Measles antibody concentrations in Gambian children immunised at 4 months of age with a high-dose Edmonston-Zagreb (EZ) measles vaccine or at 9 months with conventional Schwarz vaccine were measured 5 months after vaccination, and at 18 and 36 months of age. Schwarz vaccinees produced, on average, a 2.4-fold higher concentration of measles haemagglutinin inhibiting (HAI) antibody than EZ vaccinees, but at 36 months of age 82 of 93 (88%) EZ vaccinees and 83 of 87 (95%) Schwarz vaccinees had measles plaque-neutralising antibody concentrations above the assumed protective level of 200 mIU/ml (p greater than 0.1). HAI antibody concentrations 5 months after vaccination were inversely related to the presence of maternal antibody at vaccination, but above protective levels; at 18 and 36 months of age there was no relation to antibody concentration at vaccination, and decay of HAI antibody between 18 and 36 months of age was similar for EZ and Schwarz vaccinees.

After a short training programme 11 naval medical trainees inserted a laryngeal mask airway (LMA) and a tracheal tube (ETT) in random order in a total of 110 anaesthetised patients. They were allowed 40 s for each attempt. Success was defined as the detection of expired carbon dioxide within 40 s of Guedel airway removal which subsequently rose to an end-tidal value of at least 4 kPa, together with satisfactory lung expansion and ventilation, without other airway intervention by the anaesthetist. 104 LMA insertions were successful compared with 56 of ETTs (p less than 0.01). All first attempts at LMA insertion were successful, whereas satisfactory ETT placement was progressive. Insertion was also quicker with the LMA (20 s) than with the ETT (35 s) (p less than 0.01). Further studies are indicated to assess the value of the LMA in emergencies.

23 women with lower abdominal pain and Chlamydia trachomatis in the cervix, urethra, or both sites were studied. Laparoscopy was done with sampling of the endometrium and fallopian tubes for detection of C trachomatis. 11 women had laparoscopic evidence of pelvic inflammatory disease (PID); C trachomatis was detected in the upper genital tract of 8, but not in the upper tract of 5 who had laparoscopy again after treatment. The organism was also found in the upper genital tract of 9 of the 12 women without laparoscopic evidence of PID. Most of the women with abdominal pain or tenderness had tubal or endometrial C trachomatis infection, although only half had laparoscopic evidence of salpingitis. This finding suggests that antibiotic treatment should be given as soon as chlamydial infection is detected in the cervix and that pain does not necessarily point to C trachomatis in the upper genital tract. Laparoscopy may miss important pathogens in the upper genital tract, unless the procedure is complemented with detailed microbiological investigation.

A multicentre study (ten centres) in seven countries was done to assess the contraceptive efficacy of hormonally-induced azoospermia in 271 healthy fertile men. Each subject received 200 mg testosterone enanthate weekly by intramuscular injection. 157 men (cumulative rate at 6 months 65%) became azoospermic in three consecutive semen samples. These men entered a 12-month efficacy phase during which continuing testosterone injections were the only form of contraception. There was 1 pregnancy during 1486 months of the efficacy phase (0.8 conceptions [95% confidence interval 0.02-4.5] per 100 person-years). Discontinuations from the study were mainly because azoospermia was not achieved within 6 months and because of dislike of the injection schedule. The mean time to become azoospermic was 120 days (SD 40); reappearance of spermatozoa was detected in 11 men and in no case led to discontinuation from the study or to pregnancy. After the testosterone injections had been stopped, the estimated median time from azoospermia to recovery (sperm concentration of at least 20 million/ml) was 3.7 months (3.6-3.9) and to the subject's mean baseline sperm concentration was 6.7 months (6.2-8.7). Hormonal regimens that induce azoospermia can provide highly effective, sustained, and reversible male contraception with minimum side-effects.

352 overweight men and women took part in a six-week controlled trial of seven slimming regimens versus a placebo diet. They were recruited through a popular television programme. The findings showed that three regimens ('Bai-Lin Tea', the 'Grapefruit Pill', and the 'Natural Vitality' pill) were ineffective. Reduction in energy intake either by meal replacement or by dietary modification led to successful weight loss. Commercial slimming clubs were the most effective measures. Television and other media could be used to test other hypotheses with randomisation experiments.

The efficacy of specialist versus general practitioner (GP) treatment of problem drinkers was assessed in a randomised controlled trial. 40 problem drinkers referred consecutively to a specialist alcohol clinic by their GP were, after assessment, randomly allocated to either GP or specialist clinic treatment groups. All subjects received initial advice and counselling in the clinic about their drinking. The specialist clinic group received continued care from the clinic including, if necessary, admission to hospital. Patients in the GP group were returned to the care of the GP who was contacted and supported by the specialist. After 6 months of follow-up, there were significant reductions in alcohol consumption and alcohol-related problems in both groups. No significant difference was found between the two groups with respect to the main outcome measures. No differential treatment effect was found with the more severely dependent drinkers. The findings show that after an initial detailed assessment and advice session, the treatment provided by GPs is at least as effective as that from a specialist clinic with respect to improvements in drinking behaviour and alcohol-related problems. After initial assessment and advice, specialist clinics should encourage GPs to become more involved in the subsequent care of problem drinkers. Such a practice should be based on the individual patient's needs and the adequacy of support offered to GPs.

In a randomised, double-blind, controlled field trial in Santiago, Chile, 81,621 schoolchildren aged 5-19 years received three doses, within a week, of attenuated Salmonella typhi oral vaccine Ty21a in enteric-coated capsules or in a new liquid suspension, or placebo. Over 36 months of surveillance, the liquid formulation (76.9% vaccine efficacy) was significantly superior to the enteric-coated capsules (33.2% vaccine efficacy). The liquid formulation protected young children (5-9 years) (efficacy 82.3%) as well as older children (efficacy 69.3%), whereas the capsules significantly protected only older children. The liquid suspension was easy to prepare by mixing lyophilised vaccine with buffer in water and was easily administered, even to the youngest children. Thus, the liquid formulation of Ty21a is preferable to enteric-coated capsules.

