1152 data revealed that those with distorted red cells had a slightly more severe anaemia and lower values for T4 (Murphy-Pattee) than those without such cells. 3 patients with distorted red cells had haptoglobin and urine haemosiderin determinations and these were normal and negative, respectively. Some of the distorted cells seen resembled schistocytes. However, we could not find any possible mechanism for schistocytosis in our patients. None of them had malignant hypertension, disseminated intravascular coagulation, disseminated carcinomatosis, or prosthetic heart-valves. Some of the red cells also resembled acanthocytes. A common denominator between disorders associated with acanthocytosis, such as hereditary abetalipoproteinsemia and spur-cell anaemia, is the increase in the cholesterol/lecithin ratio, which is felt to play 6 some part in the production of the morphological changed Ishii and Nakao’ demonstrated an increase in red-cell-membrane cholesterol and a decrease in lecithin in hypothyroid patients compared to euthyroid patients. We believe that these preliminary observations warrant additional studies on hypothyroid patients possibly including L.C.A.T. assays and determination of lipoprotein profiles as well as investigation of bile-acid metabolism, all of which play a role in the kinetics of red-cell lipids. Department of Medicine, Bridgeport Hospital, Bridgeport, Connecticut 06602, U.S.A.

PASQUALF E. PFRILLIF

University of Connecticut, Farmington, Connecticut.

CAWILIHAN TFMBRFVII

I A

ENDOSCOPY AND TRANSMISSION OF HEPATITIS B

SIR,-Serum hepatitis can be transmitted by routes other than blood-transfusion, such as scratches, venereal spread, shared toothbrushes, and dental instruments. Endoscopists are aware of the potential risk of hepatitis being acquired via the endoscope, although in a postal survey of 176 patients endoscoped, Axon et a1.B found no case of jaundice reported in the 112 replies received. Endoscopy should be avoided in any patient known to have hepatitis-B (HB) antigena’mia, but it is difficult to screen all patients. Lately we did an emergency endoscopy of the upper gastrointestinal tract of a patient who had had a large haematemesis. Later he was found to have been HBsAg positive on the day of endoscopy. However, 65 more endoscopies had been performed before we knew of this. At the time we cleaned our endoscopy equipment between cases by washing through with water, and between sessions ’Savlon’ (chlorhexidme 0-015, and cetrimide z 15%) solution was used before the water wash. We have followed up the patients who underwent the subsequent endoscopies and were still attending hospital outpatient clinics. In 32 patients we have obtained liver-function tests, and in 31 of these we also obtained HBsAg studies (by

complement fixation, passive hmmagglutination, or crossover immunoelectrophoresis) in the year after exposure. No patient developed either jaundice or abnormal liver function during the follow-up period. However, the 23rd patient, endoscoped and biopsied on the 14th day after our initial case, was found to be HBsAg positive (by passive haemagglutination and radioimmunoassay) 290 days after exposure; studies at 65 days had been negative. In the interval the patient had undergone a further upper-gastrointestinal endoscopy and an inguinal hernia repair (no blood-transfusion was given). We have followed up just under half the patients exposed, and because of the infrequency of visits we cannot say if transient subclinical hepatitis or antigensemia has occurred. Nevertheless, the possibility of HBsAg transfer by the endoCooper, R. A., Diloy-Puray, M., Lando, P , Mortimer, S. G J. clin. 1972, 51, 3182. 6. Cooper, R. A. Sem. Hemat. 1970, 7, 296. 7. Ishii, J., Nakao, K. Tohoku J. exp. Med. 1968, 94, 169 8. Axon, A. T. R., Philips, I., Cotton, P. B., Avery, S. A. Lancet, 1974, 5.

Invest

i,

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our results suggest that the risk is without effective disinfection. We now disinfect with activated glutaraldehyde (’Cidex’), which has been shown to be effective against bacterial contamination ofendoscopes.’ This method of disinfection is also highly effective against many viruses. It is thought likely that the virus of hepatitis would also be susceptible, but proof of this would require an unacceptable trial.

scope

small,

remains, although even

I

Department of Gastroenterology, Walsgrave Hospital, Coventry CV2 2DX.

I. M. MORRIS D. S. CATTLE B. J. SMITS

GLUCOSE-TOLERANCE TESTS IN HL-A-TYPED RELATIVES OF PATIENTS WITH JUVENILE ONSET DIABETES MELLITUS SIR,-An association has been demonstrated between juvenile-onset diabetes mellitus (J.O.D.) and HL-A 8 and W 15 ’1whereas in maturity-onset diabetes (M.O.D.) frequencies of these antigens were within the normal range. Since researchers have looked for an association between j.o.D. and SD-1 and SD-2 locus antigens only, it was of interest to tissuetype j.o.D. patients for SD-3 locus antigens.3 Thereby, we were able to find in j.o.D. patients a statistically significant increase of the SD-3 locus antigen T 3 (p corrected