43
simple concepts and practices lead logically to punitive social policies, which divide families rather than strengthen them. Judge Baker Guidance Center, 295 Longwood Avenue, Boston, Massachusetts 02115.
Children’s Hospital Medical Center, 300 Longwood Avenue, Boston, Massachusetts 02115.
CAROLYN MOORE NEWBERGER.
area.
ELI H. NEWBERGER.
N.B.T. TEST IN PREGNANCY
SIR,-Since Park et al.l described the nitroblue-tetrazolium (N.B.T.) test as a useful aid in distinguishing bacterial from non-bacterial illness, several reports have confirmed its value in children and in adults. 2-4 More recently, however, its specificity for bacterial illness has been questioned.s-7 Various factors, such as amount of anticoagulant and incubation temperature, also influence quantitative N.B.T. reduction.8 False-negative results occur in obvious bacterial infections and in patients taking corticosteroids9 or phenylbutazone.lo Furthermore, false-positive results have been found in users of oral
contraceptives.", 12 The latter observations prompted us examine the N.B.T. test in pregnant women, using the
to
%
COAL WORKER’S PNEUMOCONIOSIS AND CARCINOMA OF THE LUNG SIR,-I have become increasingly aware during the past few years of an apparently high incidence of carcinoma of the lung in men with coal worker’s pneumoconiosis in this
N.B.T. REDUCTION IN PREGNANCY
In an attempt to discover whether this is an imaginary or a real increase, I reviewed the findings in 300 necropsies done since 1967 in miners with pneumoconiosis. All were over 50 years of age at the time of death. 65 of them were found to have some form of malignant disease-which is much the same as one would expect from the Registrar General’s tables (i.e., about 20%). The disturbing thing, however, is that 42 of them were primary carcinomas of the lung (14-0%), which is considerably higher than anticipated (about 9%). Similarly, whereas one expects lung cancer to account for about 40% of all carcinoma deaths in men over 50, in this series they account for 64% of them. These findings are quite contrary to general belief. In the past it has almost invariably been maintained that carcinoma of the lung is no commoner in miners with pneumoconiosis than in non-miners of a similar agegroup.l-3 In fact, Goldman has said that, in South Wales, the mortality from carcinoma of the lung in miners is actually less than normally would be expected. The cause of the disparity in the findings here as compared with South Wales is a matter of conjecture but, in this connection, I have read recently4 that the M.R.C. unit now attach conof siderable importance to particle size in the caused various asbestos dusts. malignancy by If there is an association between coal dust and carcinoma of the lung in South Lancashire, as the above findings suggest, then the particle size of the dust might also have some bearing on it.
degree
Mean.
t
Two
or
less determinations.
N.A.:
Not available.
method of Baehner and Nathan.l3 5 pregnant women examined, 2 of them serially into the post-partum period. All were free of bacterial infection or other illness and none was taking medication other than a prenatal vitamin supplement. Results are shown in the accompanying table. For subject 1, a follow-up N.B.T. test was not performed until 6 months after delivery, when it was positive (50%) and she was again pregnant. Serial tests every 2 weeks showed decreasing values, and 4-6 weeks later she miscarried. 10 days later the N.B.T. test was normal (14%). Observations in these 5 subjects suggest that positive
St. Helens Hospital, Marshalls Cross Road, St. Helens, Lancashire.
FRANCIS MOONEY.
were
: i
N.B.T. tests are
,
.
, ;
frequent during
pregnancy.
The apparent lack of specificity of the N.B.T. test and the usefulness of the conventional haematological measurements for determination of bacterial infection 14 raise a serious question whether the N.B.T. test is worth the time and effort of doing it routinely. District of Columbia General Hospital, Washington, D.C. 20003, U.S.A.
D. L. SOLANKI BARBARA CREGAN.
Park, B. H., Fikrig, S. M., Smithwick, E. M. Lancet, 1968, ii, 532. Matula, G., Paterson, P. New Engl. J. Med. 1971, 285, 211. Feigin, R. D., Shackelford, P. G., Choi, S. C., Flake, K. K., Franklin, F. A., Jr., Eisenberg, C. S. J. Pediat. 1971, 78, 230. 4. Humbert, J. R., Marks, M. I., Hathaway, W. E., Thoren, C. H. Pediatrics, Springfield, 1971, 48, 259. 5. Lauter, C. B., Riad El Khatib, M., Rising, J. A., Robin, E. Ann. intern. Med. 1973, 79, 59. 6. Soonatrakul, E., Andersen, B. R. New Engl. J. Med. 1973, 288, 218. 7. Mimbs, J. W. ibid. 1972, 287, 49. 8. Charette, R., Komp, D. M. ibid. p. 991. 9. Miller, D. R., Kaplan, H. G. Pediatrics, 1970, 45, 861. 10. Strauss, R. R., Paul, B. B., Sharra, A. J. J. Bact. 1968, 96, 1982. 11. Norden, C. W., Reese, R. New Engl. J. Med. 1972, 287, 254. 12. Arrowsmith, D., Morin, R. Lancet, 1973, i, 148. 13. Baehner, R. L., Nathan, D. G. New Engl. J. Med. 1968, 278, 971. 14. Steigbigel, R. T., Johnson, P. K., Remington, J. S. ibid. 1974, 1. 2. 3.
