Patients with bacteriologically positive pulmonary tuberculosis were treated initially for an average of three and a half months with isoniazid, rifampicin, and ethambutol and then a total of one year's treatment was completed with either rifampicin plus isoniazid (R+I) or with ethambutol plus isoniazid (E+I). 63 patients in each continuation group were followed up for at least one year, and no relapses occurred. Continuation treatment with E+I was as effective and acceptable as that with R+I and was much less costly.

To determine whether community health education can reduce the risk of cardiovascular disease, a field experiment was conducted in three northern California towns. In two of these communities there were extensive mass-media campaigns over a 2-year period, and in one of these, face-to-face counselling was also provided for a small subset of high-risk people. The third community served as a control. People from each community were interviewed and examined before the campaigns began and one and two years afterwards to assess knowledge and behaviour related to cardiovascular disease (e.g., diet and smoking) and also to measure physiological indicators of risk (e.g., blood-pressure, relative weight, and plasma-cholesterol). In the control community the risk of cardiovascular disease increased over the two years but in the treatment communities there was a substantial and sustained decrease in risk. In the community in which there was some face-to-face counselling the initial improvement was greater and health education was more successful in reducing cigarette smoking, but at the end of the second year the decrease in risk was similar in both treatment communities. These results strongly suggest that mass-media education campaigns directed at entire communities may be very effective in reducing the risk of cardiovascular disease.

318 patients admitted to hospital with acute upper-gastrointestinal-tract bleeding were entered into a prospective randomised comparison of investigation by either endoscopy or radiology. Although the diagnostic yield was higher in the endoscopy group than the radiology group, there was no difference between the two groups in management or survival, and the accuracy of the findings as judged independently at operation and/or necropsy was also similar in the two groups. These findings case doubt on the need to provide emergency endoscopic facilities for the investigation of patients with acute upper-gastrointestinal-tract bleeding where radiological services are already adequate.

In a prospective trial 76 patients with venous thromboembolism have received intermittent constant-dosage heparin or continuously infused heparin with laboratory control. Frequencies of bleeding were similar in both groups. 32% of all patients bled, 13% severely. Retroperitoneal haemorrhage occurred in 5 patients. Major spontaneous bleeding was commoner in older patients and minor spontaneous bleeding in women. Bleeding was uncommon during the first 2 days of treatment, and its daily frequency was relatively constant thereafter. 21% of surgical wounds and 7% of arterial and venous puncture sites bled. These preliminary results illustrate the hazards of heparin therapy and suggest that bleeding complications are more closely related to duration of therapy, age, sex, and surgical trauma than to method of administration.

The results of using interrupted nylon skin sutures or subcuticular polyglycolic acid (P.G.A.) sutures after appendicectomy were compared in a prospective controlled trial in 127 patients. Wound infections were significantly more common when subcuticular skin closure was used.

In a two-year study of 322 conservatively treated, consecutive cases of tetanus in a rural hospital (all over twelve months old), intrathecal administration of 200 units of antitetanus serum (A.T.S.) (horse) reduced the overall mortality of 4-5% (5/110) compared with 14-5% (16/111) in the control series. 200 units intrathecal A.T.S. (horse) gave better results than 1500 units A.T.S. (horse). The results with lumbar and cisternal administration did not differ. It is suggested that tetanus is a polysystemic condition requiring polysystemic therapy. A regimen in which intrathecal A.T.S. is given as an adjunct to low-dosage systemic A.T.S., high levels of systemic betamethasone and diazepam, and careful nursing gave results which compare favourably with those of centres with more elaborate equipment and specialised staff.

The relationship of future clinical coronary heart-disease (C.H.D.) to the plasma-high-density-lipoprotein (H.D.L.)-cholesterol concentration has been examined in a 2-year case-control follow-up study of 6595 men aged 20-49 years living in the municipality of Tromsø, Norway. Measurements were also made of the cholesterol concentration in lower-density (i.e., density less than 1-603 g/ml) lipoproteins, plasma-triglycerides, systolic and diastolic blood-pressures, relative body-weight, and cigarette consumption. Discriminant-function analysis showed that coronary risk was inversely related to H.D.L.-cholesterol concentration and directly related to density less than 1-063 cholesterol. These relationships were independent of each other and of the other measured variables, which showed no significant differences between the cases and controls. H.D.L. cholesterol made a three-fold greater contribution to the prediction of future C.H.D. than did density less than 1-063 cholesterol in this cohort of young men. These findings support the proposal that a low H.D.L. concentration is a common antecedent of clinical C.H.D. and is important in accelerating the progression of coronary atherosclerosis.

Patients with inguinal hernia or haemorrhoids were randomly allocated to an experimental group expected to stay in hospital for only eight hours after surgery or a control group scheduled for discharge on the fifth or sixth day. There was no difference in clinical outcome between the two groups of hernia patients. However, complications were twice as common in haemorrhoid day-patients as in long-stay haemorhoid patients. The standard postoperative regimen for haemorrhoids has since been changed and the change has been accompanied by a fall in the complication-rate. Day-case surgery appears to have similar social effects on the patient and his family as traditional hospital care. There was no significant difference in either the additional expenditure incurred or patients' perceptions of the disruption associated with their operation and convalescence. In the hospital under study, day-case surgery was saving between 20 pounds and 29 pounds per patient. However, this conclusion should not be extrapolated to the N.H.S. as a whole without taking into account the use to which the resources released by day-case surgery will be put.

D-penicillamine, 900 mg daily, was used in a randomised controlled trial for treatment of patients with primary biliary cirrhosis. 19 patients received D-penicillamine and 13 received placebo. The two groups were similar in age, duration of illness, liver function tests, and liver histology. Before entry into the trial liver-copper concentration was raised in 25 of the 27 patients in whom it was measured. After three months patients taking D-penicillamine showed a significant reduction in serum-aspartate-transaminase concentrations compared with the placebo group, and this reduction seemed to be sustained. In the 4 patients on D-penicillamine for a year, a second liver biopsy showed that mean liver-copper concentration fell from 310 +/- 128 (S.E.M.) to 84 +/- 36 microng/g dry liver, compared with a reduction from 511 +/- 169 to 454 +/- 128 in the 7 patients in the placebo group in whom serial liver-copper measurements were available. Liver histology demonstrated a comparative improvement in cholestasis in patients on penicillamine, but the degree of inflammation, necrosis, and the histological stage of disease remained similar in both groups. In 5 of the 19 patients in the D-penicillamine group the drug was discontinued because of side-effects. D-penicillamine seems to be a promising treatment for patients with primary biliary cirrhosis. It may produce its effect by reducing liver-copper concentration.

Three therapeutic regimens were investigated to find the best way of treating duodenal ulceration with the histamine H2-receptor antagonist metiamide. Relapse of duodenal ulceration was not prevented by nocturnal administration of metiamide. Recurrence was prevented by continued administration of metiamide for 1 year, but cessation of treatment was followed by rapid relapse or symptomless recurrence of the ulceration. Repeated short courses (1 month) of treatment resulted in slower symptomatic control and more rapid recurrence of the ulceration. The treatment of duodenal ulcer with H2-receptor antagonists requires further investigation.