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DEPRESSED MATERNAL LYMPHOCYTE RESPONSE TO PHYTOHÆMAGGLUTININ IN PREGNANCY
43 as well as respiratory taken into account. be physiology I agree with Dr. Sanerkin that any study in which the sputum cytology has not been considered must contain a mixture of chronic bronchitis and asthma. In my first trial of steroids in chronic asthma,4 it was the later introduction of sputum examination which revealed clearly that only the patients with excessive eosinophils responded to steroids, the others being patients with irreversible bronchitis. Sophisticated and expensive respiratory-function equipment can never do more than produce interesting data which, alone, cannot benefit the patient unless the pathological and astiological basis for the patient’s condition is also investigated and understood. Sputum cytology is a neglected but simple way of gaining very important knowledge of the cause of airway obstruction, since, in addition to examination for eosinophils, the cytology of bronchitis is quite characteristic. This procedure is rewarding and of definite diagnostic value, but only to those who trouble to examine the sputum personally, or who train a technician to follow the simple method4 which has already proven so useful over the years.
Dr.
Astin, because sputum cytology must
Derby Chest Clinic, Derwent Hospita and Derby Children’s Hospitals, H. MORROW BROWN. Derby.
is it
possible that the electric shock in membrane, aborting the rise in temperature, and could this be a possible mode of treatment to be tried in hyperpyrexia occurring during surgery ? susceptible patients, some
way stabilises the muscle
Department of Anesthesiology, Mount Sinai School of Medicine, New York, N.Y. 10029, U.S.A.
NORMAN SONNENKLAR LESLIE RENDELL-BAKER.
DEPRESSED MATERNAL LYMPHOCYTE RESPONSE TO PHYTOHÆMAGGLUTININ IN PREGNANCY
SiR,—The depressed in-vitro response of maternal lymphocytes to phytohsemagglutinin (P.H.A.) reported by Purtilo et al.1 has also been observed in our laboratory.2 We have also found suppression of the maternal-lymphocyte response in one-way mixed leucocyte cultures and vaccinia-stimulated cultures. Purtilo et al. found that a 10% concentration of plasma from pregnant women had RESULTS OF LYMPHOCYTE STIMULATION IN PLASMA FROM PREGNANT AND NON-PREGNANT WOMEN*
INTERPRETATION OF BIOCHEMICAL DATA IN PÆDIATRICS
SiR,-A recent incident has brought home forcibly to the plight of p2ediatricians in district general hospitals in the interpretation of biochemical data. In adults the problem is difficult enough because of the many methods in use for measuring the same constituent, but at least
me
biochemists have available sufficient adult " normal " material with which to define their own normal ranges should they think this necessary. But, given all the will in the world, this is not possible in paediatrics. So I would make a plea that the large pxdiatric units make much more freely available, possibly on a circulation basis, their methods and associated normal ranges for the different age-groups and for as many constituents of blood, urine, ,duodenal contents, &c., as possible. Your columns recently emphasised the dilemma faced by endocrinologists through the lack of resources for measuring circulating hormones. I feel that the dilemma faced by pxdiatricians in their bread-and-butter biochemistry is much more pressing. Department of Pathology, Airedale General Hospital, Keighley, Yorkshire, BD20 6TD.
C. SANDERSON.
HYPERPYREXIA DURING PREGNANCY SiR,—We read with great interest Dr. Crawford’s letter (June 3, p. 1244) asking whether anyone had seen a hyperpyrexial response to anxsthesia during pregnancy or for an -obstetric delivery. A muscle relaxant and halothane may well be used for an incidental anaesthetic during pregnancy. However, the use of a muscle relaxant and intubation, though highly ,desirable for safe forceps delivery, is probably the exception rather than the rule in the U.S.A. The numbers of patients thus exposed to this risk thus may be quite small. We are puzzled, however, by the fact that though succinylcholine has been used for many years in thousands - of patients for electric-shock therapy, we are unaware of any reports of malignant hyperpyrexia following its use for --this purpose. If, indeed, succinylcholine does cause muscle rigidity in
*
Means of triplicate cultures.
effect on the in-vitro P.H.A. response of lymphocytes from non-pregnant women. However, we have found that a 20% concentration of plasma from mothers at the time of birth was suppressive in vitro to cells from pregnant and non-pregnant women (see table). Furthermore, no significant difference in reactivity could be detected between maternal and normal control leucocytes when these cells were washed and cultured in 20% normal plasma and stimulated with X-irradiated allogeneic leucocytes, suboptimal (2 y per ml.) P.H.A., or vaccinia (0-1 ml. of 1 in 10 dilution of ’Dryvax ’, Wyeth). These results suggest that depressed lymphocyte responses in pregnancy are due to a plasma effect and not to an intrinsic cellular change. Since Kasakuru 3 has shown that there is more inhibition in lymphocyte reactivity in mixed leucocyte cultures as the proportion of pregnant plasma is increased, differences in concentration of plasma probably account for the divergent results in the experiments of Purtilo, Kasakuru, and myself. no
Children’s Hospital,
Washington, 1. 2. 3.
