1312 MERCAPTOETHANOL-SENSITIVE ANTIBODY TO REOVIRUS-LIKE AGENTS IN ACUTE EPIDEMIC GASTROENTERITIS the reovirus-like agents in acute gastroenteritis in infants and young children has been demonstrated by immune electron microscopy,’-3 immunofluorescent techniqueand complement-fixation (c.F.) tests.’I There is no report, however, concerning immunoglobulin classes of the antibody to the reovirus-like agents. In view of the sequential appearance of IgM and IgG antibodies in viral infections, we studied c.F. antibody titres in serum before and after 2-mercaptoethanol (2-M.E.) treatment.

SIR,-The immune response

to

Complement-fixing antibody before and after 2-M.E. treatment. o

before 2-M.E.

treatment.

w

after 2-nt.E. treatment

19 sera were collected from infants with acute epidemic gastroenteritis in Japan.5 c.F. tests were carried out by microtitration, with the pooled faecal virus suspensions as c.F. antigen. The c.F. antibody appeared as early as the third day of the illness, with peak levels from ten to twenty days after onset, which accords with the findings of Flewett et al. by immune electron microscopy. Antibody produced in acute and early convalescent phases was uniformly sensitive to 2-M.E. 2-M.E.-resistant antibody, as well as 2-M.E.-sensitive antibody, apoeared twoweeks after onset and persisted for weeks

(see accompanying figure). The early detection of 2-M.E.-sensitive antibody may indicate a response to the primary infection with reovirus-like agents. In the diagnosis of acute gastroenteritis with reoviruslike agents, the demonstration of early antibody sensitive to 2-M.E.may be

useful, in addition

to

the detection of virus par-

ticles t" fæces

T. KONNO

Department of Pædiatrics and Bacteriology, Tohoku University School of Medicine, Sendai, Japan.

A. IMAI H. SUZUKI N. ISHIDA

1. Flewett, T. H., Bryden, A. S., Davies, H., Woode, G. N., Bridger, J. C., Derrick, J. M. Lancet, 1974, ii, 61. 2. Flewett, T. H., Bryden, A. S., Davies, H., Morris, C. A. ibid. 1975, i, 4. 3. Kapikian, A. Z., Kim, H. W., Wyatt, R. G., Rodriguez, W. J., Ross, S., Cline, W. L., Parrott, R. H., Chanock, R. M. Science, 1974, 185, 1049. 4. Middleton, P. J., Szymanski, M. T., Abbott, G D., Rortolussi, R., Hamilton, J. R. Lancet, 1974, i, 1241. 5. Konno, T., Suzuki, H., Ishida, N. ibid. 1975, i, 918.

VASOACTIVE INTESTINAL PEPTIDE IN CIRRHOSIS

SIR,-Vasoactive intestinal peptide (v.i.p.), a candidate horfirst isolated from porcine small intestine in 1970,’ is widely distributed in the intestine.2 It is thought to be largely inactivated by the liver3 giving rise to the suggestion that its actions are restricted to the portal circulation. Portosystemic shunting of blood may result in failure of inactivation of v.i.p. by the liver. It has been suggested that in these circumstances the known actions of v.i.p. could explain the clinical signs which frequently accompany cirrhosis, including peripheral vasodilatation with a hyperdynamic circulation, renal sodium retention, glucose intolerance and hyperventilation.’ Said et al. have reported increased concentrations of v.i.p. in peripheral blood in patients with cirrhosis. We have measured v.i.p. in fasting peripheral venous blood by radioimmunoassay in 44 patients with clinical liver disease and in 11 controls. Of the patients with liver disease 21 had portosystemic collateral vessels demonstrable by barium swallow, oesophagoscopy, or splenic portography, and another 5 patients had surgically created portocaval anastomoses; 16 patients had portosystemic encephalopathy diagnosed by E.E.G. and other clinical criteria; 15 patients had ascites and 4 were frankly diabetic. There was no significant difference in the mean fasting plasma-v.i.p. between controls (18.4±9.0) and the entire group of patients with liver disease (20-1+8-3), nor was any difference apparent for the subgroups with liver disease and surgical portocaval shunts (21-4+9-7), natural shunts (20-9±8-9), hepatic encephalopathy (19.6±7.5), diabetes (12.9±5.8), or ascites (15.9+6.7). Though v.i.p. concentrations are high in the colon,’ treatment with lactulose did not affect peripheral-blood levels (208±9-4). v.i.p. levels did not show any correlation with other variables in liver disease such as bilirubin (r=0.2). Our results contradict the statement made by Said et al.4 that patients with cirrhosis have raised levels of v.i.p. On the basis of our findings, systemic complications of cirrhosis are unlikely to be in any way related to circulating concentrations

mone

of v.i.p. Department of Medicine, Royal Free Hospital, London NW3.

E. ELIAS

Cobbold Laboratories, Middlesex Hospital, London W1.

S.

Department of Medicine, Hammersmith Hospital,

J. MITCHELL

S. R. BLOOM

London W12.

DANGER OF ASPIRIN DURING PELVIC IRRADIATION

SIR,-Dr Pounder (Nov. 22, p. 1044) in a comment on our (Nov. 15, p. 942) rightly points out the dangers of masking signs of radiation damage by giving acetylsalicylate for diarrhoea. It must, however, be emphasised that such patients are kept under close supervision and that a moderate degree of diarrhoea is acceptable since it is usually temporary and hardly ever leads to long-term complications.

paper

The circumstances which may lead are

to more severe

damage

usually easily recognised:

(1) Previous pelvic surgery causing bowel fixation and therefore higher dose of radiation. Radiotherapy dosage and technique may therefore need to be modified or even abandoned in favour of surgery. 1. Said, S. I., Mutt, V. Science, 1970, 169, 1217. 2. Bloom, S. R. Br. med. Bull. 1974 30, 62. 3. Said, S. I., Mutt, V. Nature, 1970, 225, 863. 4. Said, S. I. and others Clin. Res. 1974, 22, 367a. 5. Bloom, S. R., Bryant, M. G., Polak, J. M. Gut, 1975,

16, 821.

Letter: Vasoactive intestinal peptide in cirrhosis.

1312 MERCAPTOETHANOL-SENSITIVE ANTIBODY TO REOVIRUS-LIKE AGENTS IN ACUTE EPIDEMIC GASTROENTERITIS the reovirus-like agents in acute gastroenteritis in...
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