Seventeen patients who received allogeneic bone-marrow transplants from matched or slightly mismatched (in four patients) siblings were observed for at least 60 days or until acute graft-versus-host disease (GvHD) developed. All donor marrows after preliminary manipulation were incubated with 1 mg of the murine monoclonal antibody OKT3 before infusion in an attempt to deplete them of immunocompetent T lymphocytes (opsonisation). In three of the seventeen patients acute GvHD of grade II or greater developed. Two of these patients died, but they had disseminated cytomegalovirus infection as well as GvHD. Eleven patients showed no evidence of acute GvHD, and four had transient limited skin rashes (grade I GvHD). Opsonisation of T lymphocytes has reduced the incidence of severe acute GvHD in this unit from 79% in an earlier group of 14 patients to 18% when added to prophylactic methotrexate.

195 (97.5%) children born to hypertensive women participating in a trial of methyldopa treatment during pregnancy were followed from birth and were extensively examined at the age of 7 1/2 years. The frequency of problems with health, physical or mental handicap, sight, hearing, and behaviour was the same in children of treated and untreated women. Sons of the untreated women were heavier and taller than those of treated women, as were their mothers. Among children of women who entered the trial between 16 and 20 weeks' gestation, sons of untreated women had larger heads than sons of treated women, but there was no difference in mean intelligence quotients. There were no significant differences between the children in the treated and untreated groups in standing and supine blood pressures, or fourteen tests of ability. Methyldopa therefore seems safe to use in pregnancy and is probably preferable to other drugs from the point of view of the neonate and child.

Since beclomethasone dipropionate (BDP) is a very potent glucocorticoid and since small oral doses (1 mg) seem to be metabolised (possibly in the gut wall or liver) before they reach the systemic circulation, a study was conducted to find out whether patients with inflammatory bowel disease could be treated with enemas containing small doses of BDP without their acquiring Cushing's syndrome or hypothalamic pituitary adrenal (HPA) suppression. The BDP in the 100 ml enemas used was stable and present in a concentration likely to be therapeutic (0.5 mg/dl). Single overnight BDP enemas, unlike conventional betamethasone (5 mg) enemas, did not interfere with the HPA axis in 6 healthy volunteers. In the double-blind randomised part of the study 2-week courses of BDP or betamethasone enemas were assessed in 9 patients having exacerbations of distal inflammatory bowel disease. The clinical and sigmoidoscopic responses as well as adrenocortical function (judged by the 'Cosyntropin' test) were evaluated on the morning after the last day of a course of enemas. Both types of enemas had similar beneficial effects, but only BDP enemas did not interfere with HPA function. Over a prolonged period, a patient with distal ulcerative colitis had been completely dependent on regular treatment with betamethasone enemas to control his symptoms. Substitution with BDP enemas successfully controlled his bowel symptoms, whilst his cushingoid features and HPA suppression regressed.

The relation of breast cancer to diazepam use was evaluated in a case-control study of 1236 women with breast cancer and 728 control subjects with other malignancies. Compared to women who never used diazepam, the relative risk for women who used the drug at least 4 days per week for at least 6 months was estimated to be 0.9, with 95% confidence limits of 0.5 and 1.6. There was no apparent association for recent use, or for use in the distant past, although confidence intervals were fairly wide in these categories. The results were not explained by various potential confounding factors, including the major risk factors for breast cancer. The findings suggest that regular diazepam use does not increase the risk of breast cancer relative to other cancers.

Azathioprine and steroids (prednisone or prednisolone) form the basis of conventional immunosuppression after renal transplantation. Most of the morbidity in the early months after transplantation. Most of the attributed to steroids, which are normally give in high doses. The only justification for giving high doses is a historical one. For this reason a randomised controlled trial was carried out to compare the efficacy of high dose (39 patients) and low dose (33 patients) oral prednisolone, both in combination with azathioprine, in patients given cadaveric renal allografts. Patients were followed up for at least two years after the transplantation. Patient and graft survival were identical in the two groups and the morbidity associated with steroids was impressively lower in patients receiving a low steroid dose. Although the optimal dose of steroids is still unknown, there seems little justification for continued use of high doses of oral steroids with azathioprine after cadaveric renal transplantation.