The effect of increased nutritional intake was evaluated in 5 growth-retarded children with sickle-cell disease. Growth on recommended daily calorie and protein intakes had been inadequate in all 5. Fat absorption and intestinal mucosal morphology were normal in all 5. 2 children were given nutritional supplementation by nasogastric intubation, 1 received nightly oral formula supplements, and 2 were supplemented with zinc, iron, folate, and vitamin E only. Nutritional supplementation by the nasogastric route produced a rapid sustained increase in growth rate, associated with striking reductions in pain crises and infections which had previously necessitated many hospital admissions. Oral supplementation improved the clinical course but had no effect on growth rate. Mineral and vitamin supplements influenced neither the growth rate nor the clinical course. The observations indicate that nasogastric nutritional supplementation may accelerate growth and reduce the incidence and severity of complications in growth-retarded children with sickle-cell disease.

When liquids of low electrical conductivity enter the stomach the impedance of the epigastric region to a 4 mA, 100 kHz current increases. There follows a decline, which logically represents gastric emptying. This method of measuring gastric emptying was compared against scintigraphy in six volunteers, and similar results were obtained. Impedance monitoring is entirely noninvasive, inexpensive, simple, and quick. The method merits further exploration.

Two randomised double-blind trials were conducted to examine the activity and tolerability of mefloquine alone and in combination with sulfadoxine/pyrimethamine (MSP). In one trial mefloquine was compared with chloroquine in 40 patients with Plasmodium vivax malaria and in the other one mefloquine was compared with MSP in 40 patients with P falciparum malaria. The former trial showed that both a single oral dose of 250 mg mefloquine and a single oral dose of 450 mg chloroquine (base) were highly effective in relieving symptoms of malaria and in clearing P vivax parasitaemia. No side-effects and no changes in laboratory variables attributable to the test drugs were observed. The other trial showed that a single oral dose of 750 mg mefloquine and a single oral dose of MSP (750 mg mefloquine plus 3 tablets of 'Fansidar', were equally effective in the treatment of falciparum malaria. 2/4 treatment failures in the mefloquine group and 2/3 treatment failures in the MSP group were due to low plasma drug levels resulting from vomiting soon after ingestion of the tablets. Gametocytes of P falciparum were unaffected by either mefloquine or MSP. 5 patients in each group had side-effects such as vomiting, skin rash, diarrhoea, and transient mental confusion. Mefloquine was well tolerated by patients with glucose-6-phosphate dehydrogenase deficiency or heterozygous haemoglobin E.

In a single-blind randomised trial in patients with acute myocardial infarction of less than 6 h duration, the frequency of coronary patency was found to be higher after intravenous administration of recombinant human tissue-type plasminogen activator (rt-PA) than after intravenous streptokinase. 64 patients were allocated to 0.75 mg rt-PA/kg over 90 min, and the infarct-related coronary artery was patent in 70% of 61 assessable coronary angiograms taken 75-90 min after the start of infusion; 65 patients were allocated to 1 500 000 IU streptokinase over 60 min, and the infarct-related vessel was patent in 55% of 62 assessable angiograms. The 95% confidence interval of the differences ranges from +/- 30 to -2% (p = 0.054). Bleeding episodes and other complications were less common in the rt-PA patients than in the streptokinase group. Hospital mortality was identical in the 2 treatment groups. At the end of the rt-PA infusion the circulating fibrinogen level was 61 +/- 35% of the starting value, as measured by a coagulation-rate assay, and 69 +/- 25% as measured by sodium sulphite precipitation. After streptokinase infusion, corresponding fibrinogen levels were 12 +/- 18% and 20 +/- 11%. In the rt-PA group only 4.5% of the fibrinogen was measured as incoagulable fibrinogen degradation products, compared with 30% in the streptokinase group. Activation of the systemic fibrinolytic system was far less pronounced with rt-PA than with streptokinase.

102 patients at high risk of pre-eclampsia and/or fetal growth retardation were randomly allocated to treatment with 300 mg dipyridamole and 150 mg aspirin daily from 3 months' gestation onwards (group A) or to the control group (group B, no treatment). Group A was twice as likely as group B to have a normal pregnancy. Pre-eclampsia occurred in 6 patients in group B and none in group A. Major complications (fetal death or severe growth retardation) occurred in 9 patients in group B and none in group A. Platelet count and plasma volume were significantly higher in group A than in group B throughout pregnancy. The treatment did not produce serious adverse effects. Antiplatelet therapy given early in pregnancy to high-risk patients may thus protect against pre-eclampsia and fetal growth retardation.

A randomised controlled trial of tamoxifen as a single adjuvant agent after mastectomy for early breast cancer, reported on at an average follow-up of almost 2 years in 1983, has now been followed up to a maximum of 6 years. 1285 patients aged 75 or less were entered into the trial. Premenopausal women with positive axillary nodes and postmenopausal women with both positive and negative axillary nodes were randomised to receive either tamoxifen 10 mg twice daily for two years or to the untreated control group with systemic therapy reserved until the time of relapse. 46% of the trial population had primary tumour specimens assayed for oestradiol receptor (ER) content. There has been a highly significant prolongation of the disease-free interval in the tamoxifen-treated group followed by a highly significant reduction in death rate, with 45 (34%) fewer deaths observed in the treated group than in the control group. This benefit appeared to be independent of menopausal, nodal, or ER status.

