- Email: [email protected]
MODIFIED LARYNGOSCOPE FOR FEMALE STERILISATION
575 Our patients were treated in an intensive-care unit with facilities for a modified form of reverse barrier nursing;’ platelet transfusions were readily available. In this environment infection was the cause of death in 20 patients, whereas only 4 died of hemorrhage, confirming the experience of others mentioned in vour editorial. Platelet transfusions seem to have diminished the risk of death from thrombocytopenia in patients with acute leukxmia, and indeed 3 of the 4 dying of haemorrhage in our series had associated disseminated intravascular coagulopathy which we believe should be closely looked for in bleeding uncontrolled by platelet transfusion. Details of these early deaths will be reported elsewhere,2 but there is one important finding we wish to emphasise here. 20 of the 24 patients dying in this first six-week period still had clinically detectable leukaemia in their blood or bone-marrow, and most of these had been treated with specific antileukaemic therapy for a long enough period to indicate drug-resistant disease. It therefore appears that although early deaths from infection still occur in a unit with highly developed facilities for supportive care, in most cases death in the first six weeks is fundamentally associated with failure to control the underlying teukxmia. That is not to suggest that intensive supportive facilities are not important, but once they exist attention mostly needs to be directed not to their further improvement but to the development of better methods for treating the
leukxmia itself.£ Royal Marsden
Hospital,
Sutton, Surrey SM2 5PT
I. E. SMITH R. POWLES T. J. McELWAIN
MODIFIED LARYNGOSCOPE FOR FEMALE STERILISATION
SIR,-Dr Lind and Dr Taylor (Aug. 14, p. 347), may be interested to know that their modified laryngoscope has a thirdworld counterpart. At a recent conference in Tunis, Dr Tarick ,Aboul Dahab, of Egypt, acquainted us with his modification of the same instrument for the same purpose, female sterilisations. This model, more easily adaptable to the developing world, retains the ordinary torchlight batteries as a light source, thus overriding situations where electricity is unavailable or undependable. In lieu of a fibreoptic attachment, a simple telescopic funnel, easily manufactured in developing countries, was added, thus directing the light and defining the area of operation for greater freedom and ease in working. A slot in the side of the funnel allows an artery forceps or Babcock to be passed freely in and out to hold the fallopian tube. The operation at our centres is usually done under local anaesthesia by paramedical workers,3 and we foresee very real promise and possibility for Dr Tarick’s instrument here, as well as great demand for it in the many similar situations of the third world. Gonoshasthaya Kendra, PO Nayarhat, ua Dhamrai, Dacca, Bangladesh
ZAFRULLAH CHOWDHURY
SIR,-Dr Lind and Dr Taylor have modified a laryngoscope and used this instrument to identify the fimbriated end of the fallopian tube and deliver it through the skin incision for confirmation and subsequent excision. Would it not be equally possible to use a vaginal speculum and head lamp to explore through the suprapubic incision? Or a proctoscope with a light on the end could be used. These are, of course, immediately available and do not require special fabrication. If the patient 1. Jameson, B, Gamble, D. R., Lynch, J., Kay, H. E. M. Lancet, 1971, i, 1034. 2. Smith, I E., Powles, R., Clink, H. MacD. Cancer, (in the press). 3. Chowdhury, S , Chowdhury, Z. Lancet, 1975, ii, 567.
were
obese, perhaps
a
sigmoidoscope
rigid bronchoscope
or
could be used. 1342 Esplanade,
ALBERT E. WARRENS
Chico, California 95926, U.S.A.
