632
known, however, that subclinical infection with rotavirus is in adult
of infected infants even in the presence of serum antibody.8 In 2 mothers, eight-fold and thirtytwo-fold rises in milk antibody titres during the post-partum period were accompanied by four-fold rises in serum fluorescent antibody9 titres. Animal studies indicate that ingestion of rotavirus antibody in milk protects the young.’o-iz A better understanding of the immune response to rotavirus may be important in the future control of infantile gastroenteritis. G. CUKOR N. BLACKLOW F. CAPOZZA University of Massachusetts Medical School, Z. PANJVANI and Memorial Hospital, F. BEDNAREK Worcester, Massachusetts 01605, U.S.A. common
contacts
MORE SEROTYPES OF HUMAN ROTAVIRUS
SIR,-We have reported the existence of two serotypes of human rotavirus and indicated the probability of a third.’ Zissis and Lambert2 also found two different serotypes of human rotavirus and have since described children in a day nursery infected with both serotypes at different times.3 Dr Rodriguez and colleagues (July 1, p. 37) described a child infected with one serotype at 12 weeks and a different serotype at 14 months of age. ROTAVIRUS SEROLOGY
These are smaller differences than we reported before, but based on more experiments by different workers.
are
Regional Virus Laboratory, East Birmingham Hospital, Birmingham B9 5ST
T. H. FLEWETT M. E. THOULESS J. N. PILFOLD A. S. BRYDEN
Department of Microbiology and Immunology, Institute of Medical Science, University of São Paulo, Brazil
J. A. N. CANDEIAS
HEPATOBILIARY SCANNING IN JAUNDICE
SIR--May we take issue with the statement in your editorial (Aug. 26, p. 457) referring to the inadequacy of radionuclide scanning with technetium-99m pyridoxylidene glutamate in jaundiced patients. A principal feature of this technique is that it can be applied in the presence of jaundice-indeed it can differentiate, in a high percentage of cases, between obstructive and non-obstructive jaundice. Our experience’ (correct in 31 out of 35 patients) confirms that of others.23 We believe that this simple, safe technique is an advance in the early assessment of jaundiced patients (as well as those with suspected acute cholecystitis) and will save many of these patients from more invasive investigations and even unnecessary laoarotomv. J. O. M. C. CRAIG Departments of Radiology and Surgery, St Mary’s Hospital, London W2 1NY
J. HINTON F. MURPHY G. GLAZER
ACTIVE CHRONIC HEPATITIS
SIR,—Your editorial (Sept. 2, p. 507) does 1975 i
The numbers represent the
reciprocal
of the
serum
dilution
giving
50% reduction in number of fluorescent foci. Sera 720, 146, and 285 were raised in rabbits against human viruses RH, RB, and MB, respectively. a
Serum 136 is a human convalescent virus 101 was obtained.
serum
from which
rota-
patient rota-
We have found another two serotypes, making a total of four. A third rabbit antiserum was raised against a Birmingham human rotavirus, which was neutralised by neither our type 1 nor type 2 rabbit antiserum. The fourth serum is an infant convalescent serum from Instituto da Crianca, H.C., Faculty of Medicine, University of Sao Paulo, Brazil. The rotavirus obtained from this child was not neutralised by types 1, 2, or 3 sera, but lamentably we do not have enough of this virus to raise a serum, although we had enough to do neutralisation tests. The table shows the average of six values obtained for the reciprocal of the serum dilution causing a 50% reduction in fluorescent foci. In each case the titre of the homologous virus and serum is four times the value with the heterologous virus. 8. Kim, H. W., Brandt, C. D., Kapikian, A. Z., Wyatt, R. G., Arrobio, Rodriguez, W. J., Chanock, R. M., Parrott, R. H. J. Am. med. Ass.
J. O., 1977,
238, 404. Blacklow, N. R., Echeverria, P., Smith,
D. H. Infect. Immun. 1976, 13, 1563. 10. Woode, G. N., Jones, J., Bridger, J. Vet. Rec. 1975, 97, 148. 11. Lecce, J. G., King, M. W., Dorsey, W. E. Science, 1978, 199, 777. 12. Snodgrass, D. R., Wells, P. W. Vet. Rec. 1978, 102, 146.
9.
1. 2. 3. 4.
