Abstract'Big' and 'big-big' hyperprolactinemia, the presence of increased serum concentrations of high molecular weight (50-60 and 150 kDa respectively) prolactin forms, has mostly been reported in women with idiopathic hyperprolactinemia and normal hypothalamic-pituitary ovarian axis function. It has been suggested that both 'big' and 'big-big' prolactin species are biologically less active than the 22 kDa form predominating in normal individuals.We report the cases of two men with pituitary adenomas who were secreting significant amounts of 'big' (50-60 kDa) prolactin documented by Sephadex G-100 column chromatography. Both patients reported normal sexual function despite high prolactin levels. Results of nocturnal rigidity and tumescence testing were normal, confirming that significant hyperprolactinemia was not interfering with either patient's sexual function. 'Big' hyperprolactinemia should thus be suspected even in male patients with prolactin-secreting pituitary adenomas who maintain adequate sexual function in the presence of high prolactin levels. European Journal of Endocrinology 138 82-85

The incidence of diabetes mellitus is increasing at an alarming rate, and diabetic men already make up a quarter of the men in our own specific medically-oriented population of erectile dysfunction. The incidence of sexual dysfunction in men with diabetes approaches 50%, and this is only slightly lower in diabetic women. Hypertension is a frequent risk co-factor, being seen between 40% and 60% of diabetics in the literature. Obesity and hyperlipidemia are other frequent co-factors. Interestingly, these risk factors are the same as those for coronary artery disease. The final common pathway for most of these factors is endothelial cell dysfunction.

No abstract

, in the obituary published in the Canadian Journal of Neurological Sciences of May 1988, has so well portrayed the truly remarkable man that Bill Keith was. Many cherish fond memories of Bill, and are indebted to Dr. Fleming for what he has written. This letter is to tell of Bill Keith's activity outside Canada in helping the development of neurosurgical services in Jamaica. In the early 60's, the staff of the Hospital for Sick Children was specially interested in pediatrics on the island of Jamaica. At the instigation of Dr. J.S. Pritchard in 1964 Bill, accompanied by his wife Eleanor, paid the first of many visits to Jamaica to assist me in the establishment of neurosurgical services there. During the next ten years Bill, often with John Silversides, would spend a month working at the University Hospital of the West Indies in Kingston. The qualities so well recorded by Dr. Ross Fleming, endeared him to us, and a visit from Bill was always a special event. His help, reassurance, and encouragement did much to foster the development of neurosurgery in Jamaica. He befriended many medical graduates of the University of the West Indies who came to Canada for further study in various specialties. Thank you for the opportunity to place on record Bill Keith's contribution in Jamaica.