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Objectives: To determine if certain loggers are at increased risk of death during logging operations. Methods: Statistical analysis of 780 logger fatalities for a nine year period (1992–2000). Results: The major findings are: (1) treefallers suffer nearly 63% of all fatalities, (2) the region where the fatality occurred and the size of the employer were not significant factors that contributed to a high percentage of treefaller fatalities, and (3) the Northeast and Midwest regions showed a higher percentage of fatalities compared with the South and West regions. Conclusions: Overall, the logger fatality rate for 1992–2000, compared with 1980–88 has decreased slightly; however, treefallers continue to be the group of loggers who suffer the highest fatality rate.

Preservation of rat kidneys by simple ice-storage has been demonstrated after 48 hr using the University of Wisconsin (UW) solution; hypothermic preservation of the rat kidney was dramatically improved. A modified UW solution without hydroxyethyl starch (HES) also gave uniform survival after 48 hr of storage, and even better function and morphology. Substitution of HES from another source also improved renal function when compared with UW (Dupont) and it is suggested that prolonged storage of UW solution prior to use may reduce its effectiveness. Reversing the Na:K ratio of the solution still allowed successful preservation, but significantly worsened morphology of the surviving kidney.

We surveyed 70 epileptic patients attending a general neurology clinic and 64 patients attending an epilepsy clinic to determine the incidence of alcohol-related seizures. Seven (10%) of the neurology clinic patients and 9 (15%) of the epilepsy clinic patients reported exacerbation of their seizures with alcohol. In the first group, two had been heavy drinkers when under-age, two had features of alcohol dependence, and three had experienced resolution of seizures following cessation of their drinking. In the second group, five drank 4 units/day or more, and one drank more heavily. The importance of alcohol in the causation of these patients’ seizures had not previously been appreciated. The relationship of alcoholism to epilepsy has been recognized for many years, but the role of alcohol in the exacerbation of primary epilepsy, and in triggering seizures in epileptic patients is often not recognized. Control of alcohol ingestion is an important factor in the management of epilepsy.

Book reviews in this article: Neurogenic claudication is characterized by sensory symptoms which appear during exercise or while maintaining a fixed posture. They are paraesthetic in quality, may be associated with ‘march’ phenomena, and patients may have bowel and bladder disturbance. The problem is most commonly secondary to lumbar canal stenosis (LCS) but rarely due to aortic disease, as shown in this case report. This report concerns a 66 year old woman who presented with symptoms of paraesthesia radiating from the buttocks to the thigh and, intermittent loss of bladder and bowel function, all associated with walking. There were no associated symptoms of vascular claudication. Clinically, there was evidence of aorto-iliac obstruction with absence of femoral pulses and a vascular index of 0.4 at both ankles. Neurological examination was normal at rest but the left ankle jerk was absent immediately after exercise. Myelogram and computerized tomographic (CT) scan were normal. An aortogram revealed a very tight irregular stenosis of the aorta at the level of the renal and mesenteric arteries. Very few lumbar vessels were seen. An aortic endarterectomy via a thoraco-abdominal approach was performed and an aortobifemoral graft inserted. The patient's symptoms resolved following this procedure. We postulate that her symptoms were caused by a ‘steal’ from the blood supply to the cauda equinda due to the severe athromatous disease of her upper abdominal aorta.

The present studies show clearly that both dexamethasone and insulin can be omitted without altering the efficacy of UW. Adenosine and glutathione are both helpful additives, as is allopurinol. These findings suggest an important role of reperfusion injury after preservation, and confirm the benefits of adding pharmacological agents likely to reduce this injury. Cold ischemic damage was significantly ameliorated by UW solution in this stringent model of rat kidney preservation for 48 hr. A substantially simplified modification of UW solution has been shown to give equally effective kidney preservation, after removal of hydroxyethyl starch, dexamethasone, and insulin. Adenosine, glutathione, and allopurinol have been confirmed as helpful pharmacological additives. These findings have defined some of the mechanisms of effectiveness of UW solution and suggest avenues of further exploration to improve simple hypothermic storage and to prevent reperfusion injury.

