- Email: [email protected]
Herbs and hepatitis
1068
treated by chemotherapy and craniospinal radiotherapy, without documented infection. These results encouraged us to increase the dose to 3 g/m2 over 3 days. Neutropenia was more profound but not prolonged, and neurotoxicity was not seen. The efficacy and toxicity of ifosfamide could be related to a particular mode of administration. Thus, in agreement with Dr Blackledge (June 9, p 1399), we regret the lack of comparative data for ifosfamide and cyclophosphamide. This lack has led to clinicians establishing dose schedules on the basis of published data and their own experience. The ifosfamide/cyclophosphamide and carboplatin/cisplatin dilemma should make us consider the crucial need to conduct multicentre phase-II trials testing various doses and schedules for each drug, followed by phase-III trials to ask, and especially to clarify, such questions, the answers to which will be too late for the benefit of some patients. If all new cytoxic agents were included in an international programme, we could save much time that would have been spent in reproducing known data or in testing regimens in too small (and uncontrolled) series. Department of Paediatric Oncology, P. CHASTAGNER D. SOMMELET-OLIVE, Children’s Hospital, for the French Society of Paediatric Oncology Nancy 54500, France JC, Helson L. High dose cyclophosphamide chemotherapy for recurrent CNS in children. Neurosurg 1981; 55: 749-56. J Chastagner P, Sommelet-Olive D, Kalifa C, et al. Phase II study of ifosfamide in
1. Allen
tumors
2.
recurrent childhood brain tumors. Pediatr Neurosci 1990; 15: 147. 3. Miser J, Krailo M, Smithson W, et al. Treatment of children with recurrent brain tumors with ifosfamide, etoposide and mesna. Proc Am Soc Clin Oncol 1989; 8: 84.
5 min, when the number of fetal similar to that normally observed in fetuses of that age. During the period of increased activity the fetus changed position frequently. The effects probably represent a direct effect of maternal psychological ’shock’; we have previously noted that changes in maternal position do not influence fetal movements. Increased fetal movement may be mediated by release of adrenaline or cortisol into the bloodstream. These observations indicate that brief periods of increased maternal emotionality, which may be considered everyday occurrences, can influence the behaviour of the fetus. Studies of maternal emotionality and reproductive outcome should not be restricted to severe or long-term heightened emotionality but should also take into account milder, more transient episodes.
gradually subsided after movements was
School of Psychology, Queen’s University of Belfast, Belfast BT7 1NN, UK
PETER G. HEPPER
Royal Maternity Hospital, Belfast
SARA SHAHIDULLAH
1.
Hepper PG. Foetal learning: implications for psychiatry? BrJ Psychiatry 1989; 155:
289-93. 2. Carlson B, LaBarba C. Maternal emotionality during pregnancy and reproductive outcome: a review of the literature J Behav Develop 1979; 2: 342-76. 3. Ferreira AJ. Emotional factors in prenatal environment. J Nerv Ment Dis 1965; 141: 108-18. 4. Sontag LW. The significance of fetal environmental differences. Am JObstet Gynecol
1941; 42: 96-103.
Herbs and Fetal response to maternal shock SIR,-Early writers such as Hippocrates proposed that maternal emotions influence pregnancy, and since then there has been much interest in the effect of maternal emotional state upon the development of the fetus.2,3 Research has concentrated upon the effects of chronic long-term or severely heightened emotionality’ (eg, after the death of the husband4), and the effects of milder short-lasting changes, such as those due to a shock or surprise, have not been examined. A healthy 27-year-old woman with an uncomplicated pregnancy missed her footing whilst climbing onto a couch for a scan and fell backwards, ending up on the floor. She was not hurt but was shocked and embarrassed rather than distressed. A minute later and fully recovered (her heart rate was 69/min) she remounted the couch and was scanned (’ATL Ultramark 4plus’ with a 3-5 MHz scan head). Her fetus, age about 16 weeks on scan measurements, was observed for 10 min. Fetal arm and leg movements were recorded. A period of fetal hyperactivity (figure)
.1.uu
BUUI)
Arm and leg movements exhibited by fetus of shocked mother and those exhibited by fetus of an unshocked mother.
