In a controlled experiment 15 (79%) of 19 severely alcoholic men but only 1 of 22 controls had a serum concentration of greater than or equal to 5 mumol/l 2,3-butanediol after ingestion of distilled spirits. Another diol, 1,2-propanediol, was found in a concentration of greater than or equal to 5 mumol/l in all patients' specimens after drinking; but it was also present in lower concentrations in the reference specimens of most of the patients. These data are consistent with the experimental evidence that ethanol can be metabolised in rats to produce 2,3-butanediol and with the epidemiological hypothesis that severely alcoholic men metabolise ethanol by a different pathway than do control subjects.

Wound healing produced by isotonic saline irrigation via a special dressing was compared with that produced by conventional saline dressings in 12 inpatients with 18 leg ulcers. Patients served as their own controls. Wound cleansing was estimated by fibrin crust disappearance and granulation tissue formation. Both occurred earlier during irrigation. Wound contraction was similar during the two treatments. Wound blood flow, estimated by means of a laser Doppler flowmeter, increased earlier with irrigation.

Elderly patients with acute urinary infections were treated in a double-blind study with either amoxycillin or cephradine. In 52 patients who had received amoxycillin for one week about a third of all intestinal Escherichia coli were highly resistant to amoxycillin, and many were resistant to tetracycline, trimethoprim, or chloramphenicol. Cephradine selected less resistance. At a week after completion of chemotherapy, cephradine-resistant E coli were replaced by sensitive cultures at a greater frequency than were amoxycillin-resistant E coli. Neither antibiotic altered the skin flora. Amoxycillin, but not cephradine, selected for Enterobacteriaceae in the saliva. The propensity of amoxycillin to select resistance in E coli will limit its usefulness in treating urinary infections.

8 patients with advanced prostatic carcinoma were treated with the luteinising-hormone releasing-hormone agonist, ICI 118630, for up to 3 months. Patients received subcutaneous injections of ICI 118630 (either 100 micrograms or 250 micrograms daily). At the higher dose level, plasma testosterone concentrations were significantly reduced by day 14 and approximated to those previously recorded in castrated or diethylstilboestrol-treated patients. Plasma concentrations of luteinising hormone and follicle-stimulating hormone were similarly reduced. Reduction in the dose, to 100 micrograms/day, similarly reduced plasma testosterone. ICI 118630 shows considerable potential for the management of patients with advanced carcinoma of the prostate.

Mean serum potassium levels were significantly higher for 9 months in renal allograft recipients receiving cyclosporin than in those receiving prednisolone and azathioprine. Sustained hyperkalaemia (serum potassium 6.0-7.1 mmol/l) inappropriate for their renal function (glomerular filtration rate 21-36 ml/min) developed in seven of forty-three cyclosporin-treated patients. All seven patients had hyperchloraemic acidosis; four were able to acidify their urine to pH less than or equal to 5.4. Six of the seven patients were hypertensive and receiving beta-blockers; one had had bilateral nephrectomy. Despite hyperkalaemia, plasma aldosterone levels were within the normal range in five patients and raised in two. During moderate sodium restriction, plasma renin activity was low or low-normal in five of the seven patients. In these patients a combination of hypoaldosteronism and renal tubular damage leading to a tubular defect of potassium and hydrogen ion secretion is the apparent cause of the hyperkalaemia and hyperchloraemic acidosis. Hyporeninaemia caused by beta-blockade probably blunts the aldosterone response to hyperkalaemia, thereby worsening it.

