- Email: [email protected]
RECURRENT HERPES SIMPLEX
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abuse, and none of the fractures. Taken together, the group of young children (49% of the sample) and the’ group of "different" children (12% of the sample) accounted for all the fractures and 75% of the cuts or burns. Confounding matters even more, we noted statistically significant differences in comparing age of child with abuser, age of child with type of abuse, and age of child with the sex of child (p<0.00001, p<0.00001, and p<0.05, respectively). Other differences were noted in comparing family-income level with the type of abuse (p<0.05) and marital status of abuser with type of abuse (P<0.0006), abusers on lower incomes or who were single, separated, divorced, or remarried accounting for the most severe injury. What could cause these differences? We propose that stress plays a large part. Stress on the parent has often been named as a key factor in child abuse, and Justice and Duncan noted that abusing parents had significantly higher scores on the Rahe-Holmes social readjustment rating scale’ than did nonabusing parents. One reason why very young children are overrepresented in the sample could be due to their inability to escape blows as easily as an older child. A reason for the presence of "different" children could also be that their abnormalities are a result of the abuse they have received earlier. However, we believe that an alternative reason could be that both young and "different" children present an increased amount of stress on the parent (many of whom already have marital difficulties); and this results in abuse. Whatever the reason, we have shown that both groups incur significantly different types of abuse and more severe abuse than supposedly normal children. Department of Psychology, University of North Dakota, Grand Forks, North Dakota 58201, U.S.A.
WILLIAM N. FRIEDRICH
JERRY A. BORISKIN
CIMETIDINE, METIAMIDE AND GASTRIC ULCER
SIR,-We were interested to see the study by Dr Pounder and his colleagues (Feb. 14, p. 337) on the healing of gastric ulcers during treatment with cimetidine. We have treated nine patients with chronic gastric ulceration with H2-receptor antagonists-four with metiamide (200 mg three times a day and 400 mg at night) and five with cimetidine (200 mg four times a day). In all cases the ulcer was located in the body of the stomach. In all respects, such as the assessment of symptoms and the antacid used, our studies were identical to those of Pounder et al. except that metiamide was given for 4 weeks only. Endoscopy was done within 4 days of starting treatment and repeated on the final day of therapy. We can confirm the dramatic symptomatic relief experienced by patients whilst on treatment with these two drugs, although this relief is not apparent from the figure on p. 337 of Dr Pounder’s article because no pre-treatment values are given for comparison. Eight of our nine patients had substantial relief of both day and night pain within a week of starting treatment (a reduction in the frequency of pain of 50% and 95%, respectively, in the first and final weeks of treatment compared to the week before treatment). This was associated with a fall in antacid consumption. Our experience of gastric ulcer healing with H2-receptor antagonists is not quite so impressive. In two patients the ulcers failed to heal, one patient being on metiamide and the other on cimetidine. However, both these ulcers were reduced in size by more than 50%, the patients being rendered totally
symptom-free. Papers have been published on the use of H2-receptor antagonists in promoting the healing of duodenal and gastric ulcers, but not on their effects on relapse-rates after ulcer heal4. Justice, B., Duncan, D. Publ. Hlth Rep., Wash. March-April, 1976. 5. Holmes, T., Rahe, R. J. psychosom. Res. 1967, 11, 213
Our experience is not encouraging: of the seven patients whose ulcers healed four relapsed (three within 6 weeks of completing treatment). The fourth patient remained well for3 months on 400 mg metiamide at night, but relapsed within a month of stopping therapy. Of the three remaining patients one is still symptom-free 2 months after completing 6 months of metiamide 400 mg at night, and two on no therapy are symptom-free 1 and 5 months later. We agree with Dr Pounder and his colleagues that a controlled study of cimetidine is indicated in chronic gastric ulceration. The limited clinical experience suggests that it may well prove as effective as carbenoxolone sodium. Of perhaps more importance is whether the drug taken in a maintenance dose can, in the long term, prevent recurrent ulceration.
ing.