Thouless, M. E., Bryden, A. S., Flewett, T. H. Lancet, 1978, i, 39. Zissis, G., Lambert, J. P. ibid. p. 39. Fonteyne, J., Zissis, G., Lambert, J. P. ibid. p. 983. Rodriguez, W. J., Kim, H. W., Brandt, C. D., Yolken, R. H., Arrobio, J. O., Kapikian, A. Z., Chanock, R. M., Parrott, R. H. ibid. ii, 37.
paper,^and
we
not
refer
to our
opportunity of reporting the patients treated with cyclophospha-
take this
longer term results in our mide and prednisolone. At that time three of the four patients showed complete clinical, biochemical, and histological recovery and the fourth showed considerable improvement in the biochemical evidence of the disease. In all four patients the diagnosis was confirmed by liver-function tests, serum antibodies, and liver biopsy. The first patient, now aged 72, started treatment in March, 1969. This was discontinued in April, 1974, and she has been symptom-free since. On April 17, 1978, serum bilirubin, alkaline phosphatase, thymol turbidity, aspartate aminotransferase (A.S.T., S.G.O.T.), alanine aminotransferase (A.L.T., S.G.P.T.), albumin, and globulin were all normal, and electrophoresis showed a normal pattern. The second patient, now aged 83, started treatment in May, 1969, and all treatment was stopped on May 1, 1975. Liverfunction tests were then normal but, although she was well on Aug. 2, 1976, her liver-function tests showed: bilirubin 9 µmol/l, alkaline phosphatase 51 i.u./l, (37°c), thymol turbidity 0-5 unit, A.S.T. 136 l.u./l A.L.T. 132 t.u./1, albumin 42 g/l, globulin 42 g/1. Electrophoresis: increased gamma-globulin. Treatment was restarted with cyclophosphamide 25 mg daily and prednisolone 2.5mg three times a day. Tests of liver function became normal by Oct. 4, 1976; treatment was stopped on Oct. 17, 1977. She has remained well since and on June 19, 1978 liver-function tests were normal. The third patient, now aged 58, started treatment in May, 1972. She was well on Oct. 8, 1974, with normal liver-function 1. 2.
Murphy, press).
F.
Hinton, J. Craig, J. O. M. C., Glazer, G. Br. J. Surg. (in the
Matolo, N. M., Stadalmk, R. C., Krohn, K. A., Jansholt, A.-L., DeNardo, G. L., Wolfman, E. F. Surgery, 1976, 80, 317. 3. Williams, J. A. R., Baker, R. J., Walsh, J. F., Marion, M. A. Surgery Gynec. Obstet 1977, 144, 525. 4. Pengelly, C. D. R., Jennings, R. C. Practitioner, 1975, 214, 233.
known, however, that subclinical infection with rotavirus is in adult
of infected infants even in the presence of serum antibody.8 In 2 mothers, eight-fold and thirtytwo-fold rises in milk antibody titres during the post-partum period were accompanied by four-fold rises in serum fluorescent antibody9 titres. Animal studies indicate that ingestion of rotavirus antibody in milk protects the young.’o-iz A better understanding of the immune response to rotavirus may be important in the future control of infantile gastroenteritis. G. CUKOR N. BLACKLOW F. CAPOZZA University of Massachusetts Medical School, Z. PANJVANI and Memorial Hospital, F. BEDNAREK Worcester, Massachusetts 01605, U.S.A. common
contacts
MORE SEROTYPES OF HUMAN ROTAVIRUS
SIR,-We have reported the existence of two serotypes of human rotavirus and indicated the probability of a third.’ Zissis and Lambert2 also found two different serotypes of human rotavirus and have since described children in a day nursery infected with both serotypes at different times.3 Dr Rodriguez and colleagues (July 1, p. 37) described a child infected with one serotype at 12 weeks and a different serotype at 14 months of age. ROTAVIRUS SEROLOGY
These are smaller differences than we reported before, but based on more experiments by different workers.
are
Regional Virus Laboratory, East Birmingham Hospital, Birmingham B9 5ST
T. H. FLEWETT M. E. THOULESS J. N. PILFOLD A. S. BRYDEN
Department of Microbiology and Immunology, Institute of Medical Science, University of São Paulo, Brazil
J. A. N. CANDEIAS
HEPATOBILIARY SCANNING IN JAUNDICE
SIR--May we take issue with the statement in your editorial (Aug. 26, p. 457) referring to the inadequacy of radionuclide scanning with technetium-99m pyridoxylidene glutamate in jaundiced patients. A principal feature of this technique is that it can be applied in the presence of jaundice-indeed it can differentiate, in a high percentage of cases, between obstructive and non-obstructive jaundice. Our experience’ (correct in 31 out of 35 patients) confirms that of others.23 We believe that this simple, safe technique is an advance in the early assessment of jaundiced patients (as well as those with suspected acute cholecystitis) and will save many of these patients from more invasive investigations and even unnecessary laoarotomv. J. O. M. C. CRAIG Departments of Radiology and Surgery, St Mary’s Hospital, London W2 1NY
J. HINTON F. MURPHY G. GLAZER
ACTIVE CHRONIC HEPATITIS
SIR,—Your editorial (Sept. 2, p. 507) does 1975 i
The numbers represent the
reciprocal
of the
serum
dilution
giving
50% reduction in number of fluorescent foci. Sera 720, 146, and 285 were raised in rabbits against human viruses RH, RB, and MB, respectively. a
Serum 136 is a human convalescent virus 101 was obtained.
