- Email: [email protected]
EPILEPTOGENIC EFFECT OF MIANSERIN
969 the TSH method. In the past year 90 000 babies.in North London have been screened by TSH assay on the spare blood spots on their Guthrie cards, and there have been few technical problems in this pilot project. The cost of the assay itself is small when compared with the expense already incurred in collecting the samples for Guthrie (phenylketonuria) testing. Our experience with the 29 cases of hypothyroidism detected during this period does not support the view that greater clinical awareness will significantly improve the rate of early detection. A. J. HULSE D. B. GRANT DOREEN JACKSON BARBARA E. CLAYTON
Hospital for Sick Children, London WC1N 3JH
ETHNIC-GROUP DIFFERENCES IN SERUM LEVELS OF CARCINOEMBRYONIC ANTIGEN
StR,—Although the detection of carcinoembryonic antigen (CEA) in serum is not specific for neoplastic disease the values may be useful in determining the presence of metastatic disease and monitoring patients receiving treatment. It is clearly important to recognise non-neoplastic factors which may give rise to increased CEA values. Unpublished data from Kenya (A.G.L., J.-P. Mach, A. M. Neville, D. J. R. Laurence, A. Wasunna) and the United States (H.A.F.) and a study in the U.K.’ suggest that Blacks may have higher CEA levels than Whites. To confirm an ethnic-group difference on larger numbers than hitherto, we have compared serum-CEA levels in Blacks and Whites working in the same factory in northwest
CEA levels in Black and White non-smokers and smokers shown in the table. Smokers were defined as those who regularly smoked one or more cigarettes per day. The difference between male Black and White non-smokers is statistically significant (unpaired t test), but the difference is not significant in females. There is a higher level of CEA in White smokers than in White non-smokers (unpaired t test). There is no significant difference between Black and White smokers in CEA levels. Blackswho smoke do not appear to have higher CEA levels than non-smoking Blacks. There was no evidence of non-malignant gastrointestinal or hepatic disease in the Blacks which might have increased CEA levels. Blood-group antigen determinants of either A, B, or Lewis specificity may be linked to CEA molecules.6 There was no consistent association of CEA level with A, B, 0 bloodgroup in this series; but the numbers were small when classified by sex and ethnic group. Males appear to have higher CEA levels than females although no such difference was noted in a previous study.4 Further work is necessary to determine the reason for these ethnic-group differences in CEA as measured by the TIDA method, are
.
M.R.C./D.H.S.S. Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex
A. P. HAINES
I.A.R.C. Research Centre, Clinical Research Centre, Harrow
A. G. LEVIN
Department of Clinical Chemistry, University of Texas System Cancer Center, Texas Medical Center, Houston, Texas, U.S.A.
H. A. FRITSCHE
London.
The triple isotope double antibody (TIDA) radioimmunoassay2 with Roche reagents3 was used. This assay method for CEA compares well with clinical findings in patients with cancer and shows quite good agreement with the perchloric-acid extraction method but values tend to be consistently higher. The TIDA radioimmunoassay may measure some background substances besides CEA.4 As with other techniques of CEA determination higher levels have been found in smokers than .4 non-smokers 30 Blacks (24 West Indians, 6 Africans) all of whom had been living in the U.K. for at least eight years and 32 Whites from amongst workers in a food-processing factory in London who are participants in a prospective study of the relation between haemostatic variables and ischxmic heart-disease5 were studied. No participant had clinical evidence of cancer.