University Department of Therapeutics, Royal Infirmary, Edinburgh 3
R. F. A. LOGAN JOHN A. H. FORREST
RECURRENT HERPES SIMPLEX
SIR--Two articles’in The Lancet on recurrent herpes simplex prompt me to raise another aspect of this illness which puzzles me. Since both herpes simplex and varicella/zoster viruses are considered to become latent in the trigeminal ganglia and posterior root ganglia, why does varicella/zoster reactivate more often as zoster, thus affecting the total dematome distribution of one or more of the three main branches of the trigeminal nerve and of other nerves, while herpes usually reactivates as a more restricted vesicular rash with no clear neurological distribution as applied to skin or mucosal surfaces ? Brain3 states that recurrent herpes-simplex infection can present as a zoster-like eruption and cites some examples, but why is this form so rare--or is it rare? Brownlee Laboratory, Ruchill Hospital, Glasgow G20 9NB
JAMES F. BOY
INHIBITION OF HUMAN NEUTROPHIL CHEMOTAXIS BY INFLUENZA VIRUS
SIR,—We have investigated the inhibition of human neutrophil chemotaxis by strains of both influenza A and B usinj techniques4 ,similar to those employed by Dr Larson and Di Blades (Feb. 7, p. 283) and have obtained similar results tc theirs with influenza B. We also found that the influenza A strains examined markedly impaired neutrophil chemotaxis and that this effect could be detected with fewer than 10 viral particles per cell as follows:
’IV
*assuming 1 hsemagglutinating unit=106 viral particles.’
help define the site of interference by the influenza virus attempted to protect- the neutrophil by preincubation with amantadine hydrochloride in concentrations known to inhibit influenza A penetration (but not adherence) of chick fibroblasts.’Preliminary results suggest partial protection by amanTo
we
1. Lehner, T., Wilton, J. M. A., Shillitoe, E. J. Lancet, 1975, ii, 60. 2. Hill, T. J., Blyth, W. A. ibid. 1976, i, 397. 3. Brain, R. T. Br. med. J. 1956, i, 1061. 4. Ginsberg, H. S., Blackman, J. B. Virology, 1956, 2, 618. 5. Andersen, B. R., Vann Epps, D. E. J. infect. Dis. 1972, 125, 353. 6. Fazekas de St. Groth, S., Cairns, H. J. F. J. Immun. 1952, 69, 173. 7. Davies, W. L. et al. Science, 1964, 144, 862.
abuse, and none of the fractures. Taken together, the group of young children (49% of the sample) and the’ group of "different" children (12% of the sample) accounted for all the fractures and 75% of the cuts or burns. Confounding matters even more, we noted statistically significant differences in comparing age of child with abuser, age of child with type of abuse, and age of child with the sex of child (p<0.00001, p<0.00001, and p<0.05, respectively). Other differences were noted in comparing family-income level with the type of abuse (p<0.05) and marital status of abuser with type of abuse (P<0.0006), abusers on lower incomes or who were single, separated, divorced, or remarried accounting for the most severe injury. What could cause these differences? We propose that stress plays a large part. Stress on the parent has often been named as a key factor in child abuse, and Justice and Duncan noted that abusing parents had significantly higher scores on the Rahe-Holmes social readjustment rating scale’ than did nonabusing parents. One reason why very young children are overrepresented in the sample could be due to their inability to escape blows as easily as an older child. A reason for the presence of "different" children could also be that their abnormalities are a result of the abuse they have received earlier. However, we believe that an alternative reason could be that both young and "different" children present an increased amount of stress on the parent (many of whom already have marital difficulties); and this results in abuse. Whatever the reason, we have shown that both groups incur significantly different types of abuse and more severe abuse than supposedly normal children. Department of Psychology, University of North Dakota, Grand Forks, North Dakota 58201, U.S.A.
