219 + 23 and 218-L 20 (1); and 222.4 + 22.4 and 219.6 24.1 (5) based on measurements with two different, commercially available, potassium ion-specific electrodes. To evaluate the applicability of this algebraic extrapolation, I calculated values for Kf1 for each of the measurements made above pH 9 (5, tables 1 and 2 Rather we have made our measurements directly in a region of ionic strength where meaningful activity coefficients may be used. Thus, our method yields thermodynamic rather than conditional values.2) Melchior does not take into account the effect of the supporting electrolyte used to control ionic strength in the earlier studies. As we have explicitly pointed out (2), an apparent lowering of the formation constant will be produced if the cation of the electrolyte associates with ATP. No additional cations are used in our study.3) As Melchior himself points out, there is no reliable method for extrapolating our thermodynamic formation constant values to media of high ionic strength. A rough estimate has shown (2) that our value would still substantially exceed earlier values at 0.2M ionic strength, even if the leveling effect of the electrolyte cation is neglected.Finally, we cannot support Melchior's suggestions that conditional values for formation constants should be used in biochemical calculations in preference to thermodynamic values.Indeed, we feel that the use of nonthermodynamic quantities is only justified as an expedient when rigorous values are not available. In those studies where electrolytes used to maintain ionic strength contain ions not even present in biological media, the validity of the resulting conditional constants is especially questionable.

Following a myelogram a patient developed postiumbar puncture headache which was incapacitating and persistent 18 weeks after onseL Scans of the lumbar spine were performed 2 hours and 20 hours after lodinated 1 131 serum albumin (Risa-131) was injected through a cistema magna puncture. These demonstrated and localized a functioning cerebrospinal fluid leak through the dura. Surgical repair of the dural hole was made with prompt cure of the syndrome. (25:168-170, 1971)

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This report is made to record the occurrence in a newborn not only of a large calcified intracranial mass (craniopharyngioma) but its concomitant association with bilateral subdural hematomata developing in utero. A survey of the literature has failed to reveal another patient in whom a craniopharyngioma was present at birth. The earliest case found was one mentioned in a report by Jackson. 9 In his paper of 1916 he referred to a case reported by Lawson in 1887. The patient was a 3-month-old male infant. Two references to craniopharyngioma occurring in children of the age of 2 years have also been found. 6,s The rarity of a large calcified tumor at birth and the presence of bilateral subdural hematomata are self-evident. A survey of other brain tumors occurring in the newborn will be made. CASE REPORTA neurosurgical consultation was requested at St. Joseph Mercy Hospital in Detroit, Michigan by the pediatrician in attendance who recognized an enlarged head and bulging widely patent fontanelles in a newborn full-term male delivered on April 24, 1955. He showed no other physical defects. The pregnancy had been normal, and the child had two normal siblings. The delivery was uncomplicated, but low forceps was employed. Immediately following birth the condition of the child was considered poor, and artificial respiration was instituted subsequent to which he was placed in an incubator. The birth weight was 7 pounds and 13 ounces.Examination. When first seen by the writer the child was ~ days of age and showed no neurological deficit except for the enlarged head (circumference 43 cm.). He cried somewhat feebly, but was otherwise active and alert. There was marked palpable separation of suture lines and bulging of intracranial contents between all ununited bone plates.Course. The initial clinical impression was of marked hydrocephalus developing in utero. However, bilateral fontanelle taps at the age of 7 days revealed that the condition apparently was caused by bilateral subdural hematomata. Sixty-three cc. of yellow fluid were easily aspirated from the right subdural space, and 58 cc. of yellowish somewhat sanguineous fluid were similarly removed from the left subdural space, resulting in marked scaphoid depression of the anterior fontane]le. The size and color of these hematomata at such a short time following birth, plus the existence of an enlarged head at birth seemed to indicate that these clots had existed in utero and had not occurred as a result of parturition. Attempts to discover a blood dyscrasia as an explanation of the development of hematomata in utero were unrewarding and became unnecessary when roentgenograms of the skull revealed the large calcified intracranial mass shown in Fig. 1. The presence of this mass and its movement with in utero movements of the fetus could well explain a tear of bridging subdural veins and consequent development of subdural hematomata.During the next 4 weeks bilateral fontanelle taps with drainage by nee~lle of the hema-* 61~ Kales Bldg., Detroit ~6, Michigan.

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