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We conducted a prospective, randomized, multicenter, single-blind trial of propranolol as compared with placebo in the prevention of first upper gastrointestinal tract bleeding in patients with cirrhosis of the liver. A total of 230 patients (90 percent with alcoholism and 46 percent with a Child-Pugh grade C classification) with large esophageal varices without previous bleeding were randomly assigned to receive either propranolol (n = 118) or placebo (n = 112), after they had been divided into two groups according to the severity of their liver disease. The end points of the study were bleeding and death. The dose of propranolol was progressively increased to decrease the heart rate by 20 to 25 percent. The final doses were 40 mg of conventional propranolol and 160 and 320 mg of long-acting propranolol daily in 22 percent, 60 percent, and 18 percent of patients, respectively. The mean (+/- SD) follow-up time among survivors without bleeding was 436 +/- 172 days. The cumulative percentages of patients free of bleeding two years after inclusion in the study were 74 percent (95 percent confidence limits, 61 and 83) in the propranolol group and 39 percent (95 percent confidence limits, 15 and 69) in the placebo group (P less than 0.05). Cumulative two-year survival was 72 percent (95 percent confidence limits, 60 and 81) in the propranolol group and 51 percent (95 percent confidence limits, 37 and 64) in the placebo group (P less than 0.05). The advantage of propranolol over placebo was maintained when potentially confounding variables were adjusted with use of the Cox model. Side effects occurred in 17 percent of the patients who received propranolol and led to the stopping of treatment in 11 percent. We conclude that propranolol can decrease the incidence of first bleeding and death during a period of two years in patients with cirrhosis and large varices.

Propranolol and nadolol are effective in preventing first bleeding and reducing the mortality rate associated with gastrointestinal bleeding in patients with cirrhosis, regardless of severity.

A permanent plot of 28 ha was established in a dense wet evergreen forest in the Western Ghats of India to study the functioning of the ecosystem. Since April 1990, 1981 trees of ≥30 cm gbh have been enumerated in a systematic sampling of five strips totalling 3.12 ha. This paper describes the main structural and floristic characteristics of the plot.The density (635 trees ≥30 cm gbh per hectare) and basal area (39.7 m2 ha−1) are high. Despite the high diversity (Simpson's D = 0.92 and Shannon's H' = 4.56), four species are distinctly, dominant in terms of an importance value index (relative density + relative basal area). Each of these four species occupies a different layer in the ecosystem: Humboldtia brunonis Wall. (Fabaceae) dominates the undergrowth, Myristica dactyloïdes Gaertn. (Myristicaceae) the intermediate strata, Valeria indica L. (Dipterocarpaceae) the higher canopy level and Dipterocarpus indicus Bedd. (Dipterocarpaceae) the emergents. This pronounced species hierarchy is one of the most important characteristics of the evergreen forests of the Western Ghats. The two dipterocarps account for 20.1% of the total number of trees and contribute 40.9% to the total basal area. This formation can, therefore, be considered as the westernmost lowland dipterocarp forest of Asia.Analysis of the spatial variations in the floristic composition and in the structure of the main species populations shows that two kinds of mature phases can be identified: where the topography is raised and gently sloping, the vertical structure of the stand is discontinuous, with Dipterocarpus indicus and Vateria indica forming an emergent layer above a dense undergrowth; on slopes, the stand is lower, vertically continuous and saturated with Valeria indica and Myristica dactyloïdes. The link between the structure of the stand and dynamic processes is discussed.