The results of 24 axillofemoral arterial bypass grafts performed over a five-year period are presented. This extraanatomical technique of arterial reconstruction is valuable following removal of an infected aortic Dacron graft and for limb salvage or severe intermittent claudication in selected poor-risk patients with aortoiliac occlusive disease. There were few early complications and the early patency rate was excellent, but the long-term success of the operation is uncertain.

A group of 55 patients were studied who showed in their EEGs prolonged episodes of delta activity, in response to either auditory or tactile stimuli or both. This unusual pattern occurred with states ranging from drowsiness to deep coma but never in alert patients. It was found in a variety of conditions, most commonly following head injury. The EEG phenomenon disappeared within 5 weeks and over half of the patients had a favourable outcome.

Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia. Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.

A child with pattern sensitive epilepsy is reported. She had both absences and generalised seizures. The latter occurred spontaneously but the former followed concentration on patterned materials. These self-induced seizures appeared to have an affective component. The EEG showed generalised atypical spike and wave discharges both in the resting state and during intermittent photic and pattern stimulation. The patient responded to sodium valproate.

Reinforced expanded polytetrafluoroethylene (PTFE) was used as a femoropopliteal bypass graft in 31 patients (37 operations). The indications were intermittent claudication (13 operations), severe ischaemia with rest pain or gangrene (20 operations), and prophylactic treatment of popliteal aneurysms (4 operations). The one-year accumulative patency rates were 75% for patients with intermittent claudication and 20% for patients with severe ischaemia. In three patients with claudication, graft thrombosis led to amputation in spite of attempted graft thrombectomy. These results compare unfavourably with our experience using autogenous vein, in which the one-year accumulative patency rates were 80% for claudication and 70% for severe ischaemia, and in which failure of the bypass graft for claudication rarely made the patient worse.

Oral tyramine activated pre-existing episodic EEG abnormalities--namely, sharp waves, spike and wave, and localised theta activity--in epileptic patients. Little change was found in the EEGs of migrainous subjects after chocolate or beta-phenylethylamine. The implications of the findings with tyramine are discussed.

Summary Four patients are reported, all over 40 years of age with a long history of bronchial asthma but no previous epilepsy, who developed serial seizures with focal onset during treatment of status asthmaticus. The seizures appeared to be related to administration of aminophylline. REsume On a etudie 4 sujets, to us âges de plusde 40 ans, avec une longue histoire d'asthme bronchique et qui n'avaient jamais eu de crises. A la suite d'un traitement de l'etat asthmatique, ils ont presente des crises en serie, a debut focal. Les crises semblaient etre dues a l'administration d'aminophylline. ZUSAMMEnfassung 4 Patienten uber 40 Jahren mit einem seit langem bestehenden Bronchialasthma aber keinen Anhalt fur Epilepsie entwickelten Anfallsserien mit fokalem Beginn wahrend der Behandlung des Status asthmaticus. Die Anfalle schienen mit der Verordnung von Aminophyllin zusammenzuhangen.

An outline of the problems and clinical features of connective tissue disorders are given, in particular for systemic lupus erythematosus (SLE). This is the commonest of the group of rarely occurring disorders in which immunological disturbance is the basic defect. SLE, a chronic disorder, occurs mainly in women and often at a young age but in the present series with a wide age range, 18–81, mean 45 years. In the two separate groups of patients studied, disorders of the nervous system occurred in about half. Seizures, vascular episodes, and a variety of psychiatric disorders are a feature, with EEG abnormality in nearly three quarters of these. Diffuse and focal slow activity as well as slowing of the background frequencies is characteristic of the majority. In particular, evidence of focal independent areas of disturbance may be shown. Illustrative case histories are presented to exemplify some of the problems in management, for example differentiation between cerebral SLE and psychosis from ste...

