Document 6L2gQpMjNJBnBMk2EMd4BQRm

570 FHE NE\S ENGLAND JOURNAL OF MLDK INF vpt When we saw him in 1970 the serum calcium was 6 2. and the phosphorus 5 8 mg per 100 ml. L.aminagrams of the i skull showed marked calcification of the basal ganglions \Treatment with calciferol w,i> initiated. Therefore, we fulh agree uth Tabaee-Zadeh et al that Ktraps ramidal motor dysfunction should result in a screen- nW for hypoparathyroidism N'.J B Christiansen, M.D. P. From H*vse\, M.D.j (ilosVup. Denmark Copenhagen Counts Hospua ACTH VS CRF-UKE SECRETION BY TUMORS k To the A/z/oi In the issue of August 19. 1971. L'ptc>/ and Amatruda reported the isolation from an oat-cell tarcnoma of the lungtond from a pancreatic tumor of peptides/hat on bioassav were shown to contain not only ACTH butJuso cor ticotropin-releasing activity rC.RF-hke") ' Both patents from whom the tumors were obtained had the so-caJLra "ectopic ACTH svndnwne." usualb regarded as C ushings syndrome owing to serreron of ACTH bv neoplasms of Vionendocnne tissue, with consequent adrenocortical oversecAtion of corti sol.- The observAions of Upton and Amatrum raise the fur ther possibility th\t these tumors exerted s/ne part of their adrenocorticotropic effect b\ stimulating midogenous pitui- tarv release of ACTH.' a possibility suggwted bv others'-4 at a time when the prevailing view was ch^ the increased fre quency of tumors im ( (thing's svridrorie was fjerhaps sec ondary to hv |>eradrentoruci'm/ Concerning the possible phvsiologu /ole of C.RF activity in such hormone-secretin A tumors, two/joints are worth mak ing. First of all. the existing fragmentary evidence suggests that CRF activity of thesAtumors is /uantitativelv iess impor tant than their ACTH aaivitv Mrador et al : showed that pituitarv ACTH content Vas sumormat and considerably below that observed in ihV neoplasms a finding that sug gests if it does not prove i*at /e sequence of secretion of ACTH bv tumor --* cortisol\o^rsecretion by adrenal cortex --* suppression of pituitarv AyI~H overrode the sequence of events of secretion of CRF b\ jflmor --* oversecretion of ACTH b\ pituitarv --* oversecretion/fYortisol adrenal cortex. Sec- ondlv. it is true that these/iormone or hormone-Iike-secret- mg tumors are not comjJeteh tyitonomous The patient of Upton and Amatruda shlbwed stvne suppression of ceroid excretion bv dexameth^one and \ considerable response to metvrapone.1 Such obyrvations haW now- been made in sev eral patients with "edopic ACTH Tndrome. Some behave as if thev were aujpnomous. like Ydrenal tumors, others behave like the piti^arv -dependent f&rm of the disease; and still others behave/i an intermediate ashion.*' These findings,^>f course, do not pwmu a distinction be tween an ACTFNand CRF function of tne tumor, but Upton and Amatruda Jfave made a valuable aiYj exciting contribu tion bv demorytrating a still greater versatility of the `hor mone-secretin/' tumors.1 *-4 New 5 ork. f.Y Nicholas^. Christs. M.D Roosevelt Hospital I Upton Amatruda TT Jr Tumor peptides wuh CRF-like ac- tiviiy i fthe ectopic ACTH syndrome. N Engl \Med 285:419- 424. 1 2. Meadi Ck. Liddle GW. fsland DP. ei al: CauseVf Cushing s svndibme in patienis with tumors arising from "nonenqpcnne" sue/l Clin Endocrinol Melab 22 693-703. 1962 A|/m EN. Skelton MO Increased adrenocortical activity associ- "d with malignant disease. Lancet 2.278-284. I960 hnsty NP: Adrenocorticotrophic activity in the plasmaXof pa tients with Cushing's syndrome association with pulmonank neo plasms, Lancet 1:85-86. 1961 Plotz CM. Knowlton Al. Ragan C The natural history of C\ish- ing's syndrome. Am J Med 13 597-614. 1952 The Human Adrenal Cortex. Edited bv NP Chnsly. New Yo\| New York. Harper and Row 19' 1. pp 359-394 M.AL/CN AN r MESO EH ELI AL TUMORS - HlMOUOt.H TYPE AND ASBESTOS EXPOSURE the Editor Malignant pleural and peritoneal mesothc- ^mas have been shown to be associated with exposure to Asbestos at work and in the home.1' In a sunev o! 42 cases r diagnosed in a shipyard area 75 per cent patients had been occupational exposed to asbestos.