British Postgraduate Medical Federation, University of London. A third insight is the effectiveness of group analytical psychotherapy. For 15 years or so we have been running groups at the Portman Clinic that have included men and women who have perpetrated incest. This treatment takes years but it works. Underlying the motivation of women who sexually abuse their children and consequently also underlying the problem of accurately diagnosing them and offering specific professional help is an understanding of the power of motherhood and the mental attitudes which lead some women to abuse it.2 ESTELA V WELLDON
Portman Clinic, London NW3 SNA I Wilkins R. Women who sexually abuse children. Br Med J 1990;300:1153-4. (5 May.) 2 Welldon EV. Mother, madonna, whore, the idealization and denigration of motherhood. London: Free Association Books, 1988.
the disease; the influence of dressings; the age, mobility, and nutritional state of the patient; and the presence of other disease, such as anaemia, diabetes, and hypertension. One factor common in venous ulceration which appears to be detrimental to healing is obesity. Indeed, healing of chronic venous ulceration of the legs has been reported after successful treatment of obesity by jaw wiring. This is an extreme example, but it illustrates the point.
The trial reported by Dr Mary-Paula Colgan and others purports to show that oxpentifylline had a significantly beneficial effect over placebo in well matched groups of patients.2 The patients differed in their relative obesity, however, those in the placebo group being much more overweight than those taking oxpentifylline. The comparison is easy to make since both groups had an average height of 166 cm, yet the average weight of the active treatment group was 74 8 kg and that of the placebo group 80 6 kg. This factor alone may be sufficient to account for the difference in healing rates between the two groups. S B BITTINER
Screening of school aged children SIR, -As a senior clinical medical officer working in audiology, I agree with Dr John W Tuke that routine repetitive screening for conductive hearing loss alone is probably not justified.' It is somewhat optimistic, however, to expect that all children with bilateral perceptive deafness will have been identified by the age of 11 months. A retrospective study in Warrington showed that eight children with bilateral severe sensorineural deafness were first detected by means of repeated screening using the school audiology service. Two of the children had a progressive form of familial deafness and had passed earlier hearing tests. The remaining six came from deprived backgrounds or were recent immigrants and their deafness had not previously been recognised. The diagnosis of hearing impairment in these children would have been delayed further had not regular hearing tests been in use. Children with severe unilateral hearing loss are often overlooked. Ten such children in Warrington were detected at a mean age of 67 months by means of repeated screening tests at school. Unilateral sensorineural loss is often acquired and will not be detected by free field testing in the preschool years.' Although unilateral loss is not as severe a handicap as bilateral loss, teachers must be made aware of the problem and children should sit with the good ear facing the teacher. We should strive to ensure that all congenital sensorineural hearing loss is detected before school entry and that all subsequently acquired loss is readily detected by astute parents or teachers. In the mean time there is still a place for repeated hearing tests in schoolchildren. M J BANNON
Community Health Services, Garven Place Clinic, Warrington WA 1 RM
Department of Dermatology, Royal Hallamshire Hospital, Sheffield S 10 2JF 1 Ardron ME, MacFarlane IA, Vaughan ED. Chronic venous leg ulceration in obesity: successful treatment by jaw wiring. BrMedJ 1986;293:1224. 2 Colgan MP, Dormandy JA, Jones PW, Schraibman IG, Shanik DG, Young RAL. Oxpentifylline treatment of venous ulcers of the leg. Br Medj 1990;300:972-5. (21 April.)
AUTHOR'S REPLY,-We fully agree that studies of the treatment of venous leg ulcers have inherent problems of standardisation of treatment. In this study, however, we hoped to overcome such problems by selecting those patients who had been attending a specialist clinic without improvement for a minimum of two months and by using a standard compression regimen in all patients. We were also aware of the relation of nutritional state and body weight to healing, and both variables were studied as possible sources of a treatment effect. This was done by using the Breslow Day test. The results for both groups are shown in the tables. TABLE i-Relation between nutritional state and healing of leg ulcers in patients given oxypentifylline compared with those given placebo
State of ulcer
Poor nutritional state*
Normal nutritional statet
(n=6)
(n=65)
Oxypentifylline Placebo Oxypentifylline Placebo
Healed Not healed
4
2
18 14
Adjusted X2=6-99; Breslow Day test= 31 (p=008). *Albumin
Portman Clinic, London NW3 SNA I Wilkins R. Women who sexually abuse children. Br Med J 1990;300:1153-4. (5 May.) 2 Welldon EV. Mother, madonna, whore, the idealization and denigration of motherhood. London: Free Association Books, 1988.
