A double-blind, parallel group, multicenter clinical trial of pentoxifylline compared with placebo enrolled 150 patients with moderately severe chronic occlusive arterial disease (COAD) at three centers in Scandinavia. The study consisted of a 4-6 week single-blind, placebocontrolled run-in phase, during which the stabilization of the initial claudication distance of all patients was assessed before randomization to a 6-month double-blind observation period. The diagnosis of COAD was established by clinical findings, conventional angiography, and noninvasive peripheral Doppler pressure assessment at rest and after exercise. The results of the overall intention-to-treat analysis of the study population show statistically significant superiority of pentoxifylline over placebo for all absolute claudication distance summary and end point measures. By using two clinically relevant parameters, which are a resting ankle/arm pressure ratio 0.8 or less and a duration of COAD for greater than 1 year, a target population could be defined in whom trial results became highly significant. For nontarget patients with mild COAD, we conclude that basic therapeutic measures should include the treatment of risk factors and the initiation of physical training. For target patients, however, a multifactorial therapeutic approach, including the use of pentoxifylline, is justified. (Circulation 1989(Circulation :80:1549(Circulation -1556 B asic measures for the treatment of chronic occlusive arterial disease (COAD) are the avoidance of risk factors and the institution of physical training.'1-" However, the decision of whether or not to use vasoactive drugs is controversial, and recommendations differ widely among different schools of medicine mainly because of the difficulty in predicting treatment outcome.The drug used in this trial, pentoxifylline, is a compound that improves blood fluidity by reducing red cell rigidity and blood viscosity.12-15 Furthermore, it inhibits platelet aggregation16 and, as recently published, diminishes the state of neutrophile granulocyte activation.17The purpose of this Scandinavian study was to compare pentoxifylline and placebo as treatment for COAD. Furthermore, those patients were to be identified in whom treatment with pentoxifylline

Over a 21 year period there seems to have been a decrease in the frequency of secondary aortoenteric fistulas after aneurysm surgery, a longer interval before they occur, a shorter diagnostic delay, and a better survival.

A fulminant case of streptococcal toxic shock syndrome is described. Early surgery was life saving, and the antibiotic regimen should include clindamycin. The value of secondary measures is discussed. High dose intravenous immunoglobulin (IVIG) has shown promising effects in recent publications. Hyperbaric oxygen (HBO) treatment is under evaluation. Piercing of mucosal surfaces might be associated with severe infections.

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