The acute effects of a single capsule of each of two phenylpropanolamine-containing preparations were determined in a group of healthy young adults, by means of a double-blind comparison with matching placebo preparations. Supine diastolic blood-pressure rose to 100 mm Hg or more in 12 out of 37 subjects taking an anorectic preparation ('Trimolets'; 85 mg phenylpropanolamine per capsule) and in 4 out of 34 subjects taking a decongestant preparation ('Contac 500'; 50 mg phenylpropanolamine per capsule). 20 of the subjects taking trimolets reported adverse side effects. The frequency and extent of the hypertensive response to high-dose phenylpropranolamine-containing preparations suggest that clinical use of such preparations should be reviewed and that their availability without prescription may not be appropriate.

In a controlled randomised clinical trial of 92 patients with surgically resected lung cancer, intrapleural BCG had no clear effect on survival. Adverse effects were insignificant.

A randomised controlled double-blind trial of aspirin in the prevention of death was conducted in 1682 patients (including 248 women) who had had a confirmed myocardial infarct (MI). 25% of the patients were admitted to the trial within 3 days of the infarction and 50% within 7 days. Aspirin, 300 mg three times daily, was given for 1 yr. Total mortality was 12.3% in patients given aspirin and 14.8% in those given placebo, a reduction by aspirin of 17%, which was not statistically significant at p less than 0.05. The reduction in specific ischaemic-heart-disease (IHD) mortality was 22% and in total mortality plus IHD morbidity (readmission to hospital for MI in survivors) was 28%.

A randomised double-blind crossover trial was done to assess the efficacy of chlorothiazide as an antihypertensive drug in patients with severe renal failure. There was a significant reduction in standing (mean drop 13/6 mm Hg) and supine (mean drop 13/5 mm Hg) blood-pressure, without postural hypotension. Chlorothiazide has a place in the management of hypertension in patients with severe renal failure and its antihypertensive effect is probably due to a change in peripheral vascular resistance and not to volume contraction.

In a randomised clinical trial to assess the value of intestinal bypass in the treatment of gross obesity 130 patients who underwent end-to-side jejunoileostomy (with either a 1/3 or a 3/1 ratio between jejunum and ileum left in continuity) were compared with 66 non-surgically treated patients. All patients in the study had gross, long-standing, treatment-resistant obesity with resultant somatic, psychic, or social problems; none were alcoholic or had liver disease or other conditions which made them poor surgical risks. Most subjects were observed for more than 3 years. Median weight loss within 24 months was 42.9 kg in the bypass group, compared with 5.9 kg in the control group. No deaths occurred among those who underwent surgery. Patients who underwent intestinal bypass also had a better improvement in quality of life and a higher degree of patient satisfaction. Complications of the operation were, however, common and occasionally severe.

In a double-blind trial patients with Argentine haemorrhagic fever treated with immune plasma within 8 days of the onset of the disease had a much lower mortality than those given normal plasma. Some patients treated with immune plasma developed late neurological complications.

The clinical efficacy of using specially trained nurses to treat hypertension at the patient's place of work was compared in a controlled trial with management by the patient's family doctor. The 457 study participants were selected from 21 906 volunteers in industry and government whose blood-pressure was screened. The nurses were allowed to prescribe and change drug therapy at the work site without prior physician approval. Patients randomly allocated to receive care at work were significantly more likely to be put on antihypertensive medications (94.7% vs 62.7%, to reach goal blood-pressure in the first six months (48.5% vs 27.5%), and to take the drugs prescribed (67.6% vs 49.1%). Only 6% of patients were dissatisfied with the care provided by the nurses. Thus provision of care at work by specially tranined nurses was well accepted and resulted in significantly improved blood-pressure control and medication compliance among employees with asymptomatic and uncomplicated hypertension.

