1345
Investigations revealed no other abnormalities in this patient. drugs had been given before the gynscomastia appeared. Alcohol consumption was steady during and after the gynxcomastia (1 or 2 bottles of beer a day). On one interpretation of the relation between diazepam and G.A.B.A.-ergic transmission,4 a high-dose diazepam mammotropic effect without changes in serum-prolactin could be explained by a release of G.A.B.A. (-aminobutyric acid) mediated prolactin-inhibitory factor from the adenohypoNo other
Twelve women, admitted for infertility surgery, were given 16 mg dexamethasone (’Decadron’) intramuscularly on the evening before the operation and 64 mg (4x 16 mg) during the operation day and the first postoperative day. From the second postoperative day onwards 3 mg dexamethasone was given orally for 6 days. Eleven infertile patients matched by age and weight, with the same extensiveness of abdominal operations, served as controls.
ohvsis5 Medical Department CT,
Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
HENNING
J. MOERCK
Psychopharmacological Research Laboratory, St. Hans Mental Hospital,
GERHARD MAGELUND
Roskilde
CADMIUM TOXICITY
SIR,-As representative of one of the sponsoring industrial organisations referred to by Linda McDougall (May 19, p. 1091), producer of the T.V. Eye programme on cadmium, I a
take exception to her characterisation of the Second International Cadmium Conference as being of value only to the industry. The conference was attended not just by people from industry but by many representatives of government and by academics also. We, as organisers, designed the programme to present all sides of the many controversies relating to the health and environmental effects of cadmium. I presume this is why the Thames Television team asked for the opportunity to cover the conference. They had the chance to cover all opinions. However, they chose to present only one side of a complex issue. In doing so, they gave their audience a biased viewpoint of the degree of environmental and industrial hazard posed by cadmium. We have come to expect this from the news media in the U.S. Until the experience with Thames T.V., we had expected more objectivity from the news media in the U.K. must
International Lead Zinc Research 292 Madison Avenue, New York, N.Y. 10017, U.S.A.
Fig. I-Serum-cortisol values on the evening before surgery, the day of operation, and 1, 2, 3, and 5 days afterwards.
on
In the dexamethasone group, serum-cortisol values were about two times higher on the first postoperative day- and in the control group about three times higher compared with preoperative values. The increase in serum-cortisol due to the stress of the operation was prevented by administration of dexamethasone and from the second postoperative day serum-cortisol levels were strongly suppressed in the dexamethasone group (fig. 1). The controls had normal serum-cortisol values with morning and evening variations from the third postoperative day onwards.
Organization, Inc.,
JEROME F. COLE, Vice-president
HIGH-DOSE DEXAMETHASONE AND ADRENAL FUNCTION
SIR,-Dr Spiegel and colleagues (March 24, p. 630) report that adrenal function is suppressed more often after short-term high-dose corticosteroid therapy than is generally appreciated. We have noticed the same tendency with the use of high-dose dexamethasone in connection with infertility surgery on otherwise healthy women. Corticosteroids, especially dexamethasone, are often used after infertility surgery because they tend to inhibit the fibroblastic proliferation necessary for the formation of collagenous connective tissue and so prevent adhesion. Not much has been published on the safety of this approach. Horne et al.’ have reported that the daily administration of 280 mg of dexamethasone during the first two postoperative days resulted in adrenal suppression in the second and third days. Urinary steroid levels had returned to normal levels by the fifth post-
operative day in all patients. 4. Guidotti,
A, Toffano, G., Baraldi, M., Schwartz, I. P., Costa, E. in GABA Neurotransmitters (edited by P. Krogsgaard-Larsen, J. Scheel-Krüger, and H. Kofod); p. 406. New York, 1979. 5. Müller, E. E., Cocchi, D., Locatelli, V., Krogsgaard-Larsen, P., Bruno, F., Racagni, G. ibid.p. 518. 1. Horne, H. W., Clyman, M., Debrovner, C., Griggs, G., Kistner, R., Kosasa, T., Stevenson, C. S.,Taymor,M.Int. J.Fertil. 1973, 18, 109.