- and of 83 patients from a hospital near a Uondon asbestos-products factory. 53 per tent had a historv of occupational or domestic exposure In Scotland. 57 per cent of definite or probable exposuies in 81) cases (73 men and seven women) were repined J In a national survev in Canada'* the proportion of patients with mesotheliomas was lower -- 20 per cent of 100 male and 2 r>er cent of 50 female patients who had defimteb or proba bly been occupationailv exposed to asbestos. Occupation'' especially associated with mesothelioma include insulation work* and asbestos-products manufacturewhereas |>ersons exposed to pure chrvsotile asbestos in mining and milling have a low rate of mesothelioma.7 It is possible that in insu lation work and asbestos-products manufacture, other tvpes of asbestos (eg., crocidolite and amosite) or other carcino genic substances mav be responsible for the greater risk Primary mesothelial tumors mav not easilv be distin guished from metastatic tumors hislologuallv, and tor as sured diagnosis, full autopsy to eliminate other primary tumors has been advocated. In keeping with the multipoten- tialitv of mesothelial cells.' the histologic pattern of mesothe liomas is variable Three histologic types have been described -- epithelial, mesenchymal and mixed/ Among mesotheliomas the last named tvpe is relatively common Hourihane found that 41 per cent of a series of cases occurring in a London hospital between 1917 and 1962 were of this tvpe"1 Churg et al described nine mixed tumors among 39 cases considered to be asbestos related, however, in 12 evi dence of exposure was limited to the finding of asbestos bodies in the lung." Thompson, in South Africa, found that 12 of 17 cases were of the mixed tvpe yy In the Canadian survev. the histology of 115 of the 165 mesotheliomas reported from all parts of the country be tween January. 1960. and June. 1968. was reviewed bv pathologists, members of the Mesothelioma Panel of the*J*J Canadian Tumor Reference Centre. Decisions regarding dy---^ agnosis were made without knowledge of the occupational!- and environmental histories. The majoritv opinion was takerT> as the panel opinion. Of the 115 cases reviewed. 62 wer^O accepted bv the panel, and of these 59 had a full standarfT") occupational and environmentaf historv obtained in an ob)ep^^ live manner 4 In addition, of 71 cases subsequently rego- tered across Canada between julv. 1968. and December. 1970. 42 were accepted bv the panel as mesotheliomas, and 40 had a full occupational and environmental history. The 99 accepted cases with occupational history were subsequent ly classified into the three main histologic types by one of us (D M.) without knowledge of sex or occupational history The findings according to histologic l\j)e and history of asbestos ex{xj.sure are shown m Table 1 Table 1. Histologic Types of Mesothelial Tumors in Relation to Asbestos Exposure. Histologic Type All Cases Patients with Definite or Probable Exposure Males. Epithelial Mesenchvmal Mixed Females: Epithelial Mesenchymal Mixed totals occupational oomestic 26 3 (11.5%) 17 3 (17.6%) 24 11 (45.8%) 19 l ( 5.2%) li 1 ( 9.1 %) > l (50.0%) 3 3 10 -- -- -- -- -- 1 1 I 1 \ ol >7 No I I ( ()RRKs|*( )\DEN ( f o CO CD CD LT: CD cr> t VIills J Pinals RS. Ropes MW.etal The'alue of bed-rest in pa tients with rheumatoid arthntis N Engl J Med 284 453-458 !9"l 2 Partridge REH. Duthie JJR t ontrolled trial ol the etfeu or complete immobilization of the joints m rheumatoid arthritis Ann Rheum Dis 22.91-99. 1963 i Duthie JJR. Thompson M. Weir MM. et al Medical and social aspects of the treatment of rheumatoid arthritis Ann Rheum Dis 14 1 3^-149. 1955 4 Zeller JW. Wame H. Jellinek k Samtorium management of rheu matoid arthritis JAMA 186 1143-1149. 1963 5 Karlen L. Should your hospital have an Arthritis Midwav House Hosp Practice 4 66-77 1969 kID.NEY f\ PROGRE.SMA E L.t.L KOE\( EPH.Ai.OPATHV l'u fhr t.ihim The finding of unexplained proteinuria in the case of progressive multifocal leukoencephalopathv asso ciated with chronic Ivmphocwic leukemia recentl* discussed bv Dr Eduard P. Richardson (Case l*M972i mav be of importance in the future investigations of the \iral nature of pmgiessive multi-local leukoencephalopathv. The elegant studies of Oldstone and Dixon.1- as well as others,1 4 indicate that the glomerular capillarv rna\ he the site of deposition of antiv iral-v iral immune complexes in chronic viral diseases, including those that principal!