dramatic response. We believe that this is the first report of successful treatment by captopril of a patient with intractable cardiac failure and profound hyponatraemia.

A study was carried out in 73 patients with mild or moderate hypertension to assess the effectiveness of treatment with labetalol. After a 2 to 4-week period on placebo, patients received 200 mg labetalol daily for 4 weeks, after which time dosage was doubled if the blood pressure was not satisfactorily controlled. Treatment was continued for a further 4 weeks and was followed by another period on placebo. Pre-treatment levels of 157/99 mmHg were significantly reduced after 2 weeks, and after 4 weeks the mean reduction was 14/8 mmHg. Half the patients had their dosage increased to 400 mg daily. At the end of the 8-week active treatment period, 80% were adequately controlled, the mean reduction in blood pressure being 22/12 mmHg compared with placebo values. Heart rate was significantly reduced from 78 to 69 beats per min during labetalol therapy. The reduction in blood pressure was similar whether or not patients had been previously treated or untreated, but heart rate was reduced more in the previously treated group. Four weeks after the end of labetalol therapy blood pressure and heart rate had increased but were less than during the initial placebo period and did not give rise to any severe problems.

The effect of oral terbutaline (controlled-release [CR] tablets) was compared with that of inhaled ipratropium bromide (aerosol) in 21 patients with nocturnal asthma. In a randomized, double-blind, crossover study, the patients were treated with terbutaline CR 10 mg twice daily, ipratropium 40 micrograms four times daily, and the two drugs in combination. Each treatment was given for 3 weeks. Before the start of the study, the patients participated in a 1-week run-in period. The mean nocturnal decline in peak expiratory flow rate (PEFR) was 29% in the run-in period and was reduced to 22% in the terbutaline CR period, 27% in the ipratropium period, and 23% in the period with the combination of the two drugs. The mean night PEFR was significantly (P < 0.05) higher in the period with terbutaline CR, as compared with the period with ipratropium. The mean morning PEFR was also highest in the terbutaline CR period. The mean evening PEFR was significantly (P < 0.05) higher during treatment with terbutaline CR alone and with the combination, as compared with treatment with ipratropium alone. Treatment with terbutaline CR alone or the combination was preferred by as many patients as was treatment with ipratropium alone. When present, adverse reactions were judged to be mild or moderate. Treatment with terbutaline CR alone and the combination significantly improved the evening and night PEFR, as compared with treatment with ipratropium alone.

No abstract

Forty-seven children, ages 1 to 14 years, with appendicular peritonitis were randomly divided into two groups: 27 were treated with the combination tobramycin-clindamycin and 20 with cephalothin followed by cephalexin. The overall rate of complications was 32%. Patients who had had their symptoms for less than 48 hours before being admitted to hospital had significantly fewer complications than those whose symptoms had lasted longer. Patients treated with tobramycin-clindamycin had significantly fewer wound infections. As clindamycin is effective against anaerobes this observation supports the view that anaerobes play an important role in the infectious complications in peritonitis. In this series, 12 species of aerobes and eight species of anaerobes were cultured from peritoneal fluid. In eight patients only one species was isolated; in the remaining 39 patients 29 different combinations of bacteria were encountered. Early diagnosis and administration of antibiotics preoperatively or during surgery, including clindamycin, metronidazol or tinidazol is recommended in the treatment of children with appendicular peritonitis.