A long-term study is described of recombinant influenza viruses produced from the avirulent laboratory strain, A/PR/8/34 (H0 N1), and newly isolated H3 N2 influenza virus variants. A number of H3 H2 recombinants were found to be attenuated for man and capable of inducing antibody formation, and were therefore potentially usable as live vaccines. However, the volunteer trials as a whole suggested that, in this system, there might not be complete segregation of virulence and antigenic characteristics. No H3 N2 recombinants were detected which were non-infective for man, like the A/PR8 (H0 N1) parent, and reciprocal hybrids (H3 N1 and H0 N2) always reflected some of the virulence of the parent from which they had inherited their haemagglutinin. This property is not a feature of mouse influenza.

Twenty-five patients in acute respiratory failure were randomised to receive either 5 cm of positive end-expiratory pressure (P.E.E.P.) or no-P.E.E.P. while weaning from controlled ventilation. The use of P.E.E.P. resulted in a significant reduction in the increase in alveolar-arterial oxygen tension gradient (AaDO21) which occurred in the group of patients who were converted from controlled ventilation to spontaneous ventilation without P.E.E.P. Patients who weaned without P.E.E.P. had a mean increase in AaDO21 of 102+/-35 mm Hg S.E. while those who weaned with P.E.E.P. had a mean increase of only 10+/-22 mm Hg (P less than 0-03). The use of P.E.E.P. was also associated with a significant improvement in the vital capacity and the maximum inspiratory force. Patients who weaned with P.E.E.P. had an increase in vital capacity of 258+/-108 ml (P less than 0-05) and an increase in inspiratory force of -15+/-5 cm H2O (P less than 0-01), while patients who weaned without P.E.E.P. did not have significant changes in these measurements. The use of P.E.E.P. during weaning may be helpful in patients who fail to wean because of the development of hypoxaemia due to rapid alveolar collapse, since P.E.E.P. appears to minimise the increase in intrapulmonary right-to-left shunt which normally occurs during weaning from controlled ventilation.

Electroencephalographic (E.E.G.) sleep changes were studied in eight young healthy male subjects who were given a normal balanced diet or a high-carbohydrate/low-fat or low-carbohydrate/high-fat isocaloric diet, according to an experimental design. Significantly less slow-wave sleep (S.W.S.) was found after consuming a high-carbohydrate/low-fat diet than after consuming a normal balanced diet or a low-carbohydrate/high-fat diet. The latter two diets did not differ in terms of the amounts of S.W.S. Both high-carbohydrate/low-fat and low-carbohydrate/high-fat isocaloric diets, especially the former, were associated with significantly more rapid-eye-movement (R.E.M.) sleep than was the normal balanced diet. These findings emphasise the importance of daily diet for the following night's sleep.

The frequency of late sequelae in 454 patients sterilised by laparoscopy and diathermy or by abdominal tubal ligation was compared with that in 154 controls whose husbands had had a vasectomy. Results showed an increase in menstrual loss and pain with menstruation in the sterilised groups, especially if this had been done by diathermy and division under laparoscopic control.

L-prolyl-L-leucyl-glycine amide (P.L.G.) has melanocyte-stimulating-hormone-inhibitory hormone (M.I.F.) activity. When injected intravenously as a bolus of 200 mg, it greatly potentiated the effect of an oral levodopa dose upon motor performance objectively measured by a battery of tests. This amelioration in motility was accompanied by improvement in intellectual functioning.

17 consecutive patients who presented with extensive deep-vein thrombosis, confirmed by phlebography, were included in this study. Of 12 patients who received streptokinase and plasminogen infusion, complete lysis of thrombi was obtained in 8 and partial but extensive lysis in 4. In contrast, thrombi remained unchanged in each of 5 patients who received the same doses of streptokinase infusion only.

A suggestion that mania is associated with an increased membrane transport of sodium has been investigated in a double-blind trial of a specific Na-K A.T.P.ase inhibitor (digoxin) in twelve female inpatients with mania. Digoxin had no effect.

341 patients with acute myocardial infarction have been treated in intensive or coronary care units. They were randomised into two groups, 172 receiving urokinase and 169 receiving a glucose infusion. Thereafter they were anticoagulated first with heparin and then for a year with oral anticoagulants. Despite a significantly faster regression of electrocardiographic alterations in the urokinase group there was no difference in mortality during the 1-year follow-up (29 deaths in the urokinase and 24 in the control group) and no difference in cardiac functional class between both groups.

The results of treatment of two groups of patients with primary melanoma are compared. 25 patients in group 1 were treated by wide local excision of the primary melanoma, and 23 in group 2 were treated by vaccination with live vaccinia virus 14 days before wide local excision. Vaccination exerts a favourable effect on the course of melanoma both in terms of survival and prolongation of the interval between treatment of the primary lesion and subsequent development of metastases.

The efficacy and toxicity of bromocriptine, a drug which simulates dopamine, have been studied in twenty-eight patients with idiopathic parkinsonism. A double-blind, within-patient comparison between maximum tolerated doses of bromocriptine (mean 46-9 mg daily) and placebo revealed a substantial and statistically significant therapeutic response to the active drug. Adverse reactions were dose dependent, reversible, and similar to those encountered with levodopa. While taking bromocriptine fourteen patients were able to stop levodopa (with or without carbidopa); in five patients the dose of levodopa was reduced by 54% (mean). Eight patients could not tolerate bromocriptine; one patient failed to comply with prescribed adjustments of dosage.

Inhaled beclomethasone dipropionate and inhaled betamethasone valerate have been compared with oral prednisone in the treatment of 75 patients with asthma who were starting long-term corticosteroids for the first time. Both of the inhaled corticosteroids controlled asthma as well as did oral prednisone in those who had responded to therapy in the initial period of the trial. A daily dose of 400 mug of inhaled drug was approximately equivalent to 7-5 mg daily of prednisone. Prednisone suppressed the adrenal response to tetracosactrin, whereas the mean responses in the groups receiving inhaled corticosteroids did not change significantly from pre-trial values. The 30% incidence of other systemic unwanted effects of prednisone contrasted sharply with the low incidence (5%) of symptomatic oropharyngeal candidiasis in the patients receiving inhaled corticosteroids. In a sample of 19 patients no change in exfoliative cytology was detected over the period of the trial nor was there any evidence of fungal colonisation of the bronchial tree. There was no difference between the three treatment groups in the number of antibiotic courses prescribed. The persistent production of sputum made no difference to the response to inhaled corticosteroids. Patients not on sodium cromoglycate did as well in the trial as those receiving sodium cromoglycate. Both inhaled beclomethasone dipropionate and inhaled betamethasone valerate have advantages over oral prednisone in the maintenance treatment of patients with asthma, but in the management of exacerbations systemic corticosteroids will usually be needed as a supplement to inhaled therapy.

In a sibship of 5 brothers and 7 sisters, 3 sisters died from acute myelocytic leukaemia while a 4th probably had the same disease. Laboratory studies on the close relatives revealed that a 5th sister had persistently high erythrocyte sedimentation-rates and serum-IgM levels and serological evidence of acute leukaemia-associated antigens. These findings suggest a possible preleukaemic state in this patient.