* affect the central nervous svstem ImmunoHuorescent studies <>| the nature ol the glomerulat de[>osits ol putative viral antigen or antiviral an- tibodv in diseases of the central nervous svstem thought to he mediated hv viruses might provide further evidence of the etiologv of these diseases Elution of antibodv from homogenized kidnev fragments might provide a reagent for the detection of antigen in the brains of similarlv affected patients. Richard j. Glassock. M D. Torrance. Cal. Harboi General Hospital 1 Oldstone MBA Autoimmunity in viruses -- fact or fiction Am J ( I in Pathol 56.299-302. 197 I 2 Oldstone MBA. Dixon fj Pathogenesis of chronic diseases asso ciated with persistent lymphocytic choriomeningitis viral infection II J Exp Med 131 1-19. 19~0 3 Gajdusek DC Slow virus diseases of the central nervous system Am J Clm Pathol 56:320. 1971 4 Hotchm J Virus, cell surface and self' lymphocytic choriomeningi tis in mice Am J Clin Pathol 56 333-349. 197 i The above letter vsas referred to Dr Richardson who offers the following replv in the t'.iiiln Dr Glassock's idea is an interesting one. and certain!* all possible wavs of arriving at more complete knowledge of this disease are to he welcomed A search for antigen-anttbodv complexes in the glomeruli of patients with progressive multifocal leukoencephalopathv could well he part of a complete post-mortem studv. and in a patient sus pected of having the disease who had persistent proteinuria, renal biops* in a search for these complexes might be justifi able I he most urgent need, however 'till is to mv mind, the isolation and identification of the agent m the brain, and I have suggested that brain biopsv for this purpose was justi fiable Of course, studies in brain tissue wouid not preclude simultaneous investigations of renal tissue, along the lines suggested b\ Dr Glassock. in appropriate cases boston Ma^ E P Richardson. )r . M D. Massachusetts General Hospital kiDNEN 1 R \NMT.ANl'IS SEYEVYF AR-OI.D I WINN /.. ;h, l.<(,!<>> We lead with interest Professor Curran amunents on the legal aspects of the kidnev transplant that we pet formed between two >e\en-vear-old identical twin o111 *. fie gives emphasis to die evidence piesenled bv a cler- g*man on the moralitv or the decision and concludes bv sav ing that iiisiice was done in ( onneuic ut There o an aspect of the situation that has not been dis cussed -- naiTielv the attitudes of the phvsiuans involved and the ethical considerations in performing the ojx*ration even with legal consent Several leading transplant centers were polled hv fudge I esto afxnit their attitudes regarding ihe procedure Then unanimous opinion seemed to tie that although the procedure was stientifuallv sound, the phvsi- nans concerned would not themselves undertake a trans plant between identical twins of this age borne thought that it was tnorallv wrong to remove a kidnev from a healrliv child for transplantation in that the child was not old enough to understand the full c onsecptences of what she was giving her consent to Others considered the risks not jusii. hed We were of the opinion, on the othei hand that this modaliiv of treatment was the best available and felt moiallv obliged to respond pnimelv to the wishes of the parents and the farmlv although perhaps an immature wish on the part ol the donor and recipient Personal acquaintance with this particular tamilv we believe would undoubted!* have persuaded others to our j.x>int of view I his judgement has fortunate!