1336 This study was supported by grants from the National Health and Medical Research Council of Australia, the Victorian Anti-Cancer Council and the Australian Government Department of Veterans’ Affairs. I. Mad. was a Commonwealth Fund scholar and visiting professor.

Requests for reprints should be addressed to T.J.M.

REFERENCES 1. Galasko

Competitive binding of

vitamin-D metabolites to

1,25(OH)2D3

receptor from MCF 7 cells. Values are mean ± SEM.

CS, Burn JI. Hypercalcæmia in patients with advanced mammary cancer. Br Med J 1971; iii: 573-77. 2. Sklarloff DM, Charkes ND. Bone metastases from breast cancer at the time of radical mastectomy. Surg Gynec Obstet 1968; 127: 763-68. 3. Eilon G, Mundy GR. Direct resorption of bone by human breast cancer cells in vitro. Nature 1978; 276: 726-28. 4. Brooks SC, Locke ER, Soule HD. Estrogen receptors in a human cell line (MCF 7) from breast carcinoma. J. Biol Chem 1973; 248: 6251-53. 5. Horwitz KB, McGuire WL. Specific progesterone receptors in human breast cancer. Steroids 1975; 25: 497-505. 6. Goral JE, Wittliff JL. Comparison of glucocorticoid-binding proteins in normal and neoplastic mammary tissues of the rat. Biochemistry 1975; 14: 2944-52.

Bruchovsky N, Sutherland DJA, Meakin JW, Minesita T. Androgen receptors-relationship to growth response and to intracellular androgen transport in nine varieties of the Shionogi mouse mammary carcinoma. Biochim Biophys Acta 1975; 381: 61-71. 8. Lippman ME, Bolan D. Oestrogen-responsive human breast cancer in long

7.

10-10 mol;1 unlabelled 1,25-(OH)2D3 reduced specific binding by about 70%, at least one thousand fold greater concentrations of 25-hydroxyvitamin D3 were required to effect similar competition. An even greater concentration of 24,25-dihydroxyvitamin D3 was required for a similar reduction in specific binding. Various other nonvitamin-D derived steroids including cortisol, oestrogen, progesterone, testosterone, and dihydrotestosterone did not cause significant competition for binding at concentrations up to 10-6mol/1 (results not shown). From the amount of hormone bound at saturation we calculated that there were approximately 4500 receptor binding sites per cell.

term tissue culture. Nature 1975; 256: 592-93 9. Eisman JA, Hamstra AJ, Kream BE, Deluca HF. A sensitive precise and convenient method for determination of 1, 25 dihydroxyvitamin D in human

plasma. Arch Biochem Biophys 1976; 176: 235-43. 10. Eisman JA, Hamstra AJ, Kream BE, Deluca HF. 1,25 dihydroxy vitamin D in biological fluids: A simplified and sensitive assay. Science 1976; 193: 1021-23. 11. Eisman JA, Deluca HF. Intestinal 1,25 dihydroxyvitamin D3 binding protein: specificity of binding. Steroids 1977; 30: 245-57. 12. Kream BE, Reynolds RR, Knutson JC, Eisman JA, Deluca HF. Intestinal cytosol binding of 1,25-dihydroxyvitamm D3 and 25 hydroxyvitamin D3.

Arch Biochem Biophys 1976; 176: 779-87. 13. Procsal DA, Okamura WH, Norman AW. Structural requirements for the interaction of 1&agr;, 25-(OH)2 vitamin D3 with its chick intestinal receptor system. J Biol Chem 1975; 250: 8382-88. 14. Wecksler WR, Mason RS, Norman AW. Specific cytosol receptors for 1,25-dihydroxyvitamin D3 in human intestine. J Clin Endocrinol Metab

1979; 48: 715-17.

DISCUSSION 15.

