18 patients with severe hypertriglyceridaemia (mean fasting plasma triglyceride 5.7 mmol/l) had significantly higher concentrations of plasma fibrinogen and clotting factor Xc than did a normolipidaemic comparison group. Fibrinolytic activity was significantly lower in the hyperlipidaemic patients. Six months of treatment (diet or diet and clofibrate) lowered the patients mean plasma triglyceride to 3.1 mmol/l and caused a fall of clotting factors VIIc and Xc and a significant rise in fibrinolytic activity. None of these variables changed in the comparison group. Raised fibrinogen and factor VIIc concentrations are risk factors for cardiovascular mortality, and raised factor Xc and lowered fibrinolytic activity have both been found in groups at high risk of ischaemic heart-disease. Despite the fact that in population studies triglycerides do not consistently appear to be an independent risk factor for ischaemic heart disease, these data suggest that a pronounced increase in triglycerides warrants energetic therapy because it may be associated with a "hypercoagulable state".

Five normal adults defaecated within 2 1/2 hours of receiving neurotensin 13.5 pmol kg-1 min-1 for 30 min, whereas none did so after control infusions, in a double-blind study. Neurotensin caused borborygmi and production of stools which resembled the normal contents of the proximal and distal colon in terms of consistency and electrolyte content. This evidence suggests that neurotensin had a major effect on propulsive colonic motility. Blood neurotensin concentrations during infusion were about three times higher than normal postprandial concentrations, but plasma neurotensin is raised in some diseases associated with diarrhoea.

The immediate haemodynamic effects of intravenous frusemide (1 mg/kg) and intravenous isosorbide dinitrate (50-200 micrograms/kg/h) were compared in a prospective, randomised, between-group study in 28 men with radiographic and haemodynamic evidence of left ventricular failure following acute myocardial infarction. The diuresis induced by frusemide reduced the left heart filling pressure and cardiac output and transiently raised systemic blood-pressure. In contrast, isosorbide dinitrate was accompanied by a reduction in systemic blood-pressure and peripheral resistance with the result that the cardiac output was not decreased despite a large fall in the pulmonary vascular and left heart filling pressures. These results indicate that reduction of excessive preload by venodilatation may be haemodynamically superior to that induced by diuresis in terms of both reducing myocardial oxygen consumption and maintaining peripheral perfusion. The influence of these contrasting treatments on the prognosis of these high-risk patients warrants further study.

In the years 1973-79, 39452 infants born to parents resident in Sheffield were scored at birth for risk of unexpected infant death. Before 1973 post-perinatal mortality in Sheffield was on average 11.5% above the rate for England and Wales. Since 1973 it has only once exceeded the rate for England and Wales. "Possibly preventable" deaths have fallen from 5.2 to 1.9 per 1000. 12% of this decline is associated with a rise in the average age of the mother and a fall in the number of pregnancies, 9% with a reduction in precipitate deliveries, 24% with an increase in breastfeeding, 18% with extra care given by health visitors to high-risk infants, and 36% with other factors. The reduction in mortality attributed directly to the effect of increased visiting of high-risk infants is numerically similar to the number of lives saved by treating cancers of children. This suggests that home visiting by health visitors is highly cost-effective.

50 patients with confirmed hypertension were treated with endralazine, a new peripheral vasodilator, in addition to the beta-blocker, pindolol, to which they had not responded adequately. The blood pressure was lowered from 173/115 mm Hg to 143/87 mm Hg in the 34 slow acetylators and from 175/111 mm Hg to 140/84 mm Hg in the 16 fast acetylators. The dosages of both pindolol and endralazine were the same in both groups. It is concluded that the acetylator phenotype does not affect the therapeutic efficacy or dosage requirement of endralazine. It is suggested that this is because endralazine is metabolised mainly by hydrazone formation and only to a minor extent by acetylation.

Normal volunteers underwent a standard course of treatment to acquire a suntan in a commercial solarium, and tests of immune function were carried out before, on completion, and 2 weeks after completion of radiation exposure. Compared with age and sex matched concurrent controls, the test subjects had reduced skin test responses to dinitrochlorobenzene (DNCB), slightly reduced blood lymphocyte numbers, and changes in the proportion of lymphocyte subpopulations. This included a relative increase in total (OKT3+) T-cell numbers which was attributable to an increase in the OKT8+ suppressor/cytotoxic subset of T cells. OKT4+ helper T cells were reduced and there was a significant decrease in the OKT4/OKT8 ratio. Other changes included a significant increase in suppressor T-cell activity against IgG production in vitro and depression of natural killer cell activity. These changes were still present in some subjects 2 weeks after solarium exposure.

There are two apparently conflicting theories on the pathogenesis of exercise-induced asthma. One view is that exercise-induced asthma is directly related to respiratory heat exchange and that mast cells are not involved. The other theory explains exercise-induced asthma on the basis of a temperature-independent release of mast-cell mediators. A theory is put forward here that airway cooling in asthmatic subjects during exercise leads directly to mast-cell degranulation and that this explains the association between exercise, respiratory heat exchange, and mediator release.