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Background: The purpose of this study was to induce immunity to p53 by using an idiotypic vaccine, composed of a pool of eight peptides derived from the complimentarity determining regions (CDRs) of human anti-p53 antibodies. Patients and methods: Subjects with advanced malignancy received up to four, monthly intradermal injections of pooled peptides (500 μg of each) admixed with granulocyte-macrophage colony-stimulating factor (GM-CSF; 100 μg). In addition, two sheep and two rabbits were also vaccinated with the pooled peptides. Results: Fourteen subjects were enrolled into the study and six of these completed the vaccination schedule. The vaccine was well tolerated by all subjects and no major adverse events were attributable to the vaccine. All subjects mounted in vivo delayed type hypersensitivity (DTH) responses to two or more of the individual vaccine peptides. Vaccine-induced antibodies specific for peptides 2,5 or 8 were detected in four of six subjects, and two of these had vaccine-specific, cell-mediated responses. Increasing titers of p53-specific antibodies were found in one patient. No T-cell response to p53 was observed in any of the subjects. All animals developed humoral immunity to the peptides and one of the sheep developed rising serum titers of anti-p53 antibodies. Conclusions: Vaccination with human antibody CDR regions represents a novel method for inducing human antibodies, which may in turn serve as immunological mimics of p53.

This phase II study was designed to evaluate the response rate (RR) and toxicity of gemcitabine/vinorelbine in patients with metastatic breast cancer. All patients had previously received anthracyclines. Treatment consisted of gemcitabine 1200 mg/m2 and vinorelbine 30 mg/m2 on days 1 and 8, every 3 weeks. Twenty-five patients were enrolled. Median age was 59 years (range, 33-73 years). Ten patients had received only adjuvant therapy with anthracyclines. The remaining 15 patients had received chemotherapy for metastatic disease, including taxanes in 11 cases. Four patients could not be evaluated for response. By intent-to-treat analysis, the overall RR was 44% (95% CI, 24.4%-65%). Median duration of response and median time to treatment failure were 21 and 17 weeks, respectively. The main toxicity was hematologic, with grade 3/4 neutropenia occurring in 13 patients and 1 patient developing febrile neutropenia. Two deaths from pneumonia occurred. These results reveal an encouraging activity with a reasonable toxicity profile in a patient population with an unfavorable prognosis. Our group is conducting a randomized study to compare this combination with vinorelbine alone in patients with metastatic breast cancer after failure to respond to anthracyclines and taxanes

Background The value of Ki67 proliferation biomarker during neoadjuvant chemotherapy (NC) is less clear than with neoadjuvant endocrine therapy. We study the role of proliferation according to Ki67 marker measured by immunohistochemistry (IHC) as a predictive factor of pathological complete response to NC. Methods From May 2002 to June 2005, 127 pts diagnosed as stage II-III, including inflammatory tumors, breast cancer patients (pts) received one of the 2 NC regimens every 2 weeks with prophylactic growth factor support. Study A: adriamicin 40mg/m2 d1 plus P 150mg/m2-G 2000 mg/m2 d2 for 6 cycles (n = 54); study B: epirubicin 90 mg/m2-cyclophophamide 600 mg/m2 d1 for 3 cycles, followed by a second sequence with paclitaxel (P) 150 mg/m2- gemcitabine (G) 2500 mg/m2 d1 +/- trastuzumab 2mg/kg/wk according to status Her2 (n= 73). In study A pts did not receive trastuzumab regardless of Her2 status. Ki67 was centrally assessed by IHC (Master Diagnostica clon SP6). Tumors were considered to have high proliferation rates (Ki67) if ≥ 20% of cell nuclei stained positive. Median age was 48 years. Her2+ was observed in 31%, HR negative 34%, grade III 46% and high Ki67 47%. Pathological complete response (pCR) defined as absence of invasive cells in breast and lymph node was achieved in 35 pts (28%). Univariate and multivariate logistic regression models were used to study the association of each clinical-pathological variable with pCR. Results High Ki67 was the main predictive factor of pCR to NC. In the univariate analysis histological grade (p = 0.001), HR (p Conclusion High proliferation determined by ki67 marker is an independent predictive factor for pCR in locally advanced breast cancer patients treated in two dose-dense NC schedules. Disclosure All authors have declared no conflicts of interest.

