1602
of enzyme, 10 µ1 was subjected to 30 cycles of PCR with general primers that amplify a 450 bp segment of the conserved Ll region of the HPV genome irrespective of HPV type.2,3 Primers that co-amplify a 268 bp segment of human &bgr;-globin DNA were included as a control for presence in the sample of DNA of cellular origin.2Positive controls in the PCR were CaSki cells (500/ml) added to 5 ml distilled water and to the solution.derived from 2% glutaraldehyde after it had gone through all of the processing steps leading up to PCR. Negative controls were 5 ml of fresh 2% glutaraldehyde collected from the instrument bath before a clinic began, 2% glutaraldehyde, distilled water, and 0-5 ng and 0-5 µg human leucocyte DNA 2 h after addition to 5 ml of 2%
glutaraldehyde. Results showed bands of expected size for HPV and &bgr;-globin in the positive controls, but no bands were seen for any of the samples, nor for the negative controls (except with the 0,5 µg human DNA control, where a band of &bgr;-globin PCR product was seen). This shows that 2% glutaraldehyde quickly destroys HPV DNA. Thus, if instruments are soaked in glutaraldehyde between patients, HPV DNA detected in cervical specimens will not originate from transfer by instruments.
Supported by the National Health and Medical Research Council of Australia. Molecular
Biology Laboratory, Department of Public Health and Clinical Biochemistry, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2006, Australia
YI-KUN Lou KAY J. MCKINNON SIMONE M. ORMSBY BRIAN N. NIGHTINGALE BRIAN J. MORRIS
BJ, Rose BR, Flanagan JL, et al. Automated polymerase chain reaction for papillomavirus screening of cervicovaginal lavages: comparison with dot-blot hybridization in a sexually transmitted diseases clinic population. J Med Virol 1990;
1. Morris
32: 22-30.
Ting Y, Manos MM. Detection and typing of genital human papillomaviruses. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, eds. PCR protocols: a guide to methods and applications. San Diego: Academic Press, 1990: 356-67. 3. Schiffman MH, Bauer HM, Lorincz AT, et al Comparison of Southern blot hybridization and polymerase chain reaction methods for the detection of human papillomavirus DNA J Clin Microbiol 1991; 29: 537-77. 2.
of irrigant absorption. In particular, the baseline may be confused by intravenous infusions containing little or no sodium (such as 5% glucose). It is also important that the sodium analyser should be able to distinguish a change in serum sodium of 2 mmol/1 as being significant so that it is not strikingly less sensitive than ethanol at
detecting low-grade absorption. Department of Anaesthesia, Huddinge University Hospital, S-141 86 Huddinge, Sweden 1. Hahn RG. Prevention of the TUR
R. G. HAHN syndrome by detection of trace ethanol
m
the
expired breath. Anaesthesia 1991; 45: 577-81. 2. Hahn RG. The transurethral resection syndrome. Acta Anaesthesiol Scand 1991; 35: 557-67. 3. Hahn RG. Calculation of irrigant absorption by measurement of breath alcohol level during transurethral resection of the prostate. Br J Urol 1991; 68: 390-93.
Deafness after
meningitis
SIR,-Dr Mayatepek and colleagues (Nov 23, p 1331) report 1 of deafness in 30 cases of meningitis due to Neisseria meningitidis and 6 cases out of 30 when unusual serogroups were identified. At the request of Sir Cyril Clarke (then directing the Medical Services Study Group, Royal College of Physicians) I investigated 60 children who had had meningococcal meningitis 5-9 years previously and 60 matched controls.’ Tests used were physical, neurological, audiological, and psychometric. No significant differences were found. The frequency of sensorineural case
deafness was 5 % in the cases and 3% in the controls. Cross-analysis for drugs, duration of illness before specific therapy, and other factors was also negative. Published figures for post-meningitis deafness ranged, at that time, between 5.8%2 and 12.3%.3 Serogroups were not specified in these series but the numbers were 337 cases and 775 cases so it is likely that unusual groups were represented. Further controlled studies are required to find the true incidence of deafness in the various serogroups, and the drugs used and the duration of illness before specific therapy should always be stated. 6 Brookes Lane,
Whalley BB6 9RG,
UK
PETER D. MOSS
Monitoring of TURP with ethanol SIR,-In your Sept 7 editorial you discuss the use of ethanol to monitor irrigating fluid absorption during TURP (transurethral resection of the prostate). In this hospital, this method has been used in more than 700 operations since 1986. We are satisfied with the ease with which information about fluid absorption can be obtained at any time. A total absorption volume of 1 litre (breath alcohol
mg/ml) should prompt action to reduce further since this volume may result in mild symptoms of transurethral resection syndrome.12 However, the operation need not be stopped until 2 litres have been absorbed (breath alcohol about 0-50 mg/ml).1 For routine resection, a nomogram provides gross correlations between ethanol concentration in exhaled air, serum sodium, and volume of irrigant absorbed.2 If the pattern of breath alcohol readings is also considered, monitoring is suitable for accurate evaluations. Dr Tormey (Oct 12, p 947) questions the use of ethanol to detect extravascular absorption. In my experience, this type of absorption is much less common than pick-up of fluid by the intravascular route. Ethanol monitoring does detect extravascular absorption, but the ethanol readings are lower and increase more slowly than when the same amount of irrigant is absorbed into the circulation. If in doubt, whether absorption is mainly intravascular or extravascular can be determined by stopping the operation for 5 min and taking a repeat exhaled air sample (one breath) at the end of that period. This will show a lower value if absorption is intravascular but will be unchanged or higher if absorption is extravascular. The measurement of serum sodium with bedside analysing equipment is an alternative method for detecting irrigating fluid absorption, as Tormey mentions. As for breath ethanol, serum sodium should be measured every 10 min during operation to give an early warning of continuing irrigant absorption.2 However, measurements of serum sodium are invasive and not a specific index
1. Moss PD. Outcome of meningococcal group B meningitis. Arch Dis Child 1982; 57: 616-21 2. Habib RG, Girgis NI, Yassin MW, Sippel JE, Edman DC. Hearing impairment in meningococcal meningitis. Scand J Infect Dis 1979; 11: 121-23. 3. Grove WE, Fox MJ. Postmeningitic complications with particular reference to otologic sequelae. Ann Otol Rhinol Laryngol 1949; 58: 771-88.
