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WRINKLING OF SKIN IN CYSTIC FIBROSIS
108 considered in relation
to the association of lower-motordisease and malignant lymphoma produced by C-type oncomaviruses in mice, suggests the possibility of a similar aetiological relationship in man. We have been unable to find reports of a similar association in humans, but it would be of interest if others have seen similar cases and important to attempt to demonstrate type-C oncomaviruses in the anterior horn cells of similar cases. Since in the mice with lymphoma and motor-neuron degeneration C particles were found in the muscle (which was not histologically damaged), muscle from these two patients and any similar ones might merit scrutiny for viral particles.
WRINKLING OF SKIN IN CYSTIC FIBROSIS
neuron
-
Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland 20014. Medical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda. Medicine Branch, National Cancer Institute, Bethesda.
JOSE C. COSTA ALAN S. RABSON TOMMIE SUE TRALKA
Department of Pædiatrics School of Medicine,
University of Auckland, Auckland, New Zealand.
GEORGE P. CANELLOS. CHARLES G. BRATENAHL
and
Friberg2 in Uppsala. Using a similar isolation technique to investigate 97 couples in Adelaide with at least two years’ primary infertility, we found a T-mycoplasma frequency of 62% which is similar to the London study (57%) and lower than the 89% found in Uppsala. We found in 36 patients with an early pregnancy an incidence of T mycoplasma of 69%, compared with 55% in the London series and 23% in the Swedish study. However, both our own criteria for infertility and those of De Louvois et al. (attending the infertility clinic for at least one year) are different from those employed by Gnarpe and Friberg (five years primary infertility); hence the infertility groups are not comparable. It is also possible that there could be geographical and social differences in the incidence of the infection. We trust that De Louvois and his colleagues will note these differences and also the difference in the method of administration of doxycycline if they wish to compare the results of their trial of the effect of doxycycline on infertile couples with those from Uppsala. What does seem important is to seek to understand how doxycycline achieved the remarkable results of Gnarpe and Friberg with regard to pregnancy. The strict criteria of patient selection of the Swedish workers should be recognised, so that any possible benefit of doxycycline should not be confused by the inclusion of patients under active investigation or other forms of treatment. Only by adopting such an attitude can the possible aEtiological factor preventing conception be pinpointed, whether it be T mycoplasma or some as yet unrecognised organism. Department of Obstetrics and
C. D. MATTHEWS R. G. ELMSLIE K. H. CLAPP J. M. SVIGOS.
1. De Louvois, J., Blades, M., Harrison, R. F., Hurley, V. C. Lancet, 1974, i, 1073. 2. Gnarpe, H., Friberg, J. Nature, 1973, 242, 120.
R. B. ELLIOTT.
IMPORTED INFECTIONS
SIR,--In late 1951
MYCOPLASMA AND FERTILITY SIR,_Dr De Louvois and his colleaguesin London report a similar frequency of T mycoplasma in the genital tracts of their fertile and infertile patients and outline the variance of their results with those obtained by Gnarpe
Gynæcology, Department of Surgery, Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011.
fibrosis wrinkles excessively early when soaked in This physical sign is highly reliable irrespective tap of the degree of nutrition of the patient. It is sometimes Normal skin wrinkles seen in infants with marasmus. eventually to exposure to water (except that from the Dead Sea). It is possible that the disorder of salt flux in cystic fibrosis is connected with the apparent excessive hypertonic reactivity of the skin. Three minutes and a bowl of water might provide a cheap screening test for this condition. water.
W. KING ENGEL.
Northern
Virginia Pathology Laboratory, Fairfax, Virginia 22030.