41 patients with active rheumatoid arthritis entered a placebo-controlled double-blind randomised study in which 21 received slow intravenous injections (given in fractions over 10 min) of thymopentin (TP-5) 50 mg 3 times a week for 3 consecutive weeks and 20 received placebo in the same way. After 3 weeks of treatment the TP-5 group showed improvement (p less than 0.05 or p less than 0.01) in all but one of the clinical variables tested. There was improvement in the number of joints painful at rest, the number of joints painful on motion, scores for tenderness on pressure and swollen joints, severity of pain on awakening and morning stiffness, and right-hand grip strength; left-hand grip strength remained unchanged. In the placebo group, only morning stiffness improved significantly. The intergroup comparisons showed that thymopentin was significantly better than placebo in reducing tenderness, joint swelling, severity of pain on awakening, and disease activity. 4 weeks after the end of the TP-5 therapy, the improvement was still present although there was a trend towards relapses. No significant modifications occurred in any of the laboratory variables tested and only minor side-effects were experienced by either group.

A randomised controlled trial to investigate the efficacy of mass screening with single-view mammography in reducing mortality from breast cancer was started in Sweden in 1977. 162 981 women aged 40 years or more and living in the counties of Kopparberg and Ostergötland were enrolled in the study and divided at random into 2 groups. Each woman in the study group was offered screening every 2 or 3 years depending on age. Women in the control group were not offered screening. This report is confined to the 134 867 women aged 40-74 years at date of entry. The results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduction in the rate of stage II or more advanced breast cancers in the group invited to screening. 7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers.

Of 109 patients with cirrhosis and endoscopically demonstrated oesophageal varices who had not bled, 56 were treated by sclerotherapy and 53 were treated conservatively. Patients were assigned to one of three categories according to varix size and Child's classification of severity of liver disease. Severity of liver disease increased with varix size. Frequency of haemorrhage in the control group also increased with varix size: haemorrhage occurred from small varices in 35% of patients, from medium varices in 53%, and from large varices in 83%. Prophylactic sclerotherapy diminished the frequency of variceal bleeding and overall mortality: over 25 months, frequency of bleeding was 9% in the therapy group and 57% in the controls, with mortality rates of 23% and 55%, respectively.

To assess the value of azathioprine in the maintenance therapy of autoimmune chronic active hepatitis a controlled trial of azathioprine withdrawal was carried out in 50 patients who had been maintained in remission on a combination of azathioprine and prednisolone. The patients were randomly allocated to remain on combination therapy (23) or to discontinue azathioprine (27). These 2 groups were comparable at the start of the study. Over a follow-up period of up to 3 years, biochemical and histological relapse occurred in 8 patients in the azathioprine-withdrawal group but in only 1 patient in the combination-therapy group. Cumulative probability of relapse was 32% among the patients in the withdrawal group, compared with 6.0% for those in the combination group.

The accuracy of liquid crystal colour thermography and clinical examination was compared with that of X-ray venography in 80 patients clinically suspected of having unilateral, lower-limb, deep-vein thrombosis. The clinical examination was not helpful in diagnosis. Of the 35 patients with confirmed deep-vein thrombosis, 34 had a positive thermogram, giving a sensitivity of 97%. 17 false-positive thermograms gave a specificity of 62%. The predictive value of a negative thermogram was 96.5%. Liquid crystal colour thermography is a quick, inexpensive, non-invasive investigation that might be useful as a screening test in patients suspected of having unilateral, lower-limb, deep-vein thrombosis. A diagnostic scheme starting with liquid crystal thermography and followed by 99mTc venoscanning might obviate the need for X-ray venography in almost 80% of patients with suspected deep-vein thrombosis.

72 cirrhotics with tense ascites were randomly assigned to treatment with either paracentesis plus intravenous albumin infusion (38 patients) or diuretics (34 patients). Paracentesis was not associated with significant changes in renal function. The clinical course of the disease was similar in the two groups of patients, both during their hospital stay and during follow-up.

Bladder irrigation with povidone-iodine in the prevention of urinary-tract infections after single or intermittent urethral catheterisation was investigated in a controlled study. In the control group (36 patients) the catheter was removed after urethral catheterisation and emptying of the bladder, and in the trial group (42 patients) 50 ml povidone-iodine 2% was instilled and allowed to drain immediately before removal of the catheter. The incidence of bacteriuria was 28% in the control group and 4% in the povidone-iodine group. After the introduction of bladder irrigation with povidone-iodine in the orthopaedic department of Leiden University Hospital the incidence of hospital-acquired bacteriuria fell from 6.9% to 3.7%.

The effects of atrial natriuretic peptide (ANP) were investigated in six healthy male volunteers taking a constant diet (120 mmol sodium and 60 mmol potassium daily). They were given an intravenous bolus of 100 micrograms human alpha-ANP on one day or placebo on another day 1-3 weeks apart in a double-blind randomised study. After ANP, urinary sodium excretion increased four-fold, and urine volume, calcium, magnesium, and phosphorus excretion doubled within 30 min of the injection. ANP induced an immediate fall in arterial pressure, followed by a longer vasodepressor phase which exceeded the duration of the effect on electrolyte excretion. There were no significant changes in plasma renin activity, aldosterone, antidiuretic hormone, or noradrenaline when compared with placebo.