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If ' * Vo. jKM No. I correspondence; IMS a Tabl* 1. Acuta Colttta Aatoclittd with Methyldopa. Pane* ho. Aos/Sit 1 Unknown 2 ~ " 53/M 3 50/M 4 H/F 5 65/F 1 60/M Itiutt Dots sto 1000 Diuum IsrsmoMt MVS 4 Bloody dianhaa Countiesteas Tatrs Proctoscopy, a-ray films 500 1000 9 OatirolMctlinal Proctoscopy, bleeding a-ray films IH Bloody diarrhea Proctoscopy 710 to 500 42 Diarrhea Various Sigmoidoscopy, blopey Biopay 710 60 Bloody diarrhea Biopsy Cowmen am Dauos Trismlertnehydrochlorothiatidc, allopurinol, probenicid Rcterpine-hydraUrinthydrochloscthiatidc None Dotepin. propranolol, conjugated estroient Hydrochlorotbiatide None ftUIATtOr Ratwuaessoe Positive after 3 days of meihyldopa (Net performed Nos performed Not perforated Positive eflar Udsyiof aselbyldops Positive after 4 days of methyldopa ClMClAN'f thfco-om Colitii Colilii Acute ukccrttfn colitii Utotutivc colitii Ukcutive prociHii Uktritivc colitii comltantly with methyldopa could be interpreted at indicating an additional cauial factor; however, the iiolatcd rechallengei with methyldopa implicate this drug ai the aole cauially related agent. In addition, in Patient S, the medication taken after methyldopa wai a diuretic, preaumably a thiaride, which wai not anociated with aymptomi of colitii. Tbe recent Journal article on a proposed mechanism of action in methyidopa-induced autoimmune hemolytic anemia* persuaded us to took (or cases of autoimmune hemolytic anetnis in patients with ulcerative colitis. Indeed, although the combination is rare, a number of cases have been reported and were recently reviewed with additional case presentations by Altman ct at.* Thus, it is pos sible that the mechanism of methyldopa-induced colitis may be similar to that proptoed for hemolytic anemia in the article by Kirtland ct al. Rockville, MD 2065? Chikvi Fostutr Osakan, R.Ph., M.D. Kevin Cauaohih, R.Ph. Juomt K. JoNts, M.D., Ph.D. OfTice of biometrics and Epidemiology bureau of Drugs I. Drug esperienoe computer file. Rockville, Md.: Division of Drug Is. perienct, Food and Drug Administration, I9S0. 3. Bonkowsky HL. Brisbane JB. Colitis and hepatitis caused by methyl. Dope. JAMA. 1916; 2)6:160}.}. 3. Kinland Hll III, Mohlcr DN, Horwiu DA. Mcibyldopa inhibition of evpprcstof.lymphocylr function: a proposed cause of autoimmune hemolytic anemia. N trig*1.2) Med. 1980, 302:823-33. 4. Altman AR, Malu C. Jtnnwju FID. Autoimmune hemolytic ancmie in ulcerative coliue. Dig Dii Set'. 1979; 34:7(2-J. pericardial mesothelioma after exposure TO ASbESTOS Talk/Editor In her article on malignant meioihelioma in the July 24 unse.' Amman atatea that "No association between pericardial mcsothelionta and acbcsios taposure has been reported." However, Chusg and Warnocl have reported a ease ol malignant meioihrlioma of the pericardium arising after direct application olasbetsos and fiberglass to the pericardium.1 The tumor was diagnosed IS years after the cpicardiai surface had been dusted with 300 mg of asbestos in an attempt so improve cardiac rirtulaiiun in a ptiurnt with anginu pectoris Amtthrr rr/insi, wliiili ii|i|m*.iio,I nltrr Amman's revsew, described a primary pericardial mcsuihc'liumj Ik^sjsecurred in a tQ.ytar-old man 30 years afier he had been ecposed to asbestos at a shipyard curing World_Vtar J|.' In both cases, amphibolic asbestos filters were identified in tissues by means of electron diflraction and energy-dispersive a-ray. analytic tech(liquet. Pericardial meioihelioma may rarely incur as a iuni|iliiti- lion of exposure lo asbestos many ytara before the patient'a clinical presentation.' Durham, NC 27710 Vicroa L Rooou, M.D. Duke University Medical Center 1. Amman KH. Malignant mesothelioma. N Engl J Med. 1910. )0):700-2. 2. Churg A, Warnocl ML, Bertels KG. Maligninl nscioihcliomi arising after direct application of asbestos and fibeiglaia to the pericardium. Am Rav Rctpir Dii. 1971; 111:419 24. ). Kahn El, Rohl A, Barren EW, Suiuki V. Primary pericardial mesothe lioma following aspotura lo asbestos Environ Rea. I9IO. 21:270-BI. GLYCOSVLATED HEMOGLOBIN WITH INSULINOMA 7a Ihr Editor: In their letter In the issue of December II Freed- man el al. suggest that in the evaluation of fasting hypoglycemia, determination of hemoglobin A, (HbA,) it a more practical procc- dure than aerial glucose estimations during a prolonged fast.' They base their conclusion on the cate of a patient with an insulinoma whose low preoperalive HbA, value returned to normal four weeks after resection of the tumor. We hive measured glycosylated hemoglobin preoperativtly in 13 patients with aurgieally confirmed insulinoma by means ol a chro prepDurtdmatographic technique using columns (Itolab, Akroit. Ohio). None of the patients was taking diatoxide. HbA, levels ranged from 1.2 to 6.6 per cent (mean, 1.940.1 per cent). None of the 13 patients'values were below the range seen in 30nondiabciic subjects (4.1 to 8.9 per cent; mean, 6.54 1.2). The use of HbA, in the evaluation of hypoglycemia has not been ayilematically addressed in the medical literature, although con- dieting comments were made during discussion of a aeries of pre sentations on glycosylated hemoglobin.' Ciabbay stated that hemoglobin A,, levels were not below normal in a population with hypoglycemia but did not give specific data, whereas Socldner nosed that two patients with insulinoma had hemoglobin A ,, levels below normal. Although we have recently demonstrated that 3 . .ur mean plasma glucose levels were significantly lower than n.iiiul in 13 other patients with insulinoma under conditions simulating normal activity (?8i 3 va. 9744 mg per deciliter, P<0.01),' the degree of deviation (ruin normal is much greater in p.tlirnli with poorly ion- nulled sliiiltrtev." Is leuimei readily it|,|,:irrsti, sheielurr. why I ll,A, levels may be quilt elevated in a patient with uncontrolled diabriei and yet nut be consistently below the normal range in a patient with an insulinonsa. We conclude ihn glycosylated hemoglobin levels arc not consis tently low in patients with insulinoma and that the HbA, lest it nus reliable in screening for Ibis disorder. In reaching a shagnmii uf in- 8005 0037 J * .V . a PRODUCED BY FORD