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This report describes a patient suffering from intolerance to amino acids, mainly L-methionine, while on prolonged total parenteral nutrition. The patient displayed tachycardia, tachypnea. central scotomas, night blindness, and irritability. leading to coma while on total parenteral nutrition. The symptoms disappeared with discontinuation ofthe administered L-aminO acid solutions. Biochemical abnormalities included high plasma methionine (I 10 to 130 �tmol/L. normal 10 to 55 jimol/L) and low serum uric acid levels (0.5 to 1.4 mg/dl) associated with increased urinary excretion of sulfite (strong positive colonimetnic reaction on Machery Nagel strips versus absent reaction in controls), thiosulfate (4.4 to 9.5 mM/d day or 30 to 50� of total sulfur excretion versus normal = 0.4 ± 0. 1 mM/day or

This is a replication of a 1956 study that compared three ways to describe the case load of a mental hygiene clinic. The methods used were to follow-up of a cohort group, cases closed, and a survey of all active cases. In 1975, as compared to 1956, it was found that patients are more likely to be psychotic, to be receiving psychotropic drugs, and to stay in treatment much longer. Rate of improvement declined slightly. The number of patients increased by 166% and the annual number of patient visits increased by 84%, with about the same size staff. Some hypotheses for these changes are discussed.

Two hundred four patients with a microscopically incomplete resection for carcinoma of the colon or rectum were accepted for study. All patients were treated with 5-fluorouracil and methyl-CCNU beginning about the second postoperative week. Concurrent immunotherapy with the methanol extraction residue of bacillus Calmette-Guérin (MER) was randomly assigned to 103 patients. Treatment was continued as long as acceptable to the patient, and until clinical recurrence. Toxic reactions to the drug were not increased by the addition of MER, and seldom were severe enough to require the discrimination of therapy. No evidence of improved survival was seen in treated patients. On the contrary, survival in patients who experienced severe reactions to treatment may have been impaired by MER, with the period of impairment continuing after all adjuvant therapy was stopped. Similar proportions of treated and control deaths were attributable to residual or recurrent disease.