31 patients with a diastolic blood-pressure between 95 and 109 mm Hg have been treated for two years with a regimen involving a moderate restriction of salt in the diet. The results are compared with those in a control group and in a drug-treated group. Salt restriction has reduced the diastolic blood-pressure by 7.3+/-1.6 mm Hg, a result similar to that in patients treated with antihypertensive drugs. In the untreated group the diastolic blood-pressure rose by 1.8+/-1.1 mm Hg. Most patients did not achieve the desired amount of salt restriction and a stricter adherence to the diet might have caused further falls in blood-pressure. Excessive salt intake is probably a major cause of the epidemic of hypertension in "civilised" countries and a reduction in salt intake may help to control the epidemic. In persons with a diastolic blood-pressure between 90 and 105 mm Hg salt restriction should be tried before drugs.

The analgesic effect of acupuncture was evaluated by a double-blind controlled trial in 90 patients undergoing gastroscopy. The endoscopy was much easier and better tolerated after real acupuncture had been performed.

50 episodes of renal allograft rejection were treated by oral prednisolone and 49 by intravenous methylprednisolone. Both treatments achieved reversal of rejection in approximately 60% of episodes. Morbidity-rates, as assessed by hypertension, oliguria, fluid retention, and infection, tended to be greater after oral treatment. When the results were reexamined for accelerated, acute, and chronic rejection episodes the only difference demonstrated was an increased frequency of fluid retention in patients treated by oral prednisolone for an acute rejection episode. There was no evidence that intravenous methylprednisolone was nephrotoxic.

The claim that an upright maternal posture during labour improves the efficiency of the uterus to the benefit of both mother and fetus has been investigated in a randomised prospective study. 40 patients undergoing induction of labour were allocated to a recumbent group or an upright group. No differences were found between the groups in the length of labour, mode of delivery, requirements of oxytocic and analgesic drugs, or fetal and neonatal condition. Our data do not support calls to change conventional intrapartum nursing attitudes.

54 patients in five centres participated in a study of the relationship between steady-state plasma-levels of amitriptyline (AT) and its active metabolite nortriptyline (NT) and therapeutic response. The participants were inpatients who, after a 7-12 day period of assessment, were rated greater than or equal to 16 on the Hamilton rating scale for depression. They were given 75 mg of amitriptyline for 3 days and then 150 mg daily for an active-treatment period of 6 weeks. Clinical ratings and plasma-samples were obtained at baseline then at 2, 4, and 6 weeks after starting therapy. Contrary to the findings of three previous trials, no important correlations were found between steady-state plasma-levels and therapeutic outcome or corrected side-effects. Corrected side-effects correlated negatively with therapeutic outcome. There seems little advantage in routine monitoring of AT and NT, since variations in plasma-levels do not account for the considerable variation in therapeutic outcome.

Approximately 20 g/day of concentrated dietary fibre from carrot, cabbage, apple, bran, and guar gum was added to the controlled basal diet of nineteen healthy volunteers. Faecal weight increased by 12% on bran, 69% on cabbage, 59% on carrot, 40% on apple, and 20% on guar gum. These changes in faecal weight were correlated with an increased intake of pentose-containing polysaccharides from the fibre. On the basal diet there were pronounced individual differences in faecal weight, and from these the response of subjects to the fibre preparations could be predicted. Addition of fibre shortened mean transit-time through the gut and significantly diluted an inert marker in the faeces. Diet-induced changes in colonic function may explain international differences in the prevalence of colonic disease, whilst personal variation in the response to dietary fibre may determine individual susceptibility to large-bowel disease within a community.

Within a group of 1026 men aged 47-54, cause-specific death-rates and the incidence of non-fatal myocardial infarction and stroke in treatment group of 635 hypertensive men (casual systolic B.P. greater than 175 or diastolic B.P. greater than 115 mm Hg on two occasions) treated at a hypertension clinic were compared with those in a control group of 391 men (causal systolic B.P. greater than 175 or diastolic greater than 115 mm Hg on only one occasion) who remained mainly untreated during their 4.3 years of follow-up. The predicted risk of coronary heart-disease (C.H.D.) at entry, calculated by a multiple logistic function, was slightly higher in the treatment group. Total death-rate during follow-up was significantly lower in the treatment group (3.3%) than in the control group (6.1%). The difference in death-rate for C.H.D. was of the same relative order (0.8% versus 1.5%), as was the incidence of non-fatal myocardial infarction (2.8% versus 5.4%), although none of the differences reached statistical significance. However, the pooled incidence of fatal and non-fatal C.H.D. was significantly lower in the treatment group (3.6%) than in the control group (6.9%). The results suggest that antihypertensive treatment might be effective in preventing or postponing C.H.D. in middle-aged men.

The unfavourable cervix in late pregnancy presents a difficult clinical problem if labour has to be induced. In an attempt to improve the outcome, the effect of applying oestradiol directly to the cervix the day before planned induction was investigated. Two groups of twenty-five primigravidas were studied, one group receiving 150 mg oestradiol in viscous gel and the other the viscous gel alone. There was a significant increase in cervical ripeness in the group who received oestradiol and a reduction both in the length of the labour and in the need to resort to caesarean section.

There is considerable uncertainty about the effects of bypass surgery on the longevity of patients with coronary-artery disease and angina. The Cleveland Clinic has reported improved survival after surgical treatment; the Duke University study indicated improvement in a high-risk subgroup only. The Veterans Administration (V.A.) randomised study initially reported improved survival only for patients with significant left main artery (L.M.) disease. Further analysis of the V.A. study shows that survival in the high-risk subgroup was 87% for the surgically treated patients and 74% for those treated medically--a highly significant difference after four years of follow-up. However, exclusion of the L.M. group reduced the difference to a non-significant one of 84% versus 79%. For patients not in the high-risk subgroup, survival at four years (with L.M. excluded) was 93% for those treated surgically and 96% for those treated medically. For all patients the rates were 85% and 86%, respectively. These findings indicate that in the evaluation of the effects of bypass surgery on longevity the characteristics of the coronary-artery disease are critical.

A prospective clinical trial compared polyglycolic acid (P.G.A.) suture material with silk in the closure of wounds in 1000 patients attending the accident service of a district hospital. Statistical analysis showed the incidence of inflammatory reaction and suppuration to be significantly lower in wounds sutured with P.G.A. The analysis took into account the site of the wound, and the age and sex of the patients. P.G.A. sutures rather than silk are therefore recommended in the treatment of wounds in an accident service.