The results of a randomised trial of irradiation of the knee (synoviorthése), by intra-articular injection of yttrium-90, and surgical synovectomy have been compared in twenty knees in seventeen patients. The mean length of follow-up was 2 years. Relapse occurred in three out of ten irradiated knees, and in 2 out of 10 operated knees. Fewer irradiated knees were involved when generalised exacerbations of polyarthritis occurred. Irradiation carries a lower risk of complications than does synovectomy, it is more acceptable to patients, requires fewer days in hospital, and is cheaper; it would seem to be the treatment of choice in the older patient.

Sixty-three girls with covert bacteriuria were included in a controlled trial of therapy. Recurrent infection in the treated group was common and was not significantly different from the rate of persistent infection in the untreated control group. Two children in each group developed clinical pyelonephritis; the others have remained healthy and all of them have a normal rate of growth. 2 years after diagnosis three of the thirty-four children in the control group and one of twenty-six children in the treated group have radiological evidence of new scars of pyelonephritis. These changes were relatively minor and in both groups of children renal growth was similar to that in normal children. It is suggested that for most of these children therapy is not essential, and that when renal changes occur they are of little or no significance. Prescriptive screening for cobert bacteriuria of childhood cannot be recommended at present.

By use of the continuous-flow blood-cell separator 137 bags of granulocyte-rich plasma were obtained from normal donors (59 bags) and patients with chronic granulocytic leukaemia (C.G.L.) (78 bags). Eighty-nine courses of granulocyte transfusion therapy consisting of 1 or more such bags were administered to forty-one ABO-compatible patients with acute leukaemia or aplastic anaemia, who had definite or probable infections that had failed to respond to antibiotics. The fever resolved after 67% of courses of transfusions of two or more bags but after only 24% of transfusions of single bags of granulocytes (p less than 0-01), and this result suggests that this form of treatment is in general effective. Granulocytes from C.G.L. and normal donors were equally effective, although transfusion reactions were commoner after C.G.L. cells (33% versus 12%, respectively, p less than 0-05). C.G.L. grafts, and probable graft-versus-host disease, occurred in three recipients of unirradiated C.G.L. cells. Recipients of normal cells whose fevers resolved received on average four times as many granulocytes per sq.m. as those fevers did not respond. No such difference was found when C.G.L. cells were used. The fever was more likely to resolve in recipients with established or clinically probable bacterial or fungal infections than in those with fever of uncertain cause. Fever was less likely to resolve in recipients with peripheral blood granulocyte counts before transfusion of greater than 1000 per mul. It is concluded that granulocyte transfusion therapy is a valuable advance in the management of infections in neutropenic patients.

The effect of lowering raised plasma-free-fatty acids (F.F.A.) on the incidence of serious ventricular arrhythmias after myocardial infarction was assessed by a double-blind trial in eighty-one patients. A nicotinic-acid analogue (N.A.A.) with very slight haemodynamic effects was given within 12 hours of the onset of myocardial infarction to lower plasma-F.F.A. When treatment with N.A.A. was started within 5 hours of the onset of symptoms, the numbers of patients with ventricular symptoms, the numbers of patients with ventricular tachycardia were significantly reduced, provided elevated plasma-F.F.A. levels were rapidly lowered and maintained in the normal range throughout the treatment period. The incidence of R-on-apex T ventricular premature beats and beats in which the ectopic R wave interrupted the apex of the T wave of a previous ventricular premature beat was also reduced in patients receiving N.A.A within 5 hours of the onset of symptoms. Plasma-total-catecholamines and serum-creatine-kinase levels were similar in the N.A.A.-treated and placebo groups. N.A.A. rarely caused skin flushing, but vomiting occurred in some patients after many hours of treatment. These findings suggest that treatment directed towards stabilsing the matabolism of the ischaemic myocardium can be of therapeutic value and lead to fewer serious ventricular arrhythmias.

A prospective, randomised trial compared polygycolic-acid subcuticular skin closure with interrupted silk skin closure in 152 patients. There was no significant difference in the incidence of wound infection. The use of polyglycolic acid was associated with economic advantages.

Rubella-specific immunoglobulin responses in sera and nasopharyngeal secretions were compared in groups of adult females who had experienced naturally acquired rubella or infection induced by Cendehill, HPV77.DE-5, RA27/3 (subcutaneously and intranasally), and To-336 vaccines. Serum IgG and IgA and nasopharyngeal IgA responses after vaccination by RA27/3 intranasally most closely resembled those induced by naturally acquired infection. However, the other vaccines failed to induce a persistent local IgA response. Levels of local antibody induced by HPV77.DE-5 were especially poor. Virus-specific IgM was detected for prolonged periods. The highest levels and the most persistent response followed vaccination by HPV77.DE-5, four of five volunteers still having rubella-specific IgM at 1 year. Virus-specific IgM persisted for 6 months in seventeen of twenty-five (68%) and for a year in nine of twenty-four (38%) vaccinees. It was still present in four of nine (44%) naturally infected patients at a year.

A randomised trial comparing radiotherapy with a multiple chemotherapy regimen in 68 patients with small cell carcinoma of bronchus is reported. Although overall survival was poor, radiotherapy resulted in significantly longer survival, better amelioration of symptoms, and less side-effects than chemotherapy. Patients achieving complete or partial remission on radiotherapy relapsed mainly with extrathoracic disease, in contradistinction to those treated with chemotherapy whose thoracic disease recurred.