40 patients prescribed electroconvulsive therapy (E.C.T.) for treatment of a depressive illness were randomly allocated to two groups. One group had the first two E.C.T. treatments replaced by simulated E.C.T. on a double-blind basis. The results show that E.C.T. is significantly superior to simulated E.C.T. in the treatment of depressive illness.

Three regimens have been used in the chemotherapeutic management of 75 adults with sarcoma. Methotrexate alone was used in 41 cases, a five-drug regimen was given in 12 cases, and adriamycin, T.I.C.-mustard, and methotrexate were given to 22 patients. Remissions, sometimes prolonged, were achieved with each regimen, and none was obviously better than the others. Because of the higher response-rate of primary or locally recurrent tumours it is suggested that sensitivity to drugs should be assessed earlier in the disease. It is proposed that a randomised study of methotrexate versus combination chemotherapy should be started in particular sarcoma subgroups, such as leiomyosarcoma and fibrosarcoma.

119 elderly, hypertensive patients were followed-up for 1 year and 48 for 2 years in a double-blind, randomised, controlled trial in which they received either placebo or 25-50 mg hydrochlorothiazide and 50-100 mg of triamterene daily. Half of the active treatment group also received 250 mg to 2 g methyldopa daily. After 2 years the active treatment group had an average increase in fasting blood-sugar of 9.6 mg/dl compared with an average fall of 3.1 mg in the placebo group (p less than 0.001). Blood-glucose rose by an average of 26.6 mg/dl in the active group when determined 1 hour after 50 g oral glucose and decreased by an average of 5.3 mg/dl in patients who had been on placebo for two years (p less than 0.05). The hyperglycaemic effect of diuretics appeared to be related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom the serum-potassium decreased over the 2 years.

Cholecystectomy increases the incidence of post-vagotomy diarrhoea. The effect of agents which either bind bile acids or prevent their action on the colonic mucosa has been studied in 31 patients with post-vagotomy diarrhoea--15 had had vagotomy and pyloroplasty alone and 16 vagotomy and pyloroplasty and cholecystectomy. Cholestyramine was particularly useful after the combined operation. Aluminium hydroxide in large doses has a similar mechanism of action to cholestyramine and is cheaper and more palatable, but propranolol was of no value. This study suggests that the excretion and chemical composition of bile and the handling of bile acids by the small intestine is of fundamental importance in the pathogenesis of post-vagotomy diarrhoea.

45 patients with healed duodenal ulcers completed a six-month double-blind trial to compare the effects of cimetidine and placebo on the prevention of duodenal-ulcer relapse. A single bedtime dose of cimetidine (800 mg) was given and ulcer relapse was assessed endoscopically at regular intervals. At the end of the six-month trial, 16 of the 21 (76%) cimetidine-treated patients remained ulcer-free compared with only 3 of the 24 (12.5%) placebo-treated patients. No untoward effects of this treatment were observed.

The delayed skin-test response to four antigens was assessed before and after 6 weeks' cimetidine therapy in patients with duodenal-ulcer disease. In the eight patients who received cimetidine there was a significant increase in both erythema and induration after six weeks' cimetidine therapy. In contrast, the intensity of delayed-hypersensitivity reactions at 6 weeks was not increased in eight control patients who did not receive cimetidine. These studies indicate that therapy with an H2-receptor antagonist may be associated with an augmentation of delayed hypersensitivity responses.

68 patients with chronic peptic ulcer took part in a double-blind trial in which 32 received the histamine H2-receptor antagonist cimetidine, (400 mg twice daily) and 36 received a placebo, for a year. 6 of those on cimetidine had an endoscopically proven recurrent ulcer within a mean of 7 months, while 30 of those on placebo had one after a mean of 4 months (P less than 0.0005). 1 patient on cimetidine had two recurrences compared with 12 patients on placebo (P less than 0.0005). No patient in the cimetidine group had complications compared to 4 patients in the placebo group, 2 of whom had melaena and haematemesis and 2 melaena alone (P less than 0.05). 15 patients on placebo and 1 on cimetidine were referred for surgery during the trial because of symptoms from their recurrent ulcers. Day and night ulcer pain and antacid consumption were significantly less, and general wellbeing better, in cimetidine group. The only probable side-effect of cimetidine was reversible drug-induced liver damage of hypersensitivity type in 1 patient.