Considerable change is occurring in arrangements for training rehabilitation workers. Amid signs that employers are finding ad hoc localised and more diverse ways of preparing staff, there is also growing concern to re-focus and rebuild systems of training that will be robust and serve the field better into the next century. The Visual Handicap Group has prepared a Consultative Report which sets the scene for a period of reform which could lead to a larger and more highly trained workforce able to cope with a work setting that is undergoing rapid change.

This paper presents a method for finding equilibrium points of arbitrary index that lie on the boundary of the region of attraction of a stable 'operating point'. It is developed in the context of interconnected power system models, but is not limited to such models. The method exploits the fact that loss of stability of the attractor is preceded by a sequence of saddle-node bifurcations involving saddle equilibria on the boundary of its region of attraction. Thus, we use the procedure of continuing the stable point until it bifurcates and disappears. Using backtracking and elementary bifurcation theory, we find a number of one-saddles, depending on the path that led to the bifurcation. A refined search then yields equilibria of larger index. In the process, we obtain considerable information on the 'orbit' or Smale diagram of the flow. A number of medium to high dimension power system models were studied using our procedure.

Patients with clinical stage I non-seminomatous germ cell tumour (NSGCT) with pathological high-risk features have a risk of recurrence on observation of approximately 40 per cent. This study evaluated the efficacy of adjuvant chemotherapy in a large series of patients treated in a multi-institutional setting.

MB Levy, A Elizur, MR Goldberg, L Nachshon, Y Katz. Ann Allergy Asthma Immunol. 2014;112(1):58–63.e1 The goal of this study was to assess the safety and efficacy of milk oral immunotherapy (OIT) in milk-allergic children and adults, including high-risk patients. The study included 280 Israeli patients, ages 4 to 27 years (median age: 7.5 years), with persistent cow’s milk allergy as defined by positive results on skin prick test and/or specific-serum IgE, positive oral food challenge, or history of clinical reaction with accidental exposure in the last 12 months. High-risk patients, including those with a history of anaphylaxis (as defined by involvement of at least …

Information on the relative cost-effectiveness of treatments for cancer is being increasingly sought as pressure on health care resources increases. The objective of this study was to assess the cost-effectiveness of gemcitabine/cisplatin (GC) versus cisplatin/etoposide (CE) in patients with advanced non-small cell lung cancer (NSCLC), using resource utilization data collected in conjunction with the first randomized clinical trial comparing both combinations.Efficacy and medical care resource utilization data were collected prospectively in an open-label, multicenter, randomized, comparative, phase III trial conducted in Spain which compared gemcitabine/cisplatin and cisplatin/etoposide in 135 chemonaive patients with Stage IIIB or IV NSCLC. There were no differences between both regimens when survival was used as primary end-point, so a cost-minimization analysis was used to compare them. In addition, cost-effectiveness analyses were conducted when percentage of responses and time to progression were used as secondary end-points.There were no differences between both regimens when survival was selected as the efficacy end-point. Despite the higher chemotherapy cost of GC when compared to CE, there were no differences in total direct costs (584523 pts for GC and 589630 pts for CE; P=NS) between both regimens. Potential savings with GC were mainly associated with a decrease in hospitalization rate. There were differences in favor of GC when response rate (40.6% for GC and 21.9% for CE; P0.05) and time to disease progression (8.7 months for GC and 7.2 months for CE; P0. 05) were used as clinical end-points. GC presented a favorable cost-effectiveness profile when compared to CE.This prospective economic evaluation conducted alongside a clinical trial offers valuable preliminary information on the potential efficiency of the combination gemcitabine-cisplatin in NSCLC. Future assessments based on larger clinical trials focused on survival and naturalistic economic studies conducted in real clinical practice settings are necessary to confirm these findings.

