- Email: [email protected]
FAILURE TO DEMONSTRATE ANTIBODY TO SPERM IN SERUM OF PROSTITUTES
56
patients uncomfortable and unnecessary investigations, such as air encephalography and cerebral angiography: and secondly because further study of this condition may help to throw more light on the mechanism of pseudo"
tumor
cerebri. "
PHILIP F. BENSON RONALD C. MAC KEITH.
Guy’s Hospital, London, S.E.1.
(3) Is there a neurogenic factor which causes shock and the heavy bleeding and maybe even thrombosis of the parametrial veins ? I should like to know whether others have observed similai thrombosis of the parametrial veins when they have amputated the uterus because of heaw uterine bleeding. Shaare Zedek Hospital, W. OPPENHEIMER. Jerusalem, Israel.
THE APLASTIC CRISIS IN SICKLE-CELL ANÆMIA
SIR,-Dr. Maclver and Dr. Parker-Williams (May 20) accept only two types of crisis in sickle-cell anæmia—the clinical or painful crisis, and the aplastic or hæmatological crisis. We have noted, however, a pure hxmolytic crisis with all the clinical and laboratory findings, in many cases of sickle-cell ansemia in this clinic. Two patients died during this hxmolytic crisis. On the other hand, the authors do not speak about the maturation arrest of the erythroblastic series, which accompanies indispensably the erythroblastopenia, as described by Owren and Gasser. Recently Cazal et al.,l who have studied the erythroblastic series by karyometry, have described in detail this maturation arrest. We have also studied by karyometry this " aplastic crisis " in 10 patients with different types of hæmolytic anxmia, and we have definitely found in all cases the complete maturation arrest. The erythroblastic series was not always hypoplastic, but sometimes hyperplastic. We do not believe that cases 6 and 7, described by Maclver and Parker-Williams, show either an erythroblastopenia or a maturation arrest. We think, too, that the reticulocyte-count in the blood is not sufficiently low, because, in all our cases, we found a reticulocyte count of nearly zero. In case 8 no bone-marrow examination was done. On the other hand, the reticulocyte count was increased. Thus we believe that the so-called " aplastic crisis " is not so common during the evolution of the hæmolytic anæmia, but that it is a rather rare phenomenon. 2nd Medical Clinic, of Athens.
University
H. TSEVRENIS A. PAPASPYROU N. VORIAS.
ANTEPARTUM HÆMORRHAGE AND THROMBOSIS OF PARAMETRIAL VEINS SIR,-A young woman aged 27 was admitted to my
department as an emergency. She was in the fourth to fifth month of pregnancy and had acute and severe uterine bleeding. I had
immediately to remove the necrotic foetus and the and perform a curettage under thiopentone anxsthesia.’Pituitrin’ and ergometrine were given, and the uterus was massaged; but it did not contract. She continued to bleed profusely, and became shocked, despite blood and plasma transfusions. A supravaginal amputation of the uterus had to
placenta,
be carried out. While cutting through the parametrial veins I observed that their cut ends were obliterated by thrombi. I therefore. unclamped all these veins and found them filled with softt thrombi, 10-12 cm. long, which could easily be extracted with simple forceps. The postoperative course was normal, and she recovered without complications. The following questions arise: (1) Is bleeding from the uterine cavity caused by a primary thrombosis of the parametrial veins, so that the blood cannot take its normal course through them, and consequently flows out of the uterine cavity ? (2) Do the lack of contractions of the uterine musculature cause uterine bleeding and stasis with consequent thrombosis of the parametrial veins due to the absence of " vis a tergo "? 1. Cazal
P., Isarn, P., Emberger, J. Sang, 1959, 30, 1.
FAILURE TO DEMONSTRATE ANTIBODY TO SPERM IN SERUM OF PROSTITUTES
SIR,—Rümke and Hellinga1 recently demonstrated by an agglutination method antibody to sperm in the serum of about 3% of husbands in childless marriages. Such immunisation has been thought to be a cause of infertility in prostitutes 23 but, to our knowledge, no specific investigations have been reported. Because a simple method of demonstrating antibody to sperm would be valuable in studying childless marriages, we tried out the Coons labelled-antibody technique with this in view. Sera were obtained from 28 professional prostitutes, aged 21-59. 21 sera from women (10 married and 11 single) aged Frozen sections of unfixed 19-50 were used as controls. normal adult testis were treated with the test sera, and then with rabbit antihuman y-globulin fluorochromed with fluorescein isothiocyanate. The preparations were examined with a conventional microscope equipped with a dark-field condenser and illuminated by a high-pressure mercury-arc bulb (Reichert), The same labelled sera and optical arrangement have given good results in demonstrating lupus factor, antithyroid antibody,4 6 and isoagglutinins A and B by the Szulman7 method. We saw no evidence of selective staining of spermatids or testicular elements by any of the sera. These results might be interpreted in several ways:
other[
(1) Immunisation to sperm is not a frequent cause of infertility in prostitutes, and presumably is an even less frequent cause of this disorder in other
women.
