of sodium and aldosterone possessed by amphenone. Thyroid function also was not affected. SU 4885 is much the less toxic of the two drugs, gastric disturbances being the only consistent symptom. The excessive drowsiness which severely limits the use of amphenone did not occur.Although the action of SU 4885 on other adrenal steroids, notably oestrogens, has not yet been studied, the relatively large doses required to suppress hydrocortisone together with the formation of 1 l-deoxyhydrocortisone and probably deoxycortone do not indicate that this particular drug has immediate clinical application as an adrenal inhibitor. On the other hand, it seems likely that further compounds will be elaborated by means of which selective inhibition of adrenal enzyme systems may be satisfactorily achieved in patients.Summary The effect of a new adrenal inhibitory compound, SU 4885, has been studied in eight patients. Inhibition is directed particularly at adrenal steroid 1 1,3-hydroxylation, so that 11-deoxyhydrocortisone (compound S) and its urinary metabolite tetrahydro-S were found in relatively large quantities in blood and urine. In sufficient dosage, orally or intravenously, SU 4885 appeared capable of reducing the levels of hydrooortisone and its urinary metabolites.The toxicity of SU 4885 was significantly less than that of amphenone B.

Several anomalies of the great vessels have been described in association with coarctation of the aorta. The case presented below had unusual features which seem worthy of placing on record. In addition, a technique of simultaneous angiocardiography and retrograde aortography is described. Case NotesThe patient was an eight-year-old white boy who had always been noted to tire rather easily and to complain of abdominal pain after strenuous exertion. Recently symptoms had increased.On examination he was thin (height, 54 inches; weight, 47 lb.) but was otherwise a normal intelligent child. The most striking feature was the prominence and tortuosity of both carotid vessels which stood out under the skin of the neck. On palpation they were tense and seemed to contain blood at a very high pressure. Elsewhere, there was complete absence of arterial pulsation and the blood pressure could not be ascertained. No scapular or other collateral vessels could be felt.Cardiac examination showed a heaving apex beat of left ventricular type in the mid-axillary line, and there was slight prominence of the left precordium. A faint systolic thrill was palpable in the suprasternal notch. On auscultation over the apex, a grade 2 (Levine, 1949) blowing systolic and a grade 4 rumbling mid-diastolic murmur were heard. From the left second to fifth interspaces there was a loud (grade 4) blowing systolic murmur followed by a normally split second sound of average intensity. Over the whole of the skull a fairly loud rumbling continuous murmur typical of arterio-venous aneurysm was present; no point of maximal intensity could be found.The fundi showed the features of hypertensive retinopathy. The arteries showed irregular zones of contraction and in the right fundus there was some papilloedema with numerous exudates and a macula star. The diastolic blood pressure in the retinal artery was about 200 mm. of mercury. The rest of the physical examination was negative.The diagnosis of coarctation of the aorta with severe hypertension of the cerebral circuit and much enlargement of the left ventricle could be made on clinical grounds alone. In addition, it seemed probable that both subclavian arteries arose in or below the coarcted segment. The continuous murmur over the head was possibly due to an arteriovenous aneurysm. However, as localization was not possible, it was more likely that the murmur developed in the greatly dilated channels caused by the increased flow in the carotid vessels. In addition, mitral stenosis was suspected.Investigations. Apart from a mild anemia (red cells, 3*8 million per cu. mm.) the blood count was normal. The sedimentation rate was 3 mm. in one hour and the Wassermann reaction was negative.Phonocardiograms confirmed the presence of the murmurs that had been heard, and electrocardiograms showed the pattern of left ventricular strain.Routine X-ray examinations did not add to the diagnosis but confirmed several points. In the postero-anterior view the aortic knuckle appeared notmal and there was no rib notching. There...

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