1267 tions of virus-infected cell-cultures are used as antigen. Highly purified non-infectious measles-virus preparations might be of help in the analysis of true antigenic effects on lymphocytes. Institute on


Karolinska Institutet, School of Medicine, Stockholm, Sweden.


Immunology and Rheumatology, Rikshospitalet, Oslo, Norway, and Department of Virology,


JOINT INFECTION BY PASTEURELLA MULTOCIDA SIR,—We were interested in the letters by Griffin et al.’ and Maurer et a1,2 on Pasteurella multocida infections of joints containing a prosthesis in patients with rheumatoid arthritis. We treated a similar case; but medical treatment failed to save the prosthesis. A 33-year-old woman with rheumatoid arthritis (treated with 6 mg of prednisone and 6 g of aspirin a day) underwent arthroplasty and insertion of a Geomedic prosthesis in the right knee. On discharge, she could walk without pain. There was slight drainage from a healing hsematoma along the suture line. A pet dog licked her leg frequently, including the area of the wound. Five weeks after leaving hospital, she returned complaining of 2 weeks’ pain, heat, and swelling of the knee. Three separate joint aspirates grew Pasteurella multocida and one also grew Staphylococcus aureus coagulase-positive. She received 2 g of cloxacillin a day for several months: synovial cultures became negative and inflammation resolved, but pain continued. 9 months later a skin ulcer developed over the joint, and the joint fluid grew pure cultures of P. multocida sensitive to penicillin (minimum inhibitory concentration 0.004 µg/ml). She was given parenteral and then oral penicillin over the next 14 months. Cultures of synovial fluid were repeatedly negative, but pain in the knee persisted. 2 years after its insertion, the prosthesis was removed and knee fusion was performed. At operation, the tibial component of the prosthesis was seen to move freely in flexion and extension. Cultures of the synovial fluid were negative. Histological signs of chronic inflammation were seen in the synovial membrane. The open surgical area was doubtless where the original infection entered. Cultures were not taken from the dog, and the patient was possibly reinfected ten months after the first infection was treated. Accommodation to the chronic pain of rheumatoid arthritis and masking of inflammation by steroids probably contributed to delay in seeking advice. Attempts to preserve the prosthesis failed, even though P. multocida is sensitive to penicillin and its analogues3 and in-vitro sensitivity was demonstrated in this case. Early diagnosis and aggressive treatment of even very sensitive bacteria are clearly important in prosthesis infections. Los Angeles County/University of Southern California Medical Center, 2025 Zonal Avenue, Los Angeles, California 90033, U.S.A.



SIR,—We agree with Professor Scheuer (Nov. 29, p. 1099) that the hepatic lesion occurring in association with the use of oral contraceptives is almost always4 that described as "focal nodular hyperplasia" and that this lesion may occur as single or multiple foci. 5 6 We consider the use of this term unfor1. Griffin, A. J.,

Barber, H. M. Lancet, 1975, i, 1347. 2. Maurer, K. H., Hasselbacher, P., Schumacher, H. R. ibid. Aug. 30, 1975, p. 409. 3. Francis, D. P., Holmes, M. A., Brandon, G. J. Am. med. Ass. 1975, 233, 42. 4. May’s E. T., Christopherson, W. M. and Barrows, G. H. Am. J. clin. Path.

1974, 61, 735. 5. VonSydow, C. Nord. Med. 1968, 80, 1278. 6. Grabowski, M., Stenram, V. and Bergvist, A. Acta path. microbiol. scand.

1975, 83, 615.


though we agree that the other available synonyms, including focal cirrhosis, hamartoma, hepatoma, and adenoma,’7 have either undesirable pathogenetic implications or alterna-


and that for the last three descriptive qualification be might necessary. The hyperplastic nodules in our cases (Nov. 22, p. 1042) and in laboratory animals are entirely hepatocytic, and perhaps confusion could be avoided by using the term "focal nodular hepatocytic hyperplasia" to describe them. tive


Department of Histopathology, Royal Postgraduate Medical School, Du Cane Road, London W12 0HS.


P. Liver

Biopsy Interpretation; p. 87. London,




C.B.E., M.B. St. And., M.R.C.P., D.T.M. & H.

Leithead, who was until recently professor of medicine at the Haile Selassie I University, Addis Ababa, Ethiopia, died in London on Dec. 1 at the age Dr Charles

of 50. He graduated M.B. from the University of St. Andrew’s in 1953. He was lecturer in tropical medicine at the University of Liverpool and consultant in tropical diseases to the Liverpool Regional Hospital Board for some years, before going to Ethiopia as professor of medicine in 1964. With Dr A. R. Lind, he was author of the book Heat Stress and Heat Disorders, which was published in 1964. He is survived by his wife and their four children.

H. M. G. writes: "Charles Leithead’s sudden and premature death came as a shock to his friends, many of whom were unaware that he was even ill. After some years of distinguished service in Liverpool-where I first knew him in 1955-he went to Ethiopia in 1964 as professor of medicine. It was in this environment for the next 11 years that his

exceptional qualities were put to the Despite tremendous difficulties, he built up a department of medicine second to none and trained a cadre of Ethiopian medical students to follow his own high principles of integrity, humanity, courage, and compassion. He achieved the most worthwhile goal of every expatriate teacher-namely, to hand over a strong and active department to a young and able Ethiopian deputy. "He was about to leave Ethiopia to take up the appointment of director of the School of Tropical Medicine in Sydney-a job which, with his wide clinical experience, excellent administrative qualities, quick wit, and ready sense of humour, he test.

would have filled with distinction. It was a tragedy that he was denied the chance. For my part, I shall remember him for his generous heart and magnanimity, for throughout the years we were good friends." WILLIAM ROBERT HENDERSON O.B.E., M.B. Edin., F.R.C.S.

Mr W. R. Henderson, honorary consultant neurosurgeon to the General Infirmary, Leeds, died on Nov. 30. He went to Leeds from Norman Dott and Harvey Cushing in 1938 and was soon removed from civilian life to take charge of the Army’s first mobile neurosurgical unit in France. In the Dunkirk retreat, the care of his patients was to him more important than his own safety and comfort, and with his patients he was imprisoned. After the war he gradually built up the

Letter: Joint infection by Pasteurella multocida.

1267 tions of virus-infected cell-cultures are used as antigen. Highly purified non-infectious measles-virus preparations might be of help in the anal...
146KB Sizes 0 Downloads 0 Views