(2) Immunity to sperm occurs with undetermined frequency prostitutes, but is produced by cellular or delayed hypersensitivity rather than by circulating antibody. (3) Such immunity is produced by circulating antibody which is not &ggr;-globulin.
in
The prostitutes we talked to think that they are relatively infertile, considering their lack of contraceptive precautions in relation to their degree of exposure. The possibility of desensitisation by chronic exposure to large amounts of antigen has to be considered; but there has been no opportunity to study comparable sera after the donors had not been exposed as often
as
usual.
We should like to thank Mrs. Lois Adams, Mrs. Hazel Wilson, Dr. David Simon, and Mrs. Catherine Carroll for their help in cnllectins snecimens and carrvins out tests. Children’s Hospital Research Foundation, Departments of Pediatrics, Obstetrics, and Pathology, University of Cincinnati,
Cincinnati, Ohio.
JAMES M. SUTHERLAND BENJAMIN H. LANDING.
ASSESSMENT OF SKIN VIABILITY MICHAEL N. TEMPEST writes: Mr. "I would beg leave to correct the impression conveyed in your annotation of June 24 that I have been the leader of the team of workers in Chepstow using the intravenous dye technique in the assessment of skin viability. " Along with other colleagues I have been intimately involved in this investigation from its beginning in the early Rümke, Ph., Hellinga, G. Amer. J. clin. Path. 1959, 32, 357. J. Amer. med. Ass. 1921, 77, 42. Gebhard, P. H., Pomeroy, W. B., Martin, C. E., Christenson, C. V Pregnancy, Birth, and Abortion. New York, 1959. 4. Coons, A. H., Kaplan, M. H. J. exp. Med. 1950, 91, 1. 5. Landing, B. H., West, C. D., Esselborn, V. M. J. clin. Endocrin. 1958, 18, 792. 6. Beutner, E. H., Witebsky, E., Rose, N. R., Gerbasi, J. R. Proc. Soc. exp. Biol., N.Y. 1958, 97, 712. 7. Szulman, A. E. J. exp. Med. 1960, 111, 785.
1. 2. 3.
;
patients uncomfortable and unnecessary investigations, such as air encephalography and cerebral angiography: and secondly because further study of this condition may help to throw more light on the mechanism of pseudo"
tumor
cerebri. "
PHILIP F. BENSON RONALD C. MAC KEITH.
Guy’s Hospital, London, S.E.1.
(3) Is there a neurogenic factor which causes shock and the heavy bleeding and maybe even thrombosis of the parametrial veins ? I should like to know whether others have observed similai thrombosis of the parametrial veins when they have amputated the uterus because of heaw uterine bleeding. Shaare Zedek Hospital, W. OPPENHEIMER. Jerusalem, Israel.
THE APLASTIC CRISIS IN SICKLE-CELL ANÆMIA
SIR,-Dr. Maclver and Dr. Parker-Williams (May 20) accept only two types of crisis in sickle-cell anæmia—the clinical or painful crisis, and the aplastic or hæmatological crisis. We have noted, however, a pure hxmolytic crisis with all the clinical and laboratory findings, in many cases of sickle-cell ansemia in this clinic. Two patients died during this hxmolytic crisis. On the other hand, the authors do not speak about the maturation arrest of the erythroblastic series, which accompanies indispensably the erythroblastopenia, as described by Owren and Gasser. Recently Cazal et al.,l who have studied the erythroblastic series by karyometry, have described in detail this maturation arrest. We have also studied by karyometry this " aplastic crisis " in 10 patients with different types of hæmolytic anxmia, and we have definitely found in all cases the complete maturation arrest. The erythroblastic series was not always hypoplastic, but sometimes hyperplastic. We do not believe that cases 6 and 7, described by Maclver and Parker-Williams, show either an erythroblastopenia or a maturation arrest. We think, too, that the reticulocyte-count in the blood is not sufficiently low, because, in all our cases, we found a reticulocyte count of nearly zero. In case 8 no bone-marrow examination was done. On the other hand, the reticulocyte count was increased. Thus we believe that the so-called " aplastic crisis " is not so common during the evolution of the hæmolytic anæmia, but that it is a rather rare phenomenon. 2nd Medical Clinic, of Athens.
