Document G6agqDkadGEQvB1jg9wdYa28Y

vcv-3^^p </&-*/ 410 the lancet, august 30, 1975 of experiments was performed according to the following iopat--e receptors, hat been reported.1-3 Minute amounts schedule: --24 hours intramuscular tranylcypromine 20 of the neuroleptics lib rated from the depot during the mg. per kg.,; 0 hour intravenous tranylcypromine (1C mg. first few hours may posably block the presynaptic receptors, per kg.); 1 hour intravenous procydidine '5 mg. per tg.j; resulmug in an increased fonntdon of dopamine. Since 4 hours intravenous tranylcypromine (10 mg. per kg.). The iopammergic agonist i increase body-temperature in neuroleptics were injected a: different times before the rabbits." die hypenhe: nia recorded in the present experi rectal temperature was recorded. ments might be due to i n exaggerated dopamine response. Intramuscular administration of a-fiupenthixol (0-3 mg. per kg.), given at --1 hour, did not change the temperamre Dtparmau ct Phsmurftmy i Tocology, course during the experiment; neither did i-fiupentmxsi decanoate in oil (10 mg. per kg.) given intramuscularly 3 days before. The following depot neuroleptics E. Luncbeck & C 7-9 Otaliavei, DK tlvO CoKOfaagta Vi Denmatk. \ V. Pedersen I. Mgllhr Nielsen. given intramuscularly at --1 hour: i-dupeatimol decao- ate (F.p.T.-d, 10 mg. per kg.,, fluphenazine decanoate i>.p,z.-d, 2-5 mg. per kg.), pipothiarine Fslmitate (P.?iP, 10 mg. per kg.), and fluspirtlene (F.SJ.., 2 mg. per kg. . f.p.t.-d did not influence the response to procydidine, rut there was a more striking rise a temperature after the last dose of tranylcypromine. Five out of six rabbits given neuroleptics and only one of the six controls had a tempera ture exceeding -40SC. In the F.P.Z.-D group one of nx rabbits died shortly after the administration of procycudine (40-7C). Death may have been caused by a carii> vascular effect, since a preliminary experiment in thra laboratory demonstrated that such a drug combination may produce dramatic tachycardia. Another animal died in hyperthermia (43-4'C) after tranylcypromine. In the P.P.Z.-P group fatal hyperthermia developed in two of sx rabbits (42-9 and 43-7 "C) in response to procydidine. There was a slightly brisker and more pronouncea response to the administration of procydidine in racbits treated with F.S.L. compared with the controls and after the last dose tranylcypromine ratal hyperthermia (44 3--44-5'C. rapidly developed in all rabbits. Thus, in a total of twenty-eight rabbits pretreated with two doses of tranylcypromine, administration of procycb, dine resulted in a moderate hyperthermia .temperature CHROMOSOMAL. AND DOMINANT LETHAL EFFECTS OF VINYL CHLORIDE Sir,--'`inyl-chloride monomer (v.tM.) is carcinogenic m rats 1 md epidemiological evidence has demonstrated ta carcmtgenictty to man.1 It is known that most carcino ids are mntagenic, and therefore evidence of mutagenic sects m man and animals has been sought. In relatively (sited rmtiies Funes-Cravioto etal.30 and Ducatman et al.u have desmtbed chromosomal aberrations in man exposed to v L.M. dsmg die manufacture of polyvinyl chloride (p.v.c). T- have examined a larger number of workers and extended the observations to dominant lethal studies in mice exposed t; T.C.M. Te hare -tudied 80 workers, 56 of whom had been work ing in the manufacture of p.v.c., and were thus exposed to v.L-M.: tie remainder were working in plants and labora tories wztere exposure to V.C.M. did not occur. The exposed grrtip corseted of autoclave workers, maintenance workers, am woriert associated with the manufacture of vinyl emende. 3iood samples were taken and lymphocyte curures prepare.: using standard Difco kits (Difco Labora tory, Demutt, Michigan, U.S.A.). Lymphocytes were not exceeding 41 4'C) in some amnals. After imecnon of a further dose of tranylcypromine 2 hours after procydidine. only cases of moderate hyperthermia were recorded, except CESCMOSOtid A3EJjU.naXS IX 71NYL-CHL0RIDE-EXP0SED WORKERS asc mxracts not exposed to vinyl chloride in animals which had also been treated with a depot neuro leptic preparation on the day of recording. Severe hyper Esprture sza&xy NO. ; B evils i Cu cells % C* eeUs thermia either m response to the administration of pro Expand . 