- Email: [email protected]
IMPROVED RADIOIMMUNODETECTION OF TUMOURS USING SECOND ANTIBODY
247 RESULTS
Christiewrote in 1969 that: "At the height... whooping cough is a dramatic and distressing disease, diagnosable at sight: but in its early stages, there is nothing to mark it out from the coughs, colds and catarrhs of early childhood" and "though there are no diagnostic symptoms in the earliest days, culture of the organism... from pernasal swabs is, at this stage, highly reliable". More than a decade later we must ask why this simple procedure is often omitted or else delayed until antibiotics have been tried and failed. With delay, the test loses much of its reliability and usefulness. Although the fine, flexible swabs and charcoal transport medium
cps= counts pe second. Results
as
mean--tSD.
readily available from laboratories, not many practitioners use them. Unfamiliarity with the procedure may be partly responsible, and it is timely that the Association of Clinical Pathologists has issued a broadsheet2giving detailed guidance. It must be recognised, however, that children do not welcome the procedure, which needs a practised hand; and even a successful pernasal swabbing may be at the expense of some damage to the doctor-child relationship. There is much to be said for swabs being taken by a few community nurses, trained in the technique and available to visit homes at the request of family doctors. Such a service was organised by the Public Health Laboratory Service and area health authorities for a survey3 which ended in 1980. I suggest that the Department of Health should encourage community physicians to make provision for this need on a continuing basis. As well as the pernasal swabs viral throat swabs could usefully be taken. There is a demand for such a service. In twelve months November, 1981, to October, 1982,I accepted for swabbing at the Blackburn laboratory 291 children referred by family doctors. Of these, 87, almost all unimmunised, were positive for Bordetella pertussis. Simultaneous viral cultures, done in about half of the cases, resulted in 12 isolates. 6 of these, from children with swabs negative for B. pertussis, were cases of simple viral infection. The other 6 (all adenoviruses) were from children positive for B. pertussis and these cases were of particular interest in that the usual history was that the child, in the course of mild pertussis, had an exacerbation of symptoms which led to his referral.
sodium iodide detector and that of a 10-50 1 blood sample (well counter) were measured for each rat before the intravenous injection of 300 g of swine anti-sheep-IgG serum in 100 1 saline. The radioactivity measurements were repeated after a further 24 h. The controls comprised five rats treated identically but given 300
Department of Pathology, Royal Infirmary,
The University of Birmingham, Immuno Diagnostic Research Laboratory,
are
W. M. DARLING*
Blackburn *Present address: Public Health
Laboratory, Royal Infirmary,
Preston PRl 6PS.
radioactivity. Department of Immunology, The Medical School, Vincent Drive, Birmingham B15 2TJ
A. R. BRADWELL A. VAUGHAN D. S. FAIRWEATHER P. W. DYKES
HANDLING CYTOSTATIC DRUGS IMPROVED RADIOIMMUNODETECTION OF TUMOURS USING SECOND ANTIBODY
SIR,-Dr Begent and colleagues (Oct. 2, p. 739) described a whereby liposome entrapped second antibody (LESA) injected intravenously enhanced the gamma camera image of tumours detected by radiolabelled tumour antibodies (goat anticarcinoembryonic-antigen [yea]). It was argued that liposomes were essential because an antigen such as digoxin could not be removed from the blood by antibody alone.4For digoxin this is predictable because the molecule is too small to be precipitated in the form of an antigen-antibody complex and it would continue to circulate in the blood even ifbound. However, this does not apply to a large molecule such as an antibody with a molecular weight of method
around 150 000. This will readily form an immune lattice with another antibody (provided it is in the correct proportion) and then be removed from the circulation. To demonstrate this we injected five rats intravenously with 10 g ofl31 I-labelled sheep anti-CEA in 100u1 of saline (1MBq per rat). At 36 h the whole body radioactivity, measured from 1 m with a 13 cm
