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STERILE BATH-LININGS
571
Fig. 3-Distribution of sex-chromatin counts in buccal epithelial cells of 30 hospital inpatients without overt malignant disease.
chromatin
bodies, as Hienz 15 once suggested, is caused by male tumour tissue. Like Meier-Ruge and Gross et al.,16 we believe that the low sex-chromatin count in tumour tissue is caused mainly by destruction of the nuclear structures, and so appears more in quickly growing, immature tumours. A strikingly low sex-chromatin count in structurally normal cells from buccal smears led Stanley et al.12 to entertain the possibility that patients with breast cancer might have a genetic predisposition to this disease, and they were even of the opinion that these findings could be used for early prognosis of breast carcinoma. We cannot agree with these propositions from our
genetically Fig. 1-Distribution of sex-chromatin counts in buccal epithelial cells from 50 patients with breast cancer.
slide, and stained with carbolic fuchsin by Eskelund’s method.13 Under an oil-immersion lens, magnification 1/1200, we counted a minimum of 100 nuclei per preparation in a continuous line, omitting no usable nuclei. Only sex-chromatin bodies lying in the periphery of the nucleus and in contact with the nuclear membrane were scored. Folding, overlapping, or overgranulated nuclei, or those covered by bacteria, were counts showed no difference greater than 6% in general. The following results are based on the average of three independent counts of each smear. The distribution of sex chromatin in the patients’ buccal epithelial cells is shown as percentages in fig. 1. 1 patient had only 16% of sex-chromatin bodies, 3 patients’ counts were below 25% (21%, 23%, and 24%), and those of 4 were below 30% (25%, 25%, 27%, and 28%). Two-thirds of our patients had sex-chromatin counts of 35-45%. The age-distribution of our patients is shown in fig. 2. The average age was 59-8 years. A control group of 30 female hospital inpatients without overt malignant disease, and of similar age (see fig. 3) had an average count of sex-chromatin bodies of 34-4% compared with an average count of 36-0% for the group with breast cancer. Thus we were not able to confirm the results of Stanley et al. In 3 of our patients the sex-chromatin bodies in the tumour tissue were kindly counted for us by Prof. L. Burkhardt (Pathological Institute, Krankenhaus Rechts der Isar, Munich). Counts of 1%, 25%, and 1% were found, the counts of the buccal smears of the same patients being 38%, 34%, and 25%. Thus, despite normal sex-chromatin counts in buccal smears, 2 patients had very low counts in the tumour tissue itself.
own
1st
excluded. Control
There is without doubt a wide range of differences in incidence of sex-chromatin count (0-50%).14 We therefore do not believe that an abnormally low count or missing sex13. 14.
Eskelund, V. Acta. endocr., Copenh. 1956, 23, 246. Soost, H.-J. Acta cytol. 1962, 6, 139. Soost, H. J., Smolka, H. Grundriss und Atlas der Gynakologischen Zytodiagnostik. Stuttgart, 1965.
investigations. University Department of Obstetrics and Gynæcology, 11 Maistrasse, 8 Munich 15, West Germany.
London W.1. 15. 16. of
patients with breast
cancer.
G. KNOTE.
STERILE BATH-LININGS SIR,-In 1941, Stannard and I used bath linings of ‘ Bakelite ’-coated silk fabric. Experience with severe burns convinced us that we would get better results and make it easier for the nurses and less upsetting for the patient if the patient could be bathed or irrigated in a bath which would also be his bed. A bed-bath was devised consisting of a canvas " dinghy " supported by a light frame, under which was placed a ’Dunlopillo ’ mattress stiffened by fracture boards. A coated-silk inner lining was suspended from the edges of the dinghy by weighted straps and a drain tube was provided at the foot end. The patient was wrapped in a coated silk gown which acted as the sole dressing and allowed adequate access for irrigation. Many severe burns have been treated in this device, which has prevented the cross-infection described by Mr. Summers (Sept. 2, p. 514); a sophisticated model has been designed and is now being prototyped. Physiological saline solution is still recommended as a medium for soaking dressings off burns. It has little or no therapeutic value, is easily contaminated, and is not selfsterilising. Hypoclorite solution, on the other hand, is therapeutically useful and is self-sterilising. I have yet to hear of any valid reason why it should not be preferred to saline. It is difficult to understand why dressings have to be soaked off now that non-adherent dressings are available. I have devised two such dressings which allow adequate drainage and yet prevent the damaging contact of the absorbent material. Work on the shock phase of burns has produced excellent results and many patients survive who would not have done so twenty years ago. But topical treatment of the burns lesion lags a long way behind, and many of the lessons of the 193945 war have been forgotten, so that, although a severely burned patient will recover from shock, he is in great danger of succumbing from infection. Medical Engineering Development Trust,
Fig. 2-Age-distribution
H.-J. SOOST
JOHN BUNYAN.
Hienz, H. A. Dt. med. Wschr. 1957, 82, 1986. Meier-Ruge, W. Med. Welt, Stuttg. 1967, 14, 871. Gross, F., Mahringer, W., Trebbin, H., Bohle, A. Germ. med. Mon. 1965, 10, 12.
