SUMMARY Among 120 consecutive patients with chronic active liver disease (CALD) randomized to different treatments, those receiving maintenance doses of prednisone 20 mg daily (Pred), prednisone in doses given on alternate days and titrated to secure resolution of clinical and biochemical abnormalities (Pred-Titrad), or a combination of prednisone 10 mg and azathioprine 50 mg daily (Comb) survived and underwent resolution of clinical and biochemical features of disease more often than a control group receiving placebo or azathioprine 100 mg daily. Histological remission occurred significantly more often with Pred and Comb than with other regimens. Major side-effects of therapy were commoner with Pred than with Comb or Pred-Titrad, which did not differ. We conclude that Comb is the initial treatment of choice for CALD, since clinical, biochemical, and histological resolution of disease activity occurs as often as with Pred, whereas early side-effects are significantly less frequent.Advances in treatment of the related conditions comprising chronic active liver disease (CALD) include three recent controlled trials with steroids, azathioprine, or both. Cook and associates (1971) showed that variable doses of prednisolone (from 10 to 2.5 mg daily) improved certain liver function tests and survival. Therapy with prednisone 15 mg daily was found by Murray-Lyon and his colleagues (1973) to be more effective than azathioprine 75 mg daily for increasing the life expectancy of patients with chronic active hepatitis with or without cirrhosis. We showed that daily maintenance with prednisone 20 mg, or a combination of prednisone 10 mg with azathioprine 50 mg, were not only equally successful in improving survival but also secured clinical, biochemical, and histological remission of disease features significantly more often than azathioprine

Percutaneous endoscopic gastrostomy (PEG) was first described in 1980 as an effective method of feeding via the stomach in situations where oral intake is not possible. Its simplicity has led to its potential use in areas of dubious clinical benefit. Our unit has faced a major increase in referrals for PEG insertion over the last 2 years. For this reason we decided to audit our PEG insertion procedures with regard to indications, complications, outcome and follow up. We studied 168 patients who had an initial PEG insertion during the period 1 February 1996–31 January 1998. The medical records of these patients were reviewed with regard to the procedure, antibiotic use and complications. All patients (or carers or next of kin) were contacted by telephone to provide details regarding late complications and follow up. There were 87 females and 81 males (aged 16–98 years, median age 70 years). At 2 years, 67% were alive. The most frequent indication for PEG insertion was a neurological condition, the commonest being stroke. Most patients received either ticarcillin/clavulanic acid or cephazolin antibiotic prophylaxis before and after the procedure. In six patients (3.6%) infection at the PEG site required intravenous antibiotics. Four of these six patients did not have antibiotic prophylaxis. Only two deaths could be directly related to the procedure. Three died within 7 days of the procedure due to unrelated medical complications. Sixteen patients died within 1 month, the majority of these patients did not leave hospital. One‐fifth of the patients (35/168) had their PEG removed due to the reestablishment of oral feeding, with median time of use, 4.3 months. It is a safe, effective feeding method in the elderly, but experience with case selection, the procedure and careful follow up remain essential. The use of prophylactic antibiotics resulted in few significant infections of the PEG site. Up to one‐fifth of patients will require their PEG only for a short term.

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Oxygen Tension.-We were unable to confirm the recent suggestion (Katz et al., 1971) that "oxygen transport" may be limited in subjects who develop exercise-induced bronchoconstriction. Though there was a higher arterial Po2 during bicycle exercise in four patients, the mean arterial oxygen saturation did not fall below 96% in either study. In Case 1, in which oxygen saturation fell to 93 3 % during treadmill exercise, the PEFR had also fallen (from 550 to 405 1./min) during the last two minutes of exercise. In the other patients, whose PEFR did not fall during exercise, the small differences in arterial Po2 may be explained by relative hyperventilation during bicycle exercise, as discussed earlier. Arterial hypoxaemia, which has been reported after exercise in patients who develop exercise-induced bronchoconstriction, is likely to be the result of bronchoconstriction rather than its cause (Rebuck and Read, 1968). ConclusionAs a result of the present study we are unable to propose any single factor which is responsible for the difference in exercise-induced bronchoconstriction after treadmill and bicycle exercise. We must speculate, as before (Anderson et al., 1971), that neuromuscular effects arising from the mechanical difference between the two forms of exercise may be responsible for the difference in exercise-induced bronchoconstriction, either alone or in combination with other variables.We are grateful to Dr. Margaret Turner-Warwick; the patients in this study were under her care. M.S. and S.D.A. were supported financially by Fisons Pharmaceuticals Limited.

Heartburn is common in the Australian community and sufferers attribute symptoms to various lifestyle events, including diet and stress. Antacid usage is the commonest mode of therapy.