423 ‘hG3 of complex and expensive monitoring equipment may permit the obstetrician to observe accurately the functioning of the fetal heart right up to the point of death. It is no substitute for effective action, but Johnstone et al. give no hint as to the type of action taken other than it was not by the way of caesarean section. It would be no less helpful to state that the death-rate from pneumonia declined after the introduction of the clinical thermometer. 1 Bunkers
Hill,
R. D. FRANCE
Girton, Cambridge
contained 10-30% of the total zinc, with an apparent molecular weight of 6000-8000. Chromatography of fat-free breast milk showed, as previously describeds a zinc peak eluting at the same volume as the third peak in the duodenal secretions. Although the ligand appears to be present in A.E., preliminary evidence suggests it may be defective in its uptake of zinc. Secretions were incubated with Zn2+ (as zinc sulphate) for 1 h at 37°C and then chromatographed. In all samples there was an increase in the amount of zinc associated with the ligand fraction (see table). After incubation, the amount of UPTAKE OF ZINC BY ZINC BINDING LIGAND
*** This letter has been shown follows.-ED.L
.
to
Dr
Johnstone, whose
reply
SIR,-Of course continuous fetal heart recording equipment does not deliver the baby. It merely makes more information available than does intermittent auscultation. This allows a more accurate diagnosis of fetal distress and, in occasional cases, the recognition of fetal distress which might have escaped detection clinically. Once the diagnosis is made the baby is delivered vaginally or abdominally as appropriate for the stage of labour. A reduction in labour-related deaths of around I/thousand deliveries is quite possible without a statistically significant increase in caesarian-section rate. This is partly because of the numbers involved (another few cxsarian sections would make no statistically significant difference to overall rates) but mostly because the patients sectioned for clinical fetal distress are not always the same patients as those sectioned for fetal distress diagnosed by continuous recording. The latter group probably contains fewer cases where the diagnosis is quite wrong and fewer cases where the decision to deliver is essentially pre-emptive (meconium staining, normal fetal heart-rate) but more cases in which a baby really in jeopardy is detected. This accounts for the small apparent reduction in labour related deaths. Department of Obstetrics and Gynæcology, University of Aberdeen, FRANK D.
Aberdeen AB9 2ZD
’Present address: Department of Obstetrics and Gynaecology, Hospital, PO Box 30588, Nairobi, Kenya.
JOHNSTONE*
Kenyatta National
ZINC BINDING IN HUMAN DUODENAL
SECRETIONS
SiR,—Human milk and
rat
small intestine contain
a
low-
molecular-weight zinc-binding ligand which facilitates zinc absorption in the neonatal rat.’It has been postulated that a similar ligand may be present in human small intestine and that it is absent or defective in acrodermatitis enteropathica (A.E.) The clinical features of this disease are consistent with severe zinc deficiency3 and probably result from an impaired absorption of this metal.4 We have tested this hypothesis by examining zinc-binding in duodenal secretions from healthy volunteers and from three A.E. patients treated with zinc supplements. Secretions were collected from the fasting subjects by duodenal intubation; standard doses of secretin and cholecystokinin were used to stimulate flow. Samples were fractionated on ’Bio-gel P-10’ using 13 mmol/1 ’Tris’ as the eluant. In all samples the zinc eluted in the void volume containing all material with a molecular weight greater than 20 000 daltons, a second peak at approximately 18 000 daltons, and in a third peak, which
All values are mean +S.D.
zinc associated with the ligand in the control samples was more than 10 times that in the A.E. samples. This difference could be explained if less ligand were available for zinc binding in the secretions from the A.E. patients. However, when the results are expressed as a ratio of zinc in the ligand to the maximum absorbance (absorbance at 280 nm was used to monitor protein content) in this fraction, the A.E. values after incubation were still nearly ten-fold lower than the control values. Several workers6have reported that prostaglandin E2 may be involved in zinc binding and absorption. We are also investigating prostaglandins in human duodenal secretions because some A.E. patients have faulty metabolism of arachidonic acid, 8 a precursor of prostaglandins.8 This work is supported by USPHS grant R01-AM-12432 from a grant (RR-69) from the General Clinical Research Centers Program of Research Resources, NIH, and a grant from the Thrasher Research Fund.