375 consecutive patients below 65 years who had an acute myocardial infarction (AMI) took part in a randomised rehabilitation and secondary prevention trial (part of a W.H.O.-coordinated project) designed to study the effects of a multifactorial intervention programme on morbidity, mortality, return to work, &c. After three years' follow-up the cumulative coronary mortality was significantly smaller in the intervention group than in the controls (18.6% versus 29.4%, p = 0.02). This difference was mainly due to a reduction of sudden deaths in the intervention group (5.8% versus 14.4%, p less than 0.01). The reduction was greatest during the first six months after AMI. 18.1% in the intervention group and 11.2% in the controls (p less than 0.10) presented with non-fatal reinfarctions. The number of patients with new Q-QS findings at the end of the three years was, however, almost the same in both groups. The results suggest that organised aftercare during the first six months after AMI with special emphasis on optimum medical control and health education contributes significantly to a reduction in the number of sudden deaths.

192 Ugandan patients with Burkitt's lymphoma were treated with various regimens containing high-dose cyclophosphamide. 21 patients died during induction therapy, and 14 died after partial responses. Of 157 patients who responded completely to treatment, 16 were lost to follow-up (10 in 69 died and 72 (51%) are alive and disease-free. 31 of the long-term survivors have relapsed at least once and have been successfully retreated. Overall, 34 surviving patients had central-nervous-system involvement, also successfully treated. It is concluded that Burkitt's lymphoma is curable in at least 50% of patients, and that relapse and central-nervous-system involvement are not incompatible with long survival.

Symptoms associated with carbohydrate malabsorption limit the usefulness to diabetics of a powerful glycoside-hydrolase inhibitor (acarbose) which reduces postprandial glycaemia. Addition of a low dose (50 mg) of a acarbose together with 14.5 g guar gum to a breakfast test meal taken by 8 healthy volunteers reduced the mean peak rise in blood-glucose at 30 min by 70%. Areas under the insulin and gastrointestinal-polypeptide response curves were also greatly reduced. No evidence of carbohydrate malabsorption, as assessed by measurement of breath hydrogen, was found during any of the test periods. When acarbose was taken alone, 3 of the 8 subjects had troublesome symptoms and the 30 min rise in blood-glucose was reduced by only 28%. Thus, combination of these two agents effectively reduces the rate of carbohydrate absorption without increasing side-effects and may make combined acarbose and guar acceptable in the management of some diabetics.

The most notable changes in the 35-lead precordial electrocardiogram in 22 subjects in the first 6--12 months after acute myocardial infarction were a reduction in the amplitude of Q waves and a significant increase in the amplitude of the R waves. Patients who, in a random trial, had been given 100 mg atenolol daily from admission showed a significantly greater recovery in R-wave amplitude and decrease in Q waves than patients given placebo. It is concluded that atenolol improves the recovery of the electrocardiographic signs of myocardial infarction.

A double-blind study of alprenolol versus placebo was done in patients with definite or suspected myocardial infarction to show the effect of the drug on mortality-rate after a year of treatment in patients aged less than or equal to 65 and to study the tolerance of the drug by patients greater than 65 years of age. The dose given was 5--10 mg intravenously, followed by 200 mg twice a day, orally. Patients in whom beta-blockade was contraindicated were excluded. All deaths, side-effects, and dropouts were recorded. Of the 480 patients in the study, 238 patients received alprenolol and 242 placebo. During the year of follow-up 108 patients dropped out from the study. Mortality was not reduced in patients greater than 65 years of age. In those less than or equal to 65 years alprenolol significantly reduced mortality-rate (20% mortality in placebo group vs 9% in treated group). There was also a significant reduction in mortality-rate among those with definite infarction (28% in the placebo vs 15% in the treated group).

In a prospective double-blind randomised trial 83 patients undergoing elective colorectal surgery were given either preoperative intravenous metronidazole or intravenous normal saline. No other antimicrobials were given. Bowel preparation was the same for both groups. Deep post-operative wound sepsis occurred in 6 of 44 (13-6%) patients on metronidazole but in 20 of 39 (51-2%) control untreated patients. Anaerobes were responsible for all cases of deep sepsis in the metronidazole group (in 5 of the 6 cases aerobes were also isolated), and for 16 of the 20 cases of deep sepsis in the control group (all with aerobes). Superficial infection in the metronidazole group was caused by aerobes. Anastomotic leakage occurred in 5 of the 6 patients who developed deep sepsis on metronidazole and in 10 of 20 patients on placebo. Peroperative intravenous metronidazole dramatically reduced postoperative sepsis but failed to prevent infection in the presence of anastomotic breakdown.