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The influence of the vagus nerve on insulin secretion in the dog has been confirmed by studies involving both vagotomy and vagal stimulation. Following vagotomy, a fall in portal vein insulin levels occurs. Following stimulation of both the right and left vagus, insulin levels rise abruptly, peak within five minutes and rapidly return to baseline levels. A small rise in blood glucose, which occurs simultaneously, cannot be blocked by phentolamine, an alpha-adrenergic blocking agent. When given alone, phentolamine stimulates insulin secretion. Atropine inhibits both the glucose and insulin rises following vagal stimulation. Only a portion of releasable insulin appears to be under vagal control. Glucose mediated insulin release and net glucose utilization are not significantly affected by vagotomy. DIABETES 16:443-48, July, 1967. The role of the nervous system in the control of blood glucose and of carbohydrate metabolism has been recognized for over ioo years, ever since Claude Bernard demonstrated the phenomenon of piqure hyperglycemia by stimulating the floor of the fourth ventricle of the dog and producing glycosuria. 1 More recent studies have suggested that certain nuclei of the ventral hypothalamus are also connected with the regulation of blood glucose inasmuch as lesions in this area produced either by electrical or chemical methods result in an obesity associated with hyperglycemia: 2 ' 3 In the study of the precise pathways by which the central nervous system mediates its influence, the importance of the autonomic nervous system has been long recognized. 4 The role of the sympathetic nervous system is that of producing an increase in blood glucose, and the effects appear to be mediated principally

Eleven patients with chronic lymphocytic leukemia were treated with chlorambucil alone and 15 patients received combined chlorambucil‐prednisone therapy in a double‐blind study. Mean age, duration of disease, physical findings, and hematologic data in the two groups were essentially comparable. Complete remission was observed in 3 and partial remission in 10 of the patients in the chlorambucil‐prednisone treated group; but only one of the patients obtained complete and four showed partial remission with chlorambucil alone. This difference was statistically significant (p < 0.05). Hematologic toxicity was less frequent in the combination group. Two‐year survival was 93% for combination group and 54% for chlorambucil‐treated group. The difference, however, was not statistically significant. Our data indicate that chlorambucil‐prednisone therapy is superior to chlorambucil in the treatment of chronic lymphocytic leukemia.

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