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OSTEITIS PUBIS AFTER INGUINAL HERNIORRHAPHY
108 and their hydrolysates on blood-sugar and glucosetolerance in healthy and hyperglycsemic subjects. But in view of the interesting letter by Dr. Bicknell2 it seems
origin)
appropriate
to
diets.
record
our
findings
with
London, W. 1.
animal-protein
appear to be liable
E. KIRZ. KiRz.
RADIATION: FURTHER WARNINGS
-
Divison of Biochemistry and Nutrition, Central Food Technological Research Institute, Mysore, India.
M. SRINIVASAN.
OSTEITIS PUBIS AFTER INGUINAL HERNIORRHAPHY SIR,-May I congratulate Mr. Le Vay and Mr. Borman
their report (Dec. 21). I would like to add to their personal one that occurred in a series of over five hundred herniae in men over 50 years of age.
on
cases a
The patient was a man of 50 and he evinced the same symptoms of backache and pubic and perineal pain. Before the diagnosis was made he was seen by a rheumatologist, a a neurologist, and my friend Mr. E. W. Riches, who diagnosed the condition: he was called in because of a suspicious hardness of the prostate ( ? carcinoma). Although in this patient there was no apparent infection, I think the underlying cause is a subclinical infection about the stitch (in this case no. 50 linen thread), which passes into the periosteum of the pubic tubercle, with a spreading reaction in the pubic vessels. He completely recovered in 18 months. His X-rays were identical with those shown by Le Vay and Borman. It is a baffling and tiresome complication.
physician,
London,
integrity of the pubic periosteum would to the complication of osteitis pubis.
HAROLD DODD.
W.1.
SIR,-Mr. Le Vay and Mr. Borman3 should be congratulated on immediately recognising the condition of osteitis pubis as their " second and third post-herniorrhaphy patients tottered into the orthopaedic clinic ". Osteitis pubis was first described as a postoperative complication by Legueu and Rochet in 19234 and fully dealt with by Edwin Beer 56 in 1924 and 1928. Many papers have appeared on osteitis pubis since, but not very much has been added to Beer’s original postulate that most probably trauma and infection were the main factors responsible for the development of this complication. I drew attention to this condition in 1947after I had
diagnosed osteitis pubis in one of my patients, who was shown at the meeting of the Middlesex County Medical Society on June 9, 1945. Although not generally known then, the syndrome later did become well recognised in the British Isles, especially among urologists, as a complication following operations on the bladder and prostate. As I observed in 1947, typical instances of osteitis pubis had already been reported following operations for hernia and further observations would prove that this complication was not rare. It was interesting to read again about the failure to influence the course of this condition by any active treatment including cortisone. I have had the opportunity of trying cortisone and found that it did relieve the pain (previously quite
unaffected by large doses of morphine) and allowed the patient free movement, but the injections had to be discontinued on account of prohibitive side-effects. In my
series of 300 suprapubic bladder operations, chiefly prostatectomies, on which I reported in 1947, osteitis pubis arose in 10 patients (3%). Looking back, I now believe that this was most probably due to a flaw in my technique, as all lower abdominal operations infringing the own
personal
2. Lancet, 1957, ii, 388. 3. Le Vay, D., Borman, J. B. Lancet, 1957, ii, 1252. 4. J. Urol., med. chir. 1923, 15, 1. 5. Beer, E. Int. J. Med. 1924, May, vol. 37, fasc. 5. 6. Beer, E. J. Urol. 1928, 20, 233. 7. Kirz, E. Brit. J. Surg. 1947, 34, 272.
SiR,ňThe leading articles and annotations of The Lancet used to be, and should still be, like Caesar’s wife. It is true they are difficult to write. They review data published in the world’s scientific and medical press and often give guidance to the reader in the form of critical editorial opinion. The journal and its editors cannot be blamed for drawing the " wrong " conclusion or holding wrong " opinions, but they can be castigated for misreporting the data. Recently I have been taken to task by my colleagues overseas for permitting to pass without comment a leading article in The Lancet referring to radiobiological work in which the data were wrongly reported. It was left to workers in the Netherlands to voice objection in a letter to The Lancet. Unhappily there is now a recurrence in the annotation of Dec. 28. I must beg leave to point "
the
out
error.
