metastatic malignant disease? Most patients are intelligent enough to know what a chiropractor can do. As a rule they will not consult a chiropractor for dysmenorrhea or chest pain, but many have found that a chiropractor can do more for them than I can if they wrench their back. Oddly enough, my experience is that patients do not visit chiropractors for sprained ankles or knees. They come to me for radiography to exclude fractures. The situation, as I see it, is that spinal manipulation is a hazardous undertaking and should be used only when it is appropriate, after adequate history and examination have excluded other possible causes of pain or dis-. ability. Physicians and physiotherapists obey these ground rules; others do not. We must therefore teach and use these techniques, as are so excellently described by Dr. Cyriax in his "Textbook of Orthopaedic Medicine". When we do, it will not be necessary for us to complain about chiropractors filling a gap that we pretended was not there. The need for them will simply wither away. C.L.W. DRAPER, MB, CH B
Lafleche, Sask
Physical fitness To the editor: To the exchange between Sidney Katz, "How we might live healthily and enjoy it more" (Can Med Assoc J 111: 1370, 1974), and John Sansom, "At which end of the population should we aim efforts to change lifestyles?" (Can Med Assoc J 112: 628, 1975), I would like to add the suggestion that physical fitness has little appeal to a large segment of the population. Only when adults become playful will fitness follow and then only because it is not intended. GEORGE SHEEHAN, MD
79 West Front St. Red Bank, NJ
Carbohydrates and brain metabolism To the editor: The comments of Dr. J.W. Mullner on carbohydrates and brain metabolism in the correspondence section of the Journal (Can Med Assoc J 112: 1046, 1975) is an excellent example of how new information, personal experiences and opinions can be communicated in a fast and efficient way. I believe that some of our recent findings concerning carbohydrate metabolism in psychogeriatric patients fit well into the picture described by Dr. Mullner in which the central components are obviously insulin, glucose, tryptophan and serotonin.1'2
We found that in the group of old, mentally ill diabetic patients evaluated, an organic brain syndrome was not present. In other words, uncontrolled diabetes commencing in older adults or during senescence, which for many reasons is the diabetes of most psychogeriatric patients, may help to prevent an "organic" impairment of the brain neurons. It seems that senile diabetes - if it is diabetes at all - does not have an arteriosclerotogenic effect but may instead be a beneficial compensatory mechanism that improves the brain biochemistry, possibly via tryptophanserotonin synthesis, as suggested by Dr. Mullner. S. HONTELA, MD
Douglas Hospital Montreal, Que.
References 1. HONTELA 5, MULLER HF: Rapport du diabete sucr. et du fonctionnement c.r6bral chez lea femmes &g.es. Vie Med Can Fr 3: 157, 1974 2. Idem: Uncontrolled diabetes in psychogeriatric subjects. J Am Geriatr Soc 23: 58, 1975
Abortion cannula should not be reused To the editor: While a therapeutic abortion was being performed on a patient 8 weeks pregnant, using the Berkeley suction apparatus, the distal end of the plastic cannula broke off at the level of the bend. The part remaining inside the uterus was approximately 8 cm long. It was difficult to retrieve the piece from the uterine cavity and it was feared that perforation of the uterus might have occurred. Eventually, however, the piece was located and removed. The cannula is only faintly radiopaque and it is doubtful if a radiograph would help to locate it. From this experience it is suggested that: (a) the manufacturer's advice that the cannula be used only once should be followed; (b) if the cannula is reused, its strength should be tested before it is inserted into the uterine cavity; and (c) the manufacturer might incorporate some radiopaque bands in the cannula so that it could be located by radiography. ..L. SIM, MD HARRY OXORN, MD
Department of obstetrics and gynecology Ottawa Civic Hospital Ottawa, Ont.
Erratum In the table (page 1273) in Appendix II of "Canadian Standards for Hospital Libraries" (Can Med Assoc J 112: 1271, 1975) the figure 2000+ should read 200+.
92 CMA JOURNAL/JULY 26, 1975/VOL. 113
Clearinghouse for cancer research To the editor: Epidemiologic studies usually take from 3 to 5 years to carry out. During this period other research workers may embark on a similar project, quite unaware that others are working in the same area. This often leads to a series of publications, the results of which cannot be compared because some relatively minor question or procedure was not carried out in each study. With this in mind the International Agency for Research on Cancer (IARC) and the German Cancer Research Centre (DKFZ) have created a clearinghouse for ongoing research in cancer epidemiology, the purpose of which is to inform cancer epidemiologists and others about ongoing work and facilitate direct contact between research workers. The clearinghouse will operate within the framework of the international cancer research data bank program of the National Cancer Institute of the United States. The clearinghouse will publish an annual directory of ongoing research in cancer epidemiology, but scientists can obtain current information on request to IARC about ongoing research in this field at any time. Further information may be obtained from the undersigned. CS. MUIR, MD
International Agency for Research on Cancer (WHO) 150, Cours Albert Thomas 69008 Lyon, France
Malignant tumours in father and son To the editor: The report "Germ-cell malignant tumours in father and son" by Musa (Can Med Assoc J 112: 1201, 1975) prompts me to report a similar situation. At age 29 a man had his left testicle removed. It measured 6.5 x 4 cm and the pathologist made a diagnosis of embryonal carcinoma. In spite of retroperitoneal lymph node dissection, radiotherapy and chemotherapy, his disease advanced rapidly, and 3 months after orchiectomy he died with widespread metastases in his lungs and liver. While the patient was under treatment his father had a right orchiectomy because of a 2-month history of enlargement of his right testicle. The testicle measured 3.5 x 3 cm and a diagnosis of seminoma with lymphocytic infiltration was made. The lymph nodes were irradiated and he has remained well for more than 6 years. One of the father's sisters had bilateral mastectomies for carcinoma but otherwise the family history is negative. J.C.M. FETrERLY, MD, CM, FRCP[C]
The Ontario Cancer Foundation London Clinic London, Ont.
