57

As the discoverers and manufacturers of pentazocine,we are anxious to maintain well-documented informationon the use of the product, including cases of possiblemisuse or dependence. We are particularly anxious thatcurrency should not be given in the social sphere to isolatedreports of dependency, which might encourage drug-seeking behaviour or social misuse. Moreover, it shouldbe realised that pentazocine is a narcotic antagonist, andwill not support patients dependent on morphine.

In assessing cases such as Dr. Schoolar’s, we hope thatthe reported incidence of misuse will be viewed againstthe very extensive background of trouble-free, rewardingusage in the field of pain relief.

J. MICHAEL MUNGAVINMedical Director.

The Bayer Products Company,Surbiton-upon-Thames,

Surrey.

A NEW ESCALATOR INJURY

SIR,-I am glad that Dr. Collins (June 21, p. 1268) hasbrought to your notice the accident hazard of the escalatorson the new Victoria line.My own experience of performing three amputations of a

limb, or part of a limb or digit, in the past three years, in anarea which has very few escalators, has led me to investigatethe problem further. One result is that for the past yearseveral agencies have been trying to make the generalpublic aware of the potential danger of escalators, and at thesame time trying to introduce legislation to make certainsafety precautions compulsory. There are several causesbesides those mentioned by Dr. Collins, and some could beeliminated if more information were available about thenumber and type of accidents.

Accidents to employees in stores and railway premisesare compulsorily notifiable under the Offices, Shops andRailway Premises Act of 1963, but there is no mandatoryregistration of accidents on these premises to members ofthe general public. My own personal experience leadsme to believe that these accidents are quite common(during the past six months three further cases have beentreated in my hospital).A previous letter had a very poor response, but perhaps

this time I will be more fortunate when asking for detailsof other surgeons’ experiences, so that a central register caneventually be kept of these injuries.

ALEXANDER KATES.London W.I.

CADMIUM TOXICOLOGY

SiR,—The survey of cadmium (Cd) toxicology by Dr.Kendrey and Dr. Roe (June 14, p. 1206) is an interestingexercise in fitting a bibliography to a disease. I have beenresponsible for the routine surveillance of workers in Cdfume for the past ten years, and my experience is contrary tothe results of the animal experiments cited in the article.The 42 men concerned have been exposed for from two toforty years. The amount of Cd which they have absorbed hasbeen far in excess of the amounts absorbed by people whoare not industrially exposed. 6 of them were exposed, formore than ten years, to concentrations in air exceeding4 mg. per c.m. and the remainder have been exposed toaverage concentrations of 0.1 mg. per c.m. Some of thesemen have proteinuria and emphysema, but none (includinga 73-year-old) has a blood-pressure greater than 140/90 mm.Hg. None is apparently sterile, nor is there any increase inthe incidence of coronary-artery disease. There has beenone case of carcinoma of the prostate, and one of carcinomaof the bronchus.A personal communication from Dr. J. Bonnell confirms

1. Kates, A. Lancet, 1968, i, 365.

that in the original M.R.C. survey of Cd-fume workersthere was no evidence that the incidence of hypertension wasincreased.

H. HOLDENGroup Medical Officer.

British Insulated Callender’s Cables Ltd.,21 Bloomsbury Street,London W.C.1.

METASTASES TO COWPER’S GLANDS IN

GRANULOCYTIC LEUKÆMIA

SIR,-Carcinoma of Cowper’s gland is a well-recognisedthough rare entity, but metastatic tumour has not beenreported to the best of our knowledge. The case describedhere was discovered during a comprehensive study of theanatomical structure and pathological lesions in Cowper’sglands in a randomly selected group of necropsies.The patient was a 13-year-old Caucasian boy in whom

stem-cell leukxmia was diagnosed 20 months before death.At no time during the course of his illness were there

symptoms referable to the genitourinary system. Necropsyshowed diffuse and local infiltration of most organs byimmature leucocytes, predominantly myeloblasts. In the

gross examination, the Cowper’s glands were normal. Stepsections through the glands showed leuksemic cells in thestroma of each diaphragmatic Cowper’s gland; however,the tumour did not extend across the midline or to theurethra. The right gland was more severely involved thanthe left and leukaemic cells were also present in the surround-

ing connective tissue on the right. There was no evidenceof obstruction of the ducts and no periductal infiltrates oftumour cells were identified. The bulbar glands were freeof tumour cells.

GARRET R. TUCKER, IIIJACK W. C. HAGSTROM.

Departments of Urologyand Pathology,

New York Hospital-CornellMedical Center,New York 10021.

ABDOMINAL AORTIC ANEURYSMS

SIR,-In your annotation on abdominal aortic aneurysm 1

you quote a hospital mortality of 15.3% in 3000 cases.

This statement was unqualified in the text and might mis-lead those who from time to time have to advise patientsand their relatives on the risks of surgery for the condition.There is a great difference between the results of treatingunruptured asymptomatic aneurysms and of treatingruptured aneurysms. (This was recorded by Short andMackey 2.) Even in the most experienced hands the resultsof surgical treatment for the ruptured aneurysm are rarelybelow a figure of 40% hospital mortality, and on occasionthey are as high as 75%. But when the operation is done asan elective procedure, under ideal conditions, the hospitalmortality can be 10% or less. These are important facts tobear in mind when deciding whether to advise operation,and in our opinion more important than considering data onthe natural history of the condition, which is notoriouslyunpredictable.Our experience of postoperative complications differ

from that of Short and Mackey.2 We have not had a highincidence of wound dehiscence using the vertical abdominalincision, and, in the management of 27 aneurysms, whetherruptured or treated electively, we have not encounteredarterial thrombosis requiring evacuation. 1 patient,however, developed diarrhoea with blood and pus in thestools on the eighth postoperative day, and, on sigmoidos-copy, showed evidence of a severe proctocolitis, presumedto be ischasmic. At the time of operation the inferiormesenteric artery was patent, as was the superior mesen-

1. Lancet, 1969, i, 1199.2. Short, D. W., Mackey, W. A. Scott. med. J. 1968, 13, 416.