DJR, Stevens U, Bettelheim R, et al. Role of plasma carcinoembryonic antigen in diagnosis of gastrointestinal, mammary, and bronchial carcinoma. Br Med J 1972; iii: 605-09. 2. Egan M, Lautenschleger J, Coligan J, Todd CW. Radio immuno assay of carcinoembryonic antigen. Immunochemistry 1972; 2: 289-99. 3 Fritsche HA, Tashima CK, Collinsworth WL, Geitner AM. Evaluation of a direct double antibody radioimmunoassay for CEA. Clin Chem 1979; 25: 1. Laurence
1107. 4. Fritsche
HA, Tashima CK, Romsdahl MM, Holoye PY, Geitner A. A clinical evaluation of the triple-isotope double-antibody radioimmunoassay for carcinoembryonic antigen. Am J Clin Pathol 1978; 69: 140-46. 5. Meade TW, North WRS. Population-based distributions of hæmostatic variables. Br Med Bull 1977; 33: 283-88. SERUM CEA LEVELS IN BLACK AND WHITE NON-SMOKERS AND SMOKERS: MEANS
±SD
(NG/ML)
EPILEPTOGENIC EFFECT OF MIANSERIN
SIR,-Iagree with Dr Tyrer and his colleagues (Oct. 13, p. 798) about the epileptogenic potential of mianserin, and with their remark that the epileptic seizure reported might have happened earlier if lorazepam had not been prescribed as well. I saw a similar complication soon after the drug was launched. In mid-1976 I reported to the manufacturers the case of a 22-year-old female patient who had had three previous admissions to our hospital because of a personality problem and severe identity crisis, associated with recurrent episodes of depression and suicidal ideas and gestures. In May 1976, the patient was put on flupenthixol decanoate 40 mg intramuscularly every 3 weeks until Aug. 2, when, because of a severe bout of depression, withdrawal, loss of interest, and inability to cope, she was put on mianserin 10 mg three times daily. On Aug. 12 she had a major epileptic seizure, followed by a brief period of confusion. Neurological examination at the time was normal, except for bilateral dilated and reactive pupils and mild blurring of both disc edges. Since there was no history of previous epileptic seizures all drugs were stopped (flupenthixol, benz-, hexol 2 mg three times daily, and mianserin). On Aug. 18 an EEG showed an irregular but symmetrical alpha rhythm, a good deal of diffuse and symmetrical fast activity, together with a diffuse excess.of theta activity over both temporal regions but a little more marked over the right hemisphere. However, there was no evidence of focal abnormality or paroxysmal activity. The conclusion was that these EEG changes were probably attributable to the drugs. A week later the patient was discharged from hospital. She is now on no medication and seems to be settling fairly well in the community. /
Stone House
Hospital,
Dartford, Kent DA2 6AU
6. Mach J-P, Singh K, Perrinjaquet J, Carrel S, Merenda Holburn A. Ann NY Acad Sci 1975; 259: 389-403.
W. I. MIKHAIL
C, MacDonald D,
Hospital for Sick Children, London WC1N 3JH
ETHNIC-GROUP DIFFERENCES IN SERUM LEVELS OF CARCINOEMBRYONIC ANTIGEN
StR,—Although the detection of carcinoembryonic antigen (CEA) in serum is not specific for neoplastic disease the values may be useful in determining the presence of metastatic disease and monitoring patients receiving treatment. It is clearly important to recognise non-neoplastic factors which may give rise to increased CEA values. Unpublished data from Kenya (A.G.L., J.-P. Mach, A. M. Neville, D. J. R. Laurence, A. Wasunna) and the United States (H.A.F.) and a study in the U.K.’ suggest that Blacks may have higher CEA levels than Whites. To confirm an ethnic-group difference on larger numbers than hitherto, we have compared serum-CEA levels in Blacks and Whites working in the same factory in northwest
CEA levels in Black and White non-smokers and smokers shown in the table. Smokers were defined as those who regularly smoked one or more cigarettes per day. The difference between male Black and White non-smokers is statistically significant (unpaired t test), but the difference is not significant in females. There is a higher level of CEA in White smokers than in White non-smokers (unpaired t test). There is no significant difference between Black and White smokers in CEA levels. Blackswho smoke do not appear to have higher CEA levels than non-smoking Blacks. There was no evidence of non-malignant gastrointestinal or hepatic disease in the Blacks which might have increased CEA levels. Blood-group antigen determinants of either A, B, or Lewis specificity may be linked to CEA molecules.6 There was no consistent association of CEA level with A, B, 0 bloodgroup in this series; but the numbers were small when classified by sex and ethnic group. Males appear to have higher CEA levels than females although no such difference was noted in a previous study.4 Further work is necessary to determine the reason for these ethnic-group differences in CEA as measured by the TIDA method, are
.
