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IMMUNOGLOBULINS IN VIRAL HEPATITIS
1188 and showing the potential reduction of L.A.T.S. by prednisone, has given further support to this hypothesis. One might further speculate whether some of the symptoms (e.g., irritability and hypercalcsmia) which develop after withdrawal of long-term steroid therapy might not represent " an element of rebound " or relative hyperthyroidism. Department of Medical Education, Lakewood Hospital, Lakewood 7, Ohio.
NEONATAL
JAUNDICE IN DOWN’S SYNDROME SIR,-The experience of Dr. Panizon (Sept. 4) regarding the frequency and intensity of neonatal jaundice in infants with Down’s syndrome is similar to other experience in Melbourne. In most of these infants bacterial infection, high intestinal obstruction, or " neonatal hepatitis " has been found. The frequency of Down’s syndrome among infants with hepatitis " within the newborn period and in the succeeding few months has been particularly striking. Of 17 infants with biopsy-proven neonatal hepatitis studied recently, 2 had Down’s syndrome-as did 2 of 5 infants with " hepatitis " occurring in the second and third months of life. An agent believed to be hepatitis virus1 was grown from both of these latter two infants, and from a nursing sister who cared for them in a maternity hospital and who developed clinical hepatitis 3-4 weeks before they became ill. Because transfer of hepatitis virus from mother to foetus may be commonit seems possible that the undue proneness of infants with Down’s syndrome to develop clinical illness, rather than symptomless infection, may explain some of the cases of neonatal hepatitis. "
LEE SATALINE.
"
SERUM-ALBUMIN IN DIABETICS
SIR,-Dr. Ismail and his colleagues (Oct. 23) conclude that capillaries of diabetics are less permeable to albumin than are those of normal subjects. They have taken the disappearance-rate of radio-iodinated serum-albumin (R.I.S.A.) from the circulation as a measure of capillary permeability. But in order to do so an undenatured preparation of R.I.S.A. must be used; denatured albumin will be rapidly removed from the circulation, and its rate of disappearance will therefore reflect other factors than the capillary permeability. Dr. Ismail and his colleagues used a commercial preparation of R...S.A. which is known to be metabolically denatured. The great reduction of intravascular acti ;ity in the normal subjects during the period of investigation emphasises this point. In Copenhagen we have investigated the same problems as have Dr. Ismail and his colleagues. Using R.I.S.A. which by no test showed any sign of denaturation, we found no differences between the disappearance-rates in 17 normal subjects and 7 diabetics. The mean reduction of the specific activity of albumin in plasma during the first 31/2 hours was 14-0% (S.D. 4-4) in the normal subjects and 14.3% (s.D. 2-2) in the the
diabetics. Thus it is doubtful whether the results of Dr. Ismail and his colleagues can be accepted as evidence of reduced capillary permeability in diabetics. Department of Clinical Physiology, Glostrup Hospital, Copenhagen.
NIELS ROSSING.
IMMUNOGLOBULINS IN VIRAL HEPATITIS
SIR,-It is unfortunate that the World Health Organisation meeting on nomenclature of immunoglobulins approved two different nomenclatures for the three immunoglobulins.1 Dr. Lee (Nov. 20) chooses to use Yc, YM, and YA. There are two objections to these names. Firstly, the immunoglobulins have a wide range of electrophoretic mobilities. They are not confined to the y-globulin region on free electrophoresis in alkaline buffers, but extend to the p and the 1X2 areas. Secondly, the W.H.O. meeting named the polypeptide chains of the three immunoglobulins: y, , and K. Confusion may arise because Y is used to describe both the whole group and the heavy chain of " YG ". The alternative names are IgG, IgM, and IgA. Ig is an abbreviation of immunoglobulin. May I recommend this
unambiguous nomenclature ? Department of Chemical Pathology, University of Leeds.
R. B. PAYNE.
EPIDEMIOLOGY OF HEPATITIS
SIR,-In your leading article (Oct. 23) you mention bizarre of parenteral dissemination of serum hepatitis. To my knowledge, insufficient attention has been paid to dissemination of the disease through barbers. Hospital barbers especially can be seen shaving patients with infective hepatitis, and using a disinfectant solution which certainly does not sterilise the razor before they pass to the next patient. Quite a number of people are probably being infected with hepatitis in this way daily all over the world-a situation which surely could be remedied. routes
Tel-Aviv,
.,-
M. KOFFLER.
Israel. 1. Bull. Wld Hlth
Org. 1964, 30,
447.
Royal Children’s Hospital, Parkville, N.2, Victoria.
"
DAVID M. DANKS.
