Profound and long-lasting analgesia (mean duration of pain relief 33.4 h, range 22.5--73.5 h) was produced by intrathecal administration of 3 mg synthetic beta-endorphin in all of 14 patients with intractable pain due to disseminated cancer. No respiratory depression, hypotension, hypothermia, or catatonia was observed.

The acute effects of a single capsule of each of two phenylpropanolamine-containing preparations were determined in a group of healthy young adults, by means of a double-blind comparison with matching placebo preparations. Supine diastolic blood-pressure rose to 100 mm Hg or more in 12 out of 37 subjects taking an anorectic preparation ('Trimolets'; 85 mg phenylpropanolamine per capsule) and in 4 out of 34 subjects taking a decongestant preparation ('Contac 500'; 50 mg phenylpropanolamine per capsule). 20 of the subjects taking trimolets reported adverse side effects. The frequency and extent of the hypertensive response to high-dose phenylpropranolamine-containing preparations suggest that clinical use of such preparations should be reviewed and that their availability without prescription may not be appropriate.

Two groups of postmenopausal women were seen at monthly intervals during a 6-month trial of cyclic therapy with conjugated equine oestrogens ('Premarin'). the seven women in the first group were taking premarin alone and the six women in the second group were taking premarin plus a progestagen, norethisterone acetate. On each visit, serum unconjugated oestrogens were measured by radioimmunoassay. Mean concentrations for the first group were 393 (+/- 203, SD) pmol/l for 17 beta-oestradiol, 599 (+/- 180) pmol/l for oestrone, and 6840 (+/- 5130) pmol/l for equilin. Corresponding levels for the second group were 342 (+/- 112) pmol/l, 564 (+/- 279) pmol/l, and 8840 (+/- 4020) pmol/l. 3 months after completion of therapy, the oestrone and 17 beta-oestradiol concentrations had returned to pre-treatment levels in both groups, but equilin was detected in 3 out of 3 women in the first group at a mean level of 532 (+/- 267) pmol/l and in 2 out of 4 women in the second group at 1170 (+/- 870) pmol/l. In view of the prolonged presence of equilin and the possible association between treatment with conjugated equine oestrogens and endometrial cancer, it is suggested that equilin-containing compounds should not be given for more than 12 months.

In a controlled randomised clinical trial of 92 patients with surgically resected lung cancer, intrapleural BCG had no clear effect on survival. Adverse effects were insignificant.

In the scientific and lay press, dietary recommendations that are aimed at prevention of coronary heart disease in the general public are appearing more and more frequently. The dietary pattern that is now most widely advocated is a low-fat, low cholesterol diet with a polyunsaturated/saturated ratio of 1. The argument for such a dietary change is supported mainly by extrapolations from epidemiological data and from animal experimentation. Reasons are given for concluding that the recommendations are unwise, impractical, and unlikely to lead to a reduced incidence of arteriosclerotic disease. Sinc complacency is equally inappropriate, a few practical questions are outlined that should be settled before the public is assured that a low-fat diet will lead to a reduced risk of coronary heart disease.

A randomised controlled double-blind trial of aspirin in the prevention of death was conducted in 1682 patients (including 248 women) who had had a confirmed myocardial infarct (MI). 25% of the patients were admitted to the trial within 3 days of the infarction and 50% within 7 days. Aspirin, 300 mg three times daily, was given for 1 yr. Total mortality was 12.3% in patients given aspirin and 14.8% in those given placebo, a reduction by aspirin of 17%, which was not statistically significant at p less than 0.05. The reduction in specific ischaemic-heart-disease (IHD) mortality was 22% and in total mortality plus IHD morbidity (readmission to hospital for MI in survivors) was 28%.

A randomised double-blind crossover trial was done to assess the efficacy of chlorothiazide as an antihypertensive drug in patients with severe renal failure. There was a significant reduction in standing (mean drop 13/6 mm Hg) and supine (mean drop 13/5 mm Hg) blood-pressure, without postural hypotension. Chlorothiazide has a place in the management of hypertension in patients with severe renal failure and its antihypertensive effect is probably due to a change in peripheral vascular resistance and not to volume contraction.

In a randomised clinical trial to assess the value of intestinal bypass in the treatment of gross obesity 130 patients who underwent end-to-side jejunoileostomy (with either a 1/3 or a 3/1 ratio between jejunum and ileum left in continuity) were compared with 66 non-surgically treated patients. All patients in the study had gross, long-standing, treatment-resistant obesity with resultant somatic, psychic, or social problems; none were alcoholic or had liver disease or other conditions which made them poor surgical risks. Most subjects were observed for more than 3 years. Median weight loss within 24 months was 42.9 kg in the bypass group, compared with 5.9 kg in the control group. No deaths occurred among those who underwent surgery. Patients who underwent intestinal bypass also had a better improvement in quality of life and a higher degree of patient satisfaction. Complications of the operation were, however, common and occasionally severe.