This article ranges over the wealth of data provided by the RNIB Needs Survey just published, and looks specifically at their significance for the future work of voluntary agencies The survey shows that the character and scale of visual Impairment have been understated In the past The twenty or so national organisations and the two hundred or so agencies working at a more local level, are addressed The output of the Needs Survey so far published (Volume /) will challenge all agencies working on behalf of blind and partially sighted people, practically and philosophically

The treatment of the burns is successful in situation when there is a separate department for burns with well-educated and highly skilled surgeons. The adequate reanimation during the first 48 hours is essential for the patients with burns to survive. Burns patients with circumferential burns of the body or the bower extremities should have at least three longitudinal incisions (escharotomy) prior to the development of the arterial ischaemia. The early tangential necrectomy should be performed between third and fifth day. The early grafting of the necrotic surfaces reduces the possibility of septicemic complications with deep burns and thus decreases the mortality rate.

Intracorporeal administration of papaverine hydrochloride is frequently used in the diagnosis and treatment of impotence. Priapism is the most serious potential complication of its use. The historical characteristics of 400 consecutive men receiving a standardized dose of papaverine were reviewed in an effort to determine the risk factors for prolonged erections. Younger men (p less than 0.0001) with better baseline erectile function (p less than 0.023) were more likely to have priapism. Despite use of a significantly lower dose, patients with overt neurological disease also had an increased rate of priapism. Patients with a history of coronary artery disease had a significantly lower risk of priapism (p less than 0.05). Patients with a final diagnosis of either psychogenic or neurogenic impotence had a much greater risk of priapism than those with vasculogenic impotence (p less than 0.001). The initial dosage in pharmacological erection therapy may be adjusted according to these risk factors. However, not all patients with psychogenic or neurogenic impotence had priapism and some patients with vascular disease did have priapism. Therefore, all impotent patients are potentially at risk for pharmacologically induced priapism.

A new case of afferent loop obstruction presenting as acute pancreatitis is described. It is an uncommon manifestation of the afferent loop syndrome: less than 20 cases found in the literature. The diagnosis of afferent loop obstruction should be suspected in any patient with acute pancreatitis and a previous Billroth II gastrectomy. Duodenopancreatic reflux seems to play an important role in the pathogenesis of acute pancreatitis in this situation. The "closed duodenal loop" experimental model of acute pancreatitis simulates quite closely this clinical situation. The physiopathological principles, diagnosis and treatment of this syndrome is reviewed.

1083 Background: The addition of Carboplatin to Trastuzumab and Paclitaxel improves the efficacy in HER2+ metastatic breast cancer (MBC). We have conducted a multicenter Phase II study to investigate the efficacy and safety of this combination given weekly × 3 followed by 1 week of rest. Primary endpoint was objective response rate and secondary endpoints were time to progression, overall survival and to study the toxicity profile of the combination. Methods: Between August 2003 and April 2006, 40 patients with HER2+ MBC (IHC 3+ or FISH+) have been included in the study. Pats received Trastuzumab (loading dose of 4 mg/kg/wk and 2 mg/kg/d following wks), Paclitaxel (80 mg/m2) and Carboplatin (AUC 2) all given weekly × 3 followed by 1 week of rest. Treatment was given until disease progression or unacceptable toxicity. Results: 40 pats had baseline data available. Median age was 54 yrs (range 29–75). 38 (95%) pats received prior adjuvant or neoadjuvant treatment. 11 (27,5%) pats have received one prior CT line for metastatic disease. 87,5% pats had PS 0 or 1 at study entry. Disease sites were liver 16 (40%), bone 12 (30%), lymph nodes 13 (32,5%) and lung 8 (20%). 19 (47,5%) had = 2 lesions. 97,5% had measurable disease. 36 pats have been evaluated for response: 11 CR (31%, 95% CI: 15–46%), 11 PR (31%, 15- 36%), 9 SD (25%, 9–36%), 5 PD (14%, 2–26%) and 4 NE resulting in an ORR of 61% (95% CI: 45–77%) and tumor growth control rate (RR+SD) of 86% of patients (95% CI: 75–97%). Median TTP was 12.1 mo (95% CI: 8.8–19.9 mo) and median duration of response and OS have not been reached yet. For a time of observation of 35 mo, the OS is 80,6%. 37 patients have received 194 cycles with a median of 5 cycles. Grade 3–4 toxicities/pats were: 3(7.5%) anaemia, 2 (5%) leucopenia, 8(20%) neutropenia, 1 (2,5%) febrile neutropenia, 1 (2,5%) trombopenia, 2(5%) asthenia, 2(5%) diarrhea, 3(7.5%) nausea, 2(5%) vomiting, 3(7.5%) mucositis Conclusions: This interim analysis shows an interesting activity with this regimen. One week of rest may be of better convenience for the patient and hospital but also may improve the tolerability profile and efficacy of the combination. Further results would be available for presentation. No significant financial relationships to disclose.

