93% of 88 children with severe frequent migraine recovered on oligoantigenic diets; the causative foods were identified by sequential reintroduction, and the role of the foods provoking migraine was established by a double-blind controlled trial in 40 of the children. Most patients responded to several foods. Many foods were involved, suggesting an allergic rather than an idiosyncratic (metabolic) pathogenesis. Associated symptoms which improved in addition to headache included abdominal pain, behaviour disorder, fits, asthma, and eczema. In most of the patients in whom migraine was provoked by non-specific factors, such as blows to the head, exercise, and flashing lights, this provocation no longer occurred while they were on the diet.

In a double-blind controlled study, oral acyclovir was compared with placebo in 39 consecutive patients undergoing bone-marrow transplantation. Acyclovir was given at a dose of 200 mg every 6 h from 8 days before to 35 days after bone-marrow transplantation. Pharmacokinetic studies showed good absorption of the drug, despite intestinal damage related to chemoradiotherapy or gut graft-versus-host disease. There was no sign of toxicity. The protection against herpes simplex virus (HSV) infection was complete in the treated group compared with the placebo group even in patients with high anti-HSV antibody titres before transplantation. The same protection was observed against cytomegalovirus (CMV) infection. The frequencies of HSV and CMV infections were the same in both groups after the cessation of treatment.

A controlled study in two centres compared the efficacy of the standard continuous ambulatory peritoneal dialysis (CAPD) system with that of a new method consisting of a Y-shaped set filled with sodium hypochlorite during the dwelling time. 62 new CAPD patients were randomly allocated to the standard method (group A: 30 patients; age 55.5 +/- 17.5 years) or to the Y-system (group B: 32 patients; age 55.1 +/- 14.3 years). In group A, there were 31 peritonitis episodes in 17 patients (57%) during a cumulative period of 351 months--1 episode every 11.3 patient-months. In group B, there were 11 peritonitis episodes in 10 patients (31%) during 363 months--1 episode every 33 patient-months. Life-table analysis showed a significant difference between the incidence of peritonitis in the two groups. The Y-system method is simple and economical and the frequency and the severity of side-effects appears to be acceptable.

The effect of plasma lipid reduction on the progression of femoral atherosclerosis was studied in hyperlipidaemic patients with stable intermittent claudication. 24 patients were randomly assigned to treatment and usual-care groups, the former receiving dietary advice and cholestyramine, nicotinic acid, or clofibrate depending on their lipoprotein phenotype. Biplanar arteriography was performed when the study began and after a mean period of 19 months. Angiograms were assessed visually, with blinding, and by computerised image analysis. Therapy reduced mean plasma total cholesterol by 25%, mean low density lipoprotein (LDL) cholesterol by 28%, and mean plasma triglycerides by 45%. Significantly fewer arterial segments showed detectable progression of atherosclerosis in the treatment group. The mean increase in plaque area (mm2/segment/year) in the treatment group was only one third of that in the usual-care group. The mean increase in edge irregularity index (a measure of the severity of disease) in the treatment group was only 40% of that in the usual care group. Twice as many arterial segments showed improvement in the treatment group. In both groups changes in edge irregularity index were directly related to plasma LDL cholesterol concentration. This study, the first randomised controlled trial of its type, provides evidence that effective treatment of hyperlipidaemia favourably influences the natural history of symptomatic peripheral atherosclerosis.

101 outpatients with irritable bowel syndrome were randomly allocated to two treatment groups. Both groups received the same medical treatment, but patients in one group also received dynamically oriented individual psychotherapy in ten hour-long sessions spread over 3 months. After 3 months there was a significantly greater improvement in somatic symptoms in the psychotherapy group. The difference became more pronounced a year later, with the patients given psychotherapy showing further improvement, and the patients who received medical treatment showing some deterioration. The combination of medical treatment with psychotherapy improves outcome, not only in the short term but also in the long run.

Combination cytotoxic chemotherapy (intravenous cyclophosphamide, methotrexate, and fluorouracil) was administered within 36 h of mastectomy to 368 women with operable breast cancer in a randomised, controlled clinical trial. The control group of 187 patients received either no chemotherapy or conventionally timed chemotherapy. Unpredictable and severe toxic effects were significantly more common in patients aged greater than or equal to 50 who had received at least 80% of the full chemotherapy dose and in patients who had received chemotherapy within 6 h of mastectomy than in other patients. Methotrexate was believed to be the principal cause of these toxic effects, because of potentiation by nitrous oxide anaesthesia. Leucovorin rescue was therefore added to the regimen.

