983 disaccharidase activity drops abruptly
20
at
weeks, presumably
when the fetus stops defxcating. Section de Génétique Médicale, Centre de Recherche Pédiatrique,
M. POTIER L. DALLAIRE S. B. MELANÇON
Hôpital Sainte-Justine, Montréal H3T 1C5, Québec, Canada
GROUP-B STREPTOCOCCI AT A LONDON HOSPITAL
SIR,—Group-B streptococci have emerged as important pathogens in the newborn. We have looked through the records to see if there has been a general increase in prevalence in this hospital or an increase among obstetric and neonatal patients. All haemolytic streptococci isolated from any site and all streptococci, whether haemolytic or not, when isolated in pure culture from a site normally sterile (e.g., blood and urine) have been identified by Lancefield grouping for many years. Computer-produced statistics are available from 1972, with a gap in
strains are included whether there was evidence of infection or not. There is no evidence for increasing prevalence. If the species had increased in virulence one might have expected an apparent increase in prevalence due, for example, to increased infection of the throat or urinary tract leading to increased investigation. During the past few years group-B streptococcal infection has been the commonest bacterial cause of death in the neonatal unit. The most likely reason for increased pathogenicity in neonates is, we think, the increased efficiency of rescue procedures resulting in a larger number of small premature babies who are especially at risk. All strains isolated from neonates in this hospital have been sensitive to penicillin. We therefore think that treatment of the mother directly membranes rupture or labour begins (whichever is the earlier) followed by treatment of the baby after delivery is indicated for all small premature babies. Group-B streptococcus is sometimes isolated from the umbilicus or ear of older neonates-which is not surprising since the organism is the most common hxmolytic streptococcus found in the vagina-but these babies come to no harm. We have no evidence of cross-infection with this species in our neonatal wards but no doubt such infection could happen as it does with other potential pathogens.
group-B
E. J. STOKES S. MEHTAR*
University College Hospital, London WC1 * Present address: don N1.
Department
of
Microbiology, Whittington Hospital,
Lon-
DARK-BROWN AMNIOTIC FLUID
SIR,-Dark-brown amniotic fluid is occasionally found at diagnostic amniocentesis done early in the second trimester. My colleagues and I have commented brieflyl on the possible significance of this, and I now present details of our observations.
Fig.1-Group-B streptococci as % of total isolates.
Fig. 2--,Group-B streptococci isolated stetric patients. 1974 when
some
records
were
from neonatal and ob
lost due
to
computer
change-
over.
The number of strains isolated monthly (repeats from the patient not included) in each year calculated from May to the end of April were as follows: 1972-73 highest number 20, lowest 7; in 1975-76 highest 31, lowest 10; and in 1976-77 highest 34, lowest 12. Fig. 1 shows the prevalence expressed as a percentage of all positive cultures. Fig. 2 shows the prevalence as a percentage of all isolates found in specimens received from the obstetric and neonatal wards. All same
Twenty-six patients were studied who, at amniocentesis at 14-20 weeks’ gestation, gave amniotic-fluid samples which were very dark brown in colour and which also often contained a fine, whitish sediment. One sample contained a trace of fresh red blood-cells. Sixteen of these fluids, including the one with the fresh red blood-cells, had alpha-fetoprotein (A.F.P.) values which were normal for the gestation. The mean value was 21 ug/ml. Ten fluids had very high A.F.P. values, the mean being 430 µg/ml. The sixteen patients with normal A.F.P. values were delivered of apparently healthy, singleton infants, within the normal weight range, at, or around, term. The ten with the raised A.F.P. levels all aborted severely macerated fetuses, 1½ 7 weeks after the amniocentesis. None of these fetuses had any congenital abnormality, but they were at an earlier stage of development than expected from their alleged gestational age. The dark-brown colour of the amniotic fluid is presumably due to old haemoglobin derived from an intra-amniotic haemorrhage some time before amniocentesis. It seems, however, that this finding should cause concern for the wellbeing of the fetus only if it is associated with a very high A.F.P level, these two observations signifying that the fetus is dying or dead. This information has been of use to the obstetricians in assessing the condition of the fetus. More recently, the last three patients in this group also underwent routine ultrasonography before amniocentesis. In each case no fetal heart beat could be detected. By contrast, the 29 cases of living fetuses with open neuraltube defects I have examined have never been associated with amniotic fluids of this colour. The liquor of anencephalics is usually red, being stained with fresh red blood-cells, presum1.
