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Perinatal HCV transmission
1072
Perinatal HCV transmission
Noticeboard European action
on
triazolam
The sleeping drug triazolam is available throughout the twelvenation European Community, except in the UK, where the licence was suspended earlier this month. Because Upjohn is appealing, first to the Committee on Safety of Medicines, against that suspension, the UK felt unable to take part in discussions in Brussels on Oct 16. It did, however, present the factual basis for its action. Earlier this month France and the Netherlands had asked for an opinion from the European Commission’s Committee for Proprietary Medicinal Products. Upjohn submitted a mass of information five days before the Brussels gathering, including a revised version of the contentious Protocol 321, and the CPMP will complete its review of that material in December. (If that material includes Protocol 6415, the CPMP’s reviewers might be well advised to ask for a videotape ofBBC Television’s Panorama edition of Oct 14, where that study was alleged to have been fraudulent.) Despite taking the preliminary view that "evidence of new risks at recommended doses does not seem to be available" the CPMP’s position is that information should be strengthened immediately. Triazolam should be indicated only when the sleeping disorder is severe; the drug should not be used for longer than 3 weeks; a dose of 0 125 mg will often be sufficient (and in the elderly should not be exceeded); and triazolam should not be used in patients with any major psychiatric disorders.
Although the possibility of intrafamilial spread of hepatitis C virus (HCV) has remained a contentious issue among hepatologists, reports at the 26th meeting of the European Association for the Study of the Liver seem to confirm that this RNA virus can be transmitted both horizontally (Dr Bellobuona and colleagues, Italy) and vertically (Dr Wejstal and co-workers, Sweden). Mother-tochild transmission has been confirmed with the nested polymerase chain reaction. However, horizontal spread has been inferred only from HCV antibody and aminotransferase estimations. A letter to Nature strengthens the evidence for mother-to-child transmission of HCV.1 Japanese researchers found HCV complementary DNA fragments that bore a close resemblance to each other in serum from a baby, the mother, and the grandmother. The nucleotide sequence that encodes the HCV envelope protein was identical for the mother and daughter between positions 901 and 1065. Only 6 (3-6%) nucleotides in the grandmother’s cDNA were different. The baby was C100-antibody positive and had an acute resolving hepatitis; the mother and grandmother had antibodies to p22, the HCV nucleocapsid antigen. The cycle of infection probably began when the grandmother received a blood transfusion that was followed by an acute non-A, non-B hepatitis. The apparent case of transmission may explain the high frequency of HCV infection in the community. 1. Inoue Y, Miyamura T, Unayama T, Takahashi K, Saito I. Maternal transfer of HCV. Nature 1991; 353: 609.
Adolescent suicides in Greece Informed consent
on
trial
Test cases against doctors at the Christie Hospital, Manchester, UK, are now being prepared by lawyers acting for patients who took
part in a trial of a new intracavity radiotherapy technique that started in 1980. Last week, a BBC Radio 4 File on Four report described how patients with cervical cancer were included in a study to compare the efficacy of the ’Selectron’ system with the more established radium pack technique. Patients interviewed for the programme claimed that they had not been told that they were being entered into a clinical trial. Dr Robert Pointon, the then director of radiotherapy at the Christie Hospital and Holt Radium Institute, stated that it was not normal practice at that time either to tell patients that they were being studied as part of a trial or to seek informed consent for such a trial. The selectron is a programmable machine that enables caesium pellets to be delivered close to the cervix through a metal cylinder. The precision offered by this technique and the shortening in treatment time that was possible because of the increased intensity of radiation, led the Christie radiotherapists to believe that there were substantial economic advantages to be obtained from the selectron. Only several years later, when patients presented with severe radiation damage to both small bowel and bladder, did the Manchester group realise that their radiation dose schedules might be excessive.1 Furthermore, this system of internal radiotherapy was tested in the same patients as those who were receiving a new means of delivering radiotherapy externally, Hex 2. Hence, there was confusion over which technique had caused the adverse effects seen in about 300 women. A diversity of bowel and urinary tract damage continues to be reported by the Manchester group.2 Although Sherragh-Davies1 commented that the error made by the Manchester group was not one of dose but was related to overreliance on the geometric considerations of the radiotherapeutic technique, other workers who adopted the selectron at the same time as the Christie team do not agree with this conclusion.3 E. Morbidity following low-dose Selectron therapy for cervical Clin Radiol 1985; 36: 131-39. 2. Taylor PM, Johnson RJ, Eddleston B, Hunter RD. Radiological changes in the gastrointestinal and genitourinary tract following radiotherapy for carcinoma of the cervix. Clin Radiol 1990; 41: 165-69. 3. Jackson SM, Fairey RN, Komelsen RO, Young MEJ, Wong FL. Clinical results in carcinoma of the cervix: radium compared to caesium using remote afterloading. Clin Radiol 1989; 40: 302-06. 1.
