997 FASTING PLASMA-GASTRIN IN VITILIGO
SIR,-Vitiligo is associated with achlorhydria and pernicious anaemia,1 and while serum-gastrin concentrations are normal in vitiligo patients with normal gastric acid secretion, those with achlorhydria or hypochlorhydria have significantly increased gastrin values. We have measured serum-gastrin in 26 patients with vitiligo and in 41 healthy controls. Gastric acid secretion was assessed by Kay’s augmented histamine test’ or the histamine infusion test;4 5 of the vitiligo patients were tested in both ways. After an overnight fast blood was collected into heparinised tubes and centrifuged, and the plasma was frozen until gastrin measurement by radioimmunoassay.S 21 vitiligo patients had normal gastric acid secretion, and their mean plasma-gastrin was 8.5 ng/1±3-3 (S.E.M.), which was not significantly different from the mean in 41 controls (11-7±2-1 ng/1). 5 vitiligo patients were achlorhydric by the augmented histamine test; their mean plasma-gastrin was 252.8 ng/1±116.4, significantly higher than that of the controls (p=0.01 by one-tailed Mann-Whitney form of Wilcoxon rank-sum test). Histamine infusion tests confirmed 2 of these patients as anacidic while the remaining 3 secreted small amounts of acid (i.e., they were hypochlorhydric). 1 of the achlorhydric patients had a plasma-gastrin of over 500 ng/1, and marrow and peripheral-blood morphology indicated pernicious
peptide content. We are witnessing the gradual collapse of morphological classification, and the alphabetic terminology will be difficult to maintain, for two reasons. First, the ultrastructural appearance may be deceiving. A morphologically homogeneous cell population may turn out to be heterogeneous, comprising several functionally differing cell types. Hence, the introduction of terms such as ECl’ EC2,8 Dl and D2.9 Secondly, identical function is not always reflected in identical morhpology. Cells that produce one and the same peptide hormone may differ in their ultrastructure from one species to another. The large-granulated PP cells in dog and cat are very different from the small-granulated cells that store PP in other species.1O Insulin cells look very different in different species. The same is true for somatostatin" and neutrotensin cells. 12 The use of letters for naming peptide-hormone-producing cells is now creating more confusion than it eliminates, and it is time to turn to a functional terminology. Whenever possible the cells should be named after the peptide(s) they store, regardless of their ultrastructure. For endocrine cells for which no peptide has been identified the morphological classification system will have to be retained. ROLF HAKANSON Departments of Histology and Pharmacology, JAN ALUMETS University of Lund, FRANK SUNDLER Lund, Sweden
ansemia. Our results thus confirm those of Howitz and Reh-
feld.2
PREGNANCY-SPECIFIC &bgr;1-GLYCOPROTEIN IN
Department of Physiology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
ELEONORE T. OKOSDINOSSIAN H. A. EL MUNSHID A. I. WASFI Department of Dermatology, M. A. AHMED Khartoum Civil Hospital Middlesex Hospital and Medical School, R. C. G. RUSSELL M. HOBSLEY London W1
NEOPLASTIC DISEASE
SiR,-Although we agreed with Dr Searle and her colleagues (March 19, p. 579) that the measurement of plasma levels of pregnancy-specific pt-glycoprotein (SP 1) is unlikely to be of notable value in the detection and monitoring of nontrophoblastic malignancies, two points arise from their data which require further consideration. Firstly, in the absence of an international standard nomenclature for this protein, the list of synonyms has been long and confusing, and Searle et al. add
to
this list:
CLASSIFICATION OF PEPTIDE-HORMONE-PRODUCING CELLS
SIR,-Endocrine cells in gut and pancreas are traditionally classified on morphological grounds such as staining properties and ultrastructure of secretory granules. When the endocrine cells of the gut attracted the attention of electronmicroscopists in the early 1960s an alphabetical system was used to designate the cells, this approach having been established for pancreatic islet cells. However, the situation soon became chaotic because of the number of endocrine cell types in the gut and because various research groups devised designations of their own. In 1969 some workers met in Wiesbaden to formulate a satisfactory terminology.’ This attempt was only partly successful: the frequent recognition of new endocrine cell types made the agreed terminology obsolete, and revisions became necessary (in Bologna in 1973,’and last year in Lausanne8). Since the Wiesbaden meeting immunohistochemistry has become an increasingly important tool for the functional classification of peptide-hormone-producing cells; and immunohistochemistry combined with electronmicroscopy is now rapidly bridging the gap between the morphological and the functional classifications. Ultimately we should be able to identify ultrastructurally any cell which has been defined with respect to its 1. Howitz, J., Schwartz, M. Lancet, 1971, i, 1331. 2. Howitz, J., Rehfeld; J. F. ibid. 1974, i, 831. 3. Kay, A. W. Br. med. J. 1953, ii, 77. 4. Lawne, J. H., Smith, G. M. R., Forrest, A. P. M. Lancet, 1964, ii, 270. 5. Russell, R. C. G., Fielding, L. P., Bloom, S. R., Bryant, M. G. Postgrad.
med. J. 1976, 52, 645. 6. Creutzfeldt, W., and others Origin, Chemistry, Physiology and Pathophysiology of the Gastrointestinal Hormones; p. 95. 7. Solcia, E., Pearse, A. G. E., Grube, O., Kobayashi, S., Bussolati, G., Creutzfeldt, W., Gepts, W.Rendic. Gastroent. 1973, 5, 13.