One-hundred-and-fifty-two patients who underwent surgery for intracranial aneurysm were studied to determine the incidence of postoperative epilepsy in relation to the site of the aneurysm and the type of surgical approach. The overall incidence of epilepsy was 22%. Of the 116 patients treated by the intracranial approach 27.5% developed epilepsy, in contrast with only 5% of the 36 patients who had carotid artery ligation in the neck. Epilepsy occurred most frequently (35%) with middle cerebral artery aneurysms, especially if moderate or severe operative trauma was sustained and there was postoperative dysphasia.

The aim of this study was to investigate aetiological factors in Alcoholic Hallucinosis. First, to determine whether or not there was an increased incidence of schizoprenia in the parents and siblings of a group of patients diagnosed as suffering from alcoholic hallucinosis as compared with two other groups of alcoholic patients. Second, to determine whether there is any difference in the drinking history of patients with alcoholic hallucinosis as compared with patients with delirium tremens or chronic alcoholics without psychosis. Third, to detect differences in marital, occupational and social class in alcoholic hallucinosis, delirium tremens, chronic alcoholics without psychosis and schizophrenics (first admission for this disease). Resume 1. Un groupe de patients souffrant d'hallucinose alcoolique a ete comparea un groupe egal d'alcooliques chroniques sans psychose et a un autre groupe de patients souffrant de delirium tremens. 2. Aucun exces de schizophrenie n'a ete constate chez les parents ou les proches du groupe d'hallucinose alcoolique. L'incidence de schizophrenie chez les parents des patients des trois groupes a ete determinee; il a ete constate qu'elle suit les previsions de la population generale, les memes constatations sont valables pour les proches des trois groupes combinees. 3. Un groupe de patients souffrant d'hallucinose alcoolique boit de la biere de preference a toute autre boisson alcoolisee. Ces constations atteignent une signification statistique. Le groupe d'hallucinose alcoolique, s'il prefere la biere a toute autre boisson alcoolisee, en consomme moins que les deux autres groupes alcooliques. Lorsque la boisson des spiritueux a ete consideree, son nombre a ete trop limite pour une analyse. 4. Les conditions sociales, maritales et professionnelles d'un groupe de patients a hallucinose alcoolique ont ete comparees a un groupe de patients souffrant de delirium tremens, a un groupe d'alcooliques chroniques et finalement a un groupe de schizophrenes. Aucune difference n'a ete constatee lorsque les groupes alcooliques ont ete compares. Le groupe schizophrene contenant une plus grande proportion de patients celibataires, ne differe en rien autrement. Zusammenfassung 1. Eine Gruppe von Alkoholhalluzinosepatienten wurde mit einer gleichabgestimmten, chronischen Alkoholikergruppe ohne Psychose und einer anderen, ebenfalls gleichabgestimmten Patientengruppe mit Delirium tremens verglichen. 2. Bei den Eltern oder Geschwistern der Alkoholhaluzinosegruppe fand man kein Ubermass von Schizophrenie. Das etwaige Auftreten von Schizophrenic bei den Eltern von Patienten aus den vereinten drei Gruppen wurde ermittelt und gefunden, dass sich dies dem Erwartungsgrad fur die Allgemeinheit der Bevolkerung annaherte, was auch aus Befunden uber die Geschwister der vereinten drei Gruppen hervortrat. 3. Eine Patientengruppe mit Alkoholhalluzinationen zieht Biertrinken dem Genuss anderer alkoholischer Getranke vor. Dieser Befund ist von statisticher Bedeutsamkeit. Jene Alkoholhalluzinosegruppe, welche Bier anderen alkoholischen Getranken vorzieht, konsumiert kleinere Mengen als die beiden anderen Alkoholikergruppen. Bei der Beurteilung der Einnahme von geistigen Getranken war die Versuchszahl zur Aufstellung einer Analyse zu gering. 4. Der Familien-, Berufs- und gesellschaftliche Stand einer Gruppe von Alkohol-halluzinosepatienten wurde mit dem einer Patientengruppe, welche an Delirium tremens litt, sowie mit einer chronischen Alkoholikergruppe und schliesslich mit einer Schizophrenengruppe verglichen. Beim Vergleiche dieser Alkoholikergruppen zeigten sich keinerlei Unterschiede. Die Schizophrenengruppe enthielt eine grossere Anzahl von ledigen Patienten, wies aber sonst keine wesentlichen Unterschiede auf.

