60 premenopausal women were assessed before and after hysterectomy for menorrhagia or fibroids or both. Their mood, sexual functioning, and plasma oestrogens and gonadotrophins were regularly assessed for a period of up to 3 years. Patients were randomly assigned to receive either oestrone sulphate or placebo tablets during the trial. No evidence was found that this group of patients showed depression or sexual difficulties related to the hysterectomy. In comparison with their baseline gynaecological condition, they showed improved mood and vigour and unimpaired sexual activity.

The blood pressures (BP) of the parents of a group of students were determined and two subgroups of students were defined, one with (PHT group) and one without (PNT group) a familial predisposition to hypertension. Observations were made in both groups during three periods of modified dietary electrolyte intake: (i) no-added sodium (low Na), (ii) no added sodium with potassium supplementation (low Na/high K), and (iii) sodium supplementation (high Na). The diets were given in random order. At the start of the trial, while the students continued their customary diet, the PHT group had higher systolic and diastolic pressures and plasma noradrenaline levels than the PNT group. At the end of 4 weeks of the high Na diet, the BP levels of both groups were significantly higher than those after the low Na diet. In contrast, when the low Na diet was supplemented for 2 weeks with potassium, BPs of the PHT group fell significantly, while those of the PNT group rose slightly. BP in the PHT group was significantly lower during the low Na/high K than during the high Na diet (systolic 10.5 mm Hg +/- 2.3 SE; diastolic 11.2 +/- 2.5, the changes being significantly different from those in the PNT group. The changes in plasma renin and aldosterone were similar in both groups during the different diets. Plasma noradrenaline fell in the PHT group, but rose in the PNT group when the low Na diet was supplemented with potassium. This fall in plasma noradrenaline in the PHT group during the low Na/high K diet correlated with the falls in systolic and diastolic BP. It is concluded that whereas young adults with a familial predisposition to hypertension behave similarly to those without such a predisposition in having a pressor response to a high sodium intake, they are peculiar in showing a depressor response to a high potassium intake.

In a double-blind randomised trial in 75 patients with duodenal ulceration diagnosed endoscopically, 38 patients were given tripotassium dicitrato bismuthate and 37 cimetidine. There was no significant difference in the healing rates between the two drugs after 1 and 2 months, although relief of symptoms was marginally quicker with cimetidine. During follow-up for at least a year, relapse was significantly more common in patients whose ulcers had healed during treatment with cimetidine than in those whose ulcers had healed during treatment with tripotassium dicitrato bismuthate. This difference appears to be related to the medication rather than to any other difference between the two groups of patients. These results suggest that drug treatment given for a short period in duodenal-ulcer disease influences the progress of the disease.

An attempt was made to control schistosomiasis mansoni with mass treatment of all subjects excreting more than 100 eggs/g of faeces. No other means of control to reduce transmission were used. A very low dosage of hycanthone (0.75 mg/kg) appeared insufficient to achieve a satisfactory reduction of the worm load. A higher dosage (1.5 mg/kg) resulted in a significant reduction of the egg output. However, reappearance of eggs, probably indicating reinfection, was very rapid. One year after treatment the egg counts were at about two-thirds of the original level again.

In a randomised cross-over study 18 nondependent (NIDDM) and 9 insulin-dependent (IDDM) diabetics were put on to a high carbohydrate diet containing leguminous fibre (HL) for 6 weeks, and also a standard low carbohydrate diet (LC) for 6 weeks. During two identical 24 h metabolic profiles mean preprandial and mean 2 hour postprandial blood glucoses were significantly lower on HL in both groups, as were also several overall measures of diabetic control, including the degree of glycosuria. Total cholesterol was reduced significantly on HL in both groups, and the HDL/LDL cholesterol ratio increased significantly on HL in the NIDDM group. A diet high in complex carbohydrate and leguminous fibre improves all aspects of diabetic control, and continued use of a low carbohydrate diet no longer appears justified.