Six,_I have observed that the skin of children with
cystic
R., Stanley,
a
troopship
was
forty-two days
at
voyage from the Korean theatre of operations to Liverpool, by which time any disease was usually overt, at least easing the diagnostic problems of port medical -officers. Today, within forty-eight hours travellers from any part of the world may arrive by air in the United Kingdom incubating any disease or harbouring any parasite known to man. In this connection it is of interest to record that the passenger flow through Heathrow Airport was 63,151 and 18,679,422, respectively, in 1946 (June-December) and 1972, whilst the passenger flow through all the United Kingdom airports in 1972-73 was 28,316,000, which compares with 11,990,000 passengers through seaports.,, According to Maegraith2 few doctors now practising have been trained to think in terms of anything but the diseases of their own area: and it has been suggested that for every case of malaria reported in the United Kingdom, and there were well over 300 such cases in 1973, 1 is missed and presumably buried under another name. The diagnostic problems in respect of imported disease, or disease in transcontinental travellers, posed to general practitioners may be formidable, but to the surgeon these may be very traumatic, particularly when appendicectomies have been performed in intestinal salmonellosis, intestinal amcebiasis, malignant tertian malaria (the supermimic and quick killer), bacillary dysentery, giardiasis, and schistosomiasis, to mention only a few. Other surgical hazards include radical surgery for amoeboma of the lower intestinal tract, haemorrhoidectomy in cryptogenic intestinal amœ biasis, or thoracic surgery for empyema thoracis secondary to hepatic amoebiasis. The late Sir Heneage Ogilvie drew attention to all this in 1945 in an article3 entitled Pitfalls of Tropical Surgery in which he concludes " but the standard textbook on tropical surgery has yet to be written ". Surely a pocket synopsis of this subject should be available to all medical students and all embryo medical and surgical consultants. It is suggested that two pamphlets 4 issued to all United Kingdom general practitioners by the Department of Health and Social Security should be supplemented by a copy of the article by Ogilvie, because there is nothing new except that which has been forgotten or remained unread. 76 Ravelston Dykes, JOHN MACKAY-DICK. Edinburgh EH12 6HF. sea en
1. Press and Public Relations 2. 3. 4.
Office, Heathrow Airport, London, Hounslow, Middlesex. Maegraith, B. G. Pulse, May 26, 1973. Ogilvie, W. H. Lancet, 1945, ii, 585. Communicable Diseases contracted outside the United Kingdom and Notice to Travellers—Health Protection. Department of Health and Social Security, 194 Euston Road (Room 236), London NW1.
to the association of lower-motordisease and malignant lymphoma produced by C-type oncomaviruses in mice, suggests the possibility of a similar aetiological relationship in man. We have been unable to find reports of a similar association in humans, but it would be of interest if others have seen similar cases and important to attempt to demonstrate type-C oncomaviruses in the anterior horn cells of similar cases. Since in the mice with lymphoma and motor-neuron degeneration C particles were found in the muscle (which was not histologically damaged), muscle from these two patients and any similar ones might merit scrutiny for viral particles.
WRINKLING OF SKIN IN CYSTIC FIBROSIS
neuron
-
Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland 20014. Medical Neurology Branch, National Institute of Neurological Diseases and Stroke, Bethesda. Medicine Branch, National Cancer Institute, Bethesda.
JOSE C. COSTA ALAN S. RABSON TOMMIE SUE TRALKA
Department of Pædiatrics School of Medicine,
University of Auckland, Auckland, New Zealand.
GEORGE P. CANELLOS. CHARLES G. BRATENAHL
and
Friberg2 in Uppsala. Using a similar isolation technique to investigate 97 couples in Adelaide with at least two years’ primary infertility, we found a T-mycoplasma frequency of 62% which is similar to the London study (57%) and lower than the 89% found in Uppsala. We found in 36 patients with an early pregnancy an incidence of T mycoplasma of 69%, compared with 55% in the London series and 23% in the Swedish study. However, both our own criteria for infertility and those of De Louvois et al. (attending the infertility clinic for at least one year) are different from those employed by Gnarpe and Friberg (five years primary infertility); hence the infertility groups are not comparable. It is also possible that there could be geographical and social differences in the incidence of the infection. We trust that De Louvois and his colleagues will note these differences and also the difference in the method of administration of doxycycline if they wish to compare the results of their trial of the effect of doxycycline on infertile couples with those from Uppsala. What does seem important is to seek to understand how doxycycline achieved the remarkable results of Gnarpe and Friberg with regard to pregnancy. The strict criteria of patient selection of the Swedish workers should be recognised, so that any possible benefit of doxycycline should not be confused by the inclusion of patients under active investigation or other forms of treatment. Only by adopting such an attitude can the possible aEtiological factor preventing conception be pinpointed, whether it be T mycoplasma or some as yet unrecognised organism. Department of Obstetrics and
C. D. MATTHEWS R. G. ELMSLIE K. H. CLAPP J. M. SVIGOS.
1. De Louvois, J., Blades, M., Harrison, R. F., Hurley, V. C. Lancet, 1974, i, 1073. 2. Gnarpe, H., Friberg, J. Nature, 1973, 242, 120.
