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GENETIC DISORDERS IN GYPSIES
1243
physical factors involved. The medical profession might take time from studying physical effects and techniques of induction to evaluate the broader consequences of increasing medical control over physiology. Division of
Geographic Medicine,
Department of Medicine, and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio 44106, U.S.A.
BETSY LOZOFF.
Anthropological Survey of India, Mysore 2, India.
RAJALAKSHMI
MISRA.
GENETIC DISORDERS IN GYPSIES
SIR,—In response to the inquiry by Dr Harper and Mr Williams (May 3, p. 1041) about rare recessive disorders in Gypsy populations in Europe, I should like to record the occurrence of citrullinsemia in an inbred Gypsy kindred originating from Hungary and Poland, now residing in Northern Germany. After the birth of the first affected offspring of a consanguineous couple (inbreeding coefficient of 009375), I have monitored the next pregnancy. The prenatal diagnosis, based on a normal 14C-citrulline incorporation of cultured amniotic-fluid cells in comparison to known mutant cells, has just been confirmed postnatally No other recessive disorder has been observed in this kindred. Institut für Humangenetik, Universität Hamburg, Martinistrasse 52, 2 Hamburg 20, West Germany.
E. PASSARGE.
LITHIUM, CALCIUM, AND PHOSPHATE SIR,—Dr Crammer (Jan 25, p. 215) reported reduced urinary excretion of calcium in patients during lithium We have observed similar changes in two treatment. with lithium. The urinary excretion of treated patients calcium and phosphate was measured before and after the start of
lithium
therapy.
1 and 2 show decreased excretion of calcium and phosphate in the lithium treatment periods, and the decrease appeared immediately after lithium was first given. During the whole investigation the patients were on a diet containing about 30 mmol calcium and 40 mmol phos-
Figs.
Fig. 2-24-hour urinary phosphate excretion
in two patients before and after treatment with lithium.
phorus per day, and this standardisation should exclude the possibility that the changes were due to changes in diet. In a crossover study of 12 Meniere patients, who were on and off lithium treatment for two periods of six months each, 24-hour urine was collected once in each period. The excretion of calcium in the lithium-free period was 7.36±2.29 mmol per 24 hours and during lithium treatment 4800-98 mmol per 24 hours (P<0.001). In a study of calcium and phosphate metabolism, urinary excretion alone gives far from a true picture of the total balance of these two elements, since most of the excretion of calcium, and about 50% of the excretion of phosphate, takes place via the fseces. A thorough investigation of lithium effects on calcium and phosphate metabolism must therefore encompass both urinary and fsecal excretion. Such studies are now in progress in our metabolic ward, and preliminary results indicate that lithium induces retention of both calcium and phosphate. These long-term effects of lithium are of importance in relation, among other things, to theories of manicmelancholic disorders focusing on electrolyte disturbances.l NIELS BJØRUM IB HORNUM ERLING T. MELLERUP PER K. PLENGE OLE J. RAFAELSEN.
Psychochemistry Institute, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
POLYGLYCOLIC-ACID SUTURES AND HYPERTROPHIC SCARS
SIR,—Iread with interest the paper by Dr Clough and Mr Alexander-Williams (Jan. 25, p. 194) and the subsequent correspondence on the use of polyglycolic-acid (P.G.A.) sutures for skin closures. Subcuticular P.G.A. sutures have been used on this unit for the past five years for all skin closures, including acute surgery in the presence of sepsis. It has been increasingly obvious that a proportion of wounds proceed to hypertrophic scar formation. In our experience, however, this phenomenon has been confined to those vertical abdominal incisions closed with 00 P.G.A. Transverse abdominal incisions are closed with 000 P.G.A. and thyroidectomy . incisions and incisions in children with 0000 P.G.A. Many of these, particularly the thyroid cases, are followed up for Fig. 1-24-hour urinary calcium excretion in two patients before and after treatment with lithium.
1.
Rafaelsen, O. J., Mellerup, Amst. 1973, 76, 523.
E.
