J.R.A. Mitchell

RANDOMISED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF FEVERFEW IN MIGRAINE PREVENTION

The use of feverfew (Tanacetum parthenium) for migraine prophylaxis was assessed in a randomised, double-blind, placebo-controlled crossover study. After a one-month single-blind placebo run-in, 72 volunteers were randomly allocated to receive either one capsule of dried feverfew leaves a day or matching placebo for four months and then transferred to the other treatment limb for a further four months. Frequency and severity of attacks were determined from diary cards which were issued every two months; efficacy of each treatment was also assessed by visual analogue scores. 60 patients completed the study and full information was available in 59. Treatment with feverfew was associated with a reduction in the mean number and severity of attacks in each two-month period, and in the degree of vomiting; duration of individual attacks was unaltered. Visual analogue scores also indicated a significant improvement with feverfew. There were no serious side-effects.

A RANDOMISED TRIAL OF HOME-VERSUS-HOSPITAL MANAGEMENT FOR PATIENTS WITH SUSPECTED MYOCARDIAL INFARCTION

Home and hospital management of patients with suspected myocardial infarction were compared in a randomised trial in which a hospital-based team responded to calls from general practitioners. 500 calls were received, and 349 patients (70%) were suspected of having myocardial infarction. Of these, 24% were excluded from the trial on predetermined medical and social grounds; for the remainder (76%) there was no significant difference in the 6-week mortality between the home group (13%) and the hospital group (11%). For the majority of patients to whom a general practitioner is called because of suspected infarction, hospital admission confers no clear advantage.

EXTRACTS OF FEVERFEW INHIBIT GRANULE SECRETION IN BLOOD PLATELETS AND POLYMORPHONUCLEAR LEUCOCYTES

Extracts of feverfew (Tanacetum parthenium) inhibited secretory activity in blood platelets and polymorphonuclear leucocytes (PMNs). Release of serotonin from platelets induced by various aggregating agents (adenosine diphosphate, adrenaline, sodium arachidonate, collagen, and U46619) was inhibited. Platelet aggregation was consistently inhibited but thromboxane synthesis was not. Feverfew also inhibited release of vitamin B12-binding protein from PMNs induced by the secretagogues formyl-methionyl-leucyl-phenylalanine, sodium arachidonate, and zymosan-activated serum. Feverfew did not inhibit the secretion induced in platelets or PMNs by the calcium ionophore A23187. The pattern of the effects of the feverfew extracts on platelets is different from that obtained with other inhibitors of platelet aggregation and the effect on PMNs is more pronounced than has been obtained with very high concentrations of non-steroidal anti-inflammatory agents.

RANDOMISED PLACEBO-CONTROLLED TRIAL COMPARING OXPRENOLOL WITH DISOPYRAMIDE PHOSPHATE IN IMMEDIATE TREATMENT OF SUSPECTED MYOCARDIAL INFARCTION

473 patients with suspected acute myocardial infarction were entered into a randomised, double-blind, placebo-controlled comparison of disopyramide phosphate, 150 mg three times a day, and oxprenolol, 40 mg three times a day. When analysed on an intension-to-treat basis there was no significant difference in 6-week mortality between the groups, but patients who were able to continue on the active medications fared better than the patients who had to be withdrawn. The withdrawal rate because of heart failure in patients randomised to receive disopyramide was significantly increased. Patients receiving this agent also showed a reduced number of arrhythmic episodes on 24-h tape recordings but this trend did not achieve statistical significance. The results show that the early use of either oxprenolol or disopyramide phosphate in patients with suspected acute myocardial infarction is unlikely to improve mortality.

A longitudinal study of platelet behaviour and thromboxane production in whole blood in normal pregnancy and the puerperium

Summary. A longitudinal study of platelet behaviour (platelet aggregation and release reaction) in whole blood and of serum thromboxane B2 production was performed before, during and after normal pregnancy. The response of platelets to arachidonic acid and to adrenaline was significantly increased in the third trimester. Six weeks after delivery, values were still modestly increased but return to non‐pregnant values was complete by 12 weeks. Serum thromboxane B2 production was unchanged throughout pregnancy and the puerperium.

Neonatal platelet reactivity and serum thromboxane B2 production in whole blood: the effect of maternal low dose aspirin.

Objectives Concern has been expressed about possible neonatal side effects after the use of maternal anti‐platelet agents in pregnancy, particularly low dose aspirin treatment. We have studied neonatal platelet behaviour using whole blood techniques, and assessed the neonatal effect of the maternal ingestion of 60 mg aspirin daily.

Platelet reactivity and serum thromboxane B2 production in whole blood in gestational hypertension and pre-eclampsia

Objective— To determine the nature and extent of changes in platelet reactivity in gestational hypertension and pre‐eclampsia (using whole blood techniques which may be more physiological than those previously employed).

An association between ABO blood-group distribution and geographical differences in death-rates.

In England, Wales, and Scotland there is a strong association between mortality-rates and ABO blood-group distribution. It is suggested that some of the discrepancies in investigations of the relation between water hardness and mortality-rates from cardiovascular disease may be attributed to genetic influences.

A randomized placebo‐controlled study of the effect of low dose aspirin on platelet reactivity and serum thromboxane B2 production in non‐pregnant women, in normal pregnancy, and in gestational hypertension

Objective To investigate the effect of 60 mg aspirin daily on platelet reactivity and prostaglandin production in various groups of patients. Similar regimens, which are thought to act through inhibition of platelet thromboxane production, are currently undergoing clinical assessment for the prevention of pre‐eclampsia and intrauterine growth retardation.

PREVENTION AND DIAGNOSIS OF VENOUS THROMBOSIS IN PATIENTS WITH HIP FRACTURES: A Survey of Current Practice

643 orthopaedic surgeons were sent a questionary asking how they attempted to prevent and diagnose deep venous thrombosis (D.V.T.) in patients with hip fractures. 411 (64%) replied. Of those who replied, 51% offered no prophylaxis, only 3% routinely used oral anticoagulation, and 85% relied on clinical signs in the diagnosis.