A long-term prevention study with oxprenolol in coronary heart disease.

We carried out a randomized double-blind controlled secondary-prevention trial of oxprenolol over seven years. Forty milligrams of oxprenolol or placebo was given twice daily to 1103 men 35 to 65 years old who had an acute myocardial infarction between 1 and 90 months previously. Overall, there was no difference in mortality or cardiac events between the placebo and oxprenolol groups. The major influence on prognosis was the time at which treatment was started after infarction. In 417 patients in whom treatment was started within four months of infarction oxprenolol increased the six-year cumulative survival rate from 77 to 95 per cent (P less than 0.001). In 274 patients with treatment starting between 5 and 12 months of infarction the survival rate was similar in the two groups, but in 412 patients entered between 1 and 7 1/2 years after their first infarction oxprenolol reduced the six-year survival rate from 92 to 79 per cent (P = 0.002). The increased mortality in this latter group mainly occurred late after withdrawal from active treatment. The value of low-dose oxprenolol in secondary prevention appears to be confined to patients treated relatively soon after myocardial infarction.

Influence of drug treatment on the irritable bowel syndrome and its interaction with psychoneurotic morbidity.

Sixty per cent of the patients referred to two gastroenterological clinics and diagnosed as suffering from the irritable bowel syndrome (IBS), were found to have significant psychoneurotic morbidity on the basis of the General Health Questionnaire. A double-blind, completely randomised, placebo controlled comparison of treatment with a combined anxiolytic/antidepressant (Motipress) found a significantly better effect of Motipress than placebo on diarrhoea and abdominal pain. Detailed analysis of the results suggests that there is no direct relationship between psychoneurotic illness and IBS, but the presence of the former has an adverse effect on the short-term outcome of the bowel disorder.

A comparison of chlormethiazole and diazepam as intravenous sedatives for fibre-endoscopic examination of the upper gastrointestinal tract.

Chlormethiazole and diazepam as intravenous sedatives were compared in 75 patients undergoing fibre-endoscopic examination of the upper gastrointestinal tract. Diazepam was considered to offer greater reliability and ease of administration. Chlormethiazole wqs found to be a safe drug and did not encourage salivation. Local pain caused by chlormethiazole injection can be abolished by the use of lignocaine. Chlormethiazole may be useful in patients who are hypotensive and who require emergency endoscopy.

Colonic retnetion of barium in the elderly after barium-meal examination and its treatment with lactulose.

Five cases of colonic retention of barium with severe constipation occurring in elderly patients after a barium-meal examination were seen in a two-year period and it is suggested that this complication may be unrecognized. Lactulose 50% (Duphalac) was an effective agent in inducing bowel evacuation in these patients, who were resistant to more generally used methods.

Pulmonary aspiration after fibre-endoscopy of the upper gastrointestinal tract.

Pulmonary aspiration occurred in 16 out of 65 patients (24.6%) undergoing fibre-endoscopic examinations of the upper gastrointestinal tract under intravenous sedation, but it was rarely followed by serious complications. Aspiration was found to occur under sedation with diazepam alone, diazepam with atropine, and with chlormethiazole. The most important factors contributing to aspiration are the local pharyngeal anaesthesia and the mechanical interference of the fibrescope with laryngeal closure and swallowing. The patient is also at risk of aspiration after completion of the procedure and should remain recumbent until the local anaesthesia has worn off.