SIR,-Your Dec. 11 editorial (p. 1317) discusses the possible hazards of anticancer drugs to medical staff. Since Falck’s letter in 19791 different recommendations for safe handling of anticancer drugs have been presented.2,3 Wilson and Solimando4 described an aseptic technique as a safety precaution, emphasising the importance of negative pressure inside vials. Nurses prepare all injectable anticancer drugs in our hospital. When supervising their work with anticancer drugs I found that no strict instruction could be given for the addition of diluent to vials of dry powder. Different vials demanded different techniques, depending on the volume of the vial, the diluent to be added, and the pressure inside the vial before and during the reconstitution. Sometimes, the addition of diluent generated positive pressure inside the vial, and an extra needle was required for venting. However, diluent was added even against counterpressure. An exception was the reconstitution of doxorubicin hydrochloride (’Adriamycin’; Adria Laboratories). Adriamycin is available in vials with deep internal negative pressure permitting preparation of the drug for injection ed. Liposomes· From physical structure to therapeutic applications. Amsterdam: Elsevier/North-Holland/Biomedica, 1981. 1. Falck K, Gröhn P, Sorsa M, Vainio H, Heinonen E, Holsti LR. Mutagenicity in urine of nurses handling cytostatic drugs. Lancet 1979, i. 1250-51. 2. Society of Hospital Pharmacists of Australia’s Specialty Practice Committee on Parenteral Services. Guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards. Hosp Pharm 1981, 16: 17-20. 3. Zimmerman PF, Larsen RK, Barkley EW, Gallelli JF. Recommendations for the safe handling of injectable antineoplastic drug products. Am J Hosp Pharm 1981; 38: 1693-95. 4. Wilson JP, Solimando DA. Aseptic technique as a safety precaution in the preparation of antineoplastic agents. Hosp Pharm 1981; 16: 575-81. 5.
1. Christie AB. Infectious diseases, 1st. ed. Edinburgh: Livingstone, 1969: 700 and 708. 2 Abbott JD, Macaulay ME, Preston NW Bacteriological diagnosis of whooping cough. Assoc of Clin. Path. Broadsheet 105, Nov. 1982. Available from the Publishing manager, Journal of Clinical Pathology, BMA House, Tavistock Square, WC1H
9JR. 3. Efficacy
of pertussis vaccination m England. Report from the PHLS Epidemiological Research Laboratory and 21 Area Health Authorities. Br Med J 1982, 285: 357-59. 4. Campbell RI, Harding NGL, Lyman BE, Tyrrell DAJ. Redistribution and altered excretion of digoxin in rats receiving digoxin antibodies incorporated in liposomes. Eur J Biochem 1980; 10: 87-92.
Knight CG,
Christiewrote in 1969 that: "At the height... whooping cough is a dramatic and distressing disease, diagnosable at sight: but in its early stages, there is nothing to mark it out from the coughs, colds and catarrhs of early childhood" and "though there are no diagnostic symptoms in the earliest days, culture of the organism... from pernasal swabs is, at this stage, highly reliable". More than a decade later we must ask why this simple procedure is often omitted or else delayed until antibiotics have been tried and failed. With delay, the test loses much of its reliability and usefulness. Although the fine, flexible swabs and charcoal transport medium
cps= counts pe second. Results
as
mean--tSD.
readily available from laboratories, not many practitioners use them. Unfamiliarity with the procedure may be partly responsible, and it is timely that the Association of Clinical Pathologists has issued a broadsheet2giving detailed guidance. It must be recognised, however, that children do not welcome the procedure, which needs a practised hand; and even a successful pernasal swabbing may be at the expense of some damage to the doctor-child relationship. There is much to be said for swabs being taken by a few community nurses, trained in the technique and available to visit homes at the request of family doctors. Such a service was organised by the Public Health Laboratory Service and area health authorities for a survey3 which ended in 1980. I suggest that the Department of Health should encourage community physicians to make provision for this need on a continuing basis. As well as the pernasal swabs viral throat swabs could usefully be taken. There is a demand for such a service. In twelve months November, 1981, to October, 1982,I accepted for swabbing at the Blackburn laboratory 291 children referred by family doctors. Of these, 87, almost all unimmunised, were positive for Bordetella pertussis. Simultaneous viral cultures, done in about half of the cases, resulted in 12 isolates. 6 of these, from children with swabs negative for B. pertussis, were cases of simple viral infection. The other 6 (all adenoviruses) were from children positive for B. pertussis and these cases were of particular interest in that the usual history was that the child, in the course of mild pertussis, had an exacerbation of symptoms which led to his referral.
