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Summary. Functional studies were performed on the ‘hairy’ cells of five cases of leukaemic reticuloendotheliosis (LRE) to see whether they behaved as histiocytes or lymphocytes. The ‘hