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BACTEROIDES AND BREAST ABSCESS
198
underlying duct abnormality, and the organism or of its antibiotic sensitivity
of the infective is of lesser importance. nature
University Department of Surgery, Welsh National School of Medicine, Heath
L. E. HUGHES
Park, Cardiff CF4 4XN
LEUCOCYTE-MIGRATION INHIBITION IN MINIMAL-CHANGE NEPHROPATHY
SIR,—Moorthy et al.’have described a blocking factor to blastogenesis in the plasma of patients with minimal-change nephropathy (M.C.N.). We have shown2that T lymphocytes from patients with M.C.N. are sensitised to renal antigens. Our studies using the leucocyte-migration inhibition test now cover 29 patients observed for at least two years. 21 of these patients had evidence of migration inhibition in the presence of renal antigens. In all these patients there is an apparently specific factor in the plasma which is found in the 7S fraction of a G200 ’Sephadex’ separation and which prevents this inhibition of leucocyte migration.4 This blocking factor is present in relapse and remission. During steroid therapy for relapse in 7 patients, migration inhibition was abolished temporarily. In 1 patient, who also received an extended course of cyclophosphamide, this aboliP.H.A.-induced
Fig. 2-Proportions of short children in groups whose appetite fair, or good. None had received corticosteroid therapy.
was
poor,
(fig. 1). Hunter and Clegg6 have shown that hypoxia will cause stunting of growth in rats. The same may be true of asthmatic children. Poor appetite (fig. 2) and small milk intake were also significantly associated with short stature (P<0.05). These findings accord with the well-known observations that restriction of food intake retards growth both of children7and of experimental rats.8 Another situation in which growth failure is associated with poor appetite is in children on hoemodialysis. Simmons et a1.9 found that growth failure in such children could be partially corrected by adding calorie-rich supplements to their diets. We were able to find no association between growth failure and low birth-weight, frequency of respiratory infections, or frequency of fevers. Our findings support the view that children with chronic asthma tend to be short, even if they have never received corticosteroids. It is particularly those whose asthma started early in life who appear to be at risk. Chronic hypoxia and chronic anorexia may be factors responsible for the poor growth. stature
The
project
was
supported
in part
Departments of Pædiatrics, Epidemiology, and
Pathology, University of British Columbia, Vancouver, British Columbia, Canada
by the
British Columbia Tuber-
ANDREW B. MURRAY BRENDA M. FRASER DAVID F. HARDWICK GORDON E. PIRIE
BACTEROIDES AND BREAST ABSCESS
SIR The paper by Mr Hale and his colleagues (July 10, p. 70) was of interest because we have also seen Bacteroides in breast abscesses, but have regarded them as opportunist invaders in abscesses secondary to duct ectasia, either the singleduct type (mamillary fistula) typically seen in young women or the multiple-duct form seen more commonly closer to the menopause. The cases reported showed features typical of such abscesses, especially in that drainage of two of the patients led to a persistent sinus necessitating corrective surgery. It would be of interest to know if the two younger women showed the central nipple retraction typical of this condition. There may be some overlap between primary abscesses due to Bacteroides and secondary involvement by Bacteroides of abscesses associated with duct ectasia, but in our experience the latter seems the significant sequence of events. If this is so, the cardinal aspect of treatment is appropriate surgery to the 6 Hunter, C., Clegg, E J. J Anat. 1973, 114, 201. 7 Howe, P. E., Schiller, M. J. appl. Physiol. 1952, 5, 51. 8. Jackson, C. M. Anat Rec 1937, 68, 371. 9. Simmons, J. M., Wilson, C. J., Potter, D. E., Holliday, Med. 1971, 285, 653.
M. A. New
Engl. J.
tion
seems
to
be permanent.
Full details of our findings will be presented to the European Dialysis and Transplantation Association and will appear in the 1976 E.D.T.A. Proceedings.