serum
from which
rota-
patient rota-
We have found another two serotypes, making a total of four. A third rabbit antiserum was raised against a Birmingham human rotavirus, which was neutralised by neither our type 1 nor type 2 rabbit antiserum. The fourth serum is an infant convalescent serum from Instituto da Crianca, H.C., Faculty of Medicine, University of Sao Paulo, Brazil. The rotavirus obtained from this child was not neutralised by types 1, 2, or 3 sera, but lamentably we do not have enough of this virus to raise a serum, although we had enough to do neutralisation tests. The table shows the average of six values obtained for the reciprocal of the serum dilution causing a 50% reduction in fluorescent foci. In each case the titre of the homologous virus and serum is four times the value with the heterologous virus. 8. Kim, H. W., Brandt, C. D., Kapikian, A. Z., Wyatt, R. G., Arrobio, Rodriguez, W. J., Chanock, R. M., Parrott, R. H. J. Am. med. Ass.
J. O., 1977,
238, 404. Blacklow, N. R., Echeverria, P., Smith,
D. H. Infect. Immun. 1976, 13, 1563. 10. Woode, G. N., Jones, J., Bridger, J. Vet. Rec. 1975, 97, 148. 11. Lecce, J. G., King, M. W., Dorsey, W. E. Science, 1978, 199, 777. 12. Snodgrass, D. R., Wells, P. W. Vet. Rec. 1978, 102, 146.
9.
1. 2. 3. 4.
Thouless, M. E., Bryden, A. S., Flewett, T. H. Lancet, 1978, i, 39. Zissis, G., Lambert, J. P. ibid. p. 39. Fonteyne, J., Zissis, G., Lambert, J. P. ibid. p. 983. Rodriguez, W. J., Kim, H. W., Brandt, C. D., Yolken, R. H., Arrobio, J. O., Kapikian, A. Z., Chanock, R. M., Parrott, R. H. ibid. ii, 37.
paper,^and
we
not
refer
to our
opportunity of reporting the patients treated with cyclophospha-
take this
longer term results in our mide and prednisolone. At that time three of the four patients showed complete clinical, biochemical, and histological recovery and the fourth showed considerable improvement in the biochemical evidence of the disease. In all four patients the diagnosis was confirmed by liver-function tests, serum antibodies, and liver biopsy. The first patient, now aged 72, started treatment in March, 1969. This was discontinued in April, 1974, and she has been symptom-free since. On April 17, 1978, serum bilirubin, alkaline phosphatase, thymol turbidity, aspartate aminotransferase (A.S.T., S.G.O.T.), alanine aminotransferase (A.L.T., S.G.P.T.), albumin, and globulin were all normal, and electrophoresis showed a normal pattern. The second patient, now aged 83, started treatment in May, 1969, and all treatment was stopped on May 1, 1975. Liverfunction tests were then normal but, although she was well on Aug. 2, 1976, her liver-function tests showed: bilirubin 9 µmol/l, alkaline phosphatase 51 i.u./l, (37°c), thymol turbidity 0-5 unit, A.S.T. 136 l.u./l A.L.T. 132 t.u./1, albumin 42 g/l, globulin 42 g/1. Electrophoresis: increased gamma-globulin. Treatment was restarted with cyclophosphamide 25 mg daily and prednisolone 2.5mg three times a day. Tests of liver function became normal by Oct. 4, 1976; treatment was stopped on Oct. 17, 1977. She has remained well since and on June 19, 1978 liver-function tests were normal. The third patient, now aged 58, started treatment in May, 1972. She was well on Oct. 8, 1974, with normal liver-function 1. 2.
Murphy, press).
F.
Hinton, J. Craig, J. O. M. C., Glazer, G. Br. J. Surg. (in the
Matolo, N. M., Stadalmk, R. C., Krohn, K. A., Jansholt, A.-L., DeNardo, G. L., Wolfman, E. F. Surgery, 1976, 80, 317. 3. Williams, J. A. R., Baker, R. J., Walsh, J. F., Marion, M. A. Surgery Gynec. Obstet 1977, 144, 525. 4. Pengelly, C. D. R., Jennings, R. C. Practitioner, 1975, 214, 233.
