- Email: [email protected]
VARIATION IN SERUM CHOLESTEROL
682
overactivity of known glutamatergic pathways. Although we could not find the hypothesised GDH deficiency in spinal cords of our ALS patients, it is nevertheless possible that activation of GDH by branched chain aminoacids may have helped to restore glutamatergic transmission, as intended by Plaitakis and colleagues, thus resulting in the therapeutic benefit observed. Institute of Biochemical Pharmacology,
University of Vienna, A-1090 Vienna, Austria
SUSANNE MALESSA
Department of Neurology, St George’s Hospital Medical School,
NIGEL LEIGH
London SW17 Institute of Biochemical University of Vienna
Pharmacology,
OLEH HORNYKIEWICZ
A, Caroscio JT. Abnormal glutamate metabolism in amyotrophic lateral sclerosis Ann Neurol 1987; 22: 575-79. 2 Plaitakis A, Bert S, Yahr MD. Abnormal glutamate metabolism in an adult-onset degenerative neurological disorder. Science 1982; 216: 193-96. 3. Finocchiaro G, Taroni F, DiDonato S. Glutamate dehydrogenase in olivopontocerebellar atrophies. leucocytes, fibroblasts, and muscle mitochondria. Neurology 1986; 36: 550-53. 4. Plaitakis A, Berl S, Yahr MD. Neurological disorders associated with deficiency of glutamate dehydrogenase. Ann Neurol 1984; 15: 144-53. 5. Perry TL, Hansen S, Jones K. Brain glutamate deficiency in amyotrophic lateral sclerosis Neurology 1987, 37: 1845-48. 6. Chee PY, Dahl LJ, Fahien A The purification and properties of rat brain glutamate dehydrogenase. J Neurochem 1979; 33: 53-60 1 Plaitakis
The parents were treated with doxycycline 400 mg daily for a week and then 200 mg daily for two or three weeks; the girls were treated with erythromycin ethylsuccinate 50 mg/kg daily for 3 weeks with resolution of symptoms. Swabs from all patients 10 days after the end of therapy were negative. In this family outbreak the transmission mechanisms are not clear. The son may have been infected via an ascending chorioamnionitis. The pathogenesis in the girls’ infections remains poorly understood, provided sexual abuse can be excluded; an indirect route of infection via hands, clothing, fomites, or toys is possible (and the same speculation might apply to the infected baby also). C trachomatis cultures for everyone in close contact with an infected individual should be done to clear up questions about transmission of this infection. ANNA MEDICI DANIELA SOLLECITO Department of Paediatrics III, DANIELA ROSSI La Sapienza University, MARIO MIDULLA 00161 Rome, Italy 1. Schachter
J, Hanna L, Hill EC, et al Are chlamydial infections the most prevalent venereal disease? JAMA 1975; 231: 1252-55. 2. Stagno S, Brasfield DM, Brown MB, et al. Infant pneumonitis associated with cytomegalovirus, chlamydia, pneumocystis, and ureaplasma: a prospective study Pediatrics 1981; 68: 322-28.