56 6-30 1-45 0-38 cydidine or io the last dose of tranylcypromine was recorded Nost-spore: 24 363 0-46 009 in some of these rabbits. It is remarkable that f.p.t.-d ic-ected 3 days before the experiment did not influence the temperature course, whereas injection of any of the depot preparations 1 hour before appeared to do so. In a period of a few hours, only minute amounts of aenve substance could have been released from the intramuscular depot, whereas an amount sufficient to establish neuroleptic effect would have been released after 3 days.*-3 Under certain conditions neuroleptics may possibly aggravate the inteacrion between aztiparkiiisoo drugs and M.A.O.I.S. The reason for this is unknown- However, all three types of drugs may affect dopaminergic neuron systems in the brain. Treatment with an .scA-O.i. increases the concentration of dopamine. In addition to the anti cholinergic effect many anuparkinson drugs inhibit dop amine uptake,3 leading to an increased amount of dopamine in the synaptic cleft .An interaeuronai feedback mechanism due to postsynapnc receptor blockade by die neuroleptics cultured ter 48 ot 72 hours. All slides were coded before scormg to msure unbiased analyses, and 100 cells from each mdivtruai were analysed using the classification of Buccan it: Pike.-'- Workers who had been exposed to X rays, pro.-ruged frog treatment, or recent viral infections were aclucci from the study. The resu.m from 48 and 72 hour cultures were not signifi cant,- diffe-mt and these data have been pooled. The resu.3 are even m the accompanying table where it can be sea that there is a significantly increased (P<0-05) peremage m 3, Cu. and Cs cells in the exposed workers. These resu-ti, which confirm those of the previous authors, 1<>';: suggest that vinyl chloride has a detectable effect :n chromosomal aberrations in man. To meek whether any genetic effects could be induced in the gem ct--5 we tamed out a dominant lethal study in is probably not operating, since a receptor blockade can be !. Caam, A- Xehr. T., Lindquist, M. J. Plumae. pant, 1974, S, demonstrated pharmacologically oniy about 24 hours after s=yl- . injection of a depot neuroleptic.1 Evidence indicating the i. ttiuas, J. -- Roth. 3, H. J. Phttmte. op. Thtr. 1974, Ml, 82. existence of a feedback control mediated via presvnapdcI. * 3 43. Quscx, a Hotra, A. Seunut 1974, 183, 539. Mi -TJ. C-. - -err--e. G. nnren. Ret. 1974, 7, 3S7. I. Nyeiark, M,, Freer, K. F., Pedersen. V., 3veer. V.t MolJer Nielsen, I. Atia Pkarmae. tax. 1973. 33. 363. 3. Jntouen. A., Fredr.oofi Overs, K., Hansel, V. tetd. 1971.29.339, 9, Cram, 1. -- (ronjee, .\1. N. J. eecup. Mtd. 1974,16, 150. .3. Fuaa-Cnv.x:. Lambert, 3 , Lindsten, J., Ebrenberg, L,, Ntomjin. - T, Ottennan-GoUtan, S. Lanai, 1975, i, 459. .:. Duaenan.Ain---ucm, K.f SeUxojT, 1. J. Mutation Ret. 1975, 3. JergeiKn, A., Gondla. c. G. Rrymofnarnrucoto^l. 1973, 27, 1. 4. Fuse, K,, Goldstein, M., Liur.goihi. A. _,/ Set. .970. 9, si 1 31. .33. .3. Buccro, K. L- M. C. Ini.}. Rad. Biel. 1964,, 439. VC5772 THE LANCET, AUGUST 30, 1975 409 The additional cases became ill 12-59 days alter the index case, strongly suggesting secondary spread of infection. However, 9 of 10 cases were associated with a single, shallow, open pit well. This well was heavily contaminated with colifbrm bacteria and fircal streptococci, but S. typki could not be isolated despite several attempts, A strain of 5. iyphi with an identical resistance pattern was isolated from household water in a neighbouring house, but, owing to cross-contamination of the water vessel, the exact source of the bacteria could not be determined. There were no typhoid cases in this household. Control measures have seemingly interrupted trans mission at this focus, since there was no further illness 8 weeks after the last case-finding. Measures included chlorination of writs, earner surveys, public-health-nurse visits for case-finding, home treatment and hospital referral, vaccination, and special sanitation instructions. This outbreak of chloramphenicol-resistant typhoid may represent a primary occurrence in Java. Our experience leads us to believe that chloramphenicol-resistant typhoid fever has been rare or absent in Indonesia in die past. Hopefully, it will