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GOLDEN LIQUOR AMNII
109 LATEX-SCREENING TEST FOR URINARY F.D.P.
SIR? The confirmation by Dr Hulme and Mr Pitcher (Jan. 6, p. 6) of our findingsconcerning fibrin/fibrinogen degradation products (F.D.P.) in the urine of renal-transplant recipients is welcome, particularly as such a rapid test was used for their detection. However, I feel there are two points which need further consideration before this simple test is widely accepted. Firstly, the latex test described was found to be two to three times less sensitive than the tanned-red-cell haEmagglutination-inhibition immunoassay (T.R.C.H.I.I.) used by us, and yet it was found that preliminary concentration of urine samples was unnecessary. In defence of the T.R.c.H.i.i., it is readily apparent that the " time-consuming urinary concentration procedure " is also unnecessary when the T.R.c.H.i.i. is used to estimate urinary F.D.P. for purely diagnostic purposes; indeed, it is possible to obtain results within four hours under these circumstances. The second point is perhaps more important. It was apparent to us that the value of urinary F.D.P. estimations in renal-transplant recipients resided predominantly in the outpatient situation, because in all inpatients F.D.P. were excreted in high concentrations during the immediate postoperative period, regardless or not of rejection, and acute rejection episodes outwith this time, while accompanied by increased urinary F.D.P., were usually readily detectable by clinical and routine biochemical In outpatients where constant medical examinations. supervision is impossible the results provided an accurate account of the natural history of chronic rejection and response to changes in therapy provided estimations were performed daily over long periods of time. I should like to see these observations confirmed in outpatients, using the latex-screening test, before discarding the inexpensively prepared fibrinogen-coated red-cells and adding the cost of the latex particles to the not inconsiderable postal account we now have in order to study outpatients. Department of Medicine, Guy’s Hospital Medical School, London Bridge, SE1.
Kielland’s forceps rotation. The infant had an " open enterocele ", the stomach, small intestine, and half of the large bowel protruding through a 6 cm. circular defect in the anterior abdominal wall, immediately above the umbilicus. There was no peritoneal covering to the enterocele. The third stage of delivery was normal. The otherwise healthy infant was transferred to the main unit in an incubator, but the defect was judged to be too large for surgical correction. Department of Obstetrics, University of Dundee.
EDWARD DAW.
TUTANKHAMUN: KLINEFELTER’S OR WILSON’S ?
SIR,-Dr Weller (Dec. 16, p. 1312) comments on the obvious breast development in the wooden statuettes of the Pharaoh Tutankhamun. In fact only one of the four statuettes (see accompanying figure) on show in the recent British Museum exhibition showed this feature; in the other three the breast development would not have attracted attention. However, all four show a sagging abdominal wall and flat feet. The presence of breasts in only one of
A. R. CLARKSON.
LIQUOR AMNII SIR,-Liquor amnii is normally clear and pale yellow, but it may show some colour changes: (a) opacification, by fetal squames; (b) green, by meconium staining, varying in degree according to freshness and amount of meconium; GOLDEN
(c) red, by blood staining (the most severe form is the port wine " of placental abruption); (d) yellow, in rhesus isoimmunisation (however, degree of staining is not prognostic or diagnostic 2). I wish to report another cause of a golden-yellow liquor. "
"
"
A 20-year-old primigravida was booked for confinement in a general-practitioner maternity unit. She was seen by her prac-
titioner at home when 36 weeks’ pregnant because she believed herself in labour. Her blood-pressure was 195/120 mm. Hg. Vaginal examination showed an almost fully dilated cervix, though the forewaters were still intact. The patient was admitted to the maternity unit and the help of the obstetric flying-squad was sought from the main unit 15 miles away. She was given an intramuscular injection of pethidine. When the flying-squad arrived, the blood-pressure had fallen to 150/I00. Vaginal examination showed the cervix to be fully dilated and, the forewaters intact, with the fetal head in the left occiput transverse position, just above the ischial spines. The forewaters were ruptured and copious golden-yellow liquor drained. A live male infant weighing 2720 g. was delivered after a 1. 2.
Clarkson, A. R., Morton, J. B., Cash, J. D. Lancet, 1970, ii, 1220. Bevis, D. C. A. Practitioner, 1967, 198, 239.
