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EPILEPTIC DEATH DUE TO SUFFOCATION DURING SLEEP
876 3. The suspicion so frightened these taciturn patients that they developed relapses of mania and depression (endogenous type) of such severity that they required supplementary treatment in the home or admission to a mental hospital. Not even then did the patients see fit to mention their concern about the tablets.
It is of course conceivable that all this happened. But is it likely ? Psychopharmacology Research Unit, Aarhus University Psychiatric Institute, MOGENS SCHOU. Risskov, Denmark.
split. The print-outs, giving the results and the details, forwarded to all the hospitals. The computer matching is a simple process which is completely fair, and could be applied to all appointments which involve a number of interested parties. It should be stressed that the service should be run by a completely neutral party, and that all preference lists should be kept absolutely confidential. Preserving secrecy of lists inspires the confidence of the candidates, who respond by adhering to the rules. Melbourne Medical Postgraduate not are
Committee East
LITHIUM TERATOGENICITY SIR,-We wish to report our finding that lithium is teratogenic in the rat. 50 mg. lithium chloride was administered intraperitoneally to pregnant rats weighing 220-250 g. on days 1, 4, 7, or 9 of gestation. This was followed by a daily dose of 20 mg. lithium chloride till day 17, when the fetuses were removed by caesarean section and examined for malformations. Serum-lithium levels were in the range observed in human beings receiving lithium therapy. The malformations observed were primarily in the eyes (62% of fetuses), as well as cleft palate (39%) and external ear defects (45%). The auricular abnormalities were of the same nature as those reported by Schou and Amdisen 1 in a baby born to a woman receiving lithium carbonate during her pregnancy. It has been demonstrated that lithium causes cleft palate in the mouse,2but, to our knowledge, lithiumrelated teratogenesis has not been demonstrated conclusively in other mammals. Department of Anatomy, University School of Medicine, Nashville, Tennessee.
Vanderbilt
T. L. WRIGHT L. H. HOFFMAN J. DAVIES.
SELECTION OF HOUSEMEN
SIR,-Iwas interested to read in your issue of Aug. 29 (p. 459) Dr. Leishman and Dr. Ryan’s account of a second computer matching programme in Great Britain-one which is very similar to the Intern Matching Service Programme which has been used in Victoria since 1967. This year will be the Australian service’s fourth year of matching, and all candidates for first-year or intern appointments in Victoria and Tasmania (except in one hospital) obtain their appointments through this service. A computer programme prepared by Dr. F. Hirst and Mr. R. Bowles of the computation centre, University of Melbourne, has been used since the inception of the service. In our programme we are only matching candidates to hospitals’ posts, and not to rosters within the hospitals, since first-year posts are fairly closely similar. Consequently, the matching involves only 280 candidates and 28 hospitals. Rosters within hospitals could be managed very easily using the same programme for an extended number. We do not ask for final submission of candidates’ priority lists till 4 days after the publication of the last medical Submissions from hospitals school’s final-year results. close 1 day later, and the matching takes place the following day, the results being published within 48 hours. This tight schedule is made possible by careful timing and working late. Candidates and hospitals are simply asked to honour their matching; no statutory declarations have been asked for, nor have they been needed. The whole of the matching is done mechanically except the checking out of married couples, or pairs who have applied to be matched together. Personal review is necessary to see that pairs are 1. 2.
Schou, M., Amdisen, A. Lancet, 1970, i, 1391. Szabo, K. T. Nature, 1970, 225, 73. See also Szabo, K. T. Lancet, 1969, ii, 849.
Melbourne, 3002, Australia.
M. O. KENT-HUGHES.
EPILEPTIC DEATH DUE TO SUFFOCATION DURING SLEEP
SIR,-Dr. Longmore and Dr. Wilson (Oct. 10, p. 782) draw attention to a hazard which, although real, fortunately does not appear to be at all frequent. For instance, in my 45 years’ neurological practice, I have encountered only three cases (all males) in which death resulted from suffocation in bed, presumably during a major convulsion. In each case the patient was found with his face buried in a soft pillow. The use of a smother-proof pillow would certainly be advisable for patients subject to major attacks, especially if nocturnal. Another hazard is that of drowning in a bath during a major attack. This occurred in two cases (both females) in my experience. The precaution would be that the bath should contain only a limited amount of water rendering it impossible for the patient’s head to become submerged. There is yet another risk of drowning, as exemplified by the following recent case: a youth under regular treatment for epilepsy was found drowned in quite a shallow river. He had been fishing from the bank and presumably suffered an epileptic attack which caused him to fall into the water. C. WORSTER-DROUGHT.
EPILEPSY AND CLEFT LIP AND PALATE
SIR,-In the course of the counselling and research work of the Genetics Division at the Lancaster Cleft Palate Clinic, an appreciable number of patients with cleft lip and/or palate were found to have a first or second degree relative with epilepsy.
These figures indicate no significant differences between the three types of malformation. However, it is interesting that the percentages for the cleft-lip and cleft-lip-andpalate groups are close and are lower than the value for the cleft-palate group. This difference, if confirmed in a larger series, would be compatible with the hypothesis that isolated cleft palate is a genetic entity distinct from cleft lip with or without cleft palate, as was first suggested by Fogh-Andersen.1 It also suggests that the possibility of a genetic relationship between epilepsy and oral clefts should be further investigated. There have been a number of reports of the effect of the anticonvulsantDilantin ’ (phenytoin), as a possible teratogenic agent in causing oral clefts in offspring, but 1.
