57 patients with obstructive jaundice were randomly allocated to surgery with preoperative external biliary drainage (29 patients) and without preoperative external biliary drainage (28 patients). 22 patients ultimately underwent laparotomy after a mean of 11.7 days of drainage and 25 had surgery without preoperative drainage. The postoperative complication rate was low and similar in both groups but complications associated with the drainage procedure were substantial. Perioperative mortality was 4/28 (14%) in the drainage group and 4/27 (15%) in the non-drainage group. There seems to be no advantage associated with routine preoperative external biliary drainage before surgery for obstructive jaundice.

To investigate a reported negative association between the use of oral contraceptives (OC) and the development of rheumatoid arthritis, a case-control study was undertaken to compare the histories of OC use between 228 women with a diagnosis of probable or definite rheumatoid arthritis and 302 women with the diagnosis of soft-tissue rheumatism and/or osteoarthritis. The use of OCs before the onset of joint complaints was acknowledged by 31.1% of the rheumatoid arthritis patients and by 55.6% of the controls. After adjustment for possible confounding variables, the rate ratio for ever use became 0.42 (95% confidence interval 0.27--0.65), while it was 0.40 (0.22-0.72) for ex-users and 0.45 (0.28-0.75) for current users. These findings confirm the finding from the Royal College of General Practitioners Oral Contraceptive Study that the incidence rate of rheumatoid arthritis among OC users was halved.

Daily and weekly bag-changing regimens were compared in 12 elderly catheterised patients with reference to their clinical condition, leakage or blockage of the catheters, and the bacteriological state of the urine. Latex Foley catheters were used for the first 3 months and silastic catheters for the second 3 months of study. All patients had bacteriuria throughout the study, and the average number of bacterial species isolated from each specimen was 3.8. There were no significant clinical or bacteriological differences between the patients on daily and those on weekly bag change. Although significantly more episodes of pyrexia were recorded during latex than during silastic catheterisation there was no correlation between these episodes and the bacteriological state of the urine. Of the 9 courses of antibacterial treatment given during the 6 months, 7 were for indications other than urinary tract infection. There were no episodes of acute pyelonephritis. There were 148 episodes of pyrexia unrelated to any clinical symptoms or signs. Only 2 were treated with antibiotics; the remainder subsided without treatment.

Ticlopidine, a potent inhibitor of platelet aggregation, was found to have no direct effects on coronary resistance or coronary flow in 5 dogs. To determine whether platelets can be implicated in the pathogenesis of myocardial ischaemia the effects of this drug were studied in 10 patients with proven coronary-artery disease and daily angina pectoris. Each underwent three single-blind treatments: (a) placebo for 2 weeks; (b) ticlopidine 500 mg for 4 weeks; and (c) placebo for 2 weeks. For 4 days after the end of each treatment ambulatory S-T segments were monitored and a record was kept of the reported frequency of chest pain. 4 weeks' treatment with ticlopidine resulted in a significant fall in both the reported frequency of chest pain and the number of episodes of S-T segment depression. This effect was most striking in those episodes of S-T segment depression that occurred without increase in heart rate and in the middle of the night. Thus, although the exact mechanisms remain to be clarified this study suggests that platelets may play an important part in the pathogenesis of myocardial ischaemia.

Charcoal haemoperfusion with a prostacyclin infusion for platelet protection was carried out daily in the treatment of 76 patients with fulminant hepatic failure. in the 31 patients who had been referred early and in whom the serial haemoperfusion was started while signs of grade III encephalopathy were still evident remarkable survival rates were obtained-70% for patients with paracetamol poisoning and 65% for the group overall. Cerebral oedema developed significantly less frequently in this group than in those patients in whom haemoperfusion was started later in the course of the disease, when signs of grade IV encephalopathy were already apparent (49% and 78% respectively, p less than 0.05), and this was likely to have been a major factor in their improved survival. Biocompatibility of the system was excellent, and both platelet and white-cell counts at the end of perfusion periods were the same as pre-perfusion values.