Vaccine regimens using 0.1 ml human diploid cell strain vaccine (HDCSV) given intradermally (id) in single and multiple sites, or with aluminum hydroxide adjuvant given subcutaneously (sc), were compared with the regimens of HDCSV and Semple vaccine currently suggested by WHO. Some groups were also given human rabies-immune globulin (HRIG). Neutralising antibody titres were monitored for 3 months. Antibody was detected earliest in subjects given 0.1 ml HDCSV id at each of eight sites. The highest antibody titres from day 14 onwards were found after intramuscular (im) administration of HDCSV, but the multiple-site id regimen, which requires only one quarter of the volume of vaccine required for the im regimen, gave similar results, provided that a booster was given on day 91. This finding suggests that a treatment schedule based on this regimen would be suitable for post-exposure prophylaxis. Adjuvanted vaccine gave similar results to the same amount of antigen given id. Semple vaccine produced the lowest titres. HRIG, given at the high dose of 40 IU per kg, suppressed the antibody response to some of the regimens.

Food hypersensitivity as a cause of abdominal symptoms was investigated by means of exclusion diets and double-blind food provocation in patients with irritable bowel syndrome. Twenty-seven patients entered the study; nineteen complied with dietary manipulation. Food hypersensitivity as a cause of their presenting symptoms was confirmed by double-blind food provocation in only three patients, who also had evidence of associated atopic disease and positive skin tests to common inhalant allergens. Evidence of minor psychiatric disorder was found in twelve of fourteen patients examined by an independent psychiatrist.

A case-control study on 1342 infants was carried out to investigate whether mid-trimester amniocentesis might be a cause of congenital talipes or hip malformation. There was no evidence of any excess risk of having an infant with either of these malformations in mothers who had an amniocentesis; the estimate of relative risk in association with amniocentesis before 28 weeks of pregnancy was 1.08 (95% confidence interval, 0.7-1.6). There was no evidence that amniocentesis increased the risk of forms of these malformations that were sufficiently severe to require strapping, splintage, or surgery (relative risk 0.75, 95% confidence interval 0.4-1.4). Although there was no statistically significant association between amniocentesis and milder forms of these malformations (those requiring either no treatment or simple treatment by double nappies, physiotherapy, or manipulation), there is less confidence about the absence of an association (relative risk 1.32, 95% confidence interval 0.8-2.2).

2069 Rh(D)-negative women in their first pregnancy received 100 micrograms doses of anti-D immunoglobulin at 28 and 34 weeks' gestation and a further dose at delivery if the infant was Rh(D)-positive. The antibody status was determined at 28 weeks, 34 weeks, at delivery, and 6 months after delivery. The findings were compared with those in a control group of 2000 Rh(D)-negative primigravidae who gave birth to Rh(D)-positive infants and received the standard post-delivery injection of anti-D immunoglobulin. 2 women in the trial group and 18 in the control group became actively immunised during the first pregnancy. 325 women in the trial group have had a further Rh(D)-positive pregnancy and in 2 anti-D antibodies were detected for the first time. 528 control women have had a further Rh(D)-positive pregnancy and anti-D was demonstrable in 29-18 in whom antibodies developed during the first pregnancy and 11 in whom antibodies first appeared during the second. The reduction in the incidence of sensitisation was significant. It is estimated that the extra cost in anti-D immunoglobulin was approximately pounds 1600 for each woman sensitised.

In a group of thirty patients with tumour-induced hypercalcaemia the effects of volume repletion and intravenous (3-amino-1-hydroxypropylidene)-1, 1-bisphosphonate (APD) were examined. Volume repletion was only partially effective in lowering serum calcium and raising glomerular filtration rate and it increased the tendency towards hypomagnesaemia. In twenty-nine of the patients serum calcium, serum magnesium, and glomerular filtration rate were rapidly restored to normal by intravenous APD, in doses of 1.75-30 mg/day. Tubular reabsorption of phosphate was lower than normal in five of nine patients in whom it was studied and remained unchanged despite correction of hypovolaemia and serum and urine calcium levels or changes in parathyroid hormone. These findings suggested that tumours may produce a phosphate-lowering factor. The improvement in clinical condition with volume repletion depends on its ability to adjust calcium excretion to the abnormal production of calcium from bone. APD, in contrast, returns pathological bone destruction to normal without any undesirable side-effects.