In a prospective randomised trial in which 93 patients undergoing elective colorectal operations were given a short prophylactic course of metronidazole and kanamycin orally or systemically, postoperative sepsis occurred in only 3 (6.5%) of those given antimicrobials systemically, compared with 17 (36%) of those given oral prophylaxis (P less than 0.01). 15 of the 17 infections in patients who received antimicrobials orally were due to kanamycin-resistant bacteria present in the colon at operation. Bacterial overgrowth of Staphylococcus aureus was recorded in 6 of the patients who received oral therapy. Antibiotic-associated pseudomembranous colitis occurred in 7 patients, 6 of whom had received prophylaxis orally. These results indicate that oral administration of prophylactic antimicrobials in colon surgery should be avoided because of the risks of bacterial resistance, superinfection, and antibiotic-associated pseudomembranous colitis. Systemic per-operative antimicrobial prophylaxis is safer and more effective.

768 men aged under 65 with angina pectoris, at least 50% obstruction in two or more major vessels, and a left-ventricular ejection fraction greater than or equal to 0.5 took part in a prospective randomised trial of the effect of coronary-artery bypass on prognosis. 373 patients were alloted to medical and 395 to surgical treatment. There was no significant difference between the two groups in the distribution of variables recorded at the time of randomisation. 1. "surgical" patient was lost to follow-up. 26 "surgical" patients did not undergo surgery and 50 "medical" patients were operated on. All these 76 patients were retained in their original treatment groups for the analysis. At 2 years there was no significant difference in mortality between the two groups. A significant difference was, however, found in the subset of patients with three-vessel disease, survival being significantly better for surgical patients. Operative (in-hospital) mortality was 3.6% in all operated patients and 1.5% in the last third. On average, 1.9 grafts per patient were inserted in the two-vessel-disease subgroup and 2.4 grafts per patient in the three-vessel-disease subgroup. Graft-patency rate was 90% within 9 months and 77% between 9 and 18 months after surgery. Symptomatic improvement was significantly better and deterioration less in the surgical group.

The minimum effective dose of intermediate factor-VIII concentrate required for the successful home treatment of spontaneous joint bleeds in six haemophiliacs has been investigated in a randomised trial. 207 episodes of bleeding were included. 5 . 7 units/kg controlled 85% of bleeds, but with a dose of 3 .0 units/kg the risk of failure doubled. This lower dose is inadequate for treatment of bleeds other than those regarded subjectively by the patient as mild. The implications of these findings in terms of availability and usage of factor VIII in this centre are discussed.

The efficiency of a gelatin capsule containing a nylon string for collection of duodenal specimens was investigated in carriers of Salmonella typhosa (typhi). Cultures of duodenal specimens obtained by means of the string capsule were compared with cultures of duodenal specimens obtained by a conventional duodenal tube and with stool cultures Duodenal contents obtained with either the string or tube were more often positive for S. typhosa than were stool cultures. The string, which is as efficient as tube collection but simpler and more comfortable, may be useful in identifying carriers of S. typhosa.

46 children (26 boys and 20 girls) admitted with mild acute gastroenteritis were randomly allocated to a regimen of continuing on full-strength milk, or to one of taking clear fluids until the diarrhoea settled before full-strength milk was reintroduced either immediately, or gradually in quarter-strength steps. There was no difference in length of hospital stay between the three groups.

A controlled clinical trial of epsilon-aminocaproic acid (E.A.C.A.), 36 g/day, was undertaken to assess its effectiveness in reducing immediate recurrence in patients with spontaneous subarachnoid haemorrhage (S.A.H.) proved by lumbar puncture. Of 83 patients treated with E.A.C.A., 3 (4%) had recurrent haemorrhage, and 1 (33%) of these died. Of 82 control patients who were not given any antifibrinolytic drug, 22 (26%) had recurrent haemorrhage, and 10 (45%) of these patients died. E.A.C.A. produced a striking reduction in the early recurrence of S.A.H. No serious side-effect resulted.

Sixteen patients with moderate essential hypertension completed a double-blind crossover trial with four treatment periods each of 6 weeks. They received in random order: placebo; tienilic acid 250 mg/day; propranolol 80 mg twice daily; and tienilic acid 250 mg/day combined with propranolol 80 mg twice daily. Average blood-pressure in the lying position was 22.6/13.1 kPa (169/98 mm Hg) on placebo; 21.0/12.5 (157/94) on tienilic aicd; 21.2/12.0 (159/90) on propranolol, and 18.9/11.5 (142/86) on tienilic acid combined with propranolol. The effects of tienilic acid and propranolol on blood-pressure were additive and there were no statistically significant interactions. Tienilic acid significantly reduced serum-urate from 0.33 to 0.18 mmol/l and induced hypokalaemia which was corrected by propranolol. Basophil count and haemoglobin were lower after tienilic acid treatment than they had been at the start of the study.

Ranitidine hydrochloride (an H2-receptor-blocking drug which does not contain the imidazole nucleus of histamine) powerfully inhibited nocturnal and pentagastrin-stimulated gastric secretion in fifteen patients with duodenal ulceration. The drug is satisfactorily absorbed and therefore warrants clinical trial.