One hundred and twenty-two patients were selected on the basis of symptoms of finger numbness and tingling thought to suggest carpal tunnel syndrome. The severity of the symptoms was graded and the patients were studied with seven established EMG procedures, motor inching to the abductor pollicis brevis and second lumbrical muscles, and sensory inching. Symptom severity was compared with the degree of nerve conduction abnormality and results from symptomatic hands with those abnormal results from patient's asymptomatic hands. Motor inching to the abductor pollicis brevis muscle was the most sensitive study and, when combined with sensory inching, gave a sensitivity of 97-100% (depending on symptom severity). Motor inching to the second lumbrical muscle alone detected the lesion site in several severely involved nerves. Guidelines are suggested with which one can estimate the likelihood that a patient's finger sensory symptoms are on the basis of carpal tunnel syndrome.

The authors report the case of a 45-year-old woman with medically intractable trigeminal neuralgia (TN) in whom a good clinical response to partial sectioning of the trigeminal nerve was attained. No evidence of vascular compression was found intraoperatively. Several other members of her family, involving three generations, also suffered from TN. The treatment of all affected patients is discussed in the context of a literature review in which the controversies surrounding the origins of the disease and treatment options for patients with the familial variant of TN are addressed.

The previous communication1 described the preparation of carbonylbis(methionyl)insulin (CBM-insulin), 1, and its conversion back to insulin by the cyanogen bromide cleavage reaction. The present communica-

To date there has been little research that describes the relation between the individual and their environment as the foundation for the coping process in advanced cancer patients. The aim of the study was to identify and describe, from a patient perspective, processes that are significant to coping with advanced cancer. We used the method Grounded Theory as described by Strauss and Corbin. Data were generated through qualitative interviews. A total of 18 interviews were conducted. The central theme was "The struggle to be a participant in one's own life". This theme involved three processes: prioritising, downplaying and self-preservation, each of which in different ways endeavours to either maintain or reestablish the feeling of being a participant. The awareness of the processes complement existing knowledge about coping in advanced cancer patients, by showing how patients make use of meaning-based coping efforts to increase their experience of being a participant in their own lives.