13-15 TRISOMY IN ARRHINENCEPHALY SIR,-As noted by Dr. Becker (Oct. 30), when arrhinencephaly (holotelencephaly) is associated with 13-15 trisomy, extracranial malformations tend to accompany the faciocerebral abnormalities. It should be noted, however, that several exceptions have been described, for arrhinencephaly associated with extracranial malformations has been reported with normal karyotype,34 and arrhinencephaly with 13-15 trisomy has been found in the absence of the usually coexisting cardiac and digital anomalies.5 Seven of the ten cases of arrhinencephaly that we reported (Oct. 9) presented extracranial malformations, and we described a technique which gave evidence for 13-15 trisomy in eight. The results therefore appear to give added support to the association stated above, especially when the exceptions are considered. Warren Anatomical Museum, Harvard Medical School and Kennedy Laboratories, Massachusetts General Hospital, Boston, U.S.A.
B. A. KAKULAS N. P. ROSMAN.
TYROSINE IN FIBROCYSTIC DISEASE SIR, The aminoacid tyrosine is catabolised in the liver, and normally only small amounts of the intermediate compounds formed in this process escape oxidation to be excreted in the urine.6One of us (R. R.), however, has observed that children with fibrocystic disease of the pancreas excrete in their urine excessive amounts of p-hydroxyphenylpyruvic acid, an intermediate product in tyrosine degradation. A possible explanation of this finding is that in these children there may be a partial block at some point in the catabolic process. If this were true, not only would the intermediate products be expected to accumulate but so too would tyrosine itself. To test this hypothesis we have estimated the serumtyrosine values of 12 children with fibrocystic disease of the pancreas. The values found ranged from 0-8 to 3-75 mg. per 100 ml. 10 of the 12 patients had values above the normal range of 0-7-2-2 mg. per 100 mJ.7 The patients with normal values had been undergoing treatment for some years; they had normal stools and were well grown for their age. But this was also true of patients who had raised values. Cole, R., Danks, D. M., Campbell, P. E. Lancet, 1965, i, 1368. Danks, D. M. Clin. Pediat., Philad. 1965, 4, 499. 3. Landau, J. W., Barry, J. M., Koch, R. J. Pediat. 1963, 62, 895. 4. Marshall, R., Newnham, R. E., Rawstron, J. R., Ellis, J. R., Stevens, L. J. Lancet, 1964, i, 556. 5. Smith, D. W., Patau, K., Therman, E., Inborn, S. L., DeMars, R. I. J. Pediat. 1963, 62, 326. 6. Robinson, R., Smith, P. Nature, Lond. 1961, 189, 323. 7. Krebs, H. A. A. Rev. Biochem. 1950, 19, 409. 1. 2.
NEONATAL
JAUNDICE IN DOWN’S SYNDROME SIR,-The experience of Dr. Panizon (Sept. 4) regarding the frequency and intensity of neonatal jaundice in infants with Down’s syndrome is similar to other experience in Melbourne. In most of these infants bacterial infection, high intestinal obstruction, or " neonatal hepatitis " has been found. The frequency of Down’s syndrome among infants with hepatitis " within the newborn period and in the succeeding few months has been particularly striking. Of 17 infants with biopsy-proven neonatal hepatitis studied recently, 2 had Down’s syndrome-as did 2 of 5 infants with " hepatitis " occurring in the second and third months of life. An agent believed to be hepatitis virus1 was grown from both of these latter two infants, and from a nursing sister who cared for them in a maternity hospital and who developed clinical hepatitis 3-4 weeks before they became ill. Because transfer of hepatitis virus from mother to foetus may be commonit seems possible that the undue proneness of infants with Down’s syndrome to develop clinical illness, rather than symptomless infection, may explain some of the cases of neonatal hepatitis. "
LEE SATALINE.
"
SERUM-ALBUMIN IN DIABETICS
SIR,-Dr. Ismail and his colleagues (Oct. 23) conclude that capillaries of diabetics are less permeable to albumin than are those of normal subjects. They have taken the disappearance-rate of radio-iodinated serum-albumin (R.I.S.A.) from the circulation as a measure of capillary permeability. But in order to do so an undenatured preparation of R.I.S.A. must be used; denatured albumin will be rapidly removed from the circulation, and its rate of disappearance will therefore reflect other factors than the capillary permeability. Dr. Ismail and his colleagues used a commercial preparation of R...S.A. which is known to be metabolically denatured. The great reduction of intravascular acti ;ity in the normal subjects during the period of investigation emphasises this point. In Copenhagen we have investigated the same problems as have Dr. Ismail and his colleagues. Using R.I.S.A. which by no test showed any sign of denaturation, we found no differences between the disappearance-rates in 17 normal subjects and 7 diabetics. The mean reduction of the specific activity of albumin in plasma during the first 31/2 hours was 14-0% (S.D. 4-4) in the normal subjects and 14.3% (s.D. 2-2) in the the
diabetics. Thus it is doubtful whether the results of Dr. Ismail and his colleagues can be accepted as evidence of reduced capillary permeability in diabetics. Department of Clinical Physiology, Glostrup Hospital, Copenhagen.
