In an international multicentre controlled single-blind trial of 93 previously untreated lepromatous leprosy patients the therapeutic effects of adding rifampicin, 450 mg/day orally or 1,200 mg once monthly in a single oral dose, to dapsone (50 mg/day orally) for the first 6 months of treatment were compared. Clinical and histopathological improvements and bacteriological regression, indicated by the decreases in the bacterial and morphological indices of the skin and nose-blow smears, were satisfactory and practically identical after 6 months' treatment. The once-monthly rifampicin schedule was better tolerated than the daily one. In view of the good therapeutic efficacy and tolerability, the much lower cost of treatment (about one-tenth of that of the daily rifampicin regimen) and the possibility of administration under supervision, once-monthly rifampicin given in a single oral 1,200 mg dose should be recommended, along with a standard dapsone regimen, for large-scale, initial, and intensive combination treatment of patients with lepromatous and borderline-lepromatous leprosy, to help prevent an increase in dapsone resistance. A third antileprosy drug (e.g., clofazimine) may be added to this initial dual-treatment regimen.

In a prospective randomised study, 47 fasting women undergoing elective caesarean section received one of the following three glucose regimens for prevention of hypotension before administration of epidural bupivacaine to produce anaesthesia from the T4 sensory level: (i) 150 ml of 5% dextrose in water (D5W) and 1000 ml normal saline (7.5 g dextrose); (ii) 150 ml of D5W, 350 ml of 5% dextrose in normal saline (D5NS), and 650 ml of normal saline (25 g dextrose); (iii) 150 ml D5W and 1000 ml D5NS (57.5 g dextrose). The maternal blood sugar at delivery was significantly raised in patients receiving 25 and 57.5 g of dextrose. 57.5 g of dextrose also raised the mean umbilical cord venous levels of glucose to 11.7 mmol/l and of insulin to 70 +/- 7 microU/ml, while decreasing glucagon to 24 +/- 5.3 pg/ml and arterial pH to 7.19 +/- 0.015 compared with the levels with 7.5 g dextrose. The raised insulin level caused neonatal hypoglycaemia (1.8 +/- 0.22 mmol/l) and delayed release of glucagon at 2 hours of age. There was a higher incidence of neonatal jaundice in infants exposed to 57.5 g of dextrose than in those exposed to 7.5 g. The addition of large amounts of dextrose to intravenous fluids was harmful to the fetus and of no benefit to the mother. Until a safe rate of administration is established, it is recommended that dextrose infusions immediately before delivery be limited to no more than 6 g/h.

In a multicentre double-blind randomised study, the effect of sotalol 320 mg once daily was compared with that of placebo in patients surviving an acute myocardial infarction. Treatment was started 5--14 days after infarction in 1456 patients (60% being randomised to sotalol, and 40% to placebo) who represented 45% of those evaluated for entry. Patients were followed for 12 months. The mortality rate was 7.3% (64 patients) in the sotalol group and 8.9% (52 patients) in the placebo group. The mortality was 18% lower in the sotalol than in the placebo group, but this difference was not statistically significant. The rate of definite myocardial reinfarction was 41% lower in the sotalol group than in the placebo group (p less than 0.05). Although the differences in mortality were not significant, this trial supports the evidence that, in the year after myocardial infarction, beta adrenoceptor blocking drugs reduce mortality by 20--25%.

126 appropriate-for-gestational age neonates born in hospital with birth-weights of 750 g-1500 g were prospectively studied in a randomised trial to determine the effect of intramuscular vitamin E on the frequency and severity of retrolental fibroplasia (RLF). In the 99 who lived for more than one month the frequency of active RLF in the vitamin E and control groups in the nursery (18.8% vs 23.5%) and at discharge (8.3% vs 19.6% was not significantly different. Vitamin E had significantly reduced the severity of RLF at follow-up eye examination 6-33 months after discharge (p less than 0.01). 3 control infants (760 g, 780 g, 1020 g) were blind in both eyes (grade V cicatricial RLF), whereas the most severe grade of disease in the vitamin E infants was grade II cicatrix. Infants in whom RLF developed were gestationally younger (p = 0.005), required a longer period of mechanical ventilation (p = 0.035), had a greater exposure to oxygen (p = 0.03), and had a greater number of arterial PO2 values between 75 and 99 mm Hg (p = 0.004). Early administration of vitamin E, while not affecting the frequency of RLF, will significantly reduce its severity and subsequent eye damage, and such treatment is recommended for all low-birth-weight infants of less than 1250 g who require supplementary oxygen.

Inosiplex was administered to 98 patients with subacute sclerosing panencephalitis (SSPE) in the United States and Canada for variable periods of time up to 9.5 years. Survival data from these 98 patients were compared by life-table analysis with survival in three SSPE control groups drawn from SSPE patients contracting the disease in Israel, Lebanon, or the United States at about the same time as the inosiplex-treated patients but treated differently or not at all. In the inosiplex-treated patients the actuarial probability of survival at 2, 4, 6, and 8 years from onset of SSPE was 78%, 69%, 65%, and 61%, compared with 38%, 20%, 14%, and 8% in a composite control group (p less than 0.01 for all four comparisons). Statistical adjustments for time-to-treatment bias did not affect this result: a modified logrank procedure demonstrated that the risk of dying in the treatment group was 43% of that in the controls. Inosiplex seems to be able to prolong life in patients with SSPE.

A controlled clinical trial was conducted to compare the value of a cream containing 2% phenoxetol and 0.2% chlorhexidine as a prophylactic agent against wound infection in patients with burns affecting up to 15% total body surface area. The acquisition of bacteria was similar in the two treatment groups but the incidence of Staphylococcus aureus in the burns treated with phenoxetol-chlorhexidine cream significantly lower. The incidence of gram-negative bacilli was low in the two treatment groups, and no wound yielded Pseudomonas aeruginosa. Unlike preparations containing silver, phenoxetol-chlorhexidine does not cause electrolyte imbalance or stain materials with which it comes into contact, and it did not produce adverse effects during this trial.

In a prospective study of neonatal jaundice 739 infants, delivered vaginally, in the vertex presentation, and without major complications, were examined. Labour was induced or stimulated after random allocation of the mothers to one of three oxytocics (prostaglandin E2 orally, oxytocin intravenously, or demoxytocin buccally). Oxytocics were unnecessary after primary amniotomy in 91 women. A linear logistic statistical analysis showed that gestational age has a highly significant influence on the risk of jaundice (defined by maximum serum level of bilirubin greater than or equal to 205 mumol/l). An apparent influence of birthweight could be explained by the correlation between birthweight and gestational age. The influence of the three oxytocic agents was not significant, although they may have had a slight effect; however, any such effect could be a consequence of the infants of mothers given oxytocics being less mature than those whom mothers did not receive oxytocics. The duration of labour and the mother's age also had no effect on risk of jaundice. Thus, neonatal jaundice after induced and stimulated labour seems to be primarily associated with fetal maturity; the pharmacological side-effect, if any, of oxytocics is of no importance.

Intravenous administration of a total dose of more than 200 million IU of penicillin-G led to sensitisation of lymphocytes and formation of specific anti-penicilloyl antibodies of the IgG class. These effects were prevented when the penicillin solution used was freshly prepared and given as a bolus rather than as a slow infusion. The causative antigens seem to be related not to penicilloylated high molecular weight impurities in the penicillin preparations, but to the degradation and/or transformation products of penicillin-G that form when the drug is in solution even if only for a few hours, and not only at room temperature but also at 4 degrees C. Thus penicillin solutions should be freshly prepared and administered from vials containing less than 10 million IU so that bolus doses can be given.