small percentage of carriers treated. These organisms might be expected to persist for a short while in the indi¬ vidual carrier, or possibly even in close contacts, but probably would be

ultimately replaced by rifampin-susceptible meningococci. Even if they were to persist for a substantial length of time or to cause disease, it would mean only that rifampin could no longer be used for prophylaxis. There would be no therapeutic impli¬ cation since rifampin-resistant men¬ ingococci are still fully susceptible to penicillin, the drug of choice. Thus, reviewing the same data

available to Dr Artenstein, I reach quite the opposite conclusion, that is, that current risk-benefit consid¬ erations support a recommendation to use rifampin for chemoprophylaxis in family contacts of patients with meningococcal disease. Theodore C. Eickhoff, MD University of Colorado Medical Center Denver

RS, Taunay AE, Morais JS, et al: Spread of meningococcal infection within households. Lancet 1:1275-1277, 1974. 2. Guttler RB, Counts GW, Avent CK, et al: Effect of rifampin and minocycline on meningococcal carrier rates. J Infect Dis 124:199-205, 1971. 3. Devine LF, Johnson DP, Hagerman CR, et al: The effect of minocycline on meningococcal nasopharyngeal carrier state in naval personnel. Am J Epidemiol 93:337\x=req-\ 345, 1971. 4. Munford RS, de Vasconcelos ZJS, Phillips CJ, et al: Eradication of carriage of Neisseria meningitidis in families: A study in Brazil. J Infect Dis 129:644-649,1974. 1. Munford

5. Vestibular reactions to minocycline after meningococcal prophylaxis, Center for Disease Control. Morbidity

Mortality Weekly Rep 24:9-11, 1975. 6. Vestibular reactions to minocycline: Follow-up, Center for Disease Control Morbidity Mortality Weekly Rep

merases, will eventually be considered too hazardous a drug to be used for a purpose of unproved benefit. Malcolm S. Artenstein, MD Walter Reed Army Medical Center Washington, DC

Corticosteroids for Pseudomembranous Colitis To the Editor.\p=m-\Iam writing regarding the article by Drs Burbige and Milligan entitled "Pseudomem-

branous Colitis: Association With Antibiotics and Therapy with Cholestyramine" (231:1157, 1975). If the use of a drug such as cholestyramine resin proves to be effective in the treatment of inflammatory bowel disease, we are indeed fortunate. The purpose of this letter is to comment on a sentence in the body of the article: "Corticosteroids have been employed in some severely affected individuals but have not been effective." It seems to me that this statement is inaccurate and misleading. There are numerous articles citing the use of corticosteroids in this condition with beneficial results. This has been our experience in this community, where we have seen an unusual number of such cases. I would appreciate the authors reconsidering their statement in view of the fact that it might mislead a physician into hesitating to use a potentially beneficial drug in a serious and possibly fatal illness. H. A. Danemann, MD

24:55-56, 1975.

7. Eickhoff TC: In vitro and in vivo studies of resistance to rifampin in meningococci. J Infect Dis 123:414\x=req-\

420, 1971.

8. Weidmer CE, Dunkel TB, Pettyjohn FS, et al: Effectiveness of rifampin in eradicating the meningococcal carrier state in a relatively closed population: Emergence of resistant strains. J Infect Dis 124:172-178, 1971. 9. Beam WE, Newberg NR, Devine LF, et al: The effect of rifampin on the nasopharyngeal carriage of Neisseria meningitidis in a military population. J Infect Dis

124:39-46, 1971.


Reply.\p=m-\DrEickhoff presents

gent argument for the


a co-

of rifam-

pin prophylaxis when meningococcal disease has been diagnosed in one member of a family. Indeed, a number of authorities hold the same opinion. However, in the absence of proved (controlled) efficacy of the drug in preventing meningococcal

disease, the controversy becomes



matter of

divergent opin-

ions based on circumstantial evidence. Minocycline was the choice of some until the recent reports of serious side reactions. I am tempted to predict, therefore, that rifampin, which has immunosuppressive effects and inhibits RNA and DNA poly-



In Reply.\p=m-\Althoughthe use of corticosteroids in the treatment of severe antibiotic-associated colitis is well documented (47% of case reports),1 its effectiveness has never been proved by careful study. The use of steroids, as in many other instances, has been empirical. Despite their use, several patients have required surgery or died.1-5 In an illness in which the cause is




not meant of any therapy


discourage the use that might be helpful. Because of their anti-inflammatory properties, the use of corticosteroids in severely ill patients has always been justified for inflammatory conditions of the colon. However, it is our hope that cholestyramine resin will prove useful, give us a better understanding of this disorder, and obviate the need for steroids. to