* been justified m that we have achieved an excel lent result We have all received numerous veih.il and writ ten marks nf appreciation from the now exubeiam donor and tec quern Bkrx vrd l.v i 11>s. M D Martin .V.iiih, Jr.. M [3 RoBt k i S Brow v M 1) New Haven Conn B VRRV StKUC h, M D. Tile I'mversiiv School nt Medicine Ihe above lettei was referred to Professor (uirian wh<> offers the following replv in thr Editor l was verv pleased to see the letter ftom the phvstctans at \ale who performed the transplant sutgerv in the Conneuicut case. I he poll of transplant centers refetted to in the letter is not mentioned at all in Judge lestos opin ion. I am rathei surprised at the apparent reluctance ex pressed bv such centers to perform such procedures These questions of the moral and ethical basis lor medical and scientific action bother us all. I here seems to be a need for the development of a more effective "public phiiosophv. as Walter lapmann called it. in the held of medical ethics In the absence of such principles and a forum tor their de velopment and interpretation, we are left with the courts of lavs as our onh resource in individual cases Boston Mass. WlLLI AM J. Cl HR AN. j D . S.M H V (. Harvard School of Public Health CHORE! FORM MOVEMENTS IN ilYI'OI' \R A I HYROIIMSM /<' :h>- L dtim Ihe case teport b\ Tabaee-Zadeh. frame and kapphahn i"kmesiogenic Choreoathetosis and Idiopathic Hv jMiparathvroidism " N Engl j Mec! 2Sb 792-763 l'C2 describing kmesiogenic choreoathetosis in a patient with idi opathic hv |Mparathv mid ism and basal-ganglion < ale i he at inn willed our attention to a similar case seen bv us in 1*17(1 The patient, who was born tn 1942 had experienced grand-mal seizures since he was 2Va vears old He treated In antiepileptics. and the grand-mal attacks subsided Emm the age of ! A spells of choreiform movements aj>peared often alter phvsual activities as huvclmg Ihe cho reiform movements involved the head arms and legs and often were so vigomus that the patient lost his balance and tell to the gmund There were no premnnitorv swnpmni' and hr w as not urn niw ions during these att.ic k' ST0566806 Vol 287 No BO -v Two 16 3 per cent) oi the 32 mesothelial tumors in ft- males were classified as mixed as compared with 24 '35 8 pt cent) of the 67 in males Six of the 10 occupational ex posed men with mixed tumors had worked in insulation or asbestos.products manufacture as compared with one of the six men with epithelial or mesenchvmal tumors The find' ings suggest that mixed mesothelial tumors were specially associated with asbestos exposure If confirmed, this observa tion would help differentiate asbestos-related tumors from others of unknown etiology Desmond Macner, M.D. Canadian Tumor Reference Centre National Cancer Institute of Canada Ottawa. Ontario. Canada L'niversitv of Ottawa Montreal. Quebec. Canada Alison D. McDonald. M.D. McGill University 1 Wagner JC. Sleggs CA. Marchand P Diffuse pleural mesotf ?!<oma and asbestos exposure in the North Western Cape Province. Br J Ind Med 17,260. I960 2 Elmer PC. MeCaughey WTE. Wade OL. Diffuse mesothelioma of the pleura and asbestos. Br Med J I 350. 1965 3 Newhouse ML. Thompson H Mesothelioma of the pleura and peritoneum following exposure to asbestos in the London area Br J Ind Med 22 261. 1965 4 McEwen J. Finlavson -V Vlair A. et al Mesothelioma in Scotland Br Med J 4 575. 1970 5 McDonald AD. Harper A. El Attar OA. el al Epidemiology of primary mesothelial tumours in Canada. Cancer 26 914. 1970 6. Seiikoff IJ. Hammond EC. Churg J. Mortality experiences of as bestos insulation workers 1943-1968. Proceedings of the Interna tional Conference on Pneumoconiosis Johannesburg. 1969. p 180 7 McDonald JC. McDonald AD. Gibbs GW. et al: Mortality in ihe chrysotile asbestos mines and mills of Quebec Arch Environ Health 22:677. 19M 8 Young JS: The experimental production of metaplasia and hyper plasia in the serosal endothelium and of hyperplasia m ihe alveo lar epithelium of the lung of the rabbit J Pathol Bactenol 31 265. 1928 9. MeCaughey WTE Criteria for diagnosis of diffuse mesothelial tumors Ann NY Acad Sci 132 603. 1965 10 Hourihane DO B' The pathology of mesotheliomata and an analy sis of their association with asbestos exposure Thorax 19 268. 1964 M Churg J. Rosen SH. Moolten S Histological characteristics of mesothelioma associated with asbestos Ann NY Acad Sci 132 614. 