induce vomiting, which could then cause acute dilatation from hypokalaemia. Secondly, the hyperosmolar effect of introducing a relatively large amount of fluid and food into a stomach which has become used to less will cause dilatation.Acute dilatation of the stomach is thus a recognized, if rare, complication of any patient suffering from anorexia nervosa who is beginning treatment. It seems that conservative management alone is adequate in the acute phase provided the condition is discovered before perforation of the stomach occurs. The mortality of uncomplicated gastric dilatation is low, but after perforation it is 80% (Evans, 1968).We considered whether any medication the patients received before presentation might have caused the dilatation. One patient had been treated with diazepam and the other with chlorpromazine. We consulted Side Effects of Drugs (Meyler and Herxheimer, 1968) which made no reference to such effects after diazepam therapy. The phenothiazines have, however, on rare occasions been noted to cause a depression of gastric secretion leading to paralytic ileus in psychotic patients. This was noted in four out of 720 people studied. Since only one of our patients had received phenothiazines, however, we feel it is unlikely to have been a precipitating cause of presentation.We thank Dr. N. C. Oswald and Mr. E. G. Tuckwell for permission to report these cases which were under their care and also Mr. W. M. Castleden for his commnents and help.

In children, acquired skull defects often close spontaneously. This is most likely to take place when the dura mater and the pericranium are intact. Congenital skull defects rarely close spontaneously. Cranioplasty will be needed when a bone defect has failed to close or when it is unlikely to do so. Various methods are available: autogenous bone, acrylic resin, and metal prostheses have been widely used. A series of 68 operations performed on children under the age of 15 years is reviewed. It is concluded that shaped titanium plates are usually preferable. These can be formed by hand, or in a pressure chamber; simple defects can be closed with ready-made titanium strips. Fixation by screws is recommended. Titanium plates have been used successfully even in very young children.

SummaryTitanium strips have been used to repair skull defects when preformed metal plates are not available and simple wiring would not be enough. The technique is simple, obviates the need to dissect the dura mater, and gives greater resistance to further impact injury than an inlay technique.

Out of 39 patients with intractable trigeminal neuralgia seven have had continuing relief for over three years after dental treatment. Five out of six recent consecutive edentulous patients had immediate improvement. More radical treatment, such as ganglion injection or nerve root section, has been at least postponed.

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