1023 our medical colleagues from ordering combined dynamic and static scintigraphy, which can effectively exclude CSH at reasonable cost when CT is not readily avaialble.
age
Division of Nuclear Medicine, Kaiser-Permanente Medical Center, Oakland, California 94611, U.S.A.
activity in SLE and disease activity, circulating immune complexes, natural thymocytotoxic antibody, and susceptibility to infection.
KAZUO OSHIMI MORITO SUMIYA NOBUYUKI GONDA SHOGO KANO FUMIMARO TAKAKU
L. V. DOS REMEDIOS Department of Medicine, Jichi Medical School, Tochigi 329-04, Japan
NATURAL KILLER CELL ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS
SIR,-Natural killer (NK) cells, defined as normal unprimed lymphocytes having the cytotoxic activity against target cells, are suspected as mediators of the first defence mechanism against cancer and viral infections.1,2 Most of their activities in T cells are found in Ty cells-i.e., IgG Fc receptor-bearing T cells in man.3 Since type-C viruses may play a possible pathogenetic role in systemic lupus erythematosus(SLE)’ and the number of T cells has been reported to be decreased in SLE, we have looked at NK cell activity in SLE. NK cell activity fluctuates from experiment to experiment in the same individual and activity may be influenced by age, sex, and treatment, so
IN-VITRO ACTIVITY OF CEFOTAXIME AGAINST GENTAMICIN AND MEZLOCILLIN RESISTANT STRAINS
SIR,-Vanhoof et al.1 have described the efficiency of cefotaxime against Enterobacteriacese: all strains tested were fully sensitive. We have determined minimum inhibitory concentrations (MIC) of cefotaxime, gentamicin, and mezlocillin by a microdilution procedure. 1112 clinical isolates of Staphylococcus aureus, Streptococcus faecalis, Pseudomonas ceruginosa, and Enterobacteriaceae were tested. Of 609 Enterobacteriaceae 31% were resistant to mezlocillin (MIC$: 32 mg/1), 15% to gentamicin (MIC 8 mg/1), and 2% to cefotaxime (MIC 16 mg/1). Amongst the 14 cefotaxime-resistant strains (2%) 10 SUSCEPTIBILITY OF GENTAMICIN
(G) AND MEZLOCILLIN (M)
RESISTANT STRAINS TO CEFOTAXIME
NK cell
activity in four female patients with (a) Age 18; (b) age 28; (c) age 18; (d) age 21.
=
Haller O. Natural killer cells in the mouse: an alternative imsurveillance mechanism? Contemp Topics Immunobiol 1978; 8: 171-201. 2. Santoli D, Koprowski H. Mechanisms of activation of human natural killer cells against tumor and virus-infected cells. Immunol Rev 1979; 44:
Kiesshng R, mune
125-63. Fernandes G, Nair M, Good RA. Spontaneous and antibody-dependent cell-mediated cytotoxicity by human T cell subpopulations. Proc Natl Acad Sci USA 1978; 75: 5137-41. 4. Phillips PE. The virus hypothesis in systemic lupus erythematosus. Ann InternMed 1975; 83: 709-15. 5. Gupta S, Good RA. Subpopulations of human T lymphocytes. I. Studies in immunodeficient patients. Clin Exp Immunol 1977; 30: 222-28. 3.
Gupta S,
I
I
I
SLE.
controls have to be matched for age and sex. With strictly selected controls, we have assayed the NK levels of four untreated patients with active SLE. The patients were all women aged 18-28. In every experiment five healthy female controls were used, matched for the patient’s age 13 years. 200 000 peripheral-blood lymphocytes separated from heparinised whole blood on ’Ficoll-Conray’ gradient were incubated in triplicate for 5 h with 10 000 51Crlabelled K562 or MOLT-4 target cells. % specific SICr release was calculated from the following formula and was considered as NK cell activity: % specific 5 ’Cr release [(E-S)/(M-S)]xlOO, where E was experimental 5’Cr release, S spontaneous 5 ’Cr release, and M maximum S 1Cr release. The results showed that NK levels against K562 and MOLT-4 cells were lower in the patients with SLE than in all normal controls. Santoli and Koprowski2 briefly mentioned similar findings of low NK cell activity in one patient with SLE. If others confirm that NK activity is definitely low in SLE the next step’would be to study the relation between NK 1.
