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A patient is described in whom right coronary artery dissection occurred 48 hours after coronary angiography. Successful operative treatment consisted of immediate saphenous vein bypass grafting and ligation of the proximal coronary artery. Several aspects of the case are characteristic of this pathological entity as reported in the literature and suggest principles of surgical management.

One particular kind of experience of inducing change in communities is described. The setting is a highly industrialized urban area consisting of several local communities. A County Community Development Committee, composed of community leaders, has functioned informally for seven years. During this period they have addressed not only a broad range of community issues, but issues which have been of concern to the communities, generally, rather than anyone specifically. They have abided with their originally stated function of being an exploratory and catalytic group. Their objectives have been realistic, recognizing that total community development is the accomplishment of many organizations, groups and individuals, functioning in several different ways. Within this process their accomplishments have been significant.

With the spread of Corporate Planning to local government, the attitudes of the elected members can be an important factor in applying the concepts. This article considers some of the pertinent aspects. It illustrates through a case description how the policies laid down by elected members are carried through on a planned basis. The author argues that corporate planning does not pose a threat to the power of the people's representatives.

Insofar as distortion of bias in clinical judgments can be isolated, this should contribute to a more deliberate assessment of patients and to a more effective clinical communication. The responses of 542 clinicians (psychoanalysts, psychiatrists, psychologists, and social workers) to the transcripts of one psychoanalytic and one psychotherapeutic hour were analyzed, to determine the effect upon case description of differences in professional training received and in sex concepts held by these clinicians.

Human homograft techniques in ophthalmology are common today in the treatment of anterior ocular diseases, but relatively little has been written regarding the use of human sclera as a homograft material. Sclera is readily available from donor eyes, easily preserved for months, and almost universally accepted by the recipient. Human sclera, like cornea, is relatively avascular; thus hypersensitivity reactions have not been sufficient to cause rejection of the graft. As the principal ocular supporting structure, sclera is strong, yet flexible due to the triple coat of interwoven fibers. These factors make it applicable to use in any shape from a patch to an elongated strand. Sclera has been used previously as a graft in the treatment of chronic scleromalacia perforans with impending rupture, as in our case description. It has served as a supporting sling in the posterior ectasia of high myopia (Borley1,2) and as a temporary or permanent

Peripilar keratin casts are characterized by asymptomatic, minute, semifirm, tannish, discrete, freely movable, cylindrical masses, distributed along the scalp hairs. M. J. Brunner and J. M. Facq described the condition as "A Pseudoparasite of the Scalp Hair" 1 and A. M. Kligman, as "Hair Cases" 2 in the same issue of the A. M. A.Archives of Dermatology, in April, 1957. None of the authors could locate an identical case description. Report of Cases In June, 1958, I examined three Caucasian sisters, aged 4, 6, and 7 years. All had numerous, barely visible, tannish nodules on their hair shafts. These lesions were asymptomatic and had been noticed simultaneously in all three children approximately three months previously. The only feasible etiological agent elicited was the application of a certain brand of hair spray on several occasions prior to the onset of the disorder. Grossly, the lesions were tan, varying

I am pleased to answer Dr. Potter's letter as it provides another opportunity to stress a point made in our article on "Mondini's Deafness," mainly that radiographic-tomographic studies, although useful diagnostic tools, cannot be equated to histological studies in terms of reliability. So-called Michel's deafness is a genetic congenital lesion characterized by complete lack of the bony and membranous labyrinth and it is true that "the only recent histological (so as not to be taken out of context) description of complete aplasia (Michel's) occurred as a result of thalidomide poisoning" and was obviously therefore not genetically induced. I suggest the case Dr. Potter described as an example of Michel deformity is unproven. In his summary he describes "a case of complete absence of the inner ear (Michel deformity) is presented," while in the preceding case description (page 603), he says "the vestibule and lateral semicircular canal made up one large

To the Editor:— InThe Journal( 209 :946, 1969) a question from a physician in Illinois concerns a patient with recurrent attacks of hepatitis. The answer raised the possibility, among others, of multiple viral exposures. Another possibility occurred to me which would merit looking into. Is it possible that this patient has been having recurrent exposures to halothane at his place of work? It is mentioned in the case description that he is a hospital employee. A strikingly similar case was described by Klatskin and Kimberg ( New Eng J Med 280 :515, 1969). An anesthesiologist who had recurrent attacks of hepatitis which were found to be caused by exposure to halothane and cleared completely when he avoided halothane exposure. The recurrent hepatitis described inThe Journalquestion is consistent with recurrent exposure to a hepatotoxin, and it would be of great interest and possible therapeutic importance to determine whether the