- Email: [email protected]
TRANSLOCATION OF INTRAUTERINE CONTRACEPTIVE DEVICES
1057
widely known
among
paediatricians
as
it may be of
con-
siderable help in management. Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ.
ALISON SMITHIES H. B. VALMAN.
C.S.F. AND RELEASE OF PITUITARY HORMONES read the paper by Dr Barbato and his colleagues (April 6, p. 599) in which they report their findings of a factor in normal human cerebrospinal fluid (c.s.F.) which released growth-hormone from monkey pituitary glands in vitro. Their findings led them to postulate that the C.S.F. might be a pathway for subIn our stances affecting release of pituitary hormones.
SIR,—We
were
interested
to
investigations two possibilities occurred to us. Firstly, c.s.F. might be a pathway for circulation of the hypothalamic releasing hormones. This we thought less likely than a second possibility that, being relatively low in protein, c.s.F. might lack the enzyme systems which metabolise releasing hormones in blood. If this were so it might be possible to detect releasing hormones by radioimmunoassay in c.s.F. more readily than in blood. We assayed luteinising-hormone-releasing hormone (L.H.R.H.) by radioimmunoassay1 in 26 samples of C.S.F. obtained for purposes of venereal-disease serology from young adults of both sexes. In 23 samples ’L.H.-R.H. was undetectable (less than 1 pg. per ml.). In the other 3, own
that the
values of 22, 25, and 120 pg. per ml. were obtained, but dilutions showed evidence of non-parallelism creating doubts about identity. In the light of our findings of L.H.-R.H. in the blood of laboratory animals and man we consider it improbable that C.S.F. contains significant levels OfL.H.-R.H. Department of Surgery, The University, Dundee DD1 4HN.
Department of Chemical Pathology, St. Thomas’s Hospital, London SE1. St. Bartholomew’s
Hospital,
London.
A. GUNN H. M. FRASER. S. L. JEFFCOATE D. T. HOLLAND. W.
J. JEFFCOATE.
TRANSLOCATION OF INTRAUTERINE CONTRACEPTIVE DEVICES
SiR,—We fully agree with Dr Sparks (April 27, p. 816) a straight abdominal X-ray is not a reliable method to diagnose extrauterine location of an intrauterine contraceptive device (I.U.D.), as suggested by Dr MacKay and that
1.
Jeffcoate,
S. L.,
In our experience, a Dr Mowat (April 13, p. 652). " normal " position of an i.u.D. on a flat plate of the abdomen can very well be associated with translocation of the device into the abdominal cavity. As a routine, we always introduce a probe into the uterine cavity before taking an X-ray, as suggested by Dr Sparks. With this policy a translocated I.U.D., which otherwise might have been missed, can be diagnosed, as demonstrated by the
following
31-year-old gravida 1, para 1, had a Copper-T 200 inserted during the first day of her menstrual period. The patient was seen seven days thereafter because she could no longer feel the tail of her i.u.D. A flat plate of the abdomen was immediately done and was compatible with a normal position of the uterus (fig. 1). With a probe inserted into the uterine cavity dislocation of the device into the abdominal cavity could be demonstrated on a flat plate (fig. 2), as well as on a lateral X-ray (fig. 3). As the patient did not want to undergo abdominal surgery, a posterior colpotomy was performed and the i.u.D. was easily removed and the patient was discharged the following day in satisfactory condition. If a copper-bearing device perforates to the abdominal cavity it should be removed as soon as the diagnosis is made, because the device tends to be embedded in the When a transomentum or tends to cause adhesions. located i.u.D. is located posterior to the uterus, removal via colpotomy should be considered. Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, LARS L. CEDERQVIST 530 East 70th Street, New York, New York 10021, U.S.A. STANLEY J. BIRNBAUM.
EARLY NEONATAL HYPOCALCÆMIA SIR,-I read with great interest your editorial (Feb. 2, p. 155) concerning the jig-saw puzzle of calcium in the newborn infant. I should like to contribute some pieces to this puzzle from my recent studies. My observations seem to suggest that neonatal hypocalcaEmia may be induced by an interaction between growth hormone (G.H.), calcitonin (C.T.), and parathyroid hormone
(P.T.H.).l Both hyperglycaeniia and hypogIycaEmia stimulate secretion of G.H. in the newborn.2.3 In a study of infants of diabetic mothers (l.D.M.) a large increase in the concentration of G.H. was found immediately after birth.1 This may be attributed to the increased amount of glucose given to
these infants after birth. Concomitant with this increase
1. 2.
Bergman, L. Acta Pediat. Scand. 1974, suppl. 248 (in the press). Cornblath, M., Parker, M. L., Reissner, S. H., Forbes, A. E., Daughaday, W. H. J. clin. Endocr. Metab. 1965, 25, 209. Westphal, O. Acta pœdiat. scand. 1968, suppl. 182.
Fraser, H. M., Holland, D. T., Gunn, A. Acta
endocr., Copenh. 1974, 75, 625.
Fig. 1-Appearances compatible with normal position.
case.
A
3.
Fig. 2-Dislocation demonstrated with probe in uterine cavity.
