It is proposed that abnormalities of glucose and insulin metabolism have a role in both the aetiology and the clinical course of hypertension. There is resistance to insulin-stimulated glucose uptake in patients with hypertension, which is associated with glucose intolerance and hyperinsulinaemia. Hyperinsulinaemia could contribute to hypertension by stimulating the activity of the sympathetic nervous system and kidney sodium and volume reabsorption. Glucose intolerance and hyperinsulinaemia have been identified as risk factors for coronary artery disease, and their presence may help explain why the frequency of this disease has not been reduced by treatment of hypertension. The fact that several antihypertensive drugs deleteriously affect glucose, insulin, and lipid metabolism makes it even more important to consider these factors in the treatment of high blood pressure.

The frequency of hospital admission for perforated ulcer was not measurably affected by concurrent use of non-steroidal anti-inflammatory drugs (NSAID) during nearly 30 million person-days of NSAID use at Group Health Cooperative of Puget Sound. Whether patients had ever used cimetidine or antacids, drugs which indicate the presence of ulcer disease or symptoms, was strongly predictive of perforation in the same population (rate ratio 5.1; 95% CI 2.6-10.0). Perforation rates increased sharply with age but were similar for men and women.

The populations of New Haven and Boston are demographically similar and receive most of their hospital care in university hospitals, but in 1982 their expenditures per head for inpatient care were $451 and $889, respectively. The 685,400 residents of Boston incurred about $300 million more in hospital expenditures and used 739 more beds than they would have if the use rates for New Haven residents had applied. Most of the extra beds were invested in higher admission rates for medical conditions in which the decision to admit can be discretionary. The overall rates for major surgery were equal, but rates for some individual operations varied widely. These findings indicate that academic standards of care are compatible with widely varying patterns of practice and that medical care costs are not necessarily high in communities served largely by university hospitals. They also emphasise the need for increased attention to the outcome and cost implications of differences in practice styles.

Of 85 children with human-immuno-deficiency-virus (HIV) infection based on clinical (opportunistic infection), epidemiological (mother a drug addict or known to be HIV infected), and immunological (helper-T-cell deficiency and impaired proliferative response to pokeweed mitogen) features, 9 were found to lack antibody to HIV as measured by a commercial enzyme-linked immunoassay (ELISA). All 9 children had detectable levels of HIV antigen in simultaneous plasma specimens, measured by a sensitive antigen-capture ELISA. The use of the western blot assay and an ELISA with recombinant HIV antigens was able to identify HIV infection in 4 of the 9 children.

Fasting hypoglycaemia developed in three growth hormone deficient children after the start of treatment with synthetic growth hormone. The effects, which occurred 36-60 h after each injection, may have been due to insulin-like effects of endogenous somatomedins after waning of insulin antagonism induced by growth hormone. Daily growth hormone injections may be necessary to maintain normal plasma glucose levels in young children.

Studies investigating steroid dose and avascular necrosis of bone (AVN) have found either a weak association or none at all. This quantitative review of published studies has evaluated the effects of steroid dose and bolus steroids on the risk of AVN. 22 papers with sufficient information for analysis were identified. The mean steroid dose for the cohort was plotted against the percentage in whom AVN developed. Total dose was divided into non-bolus (oral) and bolus dose, and doses 1, 3, 6, and 12 months after beginning steroids were tested separately for their association with AVN risk. There was a strong correlation between daily total dose and AVN rate (r = 0.61-0.80). Oral dose was strongly correlated with AVN rate (r = 0.70-0.86), but bolus dose was not associated with AVN risk. This strong association between AVN and steroid dose contrasts with the weak relations found in case-control studies from individual centres in which cases and controls received similar steroid regimens and therefore did not differ greatly in steroid dose. The method of deriving a single exposure level per study and comparing the amount of exposure across studies may be useful in assessing whether a drug's toxicity is dose dependent.