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Summary A double blind controlled trial of a house mile fortified house dust vaccine was carried out in forty-two asthmatic patients between the ages of 6 and 15 years. Improvement in height and weight was shown in eight of twenty-one children receiving the active therapy compared with one of twenty-one children receiving placebo injections. No difference between the two groups was shown by respiratory function testing or chest examination.

A double-blind cross-over trial of the effect of Epsilon-Aminocaproic acid (EACA) versus placebo on gastrointestinal blood loss in 13 patients with proctocolitis showed no statistically significant reduction in blood loss recorded by the disappearance rate, as detected by whole-body monitoring of parenterally administered59Fe. Moreover, there was poor correlation between sigmoidoscopic findings, using a standard grading, and estimated colonic blood loss. Patients with severe proctocolitis were excluded from the trial. This is the first reported controlled trial of the effect of EACA on blood loss in proctocolitis.

On the basis of reported successful hormone therapy for recurrent cancer of the endometrium, a multi-institutional program was established in 1963 and terminated in 1968 to study the adjuvant use of a progestogen in the primary definitive treatment of uterine carcinoma. The research protocol restricted entry to patients with disease limited to the uterine corpus as established by clinical evaluation, surgery, and pathology. Option of surgery alone or surgery plus irradiation was permitted. Depo-Provera and placebo given over 14 wk were randomly assigned in such a way that 285 patients received hormone; 287 served as controls. Survival analysis at 4 yr indicated no significant contribution to results by the adjuvant therapy. Overall excellent survival for treated patients and controls appeared to be the result of the high degree of patient selection incorporated in the protocol design. The influence of patient selection and of variations of disease-related parameters upon the results is discussed especially as it may affect future programs dealing with comparable patient material.

SummaryPharmacological studies of a novel chemical - daledalin tosylate (UK 3557), an indoline compound - suggested the possibility of antidepressant activity with fewer autonomic side-effects in man. A double-blind comparison of daledalin tosylate and amitriptyline hydrochloride as a standard reference antidepressant was carried out in 28 patients with depressive illnesses. Sixteen patients received daledalin tosylate and 12 amitriptyline hydrochloride. The concept of ‘depressive illness’ and the criteria for inclusion in the study are discussed at length.No statistically significant differences between the two drugs could be found in the Hamilton Rating Scale for Depression, the Wakefield Self-Assessment Depression Scale, global assessment of severity of illness or change in condition, side-effects check list, or the trend analysis of the laboratory results by linear regression.It was concluded that daledalin tosylate had antidepressant effects comparable with amitriptyline but no clinical advantages ov...

Glover, J. R., Morris, Jean G., and Khosla, T. (1974).British Journal of Industrial Medicine,31, 59-64. Back pain: a randomized clinical trial of rotational manipulation of the trunk. A therapeutic trial was conducted in a medium-sized engineering works on patients suffering from back pain with its accompanying tenderness and hyperaesthesia. The patients were randomly allocated to two treatment groups, (a) manipulation, and (b) de-tuned (i.e., simulated) short-wave diathermy, the latter acting as a placebo. The manipulated group were given one lumbar rotational manipulation session of 15 minutes or less and this was followed by four daily detuned short-wave diathermy sessions of 15 minutes. The control group were given five 15-minute daily sessions of detuned short-wave diathermy only. The patients' own subjective assessment of relief from pain was recorded in the range 0% (no relief) to 100% (complete relief). The responses were measured at three stages, (1) within 15 minutes, (2) three days after treatment, and (3) seven days after treatment. Although each of the two treatment groups showed progressive and marked improvement in the percentage of relief from pain during the seven-day period, there was no demonstrable difference between the two, except that at the 15-minute stage the relief from pain in the manipulated group was always greater than in the controls.