Fig. 2-Urinary 24 h cortisol excretion. 24 h urinary cortisol secretion increased on the first and second postoperative days in both groups, but the increase was greater in the controls (fig. 2). A strong suppression of cortisol secretion was found on the fifth and sixth days in patients on dexamethasone whereas cortisol secretion was normal in the controls from the third postoperative day onwards. Short-term high-dose corticosteroid treatment results in a strong adrenal suppression which can continue after the patient is discharged, and this suppression may expose, for example, infections and symptom-free intra-abdominal bleeding. Department of Obstetrics and Gynæcology, University Central Hospital, 90220 Oulu 22, Finland
LARS RÖNNBERG SEPPO KIVINEN
Investigations revealed no other abnormalities in this patient. drugs had been given before the gynscomastia appeared. Alcohol consumption was steady during and after the gynxcomastia (1 or 2 bottles of beer a day). On one interpretation of the relation between diazepam and G.A.B.A.-ergic transmission,4 a high-dose diazepam mammotropic effect without changes in serum-prolactin could be explained by a release of G.A.B.A. (-aminobutyric acid) mediated prolactin-inhibitory factor from the adenohypoNo other
Twelve women, admitted for infertility surgery, were given 16 mg dexamethasone (’Decadron’) intramuscularly on the evening before the operation and 64 mg (4x 16 mg) during the operation day and the first postoperative day. From the second postoperative day onwards 3 mg dexamethasone was given orally for 6 days. Eleven infertile patients matched by age and weight, with the same extensiveness of abdominal operations, served as controls.
ohvsis5 Medical Department CT,
Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
HENNING
J. MOERCK
Psychopharmacological Research Laboratory, St. Hans Mental Hospital,
GERHARD MAGELUND
Roskilde
CADMIUM TOXICITY
SIR,-As representative of one of the sponsoring industrial organisations referred to by Linda McDougall (May 19, p. 1091), producer of the T.V. Eye programme on cadmium, I a
take exception to her characterisation of the Second International Cadmium Conference as being of value only to the industry. The conference was attended not just by people from industry but by many representatives of government and by academics also. We, as organisers, designed the programme to present all sides of the many controversies relating to the health and environmental effects of cadmium. I presume this is why the Thames Television team asked for the opportunity to cover the conference. They had the chance to cover all opinions. However, they chose to present only one side of a complex issue. In doing so, they gave their audience a biased viewpoint of the degree of environmental and industrial hazard posed by cadmium. We have come to expect this from the news media in the U.S. Until the experience with Thames T.V., we had expected more objectivity from the news media in the U.K. must
International Lead Zinc Research 292 Madison Avenue, New York, N.Y. 10017, U.S.A.
Fig. I-Serum-cortisol values on the evening before surgery, the day of operation, and 1, 2, 3, and 5 days afterwards.
on
In the dexamethasone group, serum-cortisol values were about two times higher on the first postoperative day- and in the control group about three times higher compared with preoperative values. The increase in serum-cortisol due to the stress of the operation was prevented by administration of dexamethasone and from the second postoperative day serum-cortisol levels were strongly suppressed in the dexamethasone group (fig. 1). The controls had normal serum-cortisol values with morning and evening variations from the third postoperative day onwards.
Organization, Inc.,
JEROME F. COLE, Vice-president
HIGH-DOSE DEXAMETHASONE AND ADRENAL FUNCTION
SIR,-Dr Spiegel and colleagues (March 24, p. 630) report that adrenal function is suppressed more often after short-term high-dose corticosteroid therapy than is generally appreciated. We have noticed the same tendency with the use of high-dose dexamethasone in connection with infertility surgery on otherwise healthy women. Corticosteroids, especially dexamethasone, are often used after infertility surgery because they tend to inhibit the fibroblastic proliferation necessary for the formation of collagenous connective tissue and so prevent adhesion. Not much has been published on the safety of this approach. Horne et al.’ have reported that the daily administration of 280 mg of dexamethasone during the first two postoperative days resulted in adrenal suppression in the second and third days. Urinary steroid levels had returned to normal levels by the fifth post-
operative day in all patients. 4. Guidotti,
A, Toffano, G., Baraldi, M., Schwartz, I. P., Costa, E. in GABA Neurotransmitters (edited by P. Krogsgaard-Larsen, J. Scheel-Krüger, and H. Kofod); p. 406. New York, 1979. 5. Müller, E. E., Cocchi, D., Locatelli, V., Krogsgaard-Larsen, P., Bruno, F., Racagni, G. ibid.p. 518. 1. Horne, H. W., Clyman, M., Debrovner, C., Griggs, G., Kistner, R., Kosasa, T., Stevenson, C. S.,Taymor,M.Int. J.Fertil. 1973, 18, 109.
Fig. 2-Urinary 24 h cortisol excretion. 24 h urinary cortisol secretion increased on the first and second postoperative days in both groups, but the increase was greater in the controls (fig. 2). A strong suppression of cortisol secretion was found on the fifth and sixth days in patients on dexamethasone whereas cortisol secretion was normal in the controls from the third postoperative day onwards. Short-term high-dose corticosteroid treatment results in a strong adrenal suppression which can continue after the patient is discharged, and this suppression may expose, for example, infections and symptom-free intra-abdominal bleeding. Department of Obstetrics and Gynæcology, University Central Hospital, 90220 Oulu 22, Finland
LARS RÖNNBERG SEPPO KIVINEN
