153
During the second three months patients crossing over from to placebo showed a striking increase in flushes to pre-treatment levels. Several patients, including two oophorectomised women, who had been nearly free of flushes for several years, suddenly developed severe flushes on stopping oestrogen treatment. This would seem to provide some evidence that flushes occur when oestrogen levels are falling, especially if exogenous oestrogen is withdrawn suddenly in patients whose endogenous oestrogen production is lacking. Women left without treatment finally settled at their pre-treatment level of oestrogen
flushes. Thus the results of this small trial would suggest that oestrogens are effective in the treatment of flushes and that withdrawal of oestrogen causes flushing, but that placebo given de novo is also effective, possibly by stimulating production of endogenous oestrogen. It is difficult to measure the therapeutic value of exogenous oestrogen when the body manufactures its own supply, which varies in response to excitement and sexual stimuli and also shows diurnal changes. I agree with Mulley and Mitchell that oestrogens should not be prescribed routinely for all patients with hot flushes, especially in situations where there are increased risk factors for serious conditions. The
Waterhouse,
Bollington, near
JEAN K. M. COOPI
Macclesfield
PLASMA-COPPER IN SICKLE-CELL ANÆMIA
SIR,-Sachs et al.’ first reported raised serum-copper levels in a patient with sickle-cell anaemia. This observation has been confirmed in patients from the forest area of western Nigeria2: the mean serum concentration (115 µg/dl) in those with hoemoglobin (Hb)SC disease was intermediate between the mean in HbSS patients (136 fLg/dl) and normals (HbAA or HbAS subjects) (102 g/dl). Schaeffer et all described copper-containing granules in sickled erythrocytes which were not present in normal cells. Raised serum-copper concentrations have been reported in other haematological disorders, including thalassaemia, aplastic anxmia, pernicious anaemia, leukxmia, and lymphomas.4-6 We have measured plasma-copper by atomic absorption spectrophotometry in patients with sickle-cell anaemia (HbSS), in elite Nigerians (university senior staff), in non-elite Nigerians (Hausa farmers presenting as blood-donors) who were either normal Hb(AA) or had sickle-cell trait (HbAS), and in Caucasians (university senior staff) living in northern Nigeria. The mean plasma-copper concentrations in patients with sickle-cell anaemia were significantly higher than in other (see accompanying table). The mean plasgroups (P
During the second three months patients crossing over from to placebo showed a striking increase in flushes to pre-treatment levels. Several patients, including two oophorectomised women, who had been nearly free of flushes for several years, suddenly developed severe flushes on stopping oestrogen treatment. This would seem to provide some evidence that flushes occur when oestrogen levels are falling, especially if exogenous oestrogen is withdrawn suddenly in patients whose endogenous oestrogen production is lacking. Women left without treatment finally settled at their pre-treatment level of oestrogen
flushes. Thus the results of this small trial would suggest that oestrogens are effective in the treatment of flushes and that withdrawal of oestrogen causes flushing, but that placebo given de novo is also effective, possibly by stimulating production of endogenous oestrogen. It is difficult to measure the therapeutic value of exogenous oestrogen when the body manufactures its own supply, which varies in response to excitement and sexual stimuli and also shows diurnal changes. I agree with Mulley and Mitchell that oestrogens should not be prescribed routinely for all patients with hot flushes, especially in situations where there are increased risk factors for serious conditions. The
Waterhouse,
Bollington, near
JEAN K. M. COOPI
Macclesfield
PLASMA-COPPER IN SICKLE-CELL ANÆMIA
SIR,-Sachs et al.’ first reported raised serum-copper levels in a patient with sickle-cell anaemia. This observation has been confirmed in patients from the forest area of western Nigeria2: the mean serum concentration (115 µg/dl) in those with hoemoglobin (Hb)SC disease was intermediate between the mean in HbSS patients (136 fLg/dl) and normals (HbAA or HbAS subjects) (102 g/dl). Schaeffer et all described copper-containing granules in sickled erythrocytes which were not present in normal cells. Raised serum-copper concentrations have been reported in other haematological disorders, including thalassaemia, aplastic anxmia, pernicious anaemia, leukxmia, and lymphomas.4-6 We have measured plasma-copper by atomic absorption spectrophotometry in patients with sickle-cell anaemia (HbSS), in elite Nigerians (university senior staff), in non-elite Nigerians (Hausa farmers presenting as blood-donors) who were either normal Hb(AA) or had sickle-cell trait (HbAS), and in Caucasians (university senior staff) living in northern Nigeria. The mean plasma-copper concentrations in patients with sickle-cell anaemia were significantly higher than in other (see accompanying table). The mean plasgroups (P
