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INTRACATH IN SUPRAPUBIC CYSTOSTOMY
1160 necessary. Of 53 adults with acute leukaemia seen between 1966 and 1971, 27 survived at least a hundred days, and 3 developed typical transfusion-induced hepatitis. One further patient was already mildly jaundiced at the time
leukaemia was diagnosed. Since September, 1970, we have tested sera from 9 adults with acute leukxmia who have survived at least 100 days from the time of diagnosis. None has had clinical hepatitis, and we were not able to detect Au(l) in any of them by the microimmunodiffusion method. In addition, sera from 25 patients with chronic forms of leukaemia or with myeloma, and from 12 patients with other blood diseases, were negative for Au(l). In most cases, two or more samples were studied over a period of 3 to 12 months. The differing frequencies of Au(l) obtained in small series may be misleading if interpreted as reflecting profound differences in the situations in different countries. In our opinion, neither the absence of Au(l) in 28 patients with myeloblastic leukaemia in Canada, Denmark, and Finland,5 nor the finding of Au(l) in 4 out of 14 adults with acute leukaemia in Canada,6 differs substantially from the occurrence of Au(l) in 11 out of 114 cases with myeloblastic leukaemia in the United States6 or from our clinical finding of hepatitis in 3 out of 27 adults with acute leukæmia. In addition, Sutnick and his colleagues5 do not indicate the phase in the course of the disease at which they obtained the sera studied. If a substantial number of the sera were obtained early in the course of the disease, the non-appearance of Au(l) during that time does not reflect the situation when the incubation period of hepatitis has elapsed, after the first transfusions. In an environment where Au(l) is rare among the healthy population (0-3 % in our blood-donors), we obtained about the same prevalence of hepatitis (10%) as that found in the United States.5 We admit the possibility that patients with acute leukxmia may be immunologically susceptible to the persistence of Au(l). However, they are more to infection with Au(l) since they have more exposed frequent transfusions than many other patients-e.g., those with chronic forms of leukaemia. Further information must be collected on the relation between Au(l) and leukæmia, including appropriate control material, to decide whether the high frequency of Au(l) in patients with acute leukaemia is related to a basic pathogenetic mechanism of the disease itself, or whether it is rather an occasional complication associated with numerous transfusions. Department of Medicine, University of Oulu, and I. P. PALVA Public Health Laboratory, SF-90100 Oulu, Finland. VEIJO RAUNIO.
STREPTOCOCCAL INFECTION IN THALASSÆMIA SIR,—Wasi 7reports that thalasssemic patients in Thailand have increased susceptibility to streptococcal infection, with high antistreptolysin-0 titres, and that splenectomy enhances this suceptibility. He suggests that postsplenectomy pericarditis may be related to streptococcal infection. We presented similar findings at the Sixth Middle Eastern/Mediterranean Pxdiatric Congress, at Athens, in 1969. The group studied included 79 non-splenectomised and 58 splenectomised Greek patients with homozygous &bgr;-thalassæmia. The incidence of rheumatic fever was 12% for the splenectomised and only 1-2% for the non-splenectomised cases. Moreover, 3 cases of acute glomerulo7.
Wasi, P. Lancet, 1971, i, 949.
nephritis were seen in the group of splenectomised patients. The results of further work will be published shortly. Blood Research Laboratory, Hellenic Red Cross, Dracopoulion Transfusion Centre,
Athens 109, Greece.
JOANNA ECONOMIDOU M. CONSTANDOULAKIS.
BLUE SCLEROTICS IN IRON DEFICIENCY SIR,—Dr. Hall (Oct. 23, p. 935), reporting his observation that blue sclerotics are a useful guide to iron deficiency, says that he cannot find any reference to this sign in the standard works. Actually this sign was described by Osler, who, in the chapter on primary or essential ansmiachlorosis from his book The Principles and Practice of Medicine (1909), says: " The eyes have a peculiar brilliancy and the sclerotics are of a bluish color".1 I remember I saw in a young woman, when I was a young physician in 1948, a very complex syndrome with mostly circulatory troubles. In it the sign that made my famous professor, Dr. Enrico Poli, immediately suspect the right diagnosisthat is, the anxmia of ankylostomiasis-was the presence of a strong blue tinge in the sclerotics. Clinica del Lavoro,
University of Milan, Italy.
