A shortage of doctors limits the provision of post-partum sterilisation services in rural areas of Thailand. To overcome this problem nurse-midwives with theatre experience were trained to perform post-partum tubal ligation by a mini-laparotomy incision under local anaesthesia. The performance of the nurse-midwives was compared with that of doctors in a controlled, randomised clinical trial. Some operative difficulty was encountered by the nurses in 4.9% of cases and by the doctors in 2.0% of cases. This difference is not statistically significant and arose largely because the nurse-midwife cases were more obese. Nurse-midwives required a significantly longer operating-time (18.5 min) than doctors (11.9 min). However, postoperative morbidity was similar in the two groups (7.0% and 6.0%, respectively). These results suggest that trained nurse-midwives with theatre experience can safely provide post-partum sterilisation services. A further field trial is underway.

In a controlled trial 69 children with corneal xerophthalmia were given 200 000 IU oil-miscible vitamin A by mouth and a matched group of 45 children were given 100 000 IU water-miscible vitamin A intramuscularly. Both groups received an additional oral dose the next day. There was no detectable difference in the clinical response to the two regimes, even when analysis was limited to patients with concomitant diarrhoea or protein-energy malnutrition. Although serum-vitamin-A levels were significantly higher after parenteral than oral therapy, holoretinol-binding-protein levels were not. Oral administration of vitamin A is not only more practical but appears to be just as effective as parenteral administration in the treatment of severe xerophthalmia.

Intercostal block by a freezing technique was compared with blockade by local anaesthetics or no blockade as a method of treating post-thoracotomy pain. The 15 patients who received cryotherapy had significantly less postoperative pain than the 9 patients whose nerves were blocked by local anaesthetics or who did not receive any nerve block. The interruption of nerve function produced by cryotherapy was temporary (not more than 30 days), and there were no adverse sequelae.

In a study of the diagnosis and treatment of Corynebacterium vaginale (Haemophilus vaginalis) vaginitis in 30 patients, clinical and microscopical findings were compared with laboratory cultures. The study also included a double-blind randomised trial of treatment regimens including placebo therapy. Laboratory cultures of C. vaginale corresponded well with clinical findings, and we suggest that C. vaginale vaginitis can be reliably diagnosed with clinical and microscopical findings. Tetracycline was effective in half the patients treated, whereas all but 1 of the 17 patients eventually treated with metronidazole were cured. The apparent discrepancy between in-vitro sensitivity and in-vitro efficacy of metronidazole in this condition is discussed.

To determine the efficacy of perioperative cefazolin in preventing pelvic and wound infections after elective non-radical hysterectomy, a randomised, placebo-controlled, double-blind clinical trial was done. Among 86 patients undergoing vaginal hysterectomy, those who received three perioperative 1 g doses of cefazolin (44) had significantly fewer pelvic infections (21% vs. 2%); less standard febrile morbidity (31% vs. 14%); shorter length of stay (LOS); and fewer courses of antibiotics postoperatively. There was no reduction in rate of urinary-tract infection (UTI) (21% vs. 23%). Among 429 women having abdominal hysterectomy, the 206 who received cefazolin had significantly lower rates of wound and pelvic infections (21% vs. 14%), UTI (21% vs. 9%), and febrile morbidity (20% vs. 14%). They also had shorter LOS and received fewer courses of antibiotics postoperatively. Use of perioperative cefazolin was not accompanied by more side-effects. Three doses of perioperative cefazolin seem to be safe, efficacious, and cost-effective in preventing infection after vaginal or abdominal hysterectomy.

The blocking effects of aspirin, chlorpheniramine, and cimetidine were tested against the flush provoked by alcohol in twenty-four chlorpropamide-treated patients with non-insulin-dependent diabetes mellitus. Active preparations were compared in a double-blind manner with an indistinguishable placebo. Aspirin significantly decreased the number of patients who flushed. Five patients studied in detail all showed suppression of chlorpropamide/alcohol flush by aspirin, with a mean facial temperature increase during the flush of 2.4 degrees C after pretreatment with placebo and an increase of 0.4 degrees C after pretreatment with aspirin.

In a double-blind trial of phenytoin for the prevention of postoperative epilepsy in craniotomy patients, epilepsy was observed in 7.9% (8/101) of patients treated with phenytoin and in 16.7% (17/102) of those receiving placebo. Therapeutic drug levels were associated with a significant reduction in the frequency of epilepsy. Three-quarters of the fits occurred within a month of cranial surgery. High rates of epilepsy have been observed after cranial surgery in patients with meningioma, aneurysm, and head injury with or without intracranial clots, and routine prophylaxis with phenytoin would seem to be indicated in such patients.

In a double-blind study human leucocyte interferon was given for six weeks to 8 of 16 patients with chronic HBsAg-positive hepatitis. In the first week 12 x 10(6) reference units were administered daily, and thereafter the dose was halved every week. During the first two weeks leucopenia was observed in 6 of the 8 interferon-treated patients. Apart from a drop in DNA-polymerase activity in the first week, no effect was found on indices of hepatitis-B-virus infection.

In a double-blind trial physiological doses (60 microgram/day) of triiodothyronine (T3) were compared with placebo in a group of obese patients on a 320 kcal/day (1.34 MJ) liquid formula diet. T3-treated patients had a significantly greater weight-loss by the 12th week. Analysis of serum levels of T3 and thyroxine (T4) showed that those patients in the placebo group whose weight-loss tended to level off at a plateau towards the end of the trial also had the lowest T3 levels and resting metabolic rate (RMR) at that time. Patients in the T3 group had a steady rise in serum T3 levels during the 12 wk period. Those with the highest final T3 levels had the greatest tendency for their weight-loss to level out and, paradoxically, had the least suppression of serum T4 levels and lowest RMR. Some obese patients who do not readily lose weight on conventional low-calorie diets may have an impaired metabolic clearance rate of T3 and a degree of T3 resistance.

In a randomised double-blind trial 10 of 30 patients given 2 mg of intravaginal purified porcine relaxin on the evening before surgical induction of labour went into labour before the proposed induction. Of 30 control patients, none went into labour. Of the 30 patients treated with relaxin, 25 had improved cervical scores after treatment and significantly fewer required augmentation in labour with intravenous oxytocin than the control group. Administration of relaxin was associated with very little increase in uterine activity and no side-effects. The trial shows that exogenous relaxin causes cervical ripening and can initiate parturition. Endogenous relaxin may have a similar role.

A double-blind controlled trial comparing doses of 7, 14, and 28 units/kg of factor VIII for knee, ankle, and elbow haemarthroses was carried out on a group of severe haemophiliacs. Mild-to-moderate ankle bleeds responded as well to 7 units/kg as to higher doses. All grades of knee bleeds fared worse when subjected to the lowest dose. Mild elbow bleeds responded to the lowest dose, but moderate elbow bleeds required higher doses.

Profound and long-lasting analgesia (mean duration of pain relief 33.4 h, range 22.5--73.5 h) was produced by intrathecal administration of 3 mg synthetic beta-endorphin in all of 14 patients with intractable pain due to disseminated cancer. No respiratory depression, hypotension, hypothermia, or catatonia was observed.