VARIATION IN SERUM CHOLESTEROL
FAMILY OUTBREAK OF CHLAMYDIA TRACHOMATIS
SIR,7-Chlamydia trachomatis infection is the most frequent cause of disease of the lower genital tract in adults1 and of infantile conjunctivitis and pneumonia.2 In the adult infection is usually sexual, while in the newborn contamination at the time of delivery prevails. However, there is interest in alternative routes of transmission and we report here a familial "outbreak" of C trachomatis. A 53-year-old man (a doctor) and his 41-year-old wife had two daughters aged 6 and 5 and a 4-month-old son. The boy had been delivered by caesarean section (as had the girls) after a full-term pregnancy complicated by early threatened miscarriage. Membranes were artificially ruptured at the time of delivery and the amniotic fluid was clear. At 15 days of age this boy had transient conjunctival hyperaemia and a bilateral discharge. At 20 days he had a staccato cough without fever or other symptoms. He was brought to us aged 4 months because of persistent cough. Nasopharyngeal and conjunctival swabs for virus, Bordetella pertussis, and C trachoma tis cultures and for a C trachomatis direct immunofluorescent test were collected. Both tests for C trachomatis were positive. A 21-day course of oral erythromycin ethylsuccinate (50 mg/kg daily) was started with resolution of symptoms. The mother was symptom-free. The father had a history of intermittent dysuria, beginning 2 years earlier. The 6-year-old girl had had a recurrent cough for some months, and her sister had symptoms of recent vulvovaginitis with germ-free vulvar swabs, sterile urine culture, and no sign of sexual abuse. Conjunctival, nasopharyngeal, cervical, and urethral swabs were collected from the mother; conjunctival, nasopharyngeal, and urethral swabs from the father; and conjunctival, nasopharyngeal, and vaginal swabs from the girls. All specimens were cultured for chlamydia and all were positive except for the conjunctival and nasopharyngeal swabs from the 5-year-old girl and the vaginal swab from the 6-year-old
SIR,-Dr Natelson and others (Aug 13, p 404) are correct to point that concentrations of serum cholesterol can vary during the day. It has long been known that simple events, such as venous occlusion during sample collection, can result in raised cholesterol values.1,2 Even when these are avoided, large fluctuations in concentrations of serum total cholesterol and lipoprotein cholesterol out
known.3 In a controlled study,3 where blood samples were taken over 24 hours from 12 healthy people, 13 maturity-onset diabetics, and 14 insulin-requiring diabetics the mean peak-to-nadir changes in total and HDL cholesterol concentrations were 15% and 23%, respectively, of the average 24 hour concentration in normal subjects; larger variations were recorded for diabetics. Only 1 insulin-requiring diabetic did not have significant within-day changes in total cholesterol-and in only 1 control and 1 maturity-onset diabetic was there similar stability for HDL cholesterol. For both total and HDL cholesterol, the pattern of change was for the highest concentrations to be in the evening and for the lowest to be during the early hours of the morning. There was no single time which accurately reflected the avarage 24 hour value, although for most patients a sample at 0800 hours was within 0-3 mmol/1 of the average total cholesterol and within 0-2 mmol/1 of the average HDL cholesterol. Natelson and colleagues point out the implications of fluctuating serum total cholesterol levels for coronary prevention and for treatment advice for individuals. When differences in HDL cholesterol in individuals with and without arteriovascular disease are 0-2-04 MMOI/1,4 ’ knowing that the results from a single sample may be within 02 mmol/1 of the daily average hardly seems good enough. Despite this, and while agreeing that having more and better data would be a good thing, I think that to delay the implementation of cholesterol-lowering strategies would be to exaggerate the importance of these results. are
European Research Institute, DPC/ERI Corp,
(table). RESULTS OF CHLAMYDIA CULTURE
Witney, Oxfordshire OX8 6AN
HB, Lewis B, Pilkington, TRE. The effect of venous occlusion on the level of serum cholesterol. J Atheroscler Res 1961, 1: 85-88 Page IH, Moinuddin M The effect of venous occlusion on serum cholesterol and total protein. a warning Circulation 1962; 25: 651-52. Simpson RW, Carter MD, Moore RA, Penfold WAF. Diurnal changes in plasma lipoproteins in normal subjects and diabetics Diabetalogia 1980; 18: 35-40 Miller NE, Thelle DS, Førde OH, Mjøs OD The Tromso Heart Study High density lipoprotein and coronary heart disease: a prospective case-control study. Lancet 1977, i: 965-67 Rossenr S, Kjellin KG, Mettinger KL, Sidén A, Soderstrom CE Normal serum cholesterol but low HDL cholesterol concentration in young patients with ischaemic cerebrovascular disease. Lancet 1978, i: 577-79.
1. Koerselman
2. 3. 4.
5.
