Antagonism of the effects of platelet activating factor (PAF) by the ginkgolide mixture BN 52063 was assessed in a double-blind, placebo-controlled, crossover study in 6 normal subjects. Weal and flare responses to 400 ng PAF, examined 2 h after ingestion of BN 52063 (80 mg, 120 mg) were inhibited in a dose-related manner. After 120 mg the flare area was reduced by a mean 62.4% (p less than 0.005) and the weal volume by a mean 60% (p less than 0.05). Both doses of BN 52063 significantly inhibited PAF-induced platelet aggregation in platelet-rich plasma (p less than 0.001). In vitro, BN 52063 inhibited PAF-induced but not ADP-induced platelet aggregation. Thus BN 52063 seems to be an antagonist of PAF in man.

40 adult patients with cystic fibrosis (CF) were admitted to hospital with acute exacerbations of infection associated with isolation of Pseudomonas aeruginosa from sputum. The patients were randomly allocated (20 per group) to receive intravenous azlocillin 5 g and gentamicin 80 mg, or oral ciprofloxacin 500 mg. Both treatments were given three times a day for 10 days. The patients were assessed on days 1 and 10, and at 6 weeks. There was a significant improvement in lung function between days 1 and 10 in both groups (p less than 0.001). Significant improvement was maintained at 6 weeks after ciprofloxacin but not in the intravenous group. Improvement after ciprofloxacin was superior at day 10. Sputum weight decreased in both groups (p less than 0.001). Patient-recorded symptoms also improved in both groups. There was no serious toxicity or side-effects. Drug resistant organisms were isolated no more frequently after ciprofloxacin than after intravenous therapy. 17 of the ciprofloxacin-treated patients said they preferred oral treatment to intravenous therapy. Oral ciprofloxacin is a useful short-term treatment for patients with CF who are infected with Ps aeruginosa.

300 patients at high fetal risk (mean gestational age 34 wk) were randomised to a group for antenatal doppler umbilical artery waveform studies and a control group. The timing of delivery was similar in the control and doppler-report-available groups overall. However, in the report group obstetricians allowed the pregnancies of those not selected for elective delivery to continue longer. There was no difference in the rates for elective delivery (induction of labour or caesarean section) in the two groups, whereas among those who went into labour (induced or spontaneous) emergency caesarean section was more frequent in the control group (23%) than in the report group (13%). Fetal distress in labour was also more common in the control group. Babies from the control group spent longer in neonatal intensive care (level 3) and needed more respiratory support than did those in the report group. The findings indicate that the availability of doppler studies leads to better obstetrical decision making.

The serological response to measles vaccine was tested in Bangladesh in groups of infants aged 4-6 months who received equal doses of Edmonston-Zagreb or Schwarz vaccine by subcutaneous injection or by aerosol. Seroconversion (as measured by the haemagglutination test) occurred in 62% of infants receiving Edmonston-Zagreb strain by injection compared with only 37% of those receiving Schwarz strain. Seroconversion occurred in 35% of those given Edmonston-Zagreb and 34% of those given Schwarz vaccine by aerosol. Edmonston-Zagreb strain appears more effective than Schwarz vaccine in this population and further studies are indicated in other populations where early measles immunisation is desirable.

After treatment with chloroquine and pyrimethamine/sulfadoxine, 118 school children aged 6 to 10 years living near the Kenyan coast were enrolled in a malaria chemoprophylaxis study and followed up for 20 weeks. Children were randomly assigned to receive either chlorproguanil 20 mg weekly (n = 78) or placebo (n = 37). The attack rate of Plasmodium falciparum infection was 42% in chlorproguanil recipients (39.8 episodes per 1000 person-weeks of prophylaxis) and 73% in placebo recipients (69.2 episodes per 1000 person-weeks, p less than 0.02). Sensitivity tests on 36 isolates successfully cultured in vitro showed that all 21 isolates from chloroproguanil recipients were resistant to dihydrofolate-reductase inhibitors, whereas only 3 of 15 isolates from the placebo group were resistant (p less than 10(-6)). Chlorproguanil in a weekly adult dose of 40 mg does not provide adequate prophylaxis against P falciparum in Kenya, probably because drug levels between doses fall below those required to suppress parasites resistant to dihydrofolate-reductase inhibitors.