sodium iodide detector and that of a 10-50 1 blood sample (well counter) were measured for each rat before the intravenous injection of 300 g of swine anti-sheep-IgG serum in 100 1 saline. The radioactivity measurements were repeated after a further 24 h. The controls comprised five rats treated identically but given 300
Department of Pathology, Royal Infirmary,
The University of Birmingham, Immuno Diagnostic Research Laboratory,
are
W. M. DARLING*
Blackburn *Present address: Public Health
Laboratory, Royal Infirmary,
Preston PRl 6PS.
radioactivity. Department of Immunology, The Medical School, Vincent Drive, Birmingham B15 2TJ
A. R. BRADWELL A. VAUGHAN D. S. FAIRWEATHER P. W. DYKES
HANDLING CYTOSTATIC DRUGS IMPROVED RADIOIMMUNODETECTION OF TUMOURS USING SECOND ANTIBODY
SIR,-Dr Begent and colleagues (Oct. 2, p. 739) described a whereby liposome entrapped second antibody (LESA) injected intravenously enhanced the gamma camera image of tumours detected by radiolabelled tumour antibodies (goat anticarcinoembryonic-antigen [yea]). It was argued that liposomes were essential because an antigen such as digoxin could not be removed from the blood by antibody alone.4For digoxin this is predictable because the molecule is too small to be precipitated in the form of an antigen-antibody complex and it would continue to circulate in the blood even ifbound. However, this does not apply to a large molecule such as an antibody with a molecular weight of method
around 150 000. This will readily form an immune lattice with another antibody (provided it is in the correct proportion) and then be removed from the circulation. To demonstrate this we injected five rats intravenously with 10 g ofl31 I-labelled sheep anti-CEA in 100u1 of saline (1MBq per rat). At 36 h the whole body radioactivity, measured from 1 m with a 13 cm
SIR,-Your Dec. 11 editorial (p. 1317) discusses the possible hazards of anticancer drugs to medical staff. Since Falck’s letter in 19791 different recommendations for safe handling of anticancer drugs have been presented.2,3 Wilson and Solimando4 described an aseptic technique as a safety precaution, emphasising the importance of negative pressure inside vials. Nurses prepare all injectable anticancer drugs in our hospital. When supervising their work with anticancer drugs I found that no strict instruction could be given for the addition of diluent to vials of dry powder. Different vials demanded different techniques, depending on the volume of the vial, the diluent to be added, and the pressure inside the vial before and during the reconstitution. Sometimes, the addition of diluent generated positive pressure inside the vial, and an extra needle was required for venting. However, diluent was added even against counterpressure. An exception was the reconstitution of doxorubicin hydrochloride (’Adriamycin’; Adria Laboratories). Adriamycin is available in vials with deep internal negative pressure permitting preparation of the drug for injection ed. Liposomes· From physical structure to therapeutic applications. Amsterdam: Elsevier/North-Holland/Biomedica, 1981. 1. Falck K, Gröhn P, Sorsa M, Vainio H, Heinonen E, Holsti LR. Mutagenicity in urine of nurses handling cytostatic drugs. Lancet 1979, i. 1250-51. 2. Society of Hospital Pharmacists of Australia’s Specialty Practice Committee on Parenteral Services. Guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards. Hosp Pharm 1981, 16: 17-20. 3. Zimmerman PF, Larsen RK, Barkley EW, Gallelli JF. Recommendations for the safe handling of injectable antineoplastic drug products. Am J Hosp Pharm 1981; 38: 1693-95. 4. Wilson JP, Solimando DA. Aseptic technique as a safety precaution in the preparation of antineoplastic agents. Hosp Pharm 1981; 16: 575-81. 5.
1. Christie AB. Infectious diseases, 1st. ed. Edinburgh: Livingstone, 1969: 700 and 708. 2 Abbott JD, Macaulay ME, Preston NW Bacteriological diagnosis of whooping cough. Assoc of Clin. Path. Broadsheet 105, Nov. 1982. Available from the Publishing manager, Journal of Clinical Pathology, BMA House, Tavistock Square, WC1H
9JR. 3. Efficacy
of pertussis vaccination m England. Report from the PHLS Epidemiological Research Laboratory and 21 Area Health Authorities. Br Med J 1982, 285: 357-59. 4. Campbell RI, Harding NGL, Lyman BE, Tyrrell DAJ. Redistribution and altered excretion of digoxin in rats receiving digoxin antibodies incorporated in liposomes. Eur J Biochem 1980; 10: 87-92.
Knight CG,