A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.

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Tetracosactrin-Besser et al. concentrations attained 1 mg. of depot-tetracosactrin was approximately equivalent to 80 units of corticotrophin-gel. Mean plasma cortisol levels had returned to normal by 24 hours after the corticotrophin-gel, and by 48 hours after both doses of the depot tetracosactrin. To maintain a continuously elevated plasma cortisol corticotrophin-gel in this dose must be given twice daily and 1 mg. of the depot-tetracosactrin once daily; after 2 mg. alternate daily administration might be sufficient. All three preparations gave maximal adrenal cortical stimulation over the first four hours. The depot-tetracosactrin was simpler to give than the corticotrophin-gel. Local discomfort was more common after the synthetic preparation. Franmz, A. G., and Rabkin, M. T. (1964). New Engl. 7. Med., 271, 1375. Friedman, M., and Greenwood, F. C. (1967 Black, 1958 ;Brooks et al., 1963; Cope and Pearson, 1965;Ross et al., 1966). This technique has proved invaluable in equivocal cases, but is too highly specialized for routine clinical use. The same objection applies to the estimation of urinary cortisol excretion by chromatography, another procedure which has high diagnostic value (Cope and Black, 1959;Brooks et al., 1963;Rosner et al., 1963). At present most laboratories are only equipped to estimate urinary 17-oxogenic steroids or 17-hydroxycorticoids.It is now clear, however, that these levels often fall within the accepted normal range in patients with undoubted Cushing's syndrome, and so are an unreliable index of cortisol production in this disease. Indeed, Cope and Pearson (1965) Materials and MethodsThe ages of the subjects ranged from 13 to 72 years. They were divided into three groups:(1) A control group consisting of 50 females and 59 males made up of normal, subjects and of convalescent hospital patients. The latter were not acutely ill and were under no obvious stress at the

The influence of hexamethonium and pentolinium on the responses of certain peripheral effector cells to adrenaline, noradrenaline or postganglionic stimulation was studied in the cat. The actions of adrenaline and noradrenaline on the blood vessels of a limb and of adrenaline and postganglionic stimulation on the nictitating membrane were increased after the administration of hexamethonium and pentolinium. This effect was considered to be due to sensitization of the peripheral effector cells. The possible significance of these findings is discussed.Hexamethonium and pentolinium are quaternary ammonium compounds which block transmission in autonomic ganglia by competition with acetylcholine. From animal experiments it is known that, under standard conditions, these substances are extremely consistent in their behaviour and that the ganglionic synapse, no matter which ganglionic pathway is tested, shows an increasing sensitivity to subsequent doses. Repeated doses of hexamethonium and pentolinium, however, produce decreasing responses from the blood pressure (Zaimis, 1956). The same discrepancy between blood pressure and ganglionic responses is seen in man during the intravenous administration of these drugs for the reduction of blood pressure in operations; the first dose usually produces a good fall of blood pressure, but the pressure returns quite rapidly to its initial level and any subsequent doses are practically without-effect (Enderby, personal communication). Also it has been the experience of clinicians, that a daily increase in the dose of hexamethonium or pentolinium is necessary for the first few weeks if the initial rate of reduction in blood pressure is to be maintained. This is usually described as the development of "tolerance." In addition, there is the much discussed potentiation of adrenaline and noradrenaline which always occurs in the presence of hexamethonium or pentolinium, and which cannot be attributed' only to the abolition of the normal compensatory mechanisms as it is found both after vagotomy and after section of the spinal cord at a high level (Bartorelli, Carpi and Cavalca, 1954;Salerno, 1955;Maengwyn-Davies, Walz and Koppanyi, 1958). All these factors taken together suggested the possibility of a peripheral action of hexamethonium and pentolinium in the form of a sensitization of the effector cells to adrenaline and noradrenaline (Zaimis, 1955). This hypothesis has been tested in the experiments reported in the present paper. Some of these results have already been reported briefly (Zaimis, 1956). METHODSCats were anaesthetized with a mixture of chloralose (80 mg./kg.) and pentobarbitone (6 mg./kg.) injected into the cephalic vein of the fore limb or the saphenous vein of the hind limb. The addition of pentobarbitone prevented the initial stage of excitement which normally follows the intravenous injection of chloralose alone.Recording of the Venous Outflow from the Hind Limb.-An incision was made in the skin of the medial surface of the thigh to expose the femoral artery and vein,...