1025 than in individuals with normal creatinine clearances, but 24 urinary oxalic acid values were raised (mean 53-5 mg, the normal maximum level being 35 mg) and 2 patients excreted more than 70 mg. In 23 out of 27 kidneys removed at the time of transplantation calcium oxalate dihydrate deposits were observed inside and in the wall of the cortex or the medulla tubules and to a lesser extent in the interstitium. We also discovered crystals inside the renal pelvis, which shows that these crystalline collections can be excreted with the urine. h

A. CARALPS J. LLOVERAS J. ANDREU A. BRULLES J. MASRAMON M. LLORACH M. T. VIDAL M. FERNANDEZ CONDE J. AUBIA

Transplant Unit, Hospital Clinico, Barcelona, Spain; and Nephrology Service, Hospital de la Esperanza,

Renal

Barcelona

HAZARDS OF MOUTH-TO-MOUTH RESUSCITATION

SIR,-Professor Davies (Sept. 15,

p. 593) has raised imporquestions about the risk to operators of mouth-to-mouth breathing. Most people who acquire meningococcal infection do so from a carrier, and patients with meningococcal infection are thought to pose no great risk to hospital contacts.’1 However, transmission of meningococcal infection from patients to hospital staffsand other patients’ has been described. Meningococcal infection has been acquired after tant

mouth-to-mouth resuscitationbut there is no agreement as to the management of such contacts. Jacobson and Fraser5 recommended that mouth-to-mouth contacts be given the same chemoprophylaxis with rifampicin, sulfadiazine, or minocycline as are other close contacts. My concerns with this approach are that there may be a very brief period of colonisation of the upper respiratory tract before the onset of meningococcal infection6 and such infection may be very rapidly fatal.2 To eradicate a potential bacterxmia in the operator immediately after mouth-to-mouth resuscitation, Artenstein recommended procaine penicillin intramuscularly, 500 000 units three times daily for two days, followed by orally administered penicillin V 500 mg three times daily for eight days. However, Artenstein’s regimen may be ineffective because meningococcal infection has been reported in close, but not mouth-to-mouth, contacts receiving intramuscular procaine penicillin and benzathine penicillin for chemoprophylaxis.8 When faced with this dilemma I have recommended that the mouth-to-mouth contact be admitted to hospital and started on 12 million units of penicillin G intravenously in divided doses over 24 h after blood has been drawn for culture. The patients are discharged 2 days later if they remain symptom-free and if blood cultures are sterile. None of these recommendations have been evaluated formally and I would be interested in having other phys1. Artenstein MS, Ellis RE. The risk of exposure to a patient with meningococcal meningitis. Military Med 1968; 133: 474-77. 2. Fieldman HA. Some recollections of the meningococcal diseases: The first Harry F. Dowling lecture. JAMA 1972; 220: 1107-112. 3. Anonymous. Nosocomial meningococcemia—Wisconsin. Morbid Mortal

Weekly Rep 1978; 27: 358-63. 4. Cohen MS, Steere AC, Baltimore R, Von Graevenitz A, Pantelick E, Camp B, Root RK, Possible nosocomial transmission of Group Y Neisseria meningitidis among oncology patients. Ann Intern Med 1979; 91: 7-12. 5. Jacobson JA, Fraser DW. A simplified approach to meningococcal disease prophylaxis. JAMA 1976; 236: 1053-54. 6. Edwards EA, Devine LF, Sengbusch CH, Ward HW, et al. Immunological investigations of meningococcal disease. III Brevity of group C acquisition prior to disease occurrence. Scand J Infect Dis 1977; 9: 105-10. 7. Artenstein MS. Prophylaxis for meningococcal disease. JAMA 1975; 231:

1035-37. 8. Anonymous. 17: 178.

Meningococcal meningitis.

Morbid Mortal

Weekly Rep 1968;

icians’ views

on

the management of mouth-to-mouth

contacts

of patients with meningococcal infection. Clinical Pharmacology Service, St. Joseph’s Hospital, Hamilton, Ontario L8N 1Y4, Canada

MICHAEL R. ACHONG

OVARIAN OVERRIPENESS AND INTRAUTERINE GROWTH RETARDATION

SIR,-Intrauterine growth retardation (IUGR) leading to small-for-dates babies is usually related to a maternal or fetal disturbance. However, about 50% of cases of IUGR remain unexplained. Such IUGR could be similar to delayed fetal growth observed when the luteinising-hormone peak is delayed by 48 h in the rat or by 60 h in the rabbit. Overripeness of the ovum, which is the consequence of an overlong follicular phase, is difficult to study in women but an indication can be had from basal body-temperature charts (BBT). The BBT charts for 289 conception cycles have been studied. 159 (55%) were from women seeking advice after cessation of oral contraception or who were using BBT as a contraceptive method and 130 (45%) were from women who had had

previous subfertility problems. PROPORTION OF SMALL-FOR-DATES BABIES ACCORDING TO CYCLE DAY AND LENGTH OF TEMPERATURE RISE

The BBT curves were read by two independent observers who measured several items, notably the "nadir" point (the last day of hypothermia) and the duration of the temperature rise. The charts of women showing an obvious maternal factor for IUGR were discarded (53 cases), as were those with twin pregnancies (6), malformed infants (4), and stillbirths (1). 20 curves were unreadable, leaving 205 for analysis. A baby was defined as small-for-dates when the birthweight was under the tenth centile for gestational age.3 The proportion of small-for-date babies was 13% when the nadir took place between day 11 and day 16 of the cycle and 27% when it was after day 16 (p