One hundred and seven untreated patients with acute myelogenous leukaemia (AML) were admitted to St Bartholomew's Hospital between 10 October 1970 and 31 January 1973. Before receiving drugs to induce remission they were allocated alternatively into 2 groups to decide their remission treatment-a group to receive chemotherapy alone and a group to receive the same chemotherapy with immunotherapy. The patients were then given induction chemotherapy and 45 of them attained complete remission. All patients in remission then received chemotherapy consisting of 5 days treatment every 28 days. Patients receiving immunotherapy were also given multiple weekly intradermal injections of irradiated stored AML cells and Glaxo B.C.G. using a Heaf gun. There were 19 patients in the group which received only chemotherapy during remission; 7 of these patients remain alive (median survival after attaining remission 303 days) and only 5 are still in their first remission (median remission length 188 days). Twenty-three patients were allocated to receive immunotherapy during remission in addition to chemotherapy and 16 remain alive (median 545 days) and 8 are in their first remission (median 312 days). The difference in survival of the two groups is significant with a P value of 0·003.

Thirty-eight patients with lupus glomerulonephritis entered a 10-week in-hospital trial of immunosuppressive therapy. They were permitted prednisone ≤ 0.5 mg/kg/day for extrarenal manifestations and were randomly assigned to receive, in addition, cyclophosphamide or azathioprine or placebo. Renal function, urine sediment, proteinuria, anti-DNA, C3, and symptoms were assessed before and after therapy. This represents the first double-blind controlled comparison of two immunosuppressive drugs commonly used in nonmalignant diseases. Cyclophosphamide was significantly superior to both azathioprine and placebo for all six measures together and for the three renal measures alone. Cyclophosphamide was significantly better than placebo with regard to proteinuria, urinary RBC, and serum C3. Azathioprine was not significantly better than placebo in any individual measure. Although cyclophosphamide led to somewhat greater improvement than did azathioprine, additional long-term data will be necessary to establish the role of either drug in the routine management of lupus glomerulonephritis.

Previous trials at our Institute revealed the effectiveness of actinomycin-D and vincristine in the treatment of Kaposi's Sarcoma. We herein report the results of a further randomized trial designed to test the efficacy of the three-drug combination consisting of actinomycin-D, vincristine and imidazole carboxamide and to compare the results with those obtained by combining actinomycin-D and vincristine only for all forms of Kaposi's Sarcoma. Of the 40 patients treated with two drugs, 22 (55%) achieved complete tumour regression, 13 (32.5%) had partial response and 5 (12.5%) did not respond. On the other hand, 30 out of 32(94%) of those receiving three drugs had complete tumour regression, one had partial and one had no response. There is a significantly higher complete response rate (p

In June 1963, a lyophilized homogenous vaccine prepared from the primary tumor tissue was given to a child with osteogenic sarcoma and pulmonary metastasis. During the 15-day course of injections the child gained 7 pounds; following treatment the disease progressed and the patient died. However, the temporary improvement suggested that immunotherapy may have inhibited tumor growth. A more formal controlled trial of immunotherapy in less advanced disease, designed by the author, was begun in April 1966. At first, the vaccine was prepared in the laboratory of Dr. C. Sourham and later by the immunological team of Dr. R. A. Good, L. Old, H. Oettgen and Y. Hirsut. Patients under the age of 25 with osteogenic sarcoma of the long bones but no evidence of spread beyond the primary site and who had been treated by amputation were included in the study. The autogenous vaccine was given in the postoperative period following amputation. If multiple metastasis (usually pulmonary) appeared, the vaccine was judged a failure. If there was subsequent pulmonary resection for multiple metastases, any observed beneficial effect was credited to this surgical treatment [1]. A preliminary report is presented on the patients who received vaccine treatment through April 1973 (Fig. 1).

SummaryForty-three patients with unilateral severe painful patellae, fulfilling the diagnostic criteria for 'chondromalacia patellae' laid down by Robinson and Darracott (1970), took part in a double-blind trial, 23 receiving an anabolic ester – nandrolone phenyl-propionate (‘Durabolin’). All patients followed a progressive quadriceps exercise programme. Twenty of the 23 patients given the anabolic ester were clinically improved. Changes in bone density in skyline knee radiographs were measured with a simple apparatus described.In 17 of the 23 patients given the anabolic ester, the bone density measurements improved. The 20 patients given the placebo showed an almost complete lack of response to the exercise programme alone. The possible aetiological factors involved in these results are discussed.

