1236 number of negative cultures will be processed, the work is not excessive, expensive, or entirely without value. Staff learn to recognise common commensals on tellurite medium, which will help them to investigate cultures in
large
clinically suspected
cases.
We are at risk from people flown in from parts of the world where the disease is still’common, and immunisation in this country against rare infections tends to be omitted. In this situation, alertness in the laboratory, and the ability to make a diagnosis, not only reliably but quickly, is, I think,
essential. Clinicians rarely encounter diphtheria, and their expertise in recognising it cannot now be relied on. We can keep our hand in by examining simulated specimens containing C. diphtheriae sent by the Quality-control Laboratory. I think it is for us to support the clinicians, not vice versa. The maintenance of a good service often depends on curtailment of cultures not strictly necessary. I think a better choice would be sputum cultures, other than for tubercle bacilli, in patients not suffering from pneumonia. University College Hospital, Gower Street, London WC1E 6AU.
E. J. STOKES.
COPPER AND STEELY HAIR SIR,—In your editorial (April 19, p. 902) about copper and the steely-hair syndrome you pointed out the possible existence of a defective placental transport of copper resulting in an inadequate storage of the metal during the fetal period. In this context we should like to draw attention to some results from an investigation of the copper distribution in a male fetus suspected of Menkes’ steely-hair disease. 1,22 The mother had previously given birth to two boys with this disease. When she became pregnant again and prenatal diagnosis revealed a male karyotype, the pregnancy was terminated. Necropsy of the fetus showed neither macroscopical nor microscopical alterations. The concentration of copper in various organs from this fetus and from four normal fetuses was determined by neutron activation analysis with radiochemical separation:
The content of copper in the kidney, spleen, pancreas, and placenta of the fetus was significantly higher than in the controls. The liver was the only tissue containing less copper than the controls. These findings make the existence of a defective placental transport of copper unlikely, but confirm the supposition of inadequate storage of the metal in the liver. Chromosome Laboratory, John F. Kennedy Institute, DK-2600 Glostrup. Isotope Division, Research Establishment Rise, DK-4000 Roskilde.
Department of Paediatric Pathology, Rigshospitalet, DK-2100 Copenhagen Ø, Denmark.
NINA HORN MARGARETA MIKKELSEN.
K. HEYDORN ELSE DAMSGAARD.
INGE TYGSTRUP.
Damsgaard, E., Tygstrup, I. Mschr. Kinderheilk. (in the press). 2. Heydorn, K., Damsgaard, E., Tygstrup, I., Horn, N., Mikkelsen, M., Vestermark, S. To be published.
METRONIDAZOLE IN CROHN’S DISEASE SiR,—The finding by Dr Ursing and Dr Kamme (April 5, p. 775) that metronidazole helps patients with Crohn’s disease, and their suggestion that this benefit is mediated by metronidazole’s selective action against anaerobic
microorganisms, prompts this letter. A 24-year-old female came to her doctor in October, 1974, with diarrhoea and weight-loss. Barium studies of the small bowel showed findings consistent with Crohn’s disease. Because the patient did poorly on conservative non-specific therapy, she Three watery was referred for gastrointestinal consultation. stools were examined for ova and parasites with negative results. The patient was admitted to hospital on April 10, and on April 13 and 14 examination of her watery stools showed no ova nor parasites. On April 17 she had a proctosigmoidoscopy one hour after a saline enema. Watery stool aspirated during proctosigmoidoscopy was collected in a 20 ml. sterile disposalPolystyrene’ aspirating tube (Davis & Geck). Examination of this showed rare Giardia lamblia, rare Endolimax nana, and moderate numbers of other Entamceba species. The patient has essentially normal immunoglobulins.
