792
the recovered strain. Two days before the onset of illness, the patient had eaten raw oysters at a local restaurant. He was not taking antacids, but he had had gastric surgery, which predisposes to non-011 V cholerae infection, and chronic cholecystitis, which might be a predisposing factor. As far as we are aware, this is the second reported patient in whom chronic cholecystitis was present as an underlying diseased Our case is typical with respect to timing (summer), age, and history (after consumption of raw shell-fish), and in having chronic underlying factors. We believe that the frequency of non-O1 V cholerae gastroenteritis is difficult to establish because laboratories in most Italian hospitals do not use TCBS medium. Hence the importance of clinical assessment. Thus, in cases such as ours, non-01 V cholerae gastroenteritis should be borne in mind as a possible cause of foodborne gastroenteritis and bacteraemia. Clinicians should alert microbiologists if they suspect vibrio infection, so that TCBS medium is used. We thank Dr Natale Figura for his assistance in the identification of the isolate and Dr Michele Caselli for critical review of the script.
Department of Clinical Microbiology, General Hospital Umberto I°-Torrette, 60020 Ancona, Italy, and Institute of Infectious Diseases, University of Ancona
CLAUDIO PIERSIMONI VALERIA MORBIDUCCI GIORGIO SCALISE
Piergentili P, Castellani M, Fellini RD, et al. Outbreak of Vibrio cholerae non-O:1 gastroenteritis: Italy. MMWR 1981; 30: 373-75. 2. Peterson EM, Jemison-Smith P, De La Maza LM, et al. Cholecystitis: its occurrence 1.
with cholelithiasis associated with a non-O:1Vibrio cholerae. Arch Pathol Lab Med 1982; 106: 300-01.
IVIG to prevent recurrent spontaneous abortion SIR,-With respect to Professor Mueller-Eckhardt and colleagues’ report (Feb 16, p 424), lest we compound the folly further, your readers may need to be reminded that there is no evidence that recurrent abortion unattributable to known causes has an immunological basis; no antibody has been defined that may advantageously mask an offending antigen. Successful pregnancies occur in animals and man in the absence of antibody production, and tender loving care has produced better results than immunotherapy in women so far treated for recurrent abortion. The results Mueller-Eckhardt et al cite for intravenous polyvalent immunoglobulin are no better than one might expect if they had investigated a similar control group. Much as one supports the search for treatment for this distressing problem, to direct our attention first to making a diagnosis might be wiser. Department of Obstetrics and Gynaecology, Cork Regional Hospital, Wilton, Cork, Ireland
D. M.
JENKINS
NMR spectroscopy of plasma during acute rejection of transplanted hearts
Fig 1-Proton NMR spectrum recorded on plasma. Spin-echo sequence after suppression of water signal with a presaturation sequence. Only high-field region (04-24 ppm) is displayed. irradiation
applied for 6 s at the frequency of water through the decoupler channel) and Hahn spin-echo sequence. These spectra were obtained in 48 acquisitions with the following indices: interpulse delay 60 ms, spectrum width 5000 Hz, 90° pulse duration 10 ms, 8 K data table. The NMR spectrum displays several well-defined resonances including those assigned to mobile NAG and NANA residues (fig 1). For all 13 patients in the study variations in (NAG + NANA) /alanine ratio (based on areas of NMR signals) have been compared with variations in isovolumic left-ventricular relaxation time (IVRT) as estimated from doppler echocardiography. Plasma samples were collected on the same day as the doppler and biopsy studies were done. Fig 2 shows typical profiles of (NAG + NANA) /alanine ratio and IVRT in 1 patient over 500 days. The correlation seems best when investigations are done weekly: in our series correlation was good in 5 and acceptable in 3, but the fit was not so good in the 5 patients investigated monthly (or more). The magnitude of the fluctuations in the (NAG + NANA)/alanine ratio varies from patient to patient, so every patient must be monitored individually against his or her own control values. In some cases, infections or inflammatory states unrelated to rejection led to substantial variations so this test cannot be used during the first month after the graft. In all cases, NMR findings were more closely related to doppler indices than to histological results. This preliminary study suggests that proton NMR spectroscopy of the glycosylated moieties of proteins in the plasma may
SiR,—Monitoring of rejection after heart transplantation is currently achieved by a combination of invasive and non-invasive techniques, including repeated endomyocardial biopsy and doppler echocardiography. Eugene et all demonstrated a correlation between variations in proton nuclear magnetic resonance (NMR) signals arising from lipoproteins in plasma and histological grading of endomyocardial biopsy rational. The proton NMR spectrum of plasma also displays two resonances arising from the mobile glycosylated residues N-acetyl-glucosamine (NAG) and N-acetylneuraminic acid (NANA), borne mainly by glycoproteins. Variations in them reflect inflammatory processes and/or activation of immune cells.2,3 In conjunction with biopsy and doppler studies we have analysed by high resolution proton NMR spectroscopy the blood plasma of 13 heart recipients over a period of 2 years and monitored the evolution of the glycosylated residues. Proton NMR spectra were recorded at 400 MHz on a Bruker AM-400-WB spectrometer using a 5 mm probe at about 21°C and a combination of water signal suppression by saturation (continuous
Fig 2-{NAG + NANA)/alanine ratio and IlVR recorded over 500 days.
