DIAGNOSTIC TEST FOR GARGOYLISM
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420 postural-particularly in patients with strokes and with arthritis who spend hours on end sitting almost immobile in their chairs. It is obviously desirable to avoid thiazide diuretics in treating this postural oedema in old people. The alternative approach is to institute postural drainage by raising the feet and legs for a period each day. A convenient way of doing this is by using the ’ Relaxator (Lodge Equipment Ltd., Achilles Works, Island Farm Trading Estate, West Molesey, Surrey) (see accompanying figure). The legs are raised for one hour a day; crepe bandages are applied at the end of the hour. Once the oedema has been largely dispersed, below-knee elastic stockings are prescribed. JOHN C. BROCKLEHURST. The photograph is by Camera Talks Lennard Hospital. Bromley, Kent. COST OF REPRINTS D. N. BARON. Department of Chemical Pathology, Royal Free Hospital, London, W.C.1. SIR,-An English medical journal, in which I am about to publish a thirteen-page article for which I expect a limited demand, will charge E16 17s. 6d. for 50 reprints (without postage) and will issue none to me free. I can make one copy of the article on a machine here or on the university ’ Xerox’, for 6d. per double page-and presumably similar facilities are widely available. Therefore, if somebody wanting a reprint makes his own copy of my article, the cost is 3s. 6d., whereas if he writes for me to send him a proper printed reprint the cost is about 7s. The type for the article is already set up and the cost of reprints should be relatively low. As reprints are costly, is the point of printing them that their sale to authors helps to subsidise the journal ? This I am sure is better than having to pay for the article to be published. *‘:’ Printing is very expensive and so are small jobs requiring rearrangement of type. We should be surprised to learn that any medical journal produces reprints at a profit.-ED. L. SIR,-It is well established that in gargoylism (Pfaundler-Hurlei’s syndrome) there is overproduction of two sulphated mucopolysaccharides containing uronic acid-namely, chondroitin sulphate B and heparitin sulphate. Both mucopolysaccharides are excreted in the urine in quantities of 171-576 mg. per litre, whereas unaffected subjects excrete no more than 30 mg. of mucopolysaccharides per litre in their urine.1 Isolation and identification of the two mucopoly- saccharides is tedious and time-consuming ; besides, rela- tively large urine samples are required. Two simpler tests have been proposed,2 3 but their diagnostic value has not been well established. We have successfully used a new simple method, based on Dische’s carbazole reaction of uronic acids, for testing urine samples with slight pre-treatment. This method involves preliminary dialysis of the urine for 24 hours. Then, Dische’s carbazole reaction, as modified by Bitter et al. is tested on 0-5 ml. of the dialysed urine; the absorption of the colour is read at 530 mfL in -a ’Coleman Junior’ spectrophotometer, with tubes of 1-8 cm. diameter. Over eighty urine samples were tested by this method, includ- ing six samples from 3 clinically diagnosed cases of gargoylism. In the control group the mean value of optical density (o.D.) was 0-277, with a maximum value of 0-448. o.D. in the affected subjects ranged from 0.765 to 1.175. Thus, urine samples in 1. Muir, H., Mittwoch, U., Bitter, T. Arch. Dis. Childh. 1963, 38, 358. 2. Berry, H., Spinanger, J. J. Lab. clin. Med. 1960, 55, 136. 3. Dorfman, A., Lorincz, A. E. Proc. nat. Acad. Sci. 1957, 43, 443. 4. Bitter, T., Ewins, R., Muir, H. Lab. Pract. 1962, 4, 330. L cases of gargoylism can be easily distinguished from normal L urine by means of this simple method. i Analysis of the absorption spectra reveals an appreciable : interference, probably due to non-dialysable sugar present in : the urine. The interference due to an unknown amount of glucose may be calculated by reading the colour reaction of a ’ mixture of the two sugars and the colour reaction of pure ’ uronic acid at 490 and 530 mfL.5 Assuming arbitrarily that the interference in urine is due to glucose alone, the corrected values of o.D. further enhance the difference between normal and abnormal urine (maximum value in control group 0-241, minimum value in affected subjects 0.637). Obviously this is not a method for quantitative deter- mination of uronic acid in the urine. The purpose of this letter is to encourage the use of this method in a larger number of cases in order to confirm or disprove its value as a diagnostic test in gargoylism. ANTIGENIC PROPERTIES OF MITOGENIC FACTOR IN PHYTOHÆMAGGLUTININ SIR,-Extracts of some varieties of Phaseolus vulgaris can agglutinate erythrocytes, precipitate human cell homogenates and serum-proteins,’ and stimulate mitosis in leucocytes. 8 The mitogenic constituent probably differs from either the hasmagglutinating factor or the protein- precipitating factor.9 Rigas and Osgood 10 purified the extract and concluded that it was a mucoprotein. Latterly, eight different precipitin bands have been demonstrated by immunoelectrophoresis in the serum of a rabbit which had been injected subcutaneously with crude extracts of Phaseolus vulgaris together with an adjuvant.ll After an unsuccessful attempt to produce demonstrable antibodies by means of intramuscular injections without an adjuvant, we gave multiple intravenous injections (0’5 ml. daily for 5 days) of ’ Phytohemagglutinin M ’ (Difco, Detroit, Michigan, U.S.A.). Immunoelectrophoretic patterns were obtained on 26 x 76 mm. slides coated with 1 % agar in barbitone buffer at pH 8,2.12 After electrophoresis of serum from the treated rabbit, phytohaemagglutinin M (P.H.A.