D.C.
SANFORD LEIKIN.
Purtilo, D., Hallgren, H., Yunis, E. Lancet, 1972, i, 769. Leikin, S. Proceedings of VI Leukocyte-culture Conference (edited by M. R. Schwarz); p. 725. New York, 1972. Kasakuru, S. ibid. p. 711.
Dr.
Astin, because sputum cytology must
Derby Chest Clinic, Derwent Hospita and Derby Children’s Hospitals, H. MORROW BROWN. Derby.
is it
possible that the electric shock in membrane, aborting the rise in temperature, and could this be a possible mode of treatment to be tried in hyperpyrexia occurring during surgery ? susceptible patients, some
way stabilises the muscle
Department of Anesthesiology, Mount Sinai School of Medicine, New York, N.Y. 10029, U.S.A.
NORMAN SONNENKLAR LESLIE RENDELL-BAKER.
DEPRESSED MATERNAL LYMPHOCYTE RESPONSE TO PHYTOHÆMAGGLUTININ IN PREGNANCY
SiR,—The depressed in-vitro response of maternal lymphocytes to phytohsemagglutinin (P.H.A.) reported by Purtilo et al.1 has also been observed in our laboratory.2 We have also found suppression of the maternal-lymphocyte response in one-way mixed leucocyte cultures and vaccinia-stimulated cultures. Purtilo et al. found that a 10% concentration of plasma from pregnant women had RESULTS OF LYMPHOCYTE STIMULATION IN PLASMA FROM PREGNANT AND NON-PREGNANT WOMEN*
INTERPRETATION OF BIOCHEMICAL DATA IN PÆDIATRICS
SiR,-A recent incident has brought home forcibly to the plight of p2ediatricians in district general hospitals in the interpretation of biochemical data. In adults the problem is difficult enough because of the many methods in use for measuring the same constituent, but at least
me
biochemists have available sufficient adult " normal " material with which to define their own normal ranges should they think this necessary. But, given all the will in the world, this is not possible in paediatrics. So I would make a plea that the large pxdiatric units make much more freely available, possibly on a circulation basis, their methods and associated normal ranges for the different age-groups and for as many constituents of blood, urine, ,duodenal contents, &c., as possible. Your columns recently emphasised the dilemma faced by endocrinologists through the lack of resources for measuring circulating hormones. I feel that the dilemma faced by pxdiatricians in their bread-and-butter biochemistry is much more pressing. Department of Pathology, Airedale General Hospital, Keighley, Yorkshire, BD20 6TD.
C. SANDERSON.
HYPERPYREXIA DURING PREGNANCY SiR,—We read with great interest Dr. Crawford’s letter (June 3, p. 1244) asking whether anyone had seen a hyperpyrexial response to anxsthesia during pregnancy or for an -obstetric delivery. A muscle relaxant and halothane may well be used for an incidental anaesthetic during pregnancy. However, the use of a muscle relaxant and intubation, though highly ,desirable for safe forceps delivery, is probably the exception rather than the rule in the U.S.A. The numbers of patients thus exposed to this risk thus may be quite small. We are puzzled, however, by the fact that though succinylcholine has been used for many years in thousands - of patients for electric-shock therapy, we are unaware of any reports of malignant hyperpyrexia following its use for --this purpose. If, indeed, succinylcholine does cause muscle rigidity in
*
Means of triplicate cultures.
effect on the in-vitro P.H.A. response of lymphocytes from non-pregnant women. However, we have found that a 20% concentration of plasma from mothers at the time of birth was suppressive in vitro to cells from pregnant and non-pregnant women (see table). Furthermore, no significant difference in reactivity could be detected between maternal and normal control leucocytes when these cells were washed and cultured in 20% normal plasma and stimulated with X-irradiated allogeneic leucocytes, suboptimal (2 y per ml.) P.H.A., or vaccinia (0-1 ml. of 1 in 10 dilution of ’Dryvax ’, Wyeth). These results suggest that depressed lymphocyte responses in pregnancy are due to a plasma effect and not to an intrinsic cellular change. Since Kasakuru 3 has shown that there is more inhibition in lymphocyte reactivity in mixed leucocyte cultures as the proportion of pregnant plasma is increased, differences in concentration of plasma probably account for the divergent results in the experiments of Purtilo, Kasakuru, and myself. no
Children’s Hospital,
Washington, 1. 2. 3.
D.C.
SANFORD LEIKIN.
Purtilo, D., Hallgren, H., Yunis, E. Lancet, 1972, i, 769. Leikin, S. Proceedings of VI Leukocyte-culture Conference (edited by M. R. Schwarz); p. 725. New York, 1972. Kasakuru, S. ibid. p. 711.