Sherragh-Davies cancer.
Suicide rates among adolescents in Greece are among the lowest in the world, according to a report from the University of Patras.1 In the period 1980-87 suicides averaged 0-98 per 100 000 per year (1-07 for boys, 0-89 for girls) among 10-19-year-olds and were considerably more common in rural areas (1-48 per 100 000) than in Athens (0-48) and other urban areas (0-98). In rural areas more girls than boys committed suicide; elsewhere the reverse was true. A fall in the adolescent suicide rate in the last 3 years of the study contrasts with a rise in adult suicides, suggesting that factors leading youngsters to take their own lives are different from those operating in adults. Beratis’ attributes the low rate of adolescent suicide in Greece to strong family ties, a warm family environment, and an ability to discharge anger easily. Perhaps some of the factors implicated in rising rates in other countries—broken homes, breakdown of the nuclear family, high mobility of young people, substance abuse-are not affecting young people in Greece to the same extent. Failed love affairs were the commonest cause of suicide in Greek girls, especially in rural areas; and in one such area in south-west Greece nearly half of all girls who survived a suicide attempt claimed that parental restrictions on their sexual freedom had precipitated the attempt. Psychiatric disorder was the most frequent cause of suicide in boys. Hanging was the suicide method favoured by boys; girls more commonly chose poisoning, particularly in rural areas, where agricultural chemicals are easily available. 1. Beratis S. Suicide among adolescents in Greece. Br
J Psychiatry 1991; 159:
515-19.
Arctic medicine The British Schools Exploring Society, founded by a naval doctor on Scott’s 1910 Arctic expedition, marks its 60th year in 1992. It plans to celebrate with a chilly programme of activities, and doctors, medical students, or nurses who would like to take part (London edition p xvi) should first look at a map that covers the Arctic circle. The five venues for exploration and scientific study are the Svalbard archipelago in Norway, South Greenland, Iceland, the White Sea of Russia, and Svalbard again. For transport reliance will be on skidoo, ski, pulk, fishing boat, snowshoe, and kayak, with lots of well-padded footwork no doubt. The BSES is based at the Royal Geographical Society, 1 Kensington Gore, London SW7 2AR.
Perinatal HCV transmission
Noticeboard European action
on
triazolam
The sleeping drug triazolam is available throughout the twelvenation European Community, except in the UK, where the licence was suspended earlier this month. Because Upjohn is appealing, first to the Committee on Safety of Medicines, against that suspension, the UK felt unable to take part in discussions in Brussels on Oct 16. It did, however, present the factual basis for its action. Earlier this month France and the Netherlands had asked for an opinion from the European Commission’s Committee for Proprietary Medicinal Products. Upjohn submitted a mass of information five days before the Brussels gathering, including a revised version of the contentious Protocol 321, and the CPMP will complete its review of that material in December. (If that material includes Protocol 6415, the CPMP’s reviewers might be well advised to ask for a videotape ofBBC Television’s Panorama edition of Oct 14, where that study was alleged to have been fraudulent.) Despite taking the preliminary view that "evidence of new risks at recommended doses does not seem to be available" the CPMP’s position is that information should be strengthened immediately. Triazolam should be indicated only when the sleeping disorder is severe; the drug should not be used for longer than 3 weeks; a dose of 0 125 mg will often be sufficient (and in the elderly should not be exceeded); and triazolam should not be used in patients with any major psychiatric disorders.
Although the possibility of intrafamilial spread of hepatitis C virus (HCV) has remained a contentious issue among hepatologists, reports at the 26th meeting of the European Association for the Study of the Liver seem to confirm that this RNA virus can be transmitted both horizontally (Dr Bellobuona and colleagues, Italy) and vertically (Dr Wejstal and co-workers, Sweden). Mother-tochild transmission has been confirmed with the nested polymerase chain reaction. However, horizontal spread has been inferred only from HCV antibody and aminotransferase estimations. A letter to Nature strengthens the evidence for mother-to-child transmission of HCV.1 Japanese researchers found HCV complementary DNA fragments that bore a close resemblance to each other in serum from a baby, the mother, and the grandmother. The nucleotide sequence that encodes the HCV envelope protein was identical for the mother and daughter between positions 901 and 1065. Only 6 (3-6%) nucleotides in the grandmother’s cDNA were different. The baby was C100-antibody positive and had an acute resolving hepatitis; the mother and grandmother had antibodies to p22, the HCV nucleocapsid antigen. The cycle of infection probably began when the grandmother received a blood transfusion that was followed by an acute non-A, non-B hepatitis. The apparent case of transmission may explain the high frequency of HCV infection in the community. 1. Inoue Y, Miyamura T, Unayama T, Takahashi K, Saito I. Maternal transfer of HCV. Nature 1991; 353: 609.
