984 bilateral isodense acute subdural hæmatoma of exactly equal size producing no ventricular compression or shift. We have neither seen such a case nor are we aware that any have been reported. The only circumstances in which further neuroradiological studies need be considered are when there is suspicion of a hxmatoma in such rare sites as against the vertex of the skull (arising from the sagittal sinus) or low in the posterior fossa. The extent of such lesions can be difficult to appreciate in conventional, horizontal c.T. scans. The reports so far published do support our view of the reliability of c.T. scanning; indeed, the main problem since the introduction of C.T. has been, not "missing" hasmatomas, but the increased number of hxmatomas diagnosed in headinjured patients and the difficulty in deciding which of these need to be evacuated.1 Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow G514TF

SAMUEL GALBRAITH GRAHAM TEASDALE

and stored at -20°C until assay, which was in batches of 45. In spontaneous ovulatory cycles the increase in S.H.B.G. from day 7 to day 21 was statistically significant (see table.’. Similarly, in patients who ovulated in response to clomiphene. as indicated by increases in plasma oestradiol and progesterone. there was a significant rise to 59+_7.9 at day 21. Patients who did not ovulate in response to clomiphene and in whom there was no rise in plasma-oestradiol showed no change in S.H.B.G. We have thus shown a significant increase in s.H.B.G. during spontaneous and induced ovulatory cycles but which is not found in anovulatory cycles. We suggest measurement of this binding protein as an added means of assessing ovulatory function in infertile women, particularly in those receiving clomiphene therapy. S.H.B.G. measurement by the two-tier column method is simple, cheap, and quick (results are available within 3 h). Studies to evaluate the change in s.H.B.G. during other forms of therapy influencing ovarian activity are in progress.

fuged

Departments of Endocrinology Royal Free Hospital,

SEX-HORMONE-BINDING GLOBULIN: AN ADDITIONAL TEST FOR OVULATORY FUNCTION

SIR,-Sex-hormone-binding globulin (S.H.G.B.) binds 17 -hydroxyandrogens such as dihydrotestosterone and testosterone, and also oestradiol.2 Circulating S.H.B.G. concentrations increase during pregnancy and after oestrogen administration and they change with thyroid status,’,’ but no variation in s.H.B.G. has hitherto been demonstrated during the menstrual cycle. While evaluating a new method for the determination of S.H.B.G.-binding capacity,’ we noted a phasic change in plasma-s.H.B.G. concentration during ovulatory menstrual cycles. We subsequently measured plasma-s.H.B.G. during sponPLASMA-S.H.B.G.

and Medicine,

London NW3; and Endocrinology Laboratory, Chelsea Hospital for Women, London SW3

M. SOLOMON

M.J.IQBAL MAUREEN DALTON S. L. JEFFCOATE

JEAN GINSBURG

INTERFERON TREATMENT OF RHEUMATOID ARTHRITIS

SIR,-A transient ameliorating effect of measles infection on juvenile rheumatoid arthritis was described by Still himself,’ and we have confirmed this.2 The effect could be due to interferon since measles virus is a potent interferon inducer. Two other reasons make interferon a substance of interest in rheumatoid disease-the long-entertained possibility that rheumatoid arthritis may be of viral ætiology,3 and the cytostanc action of interferon.4 There is also some evidence of a beneficial effect of interferon in an experimental model related to rheumatoid arthritis.5 We decided to test the response to interferon of adults with rheumatoid arthritis. For ethical and practical reasons a trial in juvenile rheumatoid arthritis was ruled out.

P

Interferon treatment of rheumatoid arthritis.

984 bilateral isodense acute subdural hæmatoma of exactly equal size producing no ventricular compression or shift. We have neither seen such a...
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