Eugene J. Burbige, MD Francis D. Milligan, MD Johns Hopkins Medical School Baltimore

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1. Keefe EB, Katon RM, Chan TT, et al: Pseudomembranous estercolitis: Resurgence related to newer antibiotic therapy. West J Med 121:462-472, 1974. 2. Groll A, Vlassenbrouck MJ, Ramchand S, et al: Fulminating noninfective pseudomembranous colitis. Gastroenterology 58:8895, 1970. 3. Shinikin PM, Link RJ: Pseudomembranous colitis\p=m-\A consideration in the barium enema differential diagnosis of acute generalized ulcerative colitis. Br J Radiol 46:437\x=req-\ 439, 1973. 4. Schapiro RL, Newman A: Acute enterocolitis\p=m-\A complication of antibiotic therapy. Radiology 108:263-268, 1973. 5. Tully TE, Feinberg SB: A reappearance of antibiotic-induced pseudomembranous entercolitis. Radiology

110:563-567, 1974.

Measles Vaccine

Editor.\p=m-\My12-year-old son recently diagnosed as having mea-

To the was

sles. His medical records indicate that he received "measles vaccine" in 1963. His current pediatrician mentioned that he and his colleagues have seen several cases of measles in persons who supposedly were vaccinated. Some of these patients had even had booster immunizations. This raises some very interesting epidemiological questions. (1) Is the current form of measles caused by a single newly mutated viral strain, or (2) Do the current measles cases indicate that the patients received an ineffective vaccine? If this is the situation, how widely distributed was the ineffective batch(es)? To facilitate future epidemiological studies, it would be extremely helpful if physicians would record the following information on the patient's medical record: (1) name of vaccine, (2) company producing the vaccine, (3) date of production, and (4) lot or batch number used. Similar information might also be recorded for all prescribed medications. This valuable information will take only a few seconds to record and will enable a patient's new physician to know exactly which vaccines had been administered. This is critical in our highly mobile society. Arlene L. Fraikor, PhD Department of Anthropology Wichita State University Wichita, Kan

Cardiac Arrest To the Editor.\p=m-\We would take excep-

tion to Dr Loeb's statement (232:845, 1975) that a forceful blow to the chest during asystole may restore cardiac action. The clinical reports describing this phenomenon are based on the use of multiple precordial thumps, much like, but more traumatic than, routine cardiac massage. As stated by Pennington et al1 and confirmed in our


a precordial thump is of value for the reversal of cardiac asystole or ventricular fibrillation. The blow transmits only enough energy to occasionally convert ventricular tachyarrhythmias. In addition, the precordial thumping of a hypoxic myocardium\p=m-\whether active or still\p=m-\mayproduce ventricular fibrillation,2 a situation obviously irreversible in the absence of a defibrillator. The degree of hypoxemia required for this untoward event is variable, and clinical judgment in this regard is the poorest means of evaluation. Thumping, as an initial step in resuscitation, should be employed only in areas where electrocardiographic and defibrillating equipment is readily available to confirm its success or correct its failure. no

Ronald W. Yakaitis, MD

Joseph S. Redding, MD Medical University of South Carolina Charleston 1. Pennington JE, Taylor J, Lown reverting ventricular tachycardia.

283:1192-1195, 1970.

B: Chest thump for N Engl J Med

2. Yakaitis RW,

ing cardiac

Redding JS: Precardial thumping durresuscitation. Crit Care Med 1:22-26, 1973.

Most drug information services are available without charge, on a re¬ gional basis, some through toll-free telephone lines. The mini-budget of Pleasantville Hospital will stretch even further and the quality of infor¬ mation service to health professions will improve if good use is made of available drug information services. Freya Hermann, RPh, MS Lee A. Wanke, RPh, MS Drug Information Service School of Pharmacy

Oregon State University Corvallis

New Seat Belt Systems as a Cause of Meralgia Paresthetica To the Editor.\p=m-\Thelateral femoral

cutaneous nerve, which transmits cutaneous sensation to the anterolateral aspect of the thigh, may be involved at the point of passage medial to the

anterosuperior part of the iliac spine, with subsequent painful paresthesias known as meralgia paresthetica. This condition is often caused by trauma, obesity, increased intra-abdominal pressure, occupational posture requiring hip flexion, and pressure by a belt or