These experiments show for the first time a highaffinity, low-capacity binding protein specific for 1,25-(OH)2D in a cloned human breast cancer cell line. The MCF 7 cell line has been extensively studied and has been validated as a model for many human breast cancers.8 Further, studies in progress in this laboratory have already shown that our finding is not unique to this cultured cell line, although the incidence of a 1,25-(OH)2D receptor in breast cancer remains to be determined. The relative affinity of this receptor for vitamin-D metabolites is virtually identical with the best characterised 1,25-(OH)2D receptor, that from intestinal cytosol, and is quite different from that of the serum 25-OHD binding protein.l1-14 The receptor is saturated with 1,25-(OH)2D at a concentration (0.4×10-10 mol/1) near normal circulating levels (0. 8 x 10-10 Mol/1).9,10,15 This new cytosol steroid hormone receptor in breast is distinct from the well-characterised oestrogen, progesterone, and glucocorticoid receptors. The presence or absence of the 1,25-(OH)2 vitamin D receptor may prove to be of great clinical importance in detercancer

mining which breast-cancer patients are likely to develop bony complications of their disease. It is also possible that the receptor for 1,25-(OH)2 vitamin D might mediate effects on the tumour cell which are as important for tumour behaviour as those influenced by oestrogen, and thus might explain the failure of some mstrogen-receptor-positive tumours to respond to endocrine therapy.

Brumbaugh PF, Haussler DH, Bursac KM, Haussler MR Filter assay for li, 25-dihydroxyvitamin D3. Utilization of the hormone’s target tissue chromatin receptor. Biochemistry 1974; 13: 4091-97.

Methods and Devices

SIMPLE METHOD FOR EARLY DETECTION OF PERITONITIS IN PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

L. K. CHAN

D. O. OLIVER

Renal Unit, Churchill Hospital,

Oxford

THE main complication of continuous ambulatory peritoneal dialysis (CAPD) in patients with end-stage chronic renal failure is peritonitis, and early detection of the infection is therefore important. Peritoneal effluent cellularity is an important predictor of bacterial peritonitis,’ and this can be tested by medical staff when the patient is admitted to hospital. However, there is a need for a simple and rapid test for patients and nurses. A test strip developed originally for the detection of leucocytes in the urine (’Cytur-Test’, Boehringer Manheim GmbH) was first applied by us to test the peritoneal-dialysate drainage fluid. The test strip detects leucocytes in the fluid by means of a colour reaction. The reaction depends on the presence of

1337 in

granulocytes. These esterases cleave an indoxyl indoxyl so liberated is oxidised to the blue compound, indigo. Peritoneal effluent from patients on CAPD was tested while they were in hospital and at the outpatient clinic. They were then instructed to do it daily at home. The test strip was dipped briefly into fresh uncentrifuged peritoneal effluent, and esterases

ester, and the

the colour of the test patch was read after 5, 10, and 15 min. A colour reaction indicated an increase in leucocytes of more than 25cells/µ1. A total of 200 tests were performed in fifteen patients. Six patients with 46 tests showed an increase in leucocyte count of more than 25/µ1. This was confirmed by direct counting in a counting chamber. Five of these six patients subsequently developed clinical symptoms and signs of peritonitis. Reduction in leucocyte count corresponded with clinical improvement. None of the patients with negative tests had any evidence of

peritonitis.

Reviews of Books The Divine Banquet of the Brain and Other Essays MACDONALD CRITCHLEY, National Hospital for Nervous Diseases, London. New York: Raven Press. 1979. Pp. 267.$19.50.

THE title of this wide-ranging collection of essays was taken from Harvey’s third Lumleian lecture and aptly borrowed by Macdonald Critchley for his Harveian oration wherein he presented a historical survey of brairi structure and function. Other historical studies among this collection include the growth and decline of phrenology, and the neurological tradition at King’s College Hospital. Aphasiology is represented by seven essays on the evolution and future of language, the neurology of psychotic speech, the detection of minimal dysphasia, and the Broca-Dax controversy on the discovery of the speech area. The successful rehabilitation of chronic aphasiacs by intense social stimulation is of considerable practical significance, while accounts of West African drum talk and whistle speech of the Canary Islanders and others reveal the breadth of the author’s interests. Visual preservation, modes of reaction to central blindness, and the frequency of photism in the blind are authoritatively discussed, while other essays deal with aspects of corporeal awareness. The author first encountered the "idea of a presence" in shipwrecked survivors: he goes on to discuss heautoscopy (autoscopia) and the body concept that is discrepant between an individual’s true appearance and the more youthful notion he entertains of himself, a narcissistic tendency often apparent in the self portraits of artists. Related topics include discourses on man’s attitude towards his nose, facial non-recognition (or prosopagnosia), and misoplegia (or the morbid dislike directed towards a paralysed limb). Miss Haversham’s syndrome is taken from Dicken’s Great Expectations and depicts an aged, faded female attired in the fashions of her youth and who had lived as a recluse since her cruel jilting on what was to have been her wedding day. Periodic hypersomnia and megaphagia in adolescent males should rightly be termed the Kleine-Levin-Critchley syndrome since the latter has contributed most to our knowledge of this rare condition. Another study concerns subjects with an inborn indifference to pain, whereas intense pain affected some of these five illustrious neuroluetics: Henrich Heine, Jules de Goncourt, Alphonse Daudet, Guy de Maupassant, and Dan Leno. Other essays deal with idiot-savants, the training of a neurologist, a vivid pen-portrait of the late Gordon Holmes (the author’s chief at Queen Square) the psychopathology of tattooing, and the death from bladder calculus and uraemia of Napoleon III and the dyslexia of his son. Lucid, stimulating, and entertaining, these twenty-eight essays are the quintessence of Macdonald Critchley’s erudition and versality as neurologist, historian, and observer of the human condition.