Blunt, S., Berry, A. C., Seller, M. J., Vaughan Williams, C. A. J. med. Genet. 1977, 14, 232.
984
ably from the area cerebrovasculosa which is open floor of the fetal cranium.
exposed
on
the
CHROMOSOME 1 IN CERVICAL CARCINOMA
SIR,—Little is known about specific chromosome changes in forms of cancer. Chromosome no. 1 is the one altered in carcinoma of the ovary,’ bladder2 and breast.3 We have now found abnormal or extra no. 1 chromosomes in each of 14 consecutive near-diploid carcinomas of the uterine cervix (see table). 5 tumours had trisomy for no. 1 but banded preparations were too poor to reveal structural
Pædiatric Research Unit,
the
Guy’s Hospital,
most
London SE1 9RT
MARY SELLER
ABO BLOOD-GROUP DISTRIBUTION AND HEART-DISEASE
common
frequently
NO.
SIR,—Mitchell1 has reported a strong positive association between ischsmic heart-disease (I.H.D.) mortality in England, Wales, and Scotland and the prevalence of blood-group 0. In a partial correlation analysis, he showed that when allowance is made for the effect of water hardness the association between i.H.D. mortality and % group 0 is little diminished and that allowance for frequency of blood-group 0 had little effect on the association between water hardness and I.H.D.
1
CHROMOSOMES IN CERVICAL CARCINOMA
mortality. We have studied2 the relationship between I.H.D. mortality and water calcium, twelve other water trace-elements, mean annual rainfall, mean annual temperature, and a socioeconomic index derived by West and Lowe.3 There was a strong negative association between I.H.D. mortality and water calcium which could not be explained in terms of the other variables. As the 61 towns in our study were among the 81 used by Mitchell, we have reanalysed our data with % bloodgroup 0 as an additional variable. Regression analysis shows that % group 0 partially explains the variation in I.H.D. mortality but does not remove the effect of calcium. Furthermore the contribution of blood-group to the regression was less than that of calcium, and was more influenced by other independent variables. This suggests that while % blood-group 0 may make an independent contribution to the differences in I.H.D. mortality, it is confounded with the other variables, and to a greater degree than is calcium. Our results and conclusions are therefore broadly in accord with those of Mitchell. However, the interrelationships between the independent variables make studies of this kind difficult to interpret. Whilst acknowledging that Mitchell has discovered an interesting association, we must agree with Allan4that further studies on other European populations are desirable. P. C. ELWOOD M.R.C. Epidemiology Unit, A. S. ST. LEGER Cardiff CF2 3AS Tenovus Research Institute, Cardiff
M. MORTON
BLOOD-GROUP A AND GIARDIASIS
SIR,—Barnes and KayS found an association between Giardia lamblia infestation and blood-group A, and suggested that similarity between parasite and blood-group antigens prevented immunological recognition of the parasite. However, the association might also be explained by a weakening of the normal gut defence mechanisms in these patients. Acids in gastric secretions are important in this defence and I have found achlorhydria in a large proportion of the patients with Salmonella, Shigella, and Giardia infections, even in the convalescent stage. Achlorhydria has a higher than normal frequency in people with blood-group A. Such people are thus likely to be at risk from enteric infections such as G. lamblia. Clinic of Infectious Diseases. Boden Central Hospital, 96100 Boden, Sweden
1. Mitchell, J. R. A. Lancet, 1977, i, 295. 2. Elwood, P. C., St. Leger, A. S., Morton, M. Br. J. prev. 178. 3. West, R. R., Lowe, C. R. Int. J. Epidem. 1976, 5, 195. 4. Allan, T. M. Lancet, 1977, i, 541. 5. Barnes, G. L., Kay, R. ibid. p. 808.
O. PAULSEN
soc.
