- Email: [email protected]
LACTOSE INTOLERANCE IN GREEKS
271 LACTOSE INTOLERANCE IN GREEKS
MELATONIN AND PARKINSONISM
SIR In the light of two reports
1,2
pointing to a possible
beneficial effect of the pineal indole, melatonin (N-acetyl-5in parkinsonism, we carried out a this drug in 4 patients (3 men, 1 woman; age range 56-68 years). All continued to take anticholinergic drugs but had not recently been treated with levodopa. Weekly assessment of functional disabilities and physical signs was made and adverse reactions noted. Melatonin (Koch-Light Laboratories Ltd, Colnbrook, Bucks.) was given orally, starting with 100 mg. per day and gradually increasing to a maximum of 1 g. per day in divided doses. Treatment was continued for four weeks
methoxytryptamine), single-blind trial of
SIR,-Following the letter by Dr Spanidou and Dr Petrakis,l we should like to report our findings with the lactose-tolerance test, which have been published so far only in Greek.2 We performed this test on 50 normal infants and 24 normal children aged 7-13 years. 1-75 g. per kg. body-weight of lactose was given orally. Capillary
and was followed by placebo substitution. There was no alteration in parkinsonian disabilities, nor was there any change after switch to placebo. Melatonin was well tolerated, with transitory sedation the only noticeable adverse reaction. These results are in agreement with those of Papavasiliou et al.,3 published since this project was initiated. We are grateful to the Medical Research Council who the salary of K. M. S. and the cost of the melatonin.
Department of Neurology, University College Hospital, London WC1E 6JJ. Queen Charlotte’s Maternity Hospital, London W6 0XG.
defrayed
K. M. SHAW G. M. STERN. M. SANDLER.
C.P.A.P. VIA ENDOTRACHEAL TUBE
SIR,-It is known that the oxygenation of arterial blood in infants with hyaline-membrane disease may be improved by continuous positive airways pressure (C.P.A.P.).4 This can be done either by an apparatus attached to an endotracheal tube, as described by Davies et al.,5 or by a head box as described by Gregory et al.The head box has the considerable advantage of avoiding endotracheal intubation but the disadvantage that rapid intubation and resuscitation of the infant, should he become apnceic, may be hampered by the equipment. When it is considered desirable to apply C.P.A.P. via an endotracheal tube, we have found that this may conveniently be done using the Bennett ’PR 2 Special ’ ventilator. The rate-control knob is swiftly turned to zero during the inspiratory phase, leaving the Bennett delivering a constant pressure which can be varied using the pressure control. Humidity is provided from the Bennett’s own humidifier and the inspired gas composition can be varied in the usual way, using either oxygen or air drive for the machine, and adding air or oxygen from the " air dilution control. The pressure at the end of the endotracheal tube, measured by a transducer, is about 70% of that indicated on the Bennett’s " system pressure " dial. This arrangement has the advantage that, if the baby becomes apnœic, the nurse can start ventilation at once simply by turning the rate-control knob. Department of Paediatrics and P. C. ETCHES Maternity Department, C. HOUGHTON John Radcliffe Hospital, W. Oxford OX3 9DU. J. MOORE. Headington, 1. 2.
3. 4. 5.
Antón-Tay, F., Díaz, J. L., Fernández-Guardiola, A. Life Sci. I. 1971, 10, 841. Cotzias, G. C., Papavasiliou, P. S., Ginos, J., Steck, A., Düby, S. Ann. Rev. Med. 1971, 22, 305. Papavasiliou, P. S., Cotzias, G. C., Düby, S. E., Steck, A. J., Bell, M., Lawrence, W. H. J. Am. med. Ass. 1972, 221, 88. Gregory, G. A., Kitterman, J. A., Phibbs, R. H., Tooley, W. H., Hamilton, W. K. New Engl. J. Med. 1971, 284, 1332. Davies, P. A., Robinson, R. J., Scopes, J. W., Tizard, J. P. M., Wigglesworth, J. S. Medical Care of Newborn Babies; pp. 125-128. 1972
Maximum glucose rise above pre-ingestion levels.
blood
collected before lactose ingestion and 15, 30, and 120 minutes afterwards. Glucose was estimated 60, 90, by the oxidase method. We took as lactose intolerance a rise in blood-glucose of less than 20 mg. per 100 ml. above the pre-ingestion level. 13 of the 50 babies and 13 of the 24 children showed a rise indicating intolerance. The mean maximum bloodglucose rise was 29-2 mg. per 100 ml. in the babies and 17 mg. per 100 ml. in the children (see figure). None of the babies showed clinical signs of intolerance, but 6 out of the 13 children with a low rise developed abdominal pain, vomiting, or diarrhoea. It seems, therefore, that there is a discrepancy between infants and children in the clinical manifestations linked with the biochemical findings indicating lactose intolerance. Our findings support the view of Cook3 that there is an age factor in the ability of the intestinal mucosa to split lactose. We think that in the Greek population lactase deficiency starts early in life but gives rise to clinical symptoms later in childhood. S. DOXIADIS Institute of Child Health, G. PAPAGEORGIADIS. Athens 608, Greece. was
GASTROINTESTINAL BLEEDING AND ERYTHROCYTE AUTOANTIBODIES
SIR,-The hypothesis of Dr Jerne and his colleagues (Jan. 13, p. 79) that gastrointestinal bleeding originating above the pylorus could trigger the synthesis of erythrocyte autoantibodies is based, to say the least, on weak evidence. 1. 2. 3.
Spanidou, E., Petrakis, N. L. Lancet, 1972, ii, 872. S. Iatriki, 1972, 22, 226. Cook, G. C. Br. med. J. 1967, i, 527.
