The efficacy and tolerance of the nonsteroidal antiandrogen nilutamide in the treatment of prostatic cancer were studied in a large double-blind clinical trial initiated in 1986. Patients with metastatic prostatic cancer without prior endocrine manipulation underwent orchiectomy and were randomized to 1 of 2 groups receiving nilutamide (225 patients) or placebo (232). Nilutamide and placebo were evaluated for efficacy in 207 and 216 patients, respectively. Progression-free survival was significantly longer in the nilutamide group (median time to progression 20.8 months on nilutamide and 14.9 months on placebo, p = 0.005). Median time to death from prostatic cancer was 30.0 months in the placebo group and 37 months in the nilutamide group. Objective regressions were higher in the nilutamide group (41%) than in the placebo group (24%). Significant differences in favor of the nilutamide group were found at several intervals for bone pain, prostatic acid phosphatase, prostate specific antigen, alkaline phosphatase and bone scan isotope uptake. Nilutamide and orchiectomy constitute a more effective treatment for metastatic prostatic cancer than orchiectomy alone, and the adverse effects of nilutamide, usually minor, are outweighed by the significant improvements in most disease measures and progression-free survival.

Androgenic function was studied in seven diabetics with sexual impotence and in five patients with paraplegia. Plasma concentration of testosterone was measured before and after administration of 5,000 U. of human chorionic gonadotropin (HCG). Steroid biosynthesis by testicular tissue was studied in vitro and testicular morphology was evaluated by light and electron microscopy. The diabetic patients were also evaluated neurologically. Motor conduction velocity, electromyography of the quadriceps and the function of urinary bladder were studied. Plasma concentration of testosterone was in the normal range in basal conditions in impotent diabetics (mean 578 ± 234 mμg./100 ml.) and paraplegics (mean 788 ± 184 mμg./ 100 ml.). After stimulation with HCG, impotent diabetics showed a mean value of 1,523 ± 314 mμg./100 ml. In vitro steroid biosynthesis by testicular homogenates of diabetics and paraplegics was normal. The morphology of the interstitial tissue was normal in patients with diabetes or paraplegia. Subcellular characteristics of Leydig cells were also normal. In the tubules, a marked hypospermatogenesis with desquamation of the germinal epithelium was observed in the two groups in all patients. Alterations of the motility of the bladder were seen in six diabetics and all paraplegics. Motor conduction velocity was abnormal in the diabetics. It is concluded that in our patients androgenic function was normal, and therefare impotence can not be attributed to hormonal deficieney.

Clinical studies have been carried out world-wide on cefetamet pivoxil, a new orally active cephalosporin. This paper reports on the first 1000 patients treated with the antibiotic; another 505 patients received standard antibiotics, mainly cefadroxil and cefaclor, for comparison. The results show that single doses of 1500 and 1200 mg cefetamet pivoxil were fully effective in gonorrhoea. Comparative trials in uncomplicated urinary tract infection indicate a significant superiority of a single dose of 2 g cefetamet pivoxil (n = 158; 90.0% cure) versus 2 g cefadrox (n = 162; 77.0% cure). In complicated urinary tract infections, a comparable outcome was achieved with a single daily dose of 2 g cefetamet pivoxil for 10 days (n = 99; 90% cure) and 1 g cefadroxil twice daily for 10 days (n = 98; 76.5% cure). The clinical response rate in acute exacerbation of chronic bronchitis was 89.4% in the group receiving cefetamet pivoxil (136 patients) and 83% in the cefaclor-treated group (n = 122). Treatment with 1000 or 2000 mg cefetamet pivoxil achieved a (bacteriological) success rate of 96% compared to 95% with cefaclor in acute ear, nose and throat-infections (n = 91). Overall, based on 894 isolated pathogens prior to therapy, the bacteriological response rate was 90% and it would appear that in vivo the spectrum of this cephalosporin covers a wide range of Gram-negative and Gram-positive pathogens, including urinary pathogens, but excluding Enterococci and Pseudomonas. Cefetamet pivoxil proved to be well tolerated. Mild to moderate adverse events were reported in 7.1% of patients but only 2 of the 1000 patients treated with cefetamet pivoxil were withdrawn because of diarrhoea, which subsided rapidly. There were no clinically relevant deviations in laboratory parameters.

entitled Charles Scott Sherrington: An appraisal, 'In the end, understanding of the principles which physiology is now beginning to unravel must also become useful in clinical work', will come true. ZUSAMMENFASSUNG Das Problem des Muskeltonus und seine Messung wird diskutiert. Die Wichtigkeit, den ganzen Patient en zu studieren, wird betont. Eine Moglickeit der Tonusmessung ist die Bestimmung der Aktionsgeschwindigkeit und Ausdauerzunahme. RESUME Le probleme du tonus musculaire et de sa mesure est discute. II est important d'etudier Ie malade dans son ensemble. La vitesse de raction et l'augmentation de l'endurance serait utiles a etudier.

PELOT, M. G. (1963). Entero-cytoplasty in contracted bladder complicated by hydro nephrosis. Paraplegia, I, 55-6I. PENNISI, S. A. et al. (1959). Renal clearances in paraplegics with recent and old injuries. J. Ural. 82, 442-448. POWEL, T. et al. (1967). Intravenous pyelography. A comparative trial of 10 methods in patients with good renal function. Brit. J. Radial. 40, 30-37. PRICE, M. et al. (1966). Renal fu nction in patients with spinal cord injuries. Arch. phys. Med. 47, 406-41I.