Med.
1977, 31,
5
tumours
had
trisomy for chromosome
1 but gave
inadequate banded
preparations. abnormalities. Of the remainder (see table), isochromosomes were found in three tumours, 2 for the long arm and 1 for the short arm. In tumours with high chromosome numbers, structurally changed, and/or a relative excess of normal no. 1 chromosomes, were frequently present. In an anaplastic malignant small round-cell tumour involving the vault of the vagina and base of the bladder in a patient aged 68, the modal chromosome number was 47 and the only abnormality in G-banded preparations was an extra no.l-derived chromosome in which the short arm was replaced by most of a long arm of the same chromosome. It thus had an almost completely duplicated long arm and resembled an isochromosome i(lq) except that the near-centromeric heterochromatic band (q 12) was not duplicated. Abnormalities of chromosome no. 1 have been found in several tumours but not in chronic leukaemia and myeloproliferative disorders, suggesting that they are associated with the later stages of malignant transformation.4 We have, however, found a lp- chromosome in a cervical carcinoma. There may be a relationship between heteromorphism for the heterochromatic region of chromosome no. 1,4 pericentric inversions of this regionsand an increased risk of cancer.1.s Department of Cancer Research, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN
N. B. ATKIN MARION C. BAKER
RESEARCH ON ALIMENTARY CANCER accrues from detailed studies of rarities than from the commonplace. You note (Sept. 24, p. 645) the expense and doubt the cost effectiveness of epidemiological studies in alimentary cancer. More then may be learnt from detailed studies of the few individuals who acquire alimentary
SIR,-More knowledge
1. Atkin, N. B., Pickthall, V. J. Hum. Genet. 1977, 38, 25. 2. Atkin, N. B., Baker, M. C. Cytobios (in the press). 3. Cruciger, Q. V. J., Pathak, S., Cailleau, R. Cytogenet. Cell Genet. 1976, 17, 231. 4. Atkin, N. B. Br. med. J. 1977, i, 358. 5. Atkin, N. B., Baker, M. C. Cytogenet. Cell Genet. (in the press).
20
at
weeks, presumably
when the fetus stops defxcating. Section de Génétique Médicale, Centre de Recherche Pédiatrique,
M. POTIER L. DALLAIRE S. B. MELANÇON
Hôpital Sainte-Justine, Montréal H3T 1C5, Québec, Canada
GROUP-B STREPTOCOCCI AT A LONDON HOSPITAL
SIR,—Group-B streptococci have emerged as important pathogens in the newborn. We have looked through the records to see if there has been a general increase in prevalence in this hospital or an increase among obstetric and neonatal patients. All haemolytic streptococci isolated from any site and all streptococci, whether haemolytic or not, when isolated in pure culture from a site normally sterile (e.g., blood and urine) have been identified by Lancefield grouping for many years. Computer-produced statistics are available from 1972, with a gap in
strains are included whether there was evidence of infection or not. There is no evidence for increasing prevalence. If the species had increased in virulence one might have expected an apparent increase in prevalence due, for example, to increased infection of the throat or urinary tract leading to increased investigation. During the past few years group-B streptococcal infection has been the commonest bacterial cause of death in the neonatal unit. The most likely reason for increased pathogenicity in neonates is, we think, the increased efficiency of rescue procedures resulting in a larger number of small premature babies who are especially at risk. All strains isolated from neonates in this hospital have been sensitive to penicillin. We therefore think that treatment of the mother directly membranes rupture or labour begins (whichever is the earlier) followed by treatment of the baby after delivery is indicated for all small premature babies. Group-B streptococcus is sometimes isolated from the umbilicus or ear of older neonates-which is not surprising since the organism is the most common hxmolytic streptococcus found in the vagina-but these babies come to no harm. We have no evidence of cross-infection with this species in our neonatal wards but no doubt such infection could happen as it does with other potential pathogens.
group-B
E. J. STOKES S. MEHTAR*
University College Hospital, London WC1 * Present address: don N1.
