DETECTION OF LEUCOCYTES IN PERITONEAL EFFLUENT BY TEST STRIP

437 had to be abandoned in all patients within 72 h because of severe pain, nausea, and vomiting. These experiments were discontinued, as were other attempts with cholic acid. Following the report of Thistle and colleagues 10 we started using mono-octanoin again in 1980, at a slower rate of 3 ml/h via pernasal biliary catheters. the treatment was dramatically successful in one woman with a stone measuring 30 x 45 mm (fig. 1). A pernasal catheter was placed at the time of endoscopic sphincterotomy, and mono-octanoin was infused for 15 days; it was stopped for 24 h during an episode of cholangitis. The stone progressively fragmented, and a check endoscopic retrograde cholangiopancreatogram at 2 months showed the duct to be entirely clear (fig. 2). Unfortunately, there was no benefit in two other patients managed in a similar fashion. One had repeated attacks of pain (despite use of the exchange technique suggested by Thistle et al. 10) and needed surgery. There was no evidence for stone dissolution in the third patient for whom treatment was continued for 21 days. Other groups have had some success using biliary perfusion with mono-octanoin via the pernasal route, 11- 13 and it may be that greater experience will be more encouraging. Certainly, the availability of effective stone solvents should considerably alter the management of choledocholithiasis, and not only postoperatively. Gastrointestinal Unit and Department of Middlesex Hospital, London WlN8AA

Radiology,

PETER B. COTTON ALAN G. VALLON RICHARD MASON

ANTIBODY TO AG-4 AND SURVIVAL OF CARCINOMA OF CERVIX PATIENTS

SIR,-Several groups have found complement-fixing antibodies to a herpes simplex virus type-2 early antigen, (the AG-4 antigen) in 1-5

from cervical carcinoma patients. Of particular interest is the Heise et al. who attempted to correlate the AG-4 antibody response with tumour progression. They found that some patients who were initially seronegative for AG-4 antibody became seropositive after radiation and/or surgical treatment for the tumour. AG-4 antibody has been reported to be equally prevalent in treated patients. 2,4,5 The comment by Heise et al. that seropositivity to AG-4 may have a favourable prognostic significance was most interesting. Only 3 of the 26 seropositive patients died with the disease and 1 other was alive with the disease; in contrast, 3 of the 8 seronegative patients died with the disease and 2 others were alive with the disease. The difference in the progression-free rate between these two groups was significant. We have been investigating the AG-4 antibody response in cervical carcinoma patients over a two-year period, and we have found AG-4 antibody in 75% of untreated cervical carcinoma patients and in 65% of treated patients.Over this period4 out of 12 patients who were repeatedly seronegative for AG-4 antibody died with the disease, whereas all of the seropositive patients we tested are still alive. Furthermore we tested sera (taken one to seven months before

FREQUENCY OF AG-4 ANTIBODY IN DECEASED

AND SURVIVING

CER-

VICAL CARCINOMA PATIENTS

* All

were

patients

in the

Melbourne. t Determined

public by 2

wards of the

Royal

Women’s

Hospital,

death) from 21 patients who died with cervical cancer (most of whom had received some form of treatment) in a retrospective study and we found only 6 (29%) to be seropositive for AG-4, whereas in an age-matched group of 42 women surviving after treatment for cervical cancer (three months to fifteen years) 28 (67%) were AG-4 seropositive.5 There was no significant difference between the age matched controls and the patients who died of cervical carcinoma. Thus our results support the suggestion by Heise et al. that AG-4 seropositivity may correlate with a favourable outcome in cervical carcinoma patients. Department of Microbiology, La Trobe University, Bundoora, Victoria 3083, Australia

J. T. MAY

Department of Pathology, Royal Women’s Hospital, Carlton, Victoria

M. N. CAUCHI

M. ARSENAKIS

sera

study of

10. Thistle JL, Carlson GL, Hoffman AF. Mono-octanoin a dissolution agent for retained cholesterol bile duct stones: Physical properties and clinical application. Gastroenterology 1980; 78: 1016-22. 11. Witzel L, Wiederholt J, Wolberg E. Dissolution of gallstones by perfusion with Capmul via a catheter introduced endoscopically into the bile duct. N Engl J Med 1980; 303: 465. 12. Wurbs D, Phillip J, Classen M. Experiences with the longstanding nasobiliary tube in biliary diseases. Endoscopy 1980; 12: 219-23. 13. Schenk J, Schmak B, Riemann JF, Rosch W. Treatment of choledocholithiasis using the transpapillary perfusion technique. Endoscopy 1980; 12: 224-27. 1 Aurehan L, Schumann B, Marcus RL, Davis HJ. Antibody to HSV-2 induced tumor specific antigens in serums from patients with cervical carcinoma. Science 1973; 181: 161-64. 2 Notter MFD, Docherty JJ. Comparative diagnostic aspects of herpes simplex virus tumour-associated antigens. JNat cancer Inst 1976; 57: 483-88. 3. Kawana T, Sakamoto S, Kasamatsu T, Aurelian L. Frequency of anti-AG-4-antibody in patients with uterine cervical cancer and controls. Gann 1978; 69: 589-91. 4. Heise ER, Kucera LS, Raben M, Homesley H. Serological response patterns to herpes virus type 2 early and late antigens in cervical carcinoma patients. Cancer Res 1979; 39: 4022-26. 5. Arsenakis M, Georglou GM, Welsh JK, Cauchi MN, May JT. AG-4 complementfixing antibodies in cervical cancer and herpes-infected patients using local herpes simplex virus type 2. Int J Cancer 1980; 25: 67-71.

