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DUPUYTREN'S CONTRACTURE
1226 WHICH SPATULA FOR CERVICAL CYTOLOGY?
SllR,-I
to support Dr Blenkinsopp and Mr Jenkins’ (Oct 25, p 986) about the need to change the shape of the traditional Ayre spatula on national issue in the UK to reduce the error rates in cervical cytology screening. As chairman of the British Society for Clinical Cytology, in 1976set up, with Dr E. Attwood (Birmingham), Dr E. B. Butler (Manchester), Dr H. Hughs (Glasgow), and Dr E. Macgregor (Aberdeen), a trial of a new spatula design. It had a broader head and a more pointed knuckle to take the shape of the transitional zone and enter the endocervical canal (see figure). A small preliminary trial was successful but the exercise failed through lack of further central support.
would like
comments
syphilis and scabies, cancer of the uterus was common in prostitutes. He noted that uterine damage was common in such women, many of whom died from this between the ages of 40 and
50, such deaths being
rare
among
non-prostitutes. He noted that
presented at the vulva. He commented that even then contemporary opinion as to the frequency of cancer of the womb tumours often
differed amongst clinicians. He also stated that old doctors had so the idea of a link between sexual intercourse and at least one form of cancer was not new even in the early 19th century.
given him these details,
Department of Genito-urinary Medicine, General Infirmary at Leeds,
M. A. WAUGH
Leeds LS1 3EX 1
Bnggs RM, Paavonen J. Cervical intraepithelial neoplasia. In Holmes KK, Mårdh PA, Sparling PF, Wiesner PJ, eds. Sexually transmitted diseases New York:
McGraw-Hill, 1984: 589. 2. Ackerknecht EH. Medicine in the Pans Hospital 1974-1848. Baltimore: Johns Hopkins Press, 1967. 3 Parent-Duchatelet AJB. De la prostitution dans la ville de Pans Brussels Etablissement Encyclographique, 1837 80-83
DUPUYTREN’S CONTRACTURE
SiR,—Your Aug 9 editorial on Dupuytren’s contracture cites my McIndoe memorial lecture and states that I have observed "that split skin grafts do not prevent recurrence of the disorder whereas whole-thickness grafts are more successful". Nowhere in that published lecture or anywhere else have I reported such an observation. The simple truth is that resurfacing with either split skin or whole-thickness grafts or even flaps from non-palmar skin does prevent recurrence of Dupuytren’s disease. Your editorialist has read "full thickness (Wolfe) graft is preferred to prevent wound bed contraction" and has confused wound bed contracture (that will happen anywhere in the body) with recurrence of Dupuytren’s contracture. While applauding your effort to shed the light of molecular biology and other disciplines on the study of Dupuytren’s contracture, I feel that an understanding of the principles of surgical pathology is essential. 89
Royal Parade, Parkville, Melbourne, Victoria 3052, Australia
Spatula shapes. traditional Ayre spatula; 2 spatula; 4 Lemer spatula. 1
=
=
Aylesbury spatula;
3
=
BSCC design
=
Prof Peter
Vooijs (Nijmegen, Netherlands) has also produced a anatomically designed blade, and he has achieved well over 80% of smears containing endocervical cells. Both designs were submitted to Dr Margaret Wolfendale (Stoke Mandeville Hospital) who, with our assistance, orchestrated a joint development between several cytology centres, Marks & Spencers, the Women’s National Cancer Control Campaign, and the Department of Health and Social Security. This has resulted in the Aylesbury spatula, an account of which will be published in the British AMa/yoMrM<2/. Since our original intention was to introduce an improved design for the national screening programme, we trust that the DHSS will urgently consider the matter of choice and introduce the most successful sampler at bulk purchase rates as the standard issue.
