1339
promoted as a fairly inexpensive holiday
destination for the UK
traveller. We wish to emphasise that, for the short-term traveller to East Africa (overseas stay of 3 weeks or less), mefloquine 250 mg weekly is the preferred choice for prophylaxis against the highly prevalent resistant P falciparum in that area. once
Regional Department of Infectious Tropical Medicine, Monsall Hospital, Diseases and
Manchester M10 8WR, UK
A.
J. BARNES
E. E. B. E.
L. C. ONG M. DUNBAR K. MANDAL G. L. WILKINS
weeks. Symptomatic orthostatic hypotension was not seen in any patient and the drop in orthostatic systolic blood pressure did not differ among placebo, lovastatin, and pravastatin groups (2-4 [SD 75] vs 25 [11.4] vs 3-7 [9-1] mm Hg at 1 min and 2-9 [8.5] vs 3-4 [10-6] vs 2-1 [9-2] mm Hg at 3 min). Changes in diastolic blood pressure were less pronounced. Thus, in this controlled study, lovastatin and pravastatin did not cause orthostatic hypotension. UMDNJ-Robert Wood Johnson Medical School New Brunswick, New Jersey 08903, USA 1. French J, White H. Transient Lancet 1989; ii. 807-08.
Phillips-Howard PA, Bradley DJ, Blaze M, Hurn M. Malaria in Britain: 1977-86. Br Med J 1988; 296: 245-48. 2. British National Formulary, no 22, September, 1991: 225. 3. Report of meetings convened by the Malaria Reference Laboratory and the Ross Institute. Prophylaxis against malaria for travellers from the United Kingdom. Br Med J 1989; 299: 1087-89. 1.
Late Plasmodium ovale malaria SIR,-Dr Facer and Dr Rouse (Oct 5, p 896) report a case of spontaneous splenic rupture due to Plasmodium ovale malaria. We agree that visitors to malaria-endemic regions should be given advice on protection against mosquito bites and on malaria prophylaxis. However, chemoprophylaxis does not prevent infection with P ovale, although it can prevent the disease. After a mosquito bite, sporozoites are quickly taken up by the liver, resulting in exoerythrocytic schizogony with, eventually formation of hypnozoites. Sporozoites and hyponozoites are not sensitive to chemoprophylaxis.Hypnozoites can survive a long time in the liver and can give rise to malaria attacks long after chemoprophylaxis has been stopped. Of the 59 cases of P ovale infection we treated between Jan 1, 1987, and Nov 1, 1991, 48 had reliable travel data recorded on file. 40/48 patients (83 %) became ill more than one month after they had left the malarious region, and 23 of these reported that they had appropriate chemoprophylaxis regularly. Of the 8 early infections, 4 were seen in Europeans and 4 in Africans travelling to Belgium. No patient had taken chemoprophylaxis. 2 of the 8 presented with splenomegaly: 1 of them had a mixed infection with P falciparum. Disease severity was not different between early and late cases. The early death in the case reported by Facer and Rouse would have been avoided with chloroquine prophylaxis, but it should be realised that late P ovale malaria attacks are possible, not
JOHN B. KOSTIS ALAN C. WILSON
symptomatic hypotension in patients on
simvastatin.
Right ventricular conduction disturbance after balloon valvuloplasty in congenital pulmonary valve stenosis SIR,-Percutaneous balloon valvuloplasty (PBV) is accepted as effective and safe non-surgical treatment for congenital pulmonary valve stenosis. Transient extrasystoles or bradycardia are common during balloon valvuloplasty.1,2 However, conduction disturbances have rarely been described. We have noted that right ventricular conduction disturbance was frequently detected after PBV in breastfed infants and young children with severe pulmonary valve stenosis. We report electrocardiographic (ECG) changes an
associated with this disturbance after PBV in 4 such breastfed babies (group 1) and 4 young children (group 2) (pressure gradient > 80 mm Hg, and right left ventricular pressure). These patients were among 23 who have undergone PBV in our hospital during the past two years. Breastfed infants were aged 1-4 months (mean 2-9), and young children 2-5 years (mean 3-3). After PBV, pressure gradients between right ventricule and pulmonary artery decreased from 99 (7-3) mm Hg to 39 (11 -5) mm Hg in group 1 and from 99 (6-8) mm Hg to 27 (6-2) mm Hg in group 2. Mean ratio of balloon size to diameter of pulmonary valve annulus was 1-25 (0-09) in group 1 and 1-4 (01) in group 2. The balloon was inflated by hand and was filled with diluted (30%) contrast medium. The inflation/deflation cycle took less than 12 s in group 1 and 10 s in group 2. Amplitude of the R wave in V1 was
withstanding correct chemoprophylaxis.
