Fifty-eight patients with uncomplicated diverticular disease of the colon took bran crispbread, ispaghula drink, and placebo for four months each in a randomised, cross-over, double-blind controlled trial. Assessments were made subjectively, using a monthly self-administered questionnaire, and objectively, by examining a seven-day stool collection at the end of each treatment period. In terms of a pain score, lower bowel symptom score (the pain score and sensation of incomplete emptying, straining, stool consistency, flatus, and aperients taken), and total symptom score (belching, nausea, vomiting, dyspepsia, and abdominal distension) fibre supplementation conferred no benefit. Symptoms of constipation, however, when assessed alone, were significantly relieved. Both fibre regimens produced the expected changes in stool weight, consistency, and frequency.It is concluded that dietary fibre supplements in the commonly used doses do no more than relieve constipation. Perhaps the impression that fibre helps diverticular disease is simply a manifestation of Western civilisation's obsession with the need for regular frequent defecation.

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A controlled study was made of the effects of natural orange juice, synthetic orange juice, and placebo in the prevention of the common cold; both natural and synthetic orange juices contained 80 mg of ascorbic acid daily. Three-hundred sixty-two healthy normal young adult volunteers, ages 17 to 25 years, were studied for 72 days with 97% of participants completing the trial. There was a 14 to 21% reduction in total symptoms due to the common cold in the supplemented groups that was statistically significant (P less than 0.05). Ascorbic acid supplementation also increased the number of "episode-free" subjects. However, the clinical usefulness of the results does not support prophylactic ascorbic acid supplements in the well-nourished adult. The results in this study with both natural and synthetic orange juice of physiological content of ascorbic acid, are similar to those obtained using a "megadose" of ascorbic acid.

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We have studied the changes in creatine kinase (CK) and creatine kinase MB (CK-MB) activity and concentration for the diagnosis of acute myocardial infarction in 73 patients admitted to the coronary care unit with cardiac symptoms of 12 h duration or less. Serial blood samples were obtained for an 8 h period following admission and CK, CK-MB activity and concentration measured. We compared the performance of single values at optimized diagnostic cutoffs and incremental change (log slope) for all three measurements. CK slope combined with CK-MB concentration measurements allowed accurate diagnosis at 4 h from admision. CK-MB concentration determination 8 h from admission (12-16 h from the onset of chest pain) was the most efficient single measurement. Rapid diagnostic categorization and possible selection of patients for thrombolysis in patients with an uncertain admission diagnosis is possible by these techniques. Additional key phrases: diagnostic categorization; indicator for thrombolytic therapy We have previously demonstrated that determination of the rate of change of creatine kinase (CK) and creatine kinase MB (CK-MB) activity or concentration (slope measurement) in serial samples obtained within 12 h of admission from patients presenting with acute (less than 12 h duration) chest pain allows rapid and highly efficient diagnosis. I ,2 The measurement which produced the greatest discriminant between infarct and non-infarct groups in our preliminary study was CK-MB concentration (mass) measurements. CK-MB concentration measurements can now be performed rapidly in the emergency laboratory. We therefore further examined this method to determine if reliable diagnosis can be achieved by slope measurements using a shorter than 12 h time series. Methods The study was carried out on all patients admitted to the coronary care unit with cardiac symptoms

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SUMMARY The mechanism by which intragastric balloons induce weight loss is not known, although they may act simply by reducing the amount of food needed to induce satiety. The knowledge that a balloon is present may influence the patients' eating patterns and reduce caloric intake and weight. In order to test whether the balloon or the secondary psychological effect caused weight loss, a double blind balloon versus sham procedure was devised with both groups receiving identical outpatient dietary advice (800 kcallday). Twenty four obese women with body mass index greater than 30 kg/m2 from an obesity clinic were studied. Twelve had the balloon and 12 the sham procedure. The balloon was removed after three months and the patients were followed for a further three months. There was significantly greater weight loss in the balloon group, mean weight loss (SD) of 7.33 (6-12) kg compared with the sham group, mean weight loss (SD) of 3.33 (3.9) kg (p

globulin have a strong but not exclusive influence.' Changes in albumin have only a minor effect, but paraproteins2 and lipoproteins3 also increase plasma and serum viscosity. For these reasons estimations of plasma fibrinogen from the difference of plasma and serum viscosity are unreliable and can be wrong by as much as 100",.1 According to the authors' own reasoning a quantitative plasma protein determination (electrophoresis) therefore should be more reliable as a predictor of early rheumatic conditions.