ND
=not
done;
+
=positive for C
trachornatis;
-
=neganve for C crachomatzc
R. A. MOORE
overactivity of known glutamatergic pathways. Although we could not find the hypothesised GDH deficiency in spinal cords of our ALS patients, it is nevertheless possible that activation of GDH by branched chain aminoacids may have helped to restore glutamatergic transmission, as intended by Plaitakis and colleagues, thus resulting in the therapeutic benefit observed. Institute of Biochemical Pharmacology,
University of Vienna, A-1090 Vienna, Austria
SUSANNE MALESSA
Department of Neurology, St George’s Hospital Medical School,
NIGEL LEIGH
London SW17 Institute of Biochemical University of Vienna
Pharmacology,
OLEH HORNYKIEWICZ
A, Caroscio JT. Abnormal glutamate metabolism in amyotrophic lateral sclerosis Ann Neurol 1987; 22: 575-79. 2 Plaitakis A, Bert S, Yahr MD. Abnormal glutamate metabolism in an adult-onset degenerative neurological disorder. Science 1982; 216: 193-96. 3. Finocchiaro G, Taroni F, DiDonato S. Glutamate dehydrogenase in olivopontocerebellar atrophies. leucocytes, fibroblasts, and muscle mitochondria. Neurology 1986; 36: 550-53. 4. Plaitakis A, Berl S, Yahr MD. Neurological disorders associated with deficiency of glutamate dehydrogenase. Ann Neurol 1984; 15: 144-53. 5. Perry TL, Hansen S, Jones K. Brain glutamate deficiency in amyotrophic lateral sclerosis Neurology 1987, 37: 1845-48. 6. Chee PY, Dahl LJ, Fahien A The purification and properties of rat brain glutamate dehydrogenase. J Neurochem 1979; 33: 53-60 1 Plaitakis
The parents were treated with doxycycline 400 mg daily for a week and then 200 mg daily for two or three weeks; the girls were treated with erythromycin ethylsuccinate 50 mg/kg daily for 3 weeks with resolution of symptoms. Swabs from all patients 10 days after the end of therapy were negative. In this family outbreak the transmission mechanisms are not clear. The son may have been infected via an ascending chorioamnionitis. The pathogenesis in the girls’ infections remains poorly understood, provided sexual abuse can be excluded; an indirect route of infection via hands, clothing, fomites, or toys is possible (and the same speculation might apply to the infected baby also). C trachomatis cultures for everyone in close contact with an infected individual should be done to clear up questions about transmission of this infection. ANNA MEDICI DANIELA SOLLECITO Department of Paediatrics III, DANIELA ROSSI La Sapienza University, MARIO MIDULLA 00161 Rome, Italy 1. Schachter
J, Hanna L, Hill EC, et al Are chlamydial infections the most prevalent venereal disease? JAMA 1975; 231: 1252-55. 2. Stagno S, Brasfield DM, Brown MB, et al. Infant pneumonitis associated with cytomegalovirus, chlamydia, pneumocystis, and ureaplasma: a prospective study Pediatrics 1981; 68: 322-28.
