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when dealing with organisms capable of causing disease if inhaled is illustrated by a recent report of a laboratory-acquired meningococcal infection in a worker who had prepared a heavy suspension of organisms for inoculation into another gallery strip 5 test on the open bench. Bovine brucellosis has been virtually eliminated in the UK6and cases of indigenous human disease are uncommon; of 13 cases reported to the Communicable Disease Surveillance Centre in the first nine months of 1991, 11 were contracted abroad. Experience with clinical isolates at any single laboratory in the UK is therefore limited. We echo the advice given by the Oxford laboratory’ regarding precautions when handling cultures referred from areas where brucellosis is endemic and suggest these are extended to encompass specimens and isolates from patients who may have become infected in these areas before presenting to hospitals in the UK. Clinical follow-up has been instituted for operating-theatre personnel present during the laparoscopy and laboratory staff who may have been exposed to aerosols carrying the organism. Those thought to be at risk have been offered serological monitoring although no evidence of disease has been found in the 6 weeks

following possible exposure. We thank Mr Brian Parsons and staff at the Public Health Portsmouth for confirming the identity of this isolate.

Manchester Public Health Laboratory,

Withington Hospital, Manchester M20 8LR, UK

Laboratory

in

V. PEIRIS SUSAN FRASER M. FAIRHURST D. WESTON E. KACZMARSKI

Microbiological test strip (API20NE) identifies Brucella melitensis as Moraxella phenylpyruvica. Commun Dis Rep 1991; 1: 165. 2. Brinley Morgan WJ, Corbel MJ. Brucella infections in man and animals: contagious equine metritis. In: Smith GR, Easmon CSF, eds. Topley and Wilson’s principles of bacteriology, virology and immunity, 8th ed, vol III. London. Edward Arnold, 1. Anon.

1990. 3. Arnow PW, Smaron M, Ormiste V. Brucellosis in a group of travellers to Spain. JAMA 1984; 251: 505-07. 4. Collins CH. Laboratory-acquired infections. London: Butterworths, 1983. 5. Anon. Laboratory-acquired meningococcal infection. Commun Dis Rep 1992; 2: 39. 6. Ministry of Agriculture, Fisheries and Food/Scottish Office Agriculture and Fisheries Department/Welsh Office Agricultural Department. Animal health 1990. report of the Chief Veterinary Officer. London. HM Stationery Office, 1991. 7. Anon. Brucellosis surveillance. Commun Dis Rep 1991; 1: 213.

Ondansetron in carcinoid syndrome SiR,—Carcinoid syndrome is associated with metastatic carcinoid and is said to occur in less than 10% of patients with carcinoid tumours. By this stage the disease is often surgically incurable, but remains slow growing and the abdominal pain, diarrhoea, flushing, wheezing, and sweating pose a difficult challenge to the physician. We report on the use of ondansetron in a patient with this condition. A 58-year-old man had presented with a 6-month history of 14 kg weight loss, watery diarrhoea six times a day, vomiting three times per week, and hot flushes after meals. Ultrasound scan revealed multiple hepatic metastases and biopsy confirmed carcinoid tumour.

He was put on a palliative course of interferon-alpha 3 million units thrice weekly. There was a mild improvement in symptoms but these returned to their previous state within 2 months. He was then put on ondansetron 8 mg three times a day, and he noticed an immediate (same day) improvement in symptoms. The diarrhoea stopped, as did the hot flushes and vomiting, and his appetite returned. 4 weeks later his symptoms are still controlled. 5-hydroxytryptamine (5-HT), histamine, substance P, and prostaglandins have all been implicated as causative factors in the symptoms of carcinoid syndrome. 5-HT and its breakdown products such as urinary 5-hydroxyindoleacetic acid (5-HIAA) have been most consistently shown to be associated with carcinoid syndrome. One study of urinary 5-HIAA measurements showed a sensitivity of 73% and a specificity of 100% in diagnosing carcinoid

syndrome.’1

Various agents have been tried, including corticosteroids, the long-acting somatostatin analogue octreotide. In vitro, somastatin reduces the 5-HT release from carcinoid tumour celIs.2 A 5-HT receptor blocker would therefore seem a sensible therapeutic option, and in our patient a specific receptor (5-HT) blocker produced an impressive response.

phenoxybenzamine, interferon, and

A. J. PLATT R. M. HEDDLE

M. O. RAKE

Kent and

Canterbury Hospital, Canterbury CT1 3NG, UK

H. SMEDLEY

JM, O’Dorsio TM. Role of neuropeptides and serotonin in the diagnosis of carcinoid tumors. Am JMed 1986, 81 (suppl 6b): 41-48. 2. Lawrence JP, Ishizuka J, Haber B, Townsend LM Jr, Thompson JC. The effect of somatostatin on 5-HT release from a carcinoid tumour. Surgery 1990; 108: 1131-35. 1. Feldman

Early confirmation of trisomy 18 in newborn babies SIR,-Dr Bos and colleagues (April 11, p 913) describe the potential value of bone-marrow aspirates for rapid determination of numerical chromosome abnormalities in newborn babies with the external features of trisomy 18. They found that the availability of a result within hours of sampling allowed early decisions about the appropriateness of surgical intervention. We would point out that there are often sufficient numbers of spontaneously dividing cells in a neonatal blood sample to allow rapid karyotyping after direct incubation in culture medium containing colcemid.1 This technique has been used successfully in this and other laboratories for several years. If spare material is available, we routinely attempt direct karyotyping, after overnight incubation in the presence ofcolcemid, for all babies in whom a numerical chromosomal abnormality is suspected. We estimate that in at least 80% of cases, trisomies can be confirmed or excluded the following day on this basis alone, with detailed analysis being done on conventional cultures. In our experience, decisions about ventilation often have to be made immediately, but decisions about surgical intervention can often be delayed to the second day of life; there are few instances where a result a few hours after delivery, rather than the next day, would substantially alter management. When chromosome analysis is needed within hours of delivery bone-marrow aspirates may be of particular value, but we believe that routine collection of cord blood at delivery from any baby with overt congenital abnormalities would, for practical purposes, provide a rapid karyotype without need for what may be a distressing sampling procedure. Northern Region Genetics Service, 19 Claremont Place, Newcastle-upon-Tyne NE2 4AA, UK

J. WOLSTENHOLME I. CROSS

J. GOODSHIP

1. Garnham I, Sutherland GR. Three years’ diagnostic experience with direct karyotyping of neonatal blood. Clin Genet 1990; 38: 371-73.

Congenital abnormalities (VATER) in baby born to mother using lovastatin SIR,-We have encountered an infant with the VATER association (vertebral anomalies, anal atresia, tracheo-oesophageal fistula with oesophageal atresia, renal and radial dysplasias) whose mother had received lovastatin therapy during the first trimester of her pregnancy. A 32-year-old woman was seen by her primary care physician because of progressive weight gain and increased abdominal girth. Laboratory studies revealed hypercholesterolaemia. The woman was started on dextroamphetamine sulphate (Dexedrine) 10 mg daily and lovastatin (Mevacor) 10 mg daily. Her last normal menstrual period had been about 6 weeks before the beginning of the treatment. However, the patient had noticed some spotting 10 days before she saw the physician. Lovastatin and dexedrine were

Ondansetron in carcinoid syndrome.

1416 when dealing with organisms capable of causing disease if inhaled is illustrated by a recent report of a laboratory-acquired meningococcal infec...
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