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RIFAMPICIN
1094
particularly if an oxytocic has been given at the outset of the operation. My experience is that hysterectomy is readily accepted, but it is, of course, necessary to explain to the patient that it will not alter her psyche or soma, nor prevent her enjoyment of intercourse later on. A few superstitious women are unable to comprehend this, and some other procedure is preferred, but many of these patients are likely to seek gynaecological advice later, complaining of menorrhagia, polymenorrhoea, discharge, and even cancer. I have personally, in this year, treated two women with cervical cancer. Both had had sterilising operations within the past five years, both were highly parous women, one having had twelve children, and the other five. Timely hysterectomy would have served them better. E. ARTHUR WILLIAMS. RIFAMPICIN
SIR,-In your annotation (May 10, p. 976) you suggest that rifampicin is likely to be an important new addition to the antibiotic range because of its activity against mycobacteria, and gram-positive and gram-negative organisms. Successful treatment has been reported in tuberculosis and gonorrhoea .2 Rifampicin might be expected to be a useful antibiotic for treating urinay-tract infections because of high urinary excretion. We have given rifampicin to 19 female patients with urinaryinfections and the results are shown in tables I and II. Dosage schedules were 300 mg. 8-hourly, 450 mg. 12-hourly, or a loading dose of 900 mg. followed by 450 mg. 12-hourly. The loading dose did not improve the results and caused mild abdominal distension and flatulence. In spite of high serum and urine levels of rifampicin, treatment failed in 11 out of 19 patients and if treatment was continued, the minimum inhibitory concentration (M.l.c.) of rifampicin against the organism rose in a step-wise fashion to > 600 (Lg. per ml. within All 8 patients who were treated apparently a few days.
tract
Gyselen, A., Verbist, F. L., Cosemans, J., Lacquet, L. M., Vandenbergh, E. Am. Rev. resp. Dis. 1968, 98, 933. 2. Cobold, R. J. C., Morrison, G. D., Wilcox, R. R. Br. med. J. 1968, iv 1.
681.
successfully had a recurrence of infection within a few weeks of receiving rifampicin. We conclude that rifampicin is of no significant value in treating urinary-tract infections.
J. McC. MURDOCH Infectious Diseases Unit,
City Hospital, Edinburgh 10.
*,jt* Experience with rifampicin p. 1081.
COLIN F. SPEIRS NOEL WRIGHT EDITH T. WALLACE. is discussed editorially on
EFFECT OF BRAIN DISTENSION ON CEREBRAL CIRCULATION
SIR,-It was with great interest that I read Professor Greitz’s hypothesis (April 26, p. 863) that ventricular dilatation in the elderly, with or without dementia, is due to distension of the ventricles. It is difficult to be sure whether the dilatation is Professor Greitz suggests that it is the cause cause or effect. and has used two arguments to support this hypothesis. Firstly, that there is a reduced blood-flow in elderly and demented patients, both with and without communicating hydrocephalus, which he suggests is due to ventricular distension. This seems unlikely, since the cerebrospinalfluid (C.S.F.) pressure has to be increased to about 400 mm. of water before cerebral perfusion-rates are affected; as Professor Greitz points out, the intraventricular pressure is the same as in the rest of the C.S.F. space, and pressures of this magnitude are not found in elderly and demented patients. It seems much more likely that the reduction in blood-flow is due to reduced metabolic demand, which of course may also be reversible. Secondly, Professor Greitz points out that the cortex usually remains in contact with the cranium while the ventricles enlarge; again it may be difficult to distinguish cause and effect. It would seem reasonable to use Professor Greitz’s arguments concerning the effect of the transmitted pulse-pressure to suggest that, in the presence of cerebral
atrophy, than
to
ventricular dilatation is more likely to occur, rather suggest that ventricular distension is the cause of the
atrophy.
