- Email: [email protected]
UNRECOGNISED EPIDEMIC OF ANENCEPHALY AND SPINA BIFIDA
188 and his co-workershave lately rewith a persistent growth of introital enterobacteria had the most episodes OfU.T.I. during followup. A single bacterial count in excess of 100,000 per ml. in patients known to have their introital areas heavily contaminated with enterobacteria is unlikely to have the same significance as in the general female population. At least in research situations, the diagnosis of u.T.i. must be made with absolute confidence. No worker will accept the simplicity and obvious advantages of S.P.A. until he has used it. I believe it satisfies the need expressed in your editorial (Jan. 9, p. 71) for a test which will distinguish significant from non-significant bacteriuria.
Professor
ported that
O’Grady women
Renal Infection Unit, Charing Cross Hospital Medical School, Fulham Hospital,
London W.6.
SIR,-In their
paper (Jan. 2, p. 9), Dr. Lawson and Dr. Miller conclude that the benefits derived from the screening of patients for bacteriuria do not justify the effort involved in its performance. Unfortunately, they do not say precisely what bacteriological method was used, and it is impossible therefore satisfactorily to evaluate their very important findings. The routine screening of urine for significant bacteriuria can be laborious and time-consuming if this depends on the performance of a viable count. Chemical tests are not entirely satisfactory, in that certain bacteria encountered in urinary-tract infec-
tions
most
interesting
very inactive
biochemically. Currently we are exploring possibility of counting bacteria in urine by a relatively simple and quick instrumented method. are
the
Central Middlesex Hospital, London N.W.10.
Anencephalic child with
Ross R. BAILEY.
extra
leg.
developed as far as the hair-line, but there the skull stopped abruptly and the poorly developed brain, covered by meninges, protruded in a cauliflower manner. The mother was aged 17, a primipara, and a native of Jobore (six miles from Ijebu-Ode). She had her antenatal supervision at the Rural Health Centre, Ketu. When first seen there (in the first trimester) she had admitted to using a native medicine commonly taken by pregnant women
in this part of the Federation. She had
not
been ill
during this period. At the Rural Health Centre she had been given the usual antenatal drugs-ferrous sulphate, vitamin C, and folic acid. State Hospital, Ijebu-Ode, Nigeria.
A.
OKUBOYEJO.
C. E. D. TAYLOR M. A. T. COLES. REVERSIBLE DEATH
UNRECOGNISED EPIDEMIC OF ANENCEPHALY AND SPINA BIFIDA
SiR,-The interesting report by Professor MacMahon and Dr. Yen (Jan. 2, p. 31) refers to the distribution of births of babies with anencephaly and spina bifida in time, but not on a geographical basis. I think it would be of value if it were possible to ascertain the addresses of the mothers concerned at the time of conception, especially during the epidemic period. If these were plotted on a map, they might throw some light on the epidemiology of the condition. Ideally, it is not sufficient merely to register congenital abnormalities as we do in this country: each pregnancy could be investigated quite simply with an inquiry into locality at time of conception and early gestation. After all, detailed inquiries are made of personal movements and activities in outbreaks of infectious disease in attempts to ascertain the causes; and one cannot help wondering why they are not undertaken for more serious conditions, such as congenital abnormalities. Health Department, Oxford.
M. J. PLEYDELL.
EXTRA LEG WITH ANENCEPHALY
SIR,-We wish to report the delivery of a three-legged child at the State Hospital, Ijebu-Ode. The child, a male, was alive but blue at birth, and weighed 8 lb. 2 oz. He had two normal legs 8 inches long, and a third arising from the back just above the cleft of the buttocks. The third leg was 2 inches shorter than the others and had only two The face was normally toes (see accompanying figure). 8.
O’Grady, F. W., Richards, B., McSherry, M. A., O’Farrell, S. M., Cattell, W. R. Lancet, 1970, ii, 1208.
SIR,-Your editorial with this titlerightly draws attention to the fact that a flat E.E.G. (the term isoelectric E.E.G. is preferable) may be found during some forms of coma, and that it does not preclude complete recovery. It is unfortunate that the title of the editorial might be taken to mean that the isoelectric E.E.G. is synonymous with death. This is certainly not the case, and, apart from those conditions that you mention (severe brainstem damage from compressive or non-compressive cerebral lesions, hepatic coma, and hypoglycxmia), there are many, such as drug overdose2 and encephalitis,3 which may also be reversible despite an isoelectric E.E.G. These conditions, however, are all rather uncommon and an isoelectric E.E.G. unquestionably carries a severe prognosis. Indeed, a review was carried out under the xgis of the American E.E.G. Society4 concerning 2000 patients with isoelectric E.E.G.s from a variety of causes: there were only 3 survivors, all of whom had had drug overdoses. In our experience, most of the patients in whom this type of E.E.G. is recorded have had acute cerebral anoxia, and are quite different from those of Brendler and Selverstone5 in that spontaneous respiratory movements have ceased and other spontaneous reflex functions, all necessary features for the determination of death,6 are absent. Prognosis in this group can reliably be predicted from the E.E.G.7 The isoelectric E.E.G. has become particularly important 1.
2. 3.
Lancet, 1970, ii, 1172. Bird, T. D., Plum, F. Neurology, 1968, 18, 456. Bental, E., Leibowitz, U. Electroenceph. clin. Neurophysiol. 1961.
