One group of healthy full-term newborn babies was washed after birth and another was bathed to remove vernix caseosa and clean the skin. Few infections, none of them serious, occurred in either group. Bacterial colonisation of the umbilical cord on the third day of life was similar in both groups. The rectal temperature fell further and more infants cried during washing than during bathing. Thus bathing the baby after birth makes it calmer, quieter, and more comfortable than washing and causes less heat-loss. Clinical signs of infection and bacterial colonisation rates are no higher after bathing than after washing.

129 men aged 60 years or less with a diagnosis of myocardial infarction were allocated to one of three programmes of management: normal treatment (control), exercise training, or extra advice. Outcome was evaluated after twelve weeks by exercise testing and standardised assessments of psychological state and social adjustment. There were no differences between the groups in psychological outcome, physical activity, or satisfaction with leisure or work. The "exercise" patients were more enthusiastic about their treatment and achieved higher work levels on exercise testing than the "advice" or "control" groups. Those who did not attend had a significantly worse outcome. At eighteen months the only significant findings were better outcomes, in terms of overall satisfaction, hours at work, and frequency of sexual intercourse, for the "advice" group. Exercise training increased confidence during exercise in the early stages of convalescence but the overall results show that rehabilitation is of little benefit to cardiac function, everyday life, or emotional state.

Treatment of hypertensive patients with dl-propranolol (640 mg/day) significantly inhibited thromboxane synthesis by their platelets and platelet aggregation induced by thrombin or arachidonic acid. The effects were dose-related and were also caused by the stereoisomer, d-propranolol (640 mg/day), which has very little beta-blocking activity. These findings suggest that the cardioprotective effects of propranolol may be due partly to this anti-platelet activity, to a reduction in thromboxane-induced coronary-artery vasoconstriction, or to both. d-Propranolol treatment may be particularly useful, since this isomer provides similar benefits without causing pronounced beta-adrenergic blockade.

The effect of placebo on blood-pressure levels in 20 hypertensive patients was examined as part of a double-blind randomised controlled trial with indoramin. Blood-pressure was measured by both standard sphygmomanometry and ambulant intra-arterial monitoring. Blood-pressure reduction during the placebo phase, as measured by sphygmomanometry in the outpatient clinic, was highly significant for both systolic and diastolic pressures. In the same subjects, concomitant assessment by ambulatory monitoring showed no significant effect of placebo on intra-arterial pressure. After indoramin treatment blood-pressures measured in the clinic showed a mean reduction of 6/8 mm Hg whereas intra-arterial monitoring showed mean reductions of 18/13 mm Hg. The placebo response, therefore, appears to be an artifact of clinic blood-pressure measurement and its use as a control value in pharmacological trials may lead to serious underestimation of the efficacy of the active drug.

The efficacy of argon laser photocoagulation in the endoscopic control of haemorrhage from peptic ulcers was tested in a controlled trial at two centres in London. Of 330 patients consecutively admitted with acute upper gastrointestinal tract haemorrhage, 76 were seen at endoscopy to have a peptic ulcer accessible to laser therapy and stigmata of recent haemorrhage. These patients were included in the trial. Identification of the exact source of haemorrhage within the ulcer crater was achieved by use of standard endoscopes with careful washing. Patients were stratified into three groups: ulcers with a visible vessel (52 total, 11 actively spurting); those without a vessel (17); and those with an overlying clot persisting after washing (7). Of the 52 patients with visible vessel, 8 of 24 treated with the laser and 17 of 28 control patients had a further haemorrhage. 7 control patients died after an episode of rebleeding, but no treated patients. Treated and control patients were well matched for other factors known to influence the case fatality rate. This is the first controlled trial to demonstrate a significant reduction in mortality by the use of a non operative treatment in patients with bleeding peptic ulcers.