VARIATION IN SERUM CHOLESTEROL
FAMILY OUTBREAK OF CHLAMYDIA TRACHOMATIS
SIR,7-Chlamydia trachomatis infection is the most frequent cause of disease of the lower genital tract in adults1 and of infantile conjunctivitis and pneumonia.2 In the adult infection is usually sexual, while in the newborn contamination at the time of delivery prevails. However, there is interest in alternative routes of transmission and we report here a familial "outbreak" of C trachomatis. A 53-year-old man (a doctor) and his 41-year-old wife had two daughters aged 6 and 5 and a 4-month-old son. The boy had been delivered by caesarean section (as had the girls) after a full-term pregnancy complicated by early threatened miscarriage. Membranes were artificially ruptured at the time of delivery and the amniotic fluid was clear. At 15 days of age this boy had transient conjunctival hyperaemia and a bilateral discharge. At 20 days he had a staccato cough without fever or other symptoms. He was brought to us aged 4 months because of persistent cough. Nasopharyngeal and conjunctival swabs for virus, Bordetella pertussis, and C trachoma tis cultures and for a C trachomatis direct immunofluorescent test were collected. Both tests for C trachomatis were positive. A 21-day course of oral erythromycin ethylsuccinate (50 mg/kg daily) was started with resolution of symptoms. The mother was symptom-free. The father had a history of intermittent dysuria, beginning 2 years earlier. The 6-year-old girl had had a recurrent cough for some months, and her sister had symptoms of recent vulvovaginitis with germ-free vulvar swabs, sterile urine culture, and no sign of sexual abuse. Conjunctival, nasopharyngeal, cervical, and urethral swabs were collected from the mother; conjunctival, nasopharyngeal, and urethral swabs from the father; and conjunctival, nasopharyngeal, and vaginal swabs from the girls. All specimens were cultured for chlamydia and all were positive except for the conjunctival and nasopharyngeal swabs from the 5-year-old girl and the vaginal swab from the 6-year-old
SIR,-Dr Natelson and others (Aug 13, p 404) are correct to point that concentrations of serum cholesterol can vary during the day. It has long been known that simple events, such as venous occlusion during sample collection, can result in raised cholesterol values.1,2 Even when these are avoided, large fluctuations in concentrations of serum total cholesterol and lipoprotein cholesterol out
known.3 In a controlled study,3 where blood samples were taken over 24 hours from 12 healthy people, 13 maturity-onset diabetics, and 14 insulin-requiring diabetics the mean peak-to-nadir changes in total and HDL cholesterol concentrations were 15% and 23%, respectively, of the average 24 hour concentration in normal subjects; larger variations were recorded for diabetics. Only 1 insulin-requiring diabetic did not have significant within-day changes in total cholesterol-and in only 1 control and 1 maturity-onset diabetic was there similar stability for HDL cholesterol. For both total and HDL cholesterol, the pattern of change was for the highest concentrations to be in the evening and for the lowest to be during the early hours of the morning. There was no single time which accurately reflected the avarage 24 hour value, although for most patients a sample at 0800 hours was within 0-3 mmol/1 of the average total cholesterol and within 0-2 mmol/1 of the average HDL cholesterol. Natelson and colleagues point out the implications of fluctuating serum total cholesterol levels for coronary prevention and for treatment advice for individuals. When differences in HDL cholesterol in individuals with and without arteriovascular disease are 0-2-04 MMOI/1,4 ’ knowing that the results from a single sample may be within 02 mmol/1 of the daily average hardly seems good enough. Despite this, and while agreeing that having more and better data would be a good thing, I think that to delay the implementation of cholesterol-lowering strategies would be to exaggerate the importance of these results. are
European Research Institute, DPC/ERI Corp,
(table). RESULTS OF CHLAMYDIA CULTURE
Witney, Oxfordshire OX8 6AN
HB, Lewis B, Pilkington, TRE. The effect of venous occlusion on the level of serum cholesterol. J Atheroscler Res 1961, 1: 85-88 Page IH, Moinuddin M The effect of venous occlusion on serum cholesterol and total protein. a warning Circulation 1962; 25: 651-52. Simpson RW, Carter MD, Moore RA, Penfold WAF. Diurnal changes in plasma lipoproteins in normal subjects and diabetics Diabetalogia 1980; 18: 35-40 Miller NE, Thelle DS, Førde OH, Mjøs OD The Tromso Heart Study High density lipoprotein and coronary heart disease: a prospective case-control study. Lancet 1977, i: 965-67 Rossenr S, Kjellin KG, Mettinger KL, Sidén A, Soderstrom CE Normal serum cholesterol but low HDL cholesterol concentration in young patients with ischaemic cerebrovascular disease. Lancet 1978, i: 577-79.
1. Koerselman
2. 3. 4.
5.
ND
=not
done;
+
=positive for C
trachornatis;
-
=neganve for C crachomatzc
R. A. MOORE