I
were
Enterobactenaceae, 2 Citrobacter sp., and 2 Poteus vul-
garis. Cephalosporins
are less toxic than aminoglycosides, and the small percentage of resistant strains could make cefotaxime of value for the treatment of severe infections with multiresistant bacteria. For this reason, we investigated the susceptibility to cefotaxime of clinical isolates resistant to gentamicin and mezlocillin (table). Cefotaxime was especially effective against P. mirabilis: 100% inhibition was achieved at concentrations of 0-125 mg/1. For mezlocillin-resistant Escherichia coli 2 mgll was necessary, whereas gentamicin-resistant strains were fully inhibited at 0-25 mg/1. In these isolates Klebsiella posed problems : 60% were mezlocillin resistant, 38% gentamicin resistant. Cefotaxime inhibited all these isolates at 2 mg/1 concentration. The picture for Serratia was similar. However, less than 50% bf gentamicin or mezlocillin resistant Enterobacteriaceae could be inhibited with cefotaxime. Cefotaxime is a cephalosporin with some activity against Ps. a-ruginosa but the aminoglycosides, ticarcillin, azlocillin, and piperacillin are still
1. Vanhoof R, Butzler JP, Yourassowsky E. In-vitro activity of porin (HR 756) and cefazolin. Lancet 1978; ii: 209.
new
cephalos-
1024
superior. Cefotaxime (and all the aminoglycosides) are ineffective against Strep.faecalis. Cefotaxime is more active against Enterobacteriaceae than are other cephalosporins, acylureido-penicillins, and aminoglycosides. Further clinical studies are necessary the excellent in-vitro properties of cefotaxime replace the aminoglycosides.
to
show whether that it can
mean
Institute of Medical Microbiology, Technical University, D-8000 Munich 80, West Germany
I. BRAVENY H. DICKERT
PRIMARY CARPAL STENOSIS AS A CAUSE OF "IDIOPATHIC" CARPAL-TUNNEL SYNDROME
SIR,-The carpal-tunnel syndrome is the
most common
nerve-entrapment syndrome and may be caused by widely differing lesions. In about 50% of patientsthe aetiology is not clear. Such patients with "idiopathic" carpal-tunnel syndrome are often females approaching the menopause. The symptoms tend to be bilateral but commonly more severe in the dominant limb.’ Stenosis of the carpal canal as a result of trauma, osteoarthritis of the wrist joint, and neoplasms have all been recorded as leading to carpal tunnel syndrome.2 We therefore examined the cross-sectional areas of the carpal canal in seven female patients with "idiopathic" carpal-tunnel syndrome and in a group of twelve age-matched female and six male controls by computerised axial tomography (CT 1010 F3C). The diagnosis of carpal-tunnel syndrome was based on clinical history and findings and electrodiagnostic studies. Patients who may have had one of the recognised lesions leading to the carpal-tunnel syndrome were excluded. Both hands of each patient and of controls were examined. The radiographs of the cross-sections were mounted and projected to a table digitiser connected to a computer (Digital Equipment Corporation PDP 31/34). Because the flexor retinaculum was not always clearly visible on the radiographs, a line was drawn from the scaphoid tubercle to the pisiform bone and from the trapezium to the hook of the hemate corresponding to the anatomical attachments of the carpal ligament. The area enclosed by the carpal bones and this line was measured from the radiographs. The proximal carpal-tunnel cross-sectional area (pisiform bone to the tubercle of the scaphoid) of the female patients was 1428±4.6 mm2 (mean+SEM), and this was significantly smaller (p
age
Division of Nuclear Medicine, Kaiser-Permanente Medical Center, Oakland, California 94611, U.S.A.
activity in SLE and disease activity, circulating immune complexes, natural thymocytotoxic antibody, and susceptibility to infection.
