. Pulmonary function in acromegaly. The lung volumes of 12 female and eight male patients with acromegaly, chosen because of the absence of associated cardiorespiratory disease, were determined physiologically and radiographically. Enlarged lung volumes were found in half the males but in none of the females, due allowance being made for the presence of a significant thoracic kyphosis. Upper airway narrowing was suggested by an increase in the expiratoryinspiratory flow rate ratio in six patients, four of whom were male, and acromegaly of the larynx was confirmed in the three subjects who consented to laryngoscopy. Upper airway obstruction is more likely to account for respiratory death in acromegaly than disordered pulmonary function in enlarged acromegalic lungs. Neither of these respiratory findings could be correlated with the fasting level of growth hormone but there was a suggestion that they were more likely to occur when the duration of the disorder was longer.Enlargement of visceral organs such as the heart and kidney is a well recognised manifestation of acromegaly (Cushing and Davidoff, 1927;Gordon et al., 1962). The lung volumes in this condition have been measured in few subjects and the results are disparate. Brody et al. (1970) showed that in six male acromegalics the total lung capacity (TLC), functional residual capacity (FRC), and vital capacity (VC) were increased up to a mean of 140% predicted, whereas in four females these volumes were normal. In contrast, Toppell et al. (1973) found that the TLC and VC were increased in seven females with acromegaly up to a mean of 111% and 116% predicted respectively. They confirmed increases in the TLC, VC, and residual volume (RV)

The sexual functioning of 13 male patients undergoing renal dialysis and 13 male patients who had received kidney transplants was compared. Standardized interviews were used to assess the frequency of intercourse before illness, during dialysis, and after transplantation and to assess sexual difficulties experienced during these periods. In addition, plethysmographic recordings of erection levels were obtained for three dialysis and three transplant patients at eight separate time periods corresponding to particular points in the dialysis cycle. Assessments of depression and anxiety (IDA scale) and renal functioning (Marital Patterns Test) were also carried out. Dialysis patients were less able to gain and maintain erections than transplant patients and intercourse was less frequent for couples where the husband was on dialysis. Dialysis patients were more depressed than transplant patients, although transplant patients showed greater levels of anxiety. More marital difficulties were experienced by patients on dialysis than patients who had received transplants. The implications of these findings for the treatment of sexual problems in these patients are discussed.

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