Objective-To describe mortality by suicide and other causes of death in a group of patients who attempted suicide, and to identify predictive factors.Design-10 year follow up study based on records ofsuicide attempters in 1980.Setting-Poisoning treatment centre at a general hospital.Subjects A strategy to prevent suicide must be directed toward the majority ofthose who attempt suicide.

1 The absorption and elimination of a single oral dose of 400 mg cimetidine was studied in fourteen fasting patients with impaired renal function. In addition, the dialysance of cimetidine was studied in five patients on haemodialysis. 2 The absorption was somewhat, but clinically insignificantly delayed. A second unexplained peak in the absorption curve was found. 3 First order elimination kinetics were confirmed and the length of time of a cimetidine concentration over 0.5 mg/l could be correlated with creatinine clearance. 4 The magnitude of extra renal elimination was estimated to be approximately one fourth of total cimetidine elimination in normal patients and seemed unaffected by impaired renal function. 5 A dose schedule based on AUC found in the patients in renal failure is suggested. The recommendations for daily oral dose range from 300 mg (at borderline dialysis) to 1000 mg in mild renal failure. The suggested doses will give an average plasma concentration of the same order as seen in patients with normal renal function.

In order to establish improved guidelines for dosage adjustments of cimetidine before and during hemodialysis, the kinetics of this drug was investigated in 7 uremic patients undergoing regular hemodialysis. The absorption fraction was found to be 0.75 (range 0.61–0.86), the terminal half-life in plasma between 138 and 238 min, the total body clearance (C_total) between 178 and 337 ml/min, and the apparent volume of distribution about 1 1/kg. During hemodialysis no excess amounts of cimetidine were removed from serum. In 3 patients a weak rebound phenomenon was seen after hemodialysis. Based on the Cl_total obtained in this study, dosage schemes producing a 24-hours mean steady state concentration from 0.60 (2.38) to 1.20 (4.76) mg/l (µmol/l) are suggested.

The number of elderly people and Asians has increased considerably in the past decade, and therefore great care needs to be exercised before an increased incidence of tuberculosis in England is predicted. Evidence in Birmingham points to a steadily decreasing rate, and we doctors need to ensure that it stays that way.