more
Regional Cytology Unit, Division of Pathology, St Stephen’s Hospital,
O. A. N. HUSAIN
London SW10 9TH
CERVICAL CANCER
SIR,-Discussions of the cause of cervical intraepithelial neoplasia often mention the work of Rigoni-Stem (1842) in Verona. He noted that death from uterine cancer was less frequent among unmarried women than among married women, and that it hardly ever happened among nuns.’ Rigoni-Stem’s work should be considered in the context of medical thought of the day. Paris was the foremost medical school at that time,2 and one of the important figures of the hygiene movement was the medical statistician, A. J. B. Parent-Duchatelet (1790-1836), who recorded that besides
JOHN TURNER HUESTON
PARVOVIRUS INFECTION AFTER RENAL TRANSPLANT
SIR,-We report a case of parvovirus infection associated with transient bone marrow dysfunction in a renal transplant recipient. A 57-year-old West Indian man received a cadaver graft on June 23, 1985, and was put on cyclosporin and prednisolone. After a week’s delay the kidney functioned well and his plasma creatinine fell to 180 pmol/l. One month after the transplant, he was receiving daily cyclosporin 10 mg/kg and prednisolone 25 mg. On July 26, 1985, he was admitted with an acute influenza-like illness and myalgia. His temperature was 38.4OC; neither liver nor spleen was palpable and he did not have a rash. No cause for his fever was found, no new therapy was initiated, and his temperature was normal within 48 hours. On admission (day 0), plasma creatinine was increased to 220 umol/1 but returned to 180 !ill1o1/1 on day 2; haemoglobin (Hb) 91 g/dl; white blood cells (WBC) 99 x 109/1; and platelets 279 x 109/1. On day 3, Hb was 86 g(dl; WBC 3.2 x 109/1 (neutrophils 89%, metamyelocytes 4%); and platelets 178 x 109/1 (with giant forms). On day 9, Hb was 9-2 g/dl (16 nucleated red cells per 100 WBC, 6% reticulocytes); WBC 11.5 x 109/1 with a leucoerythroblastic picture. Sickle haemoglobin test and haemoglobin electrophoresis were normal. Bone marrow was not examined. Between days 4 and 24 there was no evidence for rising serum titres to cytomegalovirus, adenovirus, herpes simplex, influenza A and B, measles, and mumps viruses, or to mycoplasma, coxiella, and psittacosis/lymphogranuloma venereum. However, day 4 serum contained parvovirus B 19 DNA,’ and days 24 and 66 sera contained increasing concentrations of B19-specific IgM antibody2 but no detectable viral DNA (see table). Our diagnosis was acute parvovirus infection. The patient has since remained well and currently has a plasma creatinine of 140 nmol/1.
SllR,-I
to support Dr Blenkinsopp and Mr Jenkins’ (Oct 25, p 986) about the need to change the shape of the traditional Ayre spatula on national issue in the UK to reduce the error rates in cervical cytology screening. As chairman of the British Society for Clinical Cytology, in 1976set up, with Dr E. Attwood (Birmingham), Dr E. B. Butler (Manchester), Dr H. Hughs (Glasgow), and Dr E. Macgregor (Aberdeen), a trial of a new spatula design. It had a broader head and a more pointed knuckle to take the shape of the transitional zone and enter the endocervical canal (see figure). A small preliminary trial was successful but the exercise failed through lack of further central support.
would like
comments
syphilis and scabies, cancer of the uterus was common in prostitutes. He noted that uterine damage was common in such women, many of whom died from this between the ages of 40 and
50, such deaths being
rare
among
non-prostitutes. He noted that
presented at the vulva. He commented that even then contemporary opinion as to the frequency of cancer of the womb tumours often
differed amongst clinicians. He also stated that old doctors had so the idea of a link between sexual intercourse and at least one form of cancer was not new even in the early 19th century.
