Foodborne gastroenteritis due to Norwalk virus in a Winnipeg hotel
the index case. None of the photographs published depict the viruses detected in that person. We mentioned their detection in our article because we realized that the period of shedding was unusually long for this virus. Finally, the comments on the use of human reagents for immunoelectron microscopy require clarification. Using viruses from the feces of the two guests as antigens, Dr. Roger Glass, of the US Centers for Disease Control (CDC), Atlanta, was able to show a rise in antibody titre in serum obtained in the acute (1:20) and the convalescent (1:320) stages from one of the CDC's Norwalk volunteers.
T n o alleviate the concerns expressed by Dr. E. Owen Caul, C.R. Ashley and Dr. Alan Curry in their letter (Can Med Assoc J 1990; 142: 290) about our article (Can Med Assoc J 1989; 140: 146 1-1464) I present electron micrographs (Fig. 1) of feces from two guests at the wedding reception collected 3 days after the onset of illness. I agree that the micrographs published in our article were not properly chosen to show the features of Norwalk-like viruses. These viruses were also de- Laila Sekla, MB, BCh, DTM&H, DM, PhD tected by immunoelectron micros- Associate director copy in feces collected 6 days after Cadham Provincial Laboratory the onset of diarrhea from the Winnipeg, Man. foodhandler suspected of being
Resuscitation from hypothermia-induced cardiac arrest
32 nm of that.: of..+ virse .:'' is pane bttom 1t to .inpanel virse ,am.e...r ini
Fig. 1: Electron micrographs showing small, round, structured viruses in feces of two guests Note ragged edge 30
32 nm tmorphou
vide heat? Were toxicologic studies carried out? What was the ambient temperature? Maybe a miss is as good as a mile, but this was dangerous, expensive and maybe easily avoidable. What led up to this close call? James Campbell, MD, FRCPC Clinical professor of pathology University of Ottawa Ottawa, Ont. Visiting professor of pathology (toxicology) Memorial University of Newfoundland St. John's, Nfld.
[One author responds.] Dr. Campbell's observation regarding the paucity of background facts is quite legitimate. Our exclusion of such facts arose from our desire both to adhere to the CMAJ mandate of brevity in case reports and to avoid disclosing too much of the patient's personal history. The car, pulled off at the side of the road, did not contain any emergency supplies and had run out of gas. The patient, with a history of recurrent depressive illnesses and previous suicide attempts, had been at a social event that evening and had taken an unknown amount of amitriptyline and acetaminophen in a suicide attempt before parking her car. Both drugs were identified in toxicologic studies but not quantitated. The lowest ambient temperature that night was - 1 'C. In this case the ingestion of drugs with or without alcohol was a major factor leading to the hypothermia. The use of drugs or alcohol, or both, is the underlying factor in most of the cases of hypothermia that we have seen.
S urely this article (Can Med Assoc J 1990; 142: 741742), by Drs. Mark R. Kristjanson and Gerald K. Bristow, answers the complaints that are sometimes directed against publication of individual case reports. Especially striking is the punch line: "No one is dead until warm and dead". But for an observant and responsive farmer, responsive police and responsive and observant ambulance personnel the case would have "gone forensic". It would be interesting to have a few more background facts with a view to prevention and undergraduate teaching in foren- Gerald K. Bristow, MD, FRCPC sic medicine. Was the car dis- Professor of anesthesia abled? If so, how and why? Did Associate deanmedical education Postgraduate the driver not have any emergen- Faculty of Medicine cy supplies (e.g., a blanket or University of Manitoba sleeping bag) to preserve or pro- Winnipeg, Man.
CAN MED ASSOC J 1990; 142 (12)