- Email: [email protected]
PARATHYROID DISEASE
1133
scribing habits in this instance, compared with the relatively slow changes reported by Wade and Hood, are: (1) there was widespread reporting of the warning by news media; (2) in response to such Press reports, patients requested their doctors to prescribe the low-oestrogen preparations; and (3) since a change to the low-oestrogen preparations did not require an alteration in contraceptive method or reduce the efficacy of the method it was readily accepted by both doctors and patients.
Although this has not been studied the change in prescribing habits illustrated in this case probably reflect a similar change in private prescriptions for oral contraceptives. Knowledge of the possible risks in the use of oral contraceptives has not reduced the numbers of such preparations prescribed on the N.H.S.: in the period covered by this survey, the quantity of oral contraceptives prescribed
modifications. 0-1 ml.
the the cryostat sections after incubation for 30 minutes at 37 °C and repeated washings. The slides were dried under a fan; and 106 lymphocytes per 0-1 ml. were incubated on the sections in a moist chamber for 1 hour at 37 °C. The slides were washed in a phosphate buffer (pH 7-4) several times. It is very important to wash off lymphocytes unspecifically bound to tissue or glass. 0-5 lymphocytes may be found in negative controls. In positive cases 50 or more lymphocytes are seen per field. The results indicated that there were cooperating antibodies in Hashimoto’s thyroiditis and thyrotoxic exophthalmos but not in pemphigus vulgaris:
Hobbs with
some
1/10 and 1/100 diluted
sera were
spread
amounts ot
on
doubled. Department of Pharmacy, Medical Biology Centre, Queen’s University of Belfast, 97 Lisburn Road, Belfast BT9 7BL.
PAUL S. COLLIER.
PARATHYROID DISEASE
SIR,—Time is an important dimension in natural science. It cannot, unfortunately, be abbreviated so that the beginning of an illness is telescoped into the middle. Therefore the reason for the lesions in the interesting cases described by Dr West and Dr Herrick and by Dr Scott (May 5, p. 1005) is obscure. The first patient possibly had sarcoid thyroiditisand later tertiary hyperparaThe second patient may have sarcoid thyroidism.2 Addison’s disease, hypoparathyroidism,3 and thyroiditis, Sarcoid infiltration usually even though she is euthyroid. heals in a few years, but the inappropriate secretion of immune globulins may persist longer. Since the diagnosis of hyperparathyroidism seems to be considerably delayed4 the recording of 11 cases of hyperparathyroidism with concomitant sarcoidosis is somewhat unexpected.5 When tested by macrophage electrophoretic migration, the lymphocytes from a patient with a parathyroid adenoma and chronic thyroiditis showed the immunopathology of sarcoidosis.6 Wood Cottage,
It is known that an autoantibody to intercellular areas of stratified squamous epithelium is associated with pemphigus vulgaris, demonstrable by immunofluorescence.8 This observation has drawn attention to the possible autoimmune aetiology of pemphigus vulgaris. Our findings suggest that the autoantibodies bound to intercellular areas do not cooperate with the non-immune lymphocytes. This seems to correlate with the fact that the bullous lesions as a rule occur in the absence of lymphocytes -i.e., cellular or delayed type hypersensitivity is of doubtful relevance in pemphigus.9 B. FEKETE K. PÁLÓCZI GY. SZEGEDI P. GERGELY M. SZABOLCSI G. SZABÓ
I Department of Medicine, University of Debrecen,
Hungary.
IDENTIFICATION OF MUCOPOLYSACCHARIDOSES
SIR,-Dr Linker (May 5, p. 1010) is perfectly right in pointing out that future hopes for complete understanding of the mucopolysaccharidoses rest upon detailed analysis of the underlying biochemical faults in this group of diseases. This is
in all inborn
ABSENCE OF COOPERATING ANTIBODIES IN PEMPHIGUS VULGARIS
of metabolism, and my of our time attempting to work out the basic defects in other diseases in this category. Unfortunately, Dr Linker has read into our statements about the diagnosis of the Sanfilippo syndrome 10 a perspective very different from that we were trying to
SiRj—We read the article by Dr Fakhri and Dr Hobbs7
convey. The message of our paper, which
Chilworth, Surrey.