DETECTION OF LEUCOCYTES IN PERITONEAL EFFLUENT BY TEST STRIP

SIR,-The major complication of continuous ambulatory peri-

dialysis (CAPD) is peritonitis. Dr Zaruba and Dr Oliveri (Dec. 6, p. 1226) have described a tube method for early detection of peritoneal infection and Chan and Oliverl have adapted a test strip system for detecting leukocytosis in peritoneal effluent. We can confirm the value of this test strip system. Patients who were on CAPD or having CAPD training were enrolled in the three month period May to July, 1980. Samples of peritoneal effluent were obtained during hospital training or when patients returned to hospital for a tubing change or with signs of peritonitis (fever, abdominal pain, or cloudy drainage). White blood cells were counted.2 ’Chemstrip- L’ (Boehringer Mannheim) detects leucocytes containing esterases by a colour reaction in which the esterases liberate indoxyl from an indoxyl substrate; the unstable indoxyl is oxidised to indigo blue. We defined test strips as negative if there was no reaction or if there was only a faint blue colour. The toneal

read at 5, 10, and 15 min, and the 15 min reading was recorded. However, with high counts (>1500/1) the final colour is often present well before 15 min. For analysis we used the monocyte plus polymorphonuclear leucocyte count since eosinophils and lymphocytes do not cause a colour change. Information was complete for 254 samples. Counts in twenty-six patients without peritonitis were used to define the upper limit of normal (mean + 2SD = 33 +164 = 197/jnl). With this cut-off point the test strip was positive in only 10 samples out of the 230 from patients without peritonitis. In the nine patients with peritonitis all 24 samples were test strip positive and white cell count was 1346:Ll252/pl. The predictive value of a negative test strip reaction was thus very high (100%) though false negatives may occur when a high percentage of the cells are eosinophils. The predictive value of a positive result (24/34 or 71%) was not so impressive, and we have not found the strips to be as sensitive to low numbers of leucocytes test was

LK, Oliver DO. Simple method for early detection of peritonitis in patients on continuous ambulatory peritoneal dialysis. Lancet 1979; ii: 1336-37. 2. Hurley RM, Muogbo D, Wilson GW, Ah MAM. Cellular composition of peritoneal effluent: Response to bacterial peritonitis. Can Med Assoc J 1977; 117: 1061-62 1. Chan

438 as others have. We consider this simple inexpensive test to be useful for the diagnosis of peritoneal effluent leukocytosis. Its use by CAPD patients at home as an early indicator of peritonitis ’

requires more study. We thank Boehringer Mannheim Canada for supplying the test strips, the Kidney Foundation of Canada for student fellowship support of D. W. W., and the nurses of the peritoneal dialysis unit for the sample collection.

Departments of Pediatrics and Hematology and Nephrology Program, St. Joseph’s Hospital and McMaster University,