not develop into the problem now existing in Vietnam and Thailand. .. Warren R. Sanborn U.S. NJlkvi*rltRaeDseeteacrchhmLennt,No. 2, vA1itUnRuAnO LUBraMAu.VvAi A.P.O. Sin Frxnasco 96356, U.S.A. DAVID T. DENNIS. R.S. Fianiwed, Cilwdftk, Indoseu*. $uku Oisu Kctehmo, Jakarta SeUtw, Indonesia, Retno Trenggonowati Kadrman Irma Lita. SUYaNI. / JOINT INFECTION BY PASTEURELLA MULTOCIDA Sir,--We read with interest the letter by Griffin and Barber 1 2in3w4h5ich they described a woman with rheumatoid arthritis and a pyarthrosis caused by Pasteurello muisoada in a knee containing a prosthesis. We have also seen a woman with rheumatoid arthritis and P. multoeida septic arthritis affecting a knee containing a prosthesis; she was cured with parenteral antibiotic and without removing the prosthesis. A 55-year-old woman had an 18-year history of severe seropositive rheumatoid arthritis. She had been maintained on 7 5 mg of prednisone and 5-2 g of aspirin per day. Several years previously she had undergone surgery with the placement of bilateral knee prostheses. A 2-week history of painful swollen right knee prompted admission to hospital. She denied chills or fever. She had a pet dog which often licked her extremities, but had never bitten or scratched her. The right knee demonstrated synovitis and there were no scratches or abrasions on the extremi ties. Arthrocentesis revealed fiuid containing 45 000 white blood-cdls/mm1 and grew a pure culture of P. multoeida (confirmed by the Pennsylvania State Laboratory and the Center for Disease Control in Atlanta, Georgia). A pharyngeal culture from the patient's dog also grew P. multoeida. Intravenous penicillin therapy (10 megaunits/ day) and frequent joint aspiration led to clinical improve ment and eradication of the organism from the toint after 14 days. To date there has been no continuation of the infection and no evidence of loosening of the prosthesis. Both Griffin and Barber's patient and our patient had long standing rheumatoid arthritis, were receiving cortico steroids, and had a prosthesis in the affected joint. The in fections were eradicated without removing the prosthesis. 1. Gnffin, A. J,, Buber, H. M. Laeut. 1974, i, 1347. Unlike most gram-negative rods, P. multoeida has signifi cant in-viera sensitivity to penicillin, being sensitive to 0-19-0*39 jig, ml of penicillin.1 The excellent response to medical treatment of pyarthro sis in a joint containing a prosthesis conflicts with the widely held view that the prosthesis must be removed to eradicate the infection.' Medical management alone may be adequate to effect a cure in septic arthritis in joints contain ing prostbeses, especially if the organism is sensitive to easily obtainable antibiotic levels. Of additional interest is the reported increased ownership of pets, especially dogs, by patients with rheumatoid arthritis compared with controls with other types of arth ritis and other medical problems.1 P. multoeida is often the predominant organism of the oropharynx of dogs, cats, and other animals.1 RhcumJtC'lofy Section, PhiUdelphU Veteno* Adouniftredon Hospital, Philadelphia, Pennsylvania 19104, Kenneth H. Maurer Peter Hasselbacher U.S.A. H. Ralph Schumacher. JNTRA-ARTICULAR METHOTREXATE Sir,--The successful use of systemic methotrexate in resistant psoriasis prompted us to try intra-articuiar methotrexate in a patient with chronic psoriatic arthropathy. He was a man of 49 with persistent bilateral knee effusions which had resisted local and systemic steroid therapy. Two injections, a week apart, of 2*5 mg of methotrexate were made into each knee. 2 weeks from the first injection the effusions disappeared and have not returned after 10 months. No adverse effects were observed. Bemuse of the dramatic improvement, we have subse quently used intra-articuiar methotrexate in eleven ocher patients with persisting knee effusions: one with psoriatic arthropathy, eight with seropositive rheumatoid and two with seronegative rheumatoid arthritis. Only two (in the seropositive group) failed to show either complete resolution of inflammation or striking improvement; and none showed cither local or general side-effects. This treatment seems to be simple, safe (because of the very small dose used), and effective. We