NIAMD,
Departments of Pediatrics and Dermatology, University of Colorado Medical Center, and Denver General Hospital, Denver, Colorado, U.S.A.
H.J.Lancet, 1975,i, 855.
CLARE E. CASEY K. M. HAMBIDGE P. A. WALRAVENS A. SILVERMAN
K. H. NELDNER
CARCINOEMBRYONIC ANTIGEN IN PLEURAL EFFUSIONS
SiR,—Dr Stanford and colleagues (July 1, p. 53) found, in 50 patients, high carcinoembryonic antigen (C.E.A.) concentrations in both malignant and inflammatory effusions. The differentiation between these two categories is sometimes especially difficult because the simultaneous presence of effusion and a disease which can produce it does not establish a cause and effect. In 105 patients with pleural effusions we found C.E.A. above 10 ng/ml only in cases of malignant effusions (confirmed by cytology and/or pleural biopsy). Although C.E.A. in pleural effusions seemed very specific for malignant effusions when the 5.
1. Hurley, L. S., Duncan, J. R., Sloan, M. V., Eckhert, C. D. Proc. natn. Acad. Sci. 1977, 74, 3547. 2. Hurley, L. S., Duncan, J. R. Fed. Proc. 1978, 37, 253. 3. Neldner, K. H., Hambidge, K. M. New Engl. J. Med. 1975, 292, 879. 4. Lombeck, I., Schnippering, H. G., Ritzl, F., Feinendegen, L. E., Bremer,
(Z.B.L.) IN HUMAN
DUODENAL SECRETIONS
Eckhert, C. D., Sloan,
M.
V., Duncan, J. R., Hurley, L. S. Science, 1977,
195, 789. 6. 7. 8.
Johnson, P. E., Evans, G. W. Fed. Proc. 1978, 37, 889. Song, M. K., Adham, N. F. Am. J. Physiol. 1978, 234, E99. Hambidge, K. M., Walravens, P. A., Neldner, K. H., Daugherty, N. Trace Element Metabolism in Man and Animals III gessner); p. 413. Freising-Weihenstephan, 1978.
A. in
(edited by M. Kirch-
Hill,
R. D. FRANCE
Girton, Cambridge
contained 10-30% of the total zinc, with an apparent molecular weight of 6000-8000. Chromatography of fat-free breast milk showed, as previously describeds a zinc peak eluting at the same volume as the third peak in the duodenal secretions. Although the ligand appears to be present in A.E., preliminary evidence suggests it may be defective in its uptake of zinc. Secretions were incubated with Zn2+ (as zinc sulphate) for 1 h at 37°C and then chromatographed. In all samples there was an increase in the amount of zinc associated with the ligand fraction (see table). After incubation, the amount of UPTAKE OF ZINC BY ZINC BINDING LIGAND
*** This letter has been shown follows.-ED.L
.
to
Dr
Johnstone, whose
reply
SIR,-Of course continuous fetal heart recording equipment does not deliver the baby. It merely makes more information available than does intermittent auscultation. This allows a more accurate diagnosis of fetal distress and, in occasional cases, the recognition of fetal distress which might have escaped detection clinically. Once the diagnosis is made the baby is delivered vaginally or abdominally as appropriate for the stage of labour. A reduction in labour-related deaths of around I/thousand deliveries is quite possible without a statistically significant increase in caesarian-section rate. This is partly because of the numbers involved (another few cxsarian sections would make no statistically significant difference to overall rates) but mostly because the patients sectioned for clinical fetal distress are not always the same patients as those sectioned for fetal distress diagnosed by continuous recording. The latter group probably contains fewer cases where the diagnosis is quite wrong and fewer cases where the decision to deliver is essentially pre-emptive (meconium staining, normal fetal heart-rate) but more cases in which a baby really in jeopardy is detected. This accounts for the small apparent reduction in labour related deaths. Department of Obstetrics and Gynæcology, University of Aberdeen, FRANK D.
