To study the clinical efficacy of granulocytes obtained by filtration leukapheresis, patients with clinically evident infection and granulocyte counts of smaller than 500 per cubic millimeter were randomly assigned to receive conventional therapy alone or with a granulocyte transfusion obtained from a single donor each day for four days. Five of 19 control patients survived to day 20, and 15 of 17 in the transfused group survived. Comparison of the two populations for variables such as age, disease, and severity and type of infection revealed no other factor that could account for the difference in survival. Outcome was not demonstrated to be related to HL-A match, post-transfusion counts, or presence of leukocyte antibodies. Functional studies of granulocytes obtained by filtration leukapheresis showed only minor differences although appearance was altered. Granulocytes so obtained can be used safely and efficaciously as adjunctive therapy for infection associated with granulocytopenia.

Television and telephone communications were randomly used to compare their effectiveness in allowing consultation between a hospital-based physician and remote nurse practitioners. Visits using television for consultation averaged 50 minutes as compared with 40 minutes for telephone. This difference was caused by longer work-ups before the consultation, longer delays after it was requested, and longer consultations, themselves, on television. However, television consultations resulted in significantly fewer immediate referrals of patients to hospital physicians: 6 plus or minus 1 as compared to 12 plus or minus 1 per cent (mean plus or minus S.E.M) OF ALL TELEPHONE CONSULTATIONS (P SMALLER THAN 0.005). Although no overall difference in satisfaction was documented between the results of television and telephone consultations, participants preferred the former for medical decision making and cited it for allowing more social interaction than telephone. These findings suggest that television may have its greatest value in remote sites where the sense of isolation is great and the need to reduce long-distance referrals offsets the costs of the system.

A prospective, controlled, randomized study was done to compare the effect of early and late ambulation in hospitalized patients with acute myocardial infarction. All patients surviving longer than the first five days were studied; 64 patients were mobilized on day six and discharged on day 12, and 65 were mobilized on day 13 and discharged on day 19. Follow-up observation lasted from six to 52 weeks. Of patients without complications until day six, eight out of 32 in the early and 16 of 35 in the late groups manifested complications during the follow-up period (p smaller than 0.05). Of those who had complications before day six, seven of 32 and 26 of 30 still had or acquired new complications until last seen (p small than 0.0001). The number of serious complications in the two groups was eight and 24 respectively (p smaller than 0.001). We conclude that early ambulation is beneficial irrespective of complications on admission.

To evaluate the role of coronary bypass treatment of stable angina, 72 patients were randomly divided into surgical and medical groups. They were followed with treadmill tests and repeat catheterization. Anginal symptoms decreased or disappeared in 89 per cent of those operated on and 65 per cent of those not operated on, but more of the former than of the latter became asymptomatic: 69 vs. 11 per cent respectively (p smaller than 0.01). Exercise tolerance time improved significantly (p smaller than 0.001) in both groups, but more in the group operated on, plus 78 per cent vs. plus 48 per cent, p smaller than 0.05. During a 28-month follow-up period, fewer cardiac complications occurred in the patients operated on--14 vs. 34 (p smaller than 0.02). Mortality was 9 per cent in the patients operated on and 14 per cent in those not operated on; this difference is not significant. The results indicate that improvement, though demonstrable in both groups, is greater with surgery, and quality of life during the first 28 months is better in patients who are operated on.

A comparison was made of 125I fibrinogen count scanning and phlebography in 142 limbs of 83 patients without known prior deep venous thrombosis who underwent total hip replacement. A localized accumulation of fibrinogen located away from the hip wound represented a fresh thrombus in 25 of 29 cases (86 per cent). However, of all the fresh thrombi demonstrated by phlebography, the fibrinogen scan detected only approximately 50 per cent. Major reasons for failure to detect thrombi were the presence of the wound and the small size of some thrombi. In defining whether or not fresh venous thrombosis was present in a given patient, the scan was accurate in three quarters of the cases. We conclude that fibrinogen scanning is a useful examination in patients after elective hip surgery, but less accurate than previously reported.

In a controlled trial, 36 patients with asymptomatic radiolucent gallstones were treated with chenodeoxycholic acid, 750 mg per day, phenobarbital, 180 mg per day, combination of both drugs, and placebo. After one year, chenodeoxycholic acid, phenobarbital and the combination, but not placebo, significantly decreased biliary cholesterol saturation. The effect was significantly greater with chenodeoxycholic acid and the combination than with phenobarbital. Gallstones size decreased more than 50 per cent in nine of 20 patients receiving chenodeoxycholic acid, either alone or combined with phenobarbital, but in no patient receiving only phenobarbital or placebo. Gallstones disappeared completely in tow patients. Abnormalities in liver-function tests in thriee of 36 patients and in five of 16 liver biopsies, occured with equal frequency in the four treatment groups. Thus, after one year, phenobarbital alone was ineffective in gallstone dissolution. Chenodeoxycholic acid alone or combined with phenobarbital, however, offered a partially effective and safe treatment for asymptomatic radiolucent gallstones.

Two placebo-controlled double-blind studies were initiated to evaluate the therapeutic efficacy of 5-iodo-2-deoxyuridine (idoxuridine) in biopsy-provedcases of herpes simplex virus encephalitis. Twelve patients who on clinical grounds were thought to have herepes simplex virus encephalitis underwent brain biopsy; six of these patients were proved to have this disease, three were considered probable cases,and three were considered doubtful. The patients with proved or probably herpes simplex virus encephalitis were treated with parenteral idoxuridine (or placebo) at a dose of 100 mg per kiogram per day for five days. The occurrence of unacceptable myelosupperssion and the failure of idoxuridine therapy to prevent death led to the premature termination of both studies.

Prolonged l-phenylalanine mustard (L-PAM) administration as an adjuvant to mastectomy in the management of patients with primary breast cancer and pathologically positive axillary nodes was evaluated by a prospective, randomized, clinical trial. Treatment failures occurred in 22 per cent of 108 patients receiving placebo and 9.7 per cent of 103 women given L-PAM (p = 0.01). A statistically significant difference (p = 0.02) existed in favor of L-PAM relative to disease-free interval. In premenopausal women, the difference with respect to disease-free interval of treated and control groups was highly significant (p = 0.008). A treatment failure occurred in 30 per cent of premenopausal patients receiving placebo and 3 per cent of those treated with L-PAM (p = 0.008). Whereas a similar trend was observed in postmenopausal patients, the difference is not statistically significant. Thus, L-PAM has been demonstrated to be effective in the treatment of women with primary breast cancer, particularly those who are premenopausal. Results were achieved with minimal undesirable side effects.