hepatitis
SIR,-Dr Davies and colleagues (July 21, p 177) report hepatitis, probably toxic, from herbal therapy of eczema in a young girl. I have similar cases. I am the manager of a health control laboratory. From blood tests and physical examination we give advice about diet and lifestyle. For example, high blood lipids and the common hyperinsulin syndrome can be controlled with the help of data from the laboratory and changes in habit. An unexpected finding was the high frequency of liver abnormalities. Some abnormalities were the result of alcohol abuse, prediabetes, drugs, solvents, carcinomas, or other known conditions; however, they seemed to be most common in patients who took herbal preparations. 395 patients (the first 5 to present each day for about 80 days) were thoroughly investigated. In 160 patients (mean age 50 years) who took no drugs or alcohol and without known disease the mean serum gamma-glutamyltransferase (S-GT) was 0-19 cat/1. In a similar group of 53 people (mean age 52) who took herbal preparations, selenium, or homoeopathic remedies, the mean S-GT was 0-91 pcat/1; in 15 alcoholics (mean age 44) the mean S-GT was 1-35 pcat/1. However, the 4 patients with the highest S-GT values were all in the herbal preparation group, and they had hepatitis-like results by other liver tests. All patients in the herb-taking group were offered a free examination 6 weeks after initial testing. 12 agreed to stop taking herbal preparations and returned for follow-up. All but 1 had more normal values than before. This patient, a 40-year-old woman, had liver cirrhosis. 167 of the 395 patients took drugs or alcohol, were exposed to solvents, had known disease, or had a combination of these factors. Those in this group who took herbal preparations again had increased S-GT concentrations. Of about 15 patients the laboratory investigates every day, 1 or more regularly have liver abnormalities that disappear if they stop taking herbal preparations. Usually several remedies are taken at the same time. In Sweden, as elsewhere, physicians must report side-effects of drugs, but there is no such rule for herbal preparations. People have a strong belief in herbal preparations, and most physicians do not ask if they are taken. Perhaps we should not be surprised at the toxic effects of herbs. Many plants are protected by toxins which discourage consumption by animals. Herbal preparations may come from plants that are not eaten by other mammals. seen
Health Care Home, 53397 Gotene, Sweden
CARL CARLSSON
treated by chemotherapy and craniospinal radiotherapy, without documented infection. These results encouraged us to increase the dose to 3 g/m2 over 3 days. Neutropenia was more profound but not prolonged, and neurotoxicity was not seen. The efficacy and toxicity of ifosfamide could be related to a particular mode of administration. Thus, in agreement with Dr Blackledge (June 9, p 1399), we regret the lack of comparative data for ifosfamide and cyclophosphamide. This lack has led to clinicians establishing dose schedules on the basis of published data and their own experience. The ifosfamide/cyclophosphamide and carboplatin/cisplatin dilemma should make us consider the crucial need to conduct multicentre phase-II trials testing various doses and schedules for each drug, followed by phase-III trials to ask, and especially to clarify, such questions, the answers to which will be too late for the benefit of some patients. If all new cytoxic agents were included in an international programme, we could save much time that would have been spent in reproducing known data or in testing regimens in too small (and uncontrolled) series. Department of Paediatric Oncology, P. CHASTAGNER D. SOMMELET-OLIVE, Children’s Hospital, for the French Society of Paediatric Oncology Nancy 54500, France JC, Helson L. High dose cyclophosphamide chemotherapy for recurrent CNS in children. Neurosurg 1981; 55: 749-56. J Chastagner P, Sommelet-Olive D, Kalifa C, et al. Phase II study of ifosfamide in
1. Allen
tumors
2.
recurrent childhood brain tumors. Pediatr Neurosci 1990; 15: 147. 3. Miser J, Krailo M, Smithson W, et al. Treatment of children with recurrent brain tumors with ifosfamide, etoposide and mesna. Proc Am Soc Clin Oncol 1989; 8: 84.