the disease; the influence of dressings; the age, mobility, and nutritional state of the patient; and the presence of other disease, such as anaemia, diabetes, and hypertension. One factor common in venous ulceration which appears to be detrimental to healing is obesity. Indeed, healing of chronic venous ulceration of the legs has been reported after successful treatment of obesity by jaw wiring. This is an extreme example, but it illustrates the point.
The trial reported by Dr Mary-Paula Colgan and others purports to show that oxpentifylline had a significantly beneficial effect over placebo in well matched groups of patients.2 The patients differed in their relative obesity, however, those in the placebo group being much more overweight than those taking oxpentifylline. The comparison is easy to make since both groups had an average height of 166 cm, yet the average weight of the active treatment group was 74 8 kg and that of the placebo group 80 6 kg. This factor alone may be sufficient to account for the difference in healing rates between the two groups. S B BITTINER
Screening of school aged children SIR, -As a senior clinical medical officer working in audiology, I agree with Dr John W Tuke that routine repetitive screening for conductive hearing loss alone is probably not justified.' It is somewhat optimistic, however, to expect that all children with bilateral perceptive deafness will have been identified by the age of 11 months. A retrospective study in Warrington showed that eight children with bilateral severe sensorineural deafness were first detected by means of repeated screening using the school audiology service. Two of the children had a progressive form of familial deafness and had passed earlier hearing tests. The remaining six came from deprived backgrounds or were recent immigrants and their deafness had not previously been recognised. The diagnosis of hearing impairment in these children would have been delayed further had not regular hearing tests been in use. Children with severe unilateral hearing loss are often overlooked. Ten such children in Warrington were detected at a mean age of 67 months by means of repeated screening tests at school. Unilateral sensorineural loss is often acquired and will not be detected by free field testing in the preschool years.' Although unilateral loss is not as severe a handicap as bilateral loss, teachers must be made aware of the problem and children should sit with the good ear facing the teacher. We should strive to ensure that all congenital sensorineural hearing loss is detected before school entry and that all subsequently acquired loss is readily detected by astute parents or teachers. In the mean time there is still a place for repeated hearing tests in schoolchildren. M J BANNON
Community Health Services, Garven Place Clinic, Warrington WA 1 RM
Department of Dermatology, Royal Hallamshire Hospital, Sheffield S 10 2JF 1 Ardron ME, MacFarlane IA, Vaughan ED. Chronic venous leg ulceration in obesity: successful treatment by jaw wiring. BrMedJ 1986;293:1224. 2 Colgan MP, Dormandy JA, Jones PW, Schraibman IG, Shanik DG, Young RAL. Oxpentifylline treatment of venous ulcers of the leg. Br Medj 1990;300:972-5. (21 April.)
AUTHOR'S REPLY,-We fully agree that studies of the treatment of venous leg ulcers have inherent problems of standardisation of treatment. In this study, however, we hoped to overcome such problems by selecting those patients who had been attending a specialist clinic without improvement for a minimum of two months and by using a standard compression regimen in all patients. We were also aware of the relation of nutritional state and body weight to healing, and both variables were studied as possible sources of a treatment effect. This was done by using the Breslow Day test. The results for both groups are shown in the tables. TABLE i-Relation between nutritional state and healing of leg ulcers in patients given oxypentifylline compared with those given placebo
State of ulcer
Poor nutritional state*
Normal nutritional statet
(n=6)
(n=65)
Oxypentifylline Placebo Oxypentifylline Placebo
Healed Not healed
4
2
18 14
Adjusted X2=6-99; Breslow Day test= 31 (p=008). *Albumin