The effects of two strictly controlled diets, one rich in complex carbohydrates, the other rich in olive oil, on serum lipids were studied in healthy men and women. Serum cholesterol levels fell on average by 0.44 mmol/l in the carbohydrate group and 0.46 mmol/l in the olive oil group. HDL cholesterol levels fell by 0.19 mmol/l in the carbohydrate group and rose by 0.03 mmol/l in the olive oil group. Serum triglycerides rose by 0.19 mmol/l in the carbohydrate group and fell by 0.06 mmol/l in the olive oil group. The changes in both HDL and triglycerides were larger in men than in women. These results clearly show that the olive-oil-rich diet, unlike the complex-carbohydrate-rich diet, caused a specific fall in non-HDL cholesterol while leaving serum triglyceride levels virtually unchanged.

Brain water content was measured in tissue samples taken at operation from 19 patients with intrinsic cerebral tumours imaged preoperatively by magnetic resonance. A high correlation (r = 0.94, p less than 0.0001) between white matter water content and the longitudinal relaxation time (T1) enabled water content to be estimated from T1 to within 4%. 11 patients received dexamethasone and improved clinically but their T1, and thus brain water content, was unchanged an average of 6 days later. Intravenous infusion of 20% mannitol in 11 patients significantly reduced T1 in oedematous white matter and tumour within 15 min of administration, and by 30 min the T1 of oedematous white matter had fallen to a mean of 32.4 (SEM 7.1) ms, corresponding to a reduction in water content of 1.4 (0.3)%.

In a randomised controlled trial, preterm babies undergoing ligation of a patent ductus arteriosus were given nitrous oxide and d-tubocurarine, with (n = 8) or without (n = 8) the addition of fentanyl (10 micrograms/kg intravenously) to the anaesthetic regimen. Major hormonal responses to surgery, as indicated by changes in plasma adrenaline, noradrenaline, glucagon, aldosterone, corticosterone, 11-deoxycorticosterone, and 11-deoxycortisol levels, in the insulin/glucagon, molar ratio, and in blood glucose, lactate, and pyruvate concentrations were significantly greater in the non-fentanyl than in the fentanyl group. The urinary 3-methylhistidine/creatinine ratios were significantly greater in the non-fentanyl group on the second and third postoperative days. Compared with the fentanyl group, the non-fentanyl group had circulatory and metabolic complications postoperatively. The findings indicate that preterm babies mount a substantial stress response to surgery under anaesthesia with nitrous oxide and curare and that prevention of this response by fentanyl anaesthesia may be associated with an improved postoperative outcome.

In a district general hospital's coronary care unit (CCU) 197 patients with chest pain were admitted over a 6-month period and in 131 an acute myocardial infarction (AMI) was confirmed. 67 (51%) were eligible for thrombolytic therapy, on criteria laid down for a trial of streptokinase. Criteria for thrombolysis were not fulfilled in 41 (31%) and 12 patients (9%) had contraindications. These results suggest that around half of all patients with AMI and about one-third of patients presenting with chest pain and admitted to a CCU would be suitable for thrombolytic therapy. These data do not support the view that such therapy may be applicable to only a small minority of patients with AMI.

Three 1 microgram or 2 micrograms doses of Merck, Sharp and Dohme plasma vaccine were given to 119 infants of mothers negative for antibody to hepatitis B surface antigen (anti-HBs). Anti-HBs antibodies developed in 25/29 (86%) infants given 1 microgram and in 86/90 (96%) given 2 micrograms doses. Levels of anti-HBs achieved by three 2 micrograms doses were similar to those that have been reported for conventional 10 micrograms doses. Similar levels were recorded from infants of anti-HBs-positive mothers, which suggests that maternal antibody does not interfere with the infant's immune response to low doses of vaccine. Three 2 micrograms doses of vaccine in infancy produce satisfactory immunogenicity and make possible economic control of hepatitis B in endemic areas.

A prospective randomised single-blind study of the effects of real and sham acupuncture on exercise-induced asthma was conducted in nineteen children. Forced expiratory flow in 1st second (FEV1), forced vital capacity (FVC), and peak expiratory flow rate (PEFR) were measured throughout acupuncture and after treadmill exercise. Neither real nor sham acupuncture affected the basal bronchomotor tone but both, when applied 20 min before exercise, attenuated exercise induced asthma: mean maximum percentage falls in FEV1, FVC, and PEFR were 44.4%, 33.3%, and 49.5% without acupuncture; 23.8%, 15.8%, and 25.9% after real acupuncture; and 32.6%, 26.1%, and 34.3% after sham acupuncture. Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture (p less than 0.05).

In a randomised controlled trial, twelve matched pairs of patients with chronic obstructive pulmonary disease received traditional Chinese acupuncture or placebo acupuncture. After three weeks' treatment the traditional-acupuncture group showed significantly greater benefit in terms of subjective scores of breathlessness and six-minute walking distance. Objective measures of lung function were unchanged in either group. Whether these differences are mediated by endogenous opiate and/or peptide release remains speculative.