the statuettes is
surprising,
but
at
least shows that this
simply a matter of stylistic fashion. Could this abnormality have been of sudden late development or was it simply not portrayed in the other figurines although present in the young Pharaoh ? Perhaps three figures were carved in life to the King’s specification and the fourth carved, as a true likeness, after death when no royal sanction could be applied. We shall never know. If this is the true explanation it is possible that this was a case of Klinefelter’s syndrome. The association of three abnormalities separate certainly suggests a genetic basis to the disease, hardly surprising in a royal line that officially practised incest. What a pity that the process of mummification does not permit of chromosomal analysis. Or perhaps this is the index case of a new " Tutankhamun syndrome ". An alternative explanation is that we are seeing gynxcowas not
mastia of liver disease associated with
a
lax ascites and the
SIR? The confirmation by Dr Hulme and Mr Pitcher (Jan. 6, p. 6) of our findingsconcerning fibrin/fibrinogen degradation products (F.D.P.) in the urine of renal-transplant recipients is welcome, particularly as such a rapid test was used for their detection. However, I feel there are two points which need further consideration before this simple test is widely accepted. Firstly, the latex test described was found to be two to three times less sensitive than the tanned-red-cell haEmagglutination-inhibition immunoassay (T.R.C.H.I.I.) used by us, and yet it was found that preliminary concentration of urine samples was unnecessary. In defence of the T.R.c.H.i.i., it is readily apparent that the " time-consuming urinary concentration procedure " is also unnecessary when the T.R.c.H.i.i. is used to estimate urinary F.D.P. for purely diagnostic purposes; indeed, it is possible to obtain results within four hours under these circumstances. The second point is perhaps more important. It was apparent to us that the value of urinary F.D.P. estimations in renal-transplant recipients resided predominantly in the outpatient situation, because in all inpatients F.D.P. were excreted in high concentrations during the immediate postoperative period, regardless or not of rejection, and acute rejection episodes outwith this time, while accompanied by increased urinary F.D.P., were usually readily detectable by clinical and routine biochemical In outpatients where constant medical examinations. supervision is impossible the results provided an accurate account of the natural history of chronic rejection and response to changes in therapy provided estimations were performed daily over long periods of time. I should like to see these observations confirmed in outpatients, using the latex-screening test, before discarding the inexpensively prepared fibrinogen-coated red-cells and adding the cost of the latex particles to the not inconsiderable postal account we now have in order to study outpatients. Department of Medicine, Guy’s Hospital Medical School, London Bridge, SE1.
Kielland’s forceps rotation. The infant had an " open enterocele ", the stomach, small intestine, and half of the large bowel protruding through a 6 cm. circular defect in the anterior abdominal wall, immediately above the umbilicus. There was no peritoneal covering to the enterocele. The third stage of delivery was normal. The otherwise healthy infant was transferred to the main unit in an incubator, but the defect was judged to be too large for surgical correction. Department of Obstetrics, University of Dundee.
EDWARD DAW.
TUTANKHAMUN: KLINEFELTER’S OR WILSON’S ?
SIR,-Dr Weller (Dec. 16, p. 1312) comments on the obvious breast development in the wooden statuettes of the Pharaoh Tutankhamun. In fact only one of the four statuettes (see accompanying figure) on show in the recent British Museum exhibition showed this feature; in the other three the breast development would not have attracted attention. However, all four show a sagging abdominal wall and flat feet. The presence of breasts in only one of
A. R. CLARKSON.
LIQUOR AMNII SIR,-Liquor amnii is normally clear and pale yellow, but it may show some colour changes: (a) opacification, by fetal squames; (b) green, by meconium staining, varying in degree according to freshness and amount of meconium; GOLDEN
(c) red, by blood staining (the most severe form is the port wine " of placental abruption); (d) yellow, in rhesus isoimmunisation (however, degree of staining is not prognostic or diagnostic 2). I wish to report another cause of a golden-yellow liquor. "
"
"
A 20-year-old primigravida was booked for confinement in a general-practitioner maternity unit. She was seen by her prac-
titioner at home when 36 weeks’ pregnant because she believed herself in labour. Her blood-pressure was 195/120 mm. Hg. Vaginal examination showed an almost fully dilated cervix, though the forewaters were still intact. The patient was admitted to the maternity unit and the help of the obstetric flying-squad was sought from the main unit 15 miles away. She was given an intramuscular injection of pethidine. When the flying-squad arrived, the blood-pressure had fallen to 150/I00. Vaginal examination showed the cervix to be fully dilated and, the forewaters intact, with the fetal head in the left occiput transverse position, just above the ischial spines. The forewaters were ruptured and copious golden-yellow liquor drained. A live male infant weighing 2720 g. was delivered after a 1. 2.
Clarkson, A. R., Morton, J. B., Cash, J. D. Lancet, 1970, ii, 1220. Bevis, D. C. A. Practitioner, 1967, 198, 239.
the statuettes is
surprising,
but
at
least shows that this
simply a matter of stylistic fashion. Could this abnormality have been of sudden late development or was it simply not portrayed in the other figurines although present in the young Pharaoh ? Perhaps three figures were carved in life to the King’s specification and the fourth carved, as a true likeness, after death when no royal sanction could be applied. We shall never know. If this is the true explanation it is possible that this was a case of Klinefelter’s syndrome. The association of three abnormalities separate certainly suggests a genetic basis to the disease, hardly surprising in a royal line that officially practised incest. What a pity that the process of mummification does not permit of chromosomal analysis. Or perhaps this is the index case of a new " Tutankhamun syndrome ". An alternative explanation is that we are seeing gynxcowas not
mastia of liver disease associated with
a
lax ascites and the