We are concerned that during examination of stools days earlier we were unable to identify any ova or parasites, but pleased that we were able to do so on the specimen obtained at proctosigmoidoscopy. We wonder how many times we have previously missed ova and parasites, because we did not examine stool aspirated at proctosigmoidoscopy and relied only on examining watery stool passed in a bedpan. We wonder whether the good results obtained for metronidazole could be explained in some cases by its effect on parasites which have been present but not demonstrated Our laboratory has often demonstrated ova and parasites in routinely collected stools. However, in those cases where no parasites are found on routine stool examination, we plan to examine stools aspirated at proctosigmoidoscopy before concluding that parasites are indeed absent. 3 and 4
Memorial Hospital Medical Center of Long Beach, 2801 Atlantic Avenue, Long Beach, California 90801, U.S.A.
MANLEY COHEN.
DAPSONE IN CROHN’S DISEASE SiR,—The account1 of the use of metronidazole in Crohn’s disease prompts a preliminary report of the use in this condition of another antimicrobial agent, dapsone. This drug was originally suggested as being of potential benefit in Crohn’s disease by Golde,2 and it has been used successfully in another granulomatous condition, granuloma faciale. 6 patients with Crohn’s disease were selected as having a lesion, either fistula or rectal involvement, which could be directly observed and which had failed to respond to more conventional therapy. Case .—Female, aged 33, 10-year history of ileocolonic Crohn’s disease with previous right hemicolectomy. For the past year there had been continuous disease activity with bloody diarrhoea, resistant to sulphasalazine and corticosteroids. After 2 months’ treatment with dapsone (100 mg. and 50 mg. on alternate days), there was complete symptomatic relief and both macroscopic and microscopic improvement in the appearances of the rectum. Case 2.-Male, aged 27, 7-year history of Crohn’s enterocolitis. This patient’s symptoms of diarrhoea and abdominal pain could be controlled only by doses of prednisolone in excess of 15 mg. per day and which produced the usual corticosteroid side-effects. After 2 months’ treatment with dapsone, 100 mg. on alternate days, there was complete symptomatic relief which was confirmed by macroscopic appearances at sigmoidoscopy and by reduction
1. Horn, N.,
1. 2. 3.
Ursing, B., Kamme, C. Lancet, April 5, 1975, p. 775. Golde, D. W. ibid. 1968, i, 1144. Anderson, C. R. ibid. March 15, 1975, p. 642.
large
clinically suspected
cases.
We are at risk from people flown in from parts of the world where the disease is still’common, and immunisation in this country against rare infections tends to be omitted. In this situation, alertness in the laboratory, and the ability to make a diagnosis, not only reliably but quickly, is, I think,
essential. Clinicians rarely encounter diphtheria, and their expertise in recognising it cannot now be relied on. We can keep our hand in by examining simulated specimens containing C. diphtheriae sent by the Quality-control Laboratory. I think it is for us to support the clinicians, not vice versa. The maintenance of a good service often depends on curtailment of cultures not strictly necessary. I think a better choice would be sputum cultures, other than for tubercle bacilli, in patients not suffering from pneumonia. University College Hospital, Gower Street, London WC1E 6AU.
E. J. STOKES.
COPPER AND STEELY HAIR SIR,—In your editorial (April 19, p. 902) about copper and the steely-hair syndrome you pointed out the possible existence of a defective placental transport of copper resulting in an inadequate storage of the metal during the fetal period. In this context we should like to draw attention to some results from an investigation of the copper distribution in a male fetus suspected of Menkes’ steely-hair disease. 1,22 The mother had previously given birth to two boys with this disease. When she became pregnant again and prenatal diagnosis revealed a male karyotype, the pregnancy was terminated. Necropsy of the fetus showed neither macroscopical nor microscopical alterations. The concentration of copper in various organs from this fetus and from four normal fetuses was determined by neutron activation analysis with radiochemical separation:
The content of copper in the kidney, spleen, pancreas, and placenta of the fetus was significantly higher than in the controls. The liver was the only tissue containing less copper than the controls. These findings make the existence of a defective placental transport of copper unlikely, but confirm the supposition of inadequate storage of the metal in the liver. Chromosome Laboratory, John F. Kennedy Institute, DK-2600 Glostrup. Isotope Division, Research Establishment Rise, DK-4000 Roskilde.
