on individuals " with six arches " comments that he found 5 females with six or more arches among 104 individuals with alopecia areata. I should like to add information on 5 individuals. 2 have seven arches and normal 46, XY chromosomes, and 1 has six arches; all 3 are in a penal institution but otherwise clinically normal. 1 of my patients with Down’s syndrome (47 chromosomes with G1 trisomy) has six arches, and another normal individual in the control group has six arches. Since six or more arches are found in individuals with various clinical entities and normal individuals, it does not seem appropriate to associate this symptom with any disease at this time. Division of Medical Genetics, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
CANCER AND DERMATOGLYPHICS SiR,-It would be difficult to overemphasise the necessity for statistical caution about the recent letters on cancer and dermatoglyphics,2and for that matter about all dermatoglyphic studies. Because of the profusion of lines, angles, patterns, and counts which may be measured on two hands and ten fingers, the study of dermatoglyphics in relation to disease is uniquely endowed with a statistical pitfall into which many studies have fallen but from which few have recovered. This pitfall is the simple fact that the more correlations that are made the more likely it is that some will be found to be statistically significant. Thus, if a 5% level of significance is used, one out of twenty correlations will be statistically significant, on the average. Dr. Rosner,2 for example, studied 81 Caucasian and 44 Negro women with breast cancer. Twenty-eight correlations appear to have been made. It is not surprising that one was significant. A study of six other types of cancer was proposed. There will certainly be several " significant findings among these one hundred and sixty-eight correlations. If none were found, this statistical rarity might be worth publishing in its own right. The important point is not that these studies should not be done but rather that when a preliminary investigation is completed and several correlations observed, a completely new second study should be initiated to see whether the same correlation is significant the second time. Unfortunately, this vital second study is usually absent in dermatoglyphic reports.
D. S. BORGAONKAR.
1. Ray, E. W., Gardner, I.. I. Pediatrics, Springfield, 1959, 2. Forbes, A. P. New Engl. J. Med. 1964, 270, 1268.
23,
520.
had been given 1 ml. of iron dextran injection (’ Imferon’) intramuscularly. Her history was that of poor feeding and sudden onset of high fever 3-4 hours after imferon injection. Because the xtiology of the fever was unclear, a lumbar puncture (L.P.) was done on admission (see accompanying table). Since her condition apart from the fever was excellent, and her cerebrospinal fluid (C.S.F.) chemistry was normal, treatment was not begun. Subsequent L.P.s were performed in order to follow the progress of C.S.F. findings. Viral studies are being done. Leukasmoid reaction to intramuscular injection of imferon is well documented,S but we were unable to find any published record of the C.S.F. findings during such a reaction. THOMAS FORRISTAL Children’s Hospital, MARIAN WITT. Cincinnati, Ohio 45229. 1. Atasu, M., Telatar, H. Lancet, April 20, 1968, p. 861. 2. Rosner, F. ibid. May 25, 1968, p. 1156. 3. Helsel, E. V. Am. J. Obstet. Gynec. 1965, 91, 582.
somewhere
A. W.
J. HOUGHTON.
DERMATOGLYPHICS IN PARTIAL C TRISOMIES SIR,-Dr. Hall (April 20, p. 860) expresses interest regarding " unpublished cases of fingertip patterns with six arches in persons without E trisomy ". We have recently observed a 7-year-old girl with oligophreny and most of the somatic aspects of the osteodystrophy of Albright, type n, or pseudopseudohypoparathyroidism (round facies, dwarfism below 3rd percentile with overweight, and short distal-phalanges with a very high nail-index). The distal phalanx of the fingers and toes were very small (in the 1st digit the size was roughly that of a 21/2-year old), and the nails also were very short. The nail-index was greater than 5 (normal 1-1-1-4 1). Remarkably 20 arches were present on the fingers and toes. As a child she had had many convulsions. The clinical features of her mother and 4 uncles also were suggestive of this syndrome. They were oligophrenic and epileptic. They were not cooperative, however. The dermatoglyphics of the patient’s parents were examined : the mother had 9 loops and 1 whorl, and the father 8 loops, 1 whorl, and 1 arch. The child had a normal 46, XX karyotype; a clearly marked satellite was seen on one of the G chromosomes in 6 of 7 karyotypes. Forbes2 has noted
an
pseudohypoparathyroidism
increased incidence of arches in and
pseudopseudohypoparathy-
increased number of arches, although not pathognomonic or an essential feature, can be a valuable aid in the diagnosis of the osteodystrophy of Albright, types i and 11. One could imagine that the triad of short distal phalanges, hypoplasia of the nails, and increased number of arches on the fingers and toes, are related to one another, all three occurring as a result of deficient embryonic development in this area.
roidism. We suggest also that
Maria Roepaan Institute for Mental Defectives, Ottersum, The Netherlands.
an
"
Department of Medical Genetics, City of Hope Medical Center, Duarte, California.