Fogh-Andersen, hagen, 1942.
P. Inheritance of
Harelip
and Cleft Palate.
Copen-
It is of course conceivable that all this happened. But is it likely ? Psychopharmacology Research Unit, Aarhus University Psychiatric Institute, MOGENS SCHOU. Risskov, Denmark.
split. The print-outs, giving the results and the details, forwarded to all the hospitals. The computer matching is a simple process which is completely fair, and could be applied to all appointments which involve a number of interested parties. It should be stressed that the service should be run by a completely neutral party, and that all preference lists should be kept absolutely confidential. Preserving secrecy of lists inspires the confidence of the candidates, who respond by adhering to the rules. Melbourne Medical Postgraduate not are
Committee East
LITHIUM TERATOGENICITY SIR,-We wish to report our finding that lithium is teratogenic in the rat. 50 mg. lithium chloride was administered intraperitoneally to pregnant rats weighing 220-250 g. on days 1, 4, 7, or 9 of gestation. This was followed by a daily dose of 20 mg. lithium chloride till day 17, when the fetuses were removed by caesarean section and examined for malformations. Serum-lithium levels were in the range observed in human beings receiving lithium therapy. The malformations observed were primarily in the eyes (62% of fetuses), as well as cleft palate (39%) and external ear defects (45%). The auricular abnormalities were of the same nature as those reported by Schou and Amdisen 1 in a baby born to a woman receiving lithium carbonate during her pregnancy. It has been demonstrated that lithium causes cleft palate in the mouse,2but, to our knowledge, lithiumrelated teratogenesis has not been demonstrated conclusively in other mammals. Department of Anatomy, University School of Medicine, Nashville, Tennessee.
Vanderbilt
T. L. WRIGHT L. H. HOFFMAN J. DAVIES.
SELECTION OF HOUSEMEN
SIR,-Iwas interested to read in your issue of Aug. 29 (p. 459) Dr. Leishman and Dr. Ryan’s account of a second computer matching programme in Great Britain-one which is very similar to the Intern Matching Service Programme which has been used in Victoria since 1967. This year will be the Australian service’s fourth year of matching, and all candidates for first-year or intern appointments in Victoria and Tasmania (except in one hospital) obtain their appointments through this service. A computer programme prepared by Dr. F. Hirst and Mr. R. Bowles of the computation centre, University of Melbourne, has been used since the inception of the service. In our programme we are only matching candidates to hospitals’ posts, and not to rosters within the hospitals, since first-year posts are fairly closely similar. Consequently, the matching involves only 280 candidates and 28 hospitals. Rosters within hospitals could be managed very easily using the same programme for an extended number. We do not ask for final submission of candidates’ priority lists till 4 days after the publication of the last medical Submissions from hospitals school’s final-year results. close 1 day later, and the matching takes place the following day, the results being published within 48 hours. This tight schedule is made possible by careful timing and working late. Candidates and hospitals are simply asked to honour their matching; no statutory declarations have been asked for, nor have they been needed. The whole of the matching is done mechanically except the checking out of married couples, or pairs who have applied to be matched together. Personal review is necessary to see that pairs are 1. 2.
Schou, M., Amdisen, A. Lancet, 1970, i, 1391. Szabo, K. T. Nature, 1970, 225, 73. See also Szabo, K. T. Lancet, 1969, ii, 849.
Melbourne, 3002, Australia.
M. O. KENT-HUGHES.
EPILEPTIC DEATH DUE TO SUFFOCATION DURING SLEEP
SIR,-Dr. Longmore and Dr. Wilson (Oct. 10, p. 782) draw attention to a hazard which, although real, fortunately does not appear to be at all frequent. For instance, in my 45 years’ neurological practice, I have encountered only three cases (all males) in which death resulted from suffocation in bed, presumably during a major convulsion. In each case the patient was found with his face buried in a soft pillow. The use of a smother-proof pillow would certainly be advisable for patients subject to major attacks, especially if nocturnal. Another hazard is that of drowning in a bath during a major attack. This occurred in two cases (both females) in my experience. The precaution would be that the bath should contain only a limited amount of water rendering it impossible for the patient’s head to become submerged. There is yet another risk of drowning, as exemplified by the following recent case: a youth under regular treatment for epilepsy was found drowned in quite a shallow river. He had been fishing from the bank and presumably suffered an epileptic attack which caused him to fall into the water. C. WORSTER-DROUGHT.
EPILEPSY AND CLEFT LIP AND PALATE
SIR,-In the course of the counselling and research work of the Genetics Division at the Lancaster Cleft Palate Clinic, an appreciable number of patients with cleft lip and/or palate were found to have a first or second degree relative with epilepsy.
These figures indicate no significant differences between the three types of malformation. However, it is interesting that the percentages for the cleft-lip and cleft-lip-andpalate groups are close and are lower than the value for the cleft-palate group. This difference, if confirmed in a larger series, would be compatible with the hypothesis that isolated cleft palate is a genetic entity distinct from cleft lip with or without cleft palate, as was first suggested by Fogh-Andersen.1 It also suggests that the possibility of a genetic relationship between epilepsy and oral clefts should be further investigated. There have been a number of reports of the effect of the anticonvulsantDilantin ’ (phenytoin), as a possible teratogenic agent in causing oral clefts in offspring, but 1.
Fogh-Andersen, hagen, 1942.
P. Inheritance of
Harelip
and Cleft Palate.
Copen-