Information Services For Small Hospitals To the Editor.\p=m-\DrWest's point, that effective information services are needed in hospitals and that services available are usually weakest where the need is greatest, is well taken (232:505,1975). However, in his "minibudget" program he overlooked an

important pharmacy-sponsored drug information centers and services. Drug information centers were first established during the early 1960s in a few major university teaching hospitals and were originally developed as part of the pharmacy service of the hospital. They have comprehensive informaresource:

collections from which specific pertinent information can be retrieved and made readily available and have competent personnel to evaluate and interpret the literature





The number of such centers has increased and the sponsorship widened to include regional medical programs and schools of pharmacy. Pharmacists are a logical source of drug information, and most pharmacy curricula now include training in searching and interpreting the literature so that pharmacists can function effectively in the role of drug information spe¬ cialists.


There appears to be little doubt that the automatic lap belt retractor, recently introduced with other safety devices in the automotive industry, is

Epitomes In our current Journal style, the possessive case is not used in eponymic diseases and syndromes. For example, Baron von M\l=u"\nchausendid not own a syndrome, even though his name is associated with one: thus, we write "M\l=u"\nchausensyndrome," not "M\l=u"\nchausen'ssyndrome." Since Dr Cushing did not actually have the disease he described, we merely write "Cushing disease." Nevertheless, John C. Ling, MD, of Santa Monica, Calif, perceptively notes at least one incongruity stemming from this practice. Without the added apostrophe, only the capital letter G prevents the unwary from erroneously associating Graves disease with a cemetery. In contemplating the first reference of one of my recent editorials (233:273, 1975), readers may wonder whether The Journal is sometimes printed backward. The pagination was given as 1397-1388; it should have been 1397-1398. This is particularly embarrassing to me, as not long ago I expressed annoyance with those authors who cite references incorrectly (232:165, 1975). Oh well, the error occurred in fitting context the title of the referenced article was "A Guide Into Chaos." Joseph S. Jacob, MD, of Ann Arbor, Mich, believes medical administrators and educators should be alerted that an occa¬ sional male foreign medical graduate may,

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a new

and avoidable


for the

production of this syndrome. New cars are equipped with a starter interlock that prevents starting the car

until all front seat occupants are buckled in. Consequently, buckling of the lap belt is mandatory. The belt restraint buckle, which is fixed to the seat and is located close to it, maintains the lap belt at the level of the inguinal region. In addition, the belt

retractor, designed to automatically

take up excess webbing, will maintain increased pressure upon the region just below the anterosuperior part of the iliac spine. In the last two years, we have ob¬ served an increasing number of cases of meralgia paresthetica, sometimes bilaterally, in individuals who have acquired the good habit of wearing seat belts at all times while driving new cars that are equipped with a starter interlock and seat belt re¬




when they ceased to wear seat belts, when either the starter interlock was disconnected or when a plastic clip was placed in the belt to allow suffi¬ cient slack, thereby avoiding constant pressure over the inguinal region on

long trips.

Albert C.

Cuetter, MD

Moncrief Army Hospital Fort Jackson, SC

through cultural orientation different from that of the United States, inadvertently assume a

dominating or discriminating at¬

titude toward


Caution may be


quired in this regard to prevent disruptive influences in relationships with women pa¬

tients or staff members. Charles S. Lipton, MD, of Philadelphia, describes himself as a strongly committed conservative Jew and respects the view of Dr Fred Rosner (228:829, 1974) in opposi¬ tion to abortion. However, Dr Lipton re¬ sents the efforts of those who would impose their views on others by making abortion


Several writers take issue with the re¬ port by Lieberman et al (231:728,1975) that

questioned the validity

of the cytotoxic food test. The convergent trend of the cor¬ respondence is that the test, while not ideal, is of value to the writers-at least as an adjunct or for screening. They empha¬ size the necessity for careful technique by thoroughly trained technicians. The writers include Lawrence D. Dickey, MD, Fort Collins, Colo; Thomas R. Updegraff, MD, Waterloo, Iowa; John T. Bickmore, MD, Dayton, Ohio; and George A. Ulett, MD, St Louis, Mo. I take this opportunity to thank my col¬ league, Hugh H. Hussey, MD, Editor Emer¬ itus, for editing the Letters section for several weeks during my recent illness. John Archer, MD

Letter: Cardiac arrest.

small percentage of carriers treated. These organisms might be expected to persist for a short while in the indi¬ vidual carrier, or possibly even in ...
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