KAZUO OSHIMI MORITO SUMIYA NOBUYUKI GONDA SHOGO KANO FUMIMARO TAKAKU
L. V. DOS REMEDIOS Department of Medicine, Jichi Medical School, Tochigi 329-04, Japan
NATURAL KILLER CELL ACTIVITY IN SYSTEMIC LUPUS ERYTHEMATOSUS
SIR,-Natural killer (NK) cells, defined as normal unprimed lymphocytes having the cytotoxic activity against target cells, are suspected as mediators of the first defence mechanism against cancer and viral infections.1,2 Most of their activities in T cells are found in Ty cells-i.e., IgG Fc receptor-bearing T cells in man.3 Since type-C viruses may play a possible pathogenetic role in systemic lupus erythematosus(SLE)’ and the number of T cells has been reported to be decreased in SLE, we have looked at NK cell activity in SLE. NK cell activity fluctuates from experiment to experiment in the same individual and activity may be influenced by age, sex, and treatment, so
IN-VITRO ACTIVITY OF CEFOTAXIME AGAINST GENTAMICIN AND MEZLOCILLIN RESISTANT STRAINS
SIR,-Vanhoof et al.1 have described the efficiency of cefotaxime against Enterobacteriacese: all strains tested were fully sensitive. We have determined minimum inhibitory concentrations (MIC) of cefotaxime, gentamicin, and mezlocillin by a microdilution procedure. 1112 clinical isolates of Staphylococcus aureus, Streptococcus faecalis, Pseudomonas ceruginosa, and Enterobacteriaceae were tested. Of 609 Enterobacteriaceae 31% were resistant to mezlocillin (MIC$: 32 mg/1), 15% to gentamicin (MIC 8 mg/1), and 2% to cefotaxime (MIC 16 mg/1). Amongst the 14 cefotaxime-resistant strains (2%) 10 SUSCEPTIBILITY OF GENTAMICIN
(G) AND MEZLOCILLIN (M)
RESISTANT STRAINS TO CEFOTAXIME
NK cell
activity in four female patients with (a) Age 18; (b) age 28; (c) age 18; (d) age 21.
=
Haller O. Natural killer cells in the mouse: an alternative imsurveillance mechanism? Contemp Topics Immunobiol 1978; 8: 171-201. 2. Santoli D, Koprowski H. Mechanisms of activation of human natural killer cells against tumor and virus-infected cells. Immunol Rev 1979; 44:
Kiesshng R, mune
125-63. Fernandes G, Nair M, Good RA. Spontaneous and antibody-dependent cell-mediated cytotoxicity by human T cell subpopulations. Proc Natl Acad Sci USA 1978; 75: 5137-41. 4. Phillips PE. The virus hypothesis in systemic lupus erythematosus. Ann InternMed 1975; 83: 709-15. 5. Gupta S, Good RA. Subpopulations of human T lymphocytes. I. Studies in immunodeficient patients. Clin Exp Immunol 1977; 30: 222-28. 3.
Gupta S,
I
I
I
SLE.
controls have to be matched for age and sex. With strictly selected controls, we have assayed the NK levels of four untreated patients with active SLE. The patients were all women aged 18-28. In every experiment five healthy female controls were used, matched for the patient’s age 13 years. 200 000 peripheral-blood lymphocytes separated from heparinised whole blood on ’Ficoll-Conray’ gradient were incubated in triplicate for 5 h with 10 000 51Crlabelled K562 or MOLT-4 target cells. % specific SICr release was calculated from the following formula and was considered as NK cell activity: % specific 5 ’Cr release [(E-S)/(M-S)]xlOO, where E was experimental 5’Cr release, S spontaneous 5 ’Cr release, and M maximum S 1Cr release. The results showed that NK levels against K562 and MOLT-4 cells were lower in the patients with SLE than in all normal controls. Santoli and Koprowski2 briefly mentioned similar findings of low NK cell activity in one patient with SLE. If others confirm that NK activity is definitely low in SLE the next step’would be to study the relation between NK 1.