Institute for Tropical Medicine, B-2000 Antwerp, Belgium
E. VAN DEN ENDEN ALFONS VAN GOMPEL JEF VAN DEN ENDE TONY VERVOORT
1 Desjardins RE, Doberstyn EB, Wernsdorfer WA. The treatment and prophylaxis of malaria. In: Wernsdorfer WH, McGregor I, eds. Malaria: Principles and practice of malariology, vol 1. Edinburgh: Churchill Livingstone, 1988: 827-64.
Lack of
hypotension with lovastatin and pravastatin
SIR,—After French and White’sl report of transient symptomatic hypotension in patients on simvastatin, we added measurement of blood pressure in the sitting and standing positions to a randomised, placebo-controlled, double-blind, crossover study of pravastatin and lovastatin. 17 men took part; they were aged 36-65 years (mean 57, SD 7) and had type II hypercholesterolaemia defmed as low-density lipoprotein (LDL) cholesterol greater than 165 mg/dl after 6 weeks of a low fat ( < 30%), low cholesterol ( < 300 mg/day) diet and triglyceride less than 350 mg/dl. 9 patients were on aspirin, 3 on diuretics, 6 on converting enzyme inhibitors, 3 on calcium antagonists, 2 on digitalis, 1 on a &bgr;-blocker, and 2 on
dipyridamole. Blood pressure was measured with random zero sphygmomanometry in the sitting position and after 1 and 3 minutes standing by nurses certified in the use of the technique. Striking decreases of LDL cholesterol (by 28-30%) compared with placebo were
noted after lovastatin 40 mg and pravastatin 40 mg daily for 6
QRS frontal axis (upper) and QRS time (lower) after percutaneous balloon valvuloplasty (PBV) in 8 infants and young children. -
E-1 - breastfed babtes, --0-- young children.
promoted as a fairly inexpensive holiday
destination for the UK
traveller. We wish to emphasise that, for the short-term traveller to East Africa (overseas stay of 3 weeks or less), mefloquine 250 mg weekly is the preferred choice for prophylaxis against the highly prevalent resistant P falciparum in that area. once
Regional Department of Infectious Tropical Medicine, Monsall Hospital, Diseases and
Manchester M10 8WR, UK
A.
J. BARNES
E. E. B. E.
L. C. ONG M. DUNBAR K. MANDAL G. L. WILKINS
weeks. Symptomatic orthostatic hypotension was not seen in any patient and the drop in orthostatic systolic blood pressure did not differ among placebo, lovastatin, and pravastatin groups (2-4 [SD 75] vs 25 [11.4] vs 3-7 [9-1] mm Hg at 1 min and 2-9 [8.5] vs 3-4 [10-6] vs 2-1 [9-2] mm Hg at 3 min). Changes in diastolic blood pressure were less pronounced. Thus, in this controlled study, lovastatin and pravastatin did not cause orthostatic hypotension. UMDNJ-Robert Wood Johnson Medical School New Brunswick, New Jersey 08903, USA 1. French J, White H. Transient Lancet 1989; ii. 807-08.
Phillips-Howard PA, Bradley DJ, Blaze M, Hurn M. Malaria in Britain: 1977-86. Br Med J 1988; 296: 245-48. 2. British National Formulary, no 22, September, 1991: 225. 3. Report of meetings convened by the Malaria Reference Laboratory and the Ross Institute. Prophylaxis against malaria for travellers from the United Kingdom. Br Med J 1989; 299: 1087-89. 1.
