Changes in continuously recorded 'Finapres' finger blood pressure in ten normotensive and seven hypertensive subjects induced by self-inflation of the cuff or just wearing the inflated cuff were studied. Inflating the cuff caused an instantaneous rise in systolic blood pressure of 13 and 12 mm Hg (hypertensive and normotensive subjects, respectively). Wearing the inflated cuff did not change blood pressure. Thus the rise in pressure was related to the muscular activity required for cuff inflation. Systolic blood pressure took on average 7 s and at most 21 s to return to baseline level after stopping cuff inflation. Since first Korotkoff sounds may already be heard after 10-15 s when following recommended procedures, self-recorded systolic blood pressure may be recorded as too high when subjects inflate their cuff at too low a pressure or deflate it too fast.

In 4 out of 16 patients receiving recombinant human granulocyte macrophage colony stimulating factor (rhGM-CSF) in phase I/II studies antibodies developed to the recombinant protein. The antibodies react with sites on the native protein backbone which are normally protected by O-linked glycosylation but which are exposed in rhGM-CSF produced in yeast and Escherichia coli. Antigenicity of recombinant human proteins due to non glycosylation may have relevance to the choice of host system for production of factors for clinical use.

In a randomised, double-blind study 1258 patients were allocated to receive either anistreplase (anisoylated plasminogen streptokinase activator complex [APSAC], 'Eminase') or placebo within 6 h of onset of suspected acute myocardial infarction. At 30 days, 40 (6%) of 624 patients on anistreplase had died, compared with 77 (12%) of 634 patients on placebo (odds reduction 50.5%). On long-term follow-up a survival benefit was still observed: at 12 months, 69 (11%) patients treated with anistreplase had died, compared with 113 (18%) patients given placebo (odds reduction 43%; p = 0.0007, 95% confidence interval 21-59%). This effect on mortality was not related to time between onset of symptoms and treatment or to any patient characteristic. Site of infarction and age were the most important influences on 1-year survival in both treatment groups; tachycardia (over 100 beats/min) on admission and previously diagnosed ischaemic heart disease were also associated with increased risk. Major complications of acute myocardial infarction were less frequent in patients treated with anistreplase than in controls. As for other thrombolytic agents, haemorrhage was more common, but usually minor. These findings indicate that anistreplase is an effective and acceptably safe thrombolytic with long-term survival benefits for patients with acute myocardial infarction.

Bedding has been constructed with a vapour-permeable waterproof fabric that is impermeable to house dust mite antigen (Der p1). Der p1 levels per gram of mattress dust after 12 weeks' use of the new covering were 1% of levels in control samples from mattresses cleaned conventionally.

Ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) have been compared in the investigation of abnormalities of the pancreas and biliary tract. 208 patients undergoing ERCP were studied prospectively and all had an ultrasound examination in the 24 hours before ERCP. 15 patients had dilated bile-ducts for which no cause was seen on both ultrasound and ERCP; these patients were excluded. 120 of the remaining patients had an abnormal ERCP. In 101 ultrasound findings were in agreement (sensitivity 84%). 73 patients had a normal ERCP with ultrasound agreement in 70 (specificity 95%). The sensitivity and specificity of ultrasound is now such that patients can proceed directly to ERCP for diagnostic confirmation and papillotomy or endoprosthesis insertion where appropriate.

The effects of an oestrogen/progestagen transdermal therapeutic system (TTS) were evaluated in sixteen oestrogen-deficient women. The patients applied conventional oestradiol-TTS for 14 days, then two combined norethisterone acetate/oestradiol patches for a further 14 days. The treatment was repeated for five cycles. Ten patients then underwent metabolic studies. One patient had amenorrhoea, but the rest experienced regular withdrawal bleeding which was seldom heavy. Fourteen endometrial biopsy samples were taken during the fifth treatment cycle; none showed proliferative or hyperplastic features. The effects of transdermal norethisterone acetate on symptoms, lipid metabolism, and psychological status were determined by comparing features in the oestrogen-only phase and in the combined phase; the effects were very mild. These preliminary findings show that transdermal progestagen can be successfully administered in hormone replacement therapy to prevent endometrial proliferation while minimising the adverse effects that may be seen with oral administration.