This test-strip method to detect the presence of leucocytes is simple and quick. It can be done easily by patients on CAPD at home. From our preliminary results it corresponds well with the cell counts in the peritoneal effluent. Similar correlation with the actual leucocyte count was tested in urine specimens.2 All the patients with clinical signs of peritonitis had an increase in leucocyte count in the peritoneal effluent. We thank Test.

Boehringer

Manheim GmbH for the

supply of Cytur-

Requests for reprints should be addressed to L.K.C. REFERENCES 1. 2.

Hurley RM, Muogbo D, Wilson GW, Ali MAM. Peritoneal effluent cellularity: predictor of bacterial peritonitis. Kidney Int 1975; 8: 427. Eine kooperative Studie an elf Zentren. Diagnosis of leucocytes in urine by means ofa test-strip. Dtsch Med Wschr 1979; 104: 1236-40.

Global Signposts to the 21st Century

JOHN A. LORAINE, University of Edinburgh. London: Peter Owen. 1979. Pp. 234. 8.75. IN his latest book Dr Loraine returns to themes on which he has voiced his concern, both in his writings and on public platforms, over many years. In his preface he emphasises the extent to which he has needed to compress his material in order to present the arguments in digestible form. The care with which he has chosen his words is nowhere more evident than in the title. This is not a work of "futurology" but an analysis of some of the worlds’ current predicaments with a shrewd historical and political dissection of their origins. The options open to us for our own and our children’s lifetimes are clearly exposed, but there are few rash predictions as to the likely course of history. Dr Loraine covers such’ seemingly diverse topics as food production, nuclear energy, the economics of the world oil market, population control, and the impact of the environment on the incidence of cancer and ischaemic heart-disease. Each essay is a serious review of the topic, presented with something akin to evangelical fervour. There are no charts, no tables, few footnotes, yet an abundance of facts, and the reader is swept along on a tide of metaphor (not infrequently mixed). Curiously, Dr Loraine is at his least convince. ing in the medically-oriented chapters, possibly because he reflects, quite accurately, uncertainties-for example, about the long-term value of recent developments in contraception, or about dietary influences on coronary-artery disease. It is unfortunate that he should confuse arteriosclerosis with atherosclerosis, and that in discussing the religious and political connotations of birth-control campaigns he should make no reference to the vasectomy programme in Mrs Ghandi’s India. The chapters on energy options, however, more than compensate for lapses elsewhere. They are masterly summaries of highly complex issues and deserve to be widely read, noted, and inwardly digested. Although Dr Loraine does not disguise the fact that the omens for the 21st century are grim, he does remind us of the historical evidence that Homo sapiens is a remarkably adaptable species. He will have to be!

Epilepsies of Childhood Postgraduate Pædiatric Series. NIALL V. O’DONOHOE, Trinity College, Dublin. London and Boston: Butterworth. 1979. Pp. 318. £16. EPILEPSY not only touches almost every aspect of medicine but also has social and educational implications, and Dr O’Donohoe has painted a wide canvas with considerable success. Every chapter contains plenty of facts and advice clearly presented, and a useful reference list. As so often in paediatrics,