report these preliminary results in the hope that others may try intraarticuiar methotrexate and better define its scope and limitations in the therapy of resistant inflammatory arthro pathy. Royal Devon and Exeter Hospital, (Wooford), Bamck Road, Exeter EX3 SOW. G. H. Hall A. C. Head. HYPERTHERMIA IN RABBITS CAUSED BY INTERACTION BETWEEN M.A.O.U, ANTIPARKINSON DRUGS, AND NEUROLEPTICS Sir,--Interaction between monoamine-oxidase inhibi tors (m.a.o,ls) and tricyclic antidepressants or pethidine is well known. Experiments in our laboratories have shown a similar interaction (producing hyperthermia) between Mjt.o.i.a (tranylcypromine and nialamide) and anticholin ergic antiparkinson drugs (procyclidine and benztropine) in rabbits. To determine whether neuroleptics influence the inter action between m.A.o.i.s and antiparkinson drugs a series 2. Byrne, J. J., Boyd, T. H., Dely, A. K- Stry, Gy'iti: ObiU: i sob, tW, 57. 3. Roles, N. C. Pm. R. See. Med. 1971, 4,636. 4. Gottlieb, N. L., Ditches, N,, Foiley, j., Kiem, O. M. Arthnut RAnm. 1974, 17, 229. 5. Smith, J. E.J. temp. Path. Thtr. 1953, SS, 239. VC5773 THE LANCET, AUGUST 30, 1975 411 mitt. Fiftem male mice per treatment group were exposed to levtit of 30 000, 10 000, tod 3000 p.p.m. of v.C-M. for 6 boon a day on 5 consecutive days, and an examination for dominant lethal effects in two females mated with each male for 8 consecutive weeks was carried out. There was no significant increase in the number of early deaths per implantation compared with a control group exposed to air stone, indicating that V.C.M. does not produce dominant lethal mutations in mice even at these exceptionally high levels. It appears, therefore, that the mutagenic effects of vinyl chloride, expressed as chromosomal aberrations in lymphocytes, do not occur in the germ cells. The reason for this could well be that active metabolites of vinyl chloride are responsible for the toxic effects and these do not reach the testis. The potential danger of mutagenic effects on the ferns via the sperm does not therefore seem to exist. Imperial Chemical Indurorica Limited, Ceocil Toxicology Laboratory, Aldoicy Part, Nr- Macclesfield, Cbmhire SK10 4TJ- I. F. H. Purchase C. R. Richardson D. Anderson. THYROID-CELL-MEMBRANE antibodies Sir,--Attention has best drawn 1-1 to an association between various types of thyroid disease and infection with Ytrtma tnteroeolitica serotype 3. Lidman et al.* have also shown, using an indirect immunofluorescent technique, that a high percentage of the sera containing agglutinating antibodies to Y. tnuroeoltnca serotype 3 have antibodies which react with the membrane region of thyrotoxic thyroid epithelial cells. Following heat inactivation of complement, smooth-muscle antibody (s.m.a.) positive sera can be shown r * *- ,v x served by Biberfdd et aL' (see accompanying figure). The 46 sen investigated in this study were collected over a four-month period. Their selection was simply on the basis of the brigbmess of the thyroid-membrane fluorescence on initial screening. The indirect-immunofluorescence tech nique used was similar to tint described by Beck.* To determine the immunoglobulin class of the antibodies, specific antisera to G, A, and M were obtained from Wellcome Reagents Ltd, and D and E from Behringwerke AG. As observed by Biberfdd et al.4 some thyrotoxic thyroids used as substrates gave no staining of thyroidcell membrane with positive sera and therefore, once a thyrotoxic thyroid was found suitable, it was used through out the study. The mean age of the patients was 59*2 yean .'range 18-69'; the 46 patients comprised 26 females and 20 males. The clinical diagnoses are shown in table I. tabu t Hural di*fho*is "Ptyrmd titttcu. Thyrotoxicocs Hypothyrtnd^s -. Unspecified Dtktr aut&mmtv diuAsn- Psmaoui trrsiii Rheumatoid -arids Autoimmune anemia Chrome scpatmi ., Alopecia arma MoAfnam Yiscular Itqtcnous StuuUannm ........................................ No. of patients 12 1 2 6 .1 l 2 1 3 4 2 ll TlUt II--TiSSOdATtD AUTOANTIBODIES OrscHpeofic Thyroid miCrOKETai C-utrtc pinetBi rsi i 4* j ! IS - Non-organ-ipetific Antinuclear Smooth mvucle Mitochondrial Rcticulm 12 11 l 8 * True irequea^f of this lfitiboar could not be determined since *hsi there to bneni cytoplasmic fluorescence due to microaooai aatibocr :mi obscured ceU-tnembrUkc atainms, It is evident that some 52% of patients with this particular annbody have clinical autoimmune disease. The mean antibody titre was 1 64 (range 1/8-1/512). The immuno globulin class of the thyroid-membrane antibodies was as follows: G-45, A-34. M-16, D-6, and E-28. The nature and frequency of associated autoantibodies are shown in able ii. Like Biberfeid et aL1 we have observed that, following UnfiuU lectioa of thyrotoxic thyroid duplayxd by iadirtet limiiaixi|iinihdm technique. Note the linear staining of epithelial cell membranes, x 440. heat inactivanon of complement, 32 out of 44 sera contain ing smooth-muscle antibody reacted with sectioned thyro toxic cells to produce an identical staining pattern, but this antibody does not show as wide a spectrum of immuno to produce identical staining of thyroid-cell membranes.11 globulin class as that found in the other group and is mainly However, it is dear that this is a different antibody since of the IgG class. Geariy, however, there is some overlap not only can it be removed by absorption with pig stomach smee 11 of the unheated sen which were positive for but also it appears to be inhibited by complement.1 tnyroid-cell-menbrane antibody also contained S.M.A. We report here our studies on an antibody, found in sera The associacon between Y. emtrocelirica serotype 3 and sent to our laboratory for routine autoantibody studies, thytoid-cell-membrane antibody *-* is of interest. Infec which produces an identical staining partem to that ob-* 2 3 4tio5n with this particular organism is common in Scandi navia, bur this does not appear to be so in the United 1- Been, K,, Larsen, J. H-, Hansen, J. M., Nerup, J. Lmui, 1474, u, 4*1. 2. Lidman, K., Eriknon, U., Fsgneus, A., Norberc, R. 1474, li, 1444. 3. von Boiudcnf, M,, Frirnan, C. ibid. p. 1564, Kingdom.' Of 30 sera (10 positive for thyroid-cdl-membrane antibody, 10 positive for smooth-muscle antibody, and 10 negative for all autoantibodies) screened for evidence or infection with this organism none was positive. However,i * * 4. Biberfdd, G,, Fstncui, A., Lenka, R. Clin, tip, Immtn. 1474,1>, 371. 5. Sutton, R. N. P., Emond, R. T. D., Thomas, D. B., Domach, D. dad. 1474, 17, 427. i Beck, I. S. -jmcuacc el Clinics! Pstholo*i*tj Broadsheet, 1474, no. 69, Mur, N. S. Psnonal -omniumcroon. VC5774 V 412 THE LANCET, AUGUST 30, 1975 of 3 sera, sent to us by Dr N. S, Mair, taken from patients with antibodies to Y, enterocolitica serotype 3, 2 were shown to react with thyroid-cell membrane. Since Y. enterocolitica infection is uncommon in the United Kingdom we iecided to screen all thyroid-cell-membrane sera (46) and control sera (negative for all autoantibodies) for raised antibody litres, using a complement-fixation technique, against a variety of organisms: influenza A and B, Sendai, adenovirus, psittacosis, respiratory syncytial virus, cyto megalovirus, mumps S and V, Mycoplasma pneumonia, and Coxiella burnetii. There was no significant difference in antibody litres between test and control sera. It would appear therefore that in this country, unlike continental Europe, there is a different triggering mechanism for the appearance in the serum ofthyroid-cell-membrane antibody. As yet, the nature of this infection, if it is such, is unknown. It remains to be proven whether this antibody is of pathogenic significance in thyroid disease. Certainly of 3 patients who died and who were known to have thyroid-cellmembrane antibody in their serum, none showed any evidence of thyroid abnormality. Finally, using an organculture technique, a total of 24 thyroid-cell-membranepositive sera and controls (negative for all autoandbody tests) were studied for possible effects on the uptake of 151I by hyperplastic thyroid explants, a minimum of six to eight cultures being employed in each test. `"I uptakes after exposure to test or control serum were determined as previously described.