Sixty patients with active upper gastrointestinal bleeding were randomized to received either continuous intravenous infusions of vasopressin (29 patients) or placebo (31 patients) at a rate of 40 U/h. Six hours after beginning the study, 13 patients in the vasopressin group and 11 in the placebo group] had ceased bleeding (p = 0.46). By 24 hours. 17 patients in the vasopressin group and 14 in the placebo group had stopped bleeding (p = 0.30). Restriction of the analysis to patients bleeding from varices showed no advantage with vasopressin treatment after 6 or 24 hours. No consistent trend favoring use of vasopressin to stop hemorrhage was noted during the 30-month study period. There was little difference between the two groups in the number of patients needing surgery (13 on vasopressin, 18 on placebo; p = 0.30) or the number of deaths (eight on vasopressin, 11 on placebo; p = 0.51); the transfusion requirement was the same. In our patients, a continuous intravenous infusion of vasopressin neither controlled bleeding nor altered outcome.

No abstract

The construction of an artificial circulation for the study of thrombolysis allowing variation in fluid pressure and flow rate is described. The lysis of ¹²⁵I-fibrin was not influenced by variation in pressure between 10 and 30 cm H₂O, but was significantly faster at a flow rate of 25 ml/min than at 40 ml/min or 10 ml/min. At equivalent concentrations as assessed on fibrin plates tissue activator induced greater thrombolysis than urokinase. Thrombolysis by both activators was diminished in the presence of plasma.

draws attention to the neurologist's debt to F. J. Gall (1758-1828), " a pioneer exponent of many new and exciting theories in neuroanatomy" (p. 775). Leader at p. 770. Upper Gastro-intestinal Bleeding: Dr. Anne Banning and colleagues discuss the place of surgery in the treatment of 223 patients with severe haematemesis and melaena (p. 781). Dr. C. Mailer and colleagues consider the relative value of radiology, endoscopy, the nocturnal gastric secretory pattern, and estimation of blood loss in the early assessment of upper gastrointestinal bleeding (p. 784). Leader on this page. Psychiatric Outpatients: Dr. D. R. Willcox and colleagues report that nearly half of 125 psychiatric outpatients prescribed chlorpromazine or imipramine were failing to take their drugs (p. 790). Coarctation of Aorta: Mr. Rowan Nicks, of Sydney, Australia, reports the successful treatment of a young girl with coarctation of the lower thoracic aorta (p. 792).