13, 457. Silverman, D., Saunders, M. D., Schwab, R. S., Masland, R. L. J. Am. med. Ass. 1969, 209, 1505. 5. Brendler, S. J., Selverstone, B. Brain, 1970, 93, 381. 6. Harvard Committee, J. Am. med. Ass. 1969, 205, 337. 7. Binnie, C. D., Prior, P. F., Lloyd, D. S. L., Scott, D. F., Margerison, J. H. Br. med. J. 1970, iv, 265.
4.
Professor
ported that
O’Grady women
Renal Infection Unit, Charing Cross Hospital Medical School, Fulham Hospital,
London W.6.
SIR,-In their
paper (Jan. 2, p. 9), Dr. Lawson and Dr. Miller conclude that the benefits derived from the screening of patients for bacteriuria do not justify the effort involved in its performance. Unfortunately, they do not say precisely what bacteriological method was used, and it is impossible therefore satisfactorily to evaluate their very important findings. The routine screening of urine for significant bacteriuria can be laborious and time-consuming if this depends on the performance of a viable count. Chemical tests are not entirely satisfactory, in that certain bacteria encountered in urinary-tract infec-
tions
most
interesting
very inactive
biochemically. Currently we are exploring possibility of counting bacteria in urine by a relatively simple and quick instrumented method. are
the
Central Middlesex Hospital, London N.W.10.
Anencephalic child with
Ross R. BAILEY.
extra
leg.
developed as far as the hair-line, but there the skull stopped abruptly and the poorly developed brain, covered by meninges, protruded in a cauliflower manner. The mother was aged 17, a primipara, and a native of Jobore (six miles from Ijebu-Ode). She had her antenatal supervision at the Rural Health Centre, Ketu. When first seen there (in the first trimester) she had admitted to using a native medicine commonly taken by pregnant women
in this part of the Federation. She had
not
been ill
during this period. At the Rural Health Centre she had been given the usual antenatal drugs-ferrous sulphate, vitamin C, and folic acid. State Hospital, Ijebu-Ode, Nigeria.
A.
OKUBOYEJO.
C. E. D. TAYLOR M. A. T. COLES. REVERSIBLE DEATH
UNRECOGNISED EPIDEMIC OF ANENCEPHALY AND SPINA BIFIDA
SiR,-The interesting report by Professor MacMahon and Dr. Yen (Jan. 2, p. 31) refers to the distribution of births of babies with anencephaly and spina bifida in time, but not on a geographical basis. I think it would be of value if it were possible to ascertain the addresses of the mothers concerned at the time of conception, especially during the epidemic period. If these were plotted on a map, they might throw some light on the epidemiology of the condition. Ideally, it is not sufficient merely to register congenital abnormalities as we do in this country: each pregnancy could be investigated quite simply with an inquiry into locality at time of conception and early gestation. After all, detailed inquiries are made of personal movements and activities in outbreaks of infectious disease in attempts to ascertain the causes; and one cannot help wondering why they are not undertaken for more serious conditions, such as congenital abnormalities. Health Department, Oxford.
M. J. PLEYDELL.
EXTRA LEG WITH ANENCEPHALY
SIR,-We wish to report the delivery of a three-legged child at the State Hospital, Ijebu-Ode. The child, a male, was alive but blue at birth, and weighed 8 lb. 2 oz. He had two normal legs 8 inches long, and a third arising from the back just above the cleft of the buttocks. The third leg was 2 inches shorter than the others and had only two The face was normally toes (see accompanying figure). 8.
O’Grady, F. W., Richards, B., McSherry, M. A., O’Farrell, S. M., Cattell, W. R. Lancet, 1970, ii, 1208.
SIR,-Your editorial with this titlerightly draws attention to the fact that a flat E.E.G. (the term isoelectric E.E.G. is preferable) may be found during some forms of coma, and that it does not preclude complete recovery. It is unfortunate that the title of the editorial might be taken to mean that the isoelectric E.E.G. is synonymous with death. This is certainly not the case, and, apart from those conditions that you mention (severe brainstem damage from compressive or non-compressive cerebral lesions, hepatic coma, and hypoglycxmia), there are many, such as drug overdose2 and encephalitis,3 which may also be reversible despite an isoelectric E.E.G. These conditions, however, are all rather uncommon and an isoelectric E.E.G. unquestionably carries a severe prognosis. Indeed, a review was carried out under the xgis of the American E.E.G. Society4 concerning 2000 patients with isoelectric E.E.G.s from a variety of causes: there were only 3 survivors, all of whom had had drug overdoses. In our experience, most of the patients in whom this type of E.E.G. is recorded have had acute cerebral anoxia, and are quite different from those of Brendler and Selverstone5 in that spontaneous respiratory movements have ceased and other spontaneous reflex functions, all necessary features for the determination of death,6 are absent. Prognosis in this group can reliably be predicted from the E.E.G.7 The isoelectric E.E.G. has become particularly important 1.
2. 3.
Lancet, 1970, ii, 1172. Bird, T. D., Plum, F. Neurology, 1968, 18, 456. Bental, E., Leibowitz, U. Electroenceph. clin. Neurophysiol. 1961.
13, 457. Silverman, D., Saunders, M. D., Schwab, R. S., Masland, R. L. J. Am. med. Ass. 1969, 209, 1505. 5. Brendler, S. J., Selverstone, B. Brain, 1970, 93, 381. 6. Harvard Committee, J. Am. med. Ass. 1969, 205, 337. 7. Binnie, C. D., Prior, P. F., Lloyd, D. S. L., Scott, D. F., Margerison, J. H. Br. med. J. 1970, iv, 265.
4.