- Email: [email protected]
PROGNOSTIC SIGNIFICANCE OF SERUM-LYSOZYME IN A.M.L.
1075 FETAL SCALP ELECTRODES
SIR,-Dr Allas and Professor Serr (March 20, p. 648) and Weiss (April 10, p. 803) have drawn attention
Dr Pugh and Dr
the hazards of spiral and clip type fetal electrodes. During the past three years over 5000 labours have been monitored in Watford with the Surgicraft Copeland fetal scalp electrode without a single case of fetal trauma. We are surprised that this electrode is not more widely used. The electrode has been to
SiR,—Osserman and Lawlor’ demonstrated the association of lysozymuria and hypokalaemia in some of their patients with A.M.L., and Muggia et al .2 suggested that lysozyme was probably responsible for renal potassium wasting and hypokalaemia. Wiernik and Serpick3 were unable to confirm this but their data showed that high serum levels of lysozyme in A.M.L. carried a bad prognosis. Castro et al .4 came up with the opposite conclusion, and now Dr Currie attaches prophetic significance to serum-lysozyme in A.M.L. He concluded that a serumlysozyme of < 15 p.g/ml is bad news, that levels between 15 and 85 p.g/ml are associated with long survival, and that levels above 85 p.g/ml carry a high remission-rate. No reason is given for the remarkable prognostic value of lysozyme levels. Our experience at Manchester Royal Infirmary does not confirm Currie’s findings: Remission frequency in AM.L.
Surgicraft Copeland
fetal
scalp
electrode.
available for three years, and was designed to eliminate the disadvantages of other electrodes. The electrode consists of a round-bodied needle which is totally retractable into a base by a spring attachment. The electrode is applied directly without amnioscope or introducer, with the cervix 1-lcm dilated. It is easily removed at any stage of labour. If applied mistakenly to maternal tissue or if it comes free from fetal attachment the needle tip will always be sheathed, thus eliminating the possibility of scratch and tearing injuries described by your correspondents. The electrode may be applied to scalp or breech equally effectively, and it can be used many times after suitable cleansing.
commercially
Shrodells Maternity Wing, Watford General Hospital, Watford, Herts
SiR,—The importance of identifying prognostic factors in myelogenous leukaemia (A.M.L.) is recognised. However, we feel that Dr Currie’s suggestion (April 7, p. 835) that patients without a raised serum-lysozyme are not candidates for intensive chemotherapy may be premature. Serum lysozyme was measured’ in fourteen of seventeen consecutive patients with A.M.L., diagnosed by standard Romanowsky and cytochemical techniquesand later treated by the method of Rosenthal and Moloney.3 Erythroleukacmia and promyelocytic leukaemia were excluded. Complete remission was attained in patients with low and moderately raised serum-lysozyme levels, control values corresponding to those of Dr Currie. Remission
patients
frequency in A.M.L. with presentation
serum-lvsozvme (uk-/ml):
small numbers do notpermitconclusions
on the of the prognostic significance serum-lysozyme level, finding of two patients with initial low values and continuing remission at 4 and 24 weeks suggests caution in its use as a therapeutic guide in the individual patient.
1. 2.
Hospital,
Lysozyme is chiefly elaborated by monocytes, polymorph precursors, and macrophages. Disease states with excess of these cells are associated with raised lysozyme levels. A high serum level in A.M.L. probably reflects an increased mass of primitive myeloid cells in the body. Any prognostic or aetiological label on serum lysozyme is unwarranted. Recent work has shown that hypokalaemia is not related to lysozymaemia, and lysozymuria is probably a result rather than the cause of proximal renal tubular dysfunction, which develops in patients with A.M.L.6 Department of Cardiology, Manchester Royal Infirmary,
M. A. MIR
Manchester M 13 9WL
ASBESTOS IN THE AIR
acute
St. Vincent’s Dublin 4, Ireland
pretreatment serum-lysozyme
A. K. GHOSH R. H. TIPTON
PROGNOSTIC SIGNIFICANCE OF SERUM-LYSOZYME IN A.M.L.