the recovered strain. Two days before the onset of illness, the patient had eaten raw oysters at a local restaurant. He was not taking antacids, but he had had gastric surgery, which predisposes to non-011 V cholerae infection, and chronic cholecystitis, which might be a predisposing factor. As far as we are aware, this is the second reported patient in whom chronic cholecystitis was present as an underlying diseased Our case is typical with respect to timing (summer), age, and history (after consumption of raw shell-fish), and in having chronic underlying factors. We believe that the frequency of non-O1 V cholerae gastroenteritis is difficult to establish because laboratories in most Italian hospitals do not use TCBS medium. Hence the importance of clinical assessment. Thus, in cases such as ours, non-01 V cholerae gastroenteritis should be borne in mind as a possible cause of foodborne gastroenteritis and bacteraemia. Clinicians should alert microbiologists if they suspect vibrio infection, so that TCBS medium is used. We thank Dr Natale Figura for his assistance in the identification of the isolate and Dr Michele Caselli for critical review of the script.
Department of Clinical Microbiology, General Hospital Umberto I°-Torrette, 60020 Ancona, Italy, and Institute of Infectious Diseases, University of Ancona
CLAUDIO PIERSIMONI VALERIA MORBIDUCCI GIORGIO SCALISE
Piergentili P, Castellani M, Fellini RD, et al. Outbreak of Vibrio cholerae non-O:1 gastroenteritis: Italy. MMWR 1981; 30: 373-75. 2. Peterson EM, Jemison-Smith P, De La Maza LM, et al. Cholecystitis: its occurrence 1.
with cholelithiasis associated with a non-O:1Vibrio cholerae. Arch Pathol Lab Med 1982; 106: 300-01.
IVIG to prevent recurrent spontaneous abortion SIR,-With respect to Professor Mueller-Eckhardt and colleagues’ report (Feb 16, p 424), lest we compound the folly further, your readers may need to be reminded that there is no evidence that recurrent abortion unattributable to known causes has an immunological basis; no antibody has been defined that may advantageously mask an offending antigen. Successful pregnancies occur in animals and man in the absence of antibody production, and tender loving care has produced better results than immunotherapy in women so far treated for recurrent abortion. The results Mueller-Eckhardt et al cite for intravenous polyvalent immunoglobulin are no better than one might expect if they had investigated a similar control group. Much as one supports the search for treatment for this distressing problem, to direct our attention first to making a diagnosis might be wiser. Department of Obstetrics and Gynaecology, Cork Regional Hospital, Wilton, Cork, Ireland
D. M.
JENKINS
NMR spectroscopy of plasma during acute rejection of transplanted hearts
Fig 1-Proton NMR spectrum recorded on plasma. Spin-echo sequence after suppression of water signal with a presaturation sequence. Only high-field region (04-24 ppm) is displayed. irradiation
applied for 6 s at the frequency of water through the decoupler channel) and Hahn spin-echo sequence. These spectra were obtained in 48 acquisitions with the following indices: interpulse delay 60 ms, spectrum width 5000 Hz, 90° pulse duration 10 ms, 8 K data table. The NMR spectrum displays several well-defined resonances including those assigned to mobile NAG and NANA residues (fig 1). For all 13 patients in the study variations in (NAG + NANA) /alanine ratio (based on areas of NMR signals) have been compared with variations in isovolumic left-ventricular relaxation time (IVRT) as estimated from doppler echocardiography. Plasma samples were collected on the same day as the doppler and biopsy studies were done. Fig 2 shows typical profiles of (NAG + NANA) /alanine ratio and IVRT in 1 patient over 500 days. The correlation seems best when investigations are done weekly: in our series correlation was good in 5 and acceptable in 3, but the fit was not so good in the 5 patients investigated monthly (or more). The magnitude of the fluctuations in the (NAG + NANA)/alanine ratio varies from patient to patient, so every patient must be monitored individually against his or her own control values. In some cases, infections or inflammatory states unrelated to rejection led to substantial variations so this test cannot be used during the first month after the graft. In all cases, NMR findings were more closely related to doppler indices than to histological results. This preliminary study suggests that proton NMR spectroscopy of the glycosylated moieties of proteins in the plasma may
SiR,—Monitoring of rejection after heart transplantation is currently achieved by a combination of invasive and non-invasive techniques, including repeated endomyocardial biopsy and doppler echocardiography. Eugene et all demonstrated a correlation between variations in proton nuclear magnetic resonance (NMR) signals arising from lipoproteins in plasma and histological grading of endomyocardial biopsy rational. The proton NMR spectrum of plasma also displays two resonances arising from the mobile glycosylated residues N-acetyl-glucosamine (NAG) and N-acetylneuraminic acid (NANA), borne mainly by glycoproteins. Variations in them reflect inflammatory processes and/or activation of immune cells.2,3 In conjunction with biopsy and doppler studies we have analysed by high resolution proton NMR spectroscopy the blood plasma of 13 heart recipients over a period of 2 years and monitored the evolution of the glycosylated residues. Proton NMR spectra were recorded at 400 MHz on a Bruker AM-400-WB spectrometer using a 5 mm probe at about 21°C and a combination of water signal suppression by saturation (continuous
Fig 2-{NAG + NANA)/alanine ratio and IlVR recorded over 500 days.