K. EYRES N. P. MALLICK G. TAYLOR
Department of Renal Medicine, Manchester Royal Infirmary, Manchester M13 9WL
IRON DEFICIENCY AND THE IMMUNE RESPONSE
SIR Srikantia et awl. implicate iron deficiency in the defective immune responses of leucocytes from anxmic children: "The present data clearly indicate an important role for iron nutritional status in the maintenance of normal immune responses". They claim this despite their observation that leucocytes from children with anaemia and normal plasma-transfernn saturation had worse scores than did leucocytes from children with iron-deficiency anaemia. 22% of the anxmic children seem not to have had iron deficiency, and those children had the worst scores of all groups. They discuss the possibility that malnourished children may have other deficiencies than iron-vitamin A, riboflavine, and pyridoxine, for example, nutrients which are known to affect immune responses. However, these vitamins were not measured, and iron deficiency was blamed. The matter of immune response in the malnourished, as it now stands, leads one to suspect that iron deficiency is an easily identified but innocent
bystander. The hypothesis that iron deficiency is an important factor in immune response might easily be challenged: correct the iron deficiency without changing anything else and then retest the leucocytes. Division of Hematology, Scripps Clinic and Research Foundation, La Jolla, California 92037, U.S.A.
1.
Moorthy,
A. V., Zimmerman, S. W.,
WILLIAM H. CROSBY
Burkholder,
P. M. Lancet, 1976, i,
1160. 2.
Mallick, N. P., Williams, R. J., McFarlane, H., Orr, W. McN., Taylor, G., Williams, G. ibid. 1972,i, 507. 3. Eyres, K., Mallick, N. P., Taylor, G. ibid. 1976, i, 1158. 4. Eyres, K., Mallick, N. P., Taylor, G. Paper read at a meeting of the Renal Association on May 20, 1976. 5 Srikantia, S. G., Prasad, J. S., Bhaskaram, C., Krishnamachari, K. A V. R. Lancet, 1976, i, 1307.
underlying duct abnormality, and the organism or of its antibiotic sensitivity
of the infective is of lesser importance. nature
University Department of Surgery, Welsh National School of Medicine, Heath
L. E. HUGHES
Park, Cardiff CF4 4XN
LEUCOCYTE-MIGRATION INHIBITION IN MINIMAL-CHANGE NEPHROPATHY
SIR,—Moorthy et al.’have described a blocking factor to blastogenesis in the plasma of patients with minimal-change nephropathy (M.C.N.). We have shown2that T lymphocytes from patients with M.C.N. are sensitised to renal antigens. Our studies using the leucocyte-migration inhibition test now cover 29 patients observed for at least two years. 21 of these patients had evidence of migration inhibition in the presence of renal antigens. In all these patients there is an apparently specific factor in the plasma which is found in the 7S fraction of a G200 ’Sephadex’ separation and which prevents this inhibition of leucocyte migration.4 This blocking factor is present in relapse and remission. During steroid therapy for relapse in 7 patients, migration inhibition was abolished temporarily. In 1 patient, who also received an extended course of cyclophosphamide, this aboliP.H.A.-induced
Fig. 2-Proportions of short children in groups whose appetite fair, or good. None had received corticosteroid therapy.