While such
patients with
DONALD MCCARTHY GARRETT FITZGERALD JOHN HEGARTY FRANK GOODWIN LIAM G. O’CONNELL
Osserman, E. F., Lawlor, D. P. J. exp. Med. 1966, 124, 921. Hayhoe, F. G J., and others. Spec. Rep. Ser. med. Res. Coun. 1964, no. 304, p. 19. 3. Rosenthal, D. S., Moloney, W. C. New Engl. J. Med. 1972, 286, 1176.
the association of crocidolite with (May 1, p. 944) that this substance is no longer imported. This comment has appeared frequently in the lay Press, especially in association with reports on the Acre Mill investigation. It is somewhat misleading, however, since crocidolite does continue to come into Britain as a constituent of some types of asbestos boarding which are imported from, I understand, Belgium and Japan. The concentrations are not high, and it is unlikely that the blue colour of crocidolite will be noticed because of this dilution. The Health & Safety Executive inform me that air sampling in the vicinity of workers using these materials shows a very low concentration of crocidolite, and that a product labelling scheme is being designed. However, it is misleading to suggest that there is going to be no further exposure to crocidolite in Britain. The danger is that when these building materials are dismantled two or three decades from now the product labelling will have disappeared or been overpainted and there will be high concentrations of the substance in the confined spaces of demolition work. Whether or not it is practicable to ban the import of this substance altogether, I do not know, but it is wrong to suggest that a complete ban on imports exists.
SIR,-In referring
mesothelioma you
to
state
Medical Department, Procurement Executive, Ministry of Defence, Royal Aircraft Establishment, Farnborough, Hants.
G. E. MORLEY
Osserman, E. F., Lawlor, D. P. J. exp. Med. 1966, 124, 921. Muggia, F. M., Heinemann, H. O., Farhangi, M., Osserman, E. F. Am. J. Med. 1969, 47, 351. 3. Wiernik, P. H., Serpick, A. A. ibid. 1969, 46, 330. 4. Castro, D., Perillie, P. E., Finch, S. C. 13th int Congr. Hœmat. 1970, abstr. 1. 2.
p. 231. Mir, M. A., Brabin, B., Tang, O. T., Leyland, M. J., Delamore, I. W. Ann. intern. Med. 1975, 82, 54. 6. Mir, M. A., Delamore, I. W. Br. med. J. 1974, iii, 775. 5.
SIR,-Dr Allas and Professor Serr (March 20, p. 648) and Weiss (April 10, p. 803) have drawn attention
Dr Pugh and Dr
the hazards of spiral and clip type fetal electrodes. During the past three years over 5000 labours have been monitored in Watford with the Surgicraft Copeland fetal scalp electrode without a single case of fetal trauma. We are surprised that this electrode is not more widely used. The electrode has been to
SiR,—Osserman and Lawlor’ demonstrated the association of lysozymuria and hypokalaemia in some of their patients with A.M.L., and Muggia et al .2 suggested that lysozyme was probably responsible for renal potassium wasting and hypokalaemia. Wiernik and Serpick3 were unable to confirm this but their data showed that high serum levels of lysozyme in A.M.L. carried a bad prognosis. Castro et al .4 came up with the opposite conclusion, and now Dr Currie attaches prophetic significance to serum-lysozyme in A.M.L. He concluded that a serumlysozyme of < 15 p.g/ml is bad news, that levels between 15 and 85 p.g/ml are associated with long survival, and that levels above 85 p.g/ml carry a high remission-rate. No reason is given for the remarkable prognostic value of lysozyme levels. Our experience at Manchester Royal Infirmary does not confirm Currie’s findings: Remission frequency in AM.L.
Surgicraft Copeland
fetal
scalp
electrode.
available for three years, and was designed to eliminate the disadvantages of other electrodes. The electrode consists of a round-bodied needle which is totally retractable into a base by a spring attachment. The electrode is applied directly without amnioscope or introducer, with the cervix 1-lcm dilated. It is easily removed at any stage of labour. If applied mistakenly to maternal tissue or if it comes free from fetal attachment the needle tip will always be sheathed, thus eliminating the possibility of scratch and tearing injuries described by your correspondents. The electrode may be applied to scalp or breech equally effectively, and it can be used many times after suitable cleansing.
