1 A comparison of total sulphapyridine saliva concentrations resulting from administration of sulphapyridine and sulphasalazine at equimolar doses has been carried out. It is concluded that the extent of azo reduction of sulphasalazine to release sulphapyridine is complete in healthy volunteers. 2 An ampicillin course of treatment alters the azo reduction of sulphasalazine. The extent of cleavage is reduced by one third on average. There is no change in the rate of absorption of the release sulphapyridine. 3 An ampicillin course of treatment does not alter the disposition of sulphapyridine. The changes noted in acetyl conjugate plasma concentrations are entirely consistent with reduced availability of sulphapyridine.

No abstract

Balsalazide (BSZ) is a pro-drug which releases 5-aminosalicylic acid (5ASA) and 4-aminobenzoyl-~-alanine (an inert carrier) in the colon of various species including man. BSZ was compared with sulphasalazine (SASP) (both I g b.d. orally) in the maintenance of remission in patients with ulcerative colitis (UC). Seventy-nine patients (53 male, 26 female), mean age 49 years (range 19-79 years), with UC were randomly allocated to either treatment (41 BSZ, 38 SASP) for 6 months. The groups were similar in respect of age, sex, duration and extent of disease. Seven patients defaulted (3 BSZ, 4 SASP) leaving 38 on BSZ and 34 on SASP.Two male patients, both receiving SASP, were withdrawn because of severe side-effects. One of these patients, with an exfoliative rash, was maintained satisfactorily on open BSZ. Remission rates at 6 months (5 1 % BSZ, 63 % SASP) were not significantly different (life-table analysis P < 0.1). Twelve patients (15 %) reported troublesome side-effects (2 BSZ 5 YO, 10 SASP 26%, P = 0.017 Fisher Exact Test). Mean haemoglobin concentrations, similar on entry, increased after 6 months with BSZ (0.2 g/dl) but decreased with SASP (0.5 g/dl) (P < 0.0OOZ). BSZ was not significantly different from SASP in maintaining remission in patients with UC but had fewer side-effects. Correspondence to: Professor 1. E. Lennard-Jones, St Marks Hospital, City Road, London EC1V ZPS, LJK 23 7 238 P. B. McINTYRE ef al.

1 Plasma prednisolone levels have been compared following the administration of enteric‐coated prednisolone to fasted and non‐fasted subjects. The effect on plasma levels of altering the formulation of the enteric‐coating has also been studied. 2 The presence of food in the stomach at the time of administration does not affect the absorption of enteric‐coated prednisolone tablets. 3 There was considerable inter‐subject variation in plasma prednisolone levels after administration of shellac based enteric‐coated tablets. However, plasma levels were more consistent when a preparation whose formulation was based upon cellulose acetate phthalate (CAP) was given. 4 It is concluded that the pattern of absorption and plasma prednisolone levels depend on the formulation of the enteric coating. The bioavailability of the CAP based preparation is similar to that of plain prednisolone.

Endomyocardial fibroelastosis is a rare disorder marked by characteristic morphological changes of the endocardium. We report a case of endomyocardial fibroelastosis diagnosed by late gadolinium-enhanced CMR and confirmed by endomyocardial biopsy. The patient improved following treatment with imatinib.