201 the antibiotic was given, but faeces were not cultured at that time. A week later the third abscess was drained. No further infection developed. The ulcers began to heal, and 23 days after admission the patient was discharged. Chemotherapy was given for 4 weeks. The most likely sequence of events is that during a gastroenteritis caused by S. heidelberg a bacteraemic phase occurred. A thrombophlebitis was developing at that time, and the bacteria were trapped in the saphenous vein giving rise to the abscesses.
I thank Mr J. E.
Trapnell for his permission to
report this
case.
Public Health Laboratory, Church Lane,
Heavitree,
J. B. KURTZ
Exeter EX2 5AD.
ESCHERICHIA COLI K1
StR,-Bacon and his colleagues’ noted that agglutination tests on
strains of Escherichia coli indicated the presence of K 1
antigen, but this finding was not confirmed by immunoelectrophoresis. In a study which we have been carrying out on the relationship between E. coli Kl antigen and the group-B polysaccharide of Neisseria meningitidis, we have found that it may be difficult to demonstrate antigens in conventional systems. Other workers2 3 have shown that group-B N. meningitidis and E. coli 07:Kl(L):NM share a heat-labile antigen, and in immunodiffusion experiments Grados and Ewing2 showed a line of precipitation between the E. coli OK antiserum and an extract of group-B N. meningitidis. Kasper et al. showed that
molarity of electrolyte in the gel, the reaction became more pronounced, until finally, in agarose gel made with distilled water, not only was there a strong reaction between Kl antigen and Kl antiserum but there was also a reaction of identify between Kl antiserum and pure-group-B meningococcal polysaccharide (see figure). These results not only confirm the immunochemical identity of group-B meningococcal polysaccharide with the Klantigen of E. coli but also explain why the reaction between rabbit antiserum to the KI antigen and Kl and group-B polysaccharides may not have been seen previously in gels because of their electrolyte content. It might also be significant that Kl antisera produced in rabbits are very variable: the serum used in these studies is the most reactive that we have seen. Preliminary experiments show that by using dilute buffer the reaction between pure group-B meningococcal polysaccharide and Kl or group-B meningococcal antiserum in counterimmunoelectrophoresis is enhanced to a degree similar to that seen in ordinary immunodiffusion. This finding has obvious implications for those working with "difficult" antigen/antibody systems.
Group-B meningococcal polysaccharide and goat antiserum group-B N. meningitidis were provided by Dr E. Gotschlich. Department of Laboratory Medicine, Ruchill Hospital,
Glasgow G20
to
R. J. FALLON
9NB.
Research Department, Wellcome Reagents Limited, Wellcome Research Laboratories,
Beckenham,
M. B. MCILLMURRAY
Kent BR3 3BS.
HEREDITARY RECURRENT HÆMATURIA
SIR,-We have seen three
cases
similar
to
the
one
described
by Dr Argianas and others (Oct. 11, p. 715), in which persons of the same family had relapsing painless haematuria. Nothing was found on detailed laboratory and X-ray examinations (including angiography). Nevertheless, follow-up was suggested and one year later epithelioma of the left kidney was detected in
one
of them. Before haematuria is characterised
as
idio-
pathic investigations must be repeated so that other causes which might be missed in the first instance can be definitely excluded.
immunodiffusion using 1% agarose gel in distilled
water.
1. Group-B meningococcal polysaccharide. 2. K1 antigen. 3. Goat antiserum to group-B N. meningitidis. 4. Antiserum to E. coli 07:K1(L)NM.