given him these details,
Department of Genito-urinary Medicine, General Infirmary at Leeds,
M. A. WAUGH
Leeds LS1 3EX 1
Bnggs RM, Paavonen J. Cervical intraepithelial neoplasia. In Holmes KK, Mårdh PA, Sparling PF, Wiesner PJ, eds. Sexually transmitted diseases New York:
McGraw-Hill, 1984: 589. 2. Ackerknecht EH. Medicine in the Pans Hospital 1974-1848. Baltimore: Johns Hopkins Press, 1967. 3 Parent-Duchatelet AJB. De la prostitution dans la ville de Pans Brussels Etablissement Encyclographique, 1837 80-83
DUPUYTREN’S CONTRACTURE
SiR,—Your Aug 9 editorial on Dupuytren’s contracture cites my McIndoe memorial lecture and states that I have observed "that split skin grafts do not prevent recurrence of the disorder whereas whole-thickness grafts are more successful". Nowhere in that published lecture or anywhere else have I reported such an observation. The simple truth is that resurfacing with either split skin or whole-thickness grafts or even flaps from non-palmar skin does prevent recurrence of Dupuytren’s disease. Your editorialist has read "full thickness (Wolfe) graft is preferred to prevent wound bed contraction" and has confused wound bed contracture (that will happen anywhere in the body) with recurrence of Dupuytren’s contracture. While applauding your effort to shed the light of molecular biology and other disciplines on the study of Dupuytren’s contracture, I feel that an understanding of the principles of surgical pathology is essential. 89
Royal Parade, Parkville, Melbourne, Victoria 3052, Australia
Spatula shapes. traditional Ayre spatula; 2 spatula; 4 Lemer spatula. 1
=
=
Aylesbury spatula;
3
=
BSCC design
=
Prof Peter
Vooijs (Nijmegen, Netherlands) has also produced a anatomically designed blade, and he has achieved well over 80% of smears containing endocervical cells. Both designs were submitted to Dr Margaret Wolfendale (Stoke Mandeville Hospital) who, with our assistance, orchestrated a joint development between several cytology centres, Marks & Spencers, the Women’s National Cancer Control Campaign, and the Department of Health and Social Security. This has resulted in the Aylesbury spatula, an account of which will be published in the British AMa/yoMrM<2/. Since our original intention was to introduce an improved design for the national screening programme, we trust that the DHSS will urgently consider the matter of choice and introduce the most successful sampler at bulk purchase rates as the standard issue.
more
Regional Cytology Unit, Division of Pathology, St Stephen’s Hospital,
O. A. N. HUSAIN
London SW10 9TH
CERVICAL CANCER
SIR,-Discussions of the cause of cervical intraepithelial neoplasia often mention the work of Rigoni-Stem (1842) in Verona. He noted that death from uterine cancer was less frequent among unmarried women than among married women, and that it hardly ever happened among nuns.’ Rigoni-Stem’s work should be considered in the context of medical thought of the day. Paris was the foremost medical school at that time,2 and one of the important figures of the hygiene movement was the medical statistician, A. J. B. Parent-Duchatelet (1790-1836), who recorded that besides
JOHN TURNER HUESTON
PARVOVIRUS INFECTION AFTER RENAL TRANSPLANT
SIR,-We report a case of parvovirus infection associated with transient bone marrow dysfunction in a renal transplant recipient. A 57-year-old West Indian man received a cadaver graft on June 23, 1985, and was put on cyclosporin and prednisolone. After a week’s delay the kidney functioned well and his plasma creatinine fell to 180 pmol/l. One month after the transplant, he was receiving daily cyclosporin 10 mg/kg and prednisolone 25 mg. On July 26, 1985, he was admitted with an acute influenza-like illness and myalgia. His temperature was 38.4OC; neither liver nor spleen was palpable and he did not have a rash. No cause for his fever was found, no new therapy was initiated, and his temperature was normal within 48 hours. On admission (day 0), plasma creatinine was increased to 220 umol/1 but returned to 180 !ill1o1/1 on day 2; haemoglobin (Hb) 91 g/dl; white blood cells (WBC) 99 x 109/1; and platelets 279 x 109/1. On day 3, Hb was 86 g(dl; WBC 3.2 x 109/1 (neutrophils 89%, metamyelocytes 4%); and platelets 178 x 109/1 (with giant forms). On day 9, Hb was 9-2 g/dl (16 nucleated red cells per 100 WBC, 6% reticulocytes); WBC 11.5 x 109/1 with a leucoerythroblastic picture. Sickle haemoglobin test and haemoglobin electrophoresis were normal. Bone marrow was not examined. Between days 4 and 24 there was no evidence for rising serum titres to cytomegalovirus, adenovirus, herpes simplex, influenza A and B, measles, and mumps viruses, or to mycoplasma, coxiella, and psittacosis/lymphogranuloma venereum. However, day 4 serum contained parvovirus B 19 DNA,’ and days 24 and 66 sera contained increasing concentrations of B19-specific IgM antibody2 but no detectable viral DNA (see table). Our diagnosis was acute parvovirus infection. The patient has since remained well and currently has a plasma creatinine of 140 nmol/1.