Department of Paediatric Pathology, Rigshospitalet, DK-2100 Copenhagen Ø, Denmark.
NINA HORN MARGARETA MIKKELSEN.
K. HEYDORN ELSE DAMSGAARD.
INGE TYGSTRUP.
Damsgaard, E., Tygstrup, I. Mschr. Kinderheilk. (in the press). 2. Heydorn, K., Damsgaard, E., Tygstrup, I., Horn, N., Mikkelsen, M., Vestermark, S. To be published.
METRONIDAZOLE IN CROHN’S DISEASE SiR,—The finding by Dr Ursing and Dr Kamme (April 5, p. 775) that metronidazole helps patients with Crohn’s disease, and their suggestion that this benefit is mediated by metronidazole’s selective action against anaerobic
microorganisms, prompts this letter. A 24-year-old female came to her doctor in October, 1974, with diarrhoea and weight-loss. Barium studies of the small bowel showed findings consistent with Crohn’s disease. Because the patient did poorly on conservative non-specific therapy, she Three watery was referred for gastrointestinal consultation. stools were examined for ova and parasites with negative results. The patient was admitted to hospital on April 10, and on April 13 and 14 examination of her watery stools showed no ova nor parasites. On April 17 she had a proctosigmoidoscopy one hour after a saline enema. Watery stool aspirated during proctosigmoidoscopy was collected in a 20 ml. sterile disposalPolystyrene’ aspirating tube (Davis & Geck). Examination of this showed rare Giardia lamblia, rare Endolimax nana, and moderate numbers of other Entamceba species. The patient has essentially normal immunoglobulins.
We are concerned that during examination of stools days earlier we were unable to identify any ova or parasites, but pleased that we were able to do so on the specimen obtained at proctosigmoidoscopy. We wonder how many times we have previously missed ova and parasites, because we did not examine stool aspirated at proctosigmoidoscopy and relied only on examining watery stool passed in a bedpan. We wonder whether the good results obtained for metronidazole could be explained in some cases by its effect on parasites which have been present but not demonstrated Our laboratory has often demonstrated ova and parasites in routinely collected stools. However, in those cases where no parasites are found on routine stool examination, we plan to examine stools aspirated at proctosigmoidoscopy before concluding that parasites are indeed absent. 3 and 4
Memorial Hospital Medical Center of Long Beach, 2801 Atlantic Avenue, Long Beach, California 90801, U.S.A.
MANLEY COHEN.
DAPSONE IN CROHN’S DISEASE SiR,—The account1 of the use of metronidazole in Crohn’s disease prompts a preliminary report of the use in this condition of another antimicrobial agent, dapsone. This drug was originally suggested as being of potential benefit in Crohn’s disease by Golde,2 and it has been used successfully in another granulomatous condition, granuloma faciale. 6 patients with Crohn’s disease were selected as having a lesion, either fistula or rectal involvement, which could be directly observed and which had failed to respond to more conventional therapy. Case .—Female, aged 33, 10-year history of ileocolonic Crohn’s disease with previous right hemicolectomy. For the past year there had been continuous disease activity with bloody diarrhoea, resistant to sulphasalazine and corticosteroids. After 2 months’ treatment with dapsone (100 mg. and 50 mg. on alternate days), there was complete symptomatic relief and both macroscopic and microscopic improvement in the appearances of the rectum. Case 2.-Male, aged 27, 7-year history of Crohn’s enterocolitis. This patient’s symptoms of diarrhoea and abdominal pain could be controlled only by doses of prednisolone in excess of 15 mg. per day and which produced the usual corticosteroid side-effects. After 2 months’ treatment with dapsone, 100 mg. on alternate days, there was complete symptomatic relief which was confirmed by macroscopic appearances at sigmoidoscopy and by reduction
1. Horn, N.,
1. 2. 3.
Ursing, B., Kamme, C. Lancet, April 5, 1975, p. 775. Golde, D. W. ibid. 1968, i, 1144. Anderson, C. R. ibid. March 15, 1975, p. 642.
