There is little evidence, as yet, to inform the issue of the effect of fatigue on surgical performance.

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To determine whether prolactin secreting and non-functioning pituitary tumours respond differently in terms of shrinkage to bromocriptine, we prospectively studied ten consecutive patients (five with prolactinomas and five with non-functioning tumours) complicated by extra-sellar extensions. No patient had received prior radiotherapy or bromocriptine and the mean dose and duration of bromocriptine treatment were identical in the two groups of patients. Objective evidence of tumour shrinkage was provided by serial half-field visual evoked potentials (VEPs) and computerised tomography (CT). All five prolactinomas were shown to shrink as assessed by improvement in VEP and four of the five as assessed by CT. In contrast, only one of the five patients with non-functioning tumours showed any improvement in VEP or CT. Macroprolactinomas frequently shrink rapidly when treated with bromocriptine, whereas non-functioning tumours seldom show such a dramatic response.

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Scintiscans with technetium-ppm sodium pertechnetafe, or technetium-99m EDTA, were carried out on 10 out of 21 patients with subdural hamatoma or hygroma over the period from March to June, I970. In each case the scan successfzllly detected the lesion, which was projected as a rim of increased accumulation of radioactivity. The combination of a positive scan and a shift of midline structures opt echoencephalography is highly suggestive of a subdural lesion, and in the individual patient may obviate the need for cerebral arteriography. Scintiscanning is a simple, safe, and generally accurate and reliable procedure in the diagnosis of subdural lesions. I t can be repeated in a doubtful case m-thout hazard to the patienf.