In a double-blind study, hepatitis-B immunoglobulin significantly protected patients in a haemodialysis unit against the development of HBs antigenaemia, compared to control patients receiving normal human immunoglobulin (p less than 0-01). Injections were given at the beginning and after 6 months, and observations extended over 16 months. Analysis of antiHBc and anti-HBs antibodies suggested that neutralisation of the virus inoculum, as well as modification of infection, may be implicated in the prevention of HBs antigenaemia.

A randomised clinical trial in 124 adult patients with typhoid fever, proved by blood culture, showed that amoxycillin in a dosage of 1 g. six-hourly for fourteen days is an alternative to chloramphenicol, which has hitherto been regarded as the drug of choice.

Plasma 25-hydroxycholecalciferol (25-H.C.C.) has been measured in 67 consective cases of fracture of the proximal femur. The values found in these patients were not different from values found in these patients were not different from those in control groups at the same time of the year. Plasma 25-H.C.C. was not correlated to plasma calcium or phosphorus, the Ca times P product, or the alkaline phosphatase. X-rays showed Looser zones in only 1 patient, in whom the lowest plasma 25-H.C.C. was found. Osteomalacia is not uncommon among elderly people in Denmark, but it is more likely to depend on a decline in the renal efficiency to convert 25-H.C.C. to 1,25-dihydroxycholecalciferol than a low dietary intake of vitamin D.

In response to three reports of an association between rauwolfia derivatives and breast cancer, a case/control study was undertaken in Olmsted County, Minnesota. Comparison of a cohort of women with breast cancer to an age-match cohort of women with cholelithiasis failed to show any meaningful differences in the two groups except with respect to a history of hypertension. The rates of use of rauwolfia derivatives by hypertensive cases and controls were identical--which, along with other considerations, leads to the conclusion that an association between the use of rauwolfia derivatives and breast cancer is unlikely.

Outcome in eighty-eight recipients of cadaveric donor renal allografts preserved before implantation by machine perfusion with a solution of human albumin was compared to that for eighty-three recipients of similar kidneys implanted after simple cold storage. Average total ischaemic intervals for machine-perfused and cold-stored kidneys were 18 and 4 1/4 hours, respectively. Machine-perfused kidneys were implanted regardless of perfusion characteristics. Initial function and 1-month and 1-year graft survivals for the machine-perfused group (58%, 85%, 68%, respectively) were either similar or improved compared to those of cold-stored kidneys (58%, 81%, 52%, respectively). Improved 1-year survival for machine-perfused grafts was dependent upon reduced rejection. Careful donor selection and management ensured good machine perfusion of kidneys on 90% of occasions. In the other 10%, despite poor perfusion characteristics, outcome for kidneys was similar to those with good perfusion characteristics. Antilymphocyte globulin treatment reduced rejection whether allografts were machine perfused or not. In the absence of antilymphocyte globulin treatment, machine-perfused kidneys did much better than cold-stored kidneys. Machine perfusion had important advantages and improved the results in kidney-graft recipients.

The results of 5-day cyclical combined chemotherapy for advanced breast cancer were compared in two trials with the less demanding 1-day and 2-day regimens. At all stages, except at 3 months, 5-day treatment was significantly more successful in providing regression and remission of tumours than the 1-day regimen. However, although the differences are not statistically significant, data from the second trial indicated that the 2-day regimen tended to be more effective than the 5-day regimen. The lower 95% confidence limit for the success of the 2-day treatment was 56.2% at 3 months.

The immunogenicity, reactivity, and transmissibility of recombinant WRL 105 (H3N2) (A/Okuda/57XA/Finland/4/74) strain live attenuated influenza virus vaccine were studied in adult male volunteers in a residential community in rural England. Thirteen volunteers received a single dose of 10(7.0) E.I.D.50 recombinant WRL 105 vaccine administered as nose drops, and twelve volunteers received placebo. Nine (82%) of eleven volunteers with initial antibody titres of less than or equal to 1/96 showed a significant antibody response to vaccination, but there was no evidence of transmission of vaccine virus to those who received placebo. The incidence and nature of reactions were similar in those who received vaccine and placebo. The vaccine was shown to confer protection against natural infection with a strain exhibition antigenic characteristics equivalent to those of A/Scotland/840/74.

A 95% ethanol solution containing 0-5% chlorhexidine digluconate caused a significantly greater mean reduction in skin bacteria (99-9% plus or minus 0-024) when rubbed by a gloved hand on to the skin of one hand for two minutes than when applied to the same area for the same time with the traditional gauze applicator for operation sites (90-7% plus or minus 2-12). The latter reduction, however, was greater than that reported in five previous experiments in which application of the same solution for the same time to two hands gave mean reductions varying from 79% to 84%. An aqueous solution and a 70% alcoholic solution of chlorhexidine also gave significantly greater reduction (and alcoholic povidone iodine almost significantly greater reduction) when applied by a gloved hand than on gauze. It is inferred that the effectiveness of skin disinfection depends both on the antiseptic used and on the manner of application, and varies with the amount of friction used in applying the antiseptic. Further studies on disinfection of the surgeon's hands with 0-5% chlorhexidine in 95% alcohol rubbed on and allowed to dry have supported its value and acceptability; the mean bacterial counts of washings from gloves of surgeons after operations were lower after the use of this method than after other preoperative preparations of the hands.

A prospective study was carried out of the frequency of thrombophlebitis and bacterial contamination of cannulas associated with four commonly used intravenous cannulas of differing length and chemical composition. For all cannulas the frequency of thrombophlebitis increased significantly with time. Long 'Teflon' cannulas were significantly more likely to be contaminated with bacteria and associated with thrombophlebitis than all other cannulas, while the low frequency of thrombophlebitis with butterfly stainless steel cannulas was shown to be due to their short duration of use. It is suggested that long teflon cannulas should be avoided and that infusion thrombophlebitis could be eliminated as a clinical problem by the use of intermittent short duration intravenous infusions.

