315 OUTPATIENT WORK-LOAD
SIR,-While writing in support of my fellow dermatologist (July 24, p. 203) aggrieved by the apparent indolence of general medical colleagues in outpatients, it seems that Dr Comaish
in the past some have worked (work-loaded?) more speedily. I quote from the Royal College of Physicians 1975 catalogue Physicians’ Avocations: "The future poet Laureate, Robert Bridges (1844-1930) (St Bartholomew’s Reports, 1878, 14, pp 167-182) recorded that he had seen 13,940 patients in the course of one year with an average of 1.28 minutes given to each case, and had ordered over 200,000 doses of medicine containing iron." Private Patients’ Wing, Westminster Hospital, London SW1
P. W. M. COPEMAN
Haplotype analysis of family, based on HLA A and B typing and M.L.C. reactions, demonstrating probable bilateral recombinant (P).
DIABETES MELLITUS, CHROMOSOMAL ABERRATION, AND MALIGNANCY
ab=father, cb=mother. Offspring represented
SIR,-We read with interest the conflicting reports of Dr Suciu-Foca and Dr Rubinstein (Feb. 14, p. 371) suggesting that’the frequency of intra-HLA recombinations in families of patients with juvenile diabetes mellitus (J.D.M.) was 15% and Dr Mayr and his colleagues (April 17, p. 865) who reported normal frequencies. We have been studying a large con-
sanguineous family in which J.D.M. is rampant (see figure). HLA A and B typing and mixed leucocyte culture (M.L.C.) reactions (see table) indicate among the offspring what we to be the first bilateral intra-HLA recombinant. This person inherited chromosome b/a from his father with a crossover between loci A and B and c/d from his mother with a cross-over between loci B and D (although determination of the actual DW allele is still in progress). The patient also has diabetes. This rare event in a J.D.M. family would tend to support Suciu-Foca and Rubinstein’s observation of an increased recombination frequency in J.D.M. families. Diabetes mellitus has been associated with more than twenty autosomal recessive diseases;’ for example, cystic fibrosis, Friedrich’s ataxia, ataxia telangiectasia, and Fan-
believe
Rimoin, D. L., Schimke, R. N. Genetic Disorders of the Endocrine Glands; p. 150. St. Louis, 1971. 2. Swift, M., Sholman, L., Gilmour, D. Science, 1972, 178, 308. M.L.C.
*Results
expressed
in
c.p.m. Relative responses
t Background counts of cells before culture
()given
in italic type.
P, Q, R, and S.
coni’s anaemia.2 Some of these entities are also associated with chromosomal aberrations as well as with an increased incidence of malignancy. 3-5 It would, therefore, not be surprising if further analyses of J.D.M. families were to reveal an association of diabetes mellitus with malignancy, a suggestion made several years ago by Kessler.6 Our 38-year-old patient with J.D.M. and the bilateral recombinant haplotype also has Hodgkin’s disease of the granulomatous type. This work Children.
was
supported by the
Amie Karen Cancer Fund for
Division of Clinical Pathology, University of Alabama School of Medicine, Birmingham, Alabama 35294, U.S.A.
Division
JUNE F. SHAW
of Endocrinology,
University of
Alabama School of Medicine
Division of Pediatric
Oncology
and
RICHARD A. GATTI
Swift, M. Nature, 1971, 230, 370. McCaw, B., Hecht, F., Harnden, D. G., Teplitz, R. L. U.S.A. 1975, 72, 2071. 5. Gatti, R. A., Good, R. A. Cancer, 1971, 28, 89. 6. Kessler, I. I. J. nat. Cancer Inst. 1970, 44, 673.
REACTIONS*
tTreatment of stimulating cells with mitomycm
P. C. KANSAL
Immunology,
Cedars-Sinai Medical Center, Los Angeles, California
3. 4. 1.
as
C.
Proc.
natn.
Acad. Sci.
SIR,-While writing in support of my fellow dermatologist (July 24, p. 203) aggrieved by the apparent indolence of general medical colleagues in outpatients, it seems that Dr Comaish
in the past some have worked (work-loaded?) more speedily. I quote from the Royal College of Physicians 1975 catalogue Physicians’ Avocations: "The future poet Laureate, Robert Bridges (1844-1930) (St Bartholomew’s Reports, 1878, 14, pp 167-182) recorded that he had seen 13,940 patients in the course of one year with an average of 1.28 minutes given to each case, and had ordered over 200,000 doses of medicine containing iron." Private Patients’ Wing, Westminster Hospital, London SW1
P. W. M. COPEMAN
Haplotype analysis of family, based on HLA A and B typing and M.L.C. reactions, demonstrating probable bilateral recombinant (P).
DIABETES MELLITUS, CHROMOSOMAL ABERRATION, AND MALIGNANCY
ab=father, cb=mother. Offspring represented
SIR,-We read with interest the conflicting reports of Dr Suciu-Foca and Dr Rubinstein (Feb. 14, p. 371) suggesting that’the frequency of intra-HLA recombinations in families of patients with juvenile diabetes mellitus (J.D.M.) was 15% and Dr Mayr and his colleagues (April 17, p. 865) who reported normal frequencies. We have been studying a large con-
sanguineous family in which J.D.M. is rampant (see figure). HLA A and B typing and mixed leucocyte culture (M.L.C.) reactions (see table) indicate among the offspring what we to be the first bilateral intra-HLA recombinant. This person inherited chromosome b/a from his father with a crossover between loci A and B and c/d from his mother with a cross-over between loci B and D (although determination of the actual DW allele is still in progress). The patient also has diabetes. This rare event in a J.D.M. family would tend to support Suciu-Foca and Rubinstein’s observation of an increased recombination frequency in J.D.M. families. Diabetes mellitus has been associated with more than twenty autosomal recessive diseases;’ for example, cystic fibrosis, Friedrich’s ataxia, ataxia telangiectasia, and Fan-
believe
Rimoin, D. L., Schimke, R. N. Genetic Disorders of the Endocrine Glands; p. 150. St. Louis, 1971. 2. Swift, M., Sholman, L., Gilmour, D. Science, 1972, 178, 308. M.L.C.
*Results
expressed
in
c.p.m. Relative responses
t Background counts of cells before culture
()given
in italic type.
P, Q, R, and S.
coni’s anaemia.2 Some of these entities are also associated with chromosomal aberrations as well as with an increased incidence of malignancy. 3-5 It would, therefore, not be surprising if further analyses of J.D.M. families were to reveal an association of diabetes mellitus with malignancy, a suggestion made several years ago by Kessler.6 Our 38-year-old patient with J.D.M. and the bilateral recombinant haplotype also has Hodgkin’s disease of the granulomatous type. This work Children.
was
supported by the
Amie Karen Cancer Fund for
Division of Clinical Pathology, University of Alabama School of Medicine, Birmingham, Alabama 35294, U.S.A.
Division
JUNE F. SHAW
of Endocrinology,
University of
Alabama School of Medicine
Division of Pediatric
Oncology
and
RICHARD A. GATTI
Swift, M. Nature, 1971, 230, 370. McCaw, B., Hecht, F., Harnden, D. G., Teplitz, R. L. U.S.A. 1975, 72, 2071. 5. Gatti, R. A., Good, R. A. Cancer, 1971, 28, 89. 6. Kessler, I. I. J. nat. Cancer Inst. 1970, 44, 673.
REACTIONS*
tTreatment of stimulating cells with mitomycm
P. C. KANSAL
Immunology,
Cedars-Sinai Medical Center, Los Angeles, California
3. 4. 1.
as
C.
Proc.
natn.
Acad. Sci.
