The acute facial palsies — Investigation on the localization and pathogenesis of meato-labyrinthine facial palsies

76 an insight into the fast developing field of brain peptides. Very active research has been done on this peptide and related substances and the subjects dealt with in this book are also the subject of other symposia and publications. This may condemn the publication to be prematurely outdated. Neverthel~s the book may be ofsome value to departmental librariesand it may be also valuable for those seriously interested in pursuing some research on this peptide. There are several key chapters in the book; Leeman and Carraway summarize the work which led in Dr. Leeman's laboratory to the isolation and characterization of substance P in the search of an hypothalamic sialogogic peptide. Poweil and co-workers from one side and Nilsson and collaborators from another side give important hints on the development of radioimmunoassays for substance P determination in tissue and biological fluids. For the neurologists, the chapters of H6kfelt and collaborators and Mroz, Brownstein and Leeman are of direct interest. They deal with the neuronal localization of substance P and possible pathways containing the peptide. In a short chapter Lembeck, Gamse and Juan revise the attempts made by the Austrian group exploring a possible release of this peptide from sensory nerve endings. Otsuka and Konishi provide a short account of their very extensive work supporting a transmitter role of substance P for primary sensory neurones. Krnjevi~ discusses in this volume his abundant experience on electrophysiological effects of iontophoretically applied substance P in the CNS. He concludes in his review that "'These features of the action of substance P make it quite improbable that SP could be the ~or the main) transmitter released by primary afferent fibres". A more hopeful view on this possible role of substance P is given by Henry who presents his electrophysiological evidence favouring a participation of substance P in pain perception mechanism. Other reports are related to a generous variety of subjects and possible involvements of substance P on the flow of hepatic bile, endocrine pancreas, respiratory tract, gut, etc. The circulatory effects of purified preparations, pure substance P or its analogues are presented by several groups. Although these accounts are difficult to relate to each other due to the very different experimental approaches, the contributors tend to agree on the vasodilatatory and hypotensive actions of the peptide. A. C. Cuello

The Acute Facial Palsies m Investigations on the Localization and Pathogenesis o f Meato-Labyrinthine Facial Palsies ( N e u r o l o g y Series, No. 18), b y E. Esslen, w i t h a f o r e w o r d b y U. Fisch, x + 164 pages, 127 illustrations, 22 tables, S p r i n g e r - V e r l a g , Berlin, H e i d e l b e r g , N e w Y o r k , 1977, D M 48.00, U S $ 21.20. This is a detailed account of the methods of investigation and management of Bell's palsy developed in Zurich. The initial observation was that the facial nerve is intensely swollen in its proximal segment within the internal auditory meatus and is compressed at the entry to the facial canal. The site of injury is confirmed by the results of direct stimulation of the nerve. Linked with this is a method of determining the proportion of degenerated axons in the nerve by measuring the amplitude of the compound action potential in the peri-orai muscles following peripheral stimulation of the nerve trunk. The conclusions from this test are surprising as a very high proportion of degenerated axons is found in most cases, less than 3 % showing no degeneration at all. Despite this, no residual defect could be found even on stringent clinical examination if .50% or less of the axons had degenerated. Even 98 ~ degeneration was usually followed by satisfactory recovery. In a small group where virtually complete degeneration occurred the functional result was naturally poor in most o f the subjects but even here a good result was not unknown. The results did not confirm the prognostic value of tests commonly employed, including the stapedius reflex, gustatometry and measurement of lacrimation, a finding that causes no surprise to the reviewer. The work is critically described and will be of great interest to those who manage patients author agrees, the results provide little help with treatment. A s~ptical attitude is t a k e n to steroid therapy (although the work of Taverner is not mentioned) but plainly transtemporal decompression of the nerve cannot be the treatment of choice in a condition with an exceUent prognosis in the great majority. W. B. Matthews