Postprandial plasma glucose excursions and plasma levels of free insulin after subcutaneous bolus injection of a rapidly absorbed monomeric insulin analogue (B9AspB27Glu) or soluble human insulin ('Actrapid HM' U100) were studied in six insulin-treated diabetic subjects. 10 U actrapid or an equimolar amount of the analogue were injected, in random order with an interval of 1 week, immediately before a 500 kcal test meal. Basal insulin levels were similar on the 2 study days (mean 74.1 [SE 5.1] pmol/l, actrapid; 79.7 [13.0] pmol/l, analogue). After injection of actrapid plasma free insulin levels rose slowly, reaching a plateau by 105 min at 222 (19) pmol/l. Injection of the analogue resulted in a rapid early peak at 30 min (798 [112] pmol/l), and levels were significantly higher than those after actrapid between 15 and 210 min. The more physiological plasma insulin levels achieved with the analogue were accompanied by a substantial reduction in postprandial plasma glucose excursions; the integrated area under the incremental plasma glucose curve was 45% lower after the analogue than after actrapid.

The protective efficacy (PE) of B subunit killed whole-cell (BS-WC) and killed whole-cell-only (WC) oral cholera vaccines was assessed in a randomised double-blind field trial among children aged 2-15 years and women over 15 years in rural Bangladesh. Among the 62 285 subjects who received three doses of BS-WC, WC, or Escherichia coli K12 strain placebo, cumulative PE at 3 years of follow-up was 50% for BS-WC and 52% for WC. PE was similar against severe and non-severe cholera, but was significantly lower in children who were vaccinated at 2-5 years (26% for BS-WC; 23% for WC) than in older persons (63% for BS-WC; 68% for WC). Among persons vaccinated at 2-5 years, protection at 4-6 months of follow-up was similar to that for older persons, but rapidly waned thereafter and was not evident during the third year of follow-up. In contrast, persons vaccinated at older ages were protected even in the third year of follow-up (PE 40% for BS-WC; 62% for WC). PE was substantially higher against classical cholera (58% for BS-WC; 60% for WC) than against El Tor cholera (39% and 40%).

Of 141 women with twin pregnancies, 72 were randomly assigned to outpatient care and 69 to hospital admission between 26 and 30 weeks' gestation. There were no differences between the groups in the frequencies of major maternal complications in pregnancy and labour but more of those admitted to hospital than of the outpatient group had to be admitted after 30 weeks. There were no differences between the groups in the mean birthweights of the twins by birth order, or in their mean gestation at birth whether analysed by intention to treat or by the treatment given. 22 infants were delivered before 32 weeks' gestation in the inpatient group compared with 10 in the outpatient group. With the exception of small-for-dates infants, any trend towards greater morbidity or mortality was seen in the inpatient group. The policy of routine hospital admission of women with twin pregnancies from 26 weeks' gestation is not beneficial to mother or babies and should be abandoned.

128 patients with acute myocardial infarction of duration 6 h or less were randomised in double-blind fashion to receive 30 U anistreplase over 5 min or 1.5 MU streptokinase over 1 h, both intravenously. Angiographic patency was assessed 90 min and 24 h from the start of therapy. 55% of patients who received anistreplase and 53% of patients who received streptokinase had patent infarct-related arteries (TIMI grade 2-3) at 90 min (95% CI 42-68% and 40-66%, respectively). At 24 h 81% and 87.5% of arteries were patent respectively (95% CI, 71-91% and 83.5-91.5%). Time to therapy had no significant effect on patency rates. There was one early reocclusion within 24 h in each treatment group and clinical evidence of reocclusion was recorded between 24 h and hospital discharge in a further 5 patients (streptokinase 3, anistreplase 2). With these regimens, therefore, anistreplase and streptokinase gave the same patency rates.

Between 1979 and 1981, 45,130 women in Edinburgh aged 45-64 were entered into a randomised trial of breast cancer screening by mammography and clinical examination. The initial attendance rate was 61% but this varied according to age and socioeconomic status and decreased over succeeding years. The cancer detection rate was 6.2 per 1000 women attending at the first visit; the rate fell to around 3 per 1000 in the years when mammography was routinely repeated and to around 1 per 1000 at the intervening visits with clinical examination alone as the screening method. After 7 years of follow-up the mortality reduction achieved was 17% (relative risk = 0.83, 95% CI 0.58-1.18), which was not statistically significant, even when corrected for socioeconomic status. In women aged 50 years and over a mortality reduction of 20% was achieved.