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A FOREIGN BODY IN THE BLADDER
1124
There is evidence that blood-pressure and cardiac out- stricture. No further investigations were considered necessary put are maintained at 31°C, and the oxygen requirements in view of his general condition. Under anaesthesia, passage of a of the tissues are considerably reduced. Two practical bougie revealed no stricture, but touched a hard object in the X-rays (fig. 1) showed a sewing needle about 1112 in. points are noteworthy. Metabolism which is raised in bladder.encrusted with phosphate stone (fig. 2). This was cardiac failure is lowered, and consequently the rate at long, ’removed suprapubically, and complete closure with pursewhich drugs are detoxicated is also slowed; dosage is string suture done. The fistula opened into the prostatic approximately halved for a 5°C fall in temperature. Also urethra. at reduced temperatures coagulation times are prolonged; Careful questioning gave no indication as to how the needle this can be an adverse factor in surgery but in cyanotic had entered the bladder. Presumably it entered accidentally congenital heart-disease it may reduce the tendency to via the perineum and prostatic urethra into the bladder. thrombosis. Civil Hospital, SAID AHMAD Karachi, Hypothermia has a place in the treatment of desperately GHULAM NABI SHEIKH. Pakistan. ill babies with cardiac failure. It is particularly useful TINEA PEDIS when there is no structural anomaly (paroxysmal tachyin your editorial of April 14. interested was SIR,-I very cardia, myocarditis, &c.) or as a preoperative measure. I would disagree that " tinea pedis is almost unknown in Children’s Department, A. ROBINSON St. Thomas’s Hospital, races who go barefoot". It is probably more common in them DENNIS COTTOM. London, S.E.1.
ANTI-HISTAMINES IN MEASLES SIR,-Dr. Easton and Dr. McLean (March 10) report favourable results with anti-histamines in measles, as well as in chickenpox and burns. They refer only to Zollo1 on the use of anti-histamines in the exanthemata. Some additional reports 2-7 have been published on the use of anti-histamines in chickenpox. How much of this benefit is due to sedation, placebo action, or chance, rather than to anti-histamine activity ? A well-designed double-blind study is still needed to answer this question. HARRY WIENER. Brooklyn, New York. A FOREIGN BODY IN THE BLADDER
SIR,-We were interested to read Mr. Southam’s letter (Jan. 27) describing an unusual foreign body in the bladder. The following case may also be of interest. An 18-yearold millhand complained of frequency of micturition for about 1 year followed by
suprapubic pain and transitory retention.
After 4
asymptomatic months
he
developed
an
abscess in the
perineum which later gave rise to
a
urinary fistula. He had Fig. 1.
no
other urinary symptoms. He was
with
admitted a pre-
sumptivee diagnosis of gonococcal stricture and fistula above the
urinary 1. 2. 3. 4. 5. 6. 7.
Fig. 2. Zollo, M., Pandolfelli, P., Marrocco, S. Policlinico, 1953, 60, Gross, L. Schweiz. med. Wschr. 1948, 78, 159. Silverman, L. B. J. Pediat. 1949, 35, 442. Carneiro, O. Folia med., Rio, 1952, 33, 48. Kalmansohn, R. B. U.S. Forces med. J. 1953, 4, 937.
Watson, G. I. Brit. med. J. 1957, i, 39. Perkins, M. V. ibid. p. 1184.
625.
because communal bathrooms, floors, &c., are the sources of infection. An added factor in the tropics may be excessive sweating and unclean feet. In temperate climates, shoes and socks may also help to spread infection. Secondary bacterial infection (commonly with Staphylococcus aureus) is, in fact, a great problem in the tropics. Penicillin is necessary as well as the local application of Castellani’s paint or Whitfield’s ointment. I have often found potassium permanganate useful in the early stages. In the tropics the disease tends to become chronic. Our patients walk barefoot or wear sandals and their feet are exposed to bacteria, moisture, rain, and dust which keeps the infection chronic, and the lesions form a good nidus for secondary bacterial infection. Effia Nkwanta Hospital, P. RABINDRAN. Sekondi, Ghana.
CANCER
windmills is an exhilarating exercise SiR,-Tilting but solves no problems. Professor Smithers’ article (March 10) reads well and contains some resounding some of which I find ambiguous. For example, phrases " Cancer is no more a disease of cells than a traffic jam is a disease of cars." This may be true, but traffic jams are sometimes due to accidents caused by bad driving and a prevalent disease of cars is bad drivers. Professor Smithers says: " It is difficult to know what picture fills the minds of cancer research-workers." If he can spare the time to read Cancer, I think he will have no difficulty in seeing how it appears to me. May I quote from my final paragraph: The argument is advocated that the cancer cell is not necessarily itself diseased, though it constitutes a disease for the multicellular community of which it forms a part. It has adopted a different rhythm from that of its predecessors, it lives, not without law, but under different laws, which it has been obliged to adopt in order to survive, regardless of the consequences. Cells can be sent on this downward path by many means, any of which can be called carcinogenesis ; the common factor in their subsequent behaviour is cancer." at
.
"
Where is the " conventional theory ", to which Professor Smithers repeatedly refers, to be found ? I for one do not recognise it as presented by him. It is credited with a number of postulates which he demolishes with great gusto. To take one example: " The cancer cell, once admitted as having arrived, has then to be granted permission to become more and more cancerous. The single specific change of conventional theory will not do alone ..." and so on. I see no reason why changes, whatever their essential nature, which convert a cell from normal to malignant behaviour, should not operate similarly to make a malignant cell behave more malignly. What Professor Smithers does not apparently perceive is that this kind of change is very exceptional and is recognised only because of the characteristic proliferation of the affected cells. Thus, when millions of cells are exposed to a carcino1.
Cancer; vol. 1, ch. 4, p. 32. London,
1957.
