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THYROXINE-BINDING-GLOBULIN CONCENTRATION
725 SIMPLE METHOD FOR FÆCAL COLLECTION
brucei can persist for long periods in the domestic fowl without obvious manifestations of disease and it may, therefore, be wise to search for such infections in those avian species which share the environment of cases of sleeping sickness. Department of Bacteriology and Immunology,
SIR,—Continuous faecal collections are undertaken for research and clinical purposes. Published methods are often complex or require special apparatus (special plastic bag holder,l adapted toilet seat,22 feecal field kit,3 deep-freeze toilet4). We describe here a simple method, making use of readily available materials, which is especially suitable for outpatients. A large transparent triangular ’Polythene’ bag (45 x 45 x 65cm) is made by cutting a rectangular bag diagonally (two bags can be made if heat-sealing is available). The patient lays this across the toilet seat, or attaches it with adhesive tape, so that it hangs down into the bowl (see figure). After passing a
R. A. JOSHUA W. J. HERBERT
University of Glasgow, Western Infirmary, Glasgow G11 6NT
R. G. WHITE
THYROXINE-BINDING-GLOBULIN CONCENTRATION
SIR,—To minimise the risk of classifying as thyrotoxic a euthyroid patient with a raised thyroxine-binding-globulin (T.B.G.) concentration, the routine use of the T4/T.B.G. ratio as an index of thyroid state has been proposed.’ The free-thyroxine index-the classical index of thyroid state-is calculated from the T4 and T3 uptake but is inaccurate when the T.B.G. concentration is high.2 We have found a method3 for calculating the T.B.G. concentration which avoids the direct assay of T.B.G. by using the equation:
where A mean normal T3 uptake and b mean normal T4. To show this, we have taken the normal T4 and T3 uptake (60.2 g/1 and 36-3%, respectively) from Pickardt et al.,4 calculated the T.B.G. concentration for 21 normal subjects, and compared these calculated T.B.G. with the corresponding direct assay measurements of Pickardt et al. =
=
.
Correlation
between calculated T.B.G.
T.B.G.
and
direct-assay
measurements of
Data from Pickardt et al.4 Regression line is y
=
1.0488x-0.71.
The significant correlation (r==0-977) between the calculated T.B.G. and the direct assay results (see figure) shows that T.B.G. concentration can be calculated from independent data.
Department of Nuclear Medicine, Kantonsspital, CH-8200 Schaffhausen, Switzerland
Toilet with
bag attached and container.
motion the patient holds the ends of the bag and stands. The bag is closed with a rubber band and put in an air-tight screwtop container. If the triangular bag is placed in the rear half of the toilet it aids in the separation of urine. Inspection and palpation of the specimen is possible through the bag/ and it can then be placed directly in a deep-freeze or homogenised. The screw-top container may be cleaned and used again. We have collected over 1000 stools in this way from inpatients and outpatients aged 16-83. It is particularly useful when individual whole stools are required, as in gut transittime estimations; but even when individual stools are not required patients appreciate not having to re-open a used container. West Middlesex Hospital, Middlesex TW7 6AF
I. MCLEAN BAIRD E. R. LITTLEWOOD
M. ORNSTEIN
TERENCE I. HALE ARMEN JUCKER
1. Burr, W.
A., Ramsden, D. B., Evans, S. E., Hogan, T., Hoffenberg, R. Br. med. J. 1977, i, 485. 2. Somma, J. A., and others. Am. J. Obstet. Gynec. 1973, 116, 905. 3. Hale, T. I., Jucker, A. Nuk. Com. (in the press). 4. Pickardt, C. R., Bauer, M., Horn, K., Kubiczck, T., Scriba, P. C. Internist, 1977, 18,538.
