Rac Hughes

Sensory neuropathy and anti‐Hu antibodies in a patient with seminoma

A man with subacute sensory ncuronopathy (SSN) had a stage 1 seminoma. His serum and cerebrospinal fluid (CSF) contained anti‐Hu antibodies (type 1 anti‐neuronal nuclear antibodies, ANNA‐1). Following orchidectomy, radiotherapy, prednisolone, plasma exchange and intravenous immunoglobulin the antineuronal antibody titre fell and the neuropathy improved.

Proceedings of the International Workshop: New Trends in Multiple Sclerosis Research March 27-28 1982

great knowledge of bladder disorders. Many neurologists regard the nervous control of the bladder as a fairly mysterious subject and they will be relieved to learn such is also the opinion of many urologists. Measurement is a fundamental requirement for understanding, but the nervous control of the bladder seems not to have been greatly enlightened, at least thus far, by the availability of accurate measurements of bladder and urethral pressures, and urine flow rate during voiding. The role of the autonomic and somatic nervous systems in the control of continence and voiding remains controversial and ill understood and much of the controversy discussed in the book reflects this lack of basic understanding. Even the classification of voiding disorders reflects fundamental ignorance and the chapter on pharmacological aspects is refreshingly frank in its admission of the failure of modem pharmacology to find effective methods of managing detrusor instability and minor degress of incontinence, despite a large and expanding literature on this subject. The early chapters are concerned more with the methodology and interpretation of cystometrograms, videocystometrograms, urethral pressure profiles, and EMG of the urethral striated sphincter muscle and it is clear that there is yet much to be learned from developments of these techniques in clinical practice. The neurological reader will be struck by the relative absence of reference to the results of careful investigations of patients with defined neurological lesions, since this would seem to offer a way of approaching the more common and equally ill-understood disorders of continence believed not to be due to disorders of the nervous system. All things considered this is a much better introduction to the understanding of urinary continence, and the neurology of the bladder, than most books setting out to discuss these problems in monograph format. Most of the chapters are well referenced and the book is generally attractively produced and well illustrated. Despite the title there is a conspicuous poverty of neurologists amongst the contributors. Perhaps this explains our ignorance of this subject!

The suppression of experimental allergic encephalomyelitis and multiple sclerosis

Microneurosurgery By RW Rand (pp 470; £46.50) Chicago: YB Medical Publishers Ltd, 1979. Compared to their colleagues in otology and ophthalmology, neurosurgeons were slow to appreciate the potential of the surgical microscope, that it might allow a greater delicacy of technique, and perhaps extend the range of the possible. The history of microneurosurgery, that is microsurgery as applied to neurosurgery, is relatively short. It is less than 20 years since the first cautious reports, notably by Kurze, illustrating the many ways in which microtechniques might be employed, in chordotomy, rhizotomy, nerve anastomosis, and selected intracranial tumour removal. Today the application of these techniques is widespread, if not universal. There is a steadily growing literature on the indications for the microsurgical method and concerning the review and elaboration of anatomical detail relevant to the magnified surgical field. This volume sets out to provide a comprehensive account of the various areas in which microsurgical techniques are applied today. Originally based on a Californian symposium, this second edition is a greatly expanded work, with a large number of contributors, some already well known in their field. As in the first edition there are competent introductory chapters on the surgical microscope, and on essential instrumentation. Throughout the work there are contributions on regional microsurgical anatomy-of the sellar region, the internal auditory meatus, the jugular foramen and the circle of Willisand though many of the illustrations are familiar from earlier publication, they provide a valuable complement to the surgical texts. Of these texts it can be said that there is some variation in their style and in the attention paid to the various topics. The several approaches to the pituitary gland receive extended treatment, transfrontal, subnasal and transnasal transphenoidal rouLtes all being described in detail, with many excellent illustrations. For the problem of the acoustic neuroma however a description of the suboccipital transmeatal operation of Rand-Kurze is the essence of the presentation, and a related chapter on temporal bone surgery seems inappropriately brief. Again it must be unusual in a discourse on the surgery of trigeminal neuralgia to recommend solely the transtentorial approach for nerve section, and to make no assessment of the posterior fossa route for comparison. On the important problem of cerebral aneurysm surgery the contribution is disappointing, the illustration inadequate, and the whole of little practical value to initiates in the art. They will gain more from the chapter on microvascular surgery, which describes some basic laboratory training techniques and from the following one on vascular bypass for occlusive cerebrovascular disease. For those who engage in peripheral nerve surgery there are four chapters on all aspects of nerve injury and repair. There is also a contribution on tissue transplantation and replantation by microvascular anastomosis. This well produced volume has many attractive features. In particular the collection of beautifully reproduced detailed anatomical presentations by AL Rhoton adds greatly to the value of the work. Of the surgical contributions some are outstanding, for their concise style, clear description of operative procedures and carefully chosen illustrations. Unfortunately all are not equally valuable, because they are not comprehensive, or are inadequately illustrated, or occasionally because they adopt a wordy conversational style, filled with personal reminiscence, which can be read with interest only once. Some unevenness is difficult to avoid in a multiple author work, but clearer editorial direction might have helped, and even eliminated the inexplicable chapters on audiometry and neuroradiology of the cerebello-pontine angle. More attention might have been given to offering guidance on learning techniques, for as stated in Chapter one considerable practice must be gained in the laboratory, acquiring the varied skills of microdissection, if the surgeon is to provide proper care for his patients. I suspect that the availability