Meningeal involvement with Burkitt lymphoma cells constitutes the most challenging therapeutic problem in the management of Burkitt's tumour. The results of intrathecal chemotherapy with methotrexate or cytosine arabinoside in 55 episodes of malignant pleocytosis in 38 patients with Burkitt's tumour are described. The response was complete in nearly all patients after the administration of either agent. Cerebrospinal fluid (C.S.F.) remissions were more prolonged in patients receiving intrathecal methotrexate or cytosine arabinoside daily for four days as opposed to a 10-day schedule. A controlled randomized trial of "prophylactic" intrathecal chemotherapy in patients without malignant cells in the C.S.F. on admission showed no protective effect against the subsequent development of malignant pleocytosis. Future therapeutic approaches are considered in the light of these results.

A double-blind controlled trial of diazepam and haloperidol was carried out on four adolescent tiqueurs who were treated as in-patients. It was considered that counting the tics over a fixed period of time under standardized conditions provided the most satisfactory criterion of improvement. In the first trial, diazepam was found to have no significant effect on the frequency of the tics when a dosage of 2 mg. t.i.d. was used. However, further experience with one of the patients suggests that a higher dose may result in improvement, but with a tendency to relapse on discharge from hospital. In the trial of haloperidol, although the subjects reacted differently to a significant degree, there was a highly significant reduction in the frequency of the tics, which was due to the drug. It was also demonstrated that the conditions of measurement affect the tic frequency, which was greater whilst reading aloud. Haloperidol appeared particularly effective in preventing increase of the tics under such conditions of stress.

Within Balderton Hospital, two units treating psychopathic adolescents admitted alternately a consecutive series of 50 convicted youths. One unit practiced a self-governing group therapy regime, the other a firm, paternalistic and sympathetic approach. On the basis of follow-up indexes of reconviction, readmission and clinical well-being, the former did slightly but significantly worse than the latter.

A double-blind, randomized trial was conducted in 120 post-surgical patients to evaluate the oral analgesic activity of butorphanol tartrate (4 mg and 8 mg) and pentazocine HCl (50 mg) as compared to placebo. Both doses of butorphanol as well as pentazocine proved to be significantly (p

In a clinical controlled trial the use of vinyl-ether-ether-N2O (53 cases) and diazepam-N2O (48 cases) as general anaesthetic for operative vaginal delivery is compared. Local anaesthetic for episiotomy was applied in both methods to enhance analgesia. In the diazepam group there were no maternal complications while in the vinyl-ether-ether-group there were 14 cases of vomiting, of which 2 led to aspiration with development of Mendelsohn's syndrome. A third case in the same group also had an aspiration without evident sequelae. The time from start of anaesthetic induction till complete delivery of the baby was on average 6 min 17 sec in the vinyl-ether-ether group compared with 2 min 21 sec in the diazepam group, which means an average reduction of about 4 min. Diazepam anaesthesia is simple to administer, effective, allows rapid delivery and is comfortable and safe for the mother. This form of anaesthesia made the obstetrician's task easier during delivery. It also appears to be a safe method for the new...

SUMMARY In a controlled trial it has been shown that propanidid and thiopentone are equally useful anaesthetics for electro-convulsive therapy. Psychological tests were used successfully to detect differential effects of equipotent doses of anaesthetics in the presence of E.C.T. Results showed complication rates to be similar, a notable absence of suxamethonium pains, an increase in apnoeic periods, a decrease in waking and talking times, and a marginal improvement of psychological performances following administration of propanidid. Pre-convulsion performances of the Porteus-type maze were improved following both anaesthetics.

A double-blind trial of corticosteroid snuff treatment was carried out in a hundred patients with severe chronic perennial rhinitis of at least 3 years' duration. Symptomatic improvement was greater in patients who took dexamethasone snuff, 0·5 mg. daily, than in those who used hydrocortisone snuff, 15 mg. daily, or a placebo capsule, the difference being unlikely to be due to chance. Dexamethasone snuff seemed to be equally successful in individuals with allergic and non-allergic rhinitis and in a 12-month follow-up period prolonged good results were noted with smaller occasional doses of treatment. The treatment is probably mainly local in effect and corticotrophin-stimulation tests suggested that suprarenal suppression seems to be unlikely to be a frequent complication.

