The bronchodilator efficacy and safety of metaproterenol sulfate were evaluated by double-blind crossover tests against placebo at three intervals during a 90-day treatment period in 50 asthmatic children. One group of 25 patients was continuously treated with metaproterenol syrup, and the other 25 with placebo syrup. Pulmonary function tests showed statistically significant improvements in forced expiratory volume, forced expiratory volume in one second, and peak expiratory flow rate after metaproterenol administration as compared with those measurements after treatment with placebo. Biweekly global evaluations of responses to metaproterenol administration were consistently more favorable than responses to placebo. Tachycardia and blood pressure changes after metaproterenol administration were consistent with the pharmacologic properties of beta-sympathomimetic stimulants. Side effects during metaproterenol treatment were minimal and laboratory data remained normal.

The relative effectiveness of ephedrine, theophylline, and hydroxyzine hydrochloride and their combinations was studied in a two-part investigation of 16 youths who has asthma and exercise-induced asthma. The beneficial and adverse effects of the drugs in the control of asthma were studied in the first part of the investigation. Both theophylline and ephedrine were judged superior to placebo when given alone. When combined they were somewhat more effective than either agent alone, although adverse effects precluded their use in almost half of the subjects. The addition of hydroxyzine diminished the side effects sufficiently to make the combination acceptable to four subjects who refused to take ephedrine/theophylline. In the second part of the study, the relief of exercise-induced asthma was evaluated. Ephedrine had no effect, hydroxyzine had a weak effect on hastening recovery, but theophylline modified the postexercise response significantly. The three drugs together produced an additive effect superior to that of theophylline alone.

Ibuprofen is a nonsteroidal drug with analgesic, antipyretic, and anti-inflammatory properties that was recently introduced for use in antiarthritis therapy in the United States. In a year-long double-blind multiclinic trial in 885 patients with rheumatoid arthritis, ibuprofen was at least as satisfactory as aspirin, considering both efficacy and tolerance. In the majority of patients, daily doses ranged from 800 to 1,600 mg of ibuprofen and 3 to 6 gm of aspirin. The drugs did not differ greatly in providing relief from arthritis symptoms, but ibuprofen was definitely better tolerated, especially in regard to gastrointestinal complaints. Seven percent of the ibuprofen group dropped out of the study because of adverse reactions, as compared with 16% of the aspirin group; 17% of the ibuprofen group and 31% of the aspirin group had gastrointestinal symptoms.

A multicenter, prospective, double-blind, controlled study was performed to compare the efficacy of trimethoprim-sulfamethoxazole with that of ampicillin in the treatment of chronic urinary tract infections. The incidence of adverse clinical signs and symptoms as well as abnormal laboratory values were comparable in the two treatment groups. This study appears to establish the fact that trimethoprim-sulfamethoxazole is an acceptable alternative to ampicillin for the treatment of chronic urinary tract infections caused by susceptible Escherichia coli.

A radomized controlled trial was conducted in a metropolitan teaching hospital to determine whether improving follow-up of emergency room patients who had hypertension led to improvements in their medical care and blood pressure control. One hundred fourty four patients were randomly assigned into an intervention group and a control group. In the former, a follow-up clerk assigned patients in returning for follow-up care. Eighty-four percent of patients in this group and 63% of control patients returned to the clinic (P less than 0.1). However, five months after the patients' emergency room visits, 51% of patients in the intervention group and 53% of control patients were normotensive. There were more diagnostic and therapeutic measures in the intervention group, but long-term management was similar in both groups. Improvement in follow-up may not be by itself lead to blood pressure control among hypertensive patients.

Propoxyphene napsylate and methadone hydrochloride were each administered under double-blind conditions to 36 outpatients for 21-day heroin detoxification. The initial dosage was 24 mg/day for methadone hydrochloride and 800 mg/day for propoxyphene napsylate. At these dosages, methadone more effectively suppressed the opiate-withdrawal syndrome, and patients remained in treatment longer in the methadone group (P greater than .05). In regard to heroin abstinence, however, results were not statistically significant in either group, as indicated by the number of patients whose urine was positive for morphine on admission and became negative during treatment, and the number who had morphine-negative urine at the conclusion of 21-day treatment. A one-month follow-up of patients showed that more patients given methadone had entered long-term medical maintenance while more patients given propoxyphene were heroin-abstinent. This study indicates that 21-day heroin detoxification, regardless of chemotherapeutic agent, yields a low rate of heroin abstinence.

Three hundred eleven employees of the National Institutes of Health volunteered to take 1 gm of ascorbic acid or lactose placebo in capsules three times a day for nine months. At the onset of a cold, the volunteers were given an additional 3 gm daily of either a placebo or ascorbic acid. One hundred ninety volunteers completed the study. Dropouts were defined as those who missed at least one month of drug ingestion. They represented 44% of the placebo group and 34% of those taking ascorbic acid. Analysis of these data showed that ascorbic acid had at best only a minor influence on the duration and severity of colds, and that the effects demonstrated might be explained equally well by a break in the double blind.

Concentrated potassium chloride produces ulceration of the gastrointestinal mucosa. Dilute solutions are frequently not acceptable to the patient. A tablet containing potassium chloride crystals suspended in a waxy matrix has been developed to avoid these drawbacks. We measured fecal blood loss by a radioactive chromium technique on 20 subjects during five days while they were given potassium chloride, 40mEq/day; ten subjects took a 10% solution; the others the waxy-matrix tablet. Fecal blood loss did not differ significantly between these groups. Mean fecal blood losses in both groups were slightly increased during the potassium chloride administration but never exceeded acceptable normal limits.

In a double-blind evaluation, the efficacy of a combination of methyldopa with hydrochlorothiazide was compared with that of its components, methyldopa and hydrochlorothiazide. The combination was found to be more efficacious than either of its components. It reduced the arithmetic mean of the pressures of all patients from 170/116 to 133/95 mm Hg in four weeks. Despite the greater effect of the combination, side effects were mild.