Department
of
Microbiology, Whittington Hospital,
Lon-
DARK-BROWN AMNIOTIC FLUID
SIR,-Dark-brown amniotic fluid is occasionally found at diagnostic amniocentesis done early in the second trimester. My colleagues and I have commented brieflyl on the possible significance of this, and I now present details of our observations.
Fig.1-Group-B streptococci as % of total isolates.
Fig. 2--,Group-B streptococci isolated stetric patients. 1974 when
some
records
were
from neonatal and ob
lost due
to
computer
change-
over.
The number of strains isolated monthly (repeats from the patient not included) in each year calculated from May to the end of April were as follows: 1972-73 highest number 20, lowest 7; in 1975-76 highest 31, lowest 10; and in 1976-77 highest 34, lowest 12. Fig. 1 shows the prevalence expressed as a percentage of all positive cultures. Fig. 2 shows the prevalence as a percentage of all isolates found in specimens received from the obstetric and neonatal wards. All same
Twenty-six patients were studied who, at amniocentesis at 14-20 weeks’ gestation, gave amniotic-fluid samples which were very dark brown in colour and which also often contained a fine, whitish sediment. One sample contained a trace of fresh red blood-cells. Sixteen of these fluids, including the one with the fresh red blood-cells, had alpha-fetoprotein (A.F.P.) values which were normal for the gestation. The mean value was 21 ug/ml. Ten fluids had very high A.F.P. values, the mean being 430 µg/ml. The sixteen patients with normal A.F.P. values were delivered of apparently healthy, singleton infants, within the normal weight range, at, or around, term. The ten with the raised A.F.P. levels all aborted severely macerated fetuses, 1½ 7 weeks after the amniocentesis. None of these fetuses had any congenital abnormality, but they were at an earlier stage of development than expected from their alleged gestational age. The dark-brown colour of the amniotic fluid is presumably due to old haemoglobin derived from an intra-amniotic haemorrhage some time before amniocentesis. It seems, however, that this finding should cause concern for the wellbeing of the fetus only if it is associated with a very high A.F.P level, these two observations signifying that the fetus is dying or dead. This information has been of use to the obstetricians in assessing the condition of the fetus. More recently, the last three patients in this group also underwent routine ultrasonography before amniocentesis. In each case no fetal heart beat could be detected. By contrast, the 29 cases of living fetuses with open neuraltube defects I have examined have never been associated with amniotic fluids of this colour. The liquor of anencephalics is usually red, being stained with fresh red blood-cells, presum1.
Blunt, S., Berry, A. C., Seller, M. J., Vaughan Williams, C. A. J. med. Genet. 1977, 14, 232.
984
ably from the area cerebrovasculosa which is open floor of the fetal cranium.
exposed
on
the
CHROMOSOME 1 IN CERVICAL CARCINOMA
SIR,—Little is known about specific chromosome changes in forms of cancer. Chromosome no. 1 is the one altered in carcinoma of the ovary,’ bladder2 and breast.3 We have now found abnormal or extra no. 1 chromosomes in each of 14 consecutive near-diploid carcinomas of the uterine cervix (see table). 5 tumours had trisomy for no. 1 but banded preparations were too poor to reveal structural
Pædiatric Research Unit,
the
Guy’s Hospital,
most
London SE1 9RT
MARY SELLER
ABO BLOOD-GROUP DISTRIBUTION AND HEART-DISEASE
common
frequently
NO.
SIR,—Mitchell1 has reported a strong positive association between ischsmic heart-disease (I.H.D.) mortality in England, Wales, and Scotland and the prevalence of blood-group 0. In a partial correlation analysis, he showed that when allowance is made for the effect of water hardness the association between i.H.D. mortality and % group 0 is little diminished and that allowance for frequency of blood-group 0 had little effect on the association between water hardness and I.H.D.
