617 Routine laboratory tests were normal. His serum-globulin was15g, l; IgG 265, IgA 23, and IgM 20 mg/dl measured by radial immunodiffusion of serum taken two weeks after freshfrozen plasma. An HB, Ag test on serum was positive at greater than 1/512 Hepatest’, WeIIcome!but HB, antibody radrommmunoassay, Abbott) and HBc antibody crossed immunoelectrophoresis and complement fixation) were not detected. e antigen was detected by immunodiffusion2 and gave lines of identity with positive reference sera. Immune electron microscopy of uncentrifuged serum showed 22 nm particles, tubular forms, and double shelled (Dane) particles. Hepatitis-B specific D.N.A. polymerase activtty,3 measured in counts/min/ml serum, was 5837 (normal 113), the mean value of a series of e/HB,Ag positive patients with chronic active liver disease bemg 1322 (range 480-2984). The architecture of the liver was essentially normal. There was very slight fatty change, the portal tracts showed slight fibrosis associated with scanty mononuclear cell infiltration consisting of lymphocytes and an occasional plasma cell, some of the hepatocvtes were swollen, but there was no definite necrosis of the hepatic cells and no cirrhosis. The appearances

LYMPHOCYTE ABERRATIONS IN

20

AND AFTER INTRA-ARTICULAR

PATIENTS BEFORE COLLOIDAL

INJECTION

OF

YTTRIUM-90

Ausab’

w ere

non-specific.

Tong et al.’ have described rapidly progressive HBsAg-positactive hepatitis in an agammaglobulinæmic paThey suggested that the rapidity of progression of the disease might be attributable to inability, to synthesise IgA and IgG types of HB antibody. Our patient’s continuing good health and the biopsy appearances suggest that such antibodies are not the oniy protective mechanism. It is unlikely that freshfrozen plasma contains a therapeutic amount of HB, antibody. Furthermore the suggestion of Neurath and Strick,’ that e antigen is ar, IgG4; seems no longer tenable.

ive chronic tient.

R. G. CHADWICK H. C. THOMAS

Academic Department of Medicine, Royal Free Hospital. London NW 3 2QG

S. SHERLOCK

CHROMOSOME ABERRATIONS AND INTRA-ARTICULAR YTTRIUM-90 of colloidal radioisotopesfor SIR,—Intra-articular the treatment of per’-irtent synovitis, especially of the knees, has proved of considerable value. Unfortunately injected material may leak into the lymphatic drainage,5 exposing other parts of the body, particularly the regional lymph-nodes, to radiation. the effective dose to the disensed synovium is thus reduced and ’h; resk of rad;ation-induced malignancy elsewhere in the body increased. To confine the radiation exposure to the treated joints, the beta-gamma-emitting nuclide gold-198 has been replaced bv the beta-emitting yttrium-90, ensuring thla: radiation affects areas only within a few millimetres of the and leakage is reduced by immobithe joints with splints or plaster -and confining the patient to bed for about threedays after the injection. In a large cytogenene study of patients treated with either or chromosome aberrations in peripheral-blood lymphocytes were attributed to nuclides which had ieake.i from ike ne of the patients had been rested after the treatment and It was suggested that chromosome aberration might been less if the joints had been immobia -.1 Finlands found that the frequency of was not lower In patients who were after infections despite a very large in the ufnuctide by lymph-nodes. By contrast

gold-198

aberrations

2 Magnius,L.O., Esp mark J

3 Kaplan , P. M.,Green 4

man,

A JImmun. 1972, 109, 1017 L. Gerin, J. L., Purcell, R. H., Robinson, W.

R.

S.J. Virol. 1973, 12. 995. Tong, M. J. Nies K. M. Redeker, A.

Gastroenterology, 1977, 73, 1418. 1973, 32, suppl. 6, p. 13.

5 Williams , E.D.Ann.rheum.dis. 6

Stevensons, A.C.,

8

and others. ibid.

1973, 32, 112 1973, 32, suppl 6. p 13. De la Chapelle, A.,Oka,M. Rekonen, A., Ruotsi, A. ibid 1972, 31, 508.

7 Stevenson ,

A.C.ibid ,

later Finnish study9 on patients treated with yttrium-90 who immobilised for three days showed that aberrations were significantly less frequent than reported in the two earlier papers. This was attributed to the reduced spread of yttrium into the lymphatic system. Lately we have studied 20 patients treated with yttrium-90 and immobilised for three days. Typically 3-5 mCi of yttrium was injected per knee and some patients had both knees treated. Blood for cytogenetic studies was taken immediately before the injection and again after 6 weeks. The net increase in dicentric abnormalities following the treatment was 0011%/mCi and the total of damaged cells containing any unstable chromosome aberrations was a

were

0 - 0 12%/mCi. (see table). These results were significantly lower than the net results in earlier study6 which were 0-066% dicentrics/mCi and

our

0.097% damaged cells/mCi. Patients in the earlier study were treated with yttrium-90 now withdrawn but at that time the preparation of choice. 10 The later patients were treated with the silicate preparation (Radiochemical Centre, Amersham code no. YAS 2P), but it is unlikely that this change lowered the frequency of aberrations, since Gumpel and Stevenson" found approximately constant levels of chromosome damage in rested patients treated with either of these preparations. We therefore conclude that confining patients to bed and immobilising the joint to reduce the leakage of isotope decreases chromosome aberrations in peripheral blood lymphocytes.

resin,

We thank Dr F. M. Andrews of Battle Hospital, Reading, and Dr T. Perera of Woking Victoria Hospital for blood-samples from their

patients. National

Radiological

Protection

D. C. LLOYD E. J. REEDER

Board,

Harwell, Oxfordshire OX11 0RQ. 9. Jalava, S., Salonius, A.-L. Lancet, 1974, i, 807. 10. Gumpel, J. M., Beer, T. C., Crawley, J C. W., Farran,

H. E. A. Br.

J.

Radiol. 1975, 48, 377. 11. Gumpel,

J. M., Stevenson, A. C. Rheumatol. Rehabil. 1975, 14, 7.

Commentary from Westminster From Our Parliamentary

Correspondent

Deteriorating Relations INDUSTRIAL relations in the National Health Service have been deteriorating for several years. Now the unofficial action by telephonists in allowing only clinical calls to and from hospitals and the walkout by porters at Dulwich Hospital are the latest in a long list of disputes which have disrupted the service. But they are just the tip of the iceberg in a service now riddled with minor restrictions, perpetual aggression, and personal frictions, in which the patients invariably suffer. Disruption of one kind or another has become an increasingly familiar tactic by all groups in the N.H.S. from consultants to porters. Many incidents stem from a clash of personalities. Normansfield and Dulwich are two examples. In the latter case, still being investigated, porters walked out

Chromosome aberrations and intra-articular yttrium-90.

617 Routine laboratory tests were normal. His serum-globulin was15g, l; IgG 265, IgA 23, and IgM 20 mg/dl measured by radial immunodiffusion of serum...
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