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OBJECTIVE--To compare treatment and protection against falciparum malaria in pregnant and non-pregnant women with three drug regimens. DESIGN--Prospective intervention study with six weeks' follow up. Patients received one of three drug regimens in order of entry. SETTING--Primary care hospital and secondary girls' school in rural western Kenya. PATIENTS--158 of 988 pregnant women (89 primigravid and 69 multigravid) in the third trimester and 105 of 1488 non-pregnant schoolgirls of reproductive age were parasitaemic (more than 500 asexual forms/microliter. These women were divided into three treatment groups by gravid state. INTERVENTIONS--Women were treated with chloroquine base 25 mg/kg over three days or pyrimethamine 75 mg and sulfadoxine 1500 mg as a single dose or chlorproguanil 1.2 mg/kg and dapsone 2.4 mg/kg as a single dose. MAIN OUTCOME MEASURES--Parasitaemia and haemoglobin concentrations measured at seven day intervals for six weeks. RESULTS--Primigravid women were more likely to be parasitaemic on follow up than multigravidas or nulligravidas, whose response was about the same. Parasites did not clear by day 7 in primigravidas in six (20%) of 30 who received chloroquine, three (8%) of 35 treated with pyrimethamine and sulfadoxine, and none of 23 treated with chlorproguanil and dapsone. At day 28, 83%, 19%, and 67% of primigravidas in these treatment groups were parasitaemic. Haemoglobin concentrations rose in all women, but improvement was sustained only in women who remained free of parasites. CONCLUSIONS--Clearance of parasites was better with either pyrimethamine and sulfadoxine or chlorproguanil and dapsone than with chloroquine. Longest protection was obtained with pyrimethamine and sulfadoxine.

In every specialty there are several patients with conditions that can be dealt with almost in your sleep. For ear, nose, and throat surgery it is mastoid cavities. It is an important job and important that the patient returns to have it performed. But it is not the most exciting of tasks and one unlikely to add lustre to …

After serving in the Royal Army Medical Corps, where he took an interest in flying and saw action in the Middle East, Geoffrey specialised in occupational …

EDITOR,—Chris Ham's editorial highlights genuine concerns about the government's private finance initiative in the NHS.1 In Carlisle, where a single consortium has tendered to build and manage a major development of the hospital, we already have experience of private finance in the form of a contracted dialysis service. Under the terms of the contract (which is usually described as a “partnership” by the company), equipment, disposables, and nursing cover are provided for a …

EDITOR,—It was disturbing to learn that there is growing pressure on the BMJ's obituaries but reassuring that this is because there are more of …

The test for rebound tenderness is advocated for diagnosing general or localised irritation of the peritoneum, but the diagnostic accuracy and patients' acceptance of the test have been questioned.1,2 Other methods for identifying peritonitis include asking patients to cough and percussion of the abdomen. We routinely ask patients to cough and have evaluated this coughing test for diagnosing peritonitis. One hundred and fifty consecutive patients (70 male, 80 female; range 4-95 years, median 46) who were admitted for emergency treatment with abdominal pain were examined in a prospective study. The patients were asked to cough, and …

The association between extent and duration of smoking habit and severity of coronary atheroma was examined in 387 patients undergoing routine coronary ateriography before valve replacement surgery. Total number of cigarettes smoked in life correlated significantly with severity of coronary artery disease (p less than 0.001) and number of coronary arteries with stenoses of 50% or more (p less than 0.001). Severity of coronary artery disease in current smokers was similar to that in former smokers. Multiple regression analysis showed diastolic blood pressure, cigarette consumption, age, ratio of total cholesterol to high density lipoprotein cholesterol, and history of angina to be the important predictors of severity of coronary artery disease. An estimate of the number of cigarettes smoked in life can be useful in identifying patients with coronary artery disease if used in conjunction with data on other important risk factors.

Forty two adult patients who had been treated with continuous ambulatory peritoneal dialysis for one to 142 weeks (mean (SD) 38 (36)) received a total of 44 allografted kidneys. Twenty one had been treated with continuous ambulatory peritoneal dialysis for less than 26 weeks (mean 11 (8)) and the other 21 for longer than 26 weeks (mean 64 (35)). These two groups were compared with 55 patients who had been treated with haemodialysis and received a total of 63 grafts. In the group of patients treated with continuous ambulatory peritoneal dialysis azathioprine and low dose prednisolone were used as the immunosuppressive regimen for 20 transplantations in 18 patients, and 24 patients receiving 24 grafts were treated with cyclosporin A and low dose prednisolone. In the group of patients treated with haemodialysis 38 patients receiving 43 grafts were treated with azathioprine and low dose prednisolone, and 20 patients receiving 20 grafts were treated with cyclosporin A and low dose prednisolone. Actuarial survival of patients and grafts at two years was 95% and 72%, respectively, in the continuous ambulatory peritoneal dialysis group compared with 89% and 58%, respectively, in the haemodialysis group. No difference was found in graft survival between short term treatment with continuous ambulatory peritoneal dialysis (72% graft survival) and long term treatment (65% graft survival). In conclusion, continuous ambulatory peritoneal dialysis is suitable treatment for patients awaiting renal transplantation.

Twenty five patients with oliguric renal failure were treated by a combination of continuous arteriovenous haemofiltration and intermittent haemodialysis over 18 months. Haemofiltration was given for a mean of 6.6 days and the mean filtration volume was 6.0 1/day. Fourteen of the 25 patients survived beyond two months after the period of oliguria. Haemofiltration proved to be a simple and effective method of fluid removal; it allowed maintenance of stable fluid balance and permitted optimum nutrition during prolonged oliguria.