ALBERTO AGNOLETTO.
SIR,—Dr. Hall described blue scleræ which reverted to treatment of the associated iron deficiency. Dr. Bennett (Nov. 13, p. 1100) correctly ascribed the blueness to scleral thinning, and described its association with rheumatoid disease and corticosteroids. Although osteogenesis imperfecta is the classical clinical cause of blue sclerx, it is less well known that the other inherited
normal with
connective-tissue disorders also have this association. Beighton2 described a frequency of 7% with the EhlersDanlos syndrome. I have studied a series of 180 patients with pseudoxanthoma elasticum (P.X.E.) in England and Wales. Blue scleræ were common and occurred in 33-62% of probands, depending on the clinical type of P.X.E., of whom 3-20% claimed to have similarly affected relatives. I would be most interested to learn whether any of Dr. Hall’s patients with iron deficiency had any clinical evidence of an inherited connective-tissue disorder, for gastrointestinal bleeding is common with P.X.E. but has also been described with other disorders of this group. University Department of Medicine, L69 3BX.
Liverpool
F. M. POPE.
INTRACATH IN SUPRAPUBIC CYSTOSTOMY SIR,—The use of the‘ Intracath’ or similar devices for intravenous infusions is well known. We feel that there could be another use for the intracath. We see many patients at this health centre with acute retention of urine, and occasionally they need suprapubic cystostomy. We have used the intracath (14G) to drain the bladder suprapubically : it is then left in place for a short period till other measures are taken. This method is simple and the trauma minimal. The patient can be freely mobile, because of the flexibility and easy fixation of the intracath. The procedure is convenient in our health centre, and might be useful in emergencies elsewhere. Marampa Mines Health Centre, Sierra Leone Development Co. Ltd., P.O. Box 7, Freetown, West Africa.
A. K. SINHA.
Harvey, A. M., McKusick, V. A. (editors). Osler’s Textbook Revisited; p. 273. New York, 1967. 2. Beighton, P. The Ehlers-Danlos Syndrome; p. 81. London, 1970. 1. See
leukaemia was diagnosed. Since September, 1970, we have tested sera from 9 adults with acute leukxmia who have survived at least 100 days from the time of diagnosis. None has had clinical hepatitis, and we were not able to detect Au(l) in any of them by the microimmunodiffusion method. In addition, sera from 25 patients with chronic forms of leukaemia or with myeloma, and from 12 patients with other blood diseases, were negative for Au(l). In most cases, two or more samples were studied over a period of 3 to 12 months. The differing frequencies of Au(l) obtained in small series may be misleading if interpreted as reflecting profound differences in the situations in different countries. In our opinion, neither the absence of Au(l) in 28 patients with myeloblastic leukaemia in Canada, Denmark, and Finland,5 nor the finding of Au(l) in 4 out of 14 adults with acute leukaemia in Canada,6 differs substantially from the occurrence of Au(l) in 11 out of 114 cases with myeloblastic leukaemia in the United States6 or from our clinical finding of hepatitis in 3 out of 27 adults with acute leukæmia. In addition, Sutnick and his colleagues5 do not indicate the phase in the course of the disease at which they obtained the sera studied. If a substantial number of the sera were obtained early in the course of the disease, the non-appearance of Au(l) during that time does not reflect the situation when the incubation period of hepatitis has elapsed, after the first transfusions. In an environment where Au(l) is rare among the healthy population (0-3 % in our blood-donors), we obtained about the same prevalence of hepatitis (10%) as that found in the United States.5 We admit the possibility that patients with acute leukxmia may be immunologically susceptible to the persistence of Au(l). However, they are more to infection with Au(l) since they have more exposed frequent transfusions than many other patients-e.g., those with chronic forms of leukaemia. Further information must be collected on the relation between Au(l) and leukæmia, including appropriate control material, to decide whether the high frequency of Au(l) in patients with acute leukaemia is related to a basic pathogenetic mechanism of the disease itself, or whether it is rather an occasional complication associated with numerous transfusions. Department of Medicine, University of Oulu, and I. P. PALVA Public Health Laboratory, SF-90100 Oulu, Finland. VEIJO RAUNIO.
