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267 amblyopia similar to tobacco amblyopia occurring as a result of malnourishment only, without any intake of tobacco. He also maintained that chronic, sustained, low-level cyanide intoxication, an experimental situation similar to that produced by smoking, does not cause any neurological effects. He has also challenged the exclusive role of B1,, pointing out that deficiency of vitamins other than B1, can cause a tobacco-amblyopia-like syndrome which can be cured by an adequate diet supplemented by brewer's yeast. Also, Calhoun (1918) described similar paracentral as well as central scotomata in patients with pellegra which could be cured by the administration of nicotinic acid. Some claim has also been made for riboflavin deficiency as a factor in such amblyopias. While deficiency of vitamin B,, may play a part in the causation of tobacco amblyopia, it is likely that other B vitamins and perhaps other nutritional factors produce the same pathological effect.Whereas we found striking improvement with hydroxocobalamin in many of our cases, equal improvement was seen in others with cyanocobalamin, corticotrophin, or prednisolone, or spontaneously. Spontaneous recovery in optic neuritis is well known (Traquair, 1957;Walsh, 1957). Of the three patients with bilateral centrocaecal scotomata simulating tobacco amblyopia, one improved on corticotrophin alone, while another started improving spontaneously before hydroxocobalamin was given.Hence two conclusions can justifiably be drawn from our cases.(1) That tobacco amblyopia is rare in this part of India in spite of a large population of vegetarian smokers. This is the more interesting in view of the fact that in the control series vegetarian smokers had high plasma thiocyanate levels and the lowest serum B1, levels in the population. (2) That smoking, vegetarianism, and vitamin B1, (either as hydroxocobalamin or as cyanocobalamin) play no part in the pathogenesis of isolated "idiopathic" optic neuritis as seen in our patients.We are grateful for a grant from Glaxo Laboratories (India) Ltd., and for grant No. 01-011-1 from the National Institute of Health of t-he U.S. Department of Health, Education, and Welfare.

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, Consultant Physician hormone responses (growth hormone, cortisol, LH, FSH, thyroid-stimulating hormone) seen to these stimuli.It is proposed that combined administration of insulin and the hypothalamic releasing hormones may be used as a single test for the assessment of anterior pituitary function. The test is convenient and time saving, and with care can be performed in outpatients.

Between 1982 and 1984, fine needle aspiration biopsy cytology (ABC) was performed in 1100 patients (aged 14-80, 993 women), with nodular goitre, who had either a solitary cold nodule or dominant hypofunctioning nodule(s) within a multinodular or diffusely enlarged gland. Surgery was performed in 213 patients based on clinical and cytological criteria, and the histology of the surgical specimens was correlated with the cytological findings. ABC specimens were sufficient for cytological diagnosis in 190 patients and were classified as malignant (positive), suspicious or benign. In 37 patients who had a final histological diagnosis of malignancy, cytology was positive or suspicious in 33 and benign in 4. In the remaining 153 patients with benign histology there were 7 positive or suspicious aspirates, and 146 benign. The 37 malignancies included papillary carcinomas in 26 patients (24 positive or suspicious and 2 benign on cytology), Hürthle-cell tumours in 6 (6 positive), follicular carcinoma in 1 (negative), anaplastic carcinoma in 1 (suspicious), medullary carcinoma in 2 (1 positive, 1 negative), and lymphoma in 1 (positive). Our results indicate that the overall sensitivity rate of the ABC method for cancer was 89.2 per cent, the diagnostic specificity 95.4 per cent, the false-positive rate 17.5 per cent and the false negative rate 2.6 per cent. The overall accuracy of the method was 94.2 per cent. It is concluded that papillary and Hürthle-cell carcinomas can be diagnosed accurately with ABC but we recommend that the method be used in conjunction with clinical information and other conventional diagnostic procedures.