A polyvalent pseudomonas vaccine has been tested in controlled clinical trials at two burns units, in Birmingham and New Delhi, in children and adults with burns more than 15% full skin thickness. None of the vaccinated patients in either trial showed blood cultures containing Pseudomonas aeruginosa, and vaccinees showed raised titres of protective antibody and increased phagocytic activity against Ps. aeruginosa. In the New Delhi unit, where death from Ps. aeruginosa infection is common, the mortality in adults was reduced from 40.6% (13/32) in the unvaccinated group to 6.6% (2/30) in the vaccinated group, and in children from 20.8% (5/24) in the unvaccinated group to 4.8% (1/21) in the vaccinated group.

192 Ugandan patients with Burkitt's lymphoma were treated with various regimens containing high-dose cyclophosphamide. 21 patients died during induction therapy, and 14 died after partial responses. Of 157 patients who responded completely to treatment, 16 were lost to follow-up (10 in 69 died and 72 (51%) are alive and disease-free. 31 of the long-term survivors have relapsed at least once and have been successfully retreated. Overall, 34 surviving patients had central-nervous-system involvement, also successfully treated. It is concluded that Burkitt's lymphoma is curable in at least 50% of patients, and that relapse and central-nervous-system involvement are not incompatible with long survival.

Symptoms associated with carbohydrate malabsorption limit the usefulness to diabetics of a powerful glycoside-hydrolase inhibitor (acarbose) which reduces postprandial glycaemia. Addition of a low dose (50 mg) of a acarbose together with 14.5 g guar gum to a breakfast test meal taken by 8 healthy volunteers reduced the mean peak rise in blood-glucose at 30 min by 70%. Areas under the insulin and gastrointestinal-polypeptide response curves were also greatly reduced. No evidence of carbohydrate malabsorption, as assessed by measurement of breath hydrogen, was found during any of the test periods. When acarbose was taken alone, 3 of the 8 subjects had troublesome symptoms and the 30 min rise in blood-glucose was reduced by only 28%. Thus, combination of these two agents effectively reduces the rate of carbohydrate absorption without increasing side-effects and may make combined acarbose and guar acceptable in the management of some diabetics.

The most notable changes in the 35-lead precordial electrocardiogram in 22 subjects in the first 6--12 months after acute myocardial infarction were a reduction in the amplitude of Q waves and a significant increase in the amplitude of the R waves. Patients who, in a random trial, had been given 100 mg atenolol daily from admission showed a significantly greater recovery in R-wave amplitude and decrease in Q waves than patients given placebo. It is concluded that atenolol improves the recovery of the electrocardiographic signs of myocardial infarction.

A double-blind study of alprenolol versus placebo was done in patients with definite or suspected myocardial infarction to show the effect of the drug on mortality-rate after a year of treatment in patients aged less than or equal to 65 and to study the tolerance of the drug by patients greater than 65 years of age. The dose given was 5--10 mg intravenously, followed by 200 mg twice a day, orally. Patients in whom beta-blockade was contraindicated were excluded. All deaths, side-effects, and dropouts were recorded. Of the 480 patients in the study, 238 patients received alprenolol and 242 placebo. During the year of follow-up 108 patients dropped out from the study. Mortality was not reduced in patients greater than 65 years of age. In those less than or equal to 65 years alprenolol significantly reduced mortality-rate (20% mortality in placebo group vs 9% in treated group). There was also a significant reduction in mortality-rate among those with definite infarction (28% in the placebo vs 15% in the treated group).

In a prospective double-blind randomised trial 83 patients undergoing elective colorectal surgery were given either preoperative intravenous metronidazole or intravenous normal saline. No other antimicrobials were given. Bowel preparation was the same for both groups. Deep post-operative wound sepsis occurred in 6 of 44 (13-6%) patients on metronidazole but in 20 of 39 (51-2%) control untreated patients. Anaerobes were responsible for all cases of deep sepsis in the metronidazole group (in 5 of the 6 cases aerobes were also isolated), and for 16 of the 20 cases of deep sepsis in the control group (all with aerobes). Superficial infection in the metronidazole group was caused by aerobes. Anastomotic leakage occurred in 5 of the 6 patients who developed deep sepsis on metronidazole and in 10 of 20 patients on placebo. Peroperative intravenous metronidazole dramatically reduced postoperative sepsis but failed to prevent infection in the presence of anastomotic breakdown.

406 women--about one-fifth of those requesting an induced abortion and sterilisation over a thirty-three-month period--volunteered to be allocated randomly to either a concurrent induced-abortion/sterilisation group or a group which was sterilised six weeks after abortion. The abortion-attributable and sterilisation-attributable complication rates of 3.8% and 5.2%, respectively, for the concurrent group did not differ significantly from the 6.7% and 6.9% rates for the interval group. The estimated 2%-10% of women who would have changed their minds must be set against the 4% of women who became pregnant again before being sterilised. Efforts should be made to identify women likely to regret sterilisation.

The effect of cimetidine on the risk of further bleeding shortly after acute gastrointestinal haemorrhage from peptic ulcer was investigated in a double-blind randomised trial. 34 patients were given cimetidine and 32 placebo, the two groups being matched for age, sex, and severity of haemorrhage. Further bleeding within a week of admission was detected clinically in 8 patients on cimetidine and 15 on placebo. Cimetidine had no effect on bleeding from duodenal ulcer, but only 2 of 14 patients with gastric ulcer treated with cimetidine bled again, compared with 10 of 19 patients on placebo. Cimetidine, therefore, may help to prevent haemorrhage from gastric ulcer but not duodenal ulcer.