In a prospective randomised study of 228 patients with various renal diseases, early moderate dietary protein restriction retarded the development of end-stage renal failure. 149 patients were followed up for at least 18 months; the protein-restricted patients showed falls in serum urea and phosphate concentrations and in the 24 h excretion of urea, phosphate, and protein. Regression analysis of the reciprocals of serum creatinine against time showed that the average rate of decrease in reciprocal creatinine was three to five times lower in the protein-restricted groups than in the control groups. These results confirm that moderate dietary protein restriction is an acceptable and effective way of delaying functional renal deterioration. The finding has implications for the management of chronic renal insufficiency.

Fall off in tetanus immunity and the effect of late revaccination were investigated in a randomly selected group of Danes aged 25-30. Routine reinforcing doses of tetanus toxoid are not customary in Denmark except at injury and when there are certain occupational risks. 11% of the total group of 418 had antitoxin titres below that required for protection (ie, less than 0.01 IU/ml, determined by neutralisation technique). In those who had received only primary vaccination an exponential fall off in immunity was seen, and 25-30 years after primary vaccination, 28% had serum antitoxin concentrations below the level of protection. Up to 30 years after primary vaccination, one reinforcing dose of tetanus toxoid adsorbed by aluminium hydroxide was sufficient to induce protective titres of antitoxin. There were no serious side-effects and it was concluded that routine reinforcing doses of tetanus toxoid should be given before the age of 20 in Denmark and other countries where primary vaccination is given in the first years of life.

117 infants with gonococcal ophthalmia neonatorum, including 27 with infections due to penicillinase-producing Neisseria gonorrhoeae, were treated as outpatients with five different regimens of single-dose intramuscular kanamycin (75 mg or 150 mg) with saline eye washes, gentamicin eye ointment, or chloramphenicol eye drops. There were no treatment failures among 68 patients treated with 75 mg or 150 mg kanamycin and gentamicin eye ointment (for 3 days). However, the minimum and maximum cumulative probabilities of cure of single-dose kanamycin with saline eye washes (for 3 days) were only 60% and 89%. 1 patient of 15 treated with 150 mg kanamycin plus chloramphenicol eye drops did not respond to treatment. Postgonococcal conjunctivitis developed in 14 (12%) infants, of whom 13 had positive cultures for Chlamydia trachomatis. Nasopharyngeal infection with N gonorrhoeae was eradicated in 9 of 11 infants colonised.

30 patients with severe refractory irritable-bowel syndrome were randomly allocated to treatment with either hypnotherapy or psychotherapy and placebo. The psychotherapy patients showed a small but significant improvement in abdominal pain, abdominal distension, and general well-being but not in bowel habit. The hypnotherapy patients showed a dramatic improvement in all features, the difference between the two groups being highly significant. In the hypnotherapy group no relapses were recorded during the 3-month follow-up period, and no substitution symptoms were observed.

Recombinant hepatitis B vaccine prepared from antigen expressed in yeast was given to 30 healthy young volunteers. Seroconversion rates and anti-HBs levels were compared with those in a control group matched for age and sex who had received plasma-derived hepatitis B vaccine. 4 weeks after the third immunisation results were similar in the two groups. In the recombinant vaccine group the immune response developed more slowly during the early phase and seroconversion rates and mean anti-HBs levels were slightly lower in males; this probably reflects use of a lower dose of recombinant vaccine (10 micrograms compared with 20 micrograms of the plasma vaccine). Side-effects were slight and antibody titres against Candida albicans were not increased in recipients of the recombinant vaccine.

Dithranol (anthralin) inflammation of forearm skin was completely inhibited by various scavengers of free radicals of the oxygen species. It is concluded that dithranol inflammation is initiated by formation of free radicals; these may act through lipid peroxidation and production of inflammatory endoperoxides or by a more direct mechanism.

Limb blood flow and respiratory function were compared in ten patients with severe heart failure inadequately controlled by diuretics and normal control subjects matched for age and sex. Both forearm and calf blood flow, at rest and after exercise, were lower in the patients than in the control subjects. Oxygen consumption during submaximal exercise was also lower in the patients and minute ventilation was higher. Captopril, administered in a single-blind controlled study to the patients, resulted in an improvement in these abnormalities, with the exception of oxygen consumption. It also improved exercise tolerance and reduced perceived exertion during exercise. Captopril is effective treatment for severe heart failure and improves some of the peripheral haemodynamic and respiratory abnormalities.

The serum magnesium levels of all 12 allogeneic bone-marrow transplant recipients who experienced the neurotoxic effects of cyclosporin (CyA) were more than two standard deviations below the normal range. The neurological events seemed to segregate into three separate syndromes. 7 patients had grand-mal seizures, which occurred within the first several weeks of CyA therapy (median onset 12 days). At the time of their first seizure all 7 patients had hypomagnesaemia, which had developed rapidly over the preceding 1-3 weeks. 3 patients had four episodes of cerebellar ataxia, tremor, and depression. These subacute episodes developed after prolonged CyA therapy (median onset 67 days). Each episode was associated with hypomagnesaemia. 2 patients had a transient episode of expressive aphasia following a long period of hypomagnesaemia. In all cases symptoms resolved or did not recur with adequate magnesium replacement. These data suggest that CyA neurotoxicity is associated with hypomagnesaemia and may be treated or prevented with magnesium replacement.

Supplementary formula feeds inhibited the protective effect of expressed raw and pasteurised human milk in 226 high-risk neonates in a randomised controlled trial. The infection rate in the group given pasteurised human milk and formula (33%) was significantly higher than the rates in the groups given raw human milk (10.5%), pasteurised human milk (14.3%), and raw human milk and formula (16%). This accords with the impressions that some of the association of infection with artificial feeding is partly attributable to the lack of the protective effect of human milk. Heating expressed human milk to 62.5 degrees C for 30 min significantly reduces its protective effect.

The ability of high-dose intravenous gammaglobulin (IVGG) to prevent the coronary artery lesion of Kawasaki disease has been studied in a multicentre controlled trial of IVGG plus aspirin versus aspirin alone, aspirin being the conventional treatment for Kawasaki disease. Patients were allocated at random to aspirin (45 cases) or IVGG (40 cases), there being no significant intergroup differences in age, sex ratio, duration of disease until the start of treatment, or severity. The development of coronary artery dilatation was monitored by two-dimensional echocardiography. Within 29 days of the onset of the disease, this lesion had developed in 19 cases (42%) in the aspirin group and in 6 cases (15%) in the IVGG group. There were no new instances of this lesion: in the period 30-60 days coronary artery dilatation persisted in 14 and 3 cases, respectively. In patients found to have echocardiographic abnormalities selective coronary arteriography was done 30-60 days after onset of Kawasaki disease and the lesion was confirmed in 1 of the 6 cases in the IVGG group and in 11 of the 19 controls. High-dose IVGG seems to reduce the frequency of coronary artery abnormalities in patients with Kawasaki disease.