SynopsisA feasibility study for a controlled trial of a certain type of formal psychotherapy is described. Patients referred by consultant psychiatrists in the Inner London Area were carefully selected and fully assessed before random allocation to one of three treatment procedures. The results indicate that the trial as initially envisaged is not feasible. The reasons for this conclusion are discussed.

Summary Forty-eight previously untreated patients with advanced pulmonary tuberculosis were allocated at random to three treatment groups: IsH-isoniazid 300 mg. daily in a single dose with 4-4′ diisoamyloxythiosemicarbanilide (‘Isoxyl’) 3 g. twice daily; PH-isoniazid 300 mg. daily with 6 g. PAS twice daily; SPH-streptomycin 1 g. daily or alternate days with isoniazid and PAS. Nine patients were excluded, leaving 39 patients (13 IsH, 11 PH and 15 SPH). All had cultures sensitive to isoniazid and PAS and all but one (PH) to streptomycin. All 15 SPH patients became culture negative. One of the 11 PH patients had isoniazid resistant cultures from the 2nd month. Cultures oecame negative in the remaining 10. Of the 13 patients in the IsH group only 4 became negative and isoniazid-resistant cultures were obtained from 9. The results of treatment of advanced pulmonary tuberculosis with isoniazid and ‘Isoxyl’ appear to be no better than the results expected with isoniazid alone.

A prospective, controlled trial of the therapeutic effect of azathioprine in 30 patients with multiple sclerosis was carried out. No significant advantage of azathioprine over placebo was demonstrated in non-re-sponders to corticosteroids or corticotrophin (p < 0.5). At the present time, it cannot be concluded from the trial whether or not azathioprine should be given to corticosteroid-responsive patients.

Because of several controversial reports concerning the efficacy of cromolyn sodium in the treatment of asthma, the Drug Committee of the American Academy of Allergy instituted a collaborative study in November, 1969. The protocol was designed to select patients according to age, cooperativeness, severity of asthma, and type of asthma—extrinsic, intrinsic, or mixed. The basic design of the study involved a baseline period of one week in which inert filler (lactose) was administered in the Spinhaler apparatus and during which the patient could be familiarized with the complex record keeping. The basal period was followed by two 4 week crossover periods during which cromolyn sodium was alternated with placebo. Symptom scores, drug intake, physician evaluation, patient preference, and simple pulmonary function tests were subjected to statistical analysis. Results gleaned from 252 completed patients indicated a favorable response for the drug as compared to placebo in patient symptom scoring, ephedrine-like drug scores, physician evaluation, and patient preference. A drug carry-over effect extending over a period of 4 weeks created difficulty in assessing results of the placebo period in patients who received active drug during the first 4 week period. Although a favorable drug effect was usually observed when cromolyn sodium was the first drug in the trial sequence, efficacy was more clear-cut during active drug administration in patients who received placebo during the first 4 weeks of the study. The mechanism of this carry-over effect was not apparent. The amelioration index tended to be higher in the pediatric group and in those patients whose asthma was classified as mixed. No change in the objective indices of one-second forced expiratory volume or peak expiratory flow measured once every 2 weeks was obtained. No serious side effects were noted by the participating investigators. These results indicate that cromolyn sodium will be a useful adjunct to the pharmacological treatment of asthma.

A prospective, random controlled study was designed to evaluate the role of antibiotics in the therapy of salmonella gastroenteritis in children. Children (ages 10 months to 15 years) were randomly assigned to one of three groups: (1) sulfamethoxazoletrimethoprim (SMZ-TMP), 100 mg. and 20 mg. per kilogram per day, respectively; (2) ampicillin, 100 mg. per kilogram per day; or (3) no therapy. Antibiotics were given orally for seven days. There were no significant differences in the clinical features, duration of illness (2.6 to 4 days), bacteriologic cure rates (63 to 72 per cent at one week), or carrier states (0 at 8 weeks) among the three groups followed for six months. All isolates were sensitive in vitro to the antibiotics used and no resistance developed. The combination drug SMZ-TMP was well absorbed, and serum and urine concentrations and ratios were adequate. Although highly active (and synergistic) in vitro, the new combination drug SMZ-TMP is no more effective than ampicillin in vivo; neither of the antibiotic treatments offered any advantage over no antibiotic therapy of salmonella gastroenteritis in children.