Until the
nomenclature is resolved, we would abbreviation of the name given to this
question of
suggest the use of
an
Hans Bohn-namely, SP (Schwangerschafts glycoprotein).’ Secondly, non-specific inhibition .ST/McA in sensitive radioimmunoassays resulting in the detection of levels near the limits of sensitivity of the assay is well-known. It is not clear from the data presented whether the low plasma levels of SP recorded in 13% of healthy controls were due to this non-specificity. Until this possibility is excluded, the presence of circulating SP, in healthy non-pregnant individuals, substance
by
remains controversial. Departments of Obstetrics and Gynæcology and Reproductive Physiology, St. Bartholomew’s Hospital Medical College and London Hospital Medical College, London EC1A 7BE 8.
Solcia, E., and others
in Gut Hormones
GRUDZINSKAS Y. B. GORDON T. CHARD
J. G.
(edited by S.
R.
Bloom); p. 40. Edin-
burgh, 1978. 9.
Pearse, A. G. E., Polak, J. M., Bloom, S. R. Gastroenterology, 1977, 72,
746. 10. Larsson, L.-I., Sundler, F., Håkanson, R. Diabetologia, 1976, 12, 211. 11. Alumets, J., Sundler, F., Håkanson, R. Cell Tiss. Res. 1977, 185, 465. 12. Sundler, F., Alumets, J., Håkanson, R., Carraway, R., Leeman, S. E. Histo-
chemistry, 1977, 53, 25. 1. Bohn, H. Arch. Gynäk. 1971, 210, 440. 2. Lin, T. M., Halbert, S. P., Keifer, D., Spellacy, W. N., Gall, S. Am. J. Obstet. Gynec. 1974, 118, 223. 3. Towler, C. M., Horne, C. H. W., Jandial, V., Campbell, D. M., MacGillivray, T. Br. J. Obstet. Gynæc. 1976, 83, 775. 4. Tatarinov, Y. S., Sokolov, A. V. Int. J. Cancer, 1977, 19, 161. 5. Searle, F., Leake, B. A., Bagshawe, K. D., Dent, J. Lancet, 1978, i, 579.
SIR,-Vitiligo is associated with achlorhydria and pernicious anaemia,1 and while serum-gastrin concentrations are normal in vitiligo patients with normal gastric acid secretion, those with achlorhydria or hypochlorhydria have significantly increased gastrin values. We have measured serum-gastrin in 26 patients with vitiligo and in 41 healthy controls. Gastric acid secretion was assessed by Kay’s augmented histamine test’ or the histamine infusion test;4 5 of the vitiligo patients were tested in both ways. After an overnight fast blood was collected into heparinised tubes and centrifuged, and the plasma was frozen until gastrin measurement by radioimmunoassay.S 21 vitiligo patients had normal gastric acid secretion, and their mean plasma-gastrin was 8.5 ng/1±3-3 (S.E.M.), which was not significantly different from the mean in 41 controls (11-7±2-1 ng/1). 5 vitiligo patients were achlorhydric by the augmented histamine test; their mean plasma-gastrin was 252.8 ng/1±116.4, significantly higher than that of the controls (p=0.01 by one-tailed Mann-Whitney form of Wilcoxon rank-sum test). Histamine infusion tests confirmed 2 of these patients as anacidic while the remaining 3 secreted small amounts of acid (i.e., they were hypochlorhydric). 1 of the achlorhydric patients had a plasma-gastrin of over 500 ng/1, and marrow and peripheral-blood morphology indicated pernicious
peptide content. We are witnessing the gradual collapse of morphological classification, and the alphabetic terminology will be difficult to maintain, for two reasons. First, the ultrastructural appearance may be deceiving. A morphologically homogeneous cell population may turn out to be heterogeneous, comprising several functionally differing cell types. Hence, the introduction of terms such as ECl’ EC2,8 Dl and D2.9 Secondly, identical function is not always reflected in identical morhpology. Cells that produce one and the same peptide hormone may differ in their ultrastructure from one species to another. The large-granulated PP cells in dog and cat are very different from the small-granulated cells that store PP in other species.1O Insulin cells look very different in different species. The same is true for somatostatin" and neutrotensin cells. 12 The use of letters for naming peptide-hormone-producing cells is now creating more confusion than it eliminates, and it is time to turn to a functional terminology. Whenever possible the cells should be named after the peptide(s) they store, regardless of their ultrastructure. For endocrine cells for which no peptide has been identified the morphological classification system will have to be retained. ROLF HAKANSON Departments of Histology and Pharmacology, JAN ALUMETS University of Lund, FRANK SUNDLER Lund, Sweden
ansemia. Our results thus confirm those of Howitz and Reh-
feld.2
PREGNANCY-SPECIFIC &bgr;1-GLYCOPROTEIN IN
Department of Physiology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
ELEONORE T. OKOSDINOSSIAN H. A. EL MUNSHID A. I. WASFI Department of Dermatology, M. A. AHMED Khartoum Civil Hospital Middlesex Hospital and Medical School, R. C. G. RUSSELL M. HOBSLEY London W1
NEOPLASTIC DISEASE
SiR,-Although we agreed with Dr Searle and her colleagues (March 19, p. 579) that the measurement of plasma levels of pregnancy-specific pt-glycoprotein (SP 1) is unlikely to be of notable value in the detection and monitoring of nontrophoblastic malignancies, two points arise from their data which require further consideration. Firstly, in the absence of an international standard nomenclature for this protein, the list of synonyms has been long and confusing, and Searle et al. add
to
this list:
CLASSIFICATION OF PEPTIDE-HORMONE-PRODUCING CELLS
SIR,-Endocrine cells in gut and pancreas are traditionally classified on morphological grounds such as staining properties and ultrastructure of secretory granules. When the endocrine cells of the gut attracted the attention of electronmicroscopists in the early 1960s an alphabetical system was used to designate the cells, this approach having been established for pancreatic islet cells. However, the situation soon became chaotic because of the number of endocrine cell types in the gut and because various research groups devised designations of their own. In 1969 some workers met in Wiesbaden to formulate a satisfactory terminology.’ This attempt was only partly successful: the frequent recognition of new endocrine cell types made the agreed terminology obsolete, and revisions became necessary (in Bologna in 1973,’and last year in Lausanne8). Since the Wiesbaden meeting immunohistochemistry has become an increasingly important tool for the functional classification of peptide-hormone-producing cells; and immunohistochemistry combined with electronmicroscopy is now rapidly bridging the gap between the morphological and the functional classifications. Ultimately we should be able to identify ultrastructurally any cell which has been defined with respect to its 1. Howitz, J., Schwartz, M. Lancet, 1971, i, 1331. 2. Howitz, J., Rehfeld; J. F. ibid. 1974, i, 831. 3. Kay, A. W. Br. med. J. 1953, ii, 77. 4. Lawne, J. H., Smith, G. M. R., Forrest, A. P. M. Lancet, 1964, ii, 270. 5. Russell, R. C. G., Fielding, L. P., Bloom, S. R., Bryant, M. G. Postgrad.
med. J. 1976, 52, 645. 6. Creutzfeldt, W., and others Origin, Chemistry, Physiology and Pathophysiology of the Gastrointestinal Hormones; p. 95. 7. Solcia, E., Pearse, A. G. E., Grube, O., Kobayashi, S., Bussolati, G., Creutzfeldt, W., Gepts, W.Rendic. Gastroent. 1973, 5, 13.
Until the
nomenclature is resolved, we would abbreviation of the name given to this
question of
suggest the use of
an
Hans Bohn-namely, SP (Schwangerschafts glycoprotein).’ Secondly, non-specific inhibition .ST/McA in sensitive radioimmunoassays resulting in the detection of levels near the limits of sensitivity of the assay is well-known. It is not clear from the data presented whether the low plasma levels of SP recorded in 13% of healthy controls were due to this non-specificity. Until this possibility is excluded, the presence of circulating SP, in healthy non-pregnant individuals, substance
by
remains controversial. Departments of Obstetrics and Gynæcology and Reproductive Physiology, St. Bartholomew’s Hospital Medical College and London Hospital Medical College, London EC1A 7BE 8.
Solcia, E., and others
in Gut Hormones
GRUDZINSKAS Y. B. GORDON T. CHARD
J. G.
(edited by S.
R.
Bloom); p. 40. Edin-
burgh, 1978. 9.
Pearse, A. G. E., Polak, J. M., Bloom, S. R. Gastroenterology, 1977, 72,
746. 10. Larsson, L.-I., Sundler, F., Håkanson, R. Diabetologia, 1976, 12, 211. 11. Alumets, J., Sundler, F., Håkanson, R. Cell Tiss. Res. 1977, 185, 465. 12. Sundler, F., Alumets, J., Håkanson, R., Carraway, R., Leeman, S. E. Histo-
chemistry, 1977, 53, 25. 1. Bohn, H. Arch. Gynäk. 1971, 210, 440. 2. Lin, T. M., Halbert, S. P., Keifer, D., Spellacy, W. N., Gall, S. Am. J. Obstet. Gynec. 1974, 118, 223. 3. Towler, C. M., Horne, C. H. W., Jandial, V., Campbell, D. M., MacGillivray, T. Br. J. Obstet. Gynæc. 1976, 83, 775. 4. Tatarinov, Y. S., Sokolov, A. V. Int. J. Cancer, 1977, 19, 161. 5. Searle, F., Leake, B. A., Bagshawe, K. D., Dent, J. Lancet, 1978, i, 579.
