525 with increasing age and also with the obvious osteopenia characteristic of hyperparathyroidism.14 15 However, parathyroid hormone does stimulate osteoblasts, and some reported cases of hyperparathyroidism show pronounced radiological Dsteosc1erosis.16 17 Nonetheless, treatment with parathyroid hormone should be considered experimental, whereas fluoride and calcium can be regarded as a consistently reliable form of treatment. Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55901, U.S.A.

JENIFER JOWSEY

MAINTENANCE TREATMENT OF ENDOGENOUS DEPRESSION

SIR,-Dr Weissman’s letter (July 3, p. 45) on the evaluation efficacy of maintenance therapy of depression raises

of the

some problems. We feel it necessary to distinguish between the various types of depressions when evaluating the effect of treatment; we have studied patients with endogenous depressions for which effective maintenance therapy is available.18 19 Furthermore it is necessary to decide if maintenance therapy

is indicated in the individual patient. The following results suggest that the thyrotropin-releasing-hormone (T.R.H.) stimulation test might be of value in the solution of this problem. 40 patients with endogenous depressions were studied (15 men and 25 women, aged 46-91 years). 5 of the depressions were bipolar, 11 were unipolar, while 24 could not be classified. 31 patients were treated with electroconvulsive therapy, while 9 patients received imipramine or amitriptyline. Early relapse (i.e., relapse within 6 months) occurred in 23 patients after a mean of 2.4 months. 17 patients observed for 6-25 months (mean 11-6) did not relapse. In all patients T.R.H. stimulation tests (T.R.H. 200 fLg intravenously) were done before treatment and after clinical recovery. The increase in the maximal thyroid-stimulating hormone (T.s.H.) response (A max T.s.H.) is given in the figure. Except in 2 patients, an increase in A max T.S.H. of more than 2.0 U/ml was seen in the group without relapse, while only 1 of the 23 patients with later relapse had an increase of more than 2.00 uU/ml. Consequently, using the arbitrary limit of 2-0U/ml for the increase of A max T.s.H., a correct prognosis was possible in 93% of the patients (95% confidence limits 80-98%). Before treatment there was no difference between the groups in the T.s.H. response to T.R.H., and no differences were found in basal serum T.S.H., T4, T3, and T3-resin uptake either before treatment or after recovery. Our data suggest that the

changes in the T.s.H. response to correlated to the clinical course of the endogenous depression and not due to changes in the thyroid-hormone levels. We believe that the T.R.H. test might be of prognostic value and an aid to the decision to maintain antidepressive T.R.H. are

treatment or not. Medical

Department E and Psychiatric Department D, Frederiksberg Hospital, 2000 Copenhagen F, Denmark

CELL

C. KIRKEGAARD U. BIRK LAURIDSEN

N. BJØRUM

FUSION, GENETIC CARTOGRAPHY, AND MALIGNANCY

Increase in A

roo T.S.H. after antidepressive treatment in 17 without relapse (0) and in 23 patients with relapse (8).

patients

SIR,- You state (July 17, p. 134) that although fusion of a malignant cell with a non-malignant cell results in the suppression of the malignant phenotype this suppression is short-lived due to the rapid segregation of chromosomes (presumably including those responsible for the suppression of malignancy)1 from the hybrid. This is certainly true of mouse-cell hybrids, but you imply that human cell hybrids with a suppressed malignant phenotype2 are subject to the same instability. We have found that, on the contrary, non-malignant human cell, hybrids that were derived from the fusion of a malignant cell with a non-malignant cell have been propagated in vitro for more than two years without reverting to a malignant state. We assume that this lack of reversion to malignancy is due to the chromosomal stability of the hybrids since we have noted only a slow loss of chromosomes over this period. If this chromosomal stability proves to be a general property of intraspecific human cell hybrids then suppression of the malignant phenotype will presumably also be stable. If hybrids between malignant and non-malignant human cells can be developed which continue to express tumour-specific surface antigens and whose malignant phenotype remains suppressed, become very useful in the immunotherapy of human they may 3 cancer.

14 Riggs, B. L., Arnaud, C. D., Jowsey, J., Goldsmith, R. S., Kelly, P. J. J. clin. Incest.

1973, 52, 181.

15 Jowsey, J. Clins. Endocr. Metab. 1974, 3, 267.

Department of Medical Microbiology, University of California, Irvine, Irvine, California 92717, U.S.A.

ERIC

16 Genant, H. K., Baron, J. M., Straus, F. H., II, Paloyan, E., Jowsey, J. Am. J Med. 1975, 59, 104. 17 Connor, T. B., Freijanes, J., Stoner, R. E., Martin, L. G., Jowsey, J. Trans. Am clin. Climat. Ass. 1974, 85, 185. 18 Davis, J M. Am.J. Psychiat. 1976, 133, 1. 19 Quitkin, F, Rifkin, A., Klein, D. F. Archs gen. Psychiat. 1976, 33, 337.

1. 2.

3.

Bregula, U., Klein, G., Harris, H.J. Cell Sci. 1971, 8, Stanbridge, E. J. Nature, 1976, 260, 17. Stansly, P. G. Cancer Res. 1975, 35, 1599.

673.

J. STANBRIDGE

Maintenance treatment of endogenous depression.

525 with increasing age and also with the obvious osteopenia characteristic of hyperparathyroidism.14 15 However, parathyroid hormone does stimulate o...
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