Papageorgiadis, G., Doxiadis,
MELATONIN AND PARKINSONISM
SIR In the light of two reports
1,2
pointing to a possible
beneficial effect of the pineal indole, melatonin (N-acetyl-5in parkinsonism, we carried out a this drug in 4 patients (3 men, 1 woman; age range 56-68 years). All continued to take anticholinergic drugs but had not recently been treated with levodopa. Weekly assessment of functional disabilities and physical signs was made and adverse reactions noted. Melatonin (Koch-Light Laboratories Ltd, Colnbrook, Bucks.) was given orally, starting with 100 mg. per day and gradually increasing to a maximum of 1 g. per day in divided doses. Treatment was continued for four weeks
methoxytryptamine), single-blind trial of
SIR,-Following the letter by Dr Spanidou and Dr Petrakis,l we should like to report our findings with the lactose-tolerance test, which have been published so far only in Greek.2 We performed this test on 50 normal infants and 24 normal children aged 7-13 years. 1-75 g. per kg. body-weight of lactose was given orally. Capillary
and was followed by placebo substitution. There was no alteration in parkinsonian disabilities, nor was there any change after switch to placebo. Melatonin was well tolerated, with transitory sedation the only noticeable adverse reaction. These results are in agreement with those of Papavasiliou et al.,3 published since this project was initiated. We are grateful to the Medical Research Council who the salary of K. M. S. and the cost of the melatonin.
Department of Neurology, University College Hospital, London WC1E 6JJ. Queen Charlotte’s Maternity Hospital, London W6 0XG.
defrayed
K. M. SHAW G. M. STERN. M. SANDLER.
C.P.A.P. VIA ENDOTRACHEAL TUBE
SIR,-It is known that the oxygenation of arterial blood in infants with hyaline-membrane disease may be improved by continuous positive airways pressure (C.P.A.P.).4 This can be done either by an apparatus attached to an endotracheal tube, as described by Davies et al.,5 or by a head box as described by Gregory et al.The head box has the considerable advantage of avoiding endotracheal intubation but the disadvantage that rapid intubation and resuscitation of the infant, should he become apnceic, may be hampered by the equipment. When it is considered desirable to apply C.P.A.P. via an endotracheal tube, we have found that this may conveniently be done using the Bennett ’PR 2 Special ’ ventilator. The rate-control knob is swiftly turned to zero during the inspiratory phase, leaving the Bennett delivering a constant pressure which can be varied using the pressure control. Humidity is provided from the Bennett’s own humidifier and the inspired gas composition can be varied in the usual way, using either oxygen or air drive for the machine, and adding air or oxygen from the " air dilution control. The pressure at the end of the endotracheal tube, measured by a transducer, is about 70% of that indicated on the Bennett’s " system pressure " dial. This arrangement has the advantage that, if the baby becomes apnœic, the nurse can start ventilation at once simply by turning the rate-control knob. Department of Paediatrics and P. C. ETCHES Maternity Department, C. HOUGHTON John Radcliffe Hospital, W. Oxford OX3 9DU. J. MOORE. Headington, 1. 2.
3. 4. 5.
Antón-Tay, F., Díaz, J. L., Fernández-Guardiola, A. Life Sci. I. 1971, 10, 841. Cotzias, G. C., Papavasiliou, P. S., Ginos, J., Steck, A., Düby, S. Ann. Rev. Med. 1971, 22, 305. Papavasiliou, P. S., Cotzias, G. C., Düby, S. E., Steck, A. J., Bell, M., Lawrence, W. H. J. Am. med. Ass. 1972, 221, 88. Gregory, G. A., Kitterman, J. A., Phibbs, R. H., Tooley, W. H., Hamilton, W. K. New Engl. J. Med. 1971, 284, 1332. Davies, P. A., Robinson, R. J., Scopes, J. W., Tizard, J. P. M., Wigglesworth, J. S. Medical Care of Newborn Babies; pp. 125-128. 1972
Maximum glucose rise above pre-ingestion levels.
blood
collected before lactose ingestion and 15, 30, and 120 minutes afterwards. Glucose was estimated 60, 90, by the oxidase method. We took as lactose intolerance a rise in blood-glucose of less than 20 mg. per 100 ml. above the pre-ingestion level. 13 of the 50 babies and 13 of the 24 children showed a rise indicating intolerance. The mean maximum bloodglucose rise was 29-2 mg. per 100 ml. in the babies and 17 mg. per 100 ml. in the children (see figure). None of the babies showed clinical signs of intolerance, but 6 out of the 13 children with a low rise developed abdominal pain, vomiting, or diarrhoea. It seems, therefore, that there is a discrepancy between infants and children in the clinical manifestations linked with the biochemical findings indicating lactose intolerance. Our findings support the view of Cook3 that there is an age factor in the ability of the intestinal mucosa to split lactose. We think that in the Greek population lactase deficiency starts early in life but gives rise to clinical symptoms later in childhood. S. DOXIADIS Institute of Child Health, G. PAPAGEORGIADIS. Athens 608, Greece. was
GASTROINTESTINAL BLEEDING AND ERYTHROCYTE AUTOANTIBODIES
SIR,-The hypothesis of Dr Jerne and his colleagues (Jan. 13, p. 79) that gastrointestinal bleeding originating above the pylorus could trigger the synthesis of erythrocyte autoantibodies is based, to say the least, on weak evidence. 1. 2. 3.
Spanidou, E., Petrakis, N. L. Lancet, 1972, ii, 872. S. Iatriki, 1972, 22, 226. Cook, G. C. Br. med. J. 1967, i, 527.
Papageorgiadis, G., Doxiadis,