the
group-specific polysaccharide of group-B N. meningitidis polymer of N-acetyl neuraminic acid immunochemically similar to the polysaccharide K antigen of E. coli 07:K1(L):NM. In diffusion experiments using rabbit antiserum to N. meningitidis groulrB antigen these workers showed that E. coli K1(L) antigen gave a reaction of identity with all of four different lots of N. meningitidis group-B polysaccharide. In view of these findings one of us (M.B.M.) prepared a rabbit antiserum to E. coli Kl antigen. This serum agglutinated both E. coli 07:Kl(L):NM and group-B N. meningitidis. In conventional immunodiffusion tests using 1% agarose in saline (39 g/1), only a weak line developed between Kl antiserum and crudely purified Kl antigen. However, if immunodiffusion tests were modified by decreasing the
was a
1
Bacon, C. J , Kenna, A. P., Ingham, H. R., Gross, R. J., Rowe, B. Lancet, 1975, ii, 1091. 2. Grades, O., Ewing, W. H. J. infect. Dis. 1970, 122, 100. 3 Kasper, D. L., Winkelhake, J. L., Zollinger, W. D., Brandt, B. L., Artenstein, M. S. J. Immun. 1973, 110, 262.
Department of Urology, State General Hospital, of Athens, Greece
C. DIMOPOULOS N. PANAYOTIDES
ŒDEMA IN COR PULMONALE
SIR,-It is twenty years and
more
since I first
wrote
about
pulmonary hypertension in patients with congenital and acquired heart-disease and chronic lung disease: you might reasonably assume that senility has made me foolish enough to comment critically about your comprehensive editorial (Dec. 27, p. 1289). However, I would like to take you to task over the statement that "Despite a raised pulmonary arterial pressure the cardiac output is usually normal, so that the pulmonary vascular resistance is very high". The pulmonary vascular resistance and the pulmonary arterial blood-pressure are raised in anoxic cor pulmonale! but usually not very high when compared with levels seen in patients with congenital septal defects2 and shunt reversal with idiopathic3 or thromboembolic4 pulmonary hypertension, or quite commonly with mitral stenosis. 1 also think that you have put the cart before the horse, and I would suggest that what you were trying to say was: "Despite an increased pulmonary vascular resistance, priWhitaker, W. Q. Jl Med. 1954, 23, 57. Heath, D., Whitaker, W. Br. Heart J. 1957, 19, 327. 3. Thadani, U., Burrow, C., Whitaker, W., Heath, D. Q. Jl
1. 2.
133. 4.
Olley, P. M., Whitaker, W. Br. Heart J. 1967, 29, 369.
Med.
1975, 44,
I thank Mr J. E.
Trapnell for his permission to
report this
case.
Public Health Laboratory, Church Lane,
Heavitree,
J. B. KURTZ
Exeter EX2 5AD.
ESCHERICHIA COLI K1
StR,-Bacon and his colleagues’ noted that agglutination tests on
strains of Escherichia coli indicated the presence of K 1
antigen, but this finding was not confirmed by immunoelectrophoresis. In a study which we have been carrying out on the relationship between E. coli Kl antigen and the group-B polysaccharide of Neisseria meningitidis, we have found that it may be difficult to demonstrate antigens in conventional systems. Other workers2 3 have shown that group-B N. meningitidis and E. coli 07:Kl(L):NM share a heat-labile antigen, and in immunodiffusion experiments Grados and Ewing2 showed a line of precipitation between the E. coli OK antiserum and an extract of group-B N. meningitidis. Kasper et al. showed that
molarity of electrolyte in the gel, the reaction became more pronounced, until finally, in agarose gel made with distilled water, not only was there a strong reaction between Kl antigen and Kl antiserum but there was also a reaction of identify between Kl antiserum and pure-group-B meningococcal polysaccharide (see figure). These results not only confirm the immunochemical identity of group-B meningococcal polysaccharide with the Klantigen of E. coli but also explain why the reaction between rabbit antiserum to the KI antigen and Kl and group-B polysaccharides may not have been seen previously in gels because of their electrolyte content. It might also be significant that Kl antisera produced in rabbits are very variable: the serum used in these studies is the most reactive that we have seen. Preliminary experiments show that by using dilute buffer the reaction between pure group-B meningococcal polysaccharide and Kl or group-B meningococcal antiserum in counterimmunoelectrophoresis is enhanced to a degree similar to that seen in ordinary immunodiffusion. This finding has obvious implications for those working with "difficult" antigen/antibody systems.
