Objective-To examine the efficacy, dose, and safety profile, including neurophysiological testing of thalidomide used in 59 patients (including 23 with Behcet's disease) to treat severe oral or genital ulceration (OGU). Methods-We identified prospectively subjects (including women ofchildbearing potential) who had persistent OGU over periods lasting one to 40 years and whose active ulceration was not controlled by other therapies. They were treated with thalidomide. Retrospectively, we identified the number of subjects with complete resolution of the ulcers at one and two months of thalidomide therapy, and the dose required to maintain that improvement in those individuals who relapsed after stopping thalidomide. The decrease from the baseline sensory nerve action potential (baseline SNAP) amplitude value (derived from median, radial and sural nerve SNAPs) at which the development ofparaesthesiae was likely to occur was also determined. Results-Complete resolution of the ulcers occurred in 81% of patients within one month ofthalidomide therapy at doses of200 mg/day. No further thalidomide was required by 20% of patients responding and in the remainder improvement was maintained with smaller doses (7-200 mg/ day). Using an approximate 50% decrease from baseline SNAP as an indication to discontinue thalidomide, the incidence of symptomatic neuropathy was 13*5%. No patients with a decrease of less than 42% developed neuropathy, and a further 13 5% were asymptomatic with a decrease in SNAP between 42 and 69%. Other side effects were seen in 44% ofpatients. There were no pregnancies and no requirement for urgent pregnancy testing. Conclusions-Thalidomide provided a usefiu therapeutic option in severe oral and genital ulceration which had not responded to other therapies. The physician must remain vigilant to the continuing danger of axonal neuropathy and teratogenesis at al times during thalidomide therapy.

Although carpal tunnel syndrome is a relatively trivial condition, controversy surrounds the use of nerve conduction studies, and whether they are essential to make the diagnosis, or as a prelude to surgery. This is partly due to the lack of a generally agreed definition of the condition, and failure to recognize that the patient's first priority is rapid relief of symptoms. If nerve conduction studies do not contribute to achieving that aim it would be better not to do them. Supporters of routine preoperative nerve conduction studies ignore their shortcomings, which include lack of standardization, absence of population-based reference intervals, and lack of sensitivity and specificity. Only a controlled trial, in which patients are randomized to receive treatment either with or without nerve conduction studies, will determine whether they improve the outcome in patients with a firm clinical diagnosis of carpal tunnel syndrome.

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Ethylene glycol was administered in the diet to pregnant Fischer 344 rats on days 6 through 15 of gestation. Target dosage levels were 1.0, 0.2, 0.04, and 0.00 g/kg/day. There was no maternal toxicity, embryotoxicity, or increased incidence of malformations in fetuses from doses dams. Positive control dams received 500 mg/kg of hydroxyurea on gestation day 11 and had fetuses with numerous soft tissue and skeletal malformations. Results are interpreted as preliminary indication of lack of teratogenicity of ethylene glycol.