After summarising some recent publications, in fair but somewhat lurid form, the annotation works round to genetic damage produced by radiation; it then" becomes misleading. To Glass1 is attributed the statement: Since mutations are caused by the fracture of a chromosome followed by reunion of the broken ends in a new pattern, at least two fractures are needed for a mutation; that is why the incidence of mutations increases as the square (or some higher power) of the dose ". In fact Glass was very careful to discriminate between chromosomal mutations such as the above and point mutations. I quote from his article: "
Inasmuch as the chromosomal mutations are produced chiefly by high doses, and in those very cells that are most readily eliminated through the production of the well-known temporary sterilisation of the male after acute doses of radiation, there is relatively little genetic damage to be expected from them. Of chief importance, then, are the point mutations, in which the lesions of the hereditary material are submicroscopic in size ... " All existing genetic evidence indicates that the frequency of point mutations increases linearly with the radiation dosage." Everything that I have quoted from Glass is standard teaching based on scientific data. It has all been said many times before and is to be found in the report of the Medical Research Council’s committee2and in the report of the National Academy of Sciences.3 It is. true that Glass interprets the established data in a rather more pessimistic fashion than either of the national committees ; like any thinking scientist, he is fully entitled to his personal opinion. It is not right, however, for you to take Glass’ opinions and hang them on to distortion of the facts. Radiobiological Research Unit, JOHN’ F. LOUTIT, "
Harwell, Berks.
Director.
CHEST X-RAY EXAMINATIONS AND RADIATION HAZARDS
SIR,-Dr. Anderson, from his letter in your issue of Jan. 4, does not seem to realise that his camel has now shrunk as a result of the advent of long-term chemotherapy until it is small enough to pass through the eye of
a
needle.
The Chest Clinic, Harrow, Middlesex.
R. GRENVILLE-MATHERS.
1. Glass, B. Science, 1957, 126, 241. 2. The Hazards to Man of Nuclear and Allied Radiation. Cmd. 9780. H.M. Stationery Office, 1956. 3. National Academy of Sciences and National Research Council, The Biological Effects of Atomic Radiations. Washington, 1956.
origin)
appropriate
to
diets.
record
our
findings
with
London, W. 1.
animal-protein
appear to be liable
E. KIRZ. KiRz.
RADIATION: FURTHER WARNINGS
-
Divison of Biochemistry and Nutrition, Central Food Technological Research Institute, Mysore, India.
M. SRINIVASAN.
OSTEITIS PUBIS AFTER INGUINAL HERNIORRHAPHY SIR,-May I congratulate Mr. Le Vay and Mr. Borman
their report (Dec. 21). I would like to add to their personal one that occurred in a series of over five hundred herniae in men over 50 years of age.
on
cases a
The patient was a man of 50 and he evinced the same symptoms of backache and pubic and perineal pain. Before the diagnosis was made he was seen by a rheumatologist, a a neurologist, and my friend Mr. E. W. Riches, who diagnosed the condition: he was called in because of a suspicious hardness of the prostate ( ? carcinoma). Although in this patient there was no apparent infection, I think the underlying cause is a subclinical infection about the stitch (in this case no. 50 linen thread), which passes into the periosteum of the pubic tubercle, with a spreading reaction in the pubic vessels. He completely recovered in 18 months. His X-rays were identical with those shown by Le Vay and Borman. It is a baffling and tiresome complication.
physician,
London,
integrity of the pubic periosteum would to the complication of osteitis pubis.
HAROLD DODD.
W.1.