1965 12. Thompson JG. The pathological diagnosis of malignant mesotheli oma of pleura and peritoneum. Proceedings of the International Conference on Pneumoconiosis. Johannesburg. 1969. p 150 BOOK REVIEWS Clinical Embryology for Medical Students. B^Richard S Snell. M.D . Ph.D 360 pp.. illustrated. Bostor^^ittle, Brown and Company. 1972 510.00 Tftiais an excellent book tor the me^fal student who is not laTkliar with human organ and^vstem development. The illusTy^tions are diagrammatic ami plentiful They are \erv clear u^jne who already ut^erstands the subject, but thes mav con\ a false sense^i simplicity to the student who has never looked at an empno. The book is funaSffienialkr a condensation of classic mor phologic embryology. Nsarresult. u tends toward generaliza tions that are true buiyited some specific illustration. The references" are not uned\| the text and should have been <alled "additional raiding " Gestational timmg is somew^ut neglected; most of the il lustrated stagy^>f organ development have no indication of emhrvomc jtff or size Witschi's time scale of human developmenta^fages is not mentioned, nek is there a discussion of therelation between the time of tetetogenic insult and developmental stage. The last chapter on incidence jnd etiolog^)} maltorma- \ n n\ a tabulation of specific knoj etidruji agents To h. pter seems to be written loi /he intefWi u lavn.ui rah;'" : han tor the future physician In fyte . >f thuc .v/u.i r-sesses the book will be a useful/text. b i -v'Tli! .ndv.irci audri.-i. a striking cover that will ma/e the time >ard l-'-hoIh' Stephen W. Gra^ Ph D. The Shoulrar .and Svck. B\ james E Batemali. M.D . FRGS CiVla pp. illustrated Philadelphia \\f$ Saun ders C.orvpanvX 1972 5.-2 50. This large vVlurrc -veriects the authors vast/experience with all the problems <T the shoulder and neclV He has at tempted to provnVe a comprehensive review of/he problems bv dividing the obok into sections based on/a clinical ap proach to a region^ area, a unique and useluJmethod. The first s<cion.Y>n basic sciences, is exc/llent, but per haps more deeded \jiscussion of nerve pat/iwavs and rela tions would be of \\lue Ihe next on investigation and diagnosis, is particular of value in suggeaing history to be obtained, physical diagnosis to be done, a/d organization of patients' problem* The third, entitled. "Clinical Syndromes." is an excellent portion thit tries to assigr/diagnosis to partic - ular tvpes of pains andVpatient complaints. I believe this approach is of great use ik the upper ^ctremitv. The fourth section deals with trauma if the head/and neck. and. again, the approach is unusual since the clarification is bv etiologic circumstances such as automobile acadents and athletic inju ries "Svstem Disorders of tfte Shoi/der and the Neck." the tilth >euion. gives a good, cokcise Review ol specific disorders of the muscles and neuroloaical^v stems including medical conditions commonly met bv orthojjedic surgeon. I he sixth section, on tumors of thek/houlder and neck, is also a worthwhile <onuse review of jLmor problems in this area, with some useful operative ptpkedures mentioned. The last section, entitled 'Disability E/alilation of the bhoulder and the Neck." is perhaps the Aiostl useful. The philosophical approach is of value for aJ phvLcians, and the evaluation methods and references ade of great value to anv phvsiuan who faces the problems lis/ed in thk book. The printing ol the bo(A. needs cotrections. Several illustra tions are incorrectly lalfeled, and Vie anatomic specimens pictured would he mu/i improved ok greater use of labels on the pictures to ftt/the legends. "Ime unique division of topics often necessitates referral elsew\ere in the book for relevant discussion. The book is an e^ellent attempt at a kew approach to the discussion of regio/al problems. Its strong point is the use ful organization pathology. I believe) second printing allowing some Ranges, particularly in)[ the illustrations, would he of muth greater value and would^correct the weak points. J. Pall i rrvey, Jr , M D. The Alcoholc Patient in Surgery. Bv Alhert\B Lowentels. M D. 268 \jp . illustrated. Baltimore VVilhamsXand Wilkins. 