Hamilton, Ontario, Canada

R. MORRISON HURLEY DEAN W. WRIGHT GERALD W. WILSON MAHMOUD A. M. ALI

ETHYLENE, AN OVULATORY HORMONE? SIR,-Ethylene, a gaseous plant hormone, is exhaled by man but its role in mammalian physiology remains uncertain. I have detected a significant increase of ethylene in the breath of females at the time of ovulation. Ethylene was measured in the breath of fifteen normal subjects who were non-smokers and had not received any medication. They included five males aged 26-42, five non-pregnant females aged 22-34, and five pregnant females aged 22-26. Each subject exhaled 100 litres of air into a neoprene bag on awakening after an overnight fast of approximately lOh. Sublingual temperature was recorded before the collection. Studies were done once a week on pregnant women before delivery and daily thereafter for a week. They were done daily on other subjects for 3 months. The extraction procedure I was similar to that of Ram Chandra and Spencer. Normal females exhaled fairly consistent amounts of ethylene daily (table) and in all of them the output increased significantly (t = 5 - 09, p<0 00 1) at about the time of ovulation. This increase followed a midcycle rise in basal body temperature and always exceeded the mean volume plus three standard deviations. It recurred in each women for three consecutive cycles, and on every occasion ethylene output returned to basal levels within 24 h. Two women experienced midcycle pain (Mittelschmerz); their maximum ethylene oxide excretion occurred within 12 h of this event and menstruation was recorded 14 days later. Pregnant females and males did not show this pattern. Consistent amounts of ethylene were excreted throughout the study and occasional surges never exceeded the mean basal volume plus two standard deviations. There was no significant difference in the basal outputs of each group (table). Several women not included in this study received oral contraceptives and had an excretory pattern similar to that in males; presumably, ovulation had been suppressed. Ripening fruits excrete large amounts of ethylene and, in botanical terms, the gas participates in the maturation of ovarian components. It is conceivable that the human ovum may require ethylene for the ripening process at the time of ovulation. The surge in output of ethylene could not be accurately timed but it coincided with the midcycle rise in basal body temperature. Luteinising hormone shows a significant rise in production at this stage and together with follicle stimulating hormone (FSH) is important in the ripening of the ovum. Ethylene may participate in human physiology rather than be produced solely as a byproduct of metabolism. Department of Paediatrics and Child Health, University of Cape Town, Medical School, Observatory 7925, South Africa

V. C. HARRISON

1. Ram Chandra G, Spencer M. A micro-apparatus for absorption ofethylene and its use in determination of ethylene in exhaled gases from human subjects. Biochim Biophys Acta 1963, 69: 423-25. ETHYLENE OUTPUT

(PARTS/ 106)

ORGANIC SOLVENTS AND T LYMPHOCYTES

SIR,-Current laboratory methods for evaluating the effects of

organic solvents on the health of industrial workers permit the diagnosis of occupational disease rather than the early results of ex. posure. Neoplasms of the lymphoreticular system are more frequent than expected in populations exposed to benzene.I Since, in antitumour immunity, T lymphocytes play a key role we decided to in vestigate the effect of solvents containing benzene and its homo. logues on T lymphocytes. In 106 healthy workers (47 women and 59 men) working fromtwoto 122 months in contact with solvents for paints and varnishes T lymphocytes were counted in the peripheral blood by the Ea test (early rosettes) and the EI8h test (late rosettes) using W.H.O. methods. Chemical and toxicological examinations of the air at the work places showed that in years 1968-78 benzene, toluene and xylene concentrations ranged from zero up to 370,580, and 506 met, respectively. Urinary concentrations of phenol and hippuric acid confirmed absorption of benzene and toluene.2 T LYMPHOCYTE COUNTS PERIPHERAL. BLOOD IN WORKERS OCCUPATIONAL ORGANIC SOLVENTS

The results indicate that T lymphocyte counts are diminished only-workers with long exposure to solvents. The coefficient of partial correlation between the T lymphocyte count and exposure time with regard to age was - 0 - 293 (p<0 - 01) for Ea rosettes and for E 18h rosettes r was - 0 -344 (p<0 - 0001). There was no correlation between the T cell count and age. Numbers of B and null lym-

phocytes were not altered. Provincial Immunological 32-800 Brzesko, Poland

Laboratory,

PAULIN MOSZCZYNSKI

EYES RIGHT

SIR,-I was surprised by the spelling of some latinized names of Legionella species in Dr Ackley’s letter (Jan. 24, p. 221). Surely in forming such names of modern people the quoted genitive singular case-endings are not correct when derived from a male person called Bozemann or Gorman. The correct spelling should be bozemannior gormani. Dumoffii would be right if the name of the man thus honoured is Dumoffi, but if Dumoff then dumoffi would be right (dumoffae if the new species is dedicated to a woman). These simple rules of Latin declension have been frequently violated in the past, particularly by medical entomologists whose records are cluttered up by mis-spelled Anopheles rossii (after Ross), A. austenii (after Austen) orA. bancroftii (after Bancroft). These jarring names cannot be easily amended if they were published before 1958, when the International Code of Zoological Nomenclature (1961) was adopted by the XVth International Congress of Zoology in London and came into force. One would hope that bacteriologists would follow these eminently rational and grammatical principles of scientific nomenclature. Wellcome Museum of Medical Science, Wellcome Building,

London NW1 2BP

1. Vianna

*The average

parts/106.

reading for figures exceeding mean±SD (see text)

was

0 48-0

L. J. BRUCE-CHWATT

NJ, Polan A. Lymphomas and occupational benzene exposure Lancet 1979, i: 1394-95. 2 Moszczynski P. Cytoenzymatic studies on neutrophils in workers having contact with organic solvents containing benzene, toluene and xylene. Folio Haematol 1980, 107: 747-56.