Oral human gammaglobulin or placebo was given with each feed during the first week of life to 75 low-birth-weight babies. All were in a nursery where rotavirus was known to be endemic, 25 of the babies excreted rotavirus during the first 2 weeks of life. This group was regarded as the "challenge" group. Gammaglobulin administration was associated with delayed excretion of rotavirus and with milder symptoms of infection. Rotavirus-associated diarrhoea necessitating low-lactose feeds developed in 6 of 11 babies given placebo and 1 of 14 babies given gammaglobulin. Oral human gammaglobulin seems to protect low-birth-weight infants from diarrhoea caused by rotavirus.

The analgesic efficacy and side-effects of a single parenteral dose of metkephamid acetate 70 mg were compared with those of pethidine (meperidine) hydrochloride 100 mg and placebo in a double-blind, randomised, controlled clinical trial. 30 out of 32 postoperative patients completed the study--10 in the metkephamid group, 11 in the pethidine group, and 9 in the placebo group. The time-effect curves of summated pain measures and analyses of derived measures all indicated that the analgesic activity of metkephamid 70 mg was significantly greater than that of placebo and not less than that of pethidine 100 mg. The metkephamid group had a greater incidence of side-effects than the other two treatment groups. Some side-effects, such as sensations of heaviness of the extremities and nasal congestion, were peculiar to metkephamid but not distressing.

In randomised trials of adjuvant chemotherapy for node-positive breast cancer, significant benefits has been seen in premenopausal but not postmenopausal patients. A possible explanation for this distinction is that premenopausal groups contain a greater proportion of patients with rapidly growing tumours that respond well to chemotherapy. The purpose of this study was to assess the plausibility of this explanation, using a clinical index to estimate rate of growth. From a cohort of women with primary breast cancer, none of whom had received adjuvant chemotherapy, an adjuvant-treated population was simulated by means of a study of the 164 patients who would have been eligible for entry into an adjuvant trial. The prognosis for each patient was categorised according to premenopausal or postmenopausal status, nodal status (1-3 or greater than or equal to 4), and growth rate of the cancer (non-rapid or rapid). Patients with rapid growth rates comprised a greater proportion of the premenopausal group (32%) than of the postmenopausal group (20%). On the assumption that adjuvant chemotherapy would preferentially benefit the rapid-growth stratum, the potential impact of the disproportionate distribution of the rapid-growth-rate stratum on the results of adjuvant trials was calculated. The results showed that a disparity in distribution of the rapid-growth-rate stratum could account for the apparently greater benefit in premenopausal patients.

The effect of 10 degrees reverse Trendelenburg tilt of the bed was studied in ten patients with refractory nocturnal angina on 2 consecutive nights before aortocoronary bypass surgery. For the control night the bed was placed in the semi-orthopnoeic position, and for the test night it was put in the reverse Trendelenburg position. This position significantly reduced central venous pressure, diastolic pulmonary artery pressure, the number of isosorbide dinitrate tablets taken sublingually, and the number of angina episodes per night. Reverse Trendelenburg tilt of the bed therefore seems effective for relief of nocturnal anginal pain.

124 patients with acute diarrhoea due to Vibrio cholerae or Escherichia coli were treated with either the standard sucrose-electrolyte solution or a cereal-based electrolyte solution, containing 30 g rice powder per litre and electrolytes as recommended by the World Health Organisation. The treatments were compared by measuring the rate of purging, change in body weight, serum specific gravity, urine output, and post-hydrolysis sugar content in the stool. The proportions of successfully treated patients in the rice-powder group were 80% for cholera patients and 88% for E. coli patients--no different from those in patients receiving the sucrose-electrolyte solution. Failure was due to rates of purging that exceeded the patient's ability to drink enough replacement solution. This study suggests that a rice-powder electrolyte solution is efficient and safe to use as a rehydrating oral fluid in acute diarrhoea.

The acute effects of synthetic methionyl human growth hormone produced by recombinant DNA technology were compared with those of pituitary human growth hormone in 22 healthy male volunteers. Both caused increases in somatomedin and triglycerides and decreases in blood urea nitrogen and cholesterol. By all indices measured, synthetic methionyl human growth hormone was equipotent with pituitary human growth hormone. The ability to make biologically active synthetic human growth hormone creates an essentially unlimited supply of growth hormone for the treatment of hypopituitarism and for the study of additional therapeutic indications.

The role of dietary protein deficiency in kwashiorkor is uncertain, although it has been shown not to be involved in the famine oedema of adults. A study of six different diets given to 103 children with oedematous malnutrition showed that the rate of loss of oedema was strongly correlated with the dietary energy intake (r = 0.75) but not with the protein intake (r = 0.03). 66 patients given a very-low protein diet (2.5% protein energy) lost oedema as fast as those given five times as much protein. The energy intake above which oedema resolved and below which oedema accumulated was 245-270 KJ/kg/day. Because energy deficiency is not invariably associated with oedema it cannot be the only factor involved, and the necessary dietary component(s) must therefore have been present in surfeit in all the therapeutic diets. This could be potassium together with factors necessary for its retention. The accessory ingredients must be low in foods associated with human and experimental nutritional oedema. It is suggested that protein deficiency is not the cause of the oedema of kwashiorkor and that there is no need to postulate a different pathogenesis for this oedema from starvation oedema of adults.