20 out of 36 children (aged two to eight years) with atopic eczema completed a twelve-week, double-blind, controlled, crossover trial of an egg and cows' milk exclusion diet. During the first and third four-week periods, patients on an egg and cows' milk exclusion diet received a soya-based milk substitute (trial period) or an egg and cows' milk preparation (control period). Response was assessed in terms of eczema activity, number of areas affected, pruritus, sleeplessness, and antihistamine usage while on the two diets. During the middle period patients resumed their normal diet to minimise any carry-over effect. 14 patients responded more favourably to the antigen-avoidance diet than to the control diet, whereas only 1 responded more favourably to the control diet than the trial diet. Patients experienced more benefit during the first diet period than the second, whatever the nature of the diet. There was no correlation between a positive prick test to egg and cows' milk antigen and response to the trial diet.

Three groups of 5 chronically agoraphobic patients were treated by repeated exposure to cine film at weekly intervals for six weeks. A supraliminal group saw an agoraphobic film specially made for the study illustrating a range of phobic situations. A subliminal group viewed the same film at a level of illumination below the threshold of awareness. A control group saw a blank screen with no filmed material for the same length of time. The films were screened five times at each treatment and were alternated with neutral film shown under normal viewing conditions. Ratings of phobic and other symptoms were made by a separate assessor who was unaware of the patient's treatment. The supraliminal and subliminal groups improved significantly more than the control group with regard to phobic fears, avoidance, and overall assessment.

A double-blind cross-over trial of flufenamic acid three times a day (200 mg) was carried out in forty-four patients with primary dysmenorrhoea. While on flufenamic for 3 months 82% of patients experienced significant pain relief. Associated gastrointestinal symptoms, i.e--vomiting and diarrhoea--were relieved in 66% and 52% patients respectively while on flufenamic acid. It is concluded that the fenamates are useful and safe drugs in the treatment of primary dysmenorrhoea.

The prostaglandin-synthetase inhibitors, mefenamic acid and flufenamic acid, were compared with the analgesic, dextropropoxyphene/paracetamol, in the treatment of primary dysmenorrhoea in a double-blind crossover trial. Results were assessed in 30 patients who took each drug during menstruation for three consecutive cycles. The patients' assessment of each drug suggests that both mefenamic acid and flufenamic acid are more effective than the other analgesic for general relief of symptoms and for most of nine individual symptoms subjectively assessed by the patient. There was less absenteeism from work or school during mefenamic-acid treatment and fewer capsules of mefenamic acid were taken compared with the other two drugs. Patients took significantly fewer additional analgesics during mefenamic-acid therapy than during treatment with the other two drugs. 5 patients had possible side-effects--3 patients on mefenamic acid and 2 on dextropropoxyphene/paracetamol.

The effect on cadaver-kidney transplant survival-rates of a gamma-globulin concentrate, prepared from clotted blood centrifugally expressed from placental tissue recovered from postpartum women, was evaluated in a prospective controlled trial in 195 patients who were also given a standard immunosuppressive regimen. Allograft-survival rates were analysed according to whether or not the recipient had lymphocytotoxic antibodies before transplantation (responders) and whether the graft was a first or second transplant. The graft-survival rate was improved in responder-type recipients of first transplants who had received the gamma-globulin concentrate as adjunctive therapy (control group 28.8+/-10.1% vs. gamma-globulin 55.5 + 9.7% at 2 years, p less than 0.05). The survival-rate of grafts in non-responders was not affected by administration of gamma-globulin and data on its use in recipients of a second graft were insufficient for analysis. These results suggest that the gamma-globulin concentrate was suppressing immunological responses associated with humoral-type rejection.

31 patients with a diastolic blood-pressure between 95 and 109 mm Hg have been treated for two years with a regimen involving a moderate restriction of salt in the diet. The results are compared with those in a control group and in a drug-treated group. Salt restriction has reduced the diastolic blood-pressure by 7.3+/-1.6 mm Hg, a result similar to that in patients treated with antihypertensive drugs. In the untreated group the diastolic blood-pressure rose by 1.8+/-1.1 mm Hg. Most patients did not achieve the desired amount of salt restriction and a stricter adherence to the diet might have caused further falls in blood-pressure. Excessive salt intake is probably a major cause of the epidemic of hypertension in "civilised" countries and a reduction in salt intake may help to control the epidemic. In persons with a diastolic blood-pressure between 90 and 105 mm Hg salt restriction should be tried before drugs.