FALSE TRANSMITTERS AND MIGRAINE

333 These methods seem to reduce the incidence of infection after a micturating cystogram to a much more acceptable level. This is important because a micturating cystogram can give so much valuable information that may not be obtained by intravenous pyelography or cystoscopy. Pædiatric Department,

Ipswich Hospital, Ipswich IP4 5PD

GILLIAN CRUICKSHANK

WE CAUGHT IT ... SMILING!

3 women in the first trimester of pregnancy (1 with a slightly increased immune-complex value). Our immune-complex values were only slightly increased over those for non-pregnant women, and cannot be compared with those we usually find in typical immune-complex diseases such as glomerulonephritis and systemic lupus erythematosus. This is not surprising since pregnancy is a physiological phenomenon. Our results obtained for pre-eclampsia accord with those found by Stirrat et al., there being a high frequency of circulating immune-complexes in these cases. Further studies are necessary to clarify the nature of the heterogeneous immune complexes to explain why different results are had with different techniques. F. P. SCHENA C. MANNO L. SELVAGGI G. LOVERRO A. PASTORE S. BETTOCCHI L. BONOMO

SIR,-While examining a culture of human embryonic lung cells inoculated with a urine specimen containing cytomegalovirus, we noticed a most unusual cell. 2nd Medical Clinic and 1st Obstetric Clinic, University of Bari Polyclinic, 70124 Bari, Italy

FALSE TRANSMITTERS AND MIGRAINE

We include this

picture

to

brighten

your

day,

as

it did

ours.

JAYNEANN WOLFE

Diagnostic Virology Laboratory, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, U.S.A.

NANCY TUSTIN SUSAN GARRET OLGA MAKSYMIUK ANITA MAIATICO CHRIS FORRER HARVEY FRIEDMAN

IMMUNE COMPLEXES IN NORMAL PREGNANCY AND IN PRE-ECLAMPSIA serum levels of circulating immune complexes found in normal pregnancy by Masson et al.;’ Stirrat et al.,2 confirming these results, also noted that levels were even higher during pre-eclampsia. Gleicher et al. and Knox et awl.,’* report that immune complexes are absent during both normal pregnancy and pre-eclampsia. We studied circulating immune complexes (’1-Clq binding test) in 319 normal pregnancies of which 75 were in the first, 115 in the second, and 129 in the third trimester; in 20 women in the puerperium; and in 21 pre-eclamptic pregnancies. Our findings were presented to the 10th international meeting on EPH-Gestosis, in Cairo, on Dec. 2-4, 1978. The frequency of positive cases in normal pregnancy was 27% for the first trimester, 8.7% for the second, and 11% for the third trimester, and 15% for puerperium (=13-9, p<0.05). The frequency was much higher (72%) in pre-eclampsia than in the third trimester of normal pregnancy (=42-5, P<0.0001). Unlike Masson, Stirrat, and their colleagues, we found a low frequency of high immune-complex serum levels in normal pregnant women, except for the first trimester. The negative results of Gleicher et al. could be explained by the fact that they studied a smaller number of cases, which included only

SIR,-High

were

1 2

Masson, P. L., Delire, M., Cambiaso, C. L. Nature, 1977, 266, 542. Stirrat, G. M., Redman, C. W. G., Levinsky, R. J. Br. med. J., 1978, i, 1450. 3 Gleicher, N., Theofilopoulos, A. N., Beers, P Lancet, 1978, ii, 1108. 4. Knox, G. E., Stagno, S., Volanakis, J. E., Huddleston, J. F. Am. J. Obstet.

Gynec. 1978, 132, 87.

SIR,-The hypothesis columns of The Lancet have included several theories to explain the pathogenesis of the migraine headache.’-3 One persistent fact not readily explained is the time delay in onset of the headache following tyramine in migraine patients susceptible to tyramine-containing foods. There have been two metabolic defects proposed in such people -namely, defective sulphate conjugation of tyramine4 or defective metabolism by oxidative deamination by monoamine oxidase.5

’

However, the consequence of such defects does

not appear have been considered. An important metabolic pathway for tyramine has been readily demonstrated in animals and involves -carbon oxidation by dopamine-&bgr;-hydroxylase to the false neurotransmitter, octopamine.6 Metabolism by this route is increased when other pathways are impaired-especially that involving deamination.7 Octopamine has a much longer tissue half-life than the parent amine tyramine because of binding within neuronal storage granules, and results in significant depletion of tissue catecholamines and a reduction in their biosynthesis. These pharmacological effects resemble those of the amine-depleting agent reserpine, which is widely reported to precipitate migraine headaches. In-vivo metabolism is poorly reflected by urine analysis for metabolites, and the importance of minor routes of biotransformation which produce metabolites with long tissue halflives may be easily overlooked (e.g., the conversion of a-methylto

dopa to
could

account

for the time

delay in the onset of headache after

tyramine ingestion. Medical Unit, St. Mary’s Hospital, London W2 1NY

PETER S. SEVER

1. Sandler, M. Lancet, 1972, i, 618. 2. Hanington, E. ibid. 1978, ii, 501. 3. Blau, J. N. ibid. 1978, ii, 1136. 4. Smith, I., Kellow, A. H., Mullen, P. E., Hanington, E. Nature, 1971, 230, 246. 5. Sandler, M., Youdim, M. B. H., Hanington, E. ibid. 1974, 250, 335. 6. Musacchio, J. M., Kopin, I. J., Weise, V. K. J. Pharmac. exp. Ther. 1965,

148, 22. 7.

Kopin, I. J. Ann. Rev. Pharmac. 1968, 8, 377.