1971. SI4.</ In this extended review of the problems of Vie alcoholic patient d seen bv an attending surgeon, a tremendously ambitioui task has been undertaken. The author attempts to dehne alcoholic, review the metabolism and prarmacology of alcohol, touch on the psychiatric background of alco holism/and then take up individually the innumerable clini cal problems associated with many systems of the hfody that are directly or indirectly generated bv the use of alcqhol. To acctynpiish all of this in 300 pages means oi necessuy that the/presentation must be brief and superficial in talmost e\/rv area, as is in fact true: the reader will not tmVf am p/rsuit in depth of any subject ranging from rhinophviViu or brandy nose" to the withdrawal svndrome as it affect** s\rgi- I Ht \F.W E\( .LAND |OlR\\l. Of MEDK INF V|)I 1 \ cal patients The stvle is staccato, and the anahses simplistic Nonetheless the volume does provide a handbook in which a clinical surgeon can review in almost outline torm the mul tiple problems that he mav encounter in his alcoholic pa tients For this purpose, the book is useful, but it certamiv does* not provide anv more than a skeletal outline ot anv ol the cremendnusiv complicated clinical problems associated with the ingestion ol lai^e amounts ot alcohol over a lon^ period. Witt i cm V Me Dlrmott, ]r., M.D. BOOKS RECEIVED The receipt o) the following hooks is acknowledged, and this listing must he regarded as sufficient return for the c ourtesv of the sender. Books that appear to be oj partu u/ar interest will be reviewed as space permits. Bio and Physical Chemistry Molecular and Cellular Repair Processes: firth international Symposium on Molecular Biologs, sponsored by Miles Laboratories, Johns Hopkins Medical Institutions, Baltimore. Maryland. June 3-4, 197]. Edited by Roland F Beers. Jr : Roger M Hernott: and R Carmichael Tilghman 269 pp . illustrated r ' 'more Johns Hopkins Press. 1972 SI? 50 Cardiovascular System Diagnosis of Peripheral Vascular Diseases. By V kuppen. M D and T Winsor. M.D 08 pp . illustrated Philadelphia F A Davis Com pany. 1972 S32 00 Heart Block. B>. Richard S C osb\ M D.. and Michael Bilitch. M D 251 pp. illustrated New York McGraw-Hill Book Companv. 1972. S l 2 95 Introduction to Electrocardiography. Second edition By Thomas M. Blake 218 pp . illustrated New York Appleton-Century-Crofts ( Division of Meredith Corporation!. 1972 $7 50. Practical Electrocardiography, Fifth edition. By Henry J L Marriott. M D. 325 pp.. illustrated. Baltimore Williams and Wilkins. 1972. S 10.50 NONCLINICAL NOTES NEW ENGLAND ROENTGEN RAY SOCIETY At the Annual Meeting of the New England Roentgen Ray Society. Inc . held on May 19 1972. the following officers were elected for the year. 1972-73: President -- Morns Simon. M.D.. Boston. PresidentElect - Ferdinand A Salzman. M.D. Boston. Vice-President Marjorie LeMay. M D. Brookline. Secretary - Stefan C. Schatzki. M D . Brookline. Treasurer - Murray Janower. M D . Worcester. Chairman of Executive Committee - James B. Dealy. Jr.. M D . Boslon. Robert M. Lowman. M D New Haven. Lloyd E. Hawes. M D Boston, and Majic S. Potsaid. M.D . Boston NOTICES COURSE IN ANESTHESIA AND URGENT MEDICAL CARE A course in anesthesia and urgent medical care, presented by Har vard Medical School, will be held at the Belh Israel Hospital. Brook line October 14. from 9 00 am-5:00 pm. under the direction of l.erov D Vandam. M.D . and John Hediey-Whyte. M B This oneday course is designed to present an intensive review of both the sci entific and clinical bases of the modem practice of anesthesia, sur gery and urgent medical care. The special aspects of physiology and pharmacology of the acutely sick patient will be reviewed Presently available technics for monitoring of the acute emergency patient will r>e Jiscussed Treatment of clotting disorders, neurosurgical trauma and relative overdo.se of drugs will be considered The registration tee is $45 Further information and application forms may be obtained trom Associate Dean. Department of Continuing Education. Harvard Med ical School. 