10692 Background: X and T are highly active single agents in MBC. The XT combination leads to superior overall survival (OS), time to progression (TTP) and response rate (RR) vs. T alone in anthracycline-pretreated MBC [O’Shaughnessy et al. J Clin Oncol 2002]. The aim of this trial was to evaluate the efficacy and safety of sequentially administered T then X as first-line treatment in MBC. Methods: Pts ≥ 18 years with previously untreated, HER2neu-negative MBC, ECOG PS ≤ 2, were included in this prospective, multicenter, non-randomized, phase II study. Pts received 3 cycles of T (100mg/m2 d1) followed by 3 cycles of X (1250mg/m2 bid d1–14), every 3 weeks. Results: To date, 38 pts are evaluable for safety and 33 pts for efficacy. Baseline characteristics: median age 54.4 years (range 33–76); PS ≥ 1 50%; 36 (95%) pts had previous (neo)adjuvant anthracyclines, 8 (21%) concomitant with paclitaxel. The most frequent metastatic sites were: bone 47%, nodes 39% and liver 36%. 69% of pts had ≥ 2 metastatic sites. To date, 38 pts have received 3 cycles of T and 33 have also received 3 cycles of X. A total of 195 cycles have been administered: T 108 cycles (median 3, range 1–3); X 87 cycles (median 3, range 1–3). Dose reductions and interruptions for T vs. X were 32 vs. 21% and 21 vs. 21%, respectively. Median relative dose intensity: T 0.97 (range 0.62–1.00), X 0.93 (range 0.26–1.00). T grade 3/4 toxicities (37 evaluable pts): asthenia 19%, mucositis 16%, nausea 13%, febrile neutropenia 11%, rash 5%, diarrhea 5%, infection 3%. X grade 3/4 toxicities (33 evaluable pts): hand-foot syndrome 9%, diarrhea 9%, vomiting 9%, asthenia 6%, nausea 3%, anorexia 3%. In the 33 pts evaluable for efficacy, the RR was 61%, including 4 CRs and 16 PRs. At a median follow-up of 6.1 months, median TTP has not yet been reached. Conclusions: These preliminary results show that the sequential regimen of T followed by X is feasible, effective and well tolerated in first-line MBC, although giving X before T should also be investigated. Findings from a recent trial of XT vs. T followed by X [Beslija et al. ECCO 2005] suggest that XT should be standard in fit poor-prognosis pts with aggressive disease. No significant financial relationships to disclose.

4552 Background: The availability of reliable prognostic factors for relapse in stage I seminoma would allow a better patient stratification for individually tailored therapies. We performed a pooled analysis of patients included in two consecutive risk-adapted protocols. Methods: Between 1994 and 2004, 588 cases were prospectively registered. Median patient age was 33 years, median tumor size was 45 mm, serum BHCG levels were elevated preoperatively in 14.6%, and rete testis invasion was present in 26.9%. Three hundred and four patients (51.7%) with risk factors received two courses of adjuvant carboplatin, whereas 284 (48.3%) without these criteria were managed by surveillance. After a median follow-up of 48 months (range, 12–144), 43 relapses (7.3%) have occurred. Five-year disease-free survival was 92.3%. Univariate (log rank) and multivariate (Cox regression) analyses of prognostic factors for relapse were performed. Results: Relapses were less frequent after carboplatin treatment (3% vs 12%, p < 0.0001). Statistically significant, independent predictors of relapse were: 1) rete testis invasion and age ( No significant financial relationships to disclose.