WILLIAM N. FRIEDRICH
JERRY A. BORISKIN
CIMETIDINE, METIAMIDE AND GASTRIC ULCER
SIR,-We were interested to see the study by Dr Pounder and his colleagues (Feb. 14, p. 337) on the healing of gastric ulcers during treatment with cimetidine. We have treated nine patients with chronic gastric ulceration with H2-receptor antagonists-four with metiamide (200 mg three times a day and 400 mg at night) and five with cimetidine (200 mg four times a day). In all cases the ulcer was located in the body of the stomach. In all respects, such as the assessment of symptoms and the antacid used, our studies were identical to those of Pounder et al. except that metiamide was given for 4 weeks only. Endoscopy was done within 4 days of starting treatment and repeated on the final day of therapy. We can confirm the dramatic symptomatic relief experienced by patients whilst on treatment with these two drugs, although this relief is not apparent from the figure on p. 337 of Dr Pounder’s article because no pre-treatment values are given for comparison. Eight of our nine patients had substantial relief of both day and night pain within a week of starting treatment (a reduction in the frequency of pain of 50% and 95%, respectively, in the first and final weeks of treatment compared to the week before treatment). This was associated with a fall in antacid consumption. Our experience of gastric ulcer healing with H2-receptor antagonists is not quite so impressive. In two patients the ulcers failed to heal, one patient being on metiamide and the other on cimetidine. However, both these ulcers were reduced in size by more than 50%, the patients being rendered totally
symptom-free. Papers have been published on the use of H2-receptor antagonists in promoting the healing of duodenal and gastric ulcers, but not on their effects on relapse-rates after ulcer heal4. Justice, B., Duncan, D. Publ. Hlth Rep., Wash. March-April, 1976. 5. Holmes, T., Rahe, R. J. psychosom. Res. 1967, 11, 213
Our experience is not encouraging: of the seven patients whose ulcers healed four relapsed (three within 6 weeks of completing treatment). The fourth patient remained well for3 months on 400 mg metiamide at night, but relapsed within a month of stopping therapy. Of the three remaining patients one is still symptom-free 2 months after completing 6 months of metiamide 400 mg at night, and two on no therapy are symptom-free 1 and 5 months later. We agree with Dr Pounder and his colleagues that a controlled study of cimetidine is indicated in chronic gastric ulceration. The limited clinical experience suggests that it may well prove as effective as carbenoxolone sodium. Of perhaps more importance is whether the drug taken in a maintenance dose can, in the long term, prevent recurrent ulceration.
ing.
University Department of Therapeutics, Royal Infirmary, Edinburgh 3
R. F. A. LOGAN JOHN A. H. FORREST
RECURRENT HERPES SIMPLEX
SIR--Two articles’in The Lancet on recurrent herpes simplex prompt me to raise another aspect of this illness which puzzles me. Since both herpes simplex and varicella/zoster viruses are considered to become latent in the trigeminal ganglia and posterior root ganglia, why does varicella/zoster reactivate more often as zoster, thus affecting the total dematome distribution of one or more of the three main branches of the trigeminal nerve and of other nerves, while herpes usually reactivates as a more restricted vesicular rash with no clear neurological distribution as applied to skin or mucosal surfaces ? Brain3 states that recurrent herpes-simplex infection can present as a zoster-like eruption and cites some examples, but why is this form so rare--or is it rare? Brownlee Laboratory, Ruchill Hospital, Glasgow G20 9NB
JAMES F. BOY
INHIBITION OF HUMAN NEUTROPHIL CHEMOTAXIS BY INFLUENZA VIRUS
SIR,—We have investigated the inhibition of human neutrophil chemotaxis by strains of both influenza A and B usinj techniques4 ,similar to those employed by Dr Larson and Di Blades (Feb. 7, p. 283) and have obtained similar results tc theirs with influenza B. We also found that the influenza A strains examined markedly impaired neutrophil chemotaxis and that this effect could be detected with fewer than 10 viral particles per cell as follows:
’IV
*assuming 1 hsemagglutinating unit=106 viral particles.’
help define the site of interference by the influenza virus attempted to protect- the neutrophil by preincubation with amantadine hydrochloride in concentrations known to inhibit influenza A penetration (but not adherence) of chick fibroblasts.’Preliminary results suggest partial protection by amanTo
we
1. Lehner, T., Wilton, J. M. A., Shillitoe, E. J. Lancet, 1975, ii, 60. 2. Hill, T. J., Blyth, W. A. ibid. 1976, i, 397. 3. Brain, R. T. Br. med. J. 1956, i, 1061. 4. Ginsberg, H. S., Blackman, J. B. Virology, 1956, 2, 618. 5. Andersen, B. R., Vann Epps, D. E. J. infect. Dis. 1972, 125, 353. 6. Fazekas de St. Groth, S., Cairns, H. J. F. J. Immun. 1952, 69, 173. 7. Davies, W. L. et al. Science, 1964, 144, 862.