VASECTOMY

654 We have found, however, that steroid therapy does interfere with the N.B.T. test. Wollman et al. conclude that large-dose steroid administration, with an intravenous bolus every 12 hours, does not affect the N.B.T. test. Their tests were performed 12 hours after steroids were administered, at which point the methylprednisolone would be cleared from the serum. In fact, they did obtain a falsenegative result in one infected patient tested an hour after receiving methylprednisolone. The relation of steroid administration to the time of N.B.T. testing is crucial. In the more widely used regimen of oral steroid administration, where serum and tissue levels persist for a longer period, we have found that infected patients are unable to mount an appropriate N.B.T. response. The defect is also demonstrable in non-infected steroid-treated patients whose leucocytes are stimulated by latex particles, and in the cells of normal controls pretreated in vitro with hydrocortisone.2All these cells are capable of normal engulfment of the latex particles in spite of their defective N.B.T. reduction. Therefore, we urge continuing caution in interpretation of the N.B.T. test as a sign of infection in steroid-treated patients. Infectious Disease Service, Department of Medicine,

Georgetown University Hospital, Washington, D.C. 20007, U.S.A.

JANE HENKEL CHRETIEN VINCENT F. GARAGUSI.

BACTERIURIA IN ELDERLY WOMEN

SIR Several points arise from the paper by Mr. McMillan (Sept. 2, p. 452). There is serious doubt as to the feasibility of collecting satisfactory midstream specimens of urine from incontinent and/or paralysed patients who comprised the majority in this study. Some of the bacteria isolated may have been faecal contaminants. Mr. McMillan suggests that the greater frequency of drug-resistant bacteria in the elderly women of his series may be connected with factors such as paralysis/incontinence. It is difficult to understand this statement. It is surprising that according to fig. 1, 70% of Pseudomonas strains were regarded as sensitive to sulphonamides whereas only 15% were apparently sensitive to co-trimoxazole, of which a sulphonamide is a component. It would be desirable to know what zone size was interpreted as indicating sensitivity or resistance to a particular drug and, in particular, whether zone sizes were compared with

those of a suitable control strain. Table 11 entitled " Antibiotic sensitivities of organisms from patients " includes nitrofurantoin, nalidixic acid, sulphonamides, and co-trimoxazole. These are not antibiotics. The term " antimicrobial drugs " might have been more appropriate. Furthermore, the figures expressed on the sensitivity discs denote the actual amount of each drug and not the concentration of the drug per disc. Department of Microbiology, Central Middlesex Hospital, London NW10 7NS.

M. S. SHAFI.

SIR,—It must be difficult, if not actually impossible, to obtain a true midstream specimen of urine from an incontinent patient, particularly if she is also a paralysed bedridden old lady. Surely this alone accounts for the differences that Mr. McMillan found between his results and those reported in the several series of fit young women outpatients that he cites ? Department of Urology, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE. 1.

2.

ROGER HOLE.

Chretien, J. H., Garagusi, V. F. Experientia, 1971, 27, 1343. Chretien, J. H., Garagusi, V. F. J. reticuloendoth. Soc. 1972, 11,

358.

VASECTOMY an is increasing demand for vasectomy. SIR,—There This is likely to continue if and when the N.H.S. Vasectomy Bill reaches the Statute Book. Any extra work load placed on already busy surgical departments will necessitate their performance on an outpatient basis under local anaathesia, as in charitable clinics, such as this.

Vasectomy forceps (half actual size).

The details of new forceps designed to facilitate this procedure are shown in the accompanying figure. The advantages over other tissue forceps are less trauma and a working-end specifically shaped to encircle the vas with fine overlapping points. The operation can be undertaken through a small scrotal incision, about 0-75 cm. long, with a minimum of complications. The forceps, manufactured by Rocket of London (Imperial Way, Watford, Herts. WD2 4XX), are available at less than E2. Kingston Contraceptive Clinic, 3 Clayton Road, Chessington, Surrey.

IAN CRAFT.

ABDOMINAL ASPIRATION HYSTEROTOMY SIR,-Mr. Minchin (Sept. 9, p. 541) puts a case for abdominal aspiration hysterotomy when the patient is also to be sterilised. I find this hard to accept. These women are inevitably multigravidae, and for those at under 14 weeks’ gestation vaginal termination followed by laparoscopic sterilisation1 is safe, effective, comfortable, and economical on bed space-needing 48 hours only compared with the five days for an abdominal incision. 2,3 Should one perforate the uterus, abdominal repair is no more complicated than Mr. Minchin’s routine procedure. If Mr. Minchin finds no difficulty in delivering a 16-week fetus through a 1 cm. uterine wound, I am sure he will find less trouble in dilating a pregnant multiparous os to 10-12 mm. and removing the conceptus vaginally. The abdominal method carries the risks of an abdominal operation, 4 adhesions, endometriosis, and menstrual disturbances; retrograde dilatation must, of course, be performed at completion of evacuation to ensure proper drainage of lochia. Obstetric Department, Royal Sussex County Hospital, Brighton, Sussex.

DAVID T. Y. LIU.

ABORTION WITH EXTRA-AMNIOTIC PROSTAGLANDINS

SIR,-Iwould like to comment on the letters of Dr. Bruce (Aug. 19, p. 380) and Dr. Alderman (Aug. 5, p. 279) concerning the part played by an inflated Foley catheter balloon in the uterus when abortion is being induced with Steptoe, P. C. Br. med. Bull. 1970, 26, 60. Liu, T. Y. D., Melville, H. A. H., Measday, B. Lancet, 1972, i, 1230. Steptoe, P. C. ibid. p. 1115. 4. Huntingford, P. ibid. 1971, i, 1012.

1. 2. 3.