ONION, GARLIC, AND ATHEROSCLEROSIS SIR,-Onion and garlic are reported to have hypoglycaemic and
hypolipsemic
activities and may have
an
inhibitory
effect
atherosclerosis. 1-7 Practically all the studies reported so far are based either on acute clinical studies in volunteers or on experiments in rabbits. We know of no epidemiological study of lipid profile in various groups of persons with different eating habits of onion and garlic. This study was done in the Jain community in Poona, and three groups of healthy volunteers from the Jain community were selected as follows: on
Group 1.-45 people on mixed diet (but mostly vegetarian diet) eating liberal amounts of onion (600 g or more in a week) and garlic (50 g or more in a week). Group 7.—35 orthodox Jains who were strict vegetarians and who had never eaten onion and garlic. Group J/J.—33 persons from the Jain community and blood relatives of group n who were also strict vegetarians and had similar small amounts of onion and garlic (onion 200 g or less in a week; garlic 10 g or less in a week). All three groups were closely matched for age, sex, and social class. Group u and group III were very closely matched as they belonged to the same Jain families, and the only difference was in consumption of garlic and onion. Group i were also from the Jain community with basic habits of diet and living similar to those of group 11 and group III except that they were taking liberal amounts of onion and garlic and they were consuming mixed but mostly vegetarian diet. In all three groups a detailed history was taken, with physical examination and investigations to rule out diabetes mellitus, hypertension, and ischa’mic heart-disease. A fasting blood-sample was taken for estimation of serum cholesterol, triglycerides, alpha and beta lipoproteins, and phospholipids, coagulation-time, and plasma-fibrinogen. The results were analysed by Student’s t test (see table). COMPARISON OF SERUM
BETA-LIPOPROTEINS,
CHOLESTEROL, TRIGLYCERIDES,
AND PHOSPHOLIPID AND PLASMA-FIBRINOGEN LEVELS:
MEAN±S.D.
*
Significantly lower than in groups 11 and III (P<001). t Significantly lower than in groups n and III (P<005). t Significantly lower than in group n(r<005). § Significantly lower than in group n (r<001). The inferences drawn are: (1.) There are no significant differences in serum-cholesterol or coagulation-times (not shown) in the three groups. (2.) Serum triglycerides and beta lipoproteins ’are significantly higher in group ii and group III than in group 1.
(3.) Phospholipids and plasma-fibrinogen higher in group 11 than in groupsand ui. 1. 2.
are
significantly
Bordia, A., Bansal, H. C., Arora, S. K., Rathore, A. S., Ranawat, R. V. S., Singh, S. V. J. Ass. Physns. India, 1974, 22, 267. Gupta, N. N., Mehrotra, R. M. L., Sirkar, A. R. Ind. J. med. Res. 1966, 54, 48.
3. Jain, R. C. J. Ass. Physns. India, 1971, 19, 305. 4. Jain, R.C. ibid. p. 301. 5. Jain, R. C. ibid. 1973, 21, 357. 6. Jain, R C. Lancet, 1975, i, 1240. 7. Menon, I. S., Kendal, R. Y., Dewar, H. A., Newell, D. J. Br.
iii, 351.
med. J. 1968,
leukxmia itself.£ Royal Marsden
Hospital,
Sutton, Surrey SM2 5PT
I. E. SMITH R. POWLES T. J. McELWAIN
MODIFIED LARYNGOSCOPE FOR FEMALE STERILISATION
SIR,-Dr Lind and Dr Taylor (Aug. 14, p. 347), may be interested to know that their modified laryngoscope has a thirdworld counterpart. At a recent conference in Tunis, Dr Tarick ,Aboul Dahab, of Egypt, acquainted us with his modification of the same instrument for the same purpose, female sterilisations. This model, more easily adaptable to the developing world, retains the ordinary torchlight batteries as a light source, thus overriding situations where electricity is unavailable or undependable. In lieu of a fibreoptic attachment, a simple telescopic funnel, easily manufactured in developing countries, was added, thus directing the light and defining the area of operation for greater freedom and ease in working. A slot in the side of the funnel allows an artery forceps or Babcock to be passed freely in and out to hold the fallopian tube. The operation at our centres is usually done under local anaesthesia by paramedical workers,3 and we foresee very real promise and possibility for Dr Tarick’s instrument here, as well as great demand for it in the many similar situations of the third world. Gonoshasthaya Kendra, PO Nayarhat, ua Dhamrai, Dacca, Bangladesh
ZAFRULLAH CHOWDHURY
SIR,-Dr Lind and Dr Taylor have modified a laryngoscope and used this instrument to identify the fimbriated end of the fallopian tube and deliver it through the skin incision for confirmation and subsequent excision. Would it not be equally possible to use a vaginal speculum and head lamp to explore through the suprapubic incision? Or a proctoscope with a light on the end could be used. These are, of course, immediately available and do not require special fabrication. If the patient 1. Jameson, B, Gamble, D. R., Lynch, J., Kay, H. E. M. Lancet, 1971, i, 1034. 2. Smith, I E., Powles, R., Clink, H. MacD. Cancer, (in the press). 3. Chowdhury, S , Chowdhury, Z. Lancet, 1975, ii, 567.