38 patients (26 men) with recurring venous thromboembolism (RVTE) were enrolled in a prospective double-blind, placebo-controlled trial of dipyridamole (DPY), 100 mg a day, and aspirin (ASA), 1200 mg a day. Platelet survival (51Cr labelling of autologous platelets) was measured every 6 months for 18 months. 19 patients were randomised to treatment with DPY and ASA, and 1 had new venous thrombosis (after 15 months of treatment); 19 received placebo and 7 had new venous thrombosis (4--16 months later (chi 2 = 5.70; p< 0.05). DPY-ASA increased platelet survival whereas placebo treatment did not. The results suggest that in patients with RVTE and abnormal platelet survival time DPY in combination with ASA decreases the frequency of new venous thrombosis. Peptic ulcers developed in 2 patients treated with DPY-ASA.

70 patients with endogenous depression, defined by strict criteria, who fulfilled the Newcastle indications for electroconvulsive therapy (ECT) were randomly allocated either to a course of eight simulated ECTs or to a course of eight real ECTs. The improvement in terms of psychiatrists' ratings in the group of patients given real ECT was significantly greater (p < 0.01) than that in those given simulated ECT, but the difference between the two groups was small in relation to the considerable improvement of both groups over the 4-week treatment period. No differences were found between the two groups at one-month and six-month follow-up. The therapeutic benefits of electrically induced convulsions in depression were of lesser magnitude and were more transient than has sometimes been claimed. In the real-ECT group memory was impaired during treatment but memory tests revealed no difference between the groups at six-month follow-up.

35 consecutive patients with alcoholic hepatitis were randomly allocated to control (18 patients) and study (17 patients) groups. All patients were offered a 3000 kcal 100 g protein diet and were studied for 28 days. The study group received 70-85 g of intravenous aminoacids daily in the form of 'Aminosyn' or 'Travasol'. Both groups had similar clinical and biochemical features at the time of randomisation. Ascites and encephalopathy tended to improve more in the study group. Serum concentrations of bilirubin (p < 0.01) and albumin (p < 0.025) improved in the study but not in the control group. 4 patients died in the control group, but none died in the study group. Intravenous therapy with aminoacid for 4 weeks seemed to be associated with lower mortality rate (p < 0.02) and improved serum bilirubin and albumin concentrations in patients with alcoholic hepatitis.

Antibody to hepatitis B surface antigen (anti-HBs) developed within six months in 80% of haemodialysis patients given either two or three 40 micrograms doses of hepatitis B vaccine. A total of 89% had anti-HBs after a booster dose given six months later. Anti-HBs titres were higher in patients who received three initial doses than in those who received only two doses, but the proportion of anti-HBs-positive patients was the same in the two groups. Male patients became anti-HBs positive less often than females and their antibody titres were lower.

The safety and patient acceptance of two preparations of modified (reduced and alkylated) immune globulin for intravenous use were evaluated; one preparation was formulated as a 5% solution in 10% maltose (IGIV-maltose), the other did not contain maltose (IGIV). In this double-blind trial each of 29 immunodeficient patients received three consecutive monthly infusions (100 or 150 mg/kg immune globulin) of one preparation before being crossed over to the other. Only 3 of 29 patients had adverse reactions when on IGIV-maltose, compared with 22 who had side-effects during infusions of IGIV (p < 0.001). Adverse reactions were recorded during 3 of 87 IGIV-maltose infusions and during 51 infusions with the maltose-free IGIV (p < 0.001). 27 patients expressed preference for IGIV-maltose. IGIV-maltose seems safe and will permit rapid infusion of large doses of immune globulin, thus improving the management of patients with antibody deficiency diseases.

The opiate control of vasopressin secretion in man was investigated with a long-acting analogue of met-enkephalin, DAMME (FK33-824, Sandoz). Infusion of 1 mg DAMME into water-deprived volunteers produced a diuresis which was attenuated by naloxone; there was no change in water excretion when subjects were hydrated. Plasma-immunoreactive-vasopressin failed to rise after DAMME administration, despite osmotic stimulation with hypertonic saline infusion. Opiates appear to be involved in mechanisms which suppress the osmotically mediated release of vasopressin, while opiate involvement in baroceptor-mediated release may be quite different.