Scottish Medical Journal

Echoencephalography was performed on 80 patients with suspected intracranial pathology admitted to the medical unit of a general hospital. The accuracy of the technique in detecting the position of the midline structures, was found to be 91 per cent as confirmed in 32 patients by cerebral angiography, position of a calcified pineal body or by autopsy. The value of echoencephalography in the diagnosis of cerebro-vascular accidents and in the recognition of space occupying lesions is assessed. It is suggested that cerebro-vascular accident cases showing midline shift, should have further neurological investigation with a view to possible haematoma drainage. The presence of shift in patients with gradual onset of neurological signs and symptoms is considered strong evidence of a space occupying lesion.

Two trials were carried out with Wistar RA 27/3 live attenuated rubella vaccine. Five of six seronegative girls in a boarding school gave a positive serological response after subcutaneous administration of vaccine. Mild clinical reactions occurred following vaccination. Susceptible contacts showed no clinical or serological reaction.

Vaccine was administered intranasally to a group of boys in another boarding school. All 3 vaccinated seronegative boys developed antibody whereas the 4 vaccinated seropositive boys showed no significant alteration in antibody titre. Four susceptible contacts received a placebo but did not develop antibodies. Virus was recovered from all virus-vaccinated seronegative boys but not from seropositive nor placebo-vaccinated boys. No clinical reactions were reported.

A study of multiple primary neoplasms in the Western Hospital Region of Scotland {which covers about 3,000,000 inhabitants) has been carried out, using cancer registration data, for the period July 1958–66. The total registrations were 61,288. (1) After elimination of doubtful cases, 428 cases of multiple primary neoplasms remained for study, 0.73 per cent of the sample. (2) Multiple primaries occurred most commonly in people in whom the first malignant lesion appeared late in life. (3) In only a few sites did the relative prevalence of cancers in the multiple primaries (M.P.) series differ from that in the single primaries (S.P.) series. The incidence of bilateral breast cancer was less than 1 per cent. This figure is much lower than those reported by other workers. About half were cases of ‘simultaneous’ bilateral breast cancer, and of the others, about one quarter occurred within one year of discovery of the first neoplasm. Genital neoplasms were very common in the female M.P. series (40%), but in males, the M.P. and S.P. series showed identical prevalence of genital neoplasms. (4) Associations between pairs of cancers sufficiently pronounced to be statistically significant were few, occurring in 4 pairs of sites in males and in 5 in females. Skin cancers featured in all male and 2 of the female pairings, and genital cancers in three female pairings. (5) There was a very marked likelihood for cancers of the larynx, uterus (all types), bladder and skin to be the first primary to appear (70% of cases or over). (6) Almost one third of second primaries occurred within a year of the first and after this the number declined rapidly. This held good when the figures were related to the number of survivors and to the number of survival-months.

Three advances which disagree with many classical premises in plastic surgery are discussed. These are delayed exposed skin grafting, segmental vascular flaps, and flaps from the tongue. Application to general or orthopaedic surgery is stressed.