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The pathologic findings are described in three patients who developed second intracranial neoplasms after irradiation for central nervous system malignancy. The second neoplasms were an astrocytoma, an ependymoma, and multiple meningiomas. All were histologically different from the first neoplasms and appeared in the field of irradiation between 3 and 15 years later. It is suggested that therapeutic irradiation was a causative factor in the development of these tumors.

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SUMMARY A case is reported of a 52 year old man who sustained a head injury and survived for three years and two months in coma. He was subsequently shown to have severe brain stem damage, with a bilateral lesion of the central tegmental tract and bilateral hypertrophic olivary degeneration, associated with a widespread loss of Purkinje cells in the cerebellar cortex. Hypertrophic olivary degeneration is considered to be a trans-synaptic change associated with a lesion of the central tegmental tract, which in this case was thought to be due to primary shearing injury of the brain stem involving the superior cerebellar peduncles. It is suggested that, as a consequence oflong survival, Purkinje cell degeneration represents further trans-synaptic changes, the result of neuronal degeneration in the hypertrophied inferior olivary naclei and in the dentate nuclei. A chain or 'circuit' of degenerated neurones is thereby produced.Hypertrophic degeneration of the inferior olivary nuclei is an unusual but well-recognized change associated with a lesion of the ipsilateral central tegmental tract or of the contralateral dentate nucleus of the cerebellum. In this condition, the inferior olivary nucleus appears swollen and the normal convolutions are obscured. It was originally suggested by Trelles (1944) that hypertrophic olivary degeneration occurred after a lesion of the dentato-olivary fibres passing to the brain stem, via the superior cerebellar peduncle, to join the contralateral central tegmental tract. Loss of Purkinje cells in the cerebellar cortex has not so far been reported in association with hypertrophic olivary degeneration. In this paper the finding of widespread loss of Purkinje cells associated with bilateral hypertrophic olivary degeneration in a case of long-standing head injury is reported. CASE REPORTA 52 year old right-handed man was involved in a road accident in 1967 in which he was thrown out of his car. On admission to Addenbrooke's Hospital 30 minutes after the accident, he was deeply unconscious and had apparently been so from the outset. 826Examination at this time showed a flaccid quadriplegia. The reflexes, however, were all very brisk with bilateral extensor plantar responses. He showed decerebrate responses to painful stimuli. The pulse was 70 per minute and regular, the respiratory rate 20 per minute, and the blood pressure was 120/ 80 mmHg. A radiograph of the skull showed no fracture. There was a central calcified pineal gland. There was a double fracture of the right pubic ramus, but no other bony injury. The day after the accident exploratory burr holes showed the brain to be ' reasonably slack', with some cortical bruising at the right temporal burr hole.

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The results are reported of a small clinical trial carried out to assess the potential value of the hypoxic cell radiosensitizer misonidazole in the radiation treatment of Grade 3 and 4 supratentorial astrocytomas. A total of 55 patients were randomly allocated to one of 3 treatment groups. No significant differences were seen between the median survivals of patients in the 2 control radiation groups and that of the third group in which oral misonidazole at a dose of 3 g/m2 preceded each of 4 weekly radiation doses. Possible reasons why no improvement was seen are discussed in detail.

IN the histogenetic classification of the gliomas proposed by Baileyand Cushing (1926) the most primitive tumour of the series, postulated as arising from the epithelium of the medullary plate, was described as medulloepithelioma. Bailey and Cushing were able to find only two tumours in their series which they could put under this heading. One arose from the post-infundibular region of the third ventricle, the other from the pineal-sites in which medullary-plate cells, characterised by an internal limiting membrane, persist into post-natal life (Benda, 1898). Both tumours consisted of more or less differentiated tubules of columnar cells, partly stratified and possessing internal and external limiting membranes. One of the tumours showed some formation of perivascular rosettes. I n neither did the cells contain cilia or blepharoplasts, though in the second case (p. 54) a diplosome was present in many cells.Since this first description and naming of the tumour very few further examples have been reported (Davie, 1932 ;Greenfield, 1934) and its existence has been called into question (Mabon et aZ., 1950).The primitive medullary epithelium begins to develop cilia at the end of the fifth week of embryonic life. Russell (1950) has pointed out that cilia persist into adult life and that the ciliated ependymal cell is in fact the mature form ; it is the primitive cell that is free of cilia. The very early stage at which cilia develop would explain the extreme rarity with which true medullary epithelium has been found.The tumour here described, occurring in an infant of eight months, raises once more the problem of definition of the medulloepithelioma, of which it is considered to be an authentic example. Case reportThe patient was a male infant aged 8 months a t death. He was born a t the Central Middlesex Hospital on 4th April 1955, at full term following a normal pregnancy. Deep transverse arrest developed during labour and delivery was completed with forceps. A hzematoma and forceps marks were present, a left posterior parietal fracture being noted in a skull radiograph. The birth weight was 3.3 kg. The circumference of the skull was 39.5 em. at 9 days, when he had a convulsion followed by persistent head retraction. He was eventually discharged to a convalescent home. Several fits and clonic convulsions were noted there, and he was therefore re-admitted to the Central Middlesex Hospital on J. PATH. BACT.-VOL. LXXIV (1957) 357 Z A classification of the tumors of the glioma group on a histogenetic basis with a correlated study of prognosis, Philadelphia. Dtsch. rned. Wschr., xxiv, 476.