A retrospective study of 42 patients admitted to The London Hospital between 1948–1968 with 50 episodes of major status epilepticus is reported with particular reference to cause and outcome. It was found that the commonest precipitating factors were drug irregularity and/or systemic infections. The duration of the status was greater in the younger age group (below 10 years) and in the older age group (over 60 years), and it was further noted that this factor was closely linked with neurological outcome. Overall mortality was 21 per cent, and a further 26 per cent of the patients suffered neurological sequelae. This was particularly likely in patients with asymmetrical motor seizure activity. Frontal lobe involvement was suggested in 42 per cent of patients. The duration of status particularly before treatment was commenced was closely related to mortality and morbidity. The findings are discussed.

SUMMARY A study of the interaction of migraine and epilepsy was carried out in 25 migrainous patients, divided into three groups. One group had migraine alone, and another had migraine with a history of a dietary precipitant. The third group had both migraine and epilepsy, the latter consisting of isolated seizures temporally unrelated to headache. A double blind design was used in which all patients took oral tyramine and placebo on separate occasions. Psychological data on intelligence, mood, neuroticism and obsessionality were collected and serial EEGs were recorded. These were assessed by a blind, inter-rater method. Tyramine had no effect on blood pressure and although headache occurred on 12 of 50 possible occasions it followed tyramine alone in only three instances. None of these headaches was typical of the patients' migraine. The results of psychological testing showed that all the patients were more obsessional than a normal population but patients with migraine alone were less obsessional than those with dietary migraine or those with migraine and epilepsy. No differences in neuroticism emerged but the patients with migraine and epilepsy were less introverted than the others. EEG abnormalities were present in the preliminary records of six of ten patients with migraine alone and all of the 15 patients with dietary precipitated migraine and with migraine and epilepsy. However, definite epileptic features were seen only in the latter. These pre-existing abnormalities were activated by tyramine, especially in combination with hyperventilation, in two of ten patients with migraine alone, six of eight with dietary migraine and five of seven with migraine and epilepsy. The results in the latter two groups were statistically different from those in the former. It is suggested that this activating effect on the EEG is further evidence of a close physiological relation between migraine and epilepsy, and possible mechanisms for this action of tyramine, and its implications, are discussed. RESUME Chez 25 patients migraineux, divises en trois groupes, on a etudie les relations entre migraine et epilepsie. Un premier groupe presentait seulement des migraines, et un second groupe presentait des migraines provoquees par des facteurs alimentaires. Le troisieme groupe avait des migraines et egalement une epilepsie caracterisee par des convulsions isolees sans relation chronologique avec la cephalee. On a utilise un plan d'etude en double aveugle dans lequel tous les patients prenaient per os de la tyramine et un placebo. On a pris en consideration differents parametres psychologiques tels que l'intelligence, le caractere et les tendances nevrotiques et obsession-nelles et on a fait pratiquer des E.E.G. en serie. Ces parametres etaient evalues selon une methode en aveugle entre ceux qui analysaient les resultats. La tyramine n'avait pas d'effet sur la pression arterielle et quoique la cephalee apparut en 12 occasions sur 50 possibles, elle suivait la prise de tyramine seule dans 3 occasions seulement. Aucune de ces cephalees n'eait identique aux migraines des sujets. Les resultats des tests psychologiques ont demontre que tous les sujets etaient plus obsessionnels qu'une population normale, mais que les patients avec migraine seule etaient moins obsessionnels que ceux avec migraine en relation avec des facteurs alimentaires ou ceux avec migraine et epilepsie associees. Il n'y avait pas de difference en ce qui concerne les tendances nevrotiques mais les sujets avec l'association de migraine et epilepsie etaient moins introvertis que les autres. Avant la prise de tyramine, il y avait des anomalies EEG chez 6 des 10 sujets avec migraine seule et chez tous les patients (15) avec migraine favorisee par des facteurs alimentaires et avec migraine et epilepsie. Cependant, des aspects de type franchement epileptique etaient evidents seulement chez les sujets avec migraine et epilepsie. Ces anomalies etaient activees apres administration de tyramine, surtout lors de l'hyperpnee, chez 2 des 10 sujets avec migraine seule, chez 6 des 8 sujets avec migraine facilitee par des facteurs alimentaires et chez 5 des 7 sujets avec association de migraine et epilepsie. Les resultats dans ces deux derniers groupes etaient differents d'une facon statistiquement significative des resultats du groupe avec migraine seule. On suggere que cet effet activateur sur l'E.E.G. constitue une preuve supplementaire de la relation physiologique stricte qui existe entre migraine et epilepsie; on discute les eventuelles modalites d'action de la tyramine, responsable de cet effet.