34 hypertensive patients were assigned at random either to six weeks' treatment by yoga relaxation methods with bio-feedback or to placebo therapy (general relaxation). Both groups showed a reduction in blood-pressure (from 168/100 to 141/84 mm. Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group). The difference was highly significant. The control group was then trained in yoga relaxation, and their blood-pressure fell to that of the other group (now used as controls).

In a double-blind randomised study, single intravenous doses of propranolol (0-1 mg. per kg.), practolol (1 mg. per kg.), acebutolol (1 mg. per kg.), or placebo were each administered at weekly intervals to six healthy volunteers. Forced expiratory volume in 1 second (F.E.V.1), resting and exercise heart-rate, and resting and exercise peak flow-rate (P.F.R.) were determined before and at 2, 3, 4, and 6 hours after each treatment. Venous blood-samples were also obtained at these times. Compared with placebo, resting heart-rate was reduced after all three drugs, but the corresponding differences in exercise heart-rate were much greater, more consistent, and of greater statistical significance. At 2, 3, and 4 hours when acebutolol and propranolol produced equivalent cardiac beta-blocking activity (judged by reductions in exercise heart-rate), their mean plasma concentratios were in the ratio of about 8/1; and at 2 hours when practolol and acebutolol gave rise to almost equivalent cardiac beta blockade, their mean plasma concentratio ration was 3/1. At times, reductions in F.E.V.1 and resting P.F.R. after propranolol (but not after practolol or acebutolol) were significantly greater than the corresponding changes after placebo. The reductions in exercies P.F.R. after propranolol (6 hours) and acebutolol (4 hours) (but not after practolol) were significantly greater than the changes after placebo. Changes in F.E.V.1, resting and exercise P.F.R. after propranolol, and the corresponding changes after practolol, were significantly different, all of which confirmed that practolol was more cardioselective than propranolo. In general, the reductions in F.E.V.1 and resting P.F.R. after acebutolol were slightly smaller than after propranolol, excepting at 6 hours when the difference between them was significant. The reductions in exercise P;F.R. after acebutolol and propranolol were of the same order, there being no significant differences between the two, whereas the reductions after acebutolol were clearly greater than the corresponding changes after practolol, the differences being significant at 2, 3, and 4 hours.

The efficacy of low-dose heparin in preventing fatal postoperative pulmonary embolism has been investigated in a multicentre prospective randomised trial. 4121 patients over the age of forty years undergoing a variety of elective major surgical procedures were included in the trial; 2076 of these were in the control group and 2045 patients received heparin. The two groups were well matched for age, sex, weight, blood-group, and other factors which could predispose to the development of venous thromboembolism. 180 (4-4 %) patients died during the postoperative period, 100 in the control and 80 in the heparin group: 72% of deaths in the control and 66% in the heparin group had necropsy examination. 16 patients in the control group and 2 in the heparin group were found at necropsy to have died due to acute massive pulmonary embolism (P smaller than 0-005). In addition, emboli found at necropsy in 6 patients in the control group and 3 in the heparin group were considered either contributory to death or an incidental finding since death in these patients was attributed to other causes. Taking all pulmonary emboli together, the findings were again significant (P smaller than 0-005). Of 1292 patients in whom the 125-I-fibrinogen test was performed to detect deep-vein thrombosis (D.V.T.) 667 were in the control group and 625 in the heparin group. The frequency of isotopic D.V.T. was reduced from 24-6% in the control group 7-7% in the heparin group (P smaller 0-005). In 30 patients D.V.T. was detected at necropsy; 24 in the control and 6 in the heparin group (P smaller 0-005). 32 patients in the control group and 11 in the heparin group developed clinically diagnosed D.V.T. which was confirmed by venography (P smaller than 0-005). In addition, 24 patients in the control and 8 in the heparin group were treated for clinically suspected pulmonary emoblism. The difference in the number of patients requiring treatment for D.V.T. and/or pulmonary embolism in the two groups was again significant (P smaller than 0-005). 9 patients were found at necropsy to have died from haemorrhage; 5 were in the control and 4 in the heparin group. A careful objective analysis of operative and postoperative bleeding in 1475 patients showed no statistically significant difference in the blood-transfusion requirements or in the fall in the postoperative haemoglobin level either in the individual operative groups or in the group as a whole. However, the difference in the number of patients who developed wound haematoma in the heparin and control groups was significant (P smaller 0-01). The results of the trial indicate that this form of prophylaxis can now be recommended for use on a large scale in "high-risk" patients undergoing major surgery.

Sucrose was tested as a possible alternative to glucose in oral diarrhoea therapy. Eighteen patients were given oral sucrose plus electrolytes as a maintenance solution. Fifteen of these patients could be maintained using this solution, but three developed massive increases in net fluid losses with increases in plasma specific gravity, necessitating termination of oral therapy. Twelve patients tested all had significant concentrations of stool reducing sugar. The data contrast with the rarity of treatment failures of oral glucose-electrolyte solutions. Glucose, therefore, is preferable to sucrose for oral therapy of diarrhoeal diseases.

The analgesic effect of self-administered nitrous oxide 50%/oxygen 50% ('Entonox" analgesic apparatus) was compared with air given by the same method in a double-blind trial in 81 patients with myocardial infarction. Self-administered nitrous oxide/oxygen, which was associated with a low frequency of side-effects, proved significantly more effective than air in the early relief of severe cardiac pain, but not in the relief of moderate or slight pain or when administration was continued after ten minutes.