433 dardise anti-HA titres of I.S.G. used for hepatitis-A laxis, a reference serum of designated titre is needed. This study was supported by Forschungsgemeinschaft.
grant Fr 400/5 from the Deutschen
Zentallabor der Städt Krankenanstalten, 73
prophy-
Esslingen, West Germany
GERT G. FR&Ocaron;SNER HANS HAAS GERHARD HOTZ
had been off therapy for 9 and 2 months, respectively. healthy babies weighing 3000g and 3200g were born in May and July, 1976. Development has been normal, and chromosome banding at 3 and 5 months of age showed normal male karyotypes. Both babies are in good health, as are their mothers. These patients differ from others reported in that intensive therapy was applied. At some times cyclophosphamide caused toxicity and the drug was withdrawn until side-effects disappeared; eventually the drug was discontinued altogether. Both patients are now on oral contraceptives until further experience of pregnancies in mothers with a history of leukxmia becomes available.
they
Two
-
HONEYMOON HEPATITIS who had never had a bloodMarch 10, 1975; she had acute type-B hepatitis 50 days later, confirmed by liver-function tests and detection of hepatitis B surface antigen (HBsAg) of subtype adr in her serum. The clinical course was uneventful; HBsAg disappeared, transaminases returned to normal, and she was discharged fully recovered at the end of June. In an attempt to trace the source of the infection, samples of her family’s sera were tested for HBsAg. Her husband was a symptom-free carrier of HBsAg/adr with e antigen in his serum. Detection of HBsAg subtype adr in the serum of the wife in the acute stage of her illness and in her husband, the development of hepatitis 50 days after the marriage, and the identification of e antigen in the husband’s serum all point to the husband as the source of infection. e antigen, when present in serum containing HBsAg, signals infectivity. 1This view is strengthened by the findings that all sera containing HBsAg and e antigen revealed both HBsAgassociated D.N.A. polymerase3and hepatitis B core antigen4 activities, implicating the presence of hepatitis B virus. In contrast, no such activities were detectable in sera containing HBsAg and anti-e. Carriers of the virus may shed HBsAg into saiiva5 and seminal fluid.6 The spouses of HBsAg carriers are at risk of infection, especially if they lack anti-HBs. Perhaps patients such as ours should be given anti-HBs immunoglobulin and HBsAg vaccine before they marry an HBsAg carrier, particularly one with e antigen in serum.
SIR,-A 21-year-old
woman
transfusion got married
on
Department of Hæmatology, Children’s Hospital, La Plata, Argentina
MANUEL ESTIÚ
MEASURING D.N.C.B. SKIN SENSITIVITY
SiR,—The method of serial in-vitro measurement of dinitrochlorobenzene (D.N.C.B.) sensitivity developed by Hamilton et al.’ will be a very useful tool in the follow-up of immunocompromised patients. We have developed a "poor man’s method" for measuring D.N.C.B. skin reactivity which is similarly helpful in the follow-up of our cancer patients on im-
high
Department of Internal Medicine, Osaka Medical College, Takatsuki City, Osaka, Japan Third Department of Internal Medicine,
University of Tokyo Hepatitis Division, Tokyo Metropolitan Institute of Medical Science
AKIRA OHBAYASHI YASUKIYO NAKAMURA YUJI MATSUO
YUZO MIYAKAWA KIYOSHI BABA MAKOTO MAYUMI
have been successful in leukaemic pa-
tients.’8I would like to report two cases. Two girls, aged 12 and 14, presented in August, 1970, and June, 1972, respec-
tively, and acute lymphocytic leukxmia was diagnosed. Complete remission was, achieved on a regimen of vincristine, prednisone, and daunomycin. The first patient received central-nervous-system therapy in August, 1972, and the second patient had it early in remission, following the Pinkel protocol, which was adopted by this hospital. Maintenance drugs were stopped, and .the patients became pregnant when Okada, K., Kamiyama, I., Inomata, M., Imai, M., Miyakawa, Y., Mayumi, M. New Engl. J. Med. 1976, 294, 746. 2. Alter, H. J., and others, ibid. 1976, 295, 909. 3. Takahashi, K., Imai, M., Tsuda, F., Takahashi, T., Miyakawa, Y., Mayumi,
M. J. Immun. 1976, 117, 102. M., Tachibana, F. C., Moritsugu, Y., Miyakawa, Y., Mayumi, M. Infect. Immun. 1976, 14, 631. 5. Villarejos, V. M., Visona, K. A., Gutierrez, A., Rodriguez, A. New Engl. J. Med. 1974, 291, 1375. 6. Heathcote, J., Cameron, C. H., Dane, D. S. Lancet, 1974, i, 71. 7. Bacon, C., Kernahan, J. Lancet, 1975, ii, 515. 8. Wegelius, R. ibid. p. 1301.
