No abstract

Rural-urban and ethnic comparisons of impaired glucose tolerance and diabetes mellitus were made in the biracial population of Fiji in 1980. No statistically significant differences existed in age-standardized impaired glucose tolerance prevalence between rural and urban groups or between Melanesians and Indians. The age-standardized prevalence of diabetes in the rural Melanesian male population was one-third that of the urban male population (1.1 vs. 3.5%). In females, there was a sixfold rural-urban difference (1.2 vs. 7.1%). By contrast, rural and urban Indians had similar rates (12.1 vs. 12.9% for males; 11.3 vs. 11.0% for females). Standardization of two-hour plasma glucose for age and obesity did not eliminate the rural-urban difference in plasma glucose concentration for Melanesian males and females. The results in Melanesians confirm previously reported rural-urban diabetes prevalence differences, and suggest that factors other than obesity, such as differences in physical activity, diet, stress, or other, as yet undetermined, factors contribute to this difference. The absence of a rural-urban difference in diabetes prevalence in Indians may suggest that genetic factors are more important for producing diabetes in this ethnic group, or that causative environmental factors such as diet operate similarly upon both the rural and the urban populations.

An assessment of the side effects of therapeutic doses of tricyclic anti-depressant drugs was attempted in 32 patients with depressive illness. The patients studied had no evidence of clinical heart disease or hypertension and were not receiving any other drugs. Moderate increase in heart rate and mild prolongation of atrioventricular conduction occurred. No significant effect on the corrected QT interval or blood pressure was found. There was no correlation between the increased heart rate, prolongation of the atrioventricular conduction time (PR interval) and plasma nortriptyline levels measured in 20 out of 32 patients.

Ulcerative Colitis-Aylett MEDICAL JOURNAL 1005 reveals an overall mortality rate of 5.7 %. Two hundred and fifty patients are in normal health leading active lives. Conversion to total ileostomy has been necessary in 14 cases (5%0 of operative survivors), because of the development of carcinoma of the rectum, stricture, incontinence, or other complications.The indications for this type of operation in acute and chronic diseases are discussed. It is suggested that the best results in the surgical management of patients with ulcerative colitis can be achieved only in special centres.

Pronethalol, a beta-adrenergic-blocking agent, has been used successfully in the treatment of supraventricular and ventricular arrhythmias (Stock and Dale, 1963; Grandjean and Rivier, 1963;Johnstone, 1964;Payne and Senfield, 1964). Vaughan Williams and Sekiya (1963) demonstrated that ventricular fibrillation produced in guinea-pigs by the infusion of ouabain could be prevented and controlled by beta-sympathetic blockade. This finding raised the possibility of the use of beta-adrenergicblocking agents in the treatment of the arrhythmias accompanying digitalis intoxication and in the prevention and control of ventricular fibrillation. Pronethalol was associated with the occurrence of thymic tumours in experimental animals, and it has since been replaced by propranolol (Inderal; 1-isopropylamino-3-(l-naphthyloxy)propan-2-ol hydrochloride), which has the same beta-sympathetic-blocking action but a greatly increased therapeutic ratio (Hamer et al., 1964;Srivastava et al., 1964; Prichard and Gillam, 1964;Chamberlain and Howard, 1964).We here report our experience in treating three patients with recurrent ventricular fibrillation, using propranolol. External direct-current defibrillation was attempted, and after the third shock, using 400 watt-seconds, atrial fibrillation with a systolic