Late Plasmodium ovale malaria SIR,-Dr Facer and Dr Rouse (Oct 5, p 896) report a case of spontaneous splenic rupture due to Plasmodium ovale malaria. We agree that visitors to malaria-endemic regions should be given advice on protection against mosquito bites and on malaria prophylaxis. However, chemoprophylaxis does not prevent infection with P ovale, although it can prevent the disease. After a mosquito bite, sporozoites are quickly taken up by the liver, resulting in exoerythrocytic schizogony with, eventually formation of hypnozoites. Sporozoites and hyponozoites are not sensitive to chemoprophylaxis.Hypnozoites can survive a long time in the liver and can give rise to malaria attacks long after chemoprophylaxis has been stopped. Of the 59 cases of P ovale infection we treated between Jan 1, 1987, and Nov 1, 1991, 48 had reliable travel data recorded on file. 40/48 patients (83 %) became ill more than one month after they had left the malarious region, and 23 of these reported that they had appropriate chemoprophylaxis regularly. Of the 8 early infections, 4 were seen in Europeans and 4 in Africans travelling to Belgium. No patient had taken chemoprophylaxis. 2 of the 8 presented with splenomegaly: 1 of them had a mixed infection with P falciparum. Disease severity was not different between early and late cases. The early death in the case reported by Facer and Rouse would have been avoided with chloroquine prophylaxis, but it should be realised that late P ovale malaria attacks are possible, not
JOHN B. KOSTIS ALAN C. WILSON
symptomatic hypotension in patients on
simvastatin.
Right ventricular conduction disturbance after balloon valvuloplasty in congenital pulmonary valve stenosis SIR,-Percutaneous balloon valvuloplasty (PBV) is accepted as effective and safe non-surgical treatment for congenital pulmonary valve stenosis. Transient extrasystoles or bradycardia are common during balloon valvuloplasty.1,2 However, conduction disturbances have rarely been described. We have noted that right ventricular conduction disturbance was frequently detected after PBV in breastfed infants and young children with severe pulmonary valve stenosis. We report electrocardiographic (ECG) changes an
associated with this disturbance after PBV in 4 such breastfed babies (group 1) and 4 young children (group 2) (pressure gradient > 80 mm Hg, and right left ventricular pressure). These patients were among 23 who have undergone PBV in our hospital during the past two years. Breastfed infants were aged 1-4 months (mean 2-9), and young children 2-5 years (mean 3-3). After PBV, pressure gradients between right ventricule and pulmonary artery decreased from 99 (7-3) mm Hg to 39 (11 -5) mm Hg in group 1 and from 99 (6-8) mm Hg to 27 (6-2) mm Hg in group 2. Mean ratio of balloon size to diameter of pulmonary valve annulus was 1-25 (0-09) in group 1 and 1-4 (01) in group 2. The balloon was inflated by hand and was filled with diluted (30%) contrast medium. The inflation/deflation cycle took less than 12 s in group 1 and 10 s in group 2. Amplitude of the R wave in V1 was
withstanding correct chemoprophylaxis.
Institute for Tropical Medicine, B-2000 Antwerp, Belgium
E. VAN DEN ENDEN ALFONS VAN GOMPEL JEF VAN DEN ENDE TONY VERVOORT
1 Desjardins RE, Doberstyn EB, Wernsdorfer WA. The treatment and prophylaxis of malaria. In: Wernsdorfer WH, McGregor I, eds. Malaria: Principles and practice of malariology, vol 1. Edinburgh: Churchill Livingstone, 1988: 827-64.
Lack of
hypotension with lovastatin and pravastatin
SIR,—After French and White’sl report of transient symptomatic hypotension in patients on simvastatin, we added measurement of blood pressure in the sitting and standing positions to a randomised, placebo-controlled, double-blind, crossover study of pravastatin and lovastatin. 17 men took part; they were aged 36-65 years (mean 57, SD 7) and had type II hypercholesterolaemia defmed as low-density lipoprotein (LDL) cholesterol greater than 165 mg/dl after 6 weeks of a low fat ( < 30%), low cholesterol ( < 300 mg/day) diet and triglyceride less than 350 mg/dl. 9 patients were on aspirin, 3 on diuretics, 6 on converting enzyme inhibitors, 3 on calcium antagonists, 2 on digitalis, 1 on a &bgr;-blocker, and 2 on
dipyridamole. Blood pressure was measured with random zero sphygmomanometry in the sitting position and after 1 and 3 minutes standing by nurses certified in the use of the technique. Striking decreases of LDL cholesterol (by 28-30%) compared with placebo were
noted after lovastatin 40 mg and pravastatin 40 mg daily for 6
QRS frontal axis (upper) and QRS time (lower) after percutaneous balloon valvuloplasty (PBV) in 8 infants and young children. -
E-1 - breastfed babtes, --0-- young children.