To identify diets that are more effective than existing ones in reducing lipoprotein-mediated risk of atherosclerotic heart disease, the serum lipids and lipoprotein response to three modified diets was studied in twelve normal men living in an institution. The "Western" reference diet (40% energy from fat, P/S ratio 0.27) was compared in Latin square design with a fat-modified diet (diet B, 27% energy from fat, P/S 1.0, reduced cholesterol content); with a fat-modified diet supplemented with fruit, vegetable, and cereal fibre (diet C); and with a diet providing 40% energy from fat, having P/S ratio 1.0 and supplemented by fibre (diet D). The effects of fat modification and fibre-supplementation (diets C and D) were strongly additive-a fall serum cholesterol by 24-29%, in low-density-lipoprotein (LDL) cholesterol by 31-34%, and in serum triglyceride by 21-26%; and the reduction, by diet C, of the ratio of serum cholesterol to high-density-lipoprotein (HDL)-cholesterol by 21%, and that of LDL-cholesterol to HDL2-cholesterol by 26%. The additive effects of multiple changes in nutrient intake, each moderate in extent, permits the design of diets which are remarkably effective in reducing serum-cholesterol level.

16 202 men, aged 40-49 years, were screened for coronary risk factors, Of these, 1232 healthy, normotensive men at high risk of coronary heart disease (CHD) were selected for a 5-year randomised trial to show whether lowering of serum lipids and cessation of smoking could reduce the incidence of CHD. Men were admitted to the trial if they had serum cholesterol levels of 7.5-9.8 mmol/l (290-380) mg/dl), coronary risk scores (based on cholesterol levels, smoking habits, and blood pressure) in the upper quartile of the distribution, and systolic blood pressures below 150 mm Hg (mean of two measurements). The men in the intervention group were recommended to lower their blood lipids by change of diet and to stop smoking. Mean serum cholesterol concentrations were approximately 13% lower in the intervention group than in the control group during the trial (based on the difference between the mean of 3 prerandomisation values and the mean of yearly values during the trial). Mean fasting serum triglycerides fell by 20% in the intervention group compared with controls. 80% of the men in both groups smoked tobacco daily at the start of the study. The mean tobacco consumption per man decreased by 45% more in the intervention group than in the control group. However, only 25% of the smokers in the intervention group completely stopped smoking compared with 17% in the control group. Diagnosis of events of cardiovascular disease during the study was made blindly according to predefined criteria by two cardiologists not involved in the study. At the end of the observation period the incidence of myocardial infarction (fatal and non-fatal) and sudden death was 47% lower in the intervention group than in the controls (p = 0.028, two-tailed log rank test). When the incidence of strokes was added, the difference between the groups was still significant. It is concluded that in healthy middle-aged men at high risk of CHD advice to change eating habits and to stop smoking significantly reduced the incidence of the first event of myocardial infarction and sudden death. Statistical analysis, by Cox's proportional hazards model shows that the reduction in incidence in the intervention group is correlated with the reduction in total cholesterol and to a lesser extent with smoking reduction.

Fifteen patients with bilateral, symmetrical, chronic pyrophosphate arthropathy of the knee were given intra-articular injections of yttrium-90 (5 mCi) plus steroid (triamcinolone hexacetonide, 20 mg) into one knee, and saline plus steroid into the other (control) knee. Allocation of the 90Y injection was random and double blind. After 6 months there was significantly less pain, inactivity stiffness, joint-line tenderness, and effusion in the 90Y-injected knees than in the controls (p less than 0.01). There were also significant differences between 90Y-injected and control knees in the changes in range of movement (p less than 0.01) and joint circumference (p less than 0.05) caused partly by progression of disease in the control knees. No significant differences in joint deformity, instability, X-ray appearance, or synovial-fluid analysis were seen. In all cases patient and observer assessment favoured the treated side (p less than 0.01). These findings indicate that intra-articular 90Y may be of benefit in chronic pyrophosphate arthropathy, a disease for which there is no treatment. The predilection of this condition to affect the knees of the elderly makes such treatment highly suitable because the joint lends itself readily to injection and the procedure carries very few actual or potential risks in this age group.

A group of vitamin-D-depleted Asians was identified in the spring of 1980 and treated with 2.5 mg ergocalciferol in the autumn of that year. Treatment produced a sustained rise in the serum level of 25-hydroxyvitamin D which lasted until the spring of 1981. The response was more predictable after oral than after intramuscular administration. Treatment in the autumn provides an effective, efficient, and cheap means of prophylaxis against vitamin D deficiency in Asians during the winter. A "once a year" regimen promises a much higher compliance rate than could be achieved by daily supplementation.