Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant costs, both financial and emotional, due to high false-positive rates. The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant. This argues for a review of current guidelines.

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SUMMARY1. The jugular lymphatic trunks were cannulated in anaesthetized rabbits and cats.Over 6-8 hr, the mean lymph flow was 2-3 gl. min-in the rabbit (one side only) and .5-0 ,sl. minm-in the cat (sum of both sides).2. After a single injection of radio-iodinated albumin into a lateral cerebral ventricle without significant rise in pressure, a mean of 14-4 % of the radioactivity was recovered in deep cervical lymph of one side in the rabbit and of 12-9 % in that of both sides in the cat. 5. No significant radioactivity, other than from blood, was detected in deep cervical lymph of the rabbit or in deep and superficial cervical lymph of the cat within 6 hr after injection of radio-iodinated albumin into the aqueous humour or orbital fat.6. Gradients of radioactivity in tissues within the orbit suggested that there is a small flow of c.s.f., 0-05-0-15 /t.l min-' in the rabbit, passing centrifugally along the subarachnoid space of the optic nerve, through the posterior part of the globe and into the orbital tissue. Also a small proportion of aqueous humour, 1-2 % or more, drains through the anterior sclera into the surrounding tissue. 7. A substantial quantity of cerebrospinal fluid drains into the deep cervical lymphatic system of the rabbit, 30 % or more, and of the cat, 10-15 % or more. The small component of aqueous humour drainage passing through the wall of the glove does not enter cervical lymph within 6 hr, if at all.

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