Fig. 3-Distribution of sex-chromatin counts in buccal epithelial cells of 30 hospital inpatients without overt malignant disease.
chromatin
bodies, as Hienz 15 once suggested, is caused by male tumour tissue. Like Meier-Ruge and Gross et al.,16 we believe that the low sex-chromatin count in tumour tissue is caused mainly by destruction of the nuclear structures, and so appears more in quickly growing, immature tumours. A strikingly low sex-chromatin count in structurally normal cells from buccal smears led Stanley et al.12 to entertain the possibility that patients with breast cancer might have a genetic predisposition to this disease, and they were even of the opinion that these findings could be used for early prognosis of breast carcinoma. We cannot agree with these propositions from our
genetically Fig. 1-Distribution of sex-chromatin counts in buccal epithelial cells from 50 patients with breast cancer.
slide, and stained with carbolic fuchsin by Eskelund’s method.13 Under an oil-immersion lens, magnification 1/1200, we counted a minimum of 100 nuclei per preparation in a continuous line, omitting no usable nuclei. Only sex-chromatin bodies lying in the periphery of the nucleus and in contact with the nuclear membrane were scored. Folding, overlapping, or overgranulated nuclei, or those covered by bacteria, were counts showed no difference greater than 6% in general. The following results are based on the average of three independent counts of each smear. The distribution of sex chromatin in the patients’ buccal epithelial cells is shown as percentages in fig. 1. 1 patient had only 16% of sex-chromatin bodies, 3 patients’ counts were below 25% (21%, 23%, and 24%), and those of 4 were below 30% (25%, 25%, 27%, and 28%). Two-thirds of our patients had sex-chromatin counts of 35-45%. The age-distribution of our patients is shown in fig. 2. The average age was 59-8 years. A control group of 30 female hospital inpatients without overt malignant disease, and of similar age (see fig. 3) had an average count of sex-chromatin bodies of 34-4% compared with an average count of 36-0% for the group with breast cancer. Thus we were not able to confirm the results of Stanley et al. In 3 of our patients the sex-chromatin bodies in the tumour tissue were kindly counted for us by Prof. L. Burkhardt (Pathological Institute, Krankenhaus Rechts der Isar, Munich). Counts of 1%, 25%, and 1% were found, the counts of the buccal smears of the same patients being 38%, 34%, and 25%. Thus, despite normal sex-chromatin counts in buccal smears, 2 patients had very low counts in the tumour tissue itself.
own
1st
excluded. Control
There is without doubt a wide range of differences in incidence of sex-chromatin count (0-50%).14 We therefore do not believe that an abnormally low count or missing sex13. 14.
Eskelund, V. Acta. endocr., Copenh. 1956, 23, 246. Soost, H.-J. Acta cytol. 1962, 6, 139. Soost, H. J., Smolka, H. Grundriss und Atlas der Gynakologischen Zytodiagnostik. Stuttgart, 1965.
investigations. University Department of Obstetrics and Gynæcology, 11 Maistrasse, 8 Munich 15, West Germany.
London W.1. 15. 16. of
patients with breast
cancer.
G. KNOTE.
STERILE BATH-LININGS SIR,-In 1941, Stannard and I used bath linings of ‘ Bakelite ’-coated silk fabric. Experience with severe burns convinced us that we would get better results and make it easier for the nurses and less upsetting for the patient if the patient could be bathed or irrigated in a bath which would also be his bed. A bed-bath was devised consisting of a canvas " dinghy " supported by a light frame, under which was placed a ’Dunlopillo ’ mattress stiffened by fracture boards. A coated-silk inner lining was suspended from the edges of the dinghy by weighted straps and a drain tube was provided at the foot end. The patient was wrapped in a coated silk gown which acted as the sole dressing and allowed adequate access for irrigation. Many severe burns have been treated in this device, which has prevented the cross-infection described by Mr. Summers (Sept. 2, p. 514); a sophisticated model has been designed and is now being prototyped. Physiological saline solution is still recommended as a medium for soaking dressings off burns. It has little or no therapeutic value, is easily contaminated, and is not selfsterilising. Hypoclorite solution, on the other hand, is therapeutically useful and is self-sterilising. I have yet to hear of any valid reason why it should not be preferred to saline. It is difficult to understand why dressings have to be soaked off now that non-adherent dressings are available. I have devised two such dressings which allow adequate drainage and yet prevent the damaging contact of the absorbent material. Work on the shock phase of burns has produced excellent results and many patients survive who would not have done so twenty years ago. But topical treatment of the burns lesion lags a long way behind, and many of the lessons of the 193945 war have been forgotten, so that, although a severely burned patient will recover from shock, he is in great danger of succumbing from infection. Medical Engineering Development Trust,
Fig. 2-Age-distribution
H.-J. SOOST
JOHN BUNYAN.
Hienz, H. A. Dt. med. Wschr. 1957, 82, 1986. Meier-Ruge, W. Med. Welt, Stuttg. 1967, 14, 871. Gross, F., Mahringer, W., Trebbin, H., Bohle, A. Germ. med. Mon. 1965, 10, 12.