804

infants experience pain, and adequate analgesia is necessary for bothphysiologic and ethical reasons". Children are said to experiencemoderate to severe pain in as many as 60% of procedures and manydo not receive opioids after surgery even though postoperative painis expected. The guidelines specifically question the withholding ofanalgesics from very small infants in the belief that they mightseverely depress respiration. On the contrary, say the panelists,recent studies show that careful pain treatment of infants reducessurgical stress and postoperative deaths.

1. Acute Pain Management: operative or medical procedures and trauma. Available freefrom AHCPR Publications Clearinghouse, PO Box 8547, Silver Spring, Maryland20907, USA.

FDA warning on ACE inhibitors

The Food and Drug Administration announced last week thatlabels for all angiotensin-converting-enzyme (ACE) inhibitors willbe required to carry a "boxed warning" for women in the advancedstages of pregnancy. At FDA’s request, six manufacturers of ACEinhibitors in the US are sending out "Dear Doctor" letters aboutthe risk of harm to fetuses, including kidney failure and face or skulldeformities, when the drug is taken by women in the second andthird trimesters of pregnancy. Information accompanying theseproducts has for several years warned of these risks, but additionalcases continue to be reported. More than 50 cases of fetal damagehave been reported over the past few years. No risk to fetuses seemsto arise from exposure to ACE inhibitors limited to the firsttrimester. Pharmacists will be asked to counsel women of child-

bearing age who are taking ACE inhibitors and will be providedwith stickers for the bottle that read, "If you become pregnantconsult your doctor promptly about switching to a different drug".

Cutaneous diphtheriaThe UK’s Communicable Disease Surveillance Centre would

like to be informed of the isolation of Corynebacterium diphtheriaefrom skin infection, together with the patient’s relevant traveldetails. This appeal follows the isolation of the organism from skinulcers of two UK residents who had recently returned fromjourneys abroad- C diphtheriae var mitis, together with group Astreptococcus, was isolated from a non-healing ulcer of a man whohad been in India, and C diphtheriae vargravis, together with groupA streptococcus and Staphylococcus aureus, from a persistent footulcer that had developed after sandfly bites in the Yemen. Thesecond patient’s wife, who had remained in the UK, began to haveitchy weeping lesions on the lower limbs about a week after herhusband’s return; C diphtheriae vargravis was among the organismsisolated. The organisms were non-toxigenic and the patients weretreated with erythromycin. The last case of cutaneous diphtheriareported to the CDSC was in 1990, from a girl who had recentlyreturned from Pakistan.

1. Anon. Corynebacterium diphtheriae, skin ulcers and travel abroad. CDR Weekly 1992;2: 51.

Final attack on riverblindness

Riverblindness, that ancient scourge of many African countries,has almost been eliminated in West Africa as a result of the WorldHealth Organisation’s Onchocerciasis (Riverblindness) ControlProgramme, which is sponsored by WHO, World Bank, UnitedNations Development Programme, and United Nations Food andAgriculture Organisation. The programme, begun in 1974, isclaimed to have provided protection against the disease for 9 millionchildren, cured over 1 million seriously infected people, and freed25 million hectares of previously blackfly-infested land forresettlement and cultivation. The programme’s strategy is based onvector (savanna blackfly) control and treatment of infectedindividuals with ivermectin. The spraying of environmentally safeinsecticides effective against blackfly larvae at breeding sites infast-flowing rivers has virtually removed the parasite reservoir inthe seven countries (20 million people) in the first part of theprogramme. Phase four (the last six-year period) was launched inFebruary, 1992. Twenty-two donors have pledged$US150

million, and WHO hope that the disease will largely disappear froman eleven-countrv area.

Restriction on sale of HIV test kits

From April 1, the advertising and sale of test kits for humanimmunodeficiency virus to the public will be an offence in the UK,as will the provision of HIV testing services other than through aregistered medical practitioner. These kits are intended for use forscreening purposes and their sale, to health services for instance,must be accompanied by a warning about interpretation of results.The intention is that the kits should not be available over thecounter for self-testing, and that testing is not done without

appropriate counselling.

European Academy of Teachers in GeneralPractice

The European Conference on General Practice, Gleneagles,13-15 March, 1992, was the occasion for intimation of theformation of a European Academy of Teachers in General Practice.This is seen as a logical development of the work of the NewLeeuwenhorst Group, which brings together some 28 experiencedteachers in general practice in different European countries. Thesecretary designate is Prof Jan Heyrman, professor of generalpractice, Catholic University of Leuven, Belgium. The Academyincludes amongst its aims the coordination and promotion oftraining and teaching in general practice in Europe.

Global securityMedical Action for Global Security (MEDACT) is holding its

inaugural conference on April 4 at Regent’s College, London.MEDACT, whose first President is Sir Raymond Hoffenberg, hasbeen formed by the merger of the Medical Association forPrevention of War with the Medical Campaign Against NuclearWeapons. Further details can be obtained from MEDACT, 601Holloway Road, London N19 4DJ, UK.

Speed-trapped testes

Lots of people get shot at by policemen. Happily the ammunitionis usually a microwave and it is the speeding motorist’s purse not hisperson that is damaged. An improbable titbit in the March 2 issue ofCancer Weekly indicates that policemen in Michigan believethemselves to be victims of their weaponry. 7 of the 244 policemenworking out of Grand Rapids and Wyoming have testicularcancer--and they are blaming radar guns. One former policeman issuing the companies that make the instruments. In what directiondid he point his?

Seasonal quizThe two winners of our seasonal quiz are Mr V. Loughlin, FRCS,

Lisburn, Northern Ireland, and Dr R. Hoffmann, Neustadt,Germany.

International Diary

3rd congress of the International Society for Rheumatic Therapywill take place in Mannheim, Germany on May 10-15: Mrs MargareteDathan, Secretariat, Klinik Auerbach, Heinrichstrasse 4, 6140 Bensheim 3,Germany (06251-705149).

2nd international symposium on Familial AmyloidoticPolyneuropathy and Other Transthyretin Related Disorders is to beheld in Skelleftea, Sweden on June 1-3: Dr Lars Steen, Department ofMedicine, University of Umea, S-901 85 Umea, Sweden (46 90 151630).

The Harvard-Amsterdam Conference, formerly the EighthInternational Conference on AIDS/3rd STD World Congress, will be heldin Amsterdam on July 19-24: Harvard AIDS Institute, 8 Story Street,Cambridge, MA02138, USA (telephone 617-495 0478, fax 617-495 29630,orDutch Foundation-AIDS Conference 1992, Max Euweplein 30,1017 MBAmsterdam, Netherlands.