Adolescent suicides in Greece Informed consent
on
trial
Test cases against doctors at the Christie Hospital, Manchester, UK, are now being prepared by lawyers acting for patients who took
part in a trial of a new intracavity radiotherapy technique that started in 1980. Last week, a BBC Radio 4 File on Four report described how patients with cervical cancer were included in a study to compare the efficacy of the ’Selectron’ system with the more established radium pack technique. Patients interviewed for the programme claimed that they had not been told that they were being entered into a clinical trial. Dr Robert Pointon, the then director of radiotherapy at the Christie Hospital and Holt Radium Institute, stated that it was not normal practice at that time either to tell patients that they were being studied as part of a trial or to seek informed consent for such a trial. The selectron is a programmable machine that enables caesium pellets to be delivered close to the cervix through a metal cylinder. The precision offered by this technique and the shortening in treatment time that was possible because of the increased intensity of radiation, led the Christie radiotherapists to believe that there were substantial economic advantages to be obtained from the selectron. Only several years later, when patients presented with severe radiation damage to both small bowel and bladder, did the Manchester group realise that their radiation dose schedules might be excessive.1 Furthermore, this system of internal radiotherapy was tested in the same patients as those who were receiving a new means of delivering radiotherapy externally, Hex 2. Hence, there was confusion over which technique had caused the adverse effects seen in about 300 women. A diversity of bowel and urinary tract damage continues to be reported by the Manchester group.2 Although Sherragh-Davies1 commented that the error made by the Manchester group was not one of dose but was related to overreliance on the geometric considerations of the radiotherapeutic technique, other workers who adopted the selectron at the same time as the Christie team do not agree with this conclusion.3 E. Morbidity following low-dose Selectron therapy for cervical Clin Radiol 1985; 36: 131-39. 2. Taylor PM, Johnson RJ, Eddleston B, Hunter RD. Radiological changes in the gastrointestinal and genitourinary tract following radiotherapy for carcinoma of the cervix. Clin Radiol 1990; 41: 165-69. 3. Jackson SM, Fairey RN, Komelsen RO, Young MEJ, Wong FL. Clinical results in carcinoma of the cervix: radium compared to caesium using remote afterloading. Clin Radiol 1989; 40: 302-06. 1.
Sherragh-Davies cancer.
Suicide rates among adolescents in Greece are among the lowest in the world, according to a report from the University of Patras.1 In the period 1980-87 suicides averaged 0-98 per 100 000 per year (1-07 for boys, 0-89 for girls) among 10-19-year-olds and were considerably more common in rural areas (1-48 per 100 000) than in Athens (0-48) and other urban areas (0-98). In rural areas more girls than boys committed suicide; elsewhere the reverse was true. A fall in the adolescent suicide rate in the last 3 years of the study contrasts with a rise in adult suicides, suggesting that factors leading youngsters to take their own lives are different from those operating in adults. Beratis’ attributes the low rate of adolescent suicide in Greece to strong family ties, a warm family environment, and an ability to discharge anger easily. Perhaps some of the factors implicated in rising rates in other countries—broken homes, breakdown of the nuclear family, high mobility of young people, substance abuse-are not affecting young people in Greece to the same extent. Failed love affairs were the commonest cause of suicide in Greek girls, especially in rural areas; and in one such area in south-west Greece nearly half of all girls who survived a suicide attempt claimed that parental restrictions on their sexual freedom had precipitated the attempt. Psychiatric disorder was the most frequent cause of suicide in boys. Hanging was the suicide method favoured by boys; girls more commonly chose poisoning, particularly in rural areas, where agricultural chemicals are easily available. 1. Beratis S. Suicide among adolescents in Greece. Br
J Psychiatry 1991; 159:
515-19.
Arctic medicine The British Schools Exploring Society, founded by a naval doctor on Scott’s 1910 Arctic expedition, marks its 60th year in 1992. It plans to celebrate with a chilly programme of activities, and doctors, medical students, or nurses who would like to take part (London edition p xvi) should first look at a map that covers the Arctic circle. The five venues for exploration and scientific study are the Svalbard archipelago in Norway, South Greenland, Iceland, the White Sea of Russia, and Svalbard again. For transport reliance will be on skidoo, ski, pulk, fishing boat, snowshoe, and kayak, with lots of well-padded footwork no doubt. The BSES is based at the Royal Geographical Society, 1 Kensington Gore, London SW7 2AR.