STREPTOCOCCAL INFECTION IN THALASSÆMIA SIR,—Wasi 7reports that thalasssemic patients in Thailand have increased susceptibility to streptococcal infection, with high antistreptolysin-0 titres, and that splenectomy enhances this suceptibility. He suggests that postsplenectomy pericarditis may be related to streptococcal infection. We presented similar findings at the Sixth Middle Eastern/Mediterranean Pxdiatric Congress, at Athens, in 1969. The group studied included 79 non-splenectomised and 58 splenectomised Greek patients with homozygous &bgr;-thalassæmia. The incidence of rheumatic fever was 12% for the splenectomised and only 1-2% for the non-splenectomised cases. Moreover, 3 cases of acute glomerulo7.
Wasi, P. Lancet, 1971, i, 949.
nephritis were seen in the group of splenectomised patients. The results of further work will be published shortly. Blood Research Laboratory, Hellenic Red Cross, Dracopoulion Transfusion Centre,
Athens 109, Greece.
JOANNA ECONOMIDOU M. CONSTANDOULAKIS.
BLUE SCLEROTICS IN IRON DEFICIENCY SIR,—Dr. Hall (Oct. 23, p. 935), reporting his observation that blue sclerotics are a useful guide to iron deficiency, says that he cannot find any reference to this sign in the standard works. Actually this sign was described by Osler, who, in the chapter on primary or essential ansmiachlorosis from his book The Principles and Practice of Medicine (1909), says: " The eyes have a peculiar brilliancy and the sclerotics are of a bluish color".1 I remember I saw in a young woman, when I was a young physician in 1948, a very complex syndrome with mostly circulatory troubles. In it the sign that made my famous professor, Dr. Enrico Poli, immediately suspect the right diagnosisthat is, the anxmia of ankylostomiasis-was the presence of a strong blue tinge in the sclerotics. Clinica del Lavoro,
University of Milan, Italy.
ALBERTO AGNOLETTO.
SIR,—Dr. Hall described blue scleræ which reverted to treatment of the associated iron deficiency. Dr. Bennett (Nov. 13, p. 1100) correctly ascribed the blueness to scleral thinning, and described its association with rheumatoid disease and corticosteroids. Although osteogenesis imperfecta is the classical clinical cause of blue sclerx, it is less well known that the other inherited
normal with
connective-tissue disorders also have this association. Beighton2 described a frequency of 7% with the EhlersDanlos syndrome. I have studied a series of 180 patients with pseudoxanthoma elasticum (P.X.E.) in England and Wales. Blue scleræ were common and occurred in 33-62% of probands, depending on the clinical type of P.X.E., of whom 3-20% claimed to have similarly affected relatives. I would be most interested to learn whether any of Dr. Hall’s patients with iron deficiency had any clinical evidence of an inherited connective-tissue disorder, for gastrointestinal bleeding is common with P.X.E. but has also been described with other disorders of this group. University Department of Medicine, L69 3BX.
Liverpool
F. M. POPE.
INTRACATH IN SUPRAPUBIC CYSTOSTOMY SIR,—The use of the‘ Intracath’ or similar devices for intravenous infusions is well known. We feel that there could be another use for the intracath. We see many patients at this health centre with acute retention of urine, and occasionally they need suprapubic cystostomy. We have used the intracath (14G) to drain the bladder suprapubically : it is then left in place for a short period till other measures are taken. This method is simple and the trauma minimal. The patient can be freely mobile, because of the flexibility and easy fixation of the intracath. The procedure is convenient in our health centre, and might be useful in emergencies elsewhere. Marampa Mines Health Centre, Sierra Leone Development Co. Ltd., P.O. Box 7, Freetown, West Africa.
A. K. SINHA.
Harvey, A. M., McKusick, V. A. (editors). Osler’s Textbook Revisited; p. 273. New York, 1967. 2. Beighton, P. The Ehlers-Danlos Syndrome; p. 81. London, 1970. 1. See