922 TABLE II-BLOOD-GROUPS AND C.H.D. BY SUBCATEGORIES
DISTRIBUTION OF CASES IN EVERALL ET
AL.’S PAPFR
y
&mid ot;
Tetralogy of Fallot, Eisenmenger, transposition of great arteries, truncus arteriosus, double-outlet right ventricle. t Atrial septal defect (primum), atrioventricular canal, cleft mitral valve.
Expected numbers in parentheses. observation might cause some interest; in the present context it appears far less impressive. In summary, our results agree most closely with those from England.2 VICTOR SISKIND Drug Epidemiology Unit, OLLI P. HEINONEN Boston University Medical Center, SAMUEL SHAPIRO 720 Harrison Avenue, Boston, DENNIS SLONE. Massachusetts 02118, U.S.A.
S.S.M. =
superficial spreading melanoma.
tic type. It can be seen that there is a strong bias in their group II cases in favour of a better prognosis. A recent analysis of 1187 patients treated in the Queensland Melanoma Project revealed an age-adjusted cumulative survival-rate at 5 years of 877% for women and 73-6% for men, Similar figures for the upper limb (357 cases) were 87.1%, the lower limb (227 cases) 894%, and for the trunk (374 cases)
75.2%. Clark et al.’ report survival figures for superficial spreading melanomas as 465% compared with 273% for nodular melanomas, while McGovern2 gives figures of 70% and 53%
5-year survivals, respectively. We have shown that malignant
melanoma can be diagnosed early biological stage and that routine surgical treatment at that stage gives remarkably good results. Your readers should rely on these orthodox methods3 rather than be tempted into vaccinating, on very flimsy evidence, melanomas before at an
INCIDENCE OF CONGENITAL LIMB-REDUCTION DEFORMITIES
SIR,-As suggested by Jaffe et al.1 we have reviewed the records of all births (16 945 deliveries) from the St. Thomas’s maternity units (1969-73). There were 8 recorded cases of congenital limb-reduction deformities (I.C.D. 755.2 - 755-4). The overall rate of limbreduction deformities for this five-year period was 0-47 cases per 1000. The highest rate was 1.23 cases per 1000 in 1969. There were no recorded cases for 1970 and 1972. Our findings do not show any clear-cut pattern. Janerich et al. reported an association between limb-reduction deformities and twinning. Our 8 cases were singleton pregnancies. But one interesting feature was a family history of twins in 50% of the cases. The information was obtained from hospital and generalpractice records. Department of Obstetrics and
Community Medicine, St. Thomas’s Hospital Medical School,
JANET NALDRETT BEULAH R. BEWLEY
London SE1 7EH.
excision. Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba S.2., Brisbane, Queensland, 4102.
NEVILLE DAVIS Co-ordinator
BLOOD-LEVELS OF S-ADENOSYLMETHIONINE IN SCHIZOPHRENIA
SIR The hypothesis suggested by Dr Levi and Dr Wax(July 5, p. 11) on the deficiency of methionine adenosyltransferase (or its activity based upon cofactor abnormalities) man
schizophrenia is of great interest and now needs to be tested experimentally. Matthysse and Baldessarini4 indicated that blood-levels of S-adenosylmethionine (SAMe) in schizophrenics (n=20) were about 111% of controls (n=13), and this finding seems to conflict with the hypothesis of Levi and Waxin
man.
We have tested SAMe in
TREATMENT OF PRIMARY MELANOMA BY INTRALESIONAL VACCINIA BEFORE EXCISION SIR,-Dr Everall and his colleagues (Sept. 27, p. 583) should be slightly more cautious in their conclusions. In the summary they claim "vaccination exerts a favourable effect on the course of melanoma both in terms of survival and prolongation of the interval between treatment of the primary lesion and subsequent development of metastases." In comparing group I treated by excision alone with group II treated by vaccination before excision, they have failed to take into account other factors which are known to affect the prognosis-namely, the sex of the patient, the site of the lesion, and the histogenetic type of tumour. The accompanying table shows the distribution of cases in their two groups stratified according to sex, site, and histogene1.
Jaffe, P., Liberman,
2.
Janerich,
M.
M., McFayden, I., Valman, H. B. Lancet, 1975, i,
526. 697.
D. T.,
Piper, J. M., Glebatis,
D. M. New
Engl J.