NIELS ROSSING.
IMMUNOGLOBULINS IN VIRAL HEPATITIS
SIR,-It is unfortunate that the World Health Organisation meeting on nomenclature of immunoglobulins approved two different nomenclatures for the three immunoglobulins.1 Dr. Lee (Nov. 20) chooses to use Yc, YM, and YA. There are two objections to these names. Firstly, the immunoglobulins have a wide range of electrophoretic mobilities. They are not confined to the y-globulin region on free electrophoresis in alkaline buffers, but extend to the p and the 1X2 areas. Secondly, the W.H.O. meeting named the polypeptide chains of the three immunoglobulins: y, , and K. Confusion may arise because Y is used to describe both the whole group and the heavy chain of " YG ". The alternative names are IgG, IgM, and IgA. Ig is an abbreviation of immunoglobulin. May I recommend this
unambiguous nomenclature ? Department of Chemical Pathology, University of Leeds.
R. B. PAYNE.
EPIDEMIOLOGY OF HEPATITIS
SIR,-In your leading article (Oct. 23) you mention bizarre of parenteral dissemination of serum hepatitis. To my knowledge, insufficient attention has been paid to dissemination of the disease through barbers. Hospital barbers especially can be seen shaving patients with infective hepatitis, and using a disinfectant solution which certainly does not sterilise the razor before they pass to the next patient. Quite a number of people are probably being infected with hepatitis in this way daily all over the world-a situation which surely could be remedied. routes
Tel-Aviv,
.,-
M. KOFFLER.
Israel. 1. Bull. Wld Hlth
Org. 1964, 30,
447.
Royal Children’s Hospital, Parkville, N.2, Victoria.
"
DAVID M. DANKS.
13-15 TRISOMY IN ARRHINENCEPHALY SIR,-As noted by Dr. Becker (Oct. 30), when arrhinencephaly (holotelencephaly) is associated with 13-15 trisomy, extracranial malformations tend to accompany the faciocerebral abnormalities. It should be noted, however, that several exceptions have been described, for arrhinencephaly associated with extracranial malformations has been reported with normal karyotype,34 and arrhinencephaly with 13-15 trisomy has been found in the absence of the usually coexisting cardiac and digital anomalies.5 Seven of the ten cases of arrhinencephaly that we reported (Oct. 9) presented extracranial malformations, and we described a technique which gave evidence for 13-15 trisomy in eight. The results therefore appear to give added support to the association stated above, especially when the exceptions are considered. Warren Anatomical Museum, Harvard Medical School and Kennedy Laboratories, Massachusetts General Hospital, Boston, U.S.A.
B. A. KAKULAS N. P. ROSMAN.
TYROSINE IN FIBROCYSTIC DISEASE SIR, The aminoacid tyrosine is catabolised in the liver, and normally only small amounts of the intermediate compounds formed in this process escape oxidation to be excreted in the urine.6One of us (R. R.), however, has observed that children with fibrocystic disease of the pancreas excrete in their urine excessive amounts of p-hydroxyphenylpyruvic acid, an intermediate product in tyrosine degradation. A possible explanation of this finding is that in these children there may be a partial block at some point in the catabolic process. If this were true, not only would the intermediate products be expected to accumulate but so too would tyrosine itself. To test this hypothesis we have estimated the serumtyrosine values of 12 children with fibrocystic disease of the pancreas. The values found ranged from 0-8 to 3-75 mg. per 100 ml. 10 of the 12 patients had values above the normal range of 0-7-2-2 mg. per 100 mJ.7 The patients with normal values had been undergoing treatment for some years; they had normal stools and were well grown for their age. But this was also true of patients who had raised values. Cole, R., Danks, D. M., Campbell, P. E. Lancet, 1965, i, 1368. Danks, D. M. Clin. Pediat., Philad. 1965, 4, 499. 3. Landau, J. W., Barry, J. M., Koch, R. J. Pediat. 1963, 62, 895. 4. Marshall, R., Newnham, R. E., Rawstron, J. R., Ellis, J. R., Stevens, L. J. Lancet, 1964, i, 556. 5. Smith, D. W., Patau, K., Therman, E., Inborn, S. L., DeMars, R. I. J. Pediat. 1963, 62, 326. 6. Robinson, R., Smith, P. Nature, Lond. 1961, 189, 323. 7. Krebs, H. A. A. Rev. Biochem. 1950, 19, 409. 1. 2.