TABLE I-SUCCESSFUL TREATMENT WITH RIFAMPICIN
TABLE II-FAILED TREATMENT WITH RIFAMPICIN
particularly if an oxytocic has been given at the outset of the operation. My experience is that hysterectomy is readily accepted, but it is, of course, necessary to explain to the patient that it will not alter her psyche or soma, nor prevent her enjoyment of intercourse later on. A few superstitious women are unable to comprehend this, and some other procedure is preferred, but many of these patients are likely to seek gynaecological advice later, complaining of menorrhagia, polymenorrhoea, discharge, and even cancer. I have personally, in this year, treated two women with cervical cancer. Both had had sterilising operations within the past five years, both were highly parous women, one having had twelve children, and the other five. Timely hysterectomy would have served them better. E. ARTHUR WILLIAMS. RIFAMPICIN
SIR,-In your annotation (May 10, p. 976) you suggest that rifampicin is likely to be an important new addition to the antibiotic range because of its activity against mycobacteria, and gram-positive and gram-negative organisms. Successful treatment has been reported in tuberculosis and gonorrhoea .2 Rifampicin might be expected to be a useful antibiotic for treating urinay-tract infections because of high urinary excretion. We have given rifampicin to 19 female patients with urinaryinfections and the results are shown in tables I and II. Dosage schedules were 300 mg. 8-hourly, 450 mg. 12-hourly, or a loading dose of 900 mg. followed by 450 mg. 12-hourly. The loading dose did not improve the results and caused mild abdominal distension and flatulence. In spite of high serum and urine levels of rifampicin, treatment failed in 11 out of 19 patients and if treatment was continued, the minimum inhibitory concentration (M.l.c.) of rifampicin against the organism rose in a step-wise fashion to > 600 (Lg. per ml. within All 8 patients who were treated apparently a few days.
tract
Gyselen, A., Verbist, F. L., Cosemans, J., Lacquet, L. M., Vandenbergh, E. Am. Rev. resp. Dis. 1968, 98, 933. 2. Cobold, R. J. C., Morrison, G. D., Wilcox, R. R. Br. med. J. 1968, iv 1.
681.
successfully had a recurrence of infection within a few weeks of receiving rifampicin. We conclude that rifampicin is of no significant value in treating urinary-tract infections.
J. McC. MURDOCH Infectious Diseases Unit,
City Hospital, Edinburgh 10.
*,jt* Experience with rifampicin p. 1081.
COLIN F. SPEIRS NOEL WRIGHT EDITH T. WALLACE. is discussed editorially on
EFFECT OF BRAIN DISTENSION ON CEREBRAL CIRCULATION
SIR,-It was with great interest that I read Professor Greitz’s hypothesis (April 26, p. 863) that ventricular dilatation in the elderly, with or without dementia, is due to distension of the ventricles. It is difficult to be sure whether the dilatation is Professor Greitz suggests that it is the cause cause or effect. and has used two arguments to support this hypothesis. Firstly, that there is a reduced blood-flow in elderly and demented patients, both with and without communicating hydrocephalus, which he suggests is due to ventricular distension. This seems unlikely, since the cerebrospinalfluid (C.S.F.) pressure has to be increased to about 400 mm. of water before cerebral perfusion-rates are affected; as Professor Greitz points out, the intraventricular pressure is the same as in the rest of the C.S.F. space, and pressures of this magnitude are not found in elderly and demented patients. It seems much more likely that the reduction in blood-flow is due to reduced metabolic demand, which of course may also be reversible. Secondly, Professor Greitz points out that the cortex usually remains in contact with the cranium while the ventricles enlarge; again it may be difficult to distinguish cause and effect. It would seem reasonable to use Professor Greitz’s arguments concerning the effect of the transmitted pulse-pressure to suggest that, in the presence of cerebral
atrophy, than
to
ventricular dilatation is more likely to occur, rather suggest that ventricular distension is the cause of the
atrophy.
TABLE I-SUCCESSFUL TREATMENT WITH RIFAMPICIN
TABLE II-FAILED TREATMENT WITH RIFAMPICIN