10755 Background: To evaluate the effectiveness and tolerability of long -term treatment with capecitabine in metastatic breast cancer patients. Capecitabine (C) has been administered offering clinical benefit to women with metastatic breast cancer (MBC) (ORR: 42%). The aim of this trial was to evaluate the efficacy and tolerance of capecitbine in long-term treatment, administered as first, second and third line treatment in MBC. Methods: Patients ≥ 18 years old with MBC, ECOG performance status (PS) ≤2, HER-2 neu negative, non-chemotherapy naive were included in this prospective, multicentre, non-randomized. To date, twenty-two ambulatory patients were evaluable for toxicity and response. Median age 59.2 years (37–81). All of patients had previously received adjuvant treatment. Hormonal therapy were allowed as clinically required. They received three weekly cycles of oral capecitabine 1000–1250 mg/m2 twice daily, days 1–14, followed one week rest until progression or relapse. Results: The overall response rate (ORR) is including PR, CR, and EE 78%. The median treatment duration was 14 months, median range (3–32). Median progression-free and overall survival have not yet been reached. The most common grade ½ (NCIC CTC) treatment related adverse events were /23, hand foot syndrome 4/23, diarrea 1/23. Conclusions: These preliminary data confirm that the treatment with capecitabine (C) is an effective and well tolerated regiment in metastatic breast cancer patients. No significant financial relationships to disclose.

7337 Background: Single-agent T represents the standard treatment in NSCLC patients recurring after first-line chemotherapy. The aim was to evaluate whether T in combination with M would lead to an improved outcome with similar toxicity and increased efficacy compared to T monotherapy as second-line chemotherapy in NSCLC. Methods: Patients (pts), aged ≥18 years, with histopathological diagnosis of NSCLC with progression after first-line chemotherapy, measurable disease, ECOG < 2 and adequate bone marrow, renal and hepatic functions were included in this study. T was administered iv at 75 mg/m2 followed by M at 8 mg/m2 both on day 1, every 21 days. Results: A total of 49 pts: male/female, 41/8; median age 57 years (36–74), ECOG PS 0/1: 31%/69%. Tumor sites were lung (n=42) and mediastinum (n=7). Median number of metastatic sites was 1 located in nodes (39%), bone (29%) and adrenal (22%). Tumor histology included adenocarcinoma (43%), squamous cell (33%) and large cell (25%). A total of 230 cycles have been...

801 Background: Docetaxel (D) has been concomitantly administered with capecitabine (C) offering clinical benefit to women with metastatic breast cancer (MBC) (ORR: 42%). The aim of this trial was to evaluate the efficacy and tolerance of sequentially administered D plus C as first line treatment in MBC. Methods: Patients ≥ 18 years old with MBC, ECOG performance status (PS) ≤2, HER-2 neu negative, non-chemotherapy naive were included in this prospective, multicentre, non-randomized, phase II study. Three cycles of D (100 mg/m2 d 1) followed by three cycles of C (1250 mg/m2 PO bid d 1–14), were both administered every 3 weeks. Results: To date, 18 patients are evaluable for toxicity and 12 for response. Median age 55 years (36–76); PS 0/1: 59%/41%. All patients had previously received neo/adjuvant anthracyclines treatment, 5 of them concomitant with paclitaxel. The most frequent metastatic sites were: nodes 44%, lung 28% and liver 22%. 72% patients had ≥2 metastatic sites. To date, 18 and 12 patients have...

842 Background: GAT regimen has being tested as NC in LABC patients (pts), based on its efficacy in metastatic disease (Sanchez-Rovira et al. Oncology 2001; 15(2): 44–47). Methods: Newly diagnosed ...

