Kawasaki disease and the T-cell antigen receptor.

We investigated the evidence for an infectious etiology of Kawasaki disease (KD), an acute vasculitis of unknown etiology, by assessing the effects of KD on the T cell antigen receptor variable beta region families (V beta). Using 3-color flow cytometry, we studied KD patients pre- and post-intravenous gamma globulin (IVIG) therapy and at > 40 days post therapy, additionally comparing them to matched pediatric control patients (PCC) and their own healthy parents (one parent/KD child). Of all the V beta families examined, only V beta 2 exhibited statistically significant differences, between the pre- and post-IVIG samples and preIVIG and parent samples. No associations were found between V beta 2 findings and T cell memory, activation, or adhesion markers. For 2 KD patients, 4 parents, and 1 PCC participant, > 15% of resting CD8+ lymphocytes and > 15% of blastic CD8+ lymphocytes expressed a single V beta family, which varied by individual, without similar expansions in the CD4+ cell populations. One of the participants with this abnormality was the only one with significant cardiac abnormalities. For all participants with the V beta abnormality, other T-cell abnormalities were extensive and involved both CD4+ and CD8+ cells. We suggest that V beta 2 changes do occur in KD, as previously reported. However, these may not be involved in disease pathogenesis. Other V beta changes also occur. Those occurring in parents may reflect asymptomatic reinfection with an infectious agent causing KD. Further, some KD patients may have restricted cytotoxic T-cell responses to that as yet unidentified agent; this restricted response may be associated with more severe cardiac involvement.

A multicentre general practice study of cinnarizine in the treatment of peripheral vascular disease.

A multicentre, double-blind, crossover study monitoring walking distance and symptomatology was set up to compare the efficacy of cinnarizine with that of placebo in the treatment of patients with intermittent claudication. Walking distances were statistically significantly increased by cinnarizine treatment when it was given before placebo. This improvement was maintained without further significant deterioration when the patients were switched to placebo therapy. A smaller but statistically significant increase in walking distance was observed after the first 12 weeks of tarizine treatment an additional increase in mean walking distance, comparable to that seen during the first half of the study, was observed in these subjects. This improvement failed to reach a level of statistical significance because of the variation in response between individual patients.

A comparison of high and low dosage regimes of maprotiline (Ludiomil).

A double-blind, randomized, multicentre trial is described which was designed to compare the clinical effect of 30 mg and 75 mg daily of maprotiline (Ludiomil) administered as either once or thrice daily therapy. Physicians' assessment of patients' progress was made following 7, 14 and 28 days of treatment. Patients also assessed themselves using a visual analogue scale at the same time intervals. Of the 231 patients admitted to the study, 40 dropped out for various reasons, leaving 191 patients completing. Of the 40 drop-outs, drug-induced side-effects were considered to be responsible in the case of 17 patients. No differences between the four treatment groups were demonstrated on the physicians' assessment; however, the patients' self-assessments using the 10 cm visual analogue scale indicated that the 25 mg three times daily regime appeared to be the most satisfactory, but not statistically significantly so, when compared with the 10 mg thrice daily and 75 mg nocte regimes. The 30 mg nocte dose proved to be distinctly inferior.

A comparative double-blind study of tiaprofenic acid and aspirin in the treatment of muscular rheumatism, fibrositis, sprains and soft tissue injuries in general practice.

Analgesic and anti-inflammatory properties of tiaprofenic acid 200 mg t.d.s. were compared with those of aspirin 600 mg t.d.s. in 100 patients in general practice suffering from muscular rheumatic pain, fibrositis, sprains and soft tissue injuries. Tiaprofenic acid was shown to be better than aspirin in relieving pain by clinical assessment although both drugs were equally effective according to patients daily assessment. It was not possible to demonstrate any anti-inflammatory action by reduction of swelling, but this was only present in 20% of patients initially. Side-effects, none serious, were similar in both groups.

An open evaluation of a 3-day course of pivmecillinam (ten 200 mg tablets) in women with acute uncomplicated cystitis.

One hundred and eighty-four women, with acute uncomplicated cystitis, received a 3-day course of pivmecillinam comprising an initial 400 mg (two tablets) dose, followed by 200 mg every 8 hours; a total of ten tablets. A satisfactory clinical response was achieved in 91% of patients. Bacteriological success was observed in 94% of sixty-eight patients with a proven infection. Side-effects were reported in sixteen patients (8.4%). Two patients ceased therapy prematurely. Pivmecillinam did not select out resistant Gram-negative organisms. A trend towards reinfection with Gram-positive cocci was observed. The possible significance of reinfection with different organisms is discussed.

