613 said to be the most effective.5 Guar has been given in its natural form/ cooked in bread,6" in soup or mashed potato,3 or as guar crispbread.8 These reportss-S emphasise the efficacy of guar gum but make no direct mention of its palatability. It was therefore refreshing to find Mr Wolever and his colleagues9 acknowledging that guar-containing foods are thick, heavy, and unpalatable. We have done a pilot study to determine whether guar gum causes delayed absorption of carbohydrate or true malabsorption. We wished to include both normal subjects and diabetics and therefore used a standard xylose-tolerance test with and without hydrated guar gum. Of our seven normal subjects, all felt ill after consuming the gum and one vomited and was unable to complete the study. We therefore did not feel justified in extending the observations to diabetics. Subsequently we found that many other workers in Britain and in Australia had abandoned projects with guar gum because of its nauseating properties, even when cooked. Had this been publicised initially many investigators could have been spared both time and gastric disturbance. In the six volunteers who completed the study, guar had no consistent effect. The percentage xylose recovered from the urine in 5h was:

Plasma-xylose measurements showed reduced absorption with gum in subjects 1 and 2, delayed absorption in subjects 3 and 4, and no change in the other two. The concept of giving non-absorbable carbohydrate is an exciting one but we feel that guar gum is definitely not the sub8 stance of choice, even in the form of 26 crispbreads a day.8 Diabetic Clinic, Q.E.II Medical Centre, Nedlands, Western Australia

JOANNA DEWAR

Department of Clinical Biochemistry, University of Western Australia

P. GARCIA-WEBB

Department of Pharmacology, University of Western Australia

GILLIAN M. SHENFIELD

SELF-TREATMENT OF COLD SORES WITH ICE

SIR,-I read with considerable interest Dr Russell’s com(Feb. 10, p. 325) on the likely usefulness of a controlled

ments

double-blind trial of ice as a treatment for cold sores and on the importance of the "placebo response" in interpreting the results of such therapy. I do not share Russell’s pessimism. I have suggested this method of treatment several times since the publication of Danziger’s letter in The Lancet’ and the results in my five patients have been astonishing. I myself have recurrent 10-day attacks of herpes labialis, unrelieved by ether or idoxuridine therapy, and I find it disconcerting to have relief of pain and regression of the lesions within 18 h labelled as "placebo effect".

Alas, this experience only adds to Zimmerman’s list of anecdotal responses.2 It is a sad reflection on our sophisticated world that such an inexpensive and harmless manoeuvre should be so readily relegated to the category of a "household remedy". A controlled trial should be instituted soon: if knowl8. Jenkins, D. J. A., and others, Br. med. J. 1978, ii, 1744. 9 Wolever, T. M. S., Taylor, R., Goff, D. V. Lancet, 1978, ii, 1381. I Danziger, S. Lancet, 1978, i, 103. 2 Zimmerman, D. R. ibid. 1978, ii, 1260.

edge of this remedy were to become widely disseminated, I fear there might be few unselected patients left to admit to the trial. Mount Carmel Medical Center, Columbus, Ohio 43222, U.S.A.

IAN

J. WILSON

RESOLUTION OF HYPERPROLACTINÆMIA AFTER BROMOCRIPTINE-INDUCED PREGNANCY

StR,—Hyperprolactinsemia associated with amenorrhoea and infertility may be successfully treated with bromocriptine.l However, when the drug is withdrawn hyperprolactinaemia and hypogonadism usually recur, and a further complication has been expansion of pre-existing pituitary tumours during bromocriptine-induced pregnancies.3 In contrast, we describe a patient who, after an uneventful bromocriptine-induced pregnancy, was cured of her hyperprolactintmia, menstruated regularly for the first time, and became pregnant again on no

drug therapy. A 24-year-old otherwise healthy female presented in August, 1974, having had only two spontaneous periods since her menarche

15 years. She was of average build, with normal sexual characteristics and had no clinical evidence secondary of specific endocrinopathy. No galactorrhoea was demonstrable. She was on no drug therapy. Laparoscopy revealed a normal genital tract; basal gonadotrophins were normal; the pituitary fossa was normal. Irregular, scanty menses occurred with clomiphene therapy, but there was no ovulation. In December, 1975, the patient’s basal prolactin level was found to be very high at above 90 ng/ml (normal < 15), and this was subsequently confirmed on three occasions. Tomograms revealed no evidence of pituitary tumour and anterior pituitary function was otherwise normal. Bromocriptine therapy was started in May, 1976 (maximum dose 5 mg/day), and she had a normal menstrual period in June. On Aug. 18, 1976, she was found to be pregnant and bromocriptine therapy was discontinued. The pregnancy was uneventful and a live, healthy male was delivered on April 10, 1977. The patient breast-fed for 6 months, had no difficulty in stopping her milk secretion, and subsequently spontaneously began to menstruate every 28-31 days. In November, 1977, the serum prolactin was normal (mean 240 mU/1; reference range 60-360); so were the sleeping peak of prolactin secretion (1600 mU/1) and the increase in secretion in response to thyrotrophin-releasing hormone and metoclopramide, intravenously. After the metoclopramide study, the patient had intermittent galactorrhcea for 4 weeks. Repeat pituitary tomograms showed no change from the 1976 films and anterior pituitary function was still normal. Biochemical evidence of ovulation was obtained with a luteal-phase progesterone at 29 nmol/1. The prolactin values and the history of virtual primary amenorrhcea point to a pituitary tumour, but the resolution of clinical and biochemical abnormality after a bromocriptineinduced pregnancy suggests that the basic lesion may have been, not a tumour, but a minor "functional" hypothalamic defect which was rectified by bromocriptine. One report4 has suggested an anti-proliferative effect of bromocriptine in patients with prolactin-secreting microadenomas, but there is no proof that such treatment results in complete resolution of at

pituitary tumours. University Department of Medicine, Glasgow Royal Infirmary, Glasgow G4 0SF

E. A. COWDEN

J. A. THOMSON

1.

Besser, G. M., Parke, L., Edwards, C. R. W., Forsyth, I. A., McNeilly, A. G. Br. med. J. 1972, iii, 669. 2. Thorner, M. O., McNeilly, A. S., Hagan, C., Besser, G. M. ibid. 1974, ii, 419. 3. Lamberts, S. W. J., Seldenrath, H. J., Kwa, H. G., Birkenhager, J. C. J. clin. Endocr. Metab. 1977, 44, 180. 4. Werder, K. V., Fahlbusch, R., Landgraf, G., Pickardt, C. R., Rjosk, H. K., Scriba, P. C.J. endocr. Invest. 1978, 1, 47.

Self-treatment of cold sores with ice.

613 said to be the most effective.5 Guar has been given in its natural form/ cooked in bread,6" in soup or mashed potato,3 or as guar crispbread.8 The...
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