Aberdeen AB9 2ZD
’Present address: Department of Obstetrics and Gynaecology, Hospital, PO Box 30588, Nairobi, Kenya.
JOHNSTONE*
Kenyatta National
ZINC BINDING IN HUMAN DUODENAL
SECRETIONS
SiR,—Human milk and
rat
small intestine contain
a
low-
molecular-weight zinc-binding ligand which facilitates zinc absorption in the neonatal rat.’It has been postulated that a similar ligand may be present in human small intestine and that it is absent or defective in acrodermatitis enteropathica (A.E.) The clinical features of this disease are consistent with severe zinc deficiency3 and probably result from an impaired absorption of this metal.4 We have tested this hypothesis by examining zinc-binding in duodenal secretions from healthy volunteers and from three A.E. patients treated with zinc supplements. Secretions were collected from the fasting subjects by duodenal intubation; standard doses of secretin and cholecystokinin were used to stimulate flow. Samples were fractionated on ’Bio-gel P-10’ using 13 mmol/1 ’Tris’ as the eluant. In all samples the zinc eluted in the void volume containing all material with a molecular weight greater than 20 000 daltons, a second peak at approximately 18 000 daltons, and in a third peak, which
All values are mean +S.D.
zinc associated with the ligand in the control samples was more than 10 times that in the A.E. samples. This difference could be explained if less ligand were available for zinc binding in the secretions from the A.E. patients. However, when the results are expressed as a ratio of zinc in the ligand to the maximum absorbance (absorbance at 280 nm was used to monitor protein content) in this fraction, the A.E. values after incubation were still nearly ten-fold lower than the control values. Several workers6have reported that prostaglandin E2 may be involved in zinc binding and absorption. We are also investigating prostaglandins in human duodenal secretions because some A.E. patients have faulty metabolism of arachidonic acid, 8 a precursor of prostaglandins.8 This work is supported by USPHS grant R01-AM-12432 from a grant (RR-69) from the General Clinical Research Centers Program of Research Resources, NIH, and a grant from the Thrasher Research Fund.
NIAMD,
Departments of Pediatrics and Dermatology, University of Colorado Medical Center, and Denver General Hospital, Denver, Colorado, U.S.A.
H.J.Lancet, 1975,i, 855.
CLARE E. CASEY K. M. HAMBIDGE P. A. WALRAVENS A. SILVERMAN
K. H. NELDNER
CARCINOEMBRYONIC ANTIGEN IN PLEURAL EFFUSIONS
SiR,—Dr Stanford and colleagues (July 1, p. 53) found, in 50 patients, high carcinoembryonic antigen (C.E.A.) concentrations in both malignant and inflammatory effusions. The differentiation between these two categories is sometimes especially difficult because the simultaneous presence of effusion and a disease which can produce it does not establish a cause and effect. In 105 patients with pleural effusions we found C.E.A. above 10 ng/ml only in cases of malignant effusions (confirmed by cytology and/or pleural biopsy). Although C.E.A. in pleural effusions seemed very specific for malignant effusions when the 5.
1. Hurley, L. S., Duncan, J. R., Sloan, M. V., Eckhert, C. D. Proc. natn. Acad. Sci. 1977, 74, 3547. 2. Hurley, L. S., Duncan, J. R. Fed. Proc. 1978, 37, 253. 3. Neldner, K. H., Hambidge, K. M. New Engl. J. Med. 1975, 292, 879. 4. Lombeck, I., Schnippering, H. G., Ritzl, F., Feinendegen, L. E., Bremer,
(Z.B.L.) IN HUMAN
DUODENAL SECRETIONS
Eckhert, C. D., Sloan,
M.
V., Duncan, J. R., Hurley, L. S. Science, 1977,
195, 789. 6. 7. 8.
Johnson, P. E., Evans, G. W. Fed. Proc. 1978, 37, 889. Song, M. K., Adham, N. F. Am. J. Physiol. 1978, 234, E99. Hambidge, K. M., Walravens, P. A., Neldner, K. H., Daugherty, N. Trace Element Metabolism in Man and Animals III gessner); p. 413. Freising-Weihenstephan, 1978.
A. in
(edited by M. Kirch-
