A randomised comparison is made between methylprednisolone, 1 g intravenously daily for 7 days, and a standard ACTH regime for the treatment of multiple sclerosis in acute relapse. It is found that methylprednisolone produces a more rapid clinical improvement than ACTH but confers no longer term benefit when the two treatments are compared at 3 months. It is proposed that intravenous methylprednisolone does have a role to play in the management of a patient with an acute relapse of multiple sclerosis. In the earlier stages of multiple sclerosis morbidity may be reduced by the judicious use of a short course of steroids during an acute relapse. Both intramuscular ACTH' and oral prednisolone2 have been shown to decrease the duration of an exacerbation of multiple sclerosis but no long term benefit follows and more prolonged steroid treatment is usually ineffective.3 Recent reports4-6 have suggested that pulsed therapy with large doses of methylprednisolone may be effective in relapsing multiple sclerosis. This communication presents a randomised comparison of methylprednisolone with a standard ACTH regime. Methods Patients with clinically definite multiple sclerosis according to the criteria of McAlpine' who presented to the Department of Neurology at Middlesbrough General Hospital in acute relapse were considered for inclusion in the trial. Relapse was defined as a symptomatic deterioration within the previous 4 weeks and no patient was improving spontaneously on entry. Each patient gave fully informed consent before randomisation to receive either intravenous methylprednisolone 1 g by slow injection daily for 7 days,

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In 1977 Zaria, in Northern Nigeria, was affected by a severe epidemic of group A meningococcal infection, 1,257 patients being admitted to hospital with the disease during a three-month period. The epidemic started towards the end of the dry season when it was hot, dry and dusty and finished shortly after the onset of the rains. The over-all attack rate was 3.6 per 1,000 but this varied considerably from area to area within the town. Few cases occurred amongst those belonging to the upper social classes. The disease was seen most frequently amongst those from five to 14 years old and there was a strong male preponderance. The over-all mortality was 8.3% but mortality was much higher (40.6%) amongst 67 patients with acute meningococcaemia.

ObjectiveThe authors determined whether pretransplant reduction of hepatitis B virus (HBV) load using alpha-interferon-2b (IFN) and passive immunoprophylaxis using hepatitis B immunoglobulin (HBIg) posttransplantation can prevent HBV recurrence in patients undergoing liver transplantation (LT) for HBV cirrhosis. Summary Background DataLiver transplantation in patients with HBV cirrhosis is associated with a high rate of recurrence and reduced survival. In patients with evidence of replicating virus (HBV-DNA or hepatitis B e antigen [HBeAg]-positive serum or both), recurrence is nearly universal. Passive immunoprophylaxis with HBIg alone is not effective in preventing HBV recurrence posttransplant, especially in patients with evidence of active viral replication pretransplant. Higher doses of HBIg posttransplant has reduced recurrence rates to 30% to 50%.Lamivudine, a nucleoside analogue that has shown early promise, also is associated with significant HBV recurrence. The authors report a reliable method of preventing viral recurrence in patients even with evidence for active HBV replication pretransplant. MethodsPretransplant patients with evidence of replicating HBV were given IFN starting at 1 million IU 3 times per week subcutaneously. This dose was increased to 2 and then 3 million IU 3 times per week when patient's side effects permitted and was maintained until the patient underwent a LT. All patients were tested every 4 weeks for hepatitis B surface antigen (HBsAg), HBeAg, and HBV-DNA. When patients became negative for HBeAg and HBV-DNA, they were listed for LT. Patients that were only HBsAg positive were listed immediately and received a LT without prior IFN treatment. Post-LT, all patients began receiving HBIg 2000 IU (10 mL) daily from days 1 to 20 and then weekly for the first 2 356

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