An investigation was carried out on 199 postoperative EEGs from 83 patients who underwent surgery for ruptured intracranial aneurysm or acoustic neuroma removal. The tracings were quantified without knowlege of the diagnostic group and whether or not epilepsy had supervened. The number of spikes and sharp components and slow waves at the site of the operative brain lesion were substantially and often significantly greater in the tracings from patients who developed epilepsy than from those who did not.

Summary: Systemic herpes simplex infection with fulminant hepatitis post-transplantation. S. R. Holdsworth, R. C. Atkins, D. F. Scott and K. Hayes, Aust. N.Z. J. Med. 1976, 6, pp. 588–590. Immunosuppression for renal transplantation is associated with the risk of severe overwhelming infection with ubiquitous but normally relatively harmless micro-organisms. In recent years a number of adult cases of fatal hepatitis due to herpes simplex virus (HSV) infection have been reported. Nearly always immune deficiency was a significant factor. A case of fatal HSV infection with hepatitis following transplantation is reported. The case failed to respond to infusion with the antiviral agent cytosine arabinoside. The presentation, diagnosis and treatment of HSV fulminant hepatitis is discussed.

A device, the cerebral function monitor, provides a continuous record of the electrical activity of the brain occurring at frequencies from 2 to 15 Hz. It is relatively cheap, portable, and easy to use and interpret. The apparatus has proved of value in three circumstances: firstly, when the cerebral circulation is likely to be vulnerable during open heart surgery; secondly, as a measure of recovery or deterioration following brain damage or drug overdose; and thirdly, where information about more physiological changes in cerebral function is required, for instance when testing anaesthetic and hypnotic drugs.

Summary25-year-old female patient with a psychotic illness lasting three months in which schizophrenia and depressive episodes occurred was studied by serial EEGs. These were coded, masked and rated in a set way without knowledge of the clinical state. It was found that the schizophrenic state was characterized by a decrease in the amount and poor organization of alpha activity, as well as the occurrence of paroxysmal phenomena in particular atypical spike and wave. In the depressive episode, alpha activity was prominent and only scanty paroxysmal features were seen. Using these criteria a series of EEGs from psychiatric patients were assessed ‘blind’ with a view to separating them into either a schizophrenic or a depressive category. This proved possible in 17 cases (9 depressive and 8 schizophrenic). In only two was the categorization completely misjudged. These results suggest that further detailed study of the EEG, possibly with computer analysis, combined with assessment of the behavioural state might not only yield useful diagnostic information but also lead to a better understanding of the underlying neurophysiological basis of certain mental disorders.