Med. 1974,
291,
blood-samples of schizophrenic patients, using a double isotopic enzymatic assay.’6 As indicated below, we found no differences in SAMe levels between chronic schizophrenics and controls, but acute schizophrenics showed a 50% decrease which was statistically significant (P
DISTRIBUTION OF CASES IN EVERALL ET
AL.’S PAPFR
y
&mid ot;
Tetralogy of Fallot, Eisenmenger, transposition of great arteries, truncus arteriosus, double-outlet right ventricle. t Atrial septal defect (primum), atrioventricular canal, cleft mitral valve.
Expected numbers in parentheses. observation might cause some interest; in the present context it appears far less impressive. In summary, our results agree most closely with those from England.2 VICTOR SISKIND Drug Epidemiology Unit, OLLI P. HEINONEN Boston University Medical Center, SAMUEL SHAPIRO 720 Harrison Avenue, Boston, DENNIS SLONE. Massachusetts 02118, U.S.A.
S.S.M. =
superficial spreading melanoma.
tic type. It can be seen that there is a strong bias in their group II cases in favour of a better prognosis. A recent analysis of 1187 patients treated in the Queensland Melanoma Project revealed an age-adjusted cumulative survival-rate at 5 years of 877% for women and 73-6% for men, Similar figures for the upper limb (357 cases) were 87.1%, the lower limb (227 cases) 894%, and for the trunk (374 cases)
75.2%. Clark et al.’ report survival figures for superficial spreading melanomas as 465% compared with 273% for nodular melanomas, while McGovern2 gives figures of 70% and 53%
5-year survivals, respectively. We have shown that malignant
melanoma can be diagnosed early biological stage and that routine surgical treatment at that stage gives remarkably good results. Your readers should rely on these orthodox methods3 rather than be tempted into vaccinating, on very flimsy evidence, melanomas before at an
INCIDENCE OF CONGENITAL LIMB-REDUCTION DEFORMITIES
SIR,-As suggested by Jaffe et al.1 we have reviewed the records of all births (16 945 deliveries) from the St. Thomas’s maternity units (1969-73). There were 8 recorded cases of congenital limb-reduction deformities (I.C.D. 755.2 - 755-4). The overall rate of limbreduction deformities for this five-year period was 0-47 cases per 1000. The highest rate was 1.23 cases per 1000 in 1969. There were no recorded cases for 1970 and 1972. Our findings do not show any clear-cut pattern. Janerich et al. reported an association between limb-reduction deformities and twinning. Our 8 cases were singleton pregnancies. But one interesting feature was a family history of twins in 50% of the cases. The information was obtained from hospital and generalpractice records. Department of Obstetrics and
Community Medicine, St. Thomas’s Hospital Medical School,
JANET NALDRETT BEULAH R. BEWLEY
London SE1 7EH.
excision. Queensland Melanoma Project, Princess Alexandra Hospital, Woolloongabba S.2., Brisbane, Queensland, 4102.
NEVILLE DAVIS Co-ordinator
BLOOD-LEVELS OF S-ADENOSYLMETHIONINE IN SCHIZOPHRENIA
SIR The hypothesis suggested by Dr Levi and Dr Wax(July 5, p. 11) on the deficiency of methionine adenosyltransferase (or its activity based upon cofactor abnormalities) man
schizophrenia is of great interest and now needs to be tested experimentally. Matthysse and Baldessarini4 indicated that blood-levels of S-adenosylmethionine (SAMe) in schizophrenics (n=20) were about 111% of controls (n=13), and this finding seems to conflict with the hypothesis of Levi and Waxin
man.
We have tested SAMe in
TREATMENT OF PRIMARY MELANOMA BY INTRALESIONAL VACCINIA BEFORE EXCISION SIR,-Dr Everall and his colleagues (Sept. 27, p. 583) should be slightly more cautious in their conclusions. In the summary they claim "vaccination exerts a favourable effect on the course of melanoma both in terms of survival and prolongation of the interval between treatment of the primary lesion and subsequent development of metastases." In comparing group I treated by excision alone with group II treated by vaccination before excision, they have failed to take into account other factors which are known to affect the prognosis-namely, the sex of the patient, the site of the lesion, and the histogenetic type of tumour. The accompanying table shows the distribution of cases in their two groups stratified according to sex, site, and histogene1.
Jaffe, P., Liberman,
2.
Janerich,
M.
M., McFayden, I., Valman, H. B. Lancet, 1975, i,
526. 697.
D. T.,
Piper, J. M., Glebatis,
D. M. New
Engl J.
Med. 1974,
291,
blood-samples of schizophrenic patients, using a double isotopic enzymatic assay.’6 As indicated below, we found no differences in SAMe levels between chronic schizophrenics and controls, but acute schizophrenics showed a 50% decrease which was statistically significant (P