Lafleche, Sask
Physical fitness To the editor: To the exchange between Sidney Katz, "How we might live healthily and enjoy it more" (Can Med Assoc J 111: 1370, 1974), and John Sansom, "At which end of the population should we aim efforts to change lifestyles?" (Can Med Assoc J 112: 628, 1975), I would like to add the suggestion that physical fitness has little appeal to a large segment of the population. Only when adults become playful will fitness follow and then only because it is not intended. GEORGE SHEEHAN, MD
79 West Front St. Red Bank, NJ
Carbohydrates and brain metabolism To the editor: The comments of Dr. J.W. Mullner on carbohydrates and brain metabolism in the correspondence section of the Journal (Can Med Assoc J 112: 1046, 1975) is an excellent example of how new information, personal experiences and opinions can be communicated in a fast and efficient way. I believe that some of our recent findings concerning carbohydrate metabolism in psychogeriatric patients fit well into the picture described by Dr. Mullner in which the central components are obviously insulin, glucose, tryptophan and serotonin.1'2
We found that in the group of old, mentally ill diabetic patients evaluated, an organic brain syndrome was not present. In other words, uncontrolled diabetes commencing in older adults or during senescence, which for many reasons is the diabetes of most psychogeriatric patients, may help to prevent an "organic" impairment of the brain neurons. It seems that senile diabetes - if it is diabetes at all - does not have an arteriosclerotogenic effect but may instead be a beneficial compensatory mechanism that improves the brain biochemistry, possibly via tryptophanserotonin synthesis, as suggested by Dr. Mullner. S. HONTELA, MD
Douglas Hospital Montreal, Que.
References 1. HONTELA 5, MULLER HF: Rapport du diabete sucr. et du fonctionnement c.r6bral chez lea femmes &g.es. Vie Med Can Fr 3: 157, 1974 2. Idem: Uncontrolled diabetes in psychogeriatric subjects. J Am Geriatr Soc 23: 58, 1975
Abortion cannula should not be reused To the editor: While a therapeutic abortion was being performed on a patient 8 weeks pregnant, using the Berkeley suction apparatus, the distal end of the plastic cannula broke off at the level of the bend. The part remaining inside the uterus was approximately 8 cm long. It was difficult to retrieve the piece from the uterine cavity and it was feared that perforation of the uterus might have occurred. Eventually, however, the piece was located and removed. The cannula is only faintly radiopaque and it is doubtful if a radiograph would help to locate it. From this experience it is suggested that: (a) the manufacturer's advice that the cannula be used only once should be followed; (b) if the cannula is reused, its strength should be tested before it is inserted into the uterine cavity; and (c) the manufacturer might incorporate some radiopaque bands in the cannula so that it could be located by radiography. ..L. SIM, MD HARRY OXORN, MD
Department of obstetrics and gynecology Ottawa Civic Hospital Ottawa, Ont.
Erratum In the table (page 1273) in Appendix II of "Canadian Standards for Hospital Libraries" (Can Med Assoc J 112: 1271, 1975) the figure 2000+ should read 200+.
92 CMA JOURNAL/JULY 26, 1975/VOL. 113
Clearinghouse for cancer research To the editor: Epidemiologic studies usually take from 3 to 5 years to carry out. During this period other research workers may embark on a similar project, quite unaware that others are working in the same area. This often leads to a series of publications, the results of which cannot be compared because some relatively minor question or procedure was not carried out in each study. With this in mind the International Agency for Research on Cancer (IARC) and the German Cancer Research Centre (DKFZ) have created a clearinghouse for ongoing research in cancer epidemiology, the purpose of which is to inform cancer epidemiologists and others about ongoing work and facilitate direct contact between research workers. The clearinghouse will operate within the framework of the international cancer research data bank program of the National Cancer Institute of the United States. The clearinghouse will publish an annual directory of ongoing research in cancer epidemiology, but scientists can obtain current information on request to IARC about ongoing research in this field at any time. Further information may be obtained from the undersigned. CS. MUIR, MD
International Agency for Research on Cancer (WHO) 150, Cours Albert Thomas 69008 Lyon, France
Malignant tumours in father and son To the editor: The report "Germ-cell malignant tumours in father and son" by Musa (Can Med Assoc J 112: 1201, 1975) prompts me to report a similar situation. At age 29 a man had his left testicle removed. It measured 6.5 x 4 cm and the pathologist made a diagnosis of embryonal carcinoma. In spite of retroperitoneal lymph node dissection, radiotherapy and chemotherapy, his disease advanced rapidly, and 3 months after orchiectomy he died with widespread metastases in his lungs and liver. While the patient was under treatment his father had a right orchiectomy because of a 2-month history of enlargement of his right testicle. The testicle measured 3.5 x 3 cm and a diagnosis of seminoma with lymphocytic infiltration was made. The lymph nodes were irradiated and he has remained well for more than 6 years. One of the father's sisters had bilateral mastectomies for carcinoma but otherwise the family history is negative. J.C.M. FETrERLY, MD, CM, FRCP[C]
The Ontario Cancer Foundation London Clinic London, Ont.