Extraperitoneal unilateral iliac artery bypass was used to treat chronic lower limb ischaemia in 105 patients (110 operations). This represented 20% of all operations for aorto-iliac disease. Unilateral iliac bypass was the preferred primary procedure for 99 operations, and was used to correct complications in one limb of a prior aortic bifurcation graft in the other 11. Ipsilateral fernoropopliteal vein grafts were also performed in 45 legs (43%). prior to the iliac bypass in 18, as a synchronous operation in nine, and at a later date in 18 legs. This was a much higher proportion of combined operations than for patients by aortic bifurcation grafts (12%). Only 5 patients later required further proximal surgery, one for a blocked graft and four for contralateral iliac disease. The cumulative patency rate in surviving patients was 91% at 3 years. For the claudicants and for iliofernoral bypass operations, only one graft occluded. within 5 years, and no grafts occluded for operations where the superficial femoral artery was patent. The cumulative patency rates at 3 years were 85% for patients with critical ischaemia, 82% for ilioprofunda bypass operations, and 88% for operations where the superficial femoral artery was occluded. The cumulative foot-salvage rate in surviving patients initially treated for critical ischaemia was 77% at 3 years. The cumulative survival rate was 90% at 3 years. Extraperitoneal unilateral iliac bypass is now preferred as the primary operation for patients with apparent unilateral iliac disease causing severe ischaemia, if balloon dilatation is not appropriate or has failed.

Benzodiazepines given intravenously abort status epilepticus, and abolish paroxysmal EEG discharges. The study reported concerns the effect of small doses (about 1 mg) of lorazepam on these EEG changes, assessed visually, in the resting record, as well as during overbreathing and photic stimulation. Thirty patients were examined, approximately half had primary generalised and the remainder focal epilepsy. All showed rapid reduction of paroxysms in the first few minutes following injection. This occurred faster and was much more persistent for the generalised than for the focal group. The effect of chronic oral administration of lorazepam in these patients is under investigation.

Differences in function between the cerebral hemispheres are well documented for normal subjects and, in diseased states, these are used to lateralize and localize a dysfunction. However, the difference in frequency of occurrence of left vs. right hemisphere lesions and the greater likelihood of epilepsy occurring on the left have received scant attention. In the present study patients with a diagnosis of meningioma or cerebral abscess were identified from the EEG computer file. After operation the meningioma patients with predominantly left-sided tumours showed a statistically significant greater chance of developing seizures, similarly those with left-sided cerebral abscess. Considering a larger group of patients with temporal lobe epilepsy from a variety of causes, a left-sided EEG focus occurred more frequently - and was statistically significant - than a right-sided or bilateral disturbance. The full explanation of these results is not clear but they suggest that the hemispheres function differently in patients with a cerebral disorder like epilepsy, as is known to be the case in normal subjects.

There are various overlaps between migraine and epilepsy and another is suggested here in patients who develop seizures following surgery for intracranial aneurysm. of a group of 37 who had this complication, three with a personal history of migraine and three with a family history of the disorder all developed post-operative seizures.

Graft and patient survival in 37 patients receiving a renal allograft while on CAPD have been compared to that in 102 hemodialysis patients transplanted in the same period. Graft and patient survival was similar in both groups. Blood transfusion prior to transplantation was associated with better graft survival in both CAPD and hemodialysis patients. Although peritonitis occurred in 6 of 30 patients in whom the peritoneal catheter was left in situ at transplantation, the peritonitis rapidly subsided with antibiotics without sequelae. Thus renal transplantation may be safely and effectively performed in patients on CAPD and the catheter left in situ and used if necessary for postoperative dialysis.

A patient of 23 years of age is presented who, on recovery following a severe head injury, developed abnormal involuntary movements of the eyelids. This consisted of intermittent blepharoclonus which recurred repetitively on voluntary, but not forced, eye closure. The possible genesis of this disorder will be discussed.

Twenty four patients with drug resistant epilepsy were given lorazepam and placebo added to their pre-existing drug regime. With lorazepam there was a significant reduction in seizures, especially in those with focal and partial complex attacks. The drug proved effective whether or not the patients regarded stress as a trigger to their seizures, but on the Middlesex Hospital Questionnaire there were differences between those with high and low scores.