There is evidence that blood-pressure and cardiac out- stricture. No further investigations were considered necessary put are maintained at 31°C, and the oxygen requirements in view of his general condition. Under anaesthesia, passage of a of the tissues are considerably reduced. Two practical bougie revealed no stricture, but touched a hard object in the X-rays (fig. 1) showed a sewing needle about 1112 in. points are noteworthy. Metabolism which is raised in bladder.encrusted with phosphate stone (fig. 2). This was cardiac failure is lowered, and consequently the rate at long, ’removed suprapubically, and complete closure with pursewhich drugs are detoxicated is also slowed; dosage is string suture done. The fistula opened into the prostatic approximately halved for a 5°C fall in temperature. Also urethra. at reduced temperatures coagulation times are prolonged; Careful questioning gave no indication as to how the needle this can be an adverse factor in surgery but in cyanotic had entered the bladder. Presumably it entered accidentally congenital heart-disease it may reduce the tendency to via the perineum and prostatic urethra into the bladder. thrombosis. Civil Hospital, SAID AHMAD Karachi, Hypothermia has a place in the treatment of desperately GHULAM NABI SHEIKH. Pakistan. ill babies with cardiac failure. It is particularly useful TINEA PEDIS when there is no structural anomaly (paroxysmal tachyin your editorial of April 14. interested was SIR,-I very cardia, myocarditis, &c.) or as a preoperative measure. I would disagree that " tinea pedis is almost unknown in Children’s Department, A. ROBINSON St. Thomas’s Hospital, races who go barefoot". It is probably more common in them DENNIS COTTOM. London, S.E.1.
ANTI-HISTAMINES IN MEASLES SIR,-Dr. Easton and Dr. McLean (March 10) report favourable results with anti-histamines in measles, as well as in chickenpox and burns. They refer only to Zollo1 on the use of anti-histamines in the exanthemata. Some additional reports 2-7 have been published on the use of anti-histamines in chickenpox. How much of this benefit is due to sedation, placebo action, or chance, rather than to anti-histamine activity ? A well-designed double-blind study is still needed to answer this question. HARRY WIENER. Brooklyn, New York. A FOREIGN BODY IN THE BLADDER
SIR,-We were interested to read Mr. Southam’s letter (Jan. 27) describing an unusual foreign body in the bladder. The following case may also be of interest. An 18-yearold millhand complained of frequency of micturition for about 1 year followed by
suprapubic pain and transitory retention.
After 4
asymptomatic months
he
developed
an
abscess in the
perineum which later gave rise to
a
urinary fistula. He had Fig. 1.
no
other urinary symptoms. He was
with
admitted a pre-
sumptivee diagnosis of gonococcal stricture and fistula above the
urinary 1. 2. 3. 4. 5. 6. 7.
Fig. 2. Zollo, M., Pandolfelli, P., Marrocco, S. Policlinico, 1953, 60, Gross, L. Schweiz. med. Wschr. 1948, 78, 159. Silverman, L. B. J. Pediat. 1949, 35, 442. Carneiro, O. Folia med., Rio, 1952, 33, 48. Kalmansohn, R. B. U.S. Forces med. J. 1953, 4, 937.
Watson, G. I. Brit. med. J. 1957, i, 39. Perkins, M. V. ibid. p. 1184.
625.
because communal bathrooms, floors, &c., are the sources of infection. An added factor in the tropics may be excessive sweating and unclean feet. In temperate climates, shoes and socks may also help to spread infection. Secondary bacterial infection (commonly with Staphylococcus aureus) is, in fact, a great problem in the tropics. Penicillin is necessary as well as the local application of Castellani’s paint or Whitfield’s ointment. I have often found potassium permanganate useful in the early stages. In the tropics the disease tends to become chronic. Our patients walk barefoot or wear sandals and their feet are exposed to bacteria, moisture, rain, and dust which keeps the infection chronic, and the lesions form a good nidus for secondary bacterial infection. Effia Nkwanta Hospital, P. RABINDRAN. Sekondi, Ghana.
CANCER
windmills is an exhilarating exercise SiR,-Tilting but solves no problems. Professor Smithers’ article (March 10) reads well and contains some resounding some of which I find ambiguous. For example, phrases " Cancer is no more a disease of cells than a traffic jam is a disease of cars." This may be true, but traffic jams are sometimes due to accidents caused by bad driving and a prevalent disease of cars is bad drivers. Professor Smithers says: " It is difficult to know what picture fills the minds of cancer research-workers." If he can spare the time to read Cancer, I think he will have no difficulty in seeing how it appears to me. May I quote from my final paragraph: The argument is advocated that the cancer cell is not necessarily itself diseased, though it constitutes a disease for the multicellular community of which it forms a part. It has adopted a different rhythm from that of its predecessors, it lives, not without law, but under different laws, which it has been obliged to adopt in order to survive, regardless of the consequences. Cells can be sent on this downward path by many means, any of which can be called carcinogenesis ; the common factor in their subsequent behaviour is cancer." at
.
"
Where is the " conventional theory ", to which Professor Smithers repeatedly refers, to be found ? I for one do not recognise it as presented by him. It is credited with a number of postulates which he demolishes with great gusto. To take one example: " The cancer cell, once admitted as having arrived, has then to be granted permission to become more and more cancerous. The single specific change of conventional theory will not do alone ..." and so on. I see no reason why changes, whatever their essential nature, which convert a cell from normal to malignant behaviour, should not operate similarly to make a malignant cell behave more malignly. What Professor Smithers does not apparently perceive is that this kind of change is very exceptional and is recognised only because of the characteristic proliferation of the affected cells. Thus, when millions of cells are exposed to a carcino1.
Cancer; vol. 1, ch. 4, p. 32. London,
1957.