1218
petitive protein-binding assays for cortisol, it is possible to start immediately with treatment while awaiting the results of laboratory diagnosis, which is usually performed within a few hours. If human or rabbit diluted plasma is used as a source of transcortin it is possible to administer intravenously injectable salts of some potent synthetic glucocorticoids-i.e., dexamethasone, betamethasone, or 6-methylprednisolone; unlike prednisolone, these steroids do not interfere with the cortisol assay, since they do not show appreciable affinity for the bind89 ing protein.2
Clinica Medica II, Università degli Studi, Via Genova 3, 10126 Torino,
Italy,
ALBERTO ANGELI ROBERTO FRAJRIA
the coefficient of determination (R2) between change in bodyweight and change in serum-triglyceride level is less than 0.04. Blacket et al. suggest that a larger sample size may produce a statistically significant relationship between these two variables. However, given their earlier cited evidence of a significant reduction in weight and an equally significant reduction in triglyceride level, a sample size of 20 is certainly sufficient for statistical inference. Thus, the probability of obtaining a statistically significant relationship by increasing the sample size is virtually nil. In effect, what this means is that the triglyceride level went down significantly, not because weight also went down significantly, but for one or more other reasons. These reasons cannot be deduced from the published data, but probably could be determined from a proper multivariate analysis of the underlying data on individual patients. 68 Princeton Arms South,
SEPTICÆMIA DUE TO PORCINE STREPTOCOCCI
Cranbury, New Jersey 08512, U.S.A.
SIR Attention has lately been drawn to the pathogenicity porcine streptococcus, Strep. subacidus (Lancefield group R) in man.’ 15 cases of human infection have been recorded, and it is remarkable that all well-documented reports
ELLIOT WETZLER
of the
from the Netherlandsl2and Denmark34 and that nearly all patients had a purulent meningitis. However, we have observed a patient with a clinical picture of severe septicaemia without signs of meningitis.
have
come
The patient was a 24-year-old woman, who was working in a butcher’s shop. 3 days after injuring her right forefinger with the bone of a pork chop, she suddenly felt ill with chills, vomiting, and diarrhoea. About 12 hours later she became hypotensive, and large confluent haemorrhagic areas developed on upper and lower limbs. She complained of extreme pain in both feet. On arrival in our hospital she was in shock. Body-temperature was 38.5°C. Her feet were painful and showed acrocyanosis. The injury of the right forefinger was infected. Leucocytosis of 24 OOO/mm3 with 34% bandforms was present. Although the clinical picture resembled the Waterhouse-Friedrichsen syndrome, the neurologist did not find any symptom of meningitis. Strep. subacidus (Lancefield group R) was cultured from the blood and the infected injury. She recovered after treatment with high doses of penicillin and corticosteroids. Unfortunately necrosis of the distal phalanges of all toes developed during the first week of observation, and signs of demarcation were visible on discharge.
As mentioned by Zanen and Engel,’ it seems unlikey that such infections with porcine streptococci are confined to Denmark and Holland. We wish to call attention again to this infection emphasising, in particular, that meningitis is not M. KLOPPENBURG always present. N. H. MULDER University Hospital, The Netherlands. J. HOUWERZIJL Groningen,
TYPE-IV HYPERLIPIDÆMIA
SIR,-In the article by Professor Blacket and others (Sept. 20, p. 517) I find the statistical analysis both inadequate and fallacious. The authors show the reduction in weight of the 20 men in their sample to be statistically significant (p
petitive protein-binding assays for cortisol, it is possible to start immediately with treatment while awaiting the results of laboratory diagnosis, which is usually performed within a few hours. If human or rabbit diluted plasma is used as a source of transcortin it is possible to administer intravenously injectable salts of some potent synthetic glucocorticoids-i.e., dexamethasone, betamethasone, or 6-methylprednisolone; unlike prednisolone, these steroids do not interfere with the cortisol assay, since they do not show appreciable affinity for the bind89 ing protein.2
Clinica Medica II, Università degli Studi, Via Genova 3, 10126 Torino,
Italy,
ALBERTO ANGELI ROBERTO FRAJRIA
the coefficient of determination (R2) between change in bodyweight and change in serum-triglyceride level is less than 0.04. Blacket et al. suggest that a larger sample size may produce a statistically significant relationship between these two variables. However, given their earlier cited evidence of a significant reduction in weight and an equally significant reduction in triglyceride level, a sample size of 20 is certainly sufficient for statistical inference. Thus, the probability of obtaining a statistically significant relationship by increasing the sample size is virtually nil. In effect, what this means is that the triglyceride level went down significantly, not because weight also went down significantly, but for one or more other reasons. These reasons cannot be deduced from the published data, but probably could be determined from a proper multivariate analysis of the underlying data on individual patients. 68 Princeton Arms South,
SEPTICÆMIA DUE TO PORCINE STREPTOCOCCI
Cranbury, New Jersey 08512, U.S.A.
SIR Attention has lately been drawn to the pathogenicity porcine streptococcus, Strep. subacidus (Lancefield group R) in man.’ 15 cases of human infection have been recorded, and it is remarkable that all well-documented reports
ELLIOT WETZLER
of the
from the Netherlandsl2and Denmark34 and that nearly all patients had a purulent meningitis. However, we have observed a patient with a clinical picture of severe septicaemia without signs of meningitis.
have
come
The patient was a 24-year-old woman, who was working in a butcher’s shop. 3 days after injuring her right forefinger with the bone of a pork chop, she suddenly felt ill with chills, vomiting, and diarrhoea. About 12 hours later she became hypotensive, and large confluent haemorrhagic areas developed on upper and lower limbs. She complained of extreme pain in both feet. On arrival in our hospital she was in shock. Body-temperature was 38.5°C. Her feet were painful and showed acrocyanosis. The injury of the right forefinger was infected. Leucocytosis of 24 OOO/mm3 with 34% bandforms was present. Although the clinical picture resembled the Waterhouse-Friedrichsen syndrome, the neurologist did not find any symptom of meningitis. Strep. subacidus (Lancefield group R) was cultured from the blood and the infected injury. She recovered after treatment with high doses of penicillin and corticosteroids. Unfortunately necrosis of the distal phalanges of all toes developed during the first week of observation, and signs of demarcation were visible on discharge.
As mentioned by Zanen and Engel,’ it seems unlikey that such infections with porcine streptococci are confined to Denmark and Holland. We wish to call attention again to this infection emphasising, in particular, that meningitis is not M. KLOPPENBURG always present. N. H. MULDER University Hospital, The Netherlands. J. HOUWERZIJL Groningen,
TYPE-IV HYPERLIPIDÆMIA
SIR,-In the article by Professor Blacket and others (Sept. 20, p. 517) I find the statistical analysis both inadequate and fallacious. The authors show the reduction in weight of the 20 men in their sample to be statistically significant (p