Thirty drug-resistant epilepsy patients were given 20-30 mg of clobazam in addition to their other anticonvulsants and followed up for 2-3 years in an open-ended study. Fit frequency was markedly reduced in 43% of patients, few side effects occurred and psychological parameters including the Crown-Crisp questionnaire, showed improvement. It therefore seems that clobazam is a useful additional drug added to conventional anticonvulsant regimes.

This paper describes two cases of true atheromatous aneurysm formation within reversed autogenous saphenous vein used for femoropopliteal bypass graft. We note the rarity of this complication and review the literature for true aneurysm formation within vein grafts used for this and other bypass procedures.

The results of simple ice storage and prolonged perfusion storage of kidneys were compared in two series, each of 100 cadaver kidney transplants. There was a similar warm ischaemia time for both groups, but the average total storage time was 17 hours for the perfused kidneys as compared to three and a half hours for those stored in ice. The results of transplantation (as shown by transplant function at three and 12 months) were the same for both groups. There was no evidence of damage due to prolonged perfusion. The extra time, however, enabled a more convenient operation time to be chosen and more extensive tissue matching to be undertaken.

Electroencephalograms of 95 patients with an acute confusional state, referred over three years, were studied to determine their usefulness. The majority were abnormal, and those from patients with intracranial pathology often showed asymmetry of delta activity and paroxysmal discharges. These, and other features, suggested that the EEG was a helpful investigation.

The platelet monoamine oxidase activity (MAO) of 33 patients with epilepsy was compared with a group of neurological patients and a group of normal control subjects. We found that the MAO activity was increased significantly in the epileptic group when compared with the normal. This was not related to anticonvulsant medication. These results could be explained by the effect of epilepsy or anticonvulsant medication on the maturation of platelets.

Two techniques of desedsitization, biofeedback and relaxation, were employed in a crossover design for the treatment of three young female patinets suffering from drug resistant epilepsy associated with anxiety and phobic symptoms. The patients were followed up for 15 months after the six months of treatment. The results indicate that both relaxation and biofeedback improved the patients' control of their seizures and the effects were maintained during the follow-up period.

Sixty-nine patients who had neurosurgical treatment for acoustic neuroma by one of two different techniques were studied with a view to determining the incidence of postoperative epilepsy. Fourty-five patients who had larger tumours underwent a combined translabyrinthine and transtentorial neurosurgical approach. For the others with smaller neuromas a translabyrinthine method was used. Only the combined approach was associated with postoperative epilepsy, and it occurred in 22% of the patients. Epilepsy was associated with temporal love trauma during surgery.

The effect of chocolate on a group of volunteer migrainous subjects, who had observed that headache regularly occurred after the ingestion of small amounts of cocoa products, was investigated. Two separate studies were carried out in a double-blind placebo controlled manner. Only 13 headaches occurred to chocolate alone in 80 subject sessions, and only two subjects responded consistently to chocolate in the two studies. This suggests that chocolate on its own is rarely a precipitant of migraine. Other possible implications of the results are also discussed.

The salvage rates in 437 severely ischaemic legs (384 patients) treated by arterial reconstuction or by lumbar sympathectomy were studied by the life table method. The results were analysed in the surviving patients. Following arterial reconstruction, the salvage rate was 70 per cent at 2 years and 60 per cent at 5 years. The results were similar for aortofemoral reconstruction and for femoropopliteal bypass grafting. Following aortofemoral reconstruction the outcome was better for endarterectomy procedures than for Dacron grafts. The salvage rate for femoropopliteal bypass grafts with patent tibial vessels was higher than for grafts to an isolated popliteal segment or for femorotibial grafts. Late occlusion of a reconstruction frequently did not necessitate major amputation, whereas several amputations were required in spite of a functioning reconstruction. Following sympathectomy the salvage rate was 60 per cent from 1 year onwards. The results were better for tibial artery disease than for femoropopliteal or aortoiliac disease. Failed sympathectomy frequently led to major amputation of the leg or death of the patient. The salvage rates after either reconstruction or sympathectomy were not influenced by age, sex or a prior history of clinical myocardial ischaemia, but the rates were worse in diabetics. The outcome of either operation was best when the procedure was performed for rest pain or ischaemic ulceration, satisfactory for limited gangrene but very poor for extensive gangrene.

