The effect of low doses of heparin (5000 units of sodium heparin every 12 hours for 5 days) on arterial oxygenation was studied in 24 patients in the postoperative period after upper abdominal surgery. Another 24 patients served as a control group. The arterial oxygen tension was the same in both groups preoperatively and was equally significantly reduced during the 1st postoperative day. During the 2nd day, oxygen tension rose in the heparin-treated group to values which no longer differed significantly from the peroperative level. In the control group the significant reduction persisted until the 4th postoperative day. The arterial carbon-dioxide tension did not differ between the groups, neither did it vary significantly between days. There were no clinical signs of large pulmonary embolism during the postoperative period, chest X-ray was normal in all patients examined and a photoscan was normal in 23 of 24 subjects studied. Low-dose heparin treatment may apparently shorten the period of postoperative hypoxaemia, probably by counteracting both large pulmonary emboli and microthromboembolism.

Oral disopyramide given prophylactically following myocardial infarction has been compared with placebo in a double-blind trial using continuous-tape monoriting of the electocardiogram. It caused a significant reduction in the incidence of ventricular arrhythmias and of the various degrees of heart-block. There was a significant reduction of reinfarction during hospital stay in patients who had received disopyramide. Disopyramide appears to be a safe and effective oral therapy in the prevention of potentially serious arrhythmias following myocardial infarction.

Minor wounds presenting in the accident department requiring suture were randomly allocated to one of three treatment groups: an intramuscular injection of 1-25 megaunits of penicillin as a long-acting depot preparation, local wound irrigation with 100mg of tetracycline in solution, or no antibiotics. All wounds had a standard surgical toilet and were closed under aseptic conditions. Wound infections were noted five to seven days after suture, and in the two groups receiving antibiotics 23% of the wounds were infected whilst in the control group the frequency was 7%. The wisdom of using routine antibiotic prophylaxis in minor wounds is questioned.

A randomised prospective trial comparing "no immediate treatment" with single and multiple agent chemotherapy in 188 patients with inoperable carcinoma of the bronchus is reported. No immediate treatment proved a significantly better policy both for patients' survival and for quality of remaining life.

A multicentre randomised controlled trial of xenon-arc photocoagulation for diabetic maculopathy is reported. This interim account reports the visual-acuity results of those who were followed up for up to three years. 76 patients were seen after one year, 44 after two years, and 25 after three years. Initially each patient had two similarly affected eyes of which one was treated. The treated eyes retained significantly better visual acuity than the untreated ones. Treated eyes deteriorated by 1 or 2 Snellen lines significantly less often than did untreated eyes. 8 treated and 18 untreated eyes became blind. Prognosis was best in those with initial visual acuity of 6/24 or better.

A total of 481 adult Chinese, Malays, and Indians in Singapore with newly diagnosed smear-positive pulmonary tuberculosis were allocated at random to four regimens of intermittent rifampicin plus isoniazid. All patients received an initial 2 weeks of daily streptomycin plus isoniazid plus rifampicin. This was followed either by twice-weekly isoniazid 15 mg/kg plus rifampicin 900 mg (HR2 regimen) or 600 mg (LR2 regimen), or by once-weekly isoniazid 15 mg/kg plus rifampicin 900 mg (HR1 regimen) or 600 mg (LR1 regimen). In addition, all patients received a daily capsule containing, at random, either rifampicin 25 mg or a matched placebo to see if the rifampicin supplement would reduce the incidence of adverse reactions to the drug. At 12 months, all the patients on the two twice-weekly regimens (HR2, LR2) had a favourable bacteriological status as had 97% of 102 HR1 and 93% of 112 LR1 patients. The therapeutic response was significantly better on the twice-weekly than on the once-weekly regimens (P = 0-0005), but the dose size of rifampicin did not have a statistically significant effect. Adverse reactions to intermittent rifampicin occurred in 25% of the HR1 patients but on the other three regimens their incidence was low. The incidence of rifampicin-dependent antibodies was higher, ranging from 48% (HR1) to 24% (LR2). The effect of dose size on the incidence of the "flu" syndrome (the commonest reaction) and of antibodies was statistically significant (P less than 0-01 and less than 0-001, respectively). The interval between doses affected the incidence of the "flu" syndrome (P less than 0-001), but not of antibodies (P greater than 0-25). The rifampicin 25 mg supplement had no effect therapeutically or on the incidence of adverse reactions or of antibodies.