1
CHROMOSOMES IN CERVICAL CARCINOMA
mortality. We have studied2 the relationship between I.H.D. mortality and water calcium, twelve other water trace-elements, mean annual rainfall, mean annual temperature, and a socioeconomic index derived by West and Lowe.3 There was a strong negative association between I.H.D. mortality and water calcium which could not be explained in terms of the other variables. As the 61 towns in our study were among the 81 used by Mitchell, we have reanalysed our data with % bloodgroup 0 as an additional variable. Regression analysis shows that % group 0 partially explains the variation in I.H.D. mortality but does not remove the effect of calcium. Furthermore the contribution of blood-group to the regression was less than that of calcium, and was more influenced by other independent variables. This suggests that while % blood-group 0 may make an independent contribution to the differences in I.H.D. mortality, it is confounded with the other variables, and to a greater degree than is calcium. Our results and conclusions are therefore broadly in accord with those of Mitchell. However, the interrelationships between the independent variables make studies of this kind difficult to interpret. Whilst acknowledging that Mitchell has discovered an interesting association, we must agree with Allan4that further studies on other European populations are desirable. P. C. ELWOOD M.R.C. Epidemiology Unit, A. S. ST. LEGER Cardiff CF2 3AS Tenovus Research Institute, Cardiff
M. MORTON
BLOOD-GROUP A AND GIARDIASIS
SIR,—Barnes and KayS found an association between Giardia lamblia infestation and blood-group A, and suggested that similarity between parasite and blood-group antigens prevented immunological recognition of the parasite. However, the association might also be explained by a weakening of the normal gut defence mechanisms in these patients. Acids in gastric secretions are important in this defence and I have found achlorhydria in a large proportion of the patients with Salmonella, Shigella, and Giardia infections, even in the convalescent stage. Achlorhydria has a higher than normal frequency in people with blood-group A. Such people are thus likely to be at risk from enteric infections such as G. lamblia. Clinic of Infectious Diseases. Boden Central Hospital, 96100 Boden, Sweden
1. Mitchell, J. R. A. Lancet, 1977, i, 295. 2. Elwood, P. C., St. Leger, A. S., Morton, M. Br. J. prev. 178. 3. West, R. R., Lowe, C. R. Int. J. Epidem. 1976, 5, 195. 4. Allan, T. M. Lancet, 1977, i, 541. 5. Barnes, G. L., Kay, R. ibid. p. 808.
O. PAULSEN
soc.
Med.
1977, 31,
5
tumours
had
trisomy for chromosome
1 but gave
inadequate banded
preparations. abnormalities. Of the remainder (see table), isochromosomes were found in three tumours, 2 for the long arm and 1 for the short arm. In tumours with high chromosome numbers, structurally changed, and/or a relative excess of normal no. 1 chromosomes, were frequently present. In an anaplastic malignant small round-cell tumour involving the vault of the vagina and base of the bladder in a patient aged 68, the modal chromosome number was 47 and the only abnormality in G-banded preparations was an extra no.l-derived chromosome in which the short arm was replaced by most of a long arm of the same chromosome. It thus had an almost completely duplicated long arm and resembled an isochromosome i(lq) except that the near-centromeric heterochromatic band (q 12) was not duplicated. Abnormalities of chromosome no. 1 have been found in several tumours but not in chronic leukaemia and myeloproliferative disorders, suggesting that they are associated with the later stages of malignant transformation.4 We have, however, found a lp- chromosome in a cervical carcinoma. There may be a relationship between heteromorphism for the heterochromatic region of chromosome no. 1,4 pericentric inversions of this regionsand an increased risk of cancer.1.s Department of Cancer Research, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN
N. B. ATKIN MARION C. BAKER
RESEARCH ON ALIMENTARY CANCER accrues from detailed studies of rarities than from the commonplace. You note (Sept. 24, p. 645) the expense and doubt the cost effectiveness of epidemiological studies in alimentary cancer. More then may be learnt from detailed studies of the few individuals who acquire alimentary
SIR,-More knowledge
1. Atkin, N. B., Pickthall, V. J. Hum. Genet. 1977, 38, 25. 2. Atkin, N. B., Baker, M. C. Cytobios (in the press). 3. Cruciger, Q. V. J., Pathak, S., Cailleau, R. Cytogenet. Cell Genet. 1976, 17, 231. 4. Atkin, N. B. Br. med. J. 1977, i, 358. 5. Atkin, N. B., Baker, M. C. Cytogenet. Cell Genet. (in the press).