was
poor,
(fig. 1). Hunter and Clegg6 have shown that hypoxia will cause stunting of growth in rats. The same may be true of asthmatic children. Poor appetite (fig. 2) and small milk intake were also significantly associated with short stature (P<0.05). These findings accord with the well-known observations that restriction of food intake retards growth both of children7and of experimental rats.8 Another situation in which growth failure is associated with poor appetite is in children on hoemodialysis. Simmons et a1.9 found that growth failure in such children could be partially corrected by adding calorie-rich supplements to their diets. We were able to find no association between growth failure and low birth-weight, frequency of respiratory infections, or frequency of fevers. Our findings support the view that children with chronic asthma tend to be short, even if they have never received corticosteroids. It is particularly those whose asthma started early in life who appear to be at risk. Chronic hypoxia and chronic anorexia may be factors responsible for the poor growth. stature
The
project
was
supported
in part
Departments of Pædiatrics, Epidemiology, and
Pathology, University of British Columbia, Vancouver, British Columbia, Canada
by the
British Columbia Tuber-
ANDREW B. MURRAY BRENDA M. FRASER DAVID F. HARDWICK GORDON E. PIRIE
BACTEROIDES AND BREAST ABSCESS
SIR The paper by Mr Hale and his colleagues (July 10, p. 70) was of interest because we have also seen Bacteroides in breast abscesses, but have regarded them as opportunist invaders in abscesses secondary to duct ectasia, either the singleduct type (mamillary fistula) typically seen in young women or the multiple-duct form seen more commonly closer to the menopause. The cases reported showed features typical of such abscesses, especially in that drainage of two of the patients led to a persistent sinus necessitating corrective surgery. It would be of interest to know if the two younger women showed the central nipple retraction typical of this condition. There may be some overlap between primary abscesses due to Bacteroides and secondary involvement by Bacteroides of abscesses associated with duct ectasia, but in our experience the latter seems the significant sequence of events. If this is so, the cardinal aspect of treatment is appropriate surgery to the 6 Hunter, C., Clegg, E J. J Anat. 1973, 114, 201. 7 Howe, P. E., Schiller, M. J. appl. Physiol. 1952, 5, 51. 8. Jackson, C. M. Anat Rec 1937, 68, 371. 9. Simmons, J. M., Wilson, C. J., Potter, D. E., Holliday, Med. 1971, 285, 653.
M. A. New
Engl. J.
tion
seems
to
be permanent.
Full details of our findings will be presented to the European Dialysis and Transplantation Association and will appear in the 1976 E.D.T.A. Proceedings.
K. EYRES N. P. MALLICK G. TAYLOR
Department of Renal Medicine, Manchester Royal Infirmary, Manchester M13 9WL
IRON DEFICIENCY AND THE IMMUNE RESPONSE
SIR Srikantia et awl. implicate iron deficiency in the defective immune responses of leucocytes from anxmic children: "The present data clearly indicate an important role for iron nutritional status in the maintenance of normal immune responses". They claim this despite their observation that leucocytes from children with anaemia and normal plasma-transfernn saturation had worse scores than did leucocytes from children with iron-deficiency anaemia. 22% of the anxmic children seem not to have had iron deficiency, and those children had the worst scores of all groups. They discuss the possibility that malnourished children may have other deficiencies than iron-vitamin A, riboflavine, and pyridoxine, for example, nutrients which are known to affect immune responses. However, these vitamins were not measured, and iron deficiency was blamed. The matter of immune response in the malnourished, as it now stands, leads one to suspect that iron deficiency is an easily identified but innocent
bystander. The hypothesis that iron deficiency is an important factor in immune response might easily be challenged: correct the iron deficiency without changing anything else and then retest the leucocytes. Division of Hematology, Scripps Clinic and Research Foundation, La Jolla, California 92037, U.S.A.
1.
Moorthy,
A. V., Zimmerman, S. W.,
WILLIAM H. CROSBY
Burkholder,
P. M. Lancet, 1976, i,
1160. 2.
Mallick, N. P., Williams, R. J., McFarlane, H., Orr, W. McN., Taylor, G., Williams, G. ibid. 1972,i, 507. 3. Eyres, K., Mallick, N. P., Taylor, G. ibid. 1976, i, 1158. 4. Eyres, K., Mallick, N. P., Taylor, G. Paper read at a meeting of the Renal Association on May 20, 1976. 5 Srikantia, S. G., Prasad, J. S., Bhaskaram, C., Krishnamachari, K. A V. R. Lancet, 1976, i, 1307.