M.R.C./D.H.S.S. Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex
A. P. HAINES
I.A.R.C. Research Centre, Clinical Research Centre, Harrow
A. G. LEVIN
Department of Clinical Chemistry, University of Texas System Cancer Center, Texas Medical Center, Houston, Texas, U.S.A.
H. A. FRITSCHE
London.
The triple isotope double antibody (TIDA) radioimmunoassay2 with Roche reagents3 was used. This assay method for CEA compares well with clinical findings in patients with cancer and shows quite good agreement with the perchloric-acid extraction method but values tend to be consistently higher. The TIDA radioimmunoassay may measure some background substances besides CEA.4 As with other techniques of CEA determination higher levels have been found in smokers than .4 non-smokers 30 Blacks (24 West Indians, 6 Africans) all of whom had been living in the U.K. for at least eight years and 32 Whites from amongst workers in a food-processing factory in London who are participants in a prospective study of the relation between haemostatic variables and ischxmic heart-disease5 were studied. No participant had clinical evidence of cancer.
DJR, Stevens U, Bettelheim R, et al. Role of plasma carcinoembryonic antigen in diagnosis of gastrointestinal, mammary, and bronchial carcinoma. Br Med J 1972; iii: 605-09. 2. Egan M, Lautenschleger J, Coligan J, Todd CW. Radio immuno assay of carcinoembryonic antigen. Immunochemistry 1972; 2: 289-99. 3 Fritsche HA, Tashima CK, Collinsworth WL, Geitner AM. Evaluation of a direct double antibody radioimmunoassay for CEA. Clin Chem 1979; 25: 1. Laurence
1107. 4. Fritsche
HA, Tashima CK, Romsdahl MM, Holoye PY, Geitner A. A clinical evaluation of the triple-isotope double-antibody radioimmunoassay for carcinoembryonic antigen. Am J Clin Pathol 1978; 69: 140-46. 5. Meade TW, North WRS. Population-based distributions of hæmostatic variables. Br Med Bull 1977; 33: 283-88. SERUM CEA LEVELS IN BLACK AND WHITE NON-SMOKERS AND SMOKERS: MEANS
±SD
(NG/ML)
EPILEPTOGENIC EFFECT OF MIANSERIN
SIR,-Iagree with Dr Tyrer and his colleagues (Oct. 13, p. 798) about the epileptogenic potential of mianserin, and with their remark that the epileptic seizure reported might have happened earlier if lorazepam had not been prescribed as well. I saw a similar complication soon after the drug was launched. In mid-1976 I reported to the manufacturers the case of a 22-year-old female patient who had had three previous admissions to our hospital because of a personality problem and severe identity crisis, associated with recurrent episodes of depression and suicidal ideas and gestures. In May 1976, the patient was put on flupenthixol decanoate 40 mg intramuscularly every 3 weeks until Aug. 2, when, because of a severe bout of depression, withdrawal, loss of interest, and inability to cope, she was put on mianserin 10 mg three times daily. On Aug. 12 she had a major epileptic seizure, followed by a brief period of confusion. Neurological examination at the time was normal, except for bilateral dilated and reactive pupils and mild blurring of both disc edges. Since there was no history of previous epileptic seizures all drugs were stopped (flupenthixol, benz-, hexol 2 mg three times daily, and mianserin). On Aug. 18 an EEG showed an irregular but symmetrical alpha rhythm, a good deal of diffuse and symmetrical fast activity, together with a diffuse excess.of theta activity over both temporal regions but a little more marked over the right hemisphere. However, there was no evidence of focal abnormality or paroxysmal activity. The conclusion was that these EEG changes were probably attributable to the drugs. A week later the patient was discharged from hospital. She is now on no medication and seems to be settling fairly well in the community. /
Stone House
Hospital,
Dartford, Kent DA2 6AU
6. Mach J-P, Singh K, Perrinjaquet J, Carrel S, Merenda Holburn A. Ann NY Acad Sci 1975; 259: 389-403.
W. I. MIKHAIL
C, MacDonald D,