-M) was placed in the antigen trough, and three precipitin bands were detectable. These bands appeared to have the mobility of globulin. Two of the bands were distinct and were located closer to the antigen trough than was the single diffuse band. In order to determine whether a specific antibody to the mitogenic factor was produced, a series of human peripheral- blood leucocyte cultures were initiated according to the pro- cedure of Moorhead. Suspended leucocytes in pooled human plasma from a single donor were used for the cultures. The mitogenic agents for the control cultures were the supernatants obtained by incubation of (1) P.H.A.-M with saline solution, and (2) P.H.A.-M with serum from a control rabbit. (litter mate). The mitogenic agent for the other cultures consisted of the super- natant of the P.H.A.-M. which had been incubated for 3 hours at 37°C with selected quantities of serum from the injected rabbit. The mitotic rate progressively decreased as the quantity of the injected rabbit-serum was increased. Control cultures contain- ing the supernatant from (1) and (2) gave a mitotic rate of 8-12%, whereas the cultures containing the supernatant obtained from incubation of 0-3 ml. P.H.A.-M and 0-8 ml. iniected rabbit-serum had a mitotic rate of 0%. 5. Segni, G., Romano, C., Tortorolo, G. Minerva ped. (in the press). 6. Skoog, W. A., Beck, W. S. Blood, 1956, 11, 436. 7. Beckman, L. Nature, 1962, 195, 582. 8. Hungerford, D. A., Donnelly, A. J., Nowell, P. C., Beck, S. Amer. J. hum. Genet. 1959, 11, 215. 9. Beckman, L., Fichtelius, K.-E., Finley, S. C., Finley, W. N., Lindahl- Kiessling, K. Hereditas, 1962, 48, 619. 10. Rigas, D. A., Osgood, E. E. J. biol. Chem. 1955, 212, 607. 11. Spitz, M. Nature, Lond. 1964, 202, 902. 12. Scheidegger, J. J. Int. Arch. Allergy, 1955, 7, 103.
Transcript of DIAGNOSTIC TEST FOR GARGOYLISM
420
postural-particularly in patients with strokes and witharthritis who spend hours on end sitting almost immobile intheir chairs. It is obviously desirable to avoid thiazide diureticsin treating this postural oedema in old people. The alternativeapproach is to institute postural drainage by raising the feetand legs for a period each day.A convenient way of doing this is by using the ’ Relaxator
(Lodge Equipment Ltd., Achilles Works, Island Farm TradingEstate, West Molesey, Surrey) (see accompanying figure).The legs are raised for one hour a day; crepe bandages areapplied at the end of the hour. Once the oedema has beenlargely dispersed, below-knee elastic stockings are prescribed.
JOHN C. BROCKLEHURST.The photograph is by Camera TalksLennard Hospital.Bromley, Kent.
COST OF REPRINTS
D. N. BARON.Department of Chemical Pathology,
Royal Free Hospital,London, W.C.1.
SIR,-An English medical journal, in which I am aboutto publish a thirteen-page article for which I expect alimited demand, will charge E16 17s. 6d. for 50 reprints(without postage) and will issue none to me free. I canmake one copy of the article on a machine here or on the
university ’ Xerox’, for 6d. per double page-andpresumably similar facilities are widely available.
Therefore, if somebody wanting a reprint makes hisown copy of my article, the cost is 3s. 6d., whereas if hewrites for me to send him a proper printed reprint thecost is about 7s.The type for the article is already set up and the cost of
reprints should be relatively low. As reprints are costly,is the point of printing them that their sale to authorshelps to subsidise the journal ? This I am sure is betterthan having to pay for the article to be published.
*‘:’ Printing is very expensive and so are small jobsrequiring rearrangement of type. We should be surprisedto learn that any medical journal produces reprints at
a profit.-ED. L.
SIR,-It is well established that in gargoylism(Pfaundler-Hurlei’s syndrome) there is overproduction oftwo sulphated mucopolysaccharides containing uronic
acid-namely, chondroitin sulphate B and heparitinsulphate. Both mucopolysaccharides are excreted in theurine in quantities of 171-576 mg. per litre, whereasunaffected subjects excrete no more than 30 mg. of
mucopolysaccharides per litre in their urine.1Isolation and identification of the two mucopoly-
saccharides is tedious and time-consuming ; besides, rela-tively large urine samples are required. Two simpler testshave been proposed,2 3 but their diagnostic value has notbeen well established.We have successfully used a new simple method, based
on Dische’s carbazole reaction of uronic acids, for
testing urine samples with slight pre-treatment.This method involves preliminary dialysis of the urine for
24 hours. Then, Dische’s carbazole reaction, as modified byBitter et al. is tested on 0-5 ml. of the dialysed urine; theabsorption of the colour is read at 530 mfL in -a ’Coleman
Junior’ spectrophotometer, with tubes of 1-8 cm. diameter.Over eighty urine samples were tested by this method, includ-ing six samples from 3 clinically diagnosed cases of gargoylism.