796 men with unstable coronary artery disease (unstable angina or non-Q-wave myocardial infarction [MI] ), were randomised to double-blind placebo-controlled treatment with oral aspirin 75 mg/day and/or 5 days of intermittent intravenous heparin. The risk of MI and death was reduced by aspirin. After 5 days the risk ratio was 0.43 (confidence intervals, 0.21-0.91), at 1 month 0.31 (0.18-0.53), and at 3 months 0.36 (0.23-0.57). Aspirin reduced event rate in non-Q-wave MI and unstable angina, independently of electrocardiographic abnormalities or concurrent drug therapy. Heparin had no significant influence on event rate, although the group treated with aspirin and heparin had the lowest number of events during the initial 5 days. Treatment had few side-effects and high patient compliance.

International comparison of perinatal mortality rates is subject to various problems in methods of reporting. The main difficulties are differences in the definition of livebirth and the variation in policies on the elective delivery of very preterm fetuses at risk of intrauterine death. This study, based on geographically defined populations within the European Community, set out to compare survival rates in very low birthweight infants (below 1500 g). The first phase of the study in seven populations showed pronounced differences in survival and in the proportion of liveborn infants who weighed less than 1000 g. A further phase studied the outcome of all pregnancies from 22 to 28 weeks' gestation in four populations. There was no significant difference between the four populations in crude survival rates per 1000 livebirths among infants born at 22 to 28 weeks' gestation, but more babies were born alive at the earlier gestations in the United Kingdom. Survival rates were higher in Scotland and England when gestational age at birth was controlled for. Future comparisons of the outcome of perinatal care for extremely immature infants would be more meaningful if data on the outcome of all pregnancies ending after 22 weeks' gestation were routinely collected through the registration system.

Twenty mountaineers with acute mountain sickness (AMS) at an altitude of 4559 m were randomly allocated to treatment with oxygen-enriched (33% oxygen), carbon-dioxide-enriched (3% carbon dioxide), or normal compressed air. Treatment with oxygen significantly improved the arterial partial pressure of oxygen (PaO2), relieved symptoms of AMS, and reduced cerebral blood flow as estimated by transcranial doppler ultrasound examination of the median cerebral artery. The only significant effect of carbon dioxide was increased ventilation resulting in a slight rise in PaO2. Thus, in contrast to previous uncontrolled trials, this study does not support the usefulness of carbon dioxide treatment in AMS.

58 patients with biopsy-proven Wegener's granulomatosis (WG) were prospectively screened for clinical evidence of the disease 3-monthly, with antineutrophil cytoplasmic antibody (ANCA) measurements every month. Over 24 months, ANCA rose in 20 patients, 9 of whom were randomly assigned to receive combined 9 and 3 month courses of cyclophosphamide and prednisolone, respectively, at the time of ANCA rise; and 11 patients who were untreated except if there was a clinical relapse. 6 of 11 untreated patients relapsed within 3 months of ANCA rise. 3 of the remaining 5 patients relapsed after 3 months. There were no early or late relapses in patients randomised to treatment. Patients receiving no treatment at the time of ANCA rise took more cyclophosphamide and prednisolone than patients who were treated. Side-effects did not significantly differ between the two groups.

Twelve patients with seasonal affective disorder (SAD) and eleven normal controls were exposed to 2000 lux and 300 lux of artificial full-spectrum light on consecutive nights during the winter. Suppression of melatonin secretion under the two light intensities was measured and the difference between their effects was taken as a measure of light sensitivity. The test was repeated in summer in both groups, when the SAD subjects were well. The SAD but not the normal group showed a significant seasonal variation in sensitivity to light. There was evidence of supersensitivity in the winter but also of subsensitivity to light in the summer.

The relative safety and efficacy of intravenous administration of adenosine, lignocaine, disopyramide, flecainide, and sotalol for termination of stable, induced ventricular tachycardia was assessed in serial trials. Ventricular tachycardia was terminated by pacing if it persisted 10-15 min after the end of drug administration. 24 patients with recurrent ventricular tachycardia were studied. Ventricular tachycardia was terminated by a drug in 35 of 105 trials. In 6 patients no drug terminated the arrhythmia. Adenosine did not terminate tachycardia or have any serious adverse effect in any patient; both flecainide and disopyramide were significantly more effective than lignocaine, but flecainide had significantly more severe adverse effects than lignocaine. Lignocaine was the safest drug and should continue to be used as first-line drug therapy for stable ventricular tachycardia. Disopyramide should be considered as second-line treatment. DC cardioversion is necessary for unstable ventricular tachycardia, and its availability must be ensured before attempted pharmacological intervention.

77 children, aged 11 to 36 months (mean 24) with moderately severe recurrent wheezing, were treated with budesonide pressurised aerosol 400 micrograms twice daily or placebo for 12 weeks in a double-blind, parallel-group trial. Aerosols were inhaled from a spacer with a facemask. Budesonide significantly improved symptom scores of wheezing, sleep disturbance, and patient happiness. The frequency of severe exacerbations that required a course of oral prednisolone was also significantly reduced. The treatment effect appeared to be fully established after 6-8 weeks and no side-effects could be ascribed to the active treatment. The findings indicate that young children below 3 years of age can inhale a pressurised aerosol from a spacer with a facemask. Use of topically active glucocorticosteroids with this simple device may reduce symptoms and distress in young children with moderately severe recurrent wheeze and dyspnoea, and possibly reduce their requirement for oral steroids.