about 0-25
Incontinence after stroke
absorption,
SIR,-Dr Henriksen (Nov 23, p 1335) highlights the lack of information, in medical notes, on urinary incontinence in stroke and he surmises that this problem is not unique to Denmark. In the UK the vast majority of stroke patients are under the care of general physicians and geriatricians rather than neurologists (there are nearly 100 such patients in hospital at any one time in this district, but no "neurological" beds), but the same
patients,
problems apply. In a survey of 165 stroke patients admitted to hospital in Liverpool we found that 60% were incontinent one week after the stroke (half of these had indwelling catheters), and 25% were incontinent at discharge. Although incontinence is an important independent predictor of outcome,l,2 there was a striking lack of information about it in the medical notes. Pre-morbid functional status, including continence, is also of great importance in planning treatment and determining outcome, and we found that information on pre-stroke continence was recorded in the medical notes in 41 % and in the nursing notes in 54% of the patients in our survey. We also asked the families of 54 of these stroke patients about their premorbid functional state and obtained a history of occasional or regular urinary incontinence before the stroke in 12 (22%) cases. 8 of these 12 patients were recorded in the medical and/or nursing notes as having been continent previously. Thus not only is insufficient attention given to
of enzyme, 10 µ1 was subjected to 30 cycles of PCR with general primers that amplify a 450 bp segment of the conserved Ll region of the HPV genome irrespective of HPV type.2,3 Primers that co-amplify a 268 bp segment of human &bgr;-globin DNA were included as a control for presence in the sample of DNA of cellular origin.2Positive controls in the PCR were CaSki cells (500/ml) added to 5 ml distilled water and to the solution.derived from 2% glutaraldehyde after it had gone through all of the processing steps leading up to PCR. Negative controls were 5 ml of fresh 2% glutaraldehyde collected from the instrument bath before a clinic began, 2% glutaraldehyde, distilled water, and 0-5 ng and 0-5 µg human leucocyte DNA 2 h after addition to 5 ml of 2%
glutaraldehyde. Results showed bands of expected size for HPV and &bgr;-globin in the positive controls, but no bands were seen for any of the samples, nor for the negative controls (except with the 0,5 µg human DNA control, where a band of &bgr;-globin PCR product was seen). This shows that 2% glutaraldehyde quickly destroys HPV DNA. Thus, if instruments are soaked in glutaraldehyde between patients, HPV DNA detected in cervical specimens will not originate from transfer by instruments.
Supported by the National Health and Medical Research Council of Australia. Molecular
Biology Laboratory, Department of Public Health and Clinical Biochemistry, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2006, Australia
YI-KUN Lou KAY J. MCKINNON SIMONE M. ORMSBY BRIAN N. NIGHTINGALE BRIAN J. MORRIS
BJ, Rose BR, Flanagan JL, et al. Automated polymerase chain reaction for papillomavirus screening of cervicovaginal lavages: comparison with dot-blot hybridization in a sexually transmitted diseases clinic population. J Med Virol 1990;
1. Morris
32: 22-30.
Ting Y, Manos MM. Detection and typing of genital human papillomaviruses. In: Innis MA, Gelfand DH, Sninsky JJ, White TJ, eds. PCR protocols: a guide to methods and applications. San Diego: Academic Press, 1990: 356-67. 3. Schiffman MH, Bauer HM, Lorincz AT, et al Comparison of Southern blot hybridization and polymerase chain reaction methods for the detection of human papillomavirus DNA J Clin Microbiol 1991; 29: 537-77. 2.
of irrigant absorption. In particular, the baseline may be confused by intravenous infusions containing little or no sodium (such as 5% glucose). It is also important that the sodium analyser should be able to distinguish a change in serum sodium of 2 mmol/1 as being significant so that it is not strikingly less sensitive than ethanol at
detecting low-grade absorption. Department of Anaesthesia, Huddinge University Hospital, S-141 86 Huddinge, Sweden 1. Hahn RG. Prevention of the TUR
R. G. HAHN syndrome by detection of trace ethanol
m
the
expired breath. Anaesthesia 1991; 45: 577-81. 2. Hahn RG. The transurethral resection syndrome. Acta Anaesthesiol Scand 1991; 35: 557-67. 3. Hahn RG. Calculation of irrigant absorption by measurement of breath alcohol level during transurethral resection of the prostate. Br J Urol 1991; 68: 390-93.
