A fatal case of acute melioidosis occurred in a soldier who had recently returned from Vietnam. Pseudomonas pseudomallei was identified by culture of blood specimens taken before and after death, animal inoculation, and fluorescent antibody tests. Chloramphenicol is the drug of choice in this disease.It is imperative that military and civilian physi¬ cians be aware of the exotic infections which may confront our servicemen in Southeast Asia. The rapid transportation of military personnel to our shores literally brings the exotic diseases of the East to our doorstep. Melioidosis is one such disease. This paper reports this infection in a soldier who recently returned home from South Vietnam. Report of a CaseThis 22-year-old white man (Register No. 106 349) had a transient febrile illness of obscure etiology four months before his death but otherwise had been in good health. He had been stationed in South Vietnam since January 1966 (with the exception of temporary leave to the United States in June 1966), but was sent home on Oct 6, 1966, for emer¬ gency leave. Soon after he arrived, severe bilateral frontal headache, anorexia, nausea, prominent sore throat, dysphagia, and generalized myalgia developed. He was seen in the emergency room of a civilian hospital and given what was probably penicillin, orally and intramuscularly, with¬ out relief.On Oct 12, 1966, he was admitted to a civilian hospital. Physical examination revealed a temperature of 105 F (40.6 C), flushed skin, a striking pharyngitis with tonsillar exúdate, marked anterior cervical lymphadenopathy, clear lungs on auscultation, right and left upper abdominal ten¬ derness, and a staggering gait thought to be due to weak¬ ness.The hemoglobin level was 13 gm/100 ml and the white blood cell count (WBC) was 8,800/cu mm, with a normal differential. Prothrombin time was 75% of normal. Re¬ peated smears for malaria were negative, throat culture grew /3-hemolytic streptococcus, and results of urinalysis were normal. An antistreptolysin O titer was 250 Todd units. Febrile agglutinin titers were 1:40 to 1:80 to the typhoid and paratyphoid antigens. Skin test with purified protein derivative tuberculin was negative. Tularemia ag¬ glutination titer was 1:20. Stool cultures were negative. Sulfobromophthalein (BSP) retention was 22%. Numerous blood cultures were negative. A chest film revealed accen¬ tuated hilar markings with perihilar streaking, suggesting to the radiologist a viral pneumonia.The patient was treated with 6 million units procaine penicillin daily for six days, 5 gm chloramphenicol (Chloromycetin) daily for three days (discontinued after WBC decreased to 5,000/cu mm), and 2 gm sodium methicillin daily for four days. His hospital course was characterized by spiking temperature to 105 F and rapidly progressing weakness. The patient's hematocrit value dropped to 34% during his admission.See also page 452.On Oct 22, 1966, he was transferred to US Air Force Hos¬ pital Wright-Patterson for evaluation of fever of obscure etiology. On admission to this hospit...

The 24-h blood pressure control of bisoprolol, a new beta-selective, beta-blocking agent, was studied in 240 mild to moderate hypertensive patients in this 4-week, randomized, double-blind, placebo-controlled trial. A once-daily dosing schedule was evaluated by comparing bisoprolol's antihypertensive effectivness and safety at 24 h postdose and 3 h postdose, the latter time intended to correspond to peak effectiveness. Results from this trial demonstrated the antihypertensive effectiveness of once-daily bisprolol at doses ranging from 5-20 mg. Mean reductions from baseline diastolic blood pressure, measured 24 h postdose, were 6.3, 8.8, and 10.1 mmHg for patients receiving bisoprolol 5, 10, and 20 mg, respectively, compared with 1.6 mmHg for placebo-treated patients (p < 0.01); mean reductions from baseline systolic blood pressure for the bisoprolol groups were 8.6, 8.6, and 10.9 mmHg, respectively, versus 3.3 mmHg for placebo (p < or = 0.01); and mean reductions from baseline heart rate for the bisoprolol groups were 5.1, 7.1, and 10.2 beats/min, respectively, compared with a 0.9 beats/min increase in heart rate for the placebo group (p < 0.01). The response rates for bisoprolol-treated patients ranged from 47 to 70% compared with 18% for patients on placebo (p < 0.01). Antihypertensive effects were dose-related and sustained over the 24-h dosing interval. Near maximal antihypertensive effects were achieved within 1 week of initiation of therapy with bisoprolol and were sustained over the course of the trial.(ABSTRACT TRUNCATED AT 250 WORDS)

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