The value of radioimmunolocalization (RIL) of cancer depends on its performance in situations where the result determines the choice of management. A rise in serum carcinoembryonic antigen (CEA) values after apparently curative resection of colorectal cancer implies localized, resectable recurrence in some patients and widespread unresectable tumour in others. This study investigated the ability of RIL with radiolabelled antibody to CEA and a novel numerical method for analysis of results to determine the extent of disease in 31 patients with raised serum CEA but no physical signs of recurrence. Surgical exploration or conventional radiology later confirmed the presence of tumour in 94 per cent of sites which were positive by RIL. Negative RIL predicted the absence of disease in 53 per cent of patients. The investigation could discriminate between localized and disseminated disease and often performed better than conventional radiology. RIL appears useful in selection of patients for second look laparotomy.

Results of testing of specimens produced by transtracheal saline injection for 42 patients with community acquired pneumnonia No of patients Result of testing lower respiratory tract secretion* 22 Pneumococcal antigen positive: no pathogens on culture 13 Pneumococcal antigen negative: no pathogens on culture 4 Pneumococcal antigen positive: Str pneumoniae on culturet 2 Pneumococcal antigen not tested: no pathogens on culture 1 No specimen obtained * Pneumococcal antigen detected using countercurrent immunoelectrophoresis.5 t H Influienizae also cultured from two specimens. 1977 ;140 :9-14. 2 Tugwell P, Greenwood BM. Pneumococcal antigen in lobar pneumonia.

Two forms of bowel preparation for colonoscopy were compared--19 patients were given 5 per cent mannitol solution orally while a further 19 were infused with isotonic saline via a nasogastric tube. Both methods proved equally acceptable to the patients and endoscopists. Saline led to a rise in body weight (+0.75 +/- 0.35 kg) and blood pressure (+7.5 +/- 2.8 mmHg) while mannitol caused a significant fall in both body weight (-0.74 +/- 0.28 kg) and blood pressure (-3.8 +/- 2.9 mmHg). Plasma volume measurements were carried out on 17 patients; 8 receiving saline showed a rise (+0.22 +/- 0.08 l) while 9 taking mannitol experienced a fall (-0.17 +/- 0.08 l). Twelve further subjects prepared with a combination 10 per cent mannitol and isotonic saline showed a small fall in plasma volume (-0.08 +/- 0.05 l). Mannitol proved an acceptable preparation for colonoscopies but a fall in body weight, blood pressure and plasma volume posed a small risk to the elderly subject and in view of the known risks of mannitol during diathermy this form of preparation was not considered a suitable alternative to isotonic saline.

We present this case because, so far as we can discover, no similar one has yet been reported in a child.Case History This boy was born in June 1963. He presented at the out-patient clinic in September of 1965 at the age of 2 years and 3 months, on account of sudden excessive weight gain. He had been healthy and free of symptoms until 6 weeks before, when he had suddenly developed a ravenous appetite ('he will eat two of every meal I offer him'). He had become very fat and his face had become very red. His weight four weeks before his attendance had been 12 7 kg.: now he weighed 15-9 kg. There were no other symptoms, and he was lively and cheerful, with no polydipsia or polyuria. He had never had a fit, faint, or episode of disordered consciousness, such as might be caused by hypoglycaemia. His birthweight had been 2-7 kg., and the perinatal period and infancy had been uneventful. The parents were both alive and well, and not of abnormal size or weight. The paternal great grandfather was short and fat. He had one brother aged 4 years alive and well, weighing at present 13-5 kg.Examination. He was very fat (Fig. 1), weight 15 9 kg. (97th centile), height 88 cm. (50th centile). He had a red moon face, and there was a faint brownish pigmentation of the entire skin, but no pigment inside the mouth. The genitalia were not enlarged and there was no hirsutes. Blood pressure estimations were difficult owing to the excessive amount of fat and to the child's dislike of the procedure. Two readings of 110 mm. Hg were recorded by the flush and palpation methods using a 10 cm. cuff. A firm, non-tender rounded mass about the size of an orange could be felt in the left hypochondrium. It did not move on respiration and did not extend backward into the loin. No other abnormalities were found. A provisional diagnosis was made of a rapidly growing, probably suprarenal tumour, and the child was admitted at once into the ward.Investigations. Table I

The Burge and Grassi tests were compared in 22 patients after parietal cell vagotomy. Dissection was continued until the Burge test was negative or until no further nerve fibres could be found. Three Burge-negative patients were Grassi-positive, 2 due to inadequate division of the terminal branches of the nerve of Latarjet at the 'crow's foot' and 1 due to epiploic fibres. One Burge-positive patient was also Grassi-positive but the latter test indicated the position of an undivided oesophageal nerve fibre. It is concluded that the Grassi intraoperative test for completeness of vagotomy is superior to the Burge procedure because it shows how much stomach needs to be vagotomized to denervate the parietal cells and abolish gastric acid secretion and also indicates the position of residual fibres if vagotomy is incomplete.