EBV has long been thought to be primarily a B-lymphotropic virus. A manifestation of this tropism is the association of the virus with a variety of B-cell lymphoproliferative disorders and tumours. However, there is now considerable evidence to suggest that the permissive cell type for EBV replication is epithelial and that infection of B cells may be a secondary, and, from the point of view of the virus, an unimportant consequence. A re-evaluation of the role that epithelium plays in viral persistence and of the importance of the immune response in the development of persistent infection indicates that T-cell-mediated immunity to the epithelial infection is critical in maintaining the normal delicate balance between virus and host. It also suggests that uncontrolled EBV replication in pharyngeal epithelium may be central to the evolution of some (or all) EBV-associated lymphomas.

All 324 patients admitted over sixteen months to a general intensive therapy unit (ITU) were prospectively studied to assess the effect of a novel prophylactic antibiotic regimen on the incidence of acquired infection. Consecutive control (161 patients) and test (163 patients) groups were analyzed. In the control group, antibiotic administration was determined by clinical and microbiological evidence of infection. In the test group, treatment consisted of a triple regimen of selective decontamination of the digestive tract (polymyxin E, tobramycin, and amphotericin B) administered throughout the ITU stay, systemic cefotaxime administered for the initial four days, and regular microbiological screening of multiple sites. The test group showed a striking and consistent reduction in colonisation of the digestive tract with aerobic gram-negative bacilli, and there was a substantial reduction in the incidence of acquired infection (24% to 10%). Mortality in certain categories of patients was also reduced. There is now a considerable body of evidence to justify the more widespread use of this selective parenteral and enteral anti-sepsis regimen (SPEAR) in general intensive care practice.

Asthma management was audited prospectively for one year in a large teaching hospital. Full details were available on 77% of all patients admitted, or readmitted, with asthma during that year (150 of 195 admissions). 64 patients were admitted to general wards with a special interest in respiratory medicine, and 86 to general wards without this specialist interest. Cases in the two groups were similar in terms of age, previous severity of asthma, previous treatment, and initial pulse rate. Fewer cases in the non-specialist group were treated with oral corticosteroids (67%, vs 83%), had regular peak flow recordings (42%, vs 73%), or were given return appointments (56%, vs 92%); and fewer had their regular inhaled therapy increased after discharge (28%, vs 55%). At interview 13 days later, more patients from the non-specialist group reported sleep disturbance (41%, vs 23%), morning chest tightness (55%, vs 37%), ow wheeze on 1 flight of stairs (58%, vs 34%). 20% of first admissions in the non-specialist group were readmitted within the year, compared to 2% of the group treated on wards with a specialist interest in respiratory medicine. These data suggest that the intensive management of asthmatic patients, practised in respiratory units, prevents much unnecessary morbidity.

Xenogeneic antibodies can survive food processing procedures with their biological activity intact and even enhanced. These antibodies can be absorbed from the human gut, and will function both as antigens and antibodies in the human immune system. Antibodies to bovine gamma globulins (BGG) have been detected in human sera and the family of anti-BGG antibodies must include anti-idiotypic antibodies, very low doses of which can influence the immune response. The hypothesis is that the human immune system may be primed by low-level exposure to xenogeneic antibodies specific for those human allergens which are ubiquitous in the farm environment, such as pollens, mites, and moulds, the result being a deleterious and inappropriate response on subsequent exposure to these allergens. Dairy products are the most important source of xenogeneic antibodies in the western diet, and the hypothesis may partly explain the association between cow's milk and allergies to substances other than milk proteins.

408 adults (age 16 and over) were followed up after their initial seizure. The actuarial risk of recurrence was highest in the early weeks. For those seen within the first week, the risk of recurrence was 52% by the end of 3 years. In univariate analysis, the only clinical variable that was associated with recurrence was the time of day at which the initial seizure occurred. There was a tendency, that did not reach statistical significance, for younger age (less than 50 years) and a family history of seizures of any type, including febrile convulsions, to be associated with recurrence. Such risk factors appear to be additive, so that the risk of recurrence at 1 year for a subject with all three factors is about three times that of a subject with none of them. Sex, type of seizure, and features of the electroencephalogram were not of predictive value. Computerised tomographic scanning revealed tumours in 3% of subjects, and these individuals were particularly likely to have recurrent seizures.

Among 137 members of 30 families, 6% (and 8% of those aged under 15 years) were seropositive for toxocara antibodies. In these seropositive subjects and in 84 patients known to have raised toxocara titres the commonest clinical features were abdominal pain, hepatomegaly, anorexia, nausea, vomiting, lethargy, sleep and behaviour disturbances, pneumonia, cough, wheeze, pharyngitis, cervical adenitis, headache, limb pains, and fever. 61% of patients with raised toxocara titres had recurrent abdominal pain. Eosinophilia was in many cases associated with a raised toxocara titre, but 27% of patients with high titres had normal eosinophil counts. Toxocariasis is common, especially in children, and is associated with clinical features that are generally regarded as non-specific but together form a recognisable symptom complex. Toxocariasis should be considered in the differential diagnosis of such symptoms and especially in recurrent abdominal pain, which might otherwise be labelled as idiopathic. The absence of eosinophilia does not exclude toxocariasis.

Examination of the survival rate of 5-year cohorts with primary osteosarcoma registered by the Thames Cancer Registry between 1963 and 1982 and followed up to the end of 1984 showed a borderline significant improvement in survival (test for trend p = 0.05) for patients aged under 25 years at registration, but not for patients 25-64 years. A Cox's proportional hazards model was used to identify effects of sex, period of treatment, whether the patient received chemotherapy, and experience of the hospital. For patients aged under 25 years, a significant (p = 0.02) trend of improved survival was seen among the most recent cohort, and the greater the treatment experience of the hospital, possibly the better the results (p = 0.11), although selective referral cannot be excluded as a reason for this finding. Chemotherapy was not independently associated with survival. Period of treatment, chemotherapy, and experience of hospital were not associated with improved survival for patients aged 25-64. Recent clinical trials for primary osteosarcoma have contributed to an apparent improved survival through selection of patients with good prognosis. Claims for the efficacy of new regimens should be assessed in clinical practice by population monitoring through the analysis of cancer registers.