Deafness after
meningitis
SIR,-Dr Mayatepek and colleagues (Nov 23, p 1331) report 1 of deafness in 30 cases of meningitis due to Neisseria meningitidis and 6 cases out of 30 when unusual serogroups were identified. At the request of Sir Cyril Clarke (then directing the Medical Services Study Group, Royal College of Physicians) I investigated 60 children who had had meningococcal meningitis 5-9 years previously and 60 matched controls.’ Tests used were physical, neurological, audiological, and psychometric. No significant differences were found. The frequency of sensorineural case
deafness was 5 % in the cases and 3% in the controls. Cross-analysis for drugs, duration of illness before specific therapy, and other factors was also negative. Published figures for post-meningitis deafness ranged, at that time, between 5.8%2 and 12.3%.3 Serogroups were not specified in these series but the numbers were 337 cases and 775 cases so it is likely that unusual groups were represented. Further controlled studies are required to find the true incidence of deafness in the various serogroups, and the drugs used and the duration of illness before specific therapy should always be stated. 6 Brookes Lane,
Whalley BB6 9RG,
UK
PETER D. MOSS
Monitoring of TURP with ethanol SIR,-In your Sept 7 editorial you discuss the use of ethanol to monitor irrigating fluid absorption during TURP (transurethral resection of the prostate). In this hospital, this method has been used in more than 700 operations since 1986. We are satisfied with the ease with which information about fluid absorption can be obtained at any time. A total absorption volume of 1 litre (breath alcohol
mg/ml) should prompt action to reduce further since this volume may result in mild symptoms of transurethral resection syndrome.12 However, the operation need not be stopped until 2 litres have been absorbed (breath alcohol about 0-50 mg/ml).1 For routine resection, a nomogram provides gross correlations between ethanol concentration in exhaled air, serum sodium, and volume of irrigant absorbed.2 If the pattern of breath alcohol readings is also considered, monitoring is suitable for accurate evaluations. Dr Tormey (Oct 12, p 947) questions the use of ethanol to detect extravascular absorption. In my experience, this type of absorption is much less common than pick-up of fluid by the intravascular route. Ethanol monitoring does detect extravascular absorption, but the ethanol readings are lower and increase more slowly than when the same amount of irrigant is absorbed into the circulation. If in doubt, whether absorption is mainly intravascular or extravascular can be determined by stopping the operation for 5 min and taking a repeat exhaled air sample (one breath) at the end of that period. This will show a lower value if absorption is intravascular but will be unchanged or higher if absorption is extravascular. The measurement of serum sodium with bedside analysing equipment is an alternative method for detecting irrigating fluid absorption, as Tormey mentions. As for breath ethanol, serum sodium should be measured every 10 min during operation to give an early warning of continuing irrigant absorption.2 However, measurements of serum sodium are invasive and not a specific index
1. Moss PD. Outcome of meningococcal group B meningitis. Arch Dis Child 1982; 57: 616-21 2. Habib RG, Girgis NI, Yassin MW, Sippel JE, Edman DC. Hearing impairment in meningococcal meningitis. Scand J Infect Dis 1979; 11: 121-23. 3. Grove WE, Fox MJ. Postmeningitic complications with particular reference to otologic sequelae. Ann Otol Rhinol Laryngol 1949; 58: 771-88.
about 0-25
Incontinence after stroke
absorption,
SIR,-Dr Henriksen (Nov 23, p 1335) highlights the lack of information, in medical notes, on urinary incontinence in stroke and he surmises that this problem is not unique to Denmark. In the UK the vast majority of stroke patients are under the care of general physicians and geriatricians rather than neurologists (there are nearly 100 such patients in hospital at any one time in this district, but no "neurological" beds), but the same
patients,
problems apply. In a survey of 165 stroke patients admitted to hospital in Liverpool we found that 60% were incontinent one week after the stroke (half of these had indwelling catheters), and 25% were incontinent at discharge. Although incontinence is an important independent predictor of outcome,l,2 there was a striking lack of information about it in the medical notes. Pre-morbid functional status, including continence, is also of great importance in planning treatment and determining outcome, and we found that information on pre-stroke continence was recorded in the medical notes in 41 % and in the nursing notes in 54% of the patients in our survey. We also asked the families of 54 of these stroke patients about their premorbid functional state and obtained a history of occasional or regular urinary incontinence before the stroke in 12 (22%) cases. 8 of these 12 patients were recorded in the medical and/or nursing notes as having been continent previously. Thus not only is insufficient attention given to