An open comparative trial of Vanquin tablets and pripsen granules in the treatment of threadworm infestation.

Thirty-eight patients presenting to their general practitioner with threadworm infestation were admitted to an open, comparative, multicentre trial of Vanquin tablets and Pripsen granules. Efficacy and tolerance were assessed. Twelve of nineteen patients treated with Vanquin had positive results from a peri-anal skin test at the start of treatment, all results were negative after twenty-one days. Fourteen of nineteen patients treated with Pripsen had positive results at the start of treatment and two of these had positive results after twenty-one days. One patient treated with Vanquin and five treated with Pripsen reported side-effects.

Analgesic efficacy and acceptability of fenoprofen combined with paracetamol and compared with dihydrocodeine tartrate in general practice.

A single-blind between-patient study in general practice was made to examine the acceptability and analgesic efficacy of a combination of fenoprofen (200 mg) and paracetamol (500 mg) given 3 to 4 times daily for a period of 4 to 14 days in the treatment of acute and chronic pain. The combination was compared with dihydrocodeine tartrate (30 mg) in two groups of 75 patients suffering from a wide variety of presenting conditions, including osteo-arthritis, spondylitis, lumbago, sciatica, non-articular rheumatism and trauma. Clinical and patient assessment indicated that the combination was an effective analgesic combination, significantly better in success rate than dihydrocodeine tartrate and with a much lower incidence of side-effects (13% of patients receiving fenoprofen and paracetamol reported side-effects compared to 37% for the dihydrocodeine group). The combination demonstrated particular success in the treatment of non-articular rheumatism.

A single-blind comparative clinical trial of lymecycline and amoxycillin in the treatment of acute bronchitis in general practice.

A single-blind comparison of lymecycline and amoxycillin was performed by three general practitioners in the treatment of acute bronchitis. A total of 132 patients were treated for seven days with lymecycline (204 mg) two capsules twice daily or amoxycillin 250 mg three times daily. Symptoms and signs assessed were cough, dyspnoea, sputum volume, purulence of sputum and temperature. Both drugs brought about a statistically significant improvement. For all parameters the improvements seen with lymecycline were superior to those seen with amoxycillin although in no case did any of these reach statistical significance. However, in the case of purulent sputum those patients receiving lymecycline showed improvement which reached borderline significance (0-05 less than p less than 0-1) as compared with amoxycillin. Side-effects in the case of both drugs were negligible.

A comparison of mazindol (Teronac) with diethylpropion in the treatment of exogenous obesity.

Fifty obese patients were entered into a 12-week parallel group study of mazindol with diethylpropion in a general practice group. Both drugs produced weight loss, but patients on mazindol lost 19.9 lbs in 12 weeks, while those on diethylpropion lost 11.6 lbs, a statistically significant difference (p less than 0.01). At each visit during the trial, patients had lost more weight with mazindol, but this was only significant statistically in the period 8-12 weeks (p less than 0.01). Patients developed tolerance to the effect of diethylpropion in the last period (8-12 weeks) but this was not evident in those patients taking mazindol. The number of side-effects was less in the mazindol group and mainly of an adrenergic, peripheral type, while those in the diethylpropion group are mainly of the central stimulant type.

Patient acceptability of two diuretic/potassium supplement preparations.

In a random crossover study in general practice, sixty patients with heart failure were given one week's maintenance treatment with the recommended dosage of Burinex K or Lasix+K. Burinex K appeared to be easier to swallow than the supplement tablets of Lasix+K although the differences were not significant. Patients showed a highly significant preference to take two tablets on one occasion (Burinex K) rather than two different types of tablet on three separate occasions (Lasix+K). Despite pharmacological arguments in favour of stimultaneous versus separate administration of potassium supplement and diuretic, patient acceptibility is of over-riding importance in the long-term.

Mianserin in the treatment of depression in general practice.

In a double-blind study in general practice, both mianserin ('Bolvidon') in an average dose of 40 mg a day, and imipramine, in an average dose of 100 mg a day, were found to be significantly more effective than placebo after two to three weeks' treatment. No significant differences in antidepressant effect could be demonstrated between mianserin and imipramine. There was no significant difference in side-effects between the three treatments.