290, 235.
BENIGN TRANSFORMATION OF TESTICULAR CARCINOMA BY CHEMOTHERAPY
SIR,-Benign teratomatous metastases from embryonalcell carcinoma of the testis are very rare.5-7 Since the beginning of our programme of multiple sequential chemotherapy with bleomycin, vinblastine, cyclophosphamide, adriamycin, and actinomycin D we have observed this phenomenon in 7 cases. One of our patients was operated on for a pelvic recurrence of an embryonal-cell carcinoma. Only part of the tumour was excised because of vascular involvement. He was then put on multiple sequential chemotherapy. Forty-five days after, he developed another pelvic mass which was excised again. At that time histological analysis revealed a completely benign teratoma. The benign transformation of the tumour occurred during the period in which he received chemotherapy. It seems that there is a direct relationship between the administration of chemotherapy and the transformation of the tumour into benign teratoma.6Two explanations are possible: (1) the chemotherapy destroys only the immature malignant cells, leaving intact the mature benign teratomatous elements 5; (2) the chemotherapy, by altering the cell kinetics, pushes the totipotential malignant germ cell toward the formation of benign mature teratoma. This second explanation seems to be more in agreement 1. 2. 3. 4. 5. 6. 7.
Goldman, K. P. Br. J. industr. Med. 1965, 22, 72. James, W. R. L. ibid. 1955, 12, 87. Doll, R. ibid. 1959, 16, 181. Sunday Telegraph, Oct. 20, 1974, p. 6. Willis, G. W., Hajdu, S. I. Am. J. clin. Path. 1973, 59, 338. Smithers, D. W. Lancet, 1969, ii, 949. Dees, J. E. J. Urol. 1973, 110, 90.
simple concepts and practices lead logically to punitive social policies, which divide families rather than strengthen them. Judge Baker Guidance Center, 295 Longwood Avenue, Boston, Massachusetts 02115.
Children’s Hospital Medical Center, 300 Longwood Avenue, Boston, Massachusetts 02115.
CAROLYN MOORE NEWBERGER.
area.
ELI H. NEWBERGER.
N.B.T. TEST IN PREGNANCY
SIR,-Since Park et al.l described the nitroblue-tetrazolium (N.B.T.) test as a useful aid in distinguishing bacterial from non-bacterial illness, several reports have confirmed its value in children and in adults. 2-4 More recently, however, its specificity for bacterial illness has been questioned.s-7 Various factors, such as amount of anticoagulant and incubation temperature, also influence quantitative N.B.T. reduction.8 False-negative results occur in obvious bacterial infections and in patients taking corticosteroids9 or phenylbutazone.lo Furthermore, false-positive results have been found in users of oral
contraceptives.", 12 The latter observations prompted us examine the N.B.T. test in pregnant women, using the
to
%
COAL WORKER’S PNEUMOCONIOSIS AND CARCINOMA OF THE LUNG SIR,-I have become increasingly aware during the past few years of an apparently high incidence of carcinoma of the lung in men with coal worker’s pneumoconiosis in this
N.B.T. REDUCTION IN PREGNANCY
In an attempt to discover whether this is an imaginary or a real increase, I reviewed the findings in 300 necropsies done since 1967 in miners with pneumoconiosis. All were over 50 years of age at the time of death. 65 of them were found to have some form of malignant disease-which is much the same as one would expect from the Registrar General’s tables (i.e., about 20%). The disturbing thing, however, is that 42 of them were primary carcinomas of the lung (14-0%), which is considerably higher than anticipated (about 9%). Similarly, whereas one expects lung cancer to account for about 40% of all carcinoma deaths in men over 50, in this series they account for 64% of them. These findings are quite contrary to general belief. In the past it has almost invariably been maintained that carcinoma of the lung is no commoner in miners with pneumoconiosis than in non-miners of a similar agegroup.l-3 In fact, Goldman has said that, in South Wales, the mortality from carcinoma of the lung in miners is actually less than normally would be expected. The cause of the disparity in the findings here as compared with South Wales is a matter of conjecture but, in this connection, I have read recently4 that the M.R.C. unit now attach conof siderable importance to particle size in the caused various asbestos dusts. malignancy by If there is an association between coal dust and carcinoma of the lung in South Lancashire, as the above findings suggest, then the particle size of the dust might also have some bearing on it.
degree
Mean.
t
Two
or
less determinations.