University
H. TSEVRENIS A. PAPASPYROU N. VORIAS.
ANTEPARTUM HÆMORRHAGE AND THROMBOSIS OF PARAMETRIAL VEINS SIR,-A young woman aged 27 was admitted to my
department as an emergency. She was in the fourth to fifth month of pregnancy and had acute and severe uterine bleeding. I had
immediately to remove the necrotic foetus and the and perform a curettage under thiopentone anxsthesia.’Pituitrin’ and ergometrine were given, and the uterus was massaged; but it did not contract. She continued to bleed profusely, and became shocked, despite blood and plasma transfusions. A supravaginal amputation of the uterus had to
placenta,
be carried out. While cutting through the parametrial veins I observed that their cut ends were obliterated by thrombi. I therefore. unclamped all these veins and found them filled with softt thrombi, 10-12 cm. long, which could easily be extracted with simple forceps. The postoperative course was normal, and she recovered without complications. The following questions arise: (1) Is bleeding from the uterine cavity caused by a primary thrombosis of the parametrial veins, so that the blood cannot take its normal course through them, and consequently flows out of the uterine cavity ? (2) Do the lack of contractions of the uterine musculature cause uterine bleeding and stasis with consequent thrombosis of the parametrial veins due to the absence of " vis a tergo "? 1. Cazal
P., Isarn, P., Emberger, J. Sang, 1959, 30, 1.
FAILURE TO DEMONSTRATE ANTIBODY TO SPERM IN SERUM OF PROSTITUTES
SIR,—Rümke and Hellinga1 recently demonstrated by an agglutination method antibody to sperm in the serum of about 3% of husbands in childless marriages. Such immunisation has been thought to be a cause of infertility in prostitutes 23 but, to our knowledge, no specific investigations have been reported. Because a simple method of demonstrating antibody to sperm would be valuable in studying childless marriages, we tried out the Coons labelled-antibody technique with this in view. Sera were obtained from 28 professional prostitutes, aged 21-59. 21 sera from women (10 married and 11 single) aged Frozen sections of unfixed 19-50 were used as controls. normal adult testis were treated with the test sera, and then with rabbit antihuman y-globulin fluorochromed with fluorescein isothiocyanate. The preparations were examined with a conventional microscope equipped with a dark-field condenser and illuminated by a high-pressure mercury-arc bulb (Reichert), The same labelled sera and optical arrangement have given good results in demonstrating lupus factor, antithyroid antibody,4 6 and isoagglutinins A and B by the Szulman7 method. We saw no evidence of selective staining of spermatids or testicular elements by any of the sera. These results might be interpreted in several ways:
other[
(1) Immunisation to sperm is not a frequent cause of infertility in prostitutes, and presumably is an even less frequent cause of this disorder in other
women.
(2) Immunity to sperm occurs with undetermined frequency prostitutes, but is produced by cellular or delayed hypersensitivity rather than by circulating antibody. (3) Such immunity is produced by circulating antibody which is not &ggr;-globulin.
in
The prostitutes we talked to think that they are relatively infertile, considering their lack of contraceptive precautions in relation to their degree of exposure. The possibility of desensitisation by chronic exposure to large amounts of antigen has to be considered; but there has been no opportunity to study comparable sera after the donors had not been exposed as often
as
usual.
We should like to thank Mrs. Lois Adams, Mrs. Hazel Wilson, Dr. David Simon, and Mrs. Catherine Carroll for their help in cnllectins snecimens and carrvins out tests. Children’s Hospital Research Foundation, Departments of Pediatrics, Obstetrics, and Pathology, University of Cincinnati,
Cincinnati, Ohio.
JAMES M. SUTHERLAND BENJAMIN H. LANDING.
ASSESSMENT OF SKIN VIABILITY MICHAEL N. TEMPEST writes: Mr. "I would beg leave to correct the impression conveyed in your annotation of June 24 that I have been the leader of the team of workers in Chepstow using the intravenous dye technique in the assessment of skin viability. " Along with other colleagues I have been intimately involved in this investigation from its beginning in the early Rümke, Ph., Hellinga, G. Amer. J. clin. Path. 1959, 32, 357. J. Amer. med. Ass. 1921, 77, 42. Gebhard, P. H., Pomeroy, W. B., Martin, C. E., Christenson, C. V Pregnancy, Birth, and Abortion. New York, 1959. 4. Coons, A. H., Kaplan, M. H. J. exp. Med. 1950, 91, 1. 5. Landing, B. H., West, C. D., Esselborn, V. M. J. clin. Endocrin. 1958, 18, 792. 6. Beutner, E. H., Witebsky, E., Rose, N. R., Gerbasi, J. R. Proc. Soc. exp. Biol., N.Y. 1958, 97, 712. 7. Szulman, A. E. J. exp. Med. 1960, 111, 785.
1. 2. 3.
;