Elderly patients with acute urinary infections were treated in a double-blind study with either amoxycillin or cephradine. In 52 patients who had received amoxycillin for one week about a third of all intestinal Escherichia coli were highly resistant to amoxycillin, and many were resistant to tetracycline, trimethoprim, or chloramphenicol. Cephradine selected less resistance. At a week after completion of chemotherapy, cephradine-resistant E coli were replaced by sensitive cultures at a greater frequency than were amoxycillin-resistant E coli. Neither antibiotic altered the skin flora. Amoxycillin, but not cephradine, selected for Enterobacteriaceae in the saliva. The propensity of amoxycillin to select resistance in E coli will limit its usefulness in treating urinary infections.

Vaccine regimens using 0.1 ml human diploid cell strain vaccine (HDCSV) given intradermally (id) in single and multiple sites, or with aluminum hydroxide adjuvant given subcutaneously (sc), were compared with the regimens of HDCSV and Semple vaccine currently suggested by WHO. Some groups were also given human rabies-immune globulin (HRIG). Neutralising antibody titres were monitored for 3 months. Antibody was detected earliest in subjects given 0.1 ml HDCSV id at each of eight sites. The highest antibody titres from day 14 onwards were found after intramuscular (im) administration of HDCSV, but the multiple-site id regimen, which requires only one quarter of the volume of vaccine required for the im regimen, gave similar results, provided that a booster was given on day 91. This finding suggests that a treatment schedule based on this regimen would be suitable for post-exposure prophylaxis. Adjuvanted vaccine gave similar results to the same amount of antigen given id. Semple vaccine produced the lowest titres. HRIG, given at the high dose of 40 IU per kg, suppressed the antibody response to some of the regimens.

Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.

Selenium levels in serum samples collected in 1973 from 111 subjects in whom cancer developed during the subsequent 5 years were compared with those in serum samples from 210 cancer-free subjects matched for age, race, sex, and smoking history. The mean selenium level of cases (0.129 +/- SEM 0.002 micrograms/ml) was significantly lower than that of controls (0.136 +/- 0.002 micrograms/ml). The risk of cancer for subjects in the lowest quintile of serum selenium was twice that of subjects in the highest. Multivariate adjustment for geographical area and serum levels of lipids, vitamins A and E, and carotene, did not alter this relation. The association between low selenium level and cancer was strongest for gastrointestinal and prostatic cancers. Serum levels of vitamins A and E compounded the effect of low selenium; relative risks for the lowest tertile of selenium were 2.4 and 3.9 in the lowest tertiles of vitamins E and A, respectively.

In a double-blind, dose-comparative trial, 32 patients with duodenal ulcer were assigned to receive either 20 mg/day or 60 mg/day omeprazole for 4 weeks. The 2-week healing frequency of 100% in the 60 mg/day group was significantly higher than that in the 20 mg/day group (63%). After 4 weeks all ulcers but one in the 20 mg/day group were healed (93% healing frequency). In both groups transient and mostly slight rises in serum alanine aminotransferase levels were observed (total 10 patients). One patient in the 20 mg/day group was withdrawn because of a pronounced rise in serum alanine aminotransferase on day 8. The reason for these liver reactions is not clear, but exclusion of a causal relation with omeprazole treatment must precede further clinical evaluation of this drug.

Single-dose ceftriaxone, 125 mg or 250 mg intramuscularly (IM), was compared with spectinomycin, 2 g IM, for treatment of men with uncomplicated urethral or anorectal infections due to penicillinase-negative Neisseria gonorrhoeae. Cure rates were 100% for 31 and 28 men treated with 125 mg and 250 mg ceftriaxone, respectively, and 97% for 58 men given spectinomycin. Among patients followed up for greater than or equal to 14 days, post-gonococcal urethritis occurred in 25% of 44 men treated with ceftriaxone and 19% of 47 given spectinomycin (p = NS). The geometric mean minimum inhibitory concentration of ceftriaxone for 79 pre-treatment isolates of N gonorrhoeae was 0.0058 microgram/ml, and all strains were inhibited by less than or equal to 0.063 micrograms/ml. Neither drug caused perceptible toxicity, but patient acceptance was greater for ceftriaxone than for spectinomycin. Ceftriaxone in a single dose of 125 mg is effective against uncomplicated urethral or anorectal gonorrhoea in men and may become a regimen of choice for this infection.