DAVID E. COMINGS.
PLEOCYTOSIS AFTER IRON DEXTRAN INJECTION SIR,-Recently an irritable, febrile (temperature 105°F, 406C), Caucasian, 10-month-old girl was admitted to our The previous evening she had been in her usual hospital. " good " health except for iron-deficiency anaemia (Hb 4-4 g. per 100 ml., white blood-cells [W.B.C.] 14,000), for which she C.S.F., AND TEMPERATURE RECORDINGS, AFTER INJECTION OF IMFERON IN A 10-MONTH-OLD GIRL
FINDINGS IN BLOOD AND
INTRAAtL’SCL’LAR
P. H. JONGBLOET C. VAN KEMPEN.
SIR,-Dr. Verbov (May 18, p. 1090) in reply to Dr. Hall’s request for information on individuals " with six arches " comments that he found 5 females with six or more arches among 104 individuals with alopecia areata. I should like to add information on 5 individuals. 2 have seven arches and normal 46, XY chromosomes, and 1 has six arches; all 3 are in a penal institution but otherwise clinically normal. 1 of my patients with Down’s syndrome (47 chromosomes with G1 trisomy) has six arches, and another normal individual in the control group has six arches. Since six or more arches are found in individuals with various clinical entities and normal individuals, it does not seem appropriate to associate this symptom with any disease at this time. Division of Medical Genetics, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
CANCER AND DERMATOGLYPHICS SiR,-It would be difficult to overemphasise the necessity for statistical caution about the recent letters on cancer and dermatoglyphics,2and for that matter about all dermatoglyphic studies. Because of the profusion of lines, angles, patterns, and counts which may be measured on two hands and ten fingers, the study of dermatoglyphics in relation to disease is uniquely endowed with a statistical pitfall into which many studies have fallen but from which few have recovered. This pitfall is the simple fact that the more correlations that are made the more likely it is that some will be found to be statistically significant. Thus, if a 5% level of significance is used, one out of twenty correlations will be statistically significant, on the average. Dr. Rosner,2 for example, studied 81 Caucasian and 44 Negro women with breast cancer. Twenty-eight correlations appear to have been made. It is not surprising that one was significant. A study of six other types of cancer was proposed. There will certainly be several " significant findings among these one hundred and sixty-eight correlations. If none were found, this statistical rarity might be worth publishing in its own right. The important point is not that these studies should not be done but rather that when a preliminary investigation is completed and several correlations observed, a completely new second study should be initiated to see whether the same correlation is significant the second time. Unfortunately, this vital second study is usually absent in dermatoglyphic reports.
D. S. BORGAONKAR.
1. Ray, E. W., Gardner, I.. I. Pediatrics, Springfield, 1959, 2. Forbes, A. P. New Engl. J. Med. 1964, 270, 1268.
23,
520.
had been given 1 ml. of iron dextran injection (’ Imferon’) intramuscularly. Her history was that of poor feeding and sudden onset of high fever 3-4 hours after imferon injection. Because the xtiology of the fever was unclear, a lumbar puncture (L.P.) was done on admission (see accompanying table). Since her condition apart from the fever was excellent, and her cerebrospinal fluid (C.S.F.) chemistry was normal, treatment was not begun. Subsequent L.P.s were performed in order to follow the progress of C.S.F. findings. Viral studies are being done. Leukasmoid reaction to intramuscular injection of imferon is well documented,S but we were unable to find any published record of the C.S.F. findings during such a reaction. THOMAS FORRISTAL Children’s Hospital, MARIAN WITT. Cincinnati, Ohio 45229. 1. Atasu, M., Telatar, H. Lancet, April 20, 1968, p. 861. 2. Rosner, F. ibid. May 25, 1968, p. 1156. 3. Helsel, E. V. Am. J. Obstet. Gynec. 1965, 91, 582.