Group-B meningococcal polysaccharide and goat antiserum group-B N. meningitidis were provided by Dr E. Gotschlich. Department of Laboratory Medicine, Ruchill Hospital,
Glasgow G20
to
R. J. FALLON
9NB.
Research Department, Wellcome Reagents Limited, Wellcome Research Laboratories,
Beckenham,
M. B. MCILLMURRAY
Kent BR3 3BS.
HEREDITARY RECURRENT HÆMATURIA
SIR,-We have seen three
cases
similar
to
the
one
described
by Dr Argianas and others (Oct. 11, p. 715), in which persons of the same family had relapsing painless haematuria. Nothing was found on detailed laboratory and X-ray examinations (including angiography). Nevertheless, follow-up was suggested and one year later epithelioma of the left kidney was detected in
one
of them. Before haematuria is characterised
as
idio-
pathic investigations must be repeated so that other causes which might be missed in the first instance can be definitely excluded.
immunodiffusion using 1% agarose gel in distilled
water.
1. Group-B meningococcal polysaccharide. 2. K1 antigen. 3. Goat antiserum to group-B N. meningitidis. 4. Antiserum to E. coli 07:K1(L)NM.
the
group-specific polysaccharide of group-B N. meningitidis polymer of N-acetyl neuraminic acid immunochemically similar to the polysaccharide K antigen of E. coli 07:K1(L):NM. In diffusion experiments using rabbit antiserum to N. meningitidis groulrB antigen these workers showed that E. coli K1(L) antigen gave a reaction of identity with all of four different lots of N. meningitidis group-B polysaccharide. In view of these findings one of us (M.B.M.) prepared a rabbit antiserum to E. coli Kl antigen. This serum agglutinated both E. coli 07:Kl(L):NM and group-B N. meningitidis. In conventional immunodiffusion tests using 1% agarose in saline (39 g/1), only a weak line developed between Kl antiserum and crudely purified Kl antigen. However, if immunodiffusion tests were modified by decreasing the
was a
1
Bacon, C. J , Kenna, A. P., Ingham, H. R., Gross, R. J., Rowe, B. Lancet, 1975, ii, 1091. 2. Grades, O., Ewing, W. H. J. infect. Dis. 1970, 122, 100. 3 Kasper, D. L., Winkelhake, J. L., Zollinger, W. D., Brandt, B. L., Artenstein, M. S. J. Immun. 1973, 110, 262.
Department of Urology, State General Hospital, of Athens, Greece
C. DIMOPOULOS N. PANAYOTIDES
ŒDEMA IN COR PULMONALE
SIR,-It is twenty years and
more
since I first
wrote
about
pulmonary hypertension in patients with congenital and acquired heart-disease and chronic lung disease: you might reasonably assume that senility has made me foolish enough to comment critically about your comprehensive editorial (Dec. 27, p. 1289). However, I would like to take you to task over the statement that "Despite a raised pulmonary arterial pressure the cardiac output is usually normal, so that the pulmonary vascular resistance is very high". The pulmonary vascular resistance and the pulmonary arterial blood-pressure are raised in anoxic cor pulmonale! but usually not very high when compared with levels seen in patients with congenital septal defects2 and shunt reversal with idiopathic3 or thromboembolic4 pulmonary hypertension, or quite commonly with mitral stenosis. 1 also think that you have put the cart before the horse, and I would suggest that what you were trying to say was: "Despite an increased pulmonary vascular resistance, priWhitaker, W. Q. Jl Med. 1954, 23, 57. Heath, D., Whitaker, W. Br. Heart J. 1957, 19, 327. 3. Thadani, U., Burrow, C., Whitaker, W., Heath, D. Q. Jl
1. 2.
133. 4.
Olley, P. M., Whitaker, W. Br. Heart J. 1967, 29, 369.
Med.
1975, 44,
