1256 SPERM LYMPHOCYTE CULTURE: TREATMENT OF SPERM WITH ANTI-HLA-B ANTISERA
Al 1,BW22,CW 1,DW 1 te donor-HLA All,BW22CWlDWlt donor-HLAgenotype and lymphocyte
All,BW22,CW1,DWlt
*A: sperm
and anti-BW20,
AW32,BW40,CW3,DW3j
respectively.
tAs determined by Robinette et al.6 DW’X’ likely heterogeneity of DW1.
=
Unknown allele
at
D locus. Note that E, who is
superior to the existing methods because any male donor can provide two typing cells whereas HLA-D homozygous lymphocytes are rare. It has the special advantage that spermatozoa can be put directly into culture with lymphocytes without X irradiation or chemical treatment, resulting in the elimination of blastogenic factor with a low background, no "typing response", and excellent discrimination. We have also been able to use stored spermatozoa which potentially makes this a method of choice for HLA-D typing. We thank Antonio Arnaiz-Villena, Anwer Halim, Johnny Sachs, Eva Wolf, Paul Evans, Janet Pritchard, and Jeanne Burke and the donors for their cooperation and help, and the Cancer Research Campaign, National Kidney Research Fund, and Department of Health and Social Security for financial support. Tissue Immunology Unit, London Hospital Medical College, Turner Street, London E1 2AD.
KAMAL HALIM HILLIARD FESTENSTEIN
ALCOHOL-ASSOCIATED PANCREATITIS IN A 15-YEAR-OLD
SiR,—Teenage alcohol intake is increasing,’ so alcohol-related disease in young people will more frequently pose diagnostic problems. We report a case of acute pancreatitis initially considered to be acute appendicitis. A 15-year-old boy was admitted as an emergency with a 36 h history of generalised abdominal pain, anorexia, nausea, and vomiting. There was no previous history of serious illness or previous episodes of abdominal pain and vomiting. On examination facial flushing8 was evident, temperature 37°C, heart-rate 120/min,
120/80
The abdomen was soft but diffuse tenderness was present and this was maximal in the right iliac fossa. Bowel sounds were normal and rectal examination was negative. He was taken to theatre with a provisional diagnosis of retrocaecal appendicitis. Through a Lanz incision 500 ml of straw-coloured peritoneal fluid was aspirated, but appendix, caecum, and ileum were normal. Appendicectomy was performed and the incision was closed without drainage. While this was being done samples of blood and peritoneal fluid were sent for amylase estimation and the results were 4350 units/I and 20 000 units/1, respectively (normal serum value 70-300 units/1). These results together with the operative findings were considered an adequate base for a diagnosis of acute pancreatitis. Full supportive measures for
6.
B.P.
mm
c.p.m. of cultured sperm alone 75±12 and 79±10 after
Hg.
Robinette, M., Sachs, J. A., Burke, J. M., Festenstein, H. in Proceedings of
the Sixth International Histocompatibility Workshop Conference. Copenhagen (in the press). 7. Report of the Departmental Committee on Scottish Licensing Laws. H.M. Stationery Office, 1973. 8. Imrie, C. W. Br. med. J. 1974, iv, 593.
not
DW1, also failed
to
..
treatment
with anti-BW40
respond to DWl stimulating sperm, indicating
the patient’s pancreatitis was instituted, paying particular attention to the twin dangers of early respiratory and renal insufficiency. He made good progress and was allowed home on the sixth postoperative day. The cause of his pancreatitis has been investigated, and the morning after surgery direct questioning revealed a heavy alcohol intake approximately 20 h before illness (one full bottle of cheap wine and quarter bottle of whisky). His habit for several months was to play cards once weekly with three friends, each providing a bottle of cheap wine. On this occasion one boy added a full bottle of whisky to the alcohol shared by the group. None of the others suffered any ill-effects. In this patient cholecystogram, mineral metabolism, lipoprotein, and viral screening have all been negative. There is no family history of the disease and no history of recent blunt abdominal trauma. Strong evidence therefore exists for an alcohol ietiology in this patient. Viral, hereditary, and traumatic aetiologies for acute pancreatitis in young people are well recorded. Unfortunately, it would seem likely that alcohol-related acute pancreatitis may become a more common cause for acute pancreatitis in this younger age-group, unless the disturbing trend of "under-age" alcohol intake is reversed. W. O. THOMSON Department of Surgery, C. W. IMRIE Royal Infirmary, S. N. JOFFE Glasgow G4 0SF.
INCIDENCE OF PANCREATITIS
SIR,-Mr Bourke (Nov. 15, p. 967) reports that the annual incidence of acute pancreatitis in Nottingham has varied by fourfold over a six-year period, and he cannot explain this variation. One possible cause, not mentioned by Mr Bourke, is variation in the rate of diagnosis rather than in the incidence of the disease. Around 1950 a medical student working in the chemistry laboratory of the Boston City Hospital studied requests for urinary and blood amylase sent in by the physicians on the wards and noted a sharp increase for several months after a lecture on acute pancreatitis in the weekly house-officers’ educational series. (I do not think the data were ever published, and I cannot remember the name of the man who did the work.) In other words, the tests were ordered much more frequently in patients with obscure abdominal pain, and presumably patients with mild attacks of pancreatitis that would not otherwise have been diagnosed were picked up by the increased awareness of the physicians on the wards. Could the increase in rate of diagnosis in Nottingham have followed, stimulating postgraduate session on acute pancreatitis ? Relating the number of tests ordered per month to such lectures might give a clue to this possible eetiological factor; on the other hand, the rate of ordering the test may also reflect
Al 1,BW22,CW 1,DW 1 te donor-HLA All,BW22CWlDWlt donor-HLAgenotype and lymphocyte
All,BW22,CW1,DWlt
*A: sperm
and anti-BW20,
AW32,BW40,CW3,DW3j
respectively.
tAs determined by Robinette et al.6 DW’X’ likely heterogeneity of DW1.
