A group of 554 patients was studied to determine and compare the complications of combined preoperative radiation therapy with surgery and combined surgery with postoperative radiation therapy when used for treatment of carcinoma of the larynx and inferior hypopharynx. The complications recorded were infection, slough, carotid blowout, glottic insufficiency, pharyngeal stricture, operative death, chondritis, fistula, and margins of resection involved with tumor. The highest complication rates were in the partial laryngopharyngectopy‐postoperative radiation group (63.6%) and in the supraglottic laryngectomy‐postoperative radiation group (52.9%). Most of the increase in total complication rate was attributable to higher rates of glottic insufficiency and margins involved with tumor categories. The lowest complication rates were in the hemilaryngectomy with no radiation group (4.5%) and the total laryngectomy‐postoperative radiation group (12.8%). The complication rate for the supraglottic laryngectomy‐postoperative radiation group (52.9%) was significantly higher than for the preoperative radiation‐supraglottic laryngectomy group (26.4%). Within the partial laryngopharyngectomy group, there was no significant difference in total complication rate between the use of preoperative (47.2%) or postoperative radiation (63.6%). Within the total laryngectomy group there was no significant difference between complication rates when either preoperative or postoperative radiation was employed. There was no significant difference in the rate of carotid blowout, chondritis, operative death, slough, or fistula, between preoperative or postoperative radiation in any of the surgical groups. In general, patients with conservation surgery seem to tolerate postoperative radiation without a prohibitive increase in complications.

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This is a straightforward presentation of guides and principles regarding that most important area of a modern hospital, the emergency room. It is written by members of the staff of the Albany Medical Center Hospital and is based on experience in a large community facility. There is a good chapter on Planning and Operation which takes up construction, equipment, staffing, records etc. and brief direct chapters on emergency situations commonly encountered. The book will be especially useful to members of the house-staff assigned to emergency-room duty.

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A 50-animal herd of dairy cows was pastured throughout one year on fertilized Pangola grass pastures in the humid tropical environment of Turrialba, Costa Rica. Information was collected on monthly grazing pressure, forage consumption and digestibility and milk production. The average number of animal units (375 kg) over the year was 2-57/ha. Total milk produced was 6014 kg/ha. Forage consumption varied from 1-81-3-60 kg DM per 100 kg liveweight, with two periods of low consumption coinciding with the flowering period of Pangola grass and with a drier season. Digestibility fluctuated from 50-3--65-7% and followed the same pattern. Calculations were made of the efficiency of DM conversion, which was around 12%, with two higher values for the periods of stress, interpreted as utilization of body reserves. Calculations of the nitrogen balance of Pangola pastures are also presented.