908

macroaggregated human serum albumin. However, according to the manufacturers (Riker laboratories/3M’s, Loughborough) no reactions to the microspheres have been reported in Britain, although one has been recorded in the agent

U.S.A.

Microspheres are less immunogenic than macroaggregates, but on repeated administration of the microspheres the patient may become sensitised to the protein. However, this patient had not had a purified albumin injection before and so could not have been sensitised in this way. A little over three weeks before the first injection, however, she had had a number of infusions of blood after a retroperitoneal haematoma, and sensitisation may have occurred at that time. On both occasions signs of reaction were not observed until several minutes after the injection. The technique used in some centres of injecting the lung-scanning agent slowly in case anaphylaxis developed would not have prevented a reaction in this patient. Essex County Hospital, Colchester CO3 3NB

STEPHEN J. MATHER

ERYTHROCYTE/PLASMA LITHIUM RATIOS SIR,-Mendels and Frazer’ have suggested a possible correlation of intra-erythrocyte/plasma lithium ratios (Li ratios) with response to Li antidepressant therapy. We also tried to correlate this ratio with the prophylactic effect of Li treatment. However, we obtained unclear results because an unexpectedly large number of our patients did not relapse. However, the three patients with relapses did have low Li ratios; and bipolar patients as a group had, with some overlap, higher Li ratios than those of the unipolar group. The predictive value of the Li ratio in lithium prophylaxis is controversial,3-5 but we believe that more results are needed before a conclusion can be reached. The results presented here are for our first series of patients (eight males, seventeen females, average age 41 years) followed up for 2-4 years, and a second series (eleven males, fourteen females, average age 37) on lithium therapy with a 2-year fol-

Li ratios in relation to

relapse.

more studies of detailed ionic transport activity the cell membrane in the general population and depressed patients are needed.

problems across

of Milan Medical School, Institute of Clinical Psychiatry, 20122 Milano, Italy

University

E. SACCHETTI S. BOTTINELLI L. BELLODI R. GALASSO E. SMERALDI

low-up. Criteria of diagnosis, lithium treatment, and relapseresemble those used by Mendels et al .3 In both series the Li ratio tended to be low in those who relapsed (see figure) (P

Chronic obstructive lung disease after practolol.

908 macroaggregated human serum albumin. However, according to the manufacturers (Riker laboratories/3M’s, Loughborough) no reactions to the microsph...
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