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A 2-year prospective study was conducted on 44 early postmenopausal women to assess the effect of transdermal estradiol (TTS-E2) on vertebral bone mass. Twenty treated women and 24 untreated were studied. Treatment consisted of TTS-E2 (0.05 mg/day, 3 weeks a month) and an oral gestagen (10 days per month). At 24 months, bone mineral density, measured by Dual Photon Absorptiometry (DPA), decreased significantly in untreated women (-4.3%) (p less than 0.001), while treated women had a net gain of +5.4% (p less than 0.001). Bone turnover parameters (serum osteocalcin, urinary calcium/creatinine ratio) were significantly (p less than 0.05) reduced from the 2nd month of treatment onwards. Serum estradiol levels were sustained during the treatment and were in the range of an early follicular phase (approximately 45 pg/ml). These findings suggest that low doses of transdermal estradiol sufficient to relieve menopausal symptoms, and which, due to the association with progestogen, result in regular withdrawal bleeding, are effective in preventing postmenopausal bone loss.

We report the fifth case of carcinoid tumour of Vater ampulla with Von Recklinghausen's neurofibromatosis. We have reviewed the literature and discussed the significance of such an association which seems fortuitous.

Forty patients with hypercalcaemia (2.75 to 3.5 mmoles/l) due to bone metastases or to a neoplastic syndrome were treated with synthetic human calcitonin after previous hyperhydration. On entering the study, the patients were allocated at random to either an 0.5 mg dose or a 1 mg dose of the compound administered 6-hourly by the intravenous route. Calcemia was measured every 6 hours: if it became normal, treatment was discontinued 12 hours later, but if after 3 injections the blood calcium level had not been reduced by more than 0.4 mmoles/l, incremental doses of calcitonin were given. Synthetic human calcitonin reduced calcemia by more than 0.4 mmoles/l in 22 patients (group 1) and brought it down to normal value in 18 of these 8 hours on average after the first injection. A new rise in calcemia was observed in 12/18 cases 44 hours on average after treatment was discontinued. Reduction of calcemia by less than 0.4 mmoles/l was observed in 11 patients (group 2). Treatment was ineffective in 7 patients (group 3). There were no significant differences between the 3 groups in mean values and variances of the initial blood calcium levels. Whatever the initial dose of calcitonin, the therapeutic effect was obtained within the first 24 hours of treatment. In patients with incomplete results increasing the dosage did not result in a further reduction of calcemia. No hypocalcaemia was observed. This study confirms that synthetic human calcitonin has a normalizing effect on calcemia. This effect is not dose-dependent, and blood calcium levels rise again after treatment is discontinued.