The coagulation system was studied in twenty-seven patients undergoing second-trimester abortion induced by intra-amniotic prostaglandin (P.G.) E2 alone and in combination with a hypertonic solution of urea or glucose. Changes consistent with intravascular coagulation, namely a rise in fibrin degradation products and a fall in plasma-fibrinogen and platelet-count, were observed in those patients treated using P.G.E2 with hypertonic urea. Similar but less pronounced changes were found in the group treated using P.G.E2 with hypertonic glucose. In patients treated with P.G.E2 alone no changes suggestive of intravascular coagulation were detected. One patient treated using P.G.E2 with hypertonic urea who did not abort for 26 hours demonstrated changes indicative of a pronounced degree of disseminated intravascular coagulation. These findings show that when abortion is induced using P.G.E2 and a hypertonic solution, particularly hypertonic urea, disseminated intravascular coagulation can occur as a result of a hypertonic agent being used.

A controlled trial has been carried out in 50 patients undergoing elective colonic surgery to assess the efficacy of prophylactic oral metronidazole specifically directed against anaerobic colonic microflora in combination with kanamycin to reduce the aerobic flora. A control group received dietary and mechanical preparation alone. A significant reduction of both aerobic and anaerobic colonic microflora was achieved in the group receiving prophylactic antimicrobial agents, and this was reflected in a significant reduction in postoperative wound infections. 1 control patient died from Bacteroides septicaemia. No toxic or other side-effects from this prophylactic regimen occurred in this trial.

Highly buffered acetylsalicylate was used to treat diarrhoea and other gastrointestinal side-effects of radiotherapy in 28 women who were receiving treatment for uterine cancer. In a double-blind, balanced, and randomised trial, acetylsalicylate significantly reduced the number of bowel motions and relieved abdominal pain and flatulence.

A randomised, double-blind, controlled trial has been undertaken to compare the efficacy of hepatitis B immune globulin (H.B.I.G.) with that of immune serum globulin (I.S.G.) for the prophylaxis of viral hepatitis. Participants in the trial were individuals exposed accidentally to material infectious for hepatitis (primarily viral B hepatitis). Preliminary evaluation of the first 302 of the 561 individuals entered into the study indicates that H.B.I.G. significantly reduced the frequencies of both clinical and subclinical hepatitis during the first 3--4 months after the injection. Less than 10% of H.B.I.G. recipients had detectable anti-HBs at the sixth month after the injection, suggesting that H.B.I.G. might need to be given every 3--4 months to continually exposed individuals. Further long-term evaluation is required in order to define more clearly those most likely to benefit from H.B.I.G.

2-bromo-alpha-ergocryptine (bromocriptine) in a dosage of 2-5 mg twice daily caused a rapid fall in plasma prolactin. It was more effective than either a single dose of 4 mg quinoestrol or a placebo in suppressing puerperal lactation, as judged by milk flow and the relief of breast pain and congestion. Patients who received quinoestrol were more comfortable than those who received placebo.

In a multicentre double-blind trial 68 patients with endoscopically confirmed duodenal ulceration received metiamide (36 patients) or placebo (32 patients) for four weeks. Healing of duodenal ulcers was significantly increased in patients receiving metiamide (67%) compared with those on placebo (25%). There was also an assoicated significant decrease in daytime pain and antacid consumption in those on metiamide.

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.

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.