D.N.C.B. skin
testing.
to D.N.C.B. is established by close 2 mg D.N.C.B. (Kodak Chemicals) dissolved in acetone on a 5 x 5 mm filter-paper. This sensitisation patch is held under an airtight plastic dressing for 6 h on the medial aspect of the upper arm. Subsequent challenge is made no earlier than 12 days after sensitisation. Challenge consists of three dilutions of D.N.C.B., 20, 40, or 80 tig, applied on individual patches simultaneously to the contralateral side for 6 h in the same fashion as in sensitisation. Evaluation 48 h after application is by grading: 1+ for visible and palpable outline of patch (reaction on right in figure), 2+ for joining ofoedematous areas on corners of outline of patch (reaction in middle), 3+ for complete even oedema of area (reaction on left), and 4+ for blistering of margins of outline of patch. This method yields a dose-response result for this form of contact sensitivity. contact on
Departments of Pediatrics University of Alberta,
and Radiation
Edmonton, Alberta, Canada T6G 2G3
Oncology,
H. F. PABST R. C. URTASUN
LYMPHOCYTE TRANSFORMATION IN MINIMAL-CHANGE NEPHROTIC SYNDROME
1.
4. Imai,
to
munotherapy. Sensitisation skin
SUCCESSFUL PREGNANCY IN LEUKÆMIA
SIR,-Pregnancies
1+, 2+, and 3+ responses
SIR,-Moorthy et al. reported that plasma from patients minimal-change nephrotic syndrome inhibited the blastogenic response of lymphocytes to phytohaemaglutinin (P.H.A.) with
1. 2.
Hamilton,
Moorthy, 1160.
D. N. H., Ledger, V., Diamandopoulos, A. Lancet, 1976, ii, 1170. A. V., Zimmerman, S. W., Burkholder, P. M. Lancet, 1976, i,
grant Fr 400/5 from the Deutschen
Zentallabor der Städt Krankenanstalten, 73
prophy-
Esslingen, West Germany
GERT G. FR&Ocaron;SNER HANS HAAS GERHARD HOTZ
had been off therapy for 9 and 2 months, respectively. healthy babies weighing 3000g and 3200g were born in May and July, 1976. Development has been normal, and chromosome banding at 3 and 5 months of age showed normal male karyotypes. Both babies are in good health, as are their mothers. These patients differ from others reported in that intensive therapy was applied. At some times cyclophosphamide caused toxicity and the drug was withdrawn until side-effects disappeared; eventually the drug was discontinued altogether. Both patients are now on oral contraceptives until further experience of pregnancies in mothers with a history of leukxmia becomes available.
they
Two
-
HONEYMOON HEPATITIS who had never had a bloodMarch 10, 1975; she had acute type-B hepatitis 50 days later, confirmed by liver-function tests and detection of hepatitis B surface antigen (HBsAg) of subtype adr in her serum. The clinical course was uneventful; HBsAg disappeared, transaminases returned to normal, and she was discharged fully recovered at the end of June. In an attempt to trace the source of the infection, samples of her family’s sera were tested for HBsAg. Her husband was a symptom-free carrier of HBsAg/adr with e antigen in his serum. Detection of HBsAg subtype adr in the serum of the wife in the acute stage of her illness and in her husband, the development of hepatitis 50 days after the marriage, and the identification of e antigen in the husband’s serum all point to the husband as the source of infection. e antigen, when present in serum containing HBsAg, signals infectivity. 1This view is strengthened by the findings that all sera containing HBsAg and e antigen revealed both HBsAgassociated D.N.A. polymerase3and hepatitis B core antigen4 activities, implicating the presence of hepatitis B virus. In contrast, no such activities were detectable in sera containing HBsAg and anti-e. Carriers of the virus may shed HBsAg into saiiva5 and seminal fluid.6 The spouses of HBsAg carriers are at risk of infection, especially if they lack anti-HBs. Perhaps patients such as ours should be given anti-HBs immunoglobulin and HBsAg vaccine before they marry an HBsAg carrier, particularly one with e antigen in serum.