25 Shattuck Street. Boston. Massachusetts 021 15 COURSE IN PROCTOLOGY A course in proctology, sponsored by the Division of Colon and Rectal Surgery of the Department of Surgery of the Lniversitv of Minnesota Medical School in co-operation with the Minnesota Acade my of Physicians, will be held at the Nolle Center for Continuing Edu cation on October 23-27. 1972 The registration fee is S160 Further information may be obtained from the Office of Postgrad uate Medical Education. University of Minnesota Medical School. Box 193. Minneapolis. Minnesota 55455. or telephone (612) 373-8012 POEMS BY PARK J WHITE A collection of the poems of Dr. Park j White that have appeared in the Journal over the years has been printed pmatelv The volume entitled 'Verse and Verse Lilting along paths medical and otherwise with Park J White. M.D..'' has been published for the St Louis Chil dren's Hospital. 500 S. Kingshighway. St. Louis. Missouri 631 10. from which copies may be ordered at S2.50 each Funds accrued will he used to support the Hospital library PEDIATRIC FELLOWSHIPS PediJtnc fellowships at the Mental Retardation Institute, a multidis ciplinary University-Affiliated Training Center. New York Medical College. Valhalla. New Y'ork. are available with stipends for periods of one or two years. Under the direction of Margaret J Gtanmnt. M D F.A A P. these are full-time programs in the pediatric aspects of mental retardation, including the disciplines of neurology, rehabilita tion. psychology, psychiatry, audiology and speech, pathology, genet ics. endocrinology and metabolism Basic sciences are included and integrated at all levels. Two years of pediatric residency and American citizenship, or dec laration of intention for citizenship, are required. Further information may be obtained from Emanual Chusid. M D . F.A.A.P.. Director of Medical Services and Training. Mental Retarda tion Institute. New York Medical College. Valhalla. New Y ork 10595 PROGRAMS IN MEDICINE The eighth annual "Frontiers of Medicine Senes." sponsored by the Committee on Continuing Medical Education of the Division of the Biological Sciences and the Pntzker School of Medicine, University of Chicago, will be held in Lecture Room P-117. Frank Billings Audito rium. University Hospital and Clinics. 950 East 59th Street. Chicago. The series started on September 13 and will continue monthly, on Wednesday afternoons, through May 9. 1973 This program is acceptable for 27l/< elective hours by the Academy of Family Practice and for 270 credit hours for the Physician s Recognition Award of the American Medical Association. Further information may be obtained from Frontiers of Medicine. Room 404. Culver Hall. University of Chicago. Chicago. Illinois 60637. or by telephone 0121 947-5271. POSTGRADUATE COURSE IN RADIOLOGY AND NUCLEAR MEDICINE The Fourth Annual Radiology and Nuclear Medicine Postgraduate Course, sponsored by the Department of Radiology of Duke Universi ty Medical Center, will be held at the University of Durham. North Carolina. October 25-27. Further information may be obtained from Robert McLeMand. M.D.. Department of Radiology. Box 3808. Duke University Medical Cen ter. Durham. North Carolina 27710 PAGE AND WILLIAM BLACK POST-GRADUATE COURSES The Page and William Black Post-Graduate School of Medicine. Mount Sinai School of Medicine of the City University of New Y ork, will present postgraduate courses on a variety of topics from October 24 through December 9 Further information and application forms may be obtained trom the Registrar. Page and Wtlham Black Post-Graduate School of Medicine Mount Sinai School of Medicine. Fifth Avenue and 100th Street New York. New York 10029 ASBESTOSIS CM <r Z^~C O' to 60 C 0) wc 3o <V -rJr-l Z'Dr-l 0) OJ X zo HWZ o -i 00 tco CNJ Su D^ CO Z> W Z Z CO O Pl, X w too H CO w co to < az <c wa Du s aZ --( 8 CO C uoJ ao Ha to S z Q Ic o in o < J < MQ J Wz s H O >-< CO 0) c 60 CO H 5S Z < Z z c o o e in 0) a S^-:S802