SIR,-Mr. Le Vay and Mr. Borman3 should be congratulated on immediately recognising the condition of osteitis pubis as their " second and third post-herniorrhaphy patients tottered into the orthopaedic clinic ". Osteitis pubis was first described as a postoperative complication by Legueu and Rochet in 19234 and fully dealt with by Edwin Beer 56 in 1924 and 1928. Many papers have appeared on osteitis pubis since, but not very much has been added to Beer’s original postulate that most probably trauma and infection were the main factors responsible for the development of this complication. I drew attention to this condition in 1947after I had
diagnosed osteitis pubis in one of my patients, who was shown at the meeting of the Middlesex County Medical Society on June 9, 1945. Although not generally known then, the syndrome later did become well recognised in the British Isles, especially among urologists, as a complication following operations on the bladder and prostate. As I observed in 1947, typical instances of osteitis pubis had already been reported following operations for hernia and further observations would prove that this complication was not rare. It was interesting to read again about the failure to influence the course of this condition by any active treatment including cortisone. I have had the opportunity of trying cortisone and found that it did relieve the pain (previously quite
unaffected by large doses of morphine) and allowed the patient free movement, but the injections had to be discontinued on account of prohibitive side-effects. In my
series of 300 suprapubic bladder operations, chiefly prostatectomies, on which I reported in 1947, osteitis pubis arose in 10 patients (3%). Looking back, I now believe that this was most probably due to a flaw in my technique, as all lower abdominal operations infringing the own
personal
2. Lancet, 1957, ii, 388. 3. Le Vay, D., Borman, J. B. Lancet, 1957, ii, 1252. 4. J. Urol., med. chir. 1923, 15, 1. 5. Beer, E. Int. J. Med. 1924, May, vol. 37, fasc. 5. 6. Beer, E. J. Urol. 1928, 20, 233. 7. Kirz, E. Brit. J. Surg. 1947, 34, 272.
SiR,ňThe leading articles and annotations of The Lancet used to be, and should still be, like Caesar’s wife. It is true they are difficult to write. They review data published in the world’s scientific and medical press and often give guidance to the reader in the form of critical editorial opinion. The journal and its editors cannot be blamed for drawing the " wrong " conclusion or holding wrong " opinions, but they can be castigated for misreporting the data. Recently I have been taken to task by my colleagues overseas for permitting to pass without comment a leading article in The Lancet referring to radiobiological work in which the data were wrongly reported. It was left to workers in the Netherlands to voice objection in a letter to The Lancet. Unhappily there is now a recurrence in the annotation of Dec. 28. I must beg leave to point "
the
out
error.
After summarising some recent publications, in fair but somewhat lurid form, the annotation works round to genetic damage produced by radiation; it then" becomes misleading. To Glass1 is attributed the statement: Since mutations are caused by the fracture of a chromosome followed by reunion of the broken ends in a new pattern, at least two fractures are needed for a mutation; that is why the incidence of mutations increases as the square (or some higher power) of the dose ". In fact Glass was very careful to discriminate between chromosomal mutations such as the above and point mutations. I quote from his article: "
Inasmuch as the chromosomal mutations are produced chiefly by high doses, and in those very cells that are most readily eliminated through the production of the well-known temporary sterilisation of the male after acute doses of radiation, there is relatively little genetic damage to be expected from them. Of chief importance, then, are the point mutations, in which the lesions of the hereditary material are submicroscopic in size ... " All existing genetic evidence indicates that the frequency of point mutations increases linearly with the radiation dosage." Everything that I have quoted from Glass is standard teaching based on scientific data. It has all been said many times before and is to be found in the report of the Medical Research Council’s committee2and in the report of the National Academy of Sciences.3 It is. true that Glass interprets the established data in a rather more pessimistic fashion than either of the national committees ; like any thinking scientist, he is fully entitled to his personal opinion. It is not right, however, for you to take Glass’ opinions and hang them on to distortion of the facts. Radiobiological Research Unit, JOHN’ F. LOUTIT, "
Harwell, Berks.
Director.
CHEST X-RAY EXAMINATIONS AND RADIATION HAZARDS
SIR,-Dr. Anderson, from his letter in your issue of Jan. 4, does not seem to realise that his camel has now shrunk as a result of the advent of long-term chemotherapy until it is small enough to pass through the eye of
a
needle.
The Chest Clinic, Harrow, Middlesex.
R. GRENVILLE-MATHERS.
1. Glass, B. Science, 1957, 126, 241. 2. The Hazards to Man of Nuclear and Allied Radiation. Cmd. 9780. H.M. Stationery Office, 1956. 3. National Academy of Sciences and National Research Council, The Biological Effects of Atomic Radiations. Washington, 1956.