Malnourished children have thymic atrophy which is reversed by zinc supplementation. To see if their defect in cell-mediated immunity was also associated with zinc deficiency ten children were skin-tested with Candida antigen on both arms. One test site was covered with local zinc sulphate and the other with placebo ointment. There was a highly significant increase in the typical delayed-hypersensitivity reaction at the site covered with zinc. The magnitude of the difference between the supplemented and unsupplemented arms correlated negatively with the plasma-zinc concentration. These data show that zinc deficiency is a cause of the immunoincompetence seen in malnutrition. The normal reactions of the zinc-supplemented side indicate that, of the many nutritional deficits of malnourished children, zinc deficiency specifically impairs the cell-mediated immune system. Local skin-testing with and without zinc may provide a measure of zinc status. Local application of zinc may enhance the reliability of tests to diagnose diseases such as tuberculosis in malnourished patients.

The prophylactic effect of low-dose heparin on postoperative fatal and on clinically apparent but non-fatal thromboembolic complications was studied in a double-blind, prospective, randomised study comprising 1296 patients. 16 out of 653 patients in the placebo group had such complications within the treatment period of 1 week, compared with 4 out of 643 in the heparin group. This difference was statistically significant (P less than 0.05). 4 cases in the placebo group and 1 in the heparin group were fatal. After prophylactic treatment had been stopped at the end of the first postoperative week, the rate of thromboembolic complications was equal for the 2 groups. Low-dose heparin prophylaxis is thus effective and should be given routinely in patients aged over 40 years; it should also be given for more than 1 week in patients not ambulant by then.

20 subjects with adverse reactions to foods were given oral cromoglycate and placebo separately for seven days each. While on each medication they were given, for four consecutive days, a food to which they were sensitive. Adverse reactions were prevented in 14 subjects. These results suggest that oral cromoglycate is of value in the treatment of some patients with adverse reactions to foods.

A randomised controlled trial was carried out to compare the clinical outcome 5 years after inpatient surgery and outpatient injection/compression sclerotherapy. 91.3% of those originally treated by injection/compression sclerotherapy and 93.9% of those originally treated surgically were seen at follow-up. 40% of patients treated initially by injection/compression sclerotherapy and 24.2% of those treated surgically were given further treatment. The probability of having no further treatment is significantly greater for those treated surgically. The improved outcome after surgery increased with age, being most striking in those aged over 45. The implications of the 5-year follow-up findings for the long-term cost of treatment are discussed.

172 patients who had had mastectomy for breast cancer were treated by repeated adjuvant chemotherapy, either with phenylalanine mustard (P.A.M.) or a combination of cyclophosphamide, 5-fluorouracil, and prednisone (C.F.P.) with and without radiotherapy. Tumours recurred significantly more frequently and mortality tended to be higher in P.A.M.-treated patients than in patients on other treatment. The interval between surgery and disease recurrence was significantly shorter for P.A.M.-treated premenopausal but not postmenopausal patients than for patients of equivalent menstrual status treated with C.F.P. with or without radiation. The associations in premenopausal patients between the mode of treatment and both survival and the disease-free interval were significant before and after adjustment for variations between the treatment groups in the number of involved lymph nodes and the size of the primary tumour.

A trial involving 208 girls aged 5-12 who had bacteriuria on screening was carried out to determine the effects of covert bacteriuria on renal growth and scarring. 98 were observed for 4 years without treatment and 110 were treated. 77% of the treated girls, but only 26% of the untreated controls, were free of infection for at least half of the 4-year follow-up. However, treatment had no effect on the emergence of symptoms, clearance of vesico-ureteric reflux (V.U.R.), kidney growth, or the progression of kidney scars. New kidney scars did not develop in previously unscarred kidneys. 12 (6%) of the 208 girls had progression of re-existing kidney scars; this high-risk group was characterised by kidney scarring on the initial X-ray, a high prevalence of v.u.r., and persistent or recurrent bacteriuria. Screening for covert bacteriuria cannot therefore be recommended in schoolgirls since kidney damage associated with infection arises before the age of 5.

In groups of 16 patients with multiple sclerosis, 13 months' double-blind treatment with transfer factor from random normal donors differed from placebo treatment only in producing a temporary restoration of lymphocyte reactivity to measles virus antigen, and did not arrest the degeneration of nerve tissue.

In a double-blind trial in which 45 patients with acute schizophrenia took part the alpha-isomer of flupenthixol (which blocks the dopamine receptor) was found to be significantly more effective than both beta-flupenthixol (which does not) and placebo. The drug effect was confined to the "positive" symptoms--delusions, hallucinations, and though disorder--and appeared only in the 3rd and 4th weeks of the trial. It was as great in patients with evidence of deterioration (Feighner-positive patients) as in patients without deterioration and was less in patients who had affective disturbance in addition to schizophrenia symptoms. The findings are consistent with the hypothesis that dopamine-receptor blockade is the only requirement for antipsychotic activity and suggest that the antipsychotic effect occurs in patients with typically schizophrenic illnesses but may be limited to positive symptoms.

