Since the last comprehensive review of anticoagulation in acute myocardial infarction four additional randomized control trials have been reported. The overwhelming majority of all trials favored anticoagulation. Rates of thromboembolism were higher in the control, and hemorrhagic complications in the anticoagulated group. Pooling of all randomized control trials gives mean case fatality rates of 19.6% for the control and 15.4% for the anticoagulated group, a relative reduction of 21% (P less than 0.05 or less than 0.001, depending on the analytic method). Five of six randomized control trials reported "no effect" because the difference favoring anticoagulation was not statistically significant. However, sample sizes in these "negative" papers were too small to protect against missing a 21% reduction in true case fatality rate due to anticoagulation (beta greater than 0.10). All patients who present no specific contraindication should receive anticoagulants during hospitalization for infarction.

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The vast strides in terms of pathophysiologic understanding which have been made in the past 25 years of research in myasthenia gravis are remarkable. This period of time has also seen the evolution of many applicable technological advances to better our care of these patients. Myasthenia's place in the autoimmune family of diseases has been demonstrated. No clear-cut strategy resulting from these discoveries has, however, been more than one of temporary relief or clinical improvement. In our center over these years the performance of early thymectomy in all cases of generalized myasthenia seems to be the one demonstrably reliable technique available. The effect of this procedure on coexisting neoplasia and other autoimmune disease suggests continuing avenues of investigation.

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Plasma DBH activity was measured in 6 women, 6 days a week, over a complete menstrual cycle. The women rested for % hour before giving blood samples. DBH was assayed by a double enzymatic method. It was found that DBH activity increased during the follicular phase of the cycle, reaching a peak soon after ovulation, then decreased to a minimum during the premenstrual period. The activity of this enzyme does not seem to parallel the levels of estrogen or progesterone, nor those of peripheral indicators of autonomic activity such as skin conductance and heart rate, but the mood "Surgency" showed comparable changes over the cycle.Menstrual cycle changes have been the focus of much recent research. The areas looked at range from the purely hormonal or physiological (1-4) to those more concerned with mood or behavioral changes (5-7). While there is little evidence for serious cyclical deficits in motor or intellectual performance (8-10,16) there seems little doubt that many women suffer from some premenstrual symptoms which may range from mild tiredness or depression to extreme irritability and fatigue (6-11). Several attempts have been made to account for these symptoms in physiological terms. Wineman (12) has postulated increased sympathetic nervous system activity, the Mackinnons have found higher post-ovulatory heart rate with less sweat gland secretion (4,13), and several workers report a higher respiration rate during the luteal phase of the menstrual cycle (14,15). Recently, Little and Zahn (16) found increases in heart rate and respiration and decreases in skin conductance as well as a pronounced preovulatory in-