Hepatocellular carcinoma is a common tumour in Uganda. Thirty-six of 120 patients with hepatoma admitted during a 2 1/2-year period were submitted to surgery. Major hepatic resections were performed in 10 patients and a further 10 cases had placement of a hepatic artery catheter for regional infusion chemotherapy. In the surgically resected and regionally infused patients survival was improved compared with those receiving either systemic chemotherapy or no treatment. Hepatic resection offers a chance of cure for a small minority of patients with hepatoma, whilst regional chemotherapy via a directly placed arterial catheter at the time of exploratory laparotomy may benefit others and is being further evaluated by a controlled trial.

Background: Various local anaesthetic agents are used for brachial plexus block.We compared effectiveness of addition of Dexamethasone versus Neostigmine to Lignocaine, adrenaline admixtures for Brachial plexus block in providing perioperative analgesia. Methods: Ninety patients were randomized in three groups and were received 24ml of study drugs. The group A [Lignocaine with adrenaline (1.5%)], group B [Lignocaine with adrenaline (1.5%)] +500?g Neostigmine, and group C (Lignocaine with adrenaline (1.5%) +4mg Dexamethasone) for brachial plexus block through supraclavicular approach. The observed parameters were onset of analgesia, completion of sensory and motor blockade, Duration of analgesia, Surgeon's score, side effects, number of supplemental analgesics doses and Visual analogue scale (VAS) score for pain in 12 hour of post-operative period. Results: Mean onset of analgesia 4.6±1.1 , 4.4±0.8 , 3.8±1.8 mins in group A, B and C respectively and the Mean onset of motor blockade were 7.7±2.0, 7.0±1.8, 6.0±2.1mins in group A, B and C respectively. Similarly Mean Complete sensory block in 10.6±3, 10.4±2.5, and 8.9±2.2mins and Mean complete motor block in 17.3±4.3, 17.2±4.0 and 14.7±3.5 mins in group A, B and C respectively were achieved. Duration of analgesia was 176.5±53.5, 225.7±53.3 and 454.2±110.7 mins in group A, B and C respectively. Duration of analgesia in group C was statistically significant in comparison with other groups. The number of mean analgesic requirement by group C (0.9±0.4) was significantly (p- 0.005) lower. The mean VAS was significantly lower in group C in 12 hours post-operatively. Conclusion: The onsets of action, duration of analgesia were better in dexamethasone group and also need less number of rescue analgesics requirement. doi: 10.3126/kumj.v6i3.1704 Kathmandu University Medical Journal (2008), Vol. 6, No. 3, Issue 23, 302-309

To reduce the frequency of infection in acute leukemia, we employed isolation and air-filtration facilities ("protected environment") and a prophylactic regimen that included oral nonabsorbable antibiotics. Eighty-eight randomized patients received identical remission-induction chemotherapy within one of three groups: protected environment combined with the prophylactic regimen (Group 1); oral nonabsorbable antibiotics alone (Group 2); and neither isolation nor prophylaxis (Group 3). The groups were comparable in factors that might influence the course of leukemia and susceptibility to infection. Environmental maneuvers. were effective in reducing the potential inoculum of ambient micro-organisms. Patients in Group 1 had 1/2 as many severe infections as those in Groups 2 and 3. Whereas approximately 1/4 of the patients in Groups 2 and 3 died of infection while on study, none in Group 1 died for that reason. Despite fewer infections in Group 1, no intergroup differences were found in remission rat...