5 min, when the number of fetal similar to that normally observed in fetuses of that age. During the period of increased activity the fetus changed position frequently. The effects probably represent a direct effect of maternal psychological ’shock’; we have previously noted that changes in maternal position do not influence fetal movements. Increased fetal movement may be mediated by release of adrenaline or cortisol into the bloodstream. These observations indicate that brief periods of increased maternal emotionality, which may be considered everyday occurrences, can influence the behaviour of the fetus. Studies of maternal emotionality and reproductive outcome should not be restricted to severe or long-term heightened emotionality but should also take into account milder, more transient episodes.
gradually subsided after movements was
School of Psychology, Queen’s University of Belfast, Belfast BT7 1NN, UK
PETER G. HEPPER
Royal Maternity Hospital, Belfast
SARA SHAHIDULLAH
1.
Hepper PG. Foetal learning: implications for psychiatry? BrJ Psychiatry 1989; 155:
289-93. 2. Carlson B, LaBarba C. Maternal emotionality during pregnancy and reproductive outcome: a review of the literature J Behav Develop 1979; 2: 342-76. 3. Ferreira AJ. Emotional factors in prenatal environment. J Nerv Ment Dis 1965; 141: 108-18. 4. Sontag LW. The significance of fetal environmental differences. Am JObstet Gynecol
1941; 42: 96-103.
Herbs and Fetal response to maternal shock SIR,-Early writers such as Hippocrates proposed that maternal emotions influence pregnancy, and since then there has been much interest in the effect of maternal emotional state upon the development of the fetus.2,3 Research has concentrated upon the effects of chronic long-term or severely heightened emotionality’ (eg, after the death of the husband4), and the effects of milder short-lasting changes, such as those due to a shock or surprise, have not been examined. A healthy 27-year-old woman with an uncomplicated pregnancy missed her footing whilst climbing onto a couch for a scan and fell backwards, ending up on the floor. She was not hurt but was shocked and embarrassed rather than distressed. A minute later and fully recovered (her heart rate was 69/min) she remounted the couch and was scanned (’ATL Ultramark 4plus’ with a 3-5 MHz scan head). Her fetus, age about 16 weeks on scan measurements, was observed for 10 min. Fetal arm and leg movements were recorded. A period of fetal hyperactivity (figure)
.1.uu
BUUI)
Arm and leg movements exhibited by fetus of shocked mother and those exhibited by fetus of an unshocked mother.
hepatitis
SIR,-Dr Davies and colleagues (July 21, p 177) report hepatitis, probably toxic, from herbal therapy of eczema in a young girl. I have similar cases. I am the manager of a health control laboratory. From blood tests and physical examination we give advice about diet and lifestyle. For example, high blood lipids and the common hyperinsulin syndrome can be controlled with the help of data from the laboratory and changes in habit. An unexpected finding was the high frequency of liver abnormalities. Some abnormalities were the result of alcohol abuse, prediabetes, drugs, solvents, carcinomas, or other known conditions; however, they seemed to be most common in patients who took herbal preparations. 395 patients (the first 5 to present each day for about 80 days) were thoroughly investigated. In 160 patients (mean age 50 years) who took no drugs or alcohol and without known disease the mean serum gamma-glutamyltransferase (S-GT) was 0-19 cat/1. In a similar group of 53 people (mean age 52) who took herbal preparations, selenium, or homoeopathic remedies, the mean S-GT was 0-91 pcat/1; in 15 alcoholics (mean age 44) the mean S-GT was 1-35 pcat/1. However, the 4 patients with the highest S-GT values were all in the herbal preparation group, and they had hepatitis-like results by other liver tests. All patients in the herb-taking group were offered a free examination 6 weeks after initial testing. 12 agreed to stop taking herbal preparations and returned for follow-up. All but 1 had more normal values than before. This patient, a 40-year-old woman, had liver cirrhosis. 167 of the 395 patients took drugs or alcohol, were exposed to solvents, had known disease, or had a combination of these factors. Those in this group who took herbal preparations again had increased S-GT concentrations. Of about 15 patients the laboratory investigates every day, 1 or more regularly have liver abnormalities that disappear if they stop taking herbal preparations. Usually several remedies are taken at the same time. In Sweden, as elsewhere, physicians must report side-effects of drugs, but there is no such rule for herbal preparations. People have a strong belief in herbal preparations, and most physicians do not ask if they are taken. Perhaps we should not be surprised at the toxic effects of herbs. Many plants are protected by toxins which discourage consumption by animals. Herbal preparations may come from plants that are not eaten by other mammals. seen
Health Care Home, 53397 Gotene, Sweden
CARL CARLSSON