10 healthy early postmenopausal women were treated with oestrogen and progestagen for two cycles of 28 days. Serum alkaline phosphatase and bone Gla protein increased during progestagen administration, whereas urinary excretion of calcium and hydroxyproline fell significantly during treatment, independently of progestagen intake. Thus, bone formation increases when progestagen is added to oestrogen treatment, whereas bone resorption may be kept constantly low during oestrogen plus progestagen treatment, leading to a positive calcium balance. This makes possible effective treatment of postmenopausal osteoporosis--treatment of elderly postmenopausal women with substantial bone loss before their bones have fractured or when they have just started to fracture. This study design can be used for easy and rapid screening of potential drugs for the prevention and treatment of postmenopausal bone loss.

212 women with twin pregnancies were randomly allocated either to receive advice to rest in hospital from 32 weeks' gestation until delivery, or to be part of a control group in which hospital admission was offered selectively (and, on average, 5 weeks later). Preterm delivery was more common among women admitted routinely for bed rest than among controls, and this difference was unlikely to have occurred by chance. There is at present no scientifically acceptable evidence that this common, disruptive, and expensive obstetric policy does more good than harm.

Zinc and prolactin levels were measured in 32 male haemodialysis patients; 12 were receiving 50 mg zinc per day as zinc acetate and 20 were not. Zinc-treated patients had significantly higher plasma zinc levels (134 +/- 10 micrograms/dl v 88 +/- 2 micrograms/dl) and lower serum prolactin levels (11 +/- 4 ng/ml v 29 +/- 7 ng/ml) than untreated patients. Plasma zinc and serum prolactin were inversely related in zinc-treated and untreated patients (r = -0.79, p less than 0.001).

To determine whether reinfection with an exogenous strain of cytomegalovirus (CMV) or reactivation of endogenous CMV is responsible for post-transfusion CMV infections in patients previously infected with the virus, seropositive patients were randomised preoperatively to receive red blood-cells (RBCs) from CMV seronegative donors (group A) or from random donors (group B). Each group B patient received at least one seropositive unit. 5 of 46 group A patients and 7 of 48 group B patients had a four-fold or greater increase of IgG antibody to CMV eight to twelve weeks postoperatively. IgG antibody titre did not increase in a third group (group C) of 57 seropositive patients who received no RBCs. 10 of the 12 patients with increased IgG titres also had CMV-specific IgM antibody after transfusion. These results indicate that reactivation accounts for most post-transfusion CMV infections in seropositive adults.

A randomised, double-blind, placebo-controlled study examined the effects of alternate-day prednisone therapy on morbidity and progression of lung disease in cystic fibrosis (CF). At baseline the patients (aged 1-12 years) had mild to moderate lung disease, and the prednisone group did not differ significantly from the placebo group for any values measured. After 4 years, the prednisone-treated group had significant advantages over the placebo group for height, weight, vital capacity, forced expiratory volume in 1 s, peak flow rate, erythrocyte sedimentation rate, and serum IgG. The prednisone-treated group required 9 admissions to hospital for CF-related pulmonary disease compared with 35 for the placebo group. There were no steroid-induced side-effects. To rule out bias in case selection, 69 CF clinic patients comparable in age and clinical status but not included in the study were compared with the placebo group at 4 years; no significant differences between the groups were found.

748 children with severe pneumonia in three hospitals in Papua New Guinea were randomised to receive intramuscular injections of either chloramphenicol alone or chloramphenicol plus penicillin. Sequential analysis showed no difference between the two treatments. 48 (13%) of the 377 children in the chloramphenicol alone group died, and 3 (0.8%) were changed to different treatment. 62 (17%) of the 371 children in the chloramphenicol-plus-penicillin group died, and 6 (1.6%) were changed to different treatment. The difference in failure rates (death or withdrawal for change of treatment) was 4.8% +/- 5.2% (+/- 95% confidence limits). In children with severe pneumonia, treatment with chloramphenicol alone is as effective as treatment with chloramphenicol plus penicillin.

367 children with cerebrospinal-fluid findings suggestive of bacterial meningitis were randomised to receive either chloramphenicol alone by intramuscular injection, or chloramphenicol plus penicillin by intravenous injection. Sequential analysis showed no difference in mortality between the two treatments. 48 (26%) of the 183 children in the chloramphenicol alone group died, and 49 (27%) of the 184 children in the chloramphenicol plus penicillin group died. In children with bacterial meningitis chloramphenicol alone given by intramuscular injection is as effective as chloramphenicol plus penicillin given intravenously.

Two strategies for treatment of acute myocardial infarction were compared in a randomised trial of 533 patients admitted within 4 h of the onset of symptoms. 264 patients were allocated to conventional treatment and 269 patients to a strategy aimed at rapid recanalisation of the occluded coronary artery. At first, intracoronary streptokinase (up to 250 000 U) was given immediately after angiography. In the last 117 patients intracoronary administration was preceded by intravenous streptokinase (500 000 U). No angiography was done in 35 patients allocated to thrombolytic therapy. Among the 234 patients who underwent angiography the infarct-related coronary artery was patent on admission or recanalised in 198 (85%). The median time between onset of symptoms and angiographic confirmation of a patent infarct-related artery was 200 min. Mortality was lower in patients randomised to thrombolysis than in controls at 28 days (16 v 31 patients) and at 8 months (23 v 42); 1-year survival was higher after thrombolysis (91%) than conventional treatment (84%). The clinical course in hospital was more favourable in patients allocated to thrombolysis, with a lower incidence of ventricular fibrillation (38 v 61), pericarditis (19 v 46), and cardiogenic shock (13 v 24), although they had a higher frequency of bleeding episodes (53 v 7). Non-fatal reinfarction was commoner after thrombolysis than after conventional therapy (36 V 16 patients). In both groups reinfarctions occurred predominantly in the same area as the initial infarct.

The need for oral anticoagulation in patients with calf-vein thrombosis was examined in a randomised study of 51 patients, of whom 23 received warfarin for 3 months and 28 did not. Both groups received an initial course of heparin and all wore compression stockings. Progress was monitored by the use of serial isotope tests and physical examination. Phlebography was repeated if recurrence was suspected. During the first 3 months, 8 patients in the non-warfarin group (29%) had recurrences compared with none in the warfarin group (p less than 0.01). 5 patients had recurrence with proximal extension and 1 patient had a pulmonary embolus. After 1 year, 22 out of 23 patients in the warfarin group had not had a recurrence, compared with 19 out of 28 (p less than 0.02). The findings indicate that oral anticoagulants should be given to all patients with thrombi that produce symptoms. Treatment for 3 months seems to be sufficient.