636
cholecystectomy might be expected to heighten the role played by bile acids in the pathogenesis of post-vagotomy diarrhoea.It bile-acid secretion is the only xtiological factor then sufficient quantities of agents which bind these acids should control the diarrhoea. Although cholestyramine improves symptoms in some patients, in others it has little effect; its effect appears to be best in those who have had a cholecystectomy. We suggest that whilst bile acids play an important role in post-vagotomy diarrhoea other factors such as motility disturbances (similar to those seen in the irritable bowel syndrome2) may also be present. The poorer response obtained with aluminium hydroxide in this study is probably a reflection of the dose used. The patients who responded to aluminium hydroxide were those who had also responded to cholestyramine. Our impression is that if the dose were to be doubled or trebled results similar to those with cholestyramine could be achieved-a larger dose is effective after
Preliminary Communications BLOOD-TRANSFUSION IN GROUP-B STREPTOCOCCAL SEPSIS ANN O. SHIGEOKA ROBERT T. HALL HARRY R. HILL Division
of Clinical Immunology, Department of Pediatrics, University of Utah, Salt Lake City; and Children’s Mercy Hospital, University of Missouri, Kansas City, Missouri, U.S.A. and Department of Pathology,
Transfusion of fresh whole blood was evaluated as a means of supplying and opsonins lessening the high mortality of group-B streptococcal sepsis in neonates. Pre-transfusion and post-transfusion sera from 22 infants were examined for the presence of opsonins against group-B organisms. Opsonic activity rose only when donor blood containing heat-stable antibody was administered in high volume (>40% of blood-volume). 9 of 9 infants transfused with
Summary
containing antibody to their infecting strain surseptic episodes. 3 of 6 who received blood lacking antibody to their infecting strain died. blood vived
INTRODUCTION
GRoUp-B streptococci, despite their sensitivity to several antibiotics, are a major cause of morbidity and mortality in neonates and in other patients with comdefence mechanisms.1-7 Patients in whom group-B streptococcal sepsis develops usually lack opsonic antibody to their infecting strain;8 and Lancefield and co-workers9 have shown that mice are protected against such infections by administration of antibody to the organisms. For these reasons we have examined the effects of fresh whole-blood transfusion on serum opsonic activity and on mortality in group-B
promised
streptococcal sepsis. Organisms Reference
Requests
for
reprints should
be addressed
to
T. V. T.
REFERENCES
1.
Taylor,
T. V.,
Lambert,
M.
E., Quereshi, S., Torrance, B. Lancet, 1978,i,
295.
Ayulo, J. A. Am. J. Gastroent. 1972, 57, 207. 3. Duncombe, V M., Bolin, T. D., Davis, A E. Gut, 1977, 18, 531. 4. Sali, A., Murray, W. R., Blackwood, A., Mackay, C. Br J. Surg 1977, 64, 296. 5. Coyne, M. J., Bonorris, G. G., Chung, A., Conley, D. R., Croke, J., Schoenfield, L. H. Gastroenterology, 1976, 71, 68. 6. Conley, D., Coyne, M , Chung, A., Bonorris, G., Schoenfield, L. J. ibid. 71, 72. 7. Johnstone, E. C J psychosom. Res. 1974, 18, 205. 8. Fagerberg, S., Grevsten, S., Johanssen, H., Krauss, U. Gut, 1970, 11, 789. 9 Allan, J. G., Gerskowitch, V. P., Russell, R. I. ibid. 1973, 14, 423. 10. Mekhjian, H. S., Phillips, S. F. Gastroenterology, 1970, 59, 120. 11. Mekhjian, H. S., Phillips, S. F., Hoffman, A. F. J. clin. Invest. 1971, 50, 1569. 12. Sali, A, Watkinson, G., MacKay, C. Gut, 1977, 18A, 419 2.