SIR,-A 21-year-old
woman
transfusion got married
on
Department of Hæmatology, Children’s Hospital, La Plata, Argentina
MANUEL ESTIÚ
MEASURING D.N.C.B. SKIN SENSITIVITY
SiR,—The method of serial in-vitro measurement of dinitrochlorobenzene (D.N.C.B.) sensitivity developed by Hamilton et al.’ will be a very useful tool in the follow-up of immunocompromised patients. We have developed a "poor man’s method" for measuring D.N.C.B. skin reactivity which is similarly helpful in the follow-up of our cancer patients on im-
high
Department of Internal Medicine, Osaka Medical College, Takatsuki City, Osaka, Japan Third Department of Internal Medicine,
University of Tokyo Hepatitis Division, Tokyo Metropolitan Institute of Medical Science
AKIRA OHBAYASHI YASUKIYO NAKAMURA YUJI MATSUO
YUZO MIYAKAWA KIYOSHI BABA MAKOTO MAYUMI
have been successful in leukaemic pa-
tients.’8I would like to report two cases. Two girls, aged 12 and 14, presented in August, 1970, and June, 1972, respec-
tively, and acute lymphocytic leukxmia was diagnosed. Complete remission was, achieved on a regimen of vincristine, prednisone, and daunomycin. The first patient received central-nervous-system therapy in August, 1972, and the second patient had it early in remission, following the Pinkel protocol, which was adopted by this hospital. Maintenance drugs were stopped, and .the patients became pregnant when Okada, K., Kamiyama, I., Inomata, M., Imai, M., Miyakawa, Y., Mayumi, M. New Engl. J. Med. 1976, 294, 746. 2. Alter, H. J., and others, ibid. 1976, 295, 909. 3. Takahashi, K., Imai, M., Tsuda, F., Takahashi, T., Miyakawa, Y., Mayumi,
M. J. Immun. 1976, 117, 102. M., Tachibana, F. C., Moritsugu, Y., Miyakawa, Y., Mayumi, M. Infect. Immun. 1976, 14, 631. 5. Villarejos, V. M., Visona, K. A., Gutierrez, A., Rodriguez, A. New Engl. J. Med. 1974, 291, 1375. 6. Heathcote, J., Cameron, C. H., Dane, D. S. Lancet, 1974, i, 71. 7. Bacon, C., Kernahan, J. Lancet, 1975, ii, 515. 8. Wegelius, R. ibid. p. 1301.
D.N.C.B. skin
testing.
to D.N.C.B. is established by close 2 mg D.N.C.B. (Kodak Chemicals) dissolved in acetone on a 5 x 5 mm filter-paper. This sensitisation patch is held under an airtight plastic dressing for 6 h on the medial aspect of the upper arm. Subsequent challenge is made no earlier than 12 days after sensitisation. Challenge consists of three dilutions of D.N.C.B., 20, 40, or 80 tig, applied on individual patches simultaneously to the contralateral side for 6 h in the same fashion as in sensitisation. Evaluation 48 h after application is by grading: 1+ for visible and palpable outline of patch (reaction on right in figure), 2+ for joining ofoedematous areas on corners of outline of patch (reaction in middle), 3+ for complete even oedema of area (reaction on left), and 4+ for blistering of margins of outline of patch. This method yields a dose-response result for this form of contact sensitivity. contact on
Departments of Pediatrics University of Alberta,
and Radiation
Edmonton, Alberta, Canada T6G 2G3
Oncology,
H. F. PABST R. C. URTASUN
LYMPHOCYTE TRANSFORMATION IN MINIMAL-CHANGE NEPHROTIC SYNDROME
1.
4. Imai,
to
munotherapy. Sensitisation skin
SUCCESSFUL PREGNANCY IN LEUKÆMIA
SIR,-Pregnancies
1+, 2+, and 3+ responses
SIR,-Moorthy et al. reported that plasma from patients minimal-change nephrotic syndrome inhibited the blastogenic response of lymphocytes to phytohaemaglutinin (P.H.A.) with
1. 2.
Hamilton,
Moorthy, 1160.
D. N. H., Ledger, V., Diamandopoulos, A. Lancet, 1976, ii, 1170. A. V., Zimmerman, S. W., Burkholder, P. M. Lancet, 1976, i,