N.A.:
Not available.
method of Baehner and Nathan.l3 5 pregnant women examined, 2 of them serially into the post-partum period. All were free of bacterial infection or other illness and none was taking medication other than a prenatal vitamin supplement. Results are shown in the accompanying table. For subject 1, a follow-up N.B.T. test was not performed until 6 months after delivery, when it was positive (50%) and she was again pregnant. Serial tests every 2 weeks showed decreasing values, and 4-6 weeks later she miscarried. 10 days later the N.B.T. test was normal (14%). Observations in these 5 subjects suggest that positive
St. Helens Hospital, Marshalls Cross Road, St. Helens, Lancashire.
FRANCIS MOONEY.
were
: i
N.B.T. tests are
,
.
, ;
frequent during
pregnancy.
The apparent lack of specificity of the N.B.T. test and the usefulness of the conventional haematological measurements for determination of bacterial infection 14 raise a serious question whether the N.B.T. test is worth the time and effort of doing it routinely. District of Columbia General Hospital, Washington, D.C. 20003, U.S.A.
D. L. SOLANKI BARBARA CREGAN.
Park, B. H., Fikrig, S. M., Smithwick, E. M. Lancet, 1968, ii, 532. Matula, G., Paterson, P. New Engl. J. Med. 1971, 285, 211. Feigin, R. D., Shackelford, P. G., Choi, S. C., Flake, K. K., Franklin, F. A., Jr., Eisenberg, C. S. J. Pediat. 1971, 78, 230. 4. Humbert, J. R., Marks, M. I., Hathaway, W. E., Thoren, C. H. Pediatrics, Springfield, 1971, 48, 259. 5. Lauter, C. B., Riad El Khatib, M., Rising, J. A., Robin, E. Ann. intern. Med. 1973, 79, 59. 6. Soonatrakul, E., Andersen, B. R. New Engl. J. Med. 1973, 288, 218. 7. Mimbs, J. W. ibid. 1972, 287, 49. 8. Charette, R., Komp, D. M. ibid. p. 991. 9. Miller, D. R., Kaplan, H. G. Pediatrics, 1970, 45, 861. 10. Strauss, R. R., Paul, B. B., Sharra, A. J. J. Bact. 1968, 96, 1982. 11. Norden, C. W., Reese, R. New Engl. J. Med. 1972, 287, 254. 12. Arrowsmith, D., Morin, R. Lancet, 1973, i, 148. 13. Baehner, R. L., Nathan, D. G. New Engl. J. Med. 1968, 278, 971. 14. Steigbigel, R. T., Johnson, P. K., Remington, J. S. ibid. 1974, 1. 2. 3.
290, 235.
BENIGN TRANSFORMATION OF TESTICULAR CARCINOMA BY CHEMOTHERAPY
SIR,-Benign teratomatous metastases from embryonalcell carcinoma of the testis are very rare.5-7 Since the beginning of our programme of multiple sequential chemotherapy with bleomycin, vinblastine, cyclophosphamide, adriamycin, and actinomycin D we have observed this phenomenon in 7 cases. One of our patients was operated on for a pelvic recurrence of an embryonal-cell carcinoma. Only part of the tumour was excised because of vascular involvement. He was then put on multiple sequential chemotherapy. Forty-five days after, he developed another pelvic mass which was excised again. At that time histological analysis revealed a completely benign teratoma. The benign transformation of the tumour occurred during the period in which he received chemotherapy. It seems that there is a direct relationship between the administration of chemotherapy and the transformation of the tumour into benign teratoma.6Two explanations are possible: (1) the chemotherapy destroys only the immature malignant cells, leaving intact the mature benign teratomatous elements 5; (2) the chemotherapy, by altering the cell kinetics, pushes the totipotential malignant germ cell toward the formation of benign mature teratoma. This second explanation seems to be more in agreement 1. 2. 3. 4. 5. 6. 7.
Goldman, K. P. Br. J. industr. Med. 1965, 22, 72. James, W. R. L. ibid. 1955, 12, 87. Doll, R. ibid. 1959, 16, 181. Sunday Telegraph, Oct. 20, 1974, p. 6. Willis, G. W., Hajdu, S. I. Am. J. clin. Path. 1973, 59, 338. Smithers, D. W. Lancet, 1969, ii, 949. Dees, J. E. J. Urol. 1973, 110, 90.