* No difference between test and control sera was demonstrable. We are indebted to Dr N. S. Mair, Public Health Laboratory, Leicester, for screening our sera for antibodies against Y. tnterocoliuca and to the virus laboratory, Department of Bacteriology, Foresterhill, for carrying out the other serological tests. ,U,nivers.ity ,,Department o.f ,,Pat.hology, Foresterhill, Aberdeen ABO 2ZD. C. H. W. Horne R . Dr>. Bxrr,iTMggs "* ,,TJ LILLIAN M. HOPKINS. A NEONATAL AND INFANT PHLEBOTOMY TOURNIQUET Sm,--I have been using a simple but extremely efficient tourniquet, made from easily available disposable items, which may be of interest to doctors dealing with neonates and infants. This consists of a roller clip from a McGaw paediatric giving set and a De Lee suedon catheter. It is essential that these two items are used for best results. The catheter is passed through the roller clip so that a loop is created at the " narrow " end of the roller clip. In application the correct degree of tension is easily judged and the roller is then pushed home to maintain this. Other advantages of this tourniquet are that its size is ideal; it is released easily and can even be dismantled in situ, so as not to disturb drips; it does not pinch the infant's skin; a separate tourniquet can be made for each individual neonate or infant and hence help to reduce cross-infection; and of course it is extremely cheap and easily replaceable. Raditxiiagnoitic Department. Hammersmith Hospital, London Wl2 OHS. ___ C, METRHWBLI. 8. Htrbitz, Th.B.s Beck, J. S. Br. J. txp. Path. 19?1> 52, 231. COMPARISON OF PLASMA CARCINOEMBRYONIC ANTIGEN AND ALPHA-FETOPROTEIN IN VARIOUS TUMOURS Sir,--Among the many tumour index substances meas ured in clinical practice, the oncofetal antigens, notably carcinoembryonic antigen (ex.a.) and x-fetoprotein (a.p.p.), have received much attention. Although these substances were originally thought to be specific for carcinomas of the alimentary tract1 and hepatocellular carcinomas * respec tively, further studies have shown that both can be raised in the plasma in other conditions.* We have examined, by radioimmunoassay, the plasma C-E.A- and a.p.p. levels of 172 patients. The series consisted of cases of bronchial and mammary carcinoma, of miscel laneous chronic liver disease (cirrhosis, ethanol abuse. PLASMA C.I.A. AND A.F.F. LEVELS IN VARIOUS TUMOURS AND LIVER DISEASE Condition Plasma-cut. Normal Elevated <20 >20 ng/ml nt/ml Plasma-ARJ. Normal Elevated <15 >15 ng/ml nt/ml Total no. of patient* Colorectal cardno zaa with hepatic metattaie* 25 70 7 Bronchial circino- me 17 13 29 1 30 Mttwmfy carci noma .. 7 12 19 0 19 Miscellaneous tumour* 23 23 45 i 46 Liver ditease (non- malignant) 29 41 67 3 70 chronic hepatitis, obstructive jaundice), of colorectal carcinoma with hepatic secondaries, and cases with miscel laneous tumours including melanomas and iymphoreticular tumours, all having liver scans for suspected metastatic involvement. The results are shown in the accompanying table. More than half of the tumour-bearing patients had elevated plasma-C.E.A. levels, whereas only a small minority of these same patients had plasma a.p.p. levels outwith the normal range. There was only 1 case where the plasmaa.f.p. level (47 ng/ml) was elevated while the plasma-C.E,A. level (16 ng/ml) was in the normal range. This patient had Hodgkin's disease. Other examples of Hodgkin's disease had normal a.p.p. levels. In one other patient, with bron chial carcinoma, the plasma-A.F.p. level (92 ng/ml) was higher than the c.e.a. level (28 ng/ml). In all other cases, plasxna-c.E.A. values were raised, with normal or raised a.p.p. values, or the levels of both oncofetal antigens were within normal limits. Recently Mclntire et al.* reported that 3% of colorectal-carcinoma patients have high plasmaA.F.p. levels; none of the present group show these changes. The conclusion from these results is that in patients with non-testicular and non-primary hepatic tumours, measure ment of plasma-C.E.A. is, by itself, a more reliable index of disease activity than measurement of plasma A.F.P. Chester Beatty Research Institute, Fulham Road, London 5W3 6JB. K. M. Grigor S. I. Detre D. J. R. Laurence TT cTMTM,. =>TEVENS A. MUNRO NEVILLE.1 2 3 4 1. Gold, P., Freedman, S. O.J. sap. Mtd. IMS, 1Z2,467. 2. Abelev, G. I. Conctr Rit, IMS, 28,1344. 3. Laurence, D. J. R., Neville, A. M. Br. J. Conor, 1872, 28, 335. 4. Mclntitc, K, R-, Waldmann, T. A., Moettel, C. G., Go, V. L. W. Cancer R. 1875, 25, 881. VC5775