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3930 g. Postnatal examination of the infant revealed no abnormalityand he continues to develop normally 9 months later.

Case 3. A 22-year-old primigravida was referred for surgicaltermination of pregnancy at 9 weeks’ amenorrhoea. She received

mifepristone but vomited one and a half hours later. The patientreported seeing tablets in the vomit. Subsequently, the patientdecided to continue with her pregnancy. Apart from three shortepisodes of abdominal pain, for which no cause could be found, thepregnancy was uneventful. The patient went into spontaneouslabour at 41 weeks and delivered a healthy female infant weighing3585 g. Post partum the patient had an 800 ml blood loss, thought tobe due mainly to a labial tear. Postnatal examination of the infantrevealed no abnormality and she continues to develop well at 6months.

Although the number of cases reported is small, these initialfindings suggest that, as with animal studies,2 human fetuses whichhave been exposed to mifepristone and which are not subsequentlyaborted continue to develop normally.

Department of Obstetrics and Gynaecology, B. H. LIM

Raigmore Hospital, Inverness D. A. R. LEES

Department of Obstetrics and Gynaecology,University of Edinburgh S. BJORNSSON

Department of Obstetrics and Gynaecology,Royal Infirmary, Glasgow C. B. LUNAN

Department of Obstetrics and Gynaecology,Northern General Hospital, Sheffield

M. R. COHNP. STEWART

Roussel Laboratories Ltd,Denham UB9 5HP, UK A. DAVEY

1. Sakiz E, Euvrard C, Baulieu EE. The antiprogesterone activity of RU38486, acontragestive agent in the human In: Labne F, Proulx L, eds. Endocrinology.Amsterdam: Elsevier, 1984.

2. Jost A. Animal reproduction-new data on the hormonal requirement of the pregnantrabbit; partial pregnancies and fetal anomalies resulting from treatment with ahormonal antagonist given at a sub-abortive dosage. CR Acad Sci III 1986; 7:281-84.

3. Henrion R. RU486 abortions Nature 1989; 338: 110.4. Deraedt R, Vanmer B, Fournex R. Toxicological study on RU486. In: Baulieu EE,

Segal SJ, eds. The antiprogestin steroid RU486 and human fertility control. NewYork: Plenum, 1985.

5. Wolf JP, Chillik CF, Dubois C, Ulmann A, Baulieu EE, Hodgen GD. Tolerance ofperinidatory primate embryos to RU486 exposure in vitro and m vivo.

Contraception 1990; 41: 85-92.

Reduction of lymphorrhagia from rupturedthoracic duct by somatostatin

SIR,-In January, 1989, a 65-year-old man presented withdysphonia. A hard, fixed 8 x 5cm swelling subsequently developedon the left side of the neck. In June, 1989, a well-differentiatedepidermoid carcinoma of the larynx with cervical lymph nodemetastasis was diagnosed. Chemotherapy with 5-fluorouracil

produced a tumour regression of greater than 50%. In September,1989, supraglottic laryngectomy was performed with radicalclearance on the left side. On the second postoperative day a milkylymphorrhagia appeared from the drain site. A compressionbandage was applied and the polymeric enteral diet was changed topeptides with 77 % lipids. Because the lymphorrhagia still increased(to 1200 ml in 24 h, with protein concentration of 23 g/1), enteralnutrition was replaced by total parenteral nutrition (TPN) with2620 kcal, 16-8 g nitrogen, and 106 g fat.

After three days of TPN the lymph was no longer milky, but theflow was still considerable (1000 ml in 24 h). A second operation wasconsidered but the patient’s poor nutritional status prompted a trialof somatostatin. 1-4 This agent was administered via a peripheral veinas a continuous infusion at a dose of 250 ug/h. After 3 days oftreatment lymph flow halved, and on day 5 it ceased. Triglycerideconcentrations fell after the start of TPN but the volume of lymphdid not; volume only diminished on treatment with somatostatin(fig). Protein loss remained high on TPN and fell whensomatostatin was given. After 6 days the dosage was reduced slowlyto avoid any rebound effect. Treatment with somatostatin lasted 12

days. TPN was continued for 20 days until tolerance for oralfeedings was complete and caloric intake was adequate.

- - Triglycerides -1 Protein

Serial monitoring of lymph losses and protein and triglycerideconcentrations (in g/I).

During treatment with TPN and somatostatin no significantclinical or laboratory abnormalities were noted, except for a mildrise in blood sugar without glycosuria. This was controlled byadding insulin to the parenteral solution and was, we think, due tothe TPN.The impressive fall in the volume of lymph lost, and in its protein

content, accords with the known effects of somatostatin and

suggests a further useful application of this agent.

Department of Clinical Nutrition and Diet,Hospital de la Princesa,28006 Madrid, Spain

JOSÉ I. ULÍBARRIYOLANDA SANZCONCEPCIÓN FUENTESANTONIO MANCHAMATILDE ARAMENDIASALUD SÁNCHEZ

1. Schusdziarra V, Harris V, et al. Evidence for a role of splanchnic SST in thehomeostasis of ingested nutrients. Endocrinology 1979; 104: 1705-08.

2. Nakabayashi H, et al. Effect of SST on the flow rate and triglyceride levels of thoracicduct lymph in normal and vagotomized dogs. Diabetes 1981; 30: 440-45.

3. Schusdziarra V. Role of somatostatin in nutrient regulation. Adv Exp Med Biol 1985;188: 425-45.

4. Schusdziarra V, Rouiller D, Unger RH. Oral administration of SST reducespostprandial plasma triglycerides, gastrin and gut glucagon-like-immunoreactivity. Life Sci 1979; 24: 1595-600.

Comparison of immunoscintigraphy andcolloid scintigraphy of bone marrow

SIR,-Scintigraphy of the bone marrow was introduced to detecthaematogenous metastases or malignant lymphomas affecting theskeletal system when they are still confmed to the marrow space andwhen bone scans and plain radiographs are usually normal.1-3 Wereport a comparison of two marrow-seeking radiopharmaceuticalsin bone-marrow scintigraphy.We used human serum albumin nanocolloid (NC), which is taken

up by reticuloendothelial marrow cells, and a murine monoclonal