MECLOZINE AND CONGENITAL MALFORMATIONS

MECLOZINE AND CONGENITAL MALFORMATIONS

675 machine also is a small panel reading the slides. The centrifuge is made by A. light with magnifying F. lens for A total of 600 women who had ...

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675 machine also is a small panel reading the slides. The

centrifuge is made by A.

light with magnifying F.

lens for

A total of 600 women who had taken meclozine in pregnancy during the same period were followed up to delivery or abortion. The stage of pregnancy when meclozine was prescribed, and the malformations found in the children, are shown in the table.

Harding, 3a, Clarendon Road,

Redhill, Surrey. Redhill General Hospital,

C. N. HUDSON.

Surrey.

The 25 women who received meclozine as early as the 5th-6th weeks gave birth to 12 boys, of whom 2 were born with hypospadias, and 1 had congenital heart-disease too. In the children of women receiving meclozine in the 9th10th weeks there were 2 cases of cleft palate. In addition, there were minor deformities of the ears in 3 cases-the mothers had received meclozine in the 7th, 8th, and 9th weeks-combined in 1 case with malformation of the left hand. As this may be one of the larger studies performed at one hospital, our findings may be of interest.

THE BRACHIAL NEUROPATHIES

SIR,-Lishman and Ritchie Russell’suggested that changes at one level in the course of a nerve may affect its vulnerability at another; hence response to treatment at one level did not mean that the disease was confined to that level. Since their paper appeared we have almost daily had confirmation of these observations. Certainly in the brachial neuralgias there is much overlap of clinical syndromes. Carpal-tunnel syndrome is one striking example. My own observations show another possible and less-known mechanism responsible for pain.

A 59-year-old housewife had chronic cervical pain which was associated with pain and tiredness in the fingers of her right hand, especially in the morning. She had tenderness over her neck muscles and slight limitation of rotation of the cervical spine. X-ray showed slight.ostèoarthritic changes, and her 3rd, 4th, and 5th fingers were trigger-fingers. The patient was admitted for cervical traction and for operation on the trigger fingers. The morning after operation she reported relief not only from symptoms in the hand but also from cervical pain. We have since then had a similar response in 3 other patients. The mechanism which comes into play seems to be produced by the ever-increasing effort to press the tendon through the stenosed sheath. With it, the swelling in the rigid carpal and forearm compartments increases and presses on the nerves and blood-vessels. Trigger-finger in these cases is thus truly a

trigger-mechanism. In older patients I often find trigger fingers in association with the carpal-tunnel syndrome. Both may have a rheumatoid origin. The Neger Central Hospital, Beer-Sheba, Israel.

G. TOROK.

MECLOZINE AND CONGENITAL

MALFORMATIONS SIR,-My colleagues and I have followed the arguments for and against a teratogenic effect of meclozine. From a study in our own hospital we are now able to present the following data: In the

period

1958-62 at the

Department of Obstetrics and Gynæcology University Hospital, Uppsala, Sweden.

URINARY EXCRETION OF NICOTINIC-ACID DERIVATIVES IN RHEUMATOID ARTHRITIS

SIR,—Tryptophan is converted in the body to nicotinic acid. The intermediary metabolites include kynurenine, 3-OH-kynurenine, and 3-OH-anthranilic acid, and interconversion of these last is mediated by pyridoxal-phosphate dependent enzymes. The nicotinic acid is excreted in the urine as such or after conversion to N1-methylnicotinamide and N1-methyl-2-pyridone-5-carboxamide. In rheumatoid arthritis the urinary excretion pattern of metabolites along the tryptophan-nicotinic acid pathway is abnormal and the abnormality can be aggravated by a preliminary leading dose of tryptophan. 1-6 Characteristically, the total output

Lishman,

W.

Increased output of anthranilic acid and 3-OH-anthranilic acid has also been reported.1-9 These changes could reflect either reduced activity of the pyridoxal-phosphate dependent enzyme systems or overload of these systems by abnormally large amounts of tryptophan entering the metabolic pathway. These alternatives can be distinguished by a study of the end-products of nicotinic-acid metabolism, including N1-methylnicotin-

University Hospital, Uppsala,

A., Russell, W. R. Lancet, 1961, ii, 941.

C.H.D. =congenital heart disease.

of these intermediaries is

increased, particularly that of kynurenine and 3-OH-kynurenine, while the output of xanthurenic acid remains normal.

11,200 babies were born to women who had not received meclozine, and the frequency of congenital malformations among these was about 2’6%. Hypospadias were present in about 0-2% of the boys and cleft palates in 0-08% of all babies. 1.

FOLKE PETTERSSON.

1. 2.

Pasquariello, G. Acta Vit., Milano, 1961, 15, 255. Pasquariello, G. in X Giornate Reumatologiche Romane; p. 43. Rome,

3. 4. 5. 6. 7. 8. 9.

Pasquariello, G., Tenconi, L. T. Reumatismo, 1963, 15, 265. Scalabrino, R., Pasquariello, G. ibid., p. 289. Bett, I. M. Ann. rheum. Dis. 1962, 21, 63. Bett, I. M. ibid. p. 388. McMillan, M. J. clin. Path. 1960, 13, 140. Spiera, H. Arthr. and Rheum. 1962, 5, 658. Györki, J., Sandell, B. M. at the Vth European Congress on Rheumatic

1962.

Diseases. Stockholm, 1963.

C.D.H.

=congenital dislocation of the hip.