323 ASSESSMENT OF INFLAMMATORY ACTIVITY IN KNEE JOINT

SIR,-A frequent obstacle to the study of arthritis is the lack of objective measures of severity. We have been testing a method for rapid assessment of the inflammatory activity in the knee joint,’ based on the technetium 99m pertechnetate (99"’TCO4 ) uptake technique2 which we modified. Two collimated thallium-activited sodium-iodide crystals were used to detect the y-radiation of the 99ffiTc in the knee joint as a function of time after intravenous injection of 200 tiCi 99C04 -. The patient rested for an hour beforehand to improve the reproducibility of the test. Radioactivity in the knee joint was measured shortly after injection (2tmin) or at 30 min at most. We investigated twenty-three healthy volunteers, twentytwo patients with clinical evidence of monoarticular arthritis, and twenty-four patients with bilateral arthritis. Radioactivity, shortly after injection of 99ffiTc04- was significantly lower in the knee joints of controls (mean 54.2±; S.D. 10.9 c.p.m./[,Ci) than in clinically inflamed knee joints in patients with monoarticular arthritis (93-3±17-7) or bilateral arthritis (96.1±28.7) (P95%

National Naval Medical Center,

H. R. SCHUMACHER

Bethesda, Maryland 20014, U.S.A. Uniformed Services University of the Health Sciences,

T. P. KENEKLIS F. J. BOLLUM

Bethesda, Maryland

Service of Mali/Bamako we analysed, in May and June, 1978, 114 and 108 sera, respectively from children up to three years of age for influenza haemagglutination-inhibiting (H.I.) antibodies. The children frequently had antibodies against A/Victoria 3/75 (77-93%) and A/Texas 1/77 (87-98%) in the May series (see table). The high antibody level for A/Victoria 3/75 accords with serological picture found in another part of Africa.3 The new strain A/USSR 90/77 seems to have reached Mali by mid-1978: in May 5 children out of 114 had protective antibody levels (titre 1:40 or more), and in June the number had increased to 9 out of 108. The incidence of influenza B/Hong Kong 8/73 antibodies is negligible. The geometric mean titres for A/Victoria 3/75 and for A/Texas 1/77 tended to be lower in June than in May. In Senegalbordering Mali, an influenza virus close to A/Texas 1/77 has been isolated from children, though no influenza outbreak had been observed. The future epidemic strain in Mali looks like being A/USSR 90/77. The serological picture in May and June hints at previous epidemics with A/Victoria 3/75 and A/Texas 1/77 in that country. Secteur

no.

Bamako,

3 dela Médécine Socio-Préventive,

Mali

Institute for Vaccinology and Virology, 2000 Hamburg 26, West Germany

D. SANGARE H. ALLERDIST

W. EHRENGUT D. E. SARATEANU

INFLUENZA IN MALI 1978

SIR,-Influenza A virus very frequently shows antigenic variation, and new variants appear in different parts of the world-for instance, the strains A/Victoria 3/75 and A/Texas 1/77 were isolated in West, South, and East Africa.12 The resurgence of A1 (H, N1) influenza virus stimulated us to study the situation in Mali. In cooperation with the Public Health

6.

S. M., Baltimore, 812. 1. W.H.O. wkly epidem. Rec. 2. ibid. p. 107.

Marks,

D., McCaffrey, R. New Engl. J. Med. 1978, 298,

1978, 53, 20.

H.I. ANTIBODY TITRES IN CHILDREN

JUNE,

1978)

0

TO

3

YEARS

(MAY AND

AGRANULOCYTOSIS IN BREAST-CANCER PATIENTS TREATED WITH LEVAMISOLE

SIR,-We share the

concern

of Dr Teerenhovi and col-

leagues (July 15, p. 151)about the high frequency of agranulocytosis among patients with breast cancer treated with levamisole. In May 1977, we started a randomised placebo-controlled double-blind trial for the evaluation of the immunopotentiating effect of levamisole among patients with breast carcinoma receiving postoperative radiotherapy. Of 25 patients entering the study 14 were randomised to receive placebo and 11 levamisole in a dose of 2.5-3 mg/kg body-weight (150-250 mg daily) on two consecutive days every week (Saturdays and Sundays) during the course of radiotherapy and for six months thereafter. In the levamisole group, 2 patients during radiotherapy had marked leukopenia < 2 x 1O9/l and granulocytopenia < 1 x 109 II which recovered on withdrawal of the tablets. A third patient presented, one month after completion of her radiotherapy and while still on levamisole, with severe mouth ulceration, high temperature, and leukopenia 1.9 x 109/1 with total agranulocytosis in the peripheral blood. The patient and her blood count recovered promptly on withdrawal of levamisole. None of these patients had anaemia or thrombocytopenia at any time. A fourth patient had a severe maculopapular rash after the third weekend course of levamisole which was associated with extreme malaise for 48 h, lethargy, and mental disorientation. Her serum-transaminases during this episode rose to 166 units for A.L.T. and 114 units for the A.S.T. but returned to normal on withdrawal of the drug, within two weeks. 5 more patients, a total of 9 out of 11 levamisole treated, complained of excessive fatigue, gastrointestinal disturbances, and flu-like symptoms that necessitated withdrawal of the

drug. No significant leukopenia or granulocytopenia was observed in the placebo group. 1 patient associated tingling in the fingertips and weakness in her legs with placebo, but no objective neurological signs were detected.

3. David-West, T. S., Cooke, A. R. Bull. Wld Hlth Org,

1974, 51, 103.