R. B. ELLIOTT.
IMPORTED INFECTIONS
SIR,--In late 1951
MYCOPLASMA AND FERTILITY SIR,_Dr De Louvois and his colleaguesin London report a similar frequency of T mycoplasma in the genital tracts of their fertile and infertile patients and outline the variance of their results with those obtained by Gnarpe
Gynæcology, Department of Surgery, Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011.
fibrosis wrinkles excessively early when soaked in This physical sign is highly reliable irrespective tap of the degree of nutrition of the patient. It is sometimes Normal skin wrinkles seen in infants with marasmus. eventually to exposure to water (except that from the Dead Sea). It is possible that the disorder of salt flux in cystic fibrosis is connected with the apparent excessive hypertonic reactivity of the skin. Three minutes and a bowl of water might provide a cheap screening test for this condition. water.
W. KING ENGEL.
Northern
Virginia Pathology Laboratory, Fairfax, Virginia 22030.
Six,_I have observed that the skin of children with
cystic
R., Stanley,
a
troopship
was
forty-two days
at
voyage from the Korean theatre of operations to Liverpool, by which time any disease was usually overt, at least easing the diagnostic problems of port medical -officers. Today, within forty-eight hours travellers from any part of the world may arrive by air in the United Kingdom incubating any disease or harbouring any parasite known to man. In this connection it is of interest to record that the passenger flow through Heathrow Airport was 63,151 and 18,679,422, respectively, in 1946 (June-December) and 1972, whilst the passenger flow through all the United Kingdom airports in 1972-73 was 28,316,000, which compares with 11,990,000 passengers through seaports.,, According to Maegraith2 few doctors now practising have been trained to think in terms of anything but the diseases of their own area: and it has been suggested that for every case of malaria reported in the United Kingdom, and there were well over 300 such cases in 1973, 1 is missed and presumably buried under another name. The diagnostic problems in respect of imported disease, or disease in transcontinental travellers, posed to general practitioners may be formidable, but to the surgeon these may be very traumatic, particularly when appendicectomies have been performed in intestinal salmonellosis, intestinal amcebiasis, malignant tertian malaria (the supermimic and quick killer), bacillary dysentery, giardiasis, and schistosomiasis, to mention only a few. Other surgical hazards include radical surgery for amoeboma of the lower intestinal tract, haemorrhoidectomy in cryptogenic intestinal amœ biasis, or thoracic surgery for empyema thoracis secondary to hepatic amoebiasis. The late Sir Heneage Ogilvie drew attention to all this in 1945 in an article3 entitled Pitfalls of Tropical Surgery in which he concludes " but the standard textbook on tropical surgery has yet to be written ". Surely a pocket synopsis of this subject should be available to all medical students and all embryo medical and surgical consultants. It is suggested that two pamphlets 4 issued to all United Kingdom general practitioners by the Department of Health and Social Security should be supplemented by a copy of the article by Ogilvie, because there is nothing new except that which has been forgotten or remained unread. 76 Ravelston Dykes, JOHN MACKAY-DICK. Edinburgh EH12 6HF. sea en
1. Press and Public Relations 2. 3. 4.
Office, Heathrow Airport, London, Hounslow, Middlesex. Maegraith, B. G. Pulse, May 26, 1973. Ogilvie, W. H. Lancet, 1945, ii, 585. Communicable Diseases contracted outside the United Kingdom and Notice to Travellers—Health Protection. Department of Health and Social Security, 194 Euston Road (Room 236), London NW1.