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A prospective randomized study of 542 injured workers with continuing pain compared 271 workers who were treated at either one of two clinics that provided functional restoration with a control group of 271 subjects. Chronic pain was caused by low back injury in 78% of patients; 79% of those treated were at work 12 months after completion of treatment compared with 78% of the control subjects. When the patients were divided into subsets, based on the accident date and followed monthly, the duration of absence from work, the compensation costs, the disability award costs, and the total costs were less for those treated than the control subjects, but these were not statistically significant. Using the difference in total costs as a measure of relative success, back injuries had better results than other injuries in this study.

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Dissatisfaction with current nonsurgical treatment of acute soft tissue and back injuries initiated a search for more effective treatment. A multicenter trial, involving 12 clinics, treated 1,072 patients. Treatment consisted of intensive, time-limited exercises emphasizing mobility, muscle strengthening, work conditioning, sequence training, and appropriate education sessions. Return to full-time work was proof that the patient had recovered fully. Time off work and compensation costs were parameters used to evaluate results. A detailed study of 703 patients treated at five clinics, operational for more than 12 months, showed superior results when compared with the comparison group of 2,172 matched control subjects. The treatment group returned to work earlier and realized substantial cost savings. This treatment program has proved to be superior to the miscellaneous variety of treatment modalities used for acute soft tissue and back injuries provided to the comparison group.

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A patient with an unsuspected phaeochromocytoma presented with transient hypertension during anaesthesia for an elective hernia repair, and developed severe post-operative hypotension. The management of this acute crisis, appropriate preoperative preparation and the subsequent successful removal of the tumour is described. Awareness of this unusual presentation may help the attending physician to save such a patient.

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Groups of 120 male and 120 female rats were exposed by inhalation to 0, 2, 6, or 15 ppm formaldehyde vapor 6 hr/day, 5 days/week, for 18 months of a 24-month study. The present communication describes interim findings based on data available after 18 months of exposure. Squamous cell carcinomas occurred in the nasal cavities of 36 rats exposed to 15 ppm formaldehyde. The tumors ranged from small early carcinomas of the nasal turbinate to large invasive osteolytic neoplasms which extended into the subcutis of the premaxilla. Similar tumors were not detected in rats exposed for 18 months to 2 or 6 ppm or in mice exposed to 2, 6, or 15 ppm formaldehyde. Rhinitis, epithelial dysplasia, and squamous metaplasia occurred in rats from all exposure levels of formaldehyde; however, the severity and extent of the lesions were dose related. In contrast, papillary hyperplasia and squamous atypia occurred only in animals exposed to 15 ppm formaldehyde.

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Of 150 consecutive patients with resectable bronchogenic carcinoma, 11 were found to have multiple primary tumours of the respiratory tract. Five patients had more than one primary tumour of the lung and six had previously received treatment for carcinoma of the larynx. In the same group of 150 patients, 14 had one or more cancers involving other organs. The appearance of a new solitary lung lesion in a patient with another cancer demands special attention to determine the exact diagnosis and to decide upon the best method of treatment. Physicians should be aware that such a lung lesion may represent a new primary lung cancer rather than a metastasis. The criteria are defined for the pathological definition of two separate primary tumours in these cases.

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An artificial chest wall was constructed which was large enough to hold a whole excised human lung. this device was connected to a modified Harvard Respirator which was capable of being programmed to produce any reasonable respiration rate. Freshly excised lungs free of any disease and cuts wer placed in the chest wall and challenged with both monodisperse and polydisperse aerosol particles. Total lung deposition was measured and extremely good agreement was obtained with a specially-developed theorectical model.

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Hyperthyroidism associated with metastatic follicular carcinoma of the thyroid gland is rare. In one patient the mass of functioning follicular tissue in the primary and metastatic tumour was so great that excessive amounts of thyroxine and triiodothyronine were produced and, as a result, clinical hyperthyroidism developed. This was in spite of the fact that the activity per unit of tissue was not supranormal and may even have been slightly subnormal. The initial response of the metastases to 131I ablative therapy was excellent.

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