Summary: A case is presented of a patient with recurrent peptic ulceration due to an excluded gastric antrum. The patient demonstrated basal hypergastrinaemia and gastric secretory studies showed a high basal acid output with only a slight increase following pentagastrin stimulation. Intravenous secretin injection caused a marked fall in serum gastrin and gastric acid output in this patient. This is in contrast to two patients with Zollinger-Ellison syndrome in whom secretin produced a rise in serum gastrin; and one of these patients who had an intact stomach, also showed a rise in gastric acid output. It is suggested that gastrin and acid output measurement after secretin injection may provide a method of differentiation of an excluded gastric antrum from the Zollinger-Ellison syndrome.

The EEGs are reported on a group of 95 patients with Huntington's chorea. Thirty one showed little activity of any kind, and in particular no alpha rhythm above 10 μV in amplitude was seen. Only those records which still met these criteria when re-examined were included in the `low voltage' category. EEGs in this category occurred significantly more frequently in institutionalized patients and in those with a positive family history of Huntington's chorea, dementia, and choreiform movements together. Computer averaged responses to light and sound were found in the three patients examined, though their routine EEGs were low voltage. Neuropathological examination confirmed a clinical diagnosis of Huntington's chorea in 14 patients investigated. There was a statistically significant association between cortical atrophy, including the frontal lobe, and a `low voltage' EEG. It was concluded that the low voltage record, though not specific for Huntington's chorea, was rare in other neurological disorders. The EEG is therefore of value in patients suspected of having Huntington's chorea as well as in various presenile dementias.

SUMMARY EEG records and clinical case notes of 313 patients with major, psychomotor or other localised clinical seizures were studied retrospectively in an attempt to assess the usefulness of hyperventilation as a routine method of EEG activation in patients with epilepsy other than petit-mal. The effect of hyperventilation on “paroxysmal” and on localised EEG abnormality was compared, but bilaterally symmetrical delta wave discharges appearing during the procedure were not included. Hyperventilation evoked a small overall increase in EEG abnormalities but no significant differences emerged either in relation to type of epileptic attack or the presence or absence of an intracranial tumour. RESUME On a etudie retrospectivement les E.E.G. et la clinique de 313 malades avec des crises majeures, des crises psychomotrices ou d'autres crises localisees, dans le but de preciser l'utilitye de l'hyperpnee comme methode d'activation E.E.G. de routine chez des patients ayant des crises epileptiques autres que le petit mal. On a comparee l'effet de l'hyperpnee sur les anomalies “paroxystiques” et focales a l'exclusion des bouffees delta bilaterales et symeriques. l'hyperpnee provoquait une modeste augmentation des anomalies E.E.G. sans qu'il y ait toutefois des differences significatives en relation avec le type des crises ou avec la presence ou l'absence de tumeur intrâcranienne.

The incidence of headache and changes in the EEG after tyramine were studied in 25 migrainous patients in a double-blind placebo-controlled investigation. There were three groups of patients: the first had migraine alone, the second had migraine and epilepsy, and the third had migraine which was precipitated by food substances containing tyramine. Psychological tests showed that all the patients were more neurotic, more introverted, and more obsessional than normal subjects. Headache occurred in 12 of 50 patient sessions and 10 of these occurred in the group with dietary precipitated migraine. In this group, however, headache followed tyramine alone in only two patients. The remaining eight headaches occurred in two patients after placebo alone, and in three after both test capsules. The EEG was activated after tyramine, but not after placebo, in 11 of the 15 patients with migraine and epilepsy, and dietary precipitated migraine. This effect was observed, however, in only two of the 10 patients with classical migraine alone. There was no relation between the occurrence of headache and EEG activation. Although there was no significant relationship between tyramine ingestion and the occurrence of headache, the EEG changes observed during the study support the hypothesis that tyramine has an action on the central nervous system in some migrainous subjects.