GERALD A. MACGREGOR.
with special interest. The suggestion that specific antibodies and non-immune lymphocytes cooperate in the pathogenesis of Hashimoto’s thyroiditis, thyrotoxic exophthalmos, retinal vasculitis, and coeliac disease is of great importance. We studied the sera of 4 patients with Hashimoto’s thyroiditis, 3 with thyrotoxic exophthalmos, and 8 with pemphigus vulgaris. Cryostat sections of fresh normal human thyroid, retrobulbar tissue, and human epithelium were used. The lymphocytes were obtained from fresh human tonsils (tonsilla palatina). The cooperating-antibody detection was carried out by the method of Fakhri and 1. Karlish, A. J., MacGregor, G. A. Lancet, 1970, ii, 330. 2. MacGregor, G. A. ibid. 1969, i, 730. 3. MacGregor, G. A. ibid. 1970, ii, 1257. 4. Hellstrom, J., Ivemark, B. I. Acta chir. scand. 1962, suppl. 294. 5. Winnacker, J. L., Becker, K. L., Friedlander, M., Higgins, G. A., Moore, C. F. Am. J. Med. 1969, 46, 305. 6. Field, E. J., Caspary, E. A., MacGregor, G. A. Unpublished. 7. Fakhri, O., Hobbs, J. R. Lancet, 1972, ii, 403.
true
colleagues and I spend
errors
most
appeared in a clinically oriented pasdiatric journal, was intended to be that certain clinical features should cause clinicians to think of the Sanfilippo syndrome and that some easily available investigations are useful in confirming the diagnosis. It is a fact that at present clinicians must think of this diagnosis before biochemists like Dr Linker have any opportunity to study patients. It is also true that, as he himself admits, there is no simple and widely available laboratory method for differentiating the individual mucopolysaccharides excreted in urine in the different mucopolysaccharidoses. I look forward to watching Dr Linker, Dr Neufeld, and other research scientists in this field work out the full story of these intriguing diseases. In the meantime, I believe Beutner, E. H., Jordon, R. E., Chorzelski, T. B. J. invest. Derm. 1968, 51, 63. 9. Lever, W. F. Pemphigus and Pemphigoid. Springfield, Illinois, 1965. 10. Danks, D. M., Campbell, P. E., Cartwright, E., Mayne, V., Taft, L. I., Wilson, R. G. Aust. pœdiat. J. 1972, 8, 174. 8.
scribing habits in this instance, compared with the relatively slow changes reported by Wade and Hood, are: (1) there was widespread reporting of the warning by news media; (2) in response to such Press reports, patients requested their doctors to prescribe the low-oestrogen preparations; and (3) since a change to the low-oestrogen preparations did not require an alteration in contraceptive method or reduce the efficacy of the method it was readily accepted by both doctors and patients.
Although this has not been studied the change in prescribing habits illustrated in this case probably reflect a similar change in private prescriptions for oral contraceptives. Knowledge of the possible risks in the use of oral contraceptives has not reduced the numbers of such preparations prescribed on the N.H.S.: in the period covered by this survey, the quantity of oral contraceptives prescribed
modifications. 0-1 ml.
the the cryostat sections after incubation for 30 minutes at 37 °C and repeated washings. The slides were dried under a fan; and 106 lymphocytes per 0-1 ml. were incubated on the sections in a moist chamber for 1 hour at 37 °C. The slides were washed in a phosphate buffer (pH 7-4) several times. It is very important to wash off lymphocytes unspecifically bound to tissue or glass. 0-5 lymphocytes may be found in negative controls. In positive cases 50 or more lymphocytes are seen per field. The results indicated that there were cooperating antibodies in Hashimoto’s thyroiditis and thyrotoxic exophthalmos but not in pemphigus vulgaris:
Hobbs with
some
1/10 and 1/100 diluted
sera were
spread
amounts ot
on
doubled. Department of Pharmacy, Medical Biology Centre, Queen’s University of Belfast, 97 Lisburn Road, Belfast BT9 7BL.
PAUL S. COLLIER.