=
Unknown allele
at
D locus. Note that E, who is
superior to the existing methods because any male donor can provide two typing cells whereas HLA-D homozygous lymphocytes are rare. It has the special advantage that spermatozoa can be put directly into culture with lymphocytes without X irradiation or chemical treatment, resulting in the elimination of blastogenic factor with a low background, no "typing response", and excellent discrimination. We have also been able to use stored spermatozoa which potentially makes this a method of choice for HLA-D typing. We thank Antonio Arnaiz-Villena, Anwer Halim, Johnny Sachs, Eva Wolf, Paul Evans, Janet Pritchard, and Jeanne Burke and the donors for their cooperation and help, and the Cancer Research Campaign, National Kidney Research Fund, and Department of Health and Social Security for financial support. Tissue Immunology Unit, London Hospital Medical College, Turner Street, London E1 2AD.
KAMAL HALIM HILLIARD FESTENSTEIN
ALCOHOL-ASSOCIATED PANCREATITIS IN A 15-YEAR-OLD
SiR,—Teenage alcohol intake is increasing,’ so alcohol-related disease in young people will more frequently pose diagnostic problems. We report a case of acute pancreatitis initially considered to be acute appendicitis. A 15-year-old boy was admitted as an emergency with a 36 h history of generalised abdominal pain, anorexia, nausea, and vomiting. There was no previous history of serious illness or previous episodes of abdominal pain and vomiting. On examination facial flushing8 was evident, temperature 37°C, heart-rate 120/min,
120/80
The abdomen was soft but diffuse tenderness was present and this was maximal in the right iliac fossa. Bowel sounds were normal and rectal examination was negative. He was taken to theatre with a provisional diagnosis of retrocaecal appendicitis. Through a Lanz incision 500 ml of straw-coloured peritoneal fluid was aspirated, but appendix, caecum, and ileum were normal. Appendicectomy was performed and the incision was closed without drainage. While this was being done samples of blood and peritoneal fluid were sent for amylase estimation and the results were 4350 units/I and 20 000 units/1, respectively (normal serum value 70-300 units/1). These results together with the operative findings were considered an adequate base for a diagnosis of acute pancreatitis. Full supportive measures for
6.
B.P.
mm
c.p.m. of cultured sperm alone 75±12 and 79±10 after
Hg.
Robinette, M., Sachs, J. A., Burke, J. M., Festenstein, H. in Proceedings of
the Sixth International Histocompatibility Workshop Conference. Copenhagen (in the press). 7. Report of the Departmental Committee on Scottish Licensing Laws. H.M. Stationery Office, 1973. 8. Imrie, C. W. Br. med. J. 1974, iv, 593.
not
DW1, also failed
to
..
treatment
with anti-BW40
respond to DWl stimulating sperm, indicating
the patient’s pancreatitis was instituted, paying particular attention to the twin dangers of early respiratory and renal insufficiency. He made good progress and was allowed home on the sixth postoperative day. The cause of his pancreatitis has been investigated, and the morning after surgery direct questioning revealed a heavy alcohol intake approximately 20 h before illness (one full bottle of cheap wine and quarter bottle of whisky). His habit for several months was to play cards once weekly with three friends, each providing a bottle of cheap wine. On this occasion one boy added a full bottle of whisky to the alcohol shared by the group. None of the others suffered any ill-effects. In this patient cholecystogram, mineral metabolism, lipoprotein, and viral screening have all been negative. There is no family history of the disease and no history of recent blunt abdominal trauma. Strong evidence therefore exists for an alcohol ietiology in this patient. Viral, hereditary, and traumatic aetiologies for acute pancreatitis in young people are well recorded. Unfortunately, it would seem likely that alcohol-related acute pancreatitis may become a more common cause for acute pancreatitis in this younger age-group, unless the disturbing trend of "under-age" alcohol intake is reversed. W. O. THOMSON Department of Surgery, C. W. IMRIE Royal Infirmary, S. N. JOFFE Glasgow G4 0SF.
INCIDENCE OF PANCREATITIS
SIR,-Mr Bourke (Nov. 15, p. 967) reports that the annual incidence of acute pancreatitis in Nottingham has varied by fourfold over a six-year period, and he cannot explain this variation. One possible cause, not mentioned by Mr Bourke, is variation in the rate of diagnosis rather than in the incidence of the disease. Around 1950 a medical student working in the chemistry laboratory of the Boston City Hospital studied requests for urinary and blood amylase sent in by the physicians on the wards and noted a sharp increase for several months after a lecture on acute pancreatitis in the weekly house-officers’ educational series. (I do not think the data were ever published, and I cannot remember the name of the man who did the work.) In other words, the tests were ordered much more frequently in patients with obscure abdominal pain, and presumably patients with mild attacks of pancreatitis that would not otherwise have been diagnosed were picked up by the increased awareness of the physicians on the wards. Could the increase in rate of diagnosis in Nottingham have followed, stimulating postgraduate session on acute pancreatitis ? Relating the number of tests ordered per month to such lectures might give a clue to this possible eetiological factor; on the other hand, the rate of ordering the test may also reflect