commercially
Shrodells Maternity Wing, Watford General Hospital, Watford, Herts
SiR,—The importance of identifying prognostic factors in myelogenous leukaemia (A.M.L.) is recognised. However, we feel that Dr Currie’s suggestion (April 7, p. 835) that patients without a raised serum-lysozyme are not candidates for intensive chemotherapy may be premature. Serum lysozyme was measured’ in fourteen of seventeen consecutive patients with A.M.L., diagnosed by standard Romanowsky and cytochemical techniquesand later treated by the method of Rosenthal and Moloney.3 Erythroleukacmia and promyelocytic leukaemia were excluded. Complete remission was attained in patients with low and moderately raised serum-lysozyme levels, control values corresponding to those of Dr Currie. Remission
patients
frequency in A.M.L. with presentation
serum-lvsozvme (uk-/ml):
small numbers do notpermitconclusions
on the of the prognostic significance serum-lysozyme level, finding of two patients with initial low values and continuing remission at 4 and 24 weeks suggests caution in its use as a therapeutic guide in the individual patient.
1. 2.
Hospital,
Lysozyme is chiefly elaborated by monocytes, polymorph precursors, and macrophages. Disease states with excess of these cells are associated with raised lysozyme levels. A high serum level in A.M.L. probably reflects an increased mass of primitive myeloid cells in the body. Any prognostic or aetiological label on serum lysozyme is unwarranted. Recent work has shown that hypokalaemia is not related to lysozymaemia, and lysozymuria is probably a result rather than the cause of proximal renal tubular dysfunction, which develops in patients with A.M.L.6 Department of Cardiology, Manchester Royal Infirmary,
M. A. MIR
Manchester M 13 9WL
ASBESTOS IN THE AIR
acute
St. Vincent’s Dublin 4, Ireland
pretreatment serum-lysozyme
A. K. GHOSH R. H. TIPTON
PROGNOSTIC SIGNIFICANCE OF SERUM-LYSOZYME IN A.M.L.
While such
patients with
DONALD MCCARTHY GARRETT FITZGERALD JOHN HEGARTY FRANK GOODWIN LIAM G. O’CONNELL
Osserman, E. F., Lawlor, D. P. J. exp. Med. 1966, 124, 921. Hayhoe, F. G J., and others. Spec. Rep. Ser. med. Res. Coun. 1964, no. 304, p. 19. 3. Rosenthal, D. S., Moloney, W. C. New Engl. J. Med. 1972, 286, 1176.
the association of crocidolite with (May 1, p. 944) that this substance is no longer imported. This comment has appeared frequently in the lay Press, especially in association with reports on the Acre Mill investigation. It is somewhat misleading, however, since crocidolite does continue to come into Britain as a constituent of some types of asbestos boarding which are imported from, I understand, Belgium and Japan. The concentrations are not high, and it is unlikely that the blue colour of crocidolite will be noticed because of this dilution. The Health & Safety Executive inform me that air sampling in the vicinity of workers using these materials shows a very low concentration of crocidolite, and that a product labelling scheme is being designed. However, it is misleading to suggest that there is going to be no further exposure to crocidolite in Britain. The danger is that when these building materials are dismantled two or three decades from now the product labelling will have disappeared or been overpainted and there will be high concentrations of the substance in the confined spaces of demolition work. Whether or not it is practicable to ban the import of this substance altogether, I do not know, but it is wrong to suggest that a complete ban on imports exists.
SIR,-In referring
mesothelioma you
to
state
Medical Department, Procurement Executive, Ministry of Defence, Royal Aircraft Establishment, Farnborough, Hants.
G. E. MORLEY
Osserman, E. F., Lawlor, D. P. J. exp. Med. 1966, 124, 921. Muggia, F. M., Heinemann, H. O., Farhangi, M., Osserman, E. F. Am. J. Med. 1969, 47, 351. 3. Wiernik, P. H., Serpick, A. A. ibid. 1969, 46, 330. 4. Castro, D., Perillie, P. E., Finch, S. C. 13th int Congr. Hœmat. 1970, abstr. 1. 2.
p. 231. Mir, M. A., Brabin, B., Tang, O. T., Leyland, M. J., Delamore, I. W. Ann. intern. Med. 1975, 82, 54. 6. Mir, M. A., Delamore, I. W. Br. med. J. 1974, iii, 775. 5.