PARATHYROID DISEASE
SIR,—Time is an important dimension in natural science. It cannot, unfortunately, be abbreviated so that the beginning of an illness is telescoped into the middle. Therefore the reason for the lesions in the interesting cases described by Dr West and Dr Herrick and by Dr Scott (May 5, p. 1005) is obscure. The first patient possibly had sarcoid thyroiditisand later tertiary hyperparaThe second patient may have sarcoid thyroidism.2 Addison’s disease, hypoparathyroidism,3 and thyroiditis, Sarcoid infiltration usually even though she is euthyroid. heals in a few years, but the inappropriate secretion of immune globulins may persist longer. Since the diagnosis of hyperparathyroidism seems to be considerably delayed4 the recording of 11 cases of hyperparathyroidism with concomitant sarcoidosis is somewhat unexpected.5 When tested by macrophage electrophoretic migration, the lymphocytes from a patient with a parathyroid adenoma and chronic thyroiditis showed the immunopathology of sarcoidosis.6 Wood Cottage,
It is known that an autoantibody to intercellular areas of stratified squamous epithelium is associated with pemphigus vulgaris, demonstrable by immunofluorescence.8 This observation has drawn attention to the possible autoimmune aetiology of pemphigus vulgaris. Our findings suggest that the autoantibodies bound to intercellular areas do not cooperate with the non-immune lymphocytes. This seems to correlate with the fact that the bullous lesions as a rule occur in the absence of lymphocytes -i.e., cellular or delayed type hypersensitivity is of doubtful relevance in pemphigus.9 B. FEKETE K. PÁLÓCZI GY. SZEGEDI P. GERGELY M. SZABOLCSI G. SZABÓ
I Department of Medicine, University of Debrecen,
Hungary.
IDENTIFICATION OF MUCOPOLYSACCHARIDOSES
SIR,-Dr Linker (May 5, p. 1010) is perfectly right in pointing out that future hopes for complete understanding of the mucopolysaccharidoses rest upon detailed analysis of the underlying biochemical faults in this group of diseases. This is
in all inborn
ABSENCE OF COOPERATING ANTIBODIES IN PEMPHIGUS VULGARIS
of metabolism, and my of our time attempting to work out the basic defects in other diseases in this category. Unfortunately, Dr Linker has read into our statements about the diagnosis of the Sanfilippo syndrome 10 a perspective very different from that we were trying to
SiRj—We read the article by Dr Fakhri and Dr Hobbs7
convey. The message of our paper, which
Chilworth, Surrey.
GERALD A. MACGREGOR.
with special interest. The suggestion that specific antibodies and non-immune lymphocytes cooperate in the pathogenesis of Hashimoto’s thyroiditis, thyrotoxic exophthalmos, retinal vasculitis, and coeliac disease is of great importance. We studied the sera of 4 patients with Hashimoto’s thyroiditis, 3 with thyrotoxic exophthalmos, and 8 with pemphigus vulgaris. Cryostat sections of fresh normal human thyroid, retrobulbar tissue, and human epithelium were used. The lymphocytes were obtained from fresh human tonsils (tonsilla palatina). The cooperating-antibody detection was carried out by the method of Fakhri and 1. Karlish, A. J., MacGregor, G. A. Lancet, 1970, ii, 330. 2. MacGregor, G. A. ibid. 1969, i, 730. 3. MacGregor, G. A. ibid. 1970, ii, 1257. 4. Hellstrom, J., Ivemark, B. I. Acta chir. scand. 1962, suppl. 294. 5. Winnacker, J. L., Becker, K. L., Friedlander, M., Higgins, G. A., Moore, C. F. Am. J. Med. 1969, 46, 305. 6. Field, E. J., Caspary, E. A., MacGregor, G. A. Unpublished. 7. Fakhri, O., Hobbs, J. R. Lancet, 1972, ii, 403.
true
colleagues and I spend
errors
most
appeared in a clinically oriented pasdiatric journal, was intended to be that certain clinical features should cause clinicians to think of the Sanfilippo syndrome and that some easily available investigations are useful in confirming the diagnosis. It is a fact that at present clinicians must think of this diagnosis before biochemists like Dr Linker have any opportunity to study patients. It is also true that, as he himself admits, there is no simple and widely available laboratory method for differentiating the individual mucopolysaccharides excreted in urine in the different mucopolysaccharidoses. I look forward to watching Dr Linker, Dr Neufeld, and other research scientists in this field work out the full story of these intriguing diseases. In the meantime, I believe Beutner, E. H., Jordon, R. E., Chorzelski, T. B. J. invest. Derm. 1968, 51, 63. 9. Lever, W. F. Pemphigus and Pemphigoid. Springfield, Illinois, 1965. 10. Danks, D. M., Campbell, P. E., Cartwright, E., Mayne, V., Taft, L. I., Wilson, R. G. Aust. pœdiat. J. 1972, 8, 174. 8.