Between 1958 and 1973, one hundred patients with subdural hematoma were successfully treated without surgery. This was achieved either with bed rest, corticosteroids, mannitol, or a combination.The initial diagnosis and subsequent improvement were confirmed by cerebral angiography, but clinical observations were more important in deciding the selection of therapy. Similar medical treatment was initiated in 22 others who later were operated on because of failure to respond. Medical treatment was not attempted in severely ill or comatose patients. Of 185 patients with subdural hematoma in the Mount Sinai Hospital series, 75 recovered without surgery. After the introduction of corticosteroid therapy in 1968, there was a higher incidence of successful treatment by medical means. Follow-up examinations revealed that recovery was excellent and has been maintained.

The clinical and pathologic findings in 27 patients with paralysis of vertical gaze were studied and compared with 34 patients in whom there were lesions in similar locations but without vertical gaze paralysis. Upward gaze paralysis occurred mainly with bilateral lesions involving the pretectum, posterior commissure, or dorsal midbrain tegmentum. Unilateral lesions caused paralysis of upward gaze only when the posterior commissure was involved. Bilateral lesions of the tegmentum of the rostral and midpons also caused paralysis of upward gaze and in some cases paralysis of downward gaze as well. Paralysis of downward gaze also resulted from bilateral involvement in the prerubral region of the diencephalon and midbrain.

Evaluation of plasma hCG measurement in the diagnosis of nontrophoblastic neoplasms and assessment of the value of concomitant measurement of plasma hCG and CEA in patients with bronchogenic carcinoma and neoplasms of the digestive tract were undertaken. Only one of 70 normal control subjects had positive plasma hCG (3.5 ng/ml), whereas 54 of 320 patients with nontrophoblastic neoplasms had measurable plasma hCG (1.9 to 160 ng/ml). Forty of these patients had less than 5.1 ng/ml, 10 had 5.1 to 10 ng/ml, and only three had high levels of 96,110, and 160 ng/ml. Elevated plasma CEA levels of 3.6 to 140 ng/ml were found in 38 of the 70 patients with bronchogenic carcinoma and 30 of the 72 patients with neoplasms of the digestive tract in this series. Concomitant positive hCG was found in only six of the 68 patients who had elevated CEA levels, and positive hCG was found in eight of 74 patients who had normal plasma CEA. The low frequency and the modest elevation of plasma hCG, despite frequent advanced disease, indicate plasma hCG has limited value as a biologic marker fQr diagnosis and assessment of nontrophoblastic neoplasms.

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SUMMARY 25 children with clinically suspected or undoubted epilepsy and normal EEGS were studied. Both generalized and partial seizures were included. Each child was kept awake for 24–28 hours, after which the EEG was repeated. In 8 cases (32 per cent) abnormalities typical of convulsive disorders occurred during the waking as well as the drowsy and sleeping states. Sleep deprivation is proposed as a safe, simple method of EEG activation. RÉSUMÉ Effets de la privation de sommeil sur l' électroencephalogramme de l'enfant epileptique 25 enfants présentant une épilepsie suspectée ou confirmée cliniquement avec des EEG normaux ont été etudies. Ce groupe incluait des crises généralisées et localisees. Chaque enfant fut maintenu eveille durant 24 a 28 heures; apres quoi 1'EEG fut répété. Dans huit cas (32 pour cent) des anomalies caracteristiques de desordre convulsif sont survenues durant l'etat de veille aussi bien que durant les phases de somnolence ou de sommeil. La privation de sommeil est proposee comme une methode sure et simple d'activation d'EEG. ZUSAMMENFASSUNG Die Auswirkungen von Schlafmangel auf die Elektroencephalogramme epileptischer Kinder 25 Kinder mit klinisch vermuteter oder nachgewiesener Epilepsie und normalen EEGS sind untersucht worden. Es wurden generalisierte und fokale Anfalle einbezogen. Jedes Kind wurde 24 bis 28 Stunden wach gehalten, und danach wurde das EEG wiederholt. In acht Fallen (32 Prozent) kamen wahrend des Wach‐ wie auch wahrend des Einschlaf‐ und Schlafstadiums fiir Krampfleiden typische Veranderungen vor. Schlafentzug wird als eine zuverlassige und einfache Methode der EEG Aktivierung vorgeschlagen. RESUMEN Los efectos de la privacion de sueno en los electroencefalogramas de niños epilepticos Se estudiaron veinticinco niños epilepticos o sospechosos por sus sfntomas clinicos de serlo, pero que tenian electroencefalogramas normales. Se incluian convulsiones generalizadas asi como parciales. Cada niño tenia que velar durante 24 a 48 horas, despues de lo cual se repitio el EEG. En ocho casos (un 32 por ciento) anormalidades tipicas de desordenes convulsivos ocurrieron durante el estado de vigilia asf como durante los estados de ador‐mecimiento y sueno completo. Se propone la piivacion del sueno como metodo seguroy sencillo de estimulacion electroencefalografica.