Home and hospital management of patients with suspected myocardial infarction were compared in a randomised trial in which a hospital-based team responded to calls from general practitioners. 500 calls were received, and 349 patients (70%) were suspected of having myocardial infarction. Of these, 24% were excluded from the trial on predetermined medical and social grounds; for the remainder (76%) there was no significant difference in the 6-week mortality between the home group (13%) and the hospital group (11%). For the majority of patients to whom a general practitioner is called because of suspected infarction, hospital admission confers no clear advantage.

1020 patients with early breast cancer were treated between March, 1970, and October, 1975, according to a prospective clinical trial. The results have been recorded after a follow-up of two to seven years. 713 cases of clinical stage-1 cancer were randomly allocated to treatment by simple mastectomy and postoperative radiotherapy, or simple mastectomy alone. There was no statistically significant difference in overall survival or in survival without distant metastases between the two groups. There was a significant reduction in the incidence of local recurrence in those who had received early postoperative radiotherapy compared with those who had not. 307 cases of clinical stage-11 cancer were randomly allocated to treatment by simple mastectomy and postoperative radiotherapy or radical mastectomy alone. There was no statistically significant difference in survival or in the incidence of local recurrence or distant metastases between the two groups.

40 patients prescribed electroconvulsive therapy (E.C.T.) for treatment of a depressive illness were randomly allocated to two groups. One group had the first two E.C.T. treatments replaced by simulated E.C.T. on a double-blind basis. The results show that E.C.T. is significantly superior to simulated E.C.T. in the treatment of depressive illness.

119 elderly, hypertensive patients were followed-up for 1 year and 48 for 2 years in a double-blind, randomised, controlled trial in which they received either placebo or 25-50 mg hydrochlorothiazide and 50-100 mg of triamterene daily. Half of the active treatment group also received 250 mg to 2 g methyldopa daily. After 2 years the active treatment group had an average increase in fasting blood-sugar of 9.6 mg/dl compared with an average fall of 3.1 mg in the placebo group (p less than 0.001). Blood-glucose rose by an average of 26.6 mg/dl in the active group when determined 1 hour after 50 g oral glucose and decreased by an average of 5.3 mg/dl in patients who had been on placebo for two years (p less than 0.05). The hyperglycaemic effect of diuretics appeared to be related to potassium loss since, in both groups, impairment of glucose tolerance was most marked in those in whom the serum-potassium decreased over the 2 years.

45 patients with healed duodenal ulcers completed a six-month double-blind trial to compare the effects of cimetidine and placebo on the prevention of duodenal-ulcer relapse. A single bedtime dose of cimetidine (800 mg) was given and ulcer relapse was assessed endoscopically at regular intervals. At the end of the six-month trial, 16 of the 21 (76%) cimetidine-treated patients remained ulcer-free compared with only 3 of the 24 (12.5%) placebo-treated patients. No untoward effects of this treatment were observed.

68 patients with chronic peptic ulcer took part in a double-blind trial in which 32 received the histamine H2-receptor antagonist cimetidine, (400 mg twice daily) and 36 received a placebo, for a year. 6 of those on cimetidine had an endoscopically proven recurrent ulcer within a mean of 7 months, while 30 of those on placebo had one after a mean of 4 months (P less than 0.0005). 1 patient on cimetidine had two recurrences compared with 12 patients on placebo (P less than 0.0005). No patient in the cimetidine group had complications compared to 4 patients in the placebo group, 2 of whom had melaena and haematemesis and 2 melaena alone (P less than 0.05). 15 patients on placebo and 1 on cimetidine were referred for surgery during the trial because of symptoms from their recurrent ulcers. Day and night ulcer pain and antacid consumption were significantly less, and general wellbeing better, in cimetidine group. The only probable side-effect of cimetidine was reversible drug-induced liver damage of hypersensitivity type in 1 patient.

20 out of 36 children (aged two to eight years) with atopic eczema completed a twelve-week, double-blind, controlled, crossover trial of an egg and cows' milk exclusion diet. During the first and third four-week periods, patients on an egg and cows' milk exclusion diet received a soya-based milk substitute (trial period) or an egg and cows' milk preparation (control period). Response was assessed in terms of eczema activity, number of areas affected, pruritus, sleeplessness, and antihistamine usage while on the two diets. During the middle period patients resumed their normal diet to minimise any carry-over effect. 14 patients responded more favourably to the antigen-avoidance diet than to the control diet, whereas only 1 responded more favourably to the control diet than the trial diet. Patients experienced more benefit during the first diet period than the second, whatever the nature of the diet. There was no correlation between a positive prick test to egg and cows' milk antigen and response to the trial diet.