1. Pryke, E. S., Whyte, H. M. Gut, 1970, 11, 966. 2. Jover, A., Gordon, R. S. J. Lab. clin. Med. 1952, 59, 878. 3. Hoffman, N. E., LaRusso, N. F., Hofmann, A. F. Lancet, 1973, i, 1422. 4. Ghoos, Y., Vantrappen, G. ibid. 1977, i, 884. 5. Van Wijk, L., Wieriks, J. Br. med. J. 1977, i, 1284.
brucei can persist for long periods in the domestic fowl without obvious manifestations of disease and it may, therefore, be wise to search for such infections in those avian species which share the environment of cases of sleeping sickness. Department of Bacteriology and Immunology,
SIR,—Continuous faecal collections are undertaken for research and clinical purposes. Published methods are often complex or require special apparatus (special plastic bag holder,l adapted toilet seat,22 feecal field kit,3 deep-freeze toilet4). We describe here a simple method, making use of readily available materials, which is especially suitable for outpatients. A large transparent triangular ’Polythene’ bag (45 x 45 x 65cm) is made by cutting a rectangular bag diagonally (two bags can be made if heat-sealing is available). The patient lays this across the toilet seat, or attaches it with adhesive tape, so that it hangs down into the bowl (see figure). After passing a
R. A. JOSHUA W. J. HERBERT
University of Glasgow, Western Infirmary, Glasgow G11 6NT
R. G. WHITE
THYROXINE-BINDING-GLOBULIN CONCENTRATION
SIR,—To minimise the risk of classifying as thyrotoxic a euthyroid patient with a raised thyroxine-binding-globulin (T.B.G.) concentration, the routine use of the T4/T.B.G. ratio as an index of thyroid state has been proposed.’ The free-thyroxine index-the classical index of thyroid state-is calculated from the T4 and T3 uptake but is inaccurate when the T.B.G. concentration is high.2 We have found a method3 for calculating the T.B.G. concentration which avoids the direct assay of T.B.G. by using the equation:
where A mean normal T3 uptake and b mean normal T4. To show this, we have taken the normal T4 and T3 uptake (60.2 g/1 and 36-3%, respectively) from Pickardt et al.,4 calculated the T.B.G. concentration for 21 normal subjects, and compared these calculated T.B.G. with the corresponding direct assay measurements of Pickardt et al. =
=
.
Correlation
between calculated T.B.G.
T.B.G.
and
direct-assay
measurements of
Data from Pickardt et al.4 Regression line is y
=
1.0488x-0.71.
The significant correlation (r==0-977) between the calculated T.B.G. and the direct assay results (see figure) shows that T.B.G. concentration can be calculated from independent data.
Department of Nuclear Medicine, Kantonsspital, CH-8200 Schaffhausen, Switzerland
Toilet with
bag attached and container.
motion the patient holds the ends of the bag and stands. The bag is closed with a rubber band and put in an air-tight screwtop container. If the triangular bag is placed in the rear half of the toilet it aids in the separation of urine. Inspection and palpation of the specimen is possible through the bag/ and it can then be placed directly in a deep-freeze or homogenised. The screw-top container may be cleaned and used again. We have collected over 1000 stools in this way from inpatients and outpatients aged 16-83. It is particularly useful when individual whole stools are required, as in gut transittime estimations; but even when individual stools are not required patients appreciate not having to re-open a used container. West Middlesex Hospital, Middlesex TW7 6AF
I. MCLEAN BAIRD E. R. LITTLEWOOD
M. ORNSTEIN
TERENCE I. HALE ARMEN JUCKER
1. Burr, W.
A., Ramsden, D. B., Evans, S. E., Hogan, T., Hoffenberg, R. Br. med. J. 1977, i, 485. 2. Somma, J. A., and others. Am. J. Obstet. Gynec. 1973, 116, 905. 3. Hale, T. I., Jucker, A. Nuk. Com. (in the press). 4. Pickardt, C. R., Bauer, M., Horn, K., Kubiczck, T., Scriba, P. C. Internist, 1977, 18,538.
1. Pryke, E. S., Whyte, H. M. Gut, 1970, 11, 966. 2. Jover, A., Gordon, R. S. J. Lab. clin. Med. 1952, 59, 878. 3. Hoffman, N. E., LaRusso, N. F., Hofmann, A. F. Lancet, 1973, i, 1422. 4. Ghoos, Y., Vantrappen, G. ibid. 1977, i, 884. 5. Van Wijk, L., Wieriks, J. Br. med. J. 1977, i, 1284.