4099 Background. The efficacy of gemcitabine can be improved by using a fixed dose-rate infusion. Our objective was to evaluate the efficacy and toxicity of a fixed dose-rate infusion of gemcitabine associated to cisplatin and UFT in patients with advanced adenocarcinoma of the pancreas. Patients and method. From May 2002 to September 2003, 46 chemotherapy-naive patients were included, median age 57 years (range 27–77), male/female 30/16. Eleven patients (24%) had locally advanced disease and thirty-five (76%) distant metastases. The Karnofsky score was 80–100 in 34 (74%) and 60–70 in 12 (26%). Treatment consisted of gemcitabine 1200 mg/m2 given as a 120-minute infusion weekly for three consecutive weeks, cisplatin 50 mg/m2 on day 1 and oral UFT 400 mg/m2/day (in 2–3 daily doses) on days 1 to 21. Cycles were given every 28 days. Results. A total of 170 cycles of chemotherapy were delivered with a median of four per patient (range 1–11). There were fourteen partial responses (30%, 95%CI:19–48%), 17patients...

3726 Background: To assess the efficacy and safety of the oxaliplatin-UFT-l,LV combination as first-line treatment in patients with advanced CRC. Methods:Between 04/99 and 01/00, 81 patients with recurrent or metastatic CRC were included. Mean age was 63 years (40–77), male/female ratio 46/35, ECOG 0/1/2 39/36/6. The study regimen consisted of Oxaliplatin 85 mg/m2 in 120-minute intravenous infusion on days 1 and 15; intravenous l,LV 250 mg/m2 given in two hours on day 1, followed by oral UFT 390 mg/m2 on days 1 to 14, and oral l,LV 7.5 mg/12 hours on days 2 to 14. Pills were taken before meals to favour absorption (for instance, at 8 a.m. and 8 p.m.). Cycles were repeated every 28 days. Results:A total of 470 cycles of chemotherapy were delivered with a median of six cycles per patient (range 1–12). A pre-scheduled preliminary analysis was performed after inclusion of 16 patients. High gastro-intestinal toxicity was observed: G 3–4 diarrhoea 9/16 (56%), G 3–4 nausea-vomiting 3/16 (18%). This lead to reduc...

Purpose:: Hypogonadism is a prominent risk factor for osteoporosis in older men. However, bone loss during androgen ablation therapy for prostate cancer has rarely been quantitated.Materials and Methods:: Femoral neck bone mineral density was determined in 26 men before orchiectomy or chemical castration as initial hormone therapy for prostate cancer and at 6-month intervals thereafter for 6 to 42 months. Measurements were made in 16 other men at 12 to 24 months beginning 3 to 8 years after the onset of castration. Baseline and post-castration bone loss was related to several host and tumor characteristics, and compared to similar measurements in 12 control subjects.Results:: Average age corrected baseline femoral neck bone mineral density was higher in controls than in treated men and remained essentially unchanged for 2 years. Following orchiectomy average bone mineral density decreased 2.4% and 7.6%, respectively, during years 1 and 2 (2-year loss 2.5% to 17.0%), with similar losses documented in men u...

The critical fusion frequency (CFF) was measured across the central visual field. Stimulus parameters were adjusted to ensure an increase in CFF at the fovea. Comparison was made between the foveal and extra-foveal CFF values. The study showed that, while the CFF may be highest at the fovea when the CFF values are generally low, stimulus parameter changes that increase the CFF result in a greater increase extra-foveally. Ultimately, then, the CFF maximum shifts from the fovea to an extra-foveal area. Under the experimental conditions used in the study, the maximum occurred approximately 10 degrees from fixation.

