The relation between benign breast disease and breast cancer was investigated in a case-control study of postmenopausal patients selected either by diagnostic procedure sampling (mammography 150 cases and controls, breast biopsy 107 cases and controls) or by conventional sampling procedures (257 controls to match total number of cases). For mammography patients, the odds ratio for association between benign breast disease and breast cancer was 0.9; for biopsy patients the odds ratio was 0.8; but by use of conventional methods, the odds ratio was elevated to a "causal" and statistically significant 2.6. When patients were classified according to cancer stage, benign breast disease was present in 56/147 patients with localised cancer compared with 24/107 patients with non-localised cancer (odds ratio 2.3). Evidence that benign breast disease is a risk factor for breast cancer may therefore be misleading if choice of control groups makes no provision for bias produced by inequalities in detection of disease.

Cervical secretions from 14 women seropositive for HTLV-III/LAV were obtained between days 7 and 21 of the menstrual cycle and cultured for virus. HTLV-III/LAV was isolated from cervical secretions in 4 of 14 women, as well as from blood of 7 of 13 women tested. Female genital secretions may therefore be a source for sexual transmission of the virus to men.

Between March, 1981, and August, 1985, twenty-eight heart-lung transplant operations were done in 27 patients at a single institution. 8 patients died in the perioperative period and adhesions related to previous thoracic surgery proved to be a major risk factor for postoperative haemorrhage. Obliterative bronchiolitis developed in half of the 20 long-term survivors, a mean of 11.2 months (range 2-35 months) after surgery: 4 of these patients died, 3 are functionally limited, 2 were successfully treated with corticosteroids, and the remaining patient was successfully retransplanted. The other 10 long-term survivors returned to a normal life with essentially normal pulmonary function measured at a mean of 22.6 months (range 4-42 months) after transplantation. All the surviving patients have evidence of renal impairment related to cyclosporin nephrotoxicity. The results indicate that, although heart-lung transplantation is compatible with essentially normal long-term pulmonary function, the procedure should not yet be regarded as a routine clinical intervention.

A completely synthetically produced peptide vaccine, consisting of the 18-aminoacid Escherichia coli heat-stable toxin and the 26-aminoacid epitope of the heat-labile toxin B subunit, was given orally to thirteen volunteers. It raised antitoxin titres to both toxin components four-fold in serum samples and seven-fold in jejunal aspirates over preimmunisation control titres. Jejunal aspirates taken after immunisation from vaccinees, but not controls, neutralised the secretory activity of both toxins in appropriate biological assays. These findings show that synthetically produced vaccines are immunogenic in human beings. The peptide used is a promising vaccine for diarrhoeal disease caused by enterotoxigenic strains of E coli.

6 infants (index cases) from five different families had a near-miss sudden infant death syndrome event between 3 and 12 weeks of age and had polygraphically documented apnoeas during sleep. 4 of their siblings had died of SIDS. The index cases, their 4 living siblings, 10 parents, and 8 grandparents underwent respiratory studies during sleep. All the adults and 3 index cases had cephalometric X-rays. 2 index cases underwent volume computerised tomographic scans when awake and during sleep. Index cases had mixed and obstructive sleep apnoea. Several family members had obstructive sleep apnoea; cephalometric X-rays also showed small upper airways, particularly behind the base of the tongue. A small posterior airway at the level of the tongue may be a familial risk factor for apnoea of infancy.

Tumour volume was related to metastasis, seminal vesicle invasion, capsule invasion, and histological differentiation in a series of 100 unselected prostates with carcinoma removed at necropsy and 38 removed at radical prostatectomy. All these variables were highly inter-related. In both series, metastases were associated only with tumours larger than 4 ml, a volume attained by only 13% of the necropsy tumours. Loss of differentiation was strongly correlated with tumour volume, and only tumours of Gleason grade 4 or 5 had metastasised. It was concluded that the natural history of prostate cancer is highly predictable. The capacity to metastasise probably develops only in tumours which have grown much larger than 1 ml and acquired poorly differentiated areas as a manifestation of the phenomenon of tumour progression. The unusually low proportion of metastatic prostate cancer is readily explained by the large proportion of small-volume tumours in this organ.

Over an 8 year period, 170 patients with multiple sclerosis (MS) and 134 healthy controls were assessed at monthly intervals in order to ascertain environmental factors which might be important in producing exacerbation or progression of the illness, and to compare the frequency of common viral infections in the two groups. During cumulative periods designated "at risk" (2 weeks before the onset of infection until 5 weeks afterwards) annual exacerbation rates were almost 3-fold greater than those during periods not at risk. Approximately 9% of infections were temporally related to exacerbations, whereas 27% of exacerbations were related to infections. Frequency of common infections was approximately 20-50% less in MS patients than controls; it was progressively less in those with greater disability. Even in minimally disabled patients with similar potential for infectious contacts, the infection rate was significantly less than in controls, suggesting that MS patients could have superior immune defences against common viruses.

An abnormal circulating ganglioside was found in patients with neuroblastoma. This ganglioside appeared as a single band by resorcinol-HCl staining of thin-layer chromatograms of purified total gangliosides isolated from as little as 1 ml of patient plasma. It is a major ganglioside of neuroblastoma tumour tissue and was present (250-1500 pmol lipid-bound sialic acid/ml) in the plasma of five patients with widespread neuroblastoma. In contrast, the ganglioside was not detected (less than 50 pmol/ml) in plasma samples of six patients in complete remission, nor in plasma samples of seventeen healthy children and adults. Measurement of this circulating tumour-associated ganglioside should be clinically useful in neuroblastoma, offering a new approach to the detection of tumour and the evaluation of therapy.

Birth weight and maternal anthropometric measurements were made in a sample of 2456 deliveries in a poor, African peri-urban community. Maternal anthropometry was similar to that observed in affluent societies, whereas birth weight was significantly lower, even when adjusted for maternal weight and parity. Moreover, multiple stepwise regression showed that for a given maternal weight, fatter women had smaller babies. This is at odds with the classical hypothesis that a maternal energy deficit limits fetal growth.

A girl aged 6 years 9 months with severe heart disease secondary to homozygous familial hypercholesterolaemia underwent orthotopic cardiac transplantation and her liver was replaced with the liver of the same donor. In the first 10 weeks after transplantation serum cholesterol fell to 270 mg/dl from preoperative concentrations of more than 1000 mg/dl.