T. Psychiat. Neurol. Neurochir,
physical factors involved. The medical profession might take time from studying physical effects and techniques of induction to evaluate the broader consequences of increasing medical control over physiology. Division of
Geographic Medicine,
Department of Medicine, and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio 44106, U.S.A.
BETSY LOZOFF.
Anthropological Survey of India, Mysore 2, India.
RAJALAKSHMI
MISRA.
GENETIC DISORDERS IN GYPSIES
SIR,—In response to the inquiry by Dr Harper and Mr Williams (May 3, p. 1041) about rare recessive disorders in Gypsy populations in Europe, I should like to record the occurrence of citrullinsemia in an inbred Gypsy kindred originating from Hungary and Poland, now residing in Northern Germany. After the birth of the first affected offspring of a consanguineous couple (inbreeding coefficient of 009375), I have monitored the next pregnancy. The prenatal diagnosis, based on a normal 14C-citrulline incorporation of cultured amniotic-fluid cells in comparison to known mutant cells, has just been confirmed postnatally No other recessive disorder has been observed in this kindred. Institut für Humangenetik, Universität Hamburg, Martinistrasse 52, 2 Hamburg 20, West Germany.
E. PASSARGE.
LITHIUM, CALCIUM, AND PHOSPHATE SIR,—Dr Crammer (Jan 25, p. 215) reported reduced urinary excretion of calcium in patients during lithium We have observed similar changes in two treatment. with lithium. The urinary excretion of treated patients calcium and phosphate was measured before and after the start of
lithium
therapy.
1 and 2 show decreased excretion of calcium and phosphate in the lithium treatment periods, and the decrease appeared immediately after lithium was first given. During the whole investigation the patients were on a diet containing about 30 mmol calcium and 40 mmol phos-
Figs.
Fig. 2-24-hour urinary phosphate excretion
in two patients before and after treatment with lithium.
phorus per day, and this standardisation should exclude the possibility that the changes were due to changes in diet. In a crossover study of 12 Meniere patients, who were on and off lithium treatment for two periods of six months each, 24-hour urine was collected once in each period. The excretion of calcium in the lithium-free period was 7.36±2.29 mmol per 24 hours and during lithium treatment 4800-98 mmol per 24 hours (P<0.001). In a study of calcium and phosphate metabolism, urinary excretion alone gives far from a true picture of the total balance of these two elements, since most of the excretion of calcium, and about 50% of the excretion of phosphate, takes place via the fseces. A thorough investigation of lithium effects on calcium and phosphate metabolism must therefore encompass both urinary and fsecal excretion. Such studies are now in progress in our metabolic ward, and preliminary results indicate that lithium induces retention of both calcium and phosphate. These long-term effects of lithium are of importance in relation, among other things, to theories of manicmelancholic disorders focusing on electrolyte disturbances.l NIELS BJØRUM IB HORNUM ERLING T. MELLERUP PER K. PLENGE OLE J. RAFAELSEN.
Psychochemistry Institute, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark.
POLYGLYCOLIC-ACID SUTURES AND HYPERTROPHIC SCARS
SIR,—Iread with interest the paper by Dr Clough and Mr Alexander-Williams (Jan. 25, p. 194) and the subsequent correspondence on the use of polyglycolic-acid (P.G.A.) sutures for skin closures. Subcuticular P.G.A. sutures have been used on this unit for the past five years for all skin closures, including acute surgery in the presence of sepsis. It has been increasingly obvious that a proportion of wounds proceed to hypertrophic scar formation. In our experience, however, this phenomenon has been confined to those vertical abdominal incisions closed with 00 P.G.A. Transverse abdominal incisions are closed with 000 P.G.A. and thyroidectomy . incisions and incisions in children with 0000 P.G.A. Many of these, particularly the thyroid cases, are followed up for Fig. 1-24-hour urinary calcium excretion in two patients before and after treatment with lithium.
1.
Rafaelsen, O. J., Mellerup, Amst. 1973, 76, 523.
E.
T. Psychiat. Neurol. Neurochir,