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To the Ediotr. —I disagree with the recommendation of Drs DeCherney and Koos 1 to administer 1.5 to 2 g/d of elemental calcium to pregnant women at high risk for developing preeclampsia. The studies included in the meta-analysis on which this recommendation was based were principally studies of healthy nulliparous women. 2 There is no information with respect to the use of calcium supplementation for prevention of preeclampsia in women with multiple pregnancies, chronic hypertension, diabetes mellitus, or prior preeclampsia. As described elsewhere, 3 many of the previous studies had serious methodological shortcomings. Moreover, the safety of calcium supplementation cannot be assured in women with hypercalcemia, renal disease, or a history of urolithiasis. The multicenter trial of Calcium for Preeclampsia Prevention (CPEP) 3,4 supported by the National Institute of Child Health and Human Development and the National Heart, Lung, and Blood Institute found that calcium did not prevent preeclampsia or

To the Editor. —Dr Cappelleri and colleagues1concluded that unexplained clinically important differences between the results of large trials and meta-analyses of small trials are extremely uncommon. We have several concerns with this conclusion. First, the authors based it on the results of a random effects model. While both fixed and random effects models can be useful, the interpretation of results when these models disagree is the subject of much debate.2However, the authors note that a fixed effects model reported more disagreement between small and large studies than a random effects model. This is to be expected by the very nature of the way these 2 models address heterogeneity between studies.2Since the a priori belief of the authors was that large trials usually support the results of meta-analyses of small trials, it appears self-serving to emphasize the results of random effects models. Second, the authors

To the Editor. —Giovannucci et al 1 failed to consider the most important variable associated with diagnosing prostate cancer in the United States, that is, a patient-urologist encounter. In another study linking vasectomy to prostate cancer, Rosenberg et al 2 failed to address the same issue. Although participants in both studies provided detailed information on various lifestyle variables, information on contact with urologists was lacking. Giovannucci et al addressed detection bias by confirming that the frequency of rectal examination was similarly high in men with and without vasectomy. Rosenberg et al questioned whether vasectomized men were more health conscious and more likely to undergo surveillance than nonvasectomized men but dismissed the possibility since the risk of prostate cancer was still increased 15 years after vasectomy, when they felt it would be unlikely that men were still undergoing regular rectal examination related to vasectomy. Men electing vasectomy may have in common

IN 1964 Sweet described a distinctive dermatologic disease with systemic manifestations that he called acute febrile neutrophilic dermatosis. The skin condition consists of painful, raised plaques, nodules, and pustules that histologically show a perivascular neutrophilic infiltrate in the dermis. The eruption occurs acutely or episodically and is almost always accompanied by fever and neutrophilic leukocytosis. Antibiotics are ineffective, but corticosteroids result in prompt resolution without scarring. Eight previously reported 1-5 cases described patients with Sweet's syndrome who experienced acute leukemia during the course of their illness. We report two other cases of Sweet's syndrome in which leukemia developed and emphasize that this dermatosis appears to be associated with hematologic malignant conditions. Report of Cases Case 1.— A 45-year-old woman was hospitalized in March 1977 after having had development of painful skin eruptions over the face, neck, chest, and extremities (and similar painful lesions in the mouth) during a three-week period

To the Editor.— The American Medical Association Council on Scientific Affairs has recently noted that adequate studies of adverse effects on male reproductive function from working in hot environments do not exist. 1 Unfortunately, the Council has also made the premature judgment that such effects are not to be expected under normal working conditions. It cites a study of workers in sugar refineries and railroads by Fonio et al, 2 which is poorly documented and lacks a control group. Although Fonio et al state that heat had no negative influence on fertility since 94% of surveyed persons were reported to have had children during exposure, no attempt was made to determine if the number of children conceived might have been fewer than usual. While temporary hot exposures should, as the Council has concluded, cause no permanent effects and no substantial decrease in fertility, exposures of up to several hours experienced

On Sept 21, 1973, during and following a football game at which they had participated, 57 members of an Alabama high school marching band (and one accompanying adult) experienced an illness characterized by headache, nausea, weakness, or dizziness. Six girls fainted. Thirty-six students were treated at a hospital emergency room. Those who had played wind instruments and had worn heavier uniforms including an impermeable plastic jacket overlay were affected earlier and more frequently than the others. Several organic causes were examined in an epidemiologic investigation and considered unlikely to explain the epidemic. Female preponderance, a bimodal epidemic curve, hyperventilation, relapses, and clinical features characterized by subjective complaints in the absence of physical findings suggested a syncopal reaction to heat exacerbated and propagated by mass hysteria. ( JAMA 238:2373-2376, 1977)