were
obese, perhaps
a
sigmoidoscope
rigid bronchoscope
or
could be used. 1342 Esplanade,
ALBERT E. WARRENS
Chico, California 95926, U.S.A.
ONION, GARLIC, AND ATHEROSCLEROSIS SIR,-Onion and garlic are reported to have hypoglycaemic and
hypolipsemic
activities and may have
an
inhibitory
effect
atherosclerosis. 1-7 Practically all the studies reported so far are based either on acute clinical studies in volunteers or on experiments in rabbits. We know of no epidemiological study of lipid profile in various groups of persons with different eating habits of onion and garlic. This study was done in the Jain community in Poona, and three groups of healthy volunteers from the Jain community were selected as follows: on
Group 1.-45 people on mixed diet (but mostly vegetarian diet) eating liberal amounts of onion (600 g or more in a week) and garlic (50 g or more in a week). Group 7.—35 orthodox Jains who were strict vegetarians and who had never eaten onion and garlic. Group J/J.—33 persons from the Jain community and blood relatives of group n who were also strict vegetarians and had similar small amounts of onion and garlic (onion 200 g or less in a week; garlic 10 g or less in a week). All three groups were closely matched for age, sex, and social class. Group u and group III were very closely matched as they belonged to the same Jain families, and the only difference was in consumption of garlic and onion. Group i were also from the Jain community with basic habits of diet and living similar to those of group 11 and group III except that they were taking liberal amounts of onion and garlic and they were consuming mixed but mostly vegetarian diet. In all three groups a detailed history was taken, with physical examination and investigations to rule out diabetes mellitus, hypertension, and ischa’mic heart-disease. A fasting blood-sample was taken for estimation of serum cholesterol, triglycerides, alpha and beta lipoproteins, and phospholipids, coagulation-time, and plasma-fibrinogen. The results were analysed by Student’s t test (see table). COMPARISON OF SERUM
BETA-LIPOPROTEINS,
CHOLESTEROL, TRIGLYCERIDES,
AND PHOSPHOLIPID AND PLASMA-FIBRINOGEN LEVELS:
MEAN±S.D.
*
Significantly lower than in groups 11 and III (P<001). t Significantly lower than in groups n and III (P<005). t Significantly lower than in group n(r<005). § Significantly lower than in group n (r<001). The inferences drawn are: (1.) There are no significant differences in serum-cholesterol or coagulation-times (not shown) in the three groups. (2.) Serum triglycerides and beta lipoproteins ’are significantly higher in group ii and group III than in group 1.
(3.) Phospholipids and plasma-fibrinogen higher in group 11 than in groupsand ui. 1. 2.
are
significantly
Bordia, A., Bansal, H. C., Arora, S. K., Rathore, A. S., Ranawat, R. V. S., Singh, S. V. J. Ass. Physns. India, 1974, 22, 267. Gupta, N. N., Mehrotra, R. M. L., Sirkar, A. R. Ind. J. med. Res. 1966, 54, 48.
3. Jain, R. C. J. Ass. Physns. India, 1971, 19, 305. 4. Jain, R.C. ibid. p. 301. 5. Jain, R. C. ibid. 1973, 21, 357. 6. Jain, R C. Lancet, 1975, i, 1240. 7. Menon, I. S., Kendal, R. Y., Dewar, H. A., Newell, D. J. Br.
iii, 351.
med. J. 1968,