In the control group the mean value of optical density (o.D.)was 0-277, with a maximum value of 0-448. o.D. in the affected
subjects ranged from 0.765 to 1.175. Thus, urine samples in1. Muir, H., Mittwoch, U., Bitter, T. Arch. Dis. Childh. 1963, 38, 358.2. Berry, H., Spinanger, J. J. Lab. clin. Med. 1960, 55, 136.3. Dorfman, A., Lorincz, A. E. Proc. nat. Acad. Sci. 1957, 43, 443.4. Bitter, T., Ewins, R., Muir, H. Lab. Pract. 1962, 4, 330.
L cases of gargoylism can be easily distinguished from normalL urine by means of this simple method.i Analysis of the absorption spectra reveals an appreciable: interference, probably due to non-dialysable sugar present in: the urine. The interference due to an unknown amount of
glucose may be calculated by reading the colour reaction of a’
mixture of the two sugars and the colour reaction of pure’ uronic acid at 490 and 530 mfL.5
Assuming arbitrarily that the interference in urine is due toglucose alone, the corrected values of o.D. further enhance thedifference between normal and abnormal urine (maximumvalue in control group 0-241, minimum value in affected
subjects 0.637).Obviously this is not a method for quantitative deter-
mination of uronic acid in the urine. The purpose of thisletter is to encourage the use of this method in a largernumber of cases in order to confirm or disprove its valueas a diagnostic test in gargoylism.
ANTIGENIC PROPERTIES OF MITOGENICFACTOR IN PHYTOHÆMAGGLUTININ
SIR,-Extracts of some varieties of Phaseolus vulgariscan agglutinate erythrocytes, precipitate human cell
homogenates and serum-proteins,’ and stimulate mitosisin leucocytes. 8 The mitogenic constituent probably differsfrom either the hasmagglutinating factor or the protein-precipitating factor.9 Rigas and Osgood 10 purified theextract and concluded that it was a mucoprotein. Latterly,eight different precipitin bands have been demonstratedby immunoelectrophoresis in the serum of a rabbit whichhad been injected subcutaneously with crude extracts ofPhaseolus vulgaris together with an adjuvant.ll
After an unsuccessful attempt to produce demonstrableantibodies by means of intramuscular injections without anadjuvant, we gave multiple intravenous injections (0’5 ml.
daily for 5 days) of ’ Phytohemagglutinin M ’ (Difco, Detroit,Michigan, U.S.A.). Immunoelectrophoretic patterns were
obtained on 26 x 76 mm. slides coated with 1 % agar in barbitonebuffer at pH 8,2.12
After electrophoresis of serum from the treated rabbit,phytohaemagglutinin M (P.H.A.-M) was placed in the antigentrough, and three precipitin bands were detectable. Thesebands appeared to have the mobility of globulin. Two of thebands were distinct and were located closer to the antigentrough than was the single diffuse band.
In order to determine whether a specific antibody to themitogenic factor was produced, a series of human peripheral-blood leucocyte cultures were initiated according to the pro-cedure of Moorhead. Suspended leucocytes in pooled humanplasma from a single donor were used for the cultures. Themitogenic agents for the control cultures were the supernatantsobtained by incubation of (1) P.H.A.-M with saline solution, and(2) P.H.A.-M with serum from a control rabbit. (litter mate). Themitogenic agent for the other cultures consisted of the super-natant of the P.H.A.-M. which had been incubated for 3 hours at37°C with selected quantities of serum from the injected rabbit.The mitotic rate progressively decreased as the quantity of theinjected rabbit-serum was increased. Control cultures contain-ing the supernatant from (1) and (2) gave a mitotic rate of8-12%, whereas the cultures containing the supernatantobtained from incubation of 0-3 ml. P.H.A.-M and 0-8 ml.iniected rabbit-serum had a mitotic rate of 0%.5. Segni, G., Romano, C., Tortorolo, G. Minerva ped. (in the press).6. Skoog, W. A., Beck, W. S. Blood, 1956, 11, 436.7. Beckman, L. Nature, 1962, 195, 582.8. Hungerford, D. A., Donnelly, A. J., Nowell, P. C., Beck, S. Amer. J. hum.
Genet. 1959, 11, 215.9. Beckman, L., Fichtelius, K.-E., Finley, S. C., Finley, W. N., Lindahl-
Kiessling, K. Hereditas, 1962, 48, 619.10. Rigas, D. A., Osgood, E. E. J. biol. Chem. 1955, 212, 607.11. Spitz, M. Nature, Lond. 1964, 202, 902.12. Scheidegger, J. J. Int. Arch. Allergy, 1955, 7, 103.