Fig. 3-Dislocation in lateral view.
widely known
among
paediatricians
as
it may be of
con-
siderable help in management. Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ.
ALISON SMITHIES H. B. VALMAN.
C.S.F. AND RELEASE OF PITUITARY HORMONES read the paper by Dr Barbato and his colleagues (April 6, p. 599) in which they report their findings of a factor in normal human cerebrospinal fluid (c.s.F.) which released growth-hormone from monkey pituitary glands in vitro. Their findings led them to postulate that the C.S.F. might be a pathway for subIn our stances affecting release of pituitary hormones.
SIR,—We
were
interested
to
investigations two possibilities occurred to us. Firstly, c.s.F. might be a pathway for circulation of the hypothalamic releasing hormones. This we thought less likely than a second possibility that, being relatively low in protein, c.s.F. might lack the enzyme systems which metabolise releasing hormones in blood. If this were so it might be possible to detect releasing hormones by radioimmunoassay in c.s.F. more readily than in blood. We assayed luteinising-hormone-releasing hormone (L.H.R.H.) by radioimmunoassay1 in 26 samples of C.S.F. obtained for purposes of venereal-disease serology from young adults of both sexes. In 23 samples ’L.H.-R.H. was undetectable (less than 1 pg. per ml.). In the other 3, own
that the
values of 22, 25, and 120 pg. per ml. were obtained, but dilutions showed evidence of non-parallelism creating doubts about identity. In the light of our findings of L.H.-R.H. in the blood of laboratory animals and man we consider it improbable that C.S.F. contains significant levels OfL.H.-R.H. Department of Surgery, The University, Dundee DD1 4HN.
Department of Chemical Pathology, St. Thomas’s Hospital, London SE1. St. Bartholomew’s
Hospital,
London.
A. GUNN H. M. FRASER. S. L. JEFFCOATE D. T. HOLLAND. W.
J. JEFFCOATE.
TRANSLOCATION OF INTRAUTERINE CONTRACEPTIVE DEVICES
SiR,—We fully agree with Dr Sparks (April 27, p. 816) a straight abdominal X-ray is not a reliable method to diagnose extrauterine location of an intrauterine contraceptive device (I.U.D.), as suggested by Dr MacKay and that
1.
Jeffcoate,
S. L.,
In our experience, a Dr Mowat (April 13, p. 652). " normal " position of an i.u.D. on a flat plate of the abdomen can very well be associated with translocation of the device into the abdominal cavity. As a routine, we always introduce a probe into the uterine cavity before taking an X-ray, as suggested by Dr Sparks. With this policy a translocated I.U.D., which otherwise might have been missed, can be diagnosed, as demonstrated by the
following
31-year-old gravida 1, para 1, had a Copper-T 200 inserted during the first day of her menstrual period. The patient was seen seven days thereafter because she could no longer feel the tail of her i.u.D. A flat plate of the abdomen was immediately done and was compatible with a normal position of the uterus (fig. 1). With a probe inserted into the uterine cavity dislocation of the device into the abdominal cavity could be demonstrated on a flat plate (fig. 2), as well as on a lateral X-ray (fig. 3). As the patient did not want to undergo abdominal surgery, a posterior colpotomy was performed and the i.u.D. was easily removed and the patient was discharged the following day in satisfactory condition. If a copper-bearing device perforates to the abdominal cavity it should be removed as soon as the diagnosis is made, because the device tends to be embedded in the When a transomentum or tends to cause adhesions. located i.u.D. is located posterior to the uterus, removal via colpotomy should be considered. Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, LARS L. CEDERQVIST 530 East 70th Street, New York, New York 10021, U.S.A. STANLEY J. BIRNBAUM.
EARLY NEONATAL HYPOCALCÆMIA SIR,-I read with great interest your editorial (Feb. 2, p. 155) concerning the jig-saw puzzle of calcium in the newborn infant. I should like to contribute some pieces to this puzzle from my recent studies. My observations seem to suggest that neonatal hypocalcaEmia may be induced by an interaction between growth hormone (G.H.), calcitonin (C.T.), and parathyroid hormone
(P.T.H.).l Both hyperglycaeniia and hypogIycaEmia stimulate secretion of G.H. in the newborn.2.3 In a study of infants of diabetic mothers (l.D.M.) a large increase in the concentration of G.H. was found immediately after birth.1 This may be attributed to the increased amount of glucose given to
these infants after birth. Concomitant with this increase
1. 2.
Bergman, L. Acta Pediat. Scand. 1974, suppl. 248 (in the press). Cornblath, M., Parker, M. L., Reissner, S. H., Forbes, A. E., Daughaday, W. H. J. clin. Endocr. Metab. 1965, 25, 209. Westphal, O. Acta pœdiat. scand. 1968, suppl. 182.
Fraser, H. M., Holland, D. T., Gunn, A. Acta
endocr., Copenh. 1974, 75, 625.
Fig. 1-Appearances compatible with normal position.
case.
A
3.
Fig. 2-Dislocation demonstrated with probe in uterine cavity.
Fig. 3-Dislocation in lateral view.