infected patients were cultured at 37°C in Todd-Hewitt broth for 18 h.8 The organisms were washed and then adjusted to an optical density of 0.9nm (S x 10$to 1 x 109 colony-forming units per ml) in phosphate-buffered saline (P.B.s.). Serum Serum was used immediately after collection or frozen at —70°C. To ensure an intact classical complement pathway we added 0-025 ml of whole human complement (Cordis Laboratories, Miami, Florida), which maximally enhances antibodymediated
opsonisation
cholecystectomy might be expected to heighten the role played by bile acids in the pathogenesis of post-vagotomy diarrhoea.It bile-acid secretion is the only xtiological factor then sufficient quantities of agents which bind these acids should control the diarrhoea. Although cholestyramine improves symptoms in some patients, in others it has little effect; its effect appears to be best in those who have had a cholecystectomy. We suggest that whilst bile acids play an important role in post-vagotomy diarrhoea other factors such as motility disturbances (similar to those seen in the irritable bowel syndrome2) may also be present. The poorer response obtained with aluminium hydroxide in this study is probably a reflection of the dose used. The patients who responded to aluminium hydroxide were those who had also responded to cholestyramine. Our impression is that if the dose were to be doubled or trebled results similar to those with cholestyramine could be achieved-a larger dose is effective after
Preliminary Communications BLOOD-TRANSFUSION IN GROUP-B STREPTOCOCCAL SEPSIS ANN O. SHIGEOKA ROBERT T. HALL HARRY R. HILL Division
of Clinical Immunology, Department of Pediatrics, University of Utah, Salt Lake City; and Children’s Mercy Hospital, University of Missouri, Kansas City, Missouri, U.S.A. and Department of Pathology,
Transfusion of fresh whole blood was evaluated as a means of supplying and opsonins lessening the high mortality of group-B streptococcal sepsis in neonates. Pre-transfusion and post-transfusion sera from 22 infants were examined for the presence of opsonins against group-B organisms. Opsonic activity rose only when donor blood containing heat-stable antibody was administered in high volume (>40% of blood-volume). 9 of 9 infants transfused with
Summary
containing antibody to their infecting strain surseptic episodes. 3 of 6 who received blood lacking antibody to their infecting strain died. blood vived
INTRODUCTION
GRoUp-B streptococci, despite their sensitivity to several antibiotics, are a major cause of morbidity and mortality in neonates and in other patients with comdefence mechanisms.1-7 Patients in whom group-B streptococcal sepsis develops usually lack opsonic antibody to their infecting strain;8 and Lancefield and co-workers9 have shown that mice are protected against such infections by administration of antibody to the organisms. For these reasons we have examined the effects of fresh whole-blood transfusion on serum opsonic activity and on mortality in group-B
promised
streptococcal sepsis. Organisms Reference
Requests
for
reprints should
be addressed
to
T. V. T.
REFERENCES
1.
Taylor,
T. V.,
Lambert,
M.
E., Quereshi, S., Torrance, B. Lancet, 1978,i,
295.
Ayulo, J. A. Am. J. Gastroent. 1972, 57, 207. 3. Duncombe, V M., Bolin, T. D., Davis, A E. Gut, 1977, 18, 531. 4. Sali, A., Murray, W. R., Blackwood, A., Mackay, C. Br J. Surg 1977, 64, 296. 5. Coyne, M. J., Bonorris, G. G., Chung, A., Conley, D. R., Croke, J., Schoenfield, L. H. Gastroenterology, 1976, 71, 68. 6. Conley, D., Coyne, M , Chung, A., Bonorris, G., Schoenfield, L. J. ibid. 71, 72. 7. Johnstone, E. C J psychosom. Res. 1974, 18, 205. 8. Fagerberg, S., Grevsten, S., Johanssen, H., Krauss, U. Gut, 1970, 11, 789. 9 Allan, J. G., Gerskowitch, V. P., Russell, R. I. ibid. 1973, 14, 423. 10. Mekhjian, H. S., Phillips, S. F. Gastroenterology, 1970, 59, 120. 11. Mekhjian, H. S., Phillips, S. F., Hoffman, A. F. J. clin. Invest. 1971, 50, 1569. 12. Sali, A, Watkinson, G., MacKay, C. Gut, 1977, 18A, 419 2.
infected patients were cultured at 37°C in Todd-Hewitt broth for 18 h.8 The organisms were washed and then adjusted to an optical density of 0.9nm (S x 10$to 1 x 109 colony-forming units per ml) in phosphate-buffered saline (P.B.s.). Serum Serum was used immediately after collection or frozen at —70°C. To ensure an intact classical complement pathway we added 0-025 ml of whole human complement (Cordis Laboratories, Miami, Florida), which maximally enhances antibodymediated
opsonisation