In a controlled trial of three alternative methods for local treatment of severe burns, a significantly lower incidence of bacterial colonisation was recorded in burns treated with local chemoprophylactic agents than in those treated by exposure in warm, dry air. Of the local chemoprophylactic methods, compresses of 0.5% silver-nitrate solution gave better protection in general against bacterial colonisation than 11.2% mafenide ('Sulfamylon') acetate cream with exposure of burns, but infection with Pseudomonas œruginosa occurred about as often in burns treated with silver-nitrate compresses as in those treated with mafenide cream. Miscellaneous coliform bacilli colonised similar proportions of burns in the three treatment groups. The mean of the highest respiration-rates per patient was significantly higher in patients treated by exposure in warm, dry air than in those treated with silver-nitrate compresses. The mean respiration-rate of patients treated with mafenide was slightly higher than that of patients in the silver-nitrate group, and slightly lower than that of patients in the group treated by exposure in warm, dry air; the mean temperature of patients treated with mafenide was slightly lower than that of the patients treated by exposure, but not apparently different from that of patients treated with silver-nitrate compresses. Mortality in each group was slightly, but not significantly, lower than that expected on a probability chart based on findings in the unit during the years 1965-70. Most of the patients treated with mafenide did not complete the course of treatment because of pain; acidosis occurred only in one patient treated with this agent. Side-effects of silver-nitrate treatment were noted in some patients, including low serum-sodium, acidosis, and diarrhœa. A trial of 1% silver-sulphadiazine cream on smaller burns showed that daily reapplication of the cream gave significantly better protection than reapplication every three or four days; the prophylactic effects of this treatment were similar, whether burns were covered with dressings or exposed.

Ventilatory function after three types of exercise-running, cycling, and swimming-was studied in 10 control subjects and 40 asthmatic patients. All performed eight minutes of submaximal aerobic exercise during each of the programmes, which were conducted in a randomly selected order. Biotelemetric monitoring of heart rates was used to equate the intensity of the exertion undertaken during the three systems of exercise. No control subject showed any significant variation in ventilatory capacity after exercise, and the responses after the three forms of exercise did not differ.In asthmatics exercise-induced asthma was observed after 72.5% of running tests, 65% of cycling tests, and 35% of swimming tests. In addition, those patients who developed exercise-induced asthma after swimming were noted to have significantly smaller falls in FEV(1) levels than were recorded after running and cycling. These results were statistically significant (P

Summary In a double blind trial of nasal spray of sodium cromoglycate (DSCG) for hay fever, fifteen of twenty-three patients taking the drug were helped, compared with thirteen of twenty-three receiving placebo—a statistically insignificant difference. Serum levels of IgE were raised in thirty-eight of forty-four patients examined. There was no significant difference between preseasonal and seasonal serum IgE levels in either of the DSCG or the placebo group. Serum IgE levels were significantly higher in the patients showing peripheral blood or nasal secretion eosinophilia during the hay fever season. There was no significant difference in the frequency of nasal secretion eosinophilia between those taking DSCG and those taking placebo. It is concluded that DSCG spray does not affect serum IgE levels or eosinophilia of either peripheral blood or nasal secretions under the conditions applying in this trial. Neither was DSCG significantly better than placebo in controlling symptoms.

A series of 265 sutured hand lacerations in an urban casualty department were grouped randomly into 3 groups: those receiving no dressing, an Elastoplast strip dressing, or a tubegauze dressing. Wounds showing microscopic or macroscopic pus at 10 days were deemed infected. Thirty-six per cent of wounds with no dressing became infected compared with 19 per cent and 16 per cent in the other two groups, this result being statistically significant (P

A double-blind between-patient study was carried out comparing pentazocine with pethidine in 94 women in labour. Similar analgesic and sedative effects were obtained with the two drugs, and Apgar scores were similar for babies of both drug groups. Fewer emetic sequelae were reported after pentazocine injections, though there was no statistically significant difference between the two drug groups in incidence of other side-effects.

A controlled, double-blind, crossover trial of haloperidol in a group of 16 children with behaviour disorders is described. Selection was based on the presence of at least four of the following symptoms: overactivity, restlessness, aggressiveness, temper, attention-seeking behaviour, disobedience, destructiveness, poor concentration. Benzhexol was administered concurrently with both active and placebo tablets. Thirteen children were rated as better on haloperidol, two as better on placebo and one as showing no difference. This result is statistically significant. Side-effects were minimal. It is concluded that haloperidol merits more extensive trial in conditions of the type studied.

SUMMARY A double blind study has shown no statistical difference between the clinical response of fifty atopic eczema patients to topical treatment with 1% hydrocortisone in a stabilized 10% urea cream (Calmurid HC) and a 0.1% betamethasone 17-valerate cream (Betnovate).