I
were
Enterobactenaceae, 2 Citrobacter sp., and 2 Poteus vul-
garis. Cephalosporins
are less toxic than aminoglycosides, and the small percentage of resistant strains could make cefotaxime of value for the treatment of severe infections with multiresistant bacteria. For this reason, we investigated the susceptibility to cefotaxime of clinical isolates resistant to gentamicin and mezlocillin (table). Cefotaxime was especially effective against P. mirabilis: 100% inhibition was achieved at concentrations of 0-125 mg/1. For mezlocillin-resistant Escherichia coli 2 mgll was necessary, whereas gentamicin-resistant strains were fully inhibited at 0-25 mg/1. In these isolates Klebsiella posed problems : 60% were mezlocillin resistant, 38% gentamicin resistant. Cefotaxime inhibited all these isolates at 2 mg/1 concentration. The picture for Serratia was similar. However, less than 50% bf gentamicin or mezlocillin resistant Enterobacteriaceae could be inhibited with cefotaxime. Cefotaxime is a cephalosporin with some activity against Ps. a-ruginosa but the aminoglycosides, ticarcillin, azlocillin, and piperacillin are still
1. Vanhoof R, Butzler JP, Yourassowsky E. In-vitro activity of porin (HR 756) and cefazolin. Lancet 1978; ii: 209.
new
cephalos-
1024
superior. Cefotaxime (and all the aminoglycosides) are ineffective against Strep.faecalis. Cefotaxime is more active against Enterobacteriaceae than are other cephalosporins, acylureido-penicillins, and aminoglycosides. Further clinical studies are necessary the excellent in-vitro properties of cefotaxime replace the aminoglycosides.
to
show whether that it can
mean
Institute of Medical Microbiology, Technical University, D-8000 Munich 80, West Germany
I. BRAVENY H. DICKERT
PRIMARY CARPAL STENOSIS AS A CAUSE OF "IDIOPATHIC" CARPAL-TUNNEL SYNDROME
SIR,-The carpal-tunnel syndrome is the
most common
nerve-entrapment syndrome and may be caused by widely differing lesions. In about 50% of patientsthe aetiology is not clear. Such patients with "idiopathic" carpal-tunnel syndrome are often females approaching the menopause. The symptoms tend to be bilateral but commonly more severe in the dominant limb.’ Stenosis of the carpal canal as a result of trauma, osteoarthritis of the wrist joint, and neoplasms have all been recorded as leading to carpal tunnel syndrome.2 We therefore examined the cross-sectional areas of the carpal canal in seven female patients with "idiopathic" carpal-tunnel syndrome and in a group of twelve age-matched female and six male controls by computerised axial tomography (CT 1010 F3C). The diagnosis of carpal-tunnel syndrome was based on clinical history and findings and electrodiagnostic studies. Patients who may have had one of the recognised lesions leading to the carpal-tunnel syndrome were excluded. Both hands of each patient and of controls were examined. The radiographs of the cross-sections were mounted and projected to a table digitiser connected to a computer (Digital Equipment Corporation PDP 31/34). Because the flexor retinaculum was not always clearly visible on the radiographs, a line was drawn from the scaphoid tubercle to the pisiform bone and from the trapezium to the hook of the hemate corresponding to the anatomical attachments of the carpal ligament. The area enclosed by the carpal bones and this line was measured from the radiographs. The proximal carpal-tunnel cross-sectional area (pisiform bone to the tubercle of the scaphoid) of the female patients was 1428±4.6 mm2 (mean+SEM), and this was significantly smaller (p
