MEASUREMENT OF HBsAg IN RENAL-UNIT PATIENTS A ra a A.i a Is
SIR,-We have observed that the concentration ofHBsAg in the sera of patients on chronic haemodialysis is often very high. Sera were collected from three groups of 10 consecutive subjects who were found to be HBsAg-positive from among renalunit patients on periodic hxmodialysis, patients with hepatitis B, and healthy subjects who volunteered to donate blood. Samples were diluted in physiological saline in two-fold steps from 1/2 to 1/4096 and tested for HBsAg in counterimmunoelectro-
HBsAg TITRE IN THE
SERA OF HEALTHY CARRIERS AND PATIENTS
WITH RENAL DISEASE AND HEPATITIS
Among the renal-unit patients, 8 (80%) had HBsAg titres of to 2048, whereas 19 subjects from the other two groups (95‘c) had titres of 64 or less. Infection and disease due to hepatitis B virus (H.B.v.) are common among patients and staff in many renal units.2,3 Environmental contamination with HBsAg has been demon128
strated in renal units and is suspected to be an important reason for the frequent hospital infection.’·5 Patients on repeated hxmodialysis are more susceptible to infection and are more likely to become chronic carriers than are normal subjects. Moreover they develop anicteric rather than overt hepatitis. These features indicate certain immunological abnormalities, another expression of which appears to be the high concentration ofHB.Ag in their blood. It is likely that the concentration of hepatitis B virus is also high in them, contributing to environmental contamination and the perpetuation of infection m renal units. Departments of Virology and Christian Medical College and Vellore 632004, India
T. JACOB JOHN J. C. M. SHASTRI
10 years before starting D.N.C.B. All patients became sensitised at the first attempt to 2% D.N.C.B. They then applied 0-1-0.3% D.N.C.B. in acetone weekly to a randomly selected half of the head, the other side acting as a control (although it is quite possible that D.N.C.B. may have a systemic action in additon to its local effect). All patients developed a moderate or severe eczematous reaction for 24 to 48 h after the D.N.C.B. applications. 3 patients had some regrowth on the treated side only by 12-18 weeks, but in only 1 was the growth impressive. In 3 patients, there was some regrowth on both sides at 10-18 weeks. In 2 patients there was no regrowth after 17 and 33 weeks, respectively. In the patient with an excellent result, all the hair fell out at 24 weeks, after a single application was missed. In the 5 patients with the partial response to D.N.C.B., all the hair fell out-even though they continued the weekly treatment-at 16, 18, 25, 32, and 40 weeks. No patient has had a cosmetically acceptable regrowth of hair and all the patients continue to wear a wig. The conclusion from this small study is that D.N.C.B. treatment will induce regrowth of hair in many patients with alopecia areata, but that it is not a useful treatment. It should be noted that a marked eczematous reaction is necessary to achieve even moderate regrowth, and patients have to tolerate itching and even weeping of the scalp for 24-48 h after each treatment. It is possible that D.N.C.B. treatment may have a role in patients with alopecia areata of a very short duration, in whom it may accelerate the regrowth that usually occurs without to
treatment. St. John’s Hospital, Lisle Street, London, WC2H 7BJ
ANDREW P. WARIN
CHOLELITHIASIS AND HIATUS HERNIA
SIR,-A prospective well-controlled study’ found a statistically significant association between cholelithiasis and hiatus hernia, as diagnosed radiologically according to well-established criteria.2-4 I report here the findings of a retrospective
study in support of this association. In the study group, consisting of patients treated by cholecystectomy from 1975 to 1978, the diagnosis of cholelithiasis AGE DISTRIBUTION OF CONTROL AND CHOLELITHIASIS PATIENTS
DINITROCHLORBENZENE IN ALOPECIA AREATA
SIR,-Dinitrochlorobenzene (D.N.C.B.) has been claimed by several authors to induce hair growth in alopecia areata.6-10 I can confirm that this is so. However, D.N.C.B. can only be considered a useful treatment if the result is cosmetically acceptable and the patient no longer requires a wig. I am conducting a trial of topical D.N.C.B. treatment in 15 patients with extensive alopecia areata or alopecia totalis. 7 patients have been on treatment for less than 6 weeks and will not be discussed; none have shown any regrowth of hair so far. Results are presented here for 8 patients (5 female; 3 male, aged 6-42 years). 6 had alopecia totalis and 2 had very extensive alopecia areata. They had had the condition for 9 months
clinically and confirmed radiologically in most cases. gallstones were grossly identified as of the cholesterol variety on the basis of well-recognised characteristics.5 The charts of these patients were screened for evidence of sliding hiatus hernia, whether recognised in the past or at cholecystectomy.
The 1 Hill, P
G, John, T. J., Shanmugham, R. V., Carman, R. H. Ind. J. med.
1973, 61, 378.
2 Polakoff, S., Cossart, Y. E., Tilkt, H. E. Br. med. J. 1972, iii, 94. Szmuness, W., and others. J. Am. med.Ass. 1974, 227, 901. 4 Gunasekaran, G., Kirubakaran, M. G., Johny, K. V., Shastry, J. C. M., 3
John, T J. Ind. J. med. Res. (in thepress) 5 Dankert, J., Uitentuis, J., Houwent, B., Tegzess, A. M., Van der Hem, G. K. J infect Dis. 1976, 134, 123. 6 Dunaway, A. D. Archs Dermat. 1976, 112, 256. 7. Frentz G., Eriksen, K. Acta dermato-vener.Stockh. 1977, 57, 370. 8. Happle,R, Echternach, K. Lancet, 1977, ii, 1002. 9. Daman, L., Rosenberg, E. W., Drake, L. Archs Dermat. 1978, 114, 1036. 10. Breuillard, F., Szapiro, E.Lancet, 1978, ii, 1304.
J-P., Dupont, M., Payenneville, H., Dupas, J-L., Lorriaux. A Lanii, 329. 2. Stein, G. N., Finkelstein, A. Am. J. dig. Dis. 1960, 5, 77 3 Cohen, S., Harris, L. D. New Engl. J Med. 1971, 284, 1053. 4. Kreel, L. Clins Gastroent. 1973, 2, 185 5. Bockus, H. L. in Gastroenterology (edited by H. L. Bockus),vol III, p. 754 cet, 1978,