In all subjects of the Australian therapeutic trial in mild hypertension, mean pressures for the two screening visits were within the range 95-109 mm Hg for diastolic blood-pressure phase V(DBP) and less than 200 mm Hg for systolic blood-pressure (SBP). In the 1943 control (placebo) subjects mean blood-pressures fell from 158/102 mm Hg at the first screening visit to 144/91 mm Hg 3 years later. At that time pressures remained within the mild hypertension range in 32%, ahd risen above it in 12%, and had fallen below in 48%. Trial end-points (ischaemic heart disease or cerebrovascular accident) occurred in 8%. The outcome was related to the level of initial pressure but not to other characteristics measured at entry. The mean initial pressures of 22 subjects who experienced a cerebrovascular event were higher than those of a matched group with no hypertensive complications, but the 88 subjects who experienced ischaemic-heart-disease events had initial pressures similar to those in a matched control group. The trial end-point rate was related to the average DBP of subjects throughout the trial in those with average DBP greater than or equal to 95 mm Hg, and at those levels subjects on active treatment had a higher incidence than subjects of the placebo group with the same DBP level. For those with average DBP below 95 mm Hg the incidence of trial end-points was not related to blood-pressure level or treatment. 16% of placebo subjects in this mild hypertensive population had a mean DBP of less than 95 mm Hg at the first three visits. If this were taken as an indication to withhold drug treatment, 3 years later one-quarter of them (4% of all subjects) would be found to be hypertensive or to have experienced a trial end-point, and thus inappropriately untreated, while the other 12% would have pressures below 95 mm Hg and have had no trial end-point.

Eleven consecutive patients with pyogenic liver abscesses were seen in a 20-month study period. Ten patients were treated with antibiotics alone. All ten had abscesses demonstrated by hepatic scintigraphy or sonography. In six patients purulent material was obtained by percutaneous aspiration of the liver. Blood-cultures were positive in each of the nine patients in whom they were obtained. Nine of the ten patients treated with antibiotics alone were cured; one died from complications of a liver biopsy. These results indicate that pyogenic liver abscesses can be effectively managed by medical therapy and that surgery is rarely required.

Although most strains of Campylobacter jejuni are susceptible in vitro to erythromycin and the drug has been recommended for treatment of campylobacter enteritis, prospective controlled trials have not been done. Erythromycin (250 mg 6-hourly for adults and 40 mg/kg daily for children) has been compared with placebo in a double-blind trial of 5-day therapy for acute campylobacter enteritis. The mean number of days of illness at onset of therapy was 5.6 for the treatment group (n = 15) and 6.5 for the placebo group (n = 14). There were no differences in temperature, symptoms, and stool characteristics between the two groups. The mean duration of unformed stools after treatment was 4.1 days in the erythromycin group and 3.5 days in the placebo group. Fever, when present, abated within 48 h in all but two patients in each group. Follow-up faecal cultures 2 days after completion of therapy, however, were negative in all 15 of the erythromycin-treated patients compared with 6 out of 14 controls. Thus erythromycin promptly eradicates C. jejuni from the faeces but does not alter the natural course of uncomplicated campylobacter enteritis when therapy begins 4 or more days after the onset of symptoms.

Analysis of 107 patients with cirrhosis and recent variceal haemorrhage included in a prospective randomised trial of endoscopic injection sclerotherapy showed that in the sclerotherapy group 22 (43%) of the 51 patients had episodes of haemorrhage during the period of treatment, but in only 4 did bleeding occur after the varices had been obliterated. This contrasts with episodes of bleeding in 42 (75%) of the 56 patients receiving standard medical management-a highly significant difference. The overall risk of bleeding per patient-month of follow-up was reduced threefold with sclerotherapy. Of 22 patients followed up for at least one year after obliteration of varices, 14 had no evidence of reappearance of varices within this period and, by means of cumulative life-analysis tables, survival was shown to be significantly improved in the sclerotherapy group.

The effect of 6 months of strict metabolic control upon eye and kidney function was studied in 32 insulin-dependent diabetics randomised either to unchanged conventional treatment (UCT) or to continuous subcutaneous insulin infusion (CSII). Retinal function was assessed by means of the macular recovery time (measured with nyctometry), the oscillatory potential (measured with electroretinography), and fluorophotometry. Renal function was assessed by the glomerular filtration rate (GFR) and the urinary albumin excretion rate. Individual median blood-glucose levels during the 6 months were 9.2 +/- 2.0 mmol/l (mean +/- SD) in the UCT group and 5.6 +/- 0.7 mmol/l in the CSII group. Haemoglobin Alc fell from 8.8 +/- 1.2 to 8.0 +/- 2% in the UCT group and from 9.6 +/- 1.7 to 6.7 +/- 1.0% in the CSII group. The UCT group showed a significant deterioration in all indices of retinal function (macular recovery -6%, oscillatory potential -5%, fluorophotometry +9%, whereas patients treated with CSII showed a distinct improvement (macular recovery +5%, oscillatory potential +7%, fluorophotometry -7%). GFR fell by 9% with CSII and rose 2% with UCT. Urinary albumin excretion fell by 12% with CSII and rose by 56% with UCT. This interim report of a one-year study supports the view that long-term control achieving near-normal blood-glucose levels may arrest or even reverse some of the features associated with diabetic microangiopathy.

The effects of topical glyceryl trinitrate in Raynaud's disease were compared with those of placebo in a double-blind, crossover trial in 17 patients with bilateral Raynaud's disease and an associated collagen disease, who were receiving oral sympatholytic agents at the maximum levels they could tolerate. 1% glyceryl trinitrate ointment or a placebo of lanolin was applied to one hand only for 6 weeks, then patients changed to the other preparation for 6 weeks. The results were evaluated every 2 weeks. The frequency of attacks, severity of attacks, and size of ulcers in the treated hand were significantly lower when the patients were using glyceryl trinitrate ointment than when they were using placebo. The treatment of Raynaud's disease may be improved by using topical glyceryl trinitrate ointment as an adjunct to a basic regimen of oral sympatholytic agents. Glyceryl trinitrate ointment may obviate the need for more aggressive treatment, such as intraarterial reserpine, in selected patients.

In a comparative clinical trial to examine the influence of 10 days of preoperative parenteral nutrition (PPN) on the postoperative complication rate for gastrointestinal carcinoma 59 patients (controls) received the regular hospital diet and 66 received PPN. The two groups were similar in nutritional status and in distribution of site and stage of tumour and type of operation. The rates of postoperative wound infection, pneumonia, major complications, and mortality were generally lower in the PPN group, but the differences were significant only for major complications and mortality. The clinical results can be explained by the improvement in various indices of humoral and cellular immunocompetence and the protein status in the PPN group and their deterioration in the control group during the preoperative course.

43 patients undergoing treatment for acute leukaemia were randomised to receive either co-trimoxazole alone or co-trimoxazole with framycetin and colistin as antibacterial prophylaxis during periods of neutropenia. There were no significant differences between the two treatment groups in the time before the onset of the first fever, the number of episodes of fever or of septicaemia per patient, the number of neutropenic days during which patients remained afebrile or did not require systemic antibiotics, or the number of resistant organisms acquired. Co-trimoxazole alone is cheaper and easier to take than co-trimoxazole with framycetin and colistin, and it is therefore preferable to the three-drug combination for the prophylaxis of bacterial infection.