Three hundred and twelve patients suffering from painful conditions were admitted to a multicentre, double-blind controlled trial, conducted in general practice in which five analgesics—floctafenine (Idarac), paracetamol, aspirin, dihydrocodeine and pentazocine—were compared. Overall ratings of analgesic effect placed floctafenine first in rank order. Floctafenine was statistically significantly superior in effect to pentazocine but not to the other three agents as far as doctor ratings were concerned; and superior to both pentazocine and dihydrocodeine in the opinion of patients. Fewer patients experienced side-effects on floctafenine than on the other four analgesics and this difference between floctafenine and pentazocine, and floctafenine and dihydrocodeine was statistically significant.

General practice patients with mild to moderate congestive cardiac failure recorded their frequency of micturition after taking frusemide 40 mg or bumetanide 1 mg at 8 a.m. or bumetanide 1 mg at 6 p.m. Morning doses of bumetanide or frusemide caused a similar pattern of urinary frequency, although the period of increased frequency appeared to be shorter with bumetanide. If an evening diuresis is required, bumetanide should be given between 4 and 6 p.m. The use of potent and short acting diuretics such as bumetanide allow the physician and patient scope to decide upon the most appropriate time for administration and so reduce major disruptions in the patient's daily routine.

If we wish to seek the origins of recent research studies on inner London, * and the government's new policies for inner cities,** we must look to the late 1960s. That period marked a major turning point in the shaping of attitudes regarding the future development of London and of British cities generally. Conurbations had been subject to strategic planning under the strong influence of successive national governments since 1940, with the dispersal of people and jobs being officially encouraged through regional development policies, and through the development of new and expanded towns, the delineation of green belts and the development of a national motorway network. Parallel to these measures was a strong emphasis on the internal restructuring of the inner cities by quite massive redevelopment programmes, mainly sponsored by local authorities. These policies were reinforced in the earlyand midI960s as public expenditure on environmental planning grew in real terms. A further dimension was added in the mid1960swhen it was recognised that parts of the inner urban areas contained communities that still remained disadvantaged in housing, education and other aspects of social provision. A number of experimental programmes were begun again initiated by central government aiming to redress such local social stresses. These comprised the educational priority areas, community development projects, the definition of housing stress areas, and the urban programme. They aimed to assist groups of residents in situ, by selecting certain areas for special treatment. The programmes were small in scale, which reflected not merely the fact that the principal target groups comprised newly settled ethnic minorities and districts consisting predominantly of low skilled workers, but more particularly that the mainstream policies were still considered comprehensive and well founded and that all that was needed was a little extra for a few blackspots. Looking back to that period, it is apparent from the literature that very little thought was being given by those in authority, or by social scientists, to the side effects of national and regional policies within the inner city (though there was, it is true, a

A double-blind, comparative, multicentre study comparing the efficacy and tolerability of maprotiline (Ludiomil) and viloxazine as antidepressants in general practice usage is described. Progress was measured at weekly intervals over the 4-week trial duration using a modified Hamilton Rating Scale and patient self-assessment visual analogue scales. A total of 127 patients were randomized into two groups; 63 patients being allocated maprotiline and 64 patients being allocated viloxazine. Of the patients receiving maprotiline, 12 withdrew during the course of the study compared to 9 patients receiving viloxazine. Maprotiline appeared to be superior to viloxazine on the sleep and sadness scales and some evidence to show it to be better also on the tension scale. Whilst the trend favoured maprotiline, the two drugs did not appear to be significantly different on either the doctors' or the patients' assessments. There was little to choose between the drugs in terms of side-effects or ultimate patient tolerability and preference.

The relevance of mixed genital infections in our area was evaluated, and we report their clinical and epidemiological features for both viral types. We evaluated overall 54 Herpes simplex virus (HSV) isolates from 44 patients seen at the clinic of sexually transmitted diseases (STD) of the Sevilla School of Medicine during 1986 and 1987. The identification of the isolated strains was made by direct immunofluorescence with type-specific monoclonal antibodies. In those isolates where we detected both viral types confirmation was obtained with the endonuclease analysis: Hind III and Xho I. Four mixed infections were diagnosed, representing 7% of all HVS isolates of genital origin. Two were classified as initial nonprimary infections, and the remaining two were asymptomatic infections. Two patients showed simultaneous infections by other organisms.