This study was designed as a double-blind trial of .25 mg ethynodiol diacetate versus the combined, established preparation, Ovulen 21 (1 mg ethynodiol diacetate and .1 mg mestranol). Blanks were added to the sets of Ovulen 21 capsules so that there was no obvious difference in appearance of the medications. 43 young women enrolled in each group. There were more dropouts in the experimental group so that the average number of months of study was 9.2 for the control group and only 6.7 for the experimental group. The experimental group reported more intercyclic bleeding and more irregularity of cycles than the Ovulen 21 control group (p.001 in each case). Cramping was reported 3 times more frequently by the experimental group, (p.05). There was 1 unusually prolonged case of amenorrhea (7 months) in a patient taking ethynodiol diacetate. This patient responded to discontinuation of the tablet and had a menstrual cycle within 36 days. There were no unintended pregnancies.

SummaryA multi-centre trial was carried out to compare the effectiveness in the treatment of chronic constipation of a lactulose preparation (‘Duphalac’) and ‘irritant’ laxatives containing senna, anthraquinone derivatives or bisacodyl. The results, in 164 patients, indicate that the lactulose preparation was more effective than the ‘irritant’ laxatives. By Day 7, 58 % of the lactulose-treated group were passing a normal stool whereas only 42 % of the patients receiving an ‘irritant’ laxative did so at the same stage in treatment. The lactulose preparation was shown to have a persistent ‘carry-over’ effect, and this effect was seen in significantly more patients receiving ‘Duphalac’ than in the ‘irritant’ laxative group.

In a controlled (crossover) study a group of phobic neurotic psychiatric outpatients were treated with standard systematic desensitization aided by intravenously administered methohexital sodium (Brevital Sodium). Results show that desensitization is effective in reducing the severity of phobic symptoms. Methohexital-aided desensitization may be significantly superior to conventional systematic desensitization in causing greater improvement of the phobic symptoms during an equal time period. The dosage range of intravenously administered methohexital sodium used in this study (up to 60 mg per 50 minute session) was found to be extremely safe and practical for outpatient use.

Betamethasone valerate aerosol is a new compound for the treatment of asthma. Its clinical effectiveness was established in a double-blind cross-over trial in non-steroid-dependent asthmatic patients. At a dosage of 400 to 800 mug/day for three months there was no evidence of suppression of hypothalamic-pituitary-adrenal function, as assessed by tetracosactrin and insulin stress tests.A 12-month follow-up study of 120 patients using steroid aerosols (betamethasone valerate or beclomethasone dipropionate) indicated that tolerance does not develop and that a daily maintenance dose of 200 mug/day was adequate in most patients. Temporary lack of response was observed during episodes of sputum production or of heavy exposure to antigen.There were no observed side effects other than fungal infections of the respiratory tract. However, the incidence of candidiasis of the pharynx (13%) and particularly of the larynx (5%) in apparently immunologically normal patients was disturbing. These infections were not seen in patients taking 200 mug/day. Though there is yet no evidence that fungal infections associated with steroid aerosols may penetrate the trachea and bronchi the possibility of this indicates that caution should be exercised in their use, particularly in long-term high dosage.

We examined the effects of chlorpromazine and major role therapy (MRT) on the quality of community adjustment of schizophrenic patients during a two-year period following hospital discharge. Among patients in the community, those treated with combined drug and sociotherapy adjust better than those taking the drug alone; to a greater extent, those receiving placebo alone adjust better than those receiving placebo and sociotherapy. However, only 20% of those in the placebo group have not relapsed after two years while the comparable percentage for the drug group is 52%. Effects found on assessments made by psychiatrists, social workers, family ratings, and self-reports replicate at three clinics. Maximum restorative benefits require both maintenance phenothiazine and psychologic treatment continued for beyond a single year following hospital discharge.

The effect of topical ampicillin on the rate of wound infection after emergency appendicectomy was studied in a prospective controlled trial of 200 patients. Sixteen per cent of patients in the control group developed a wound injection compared with 3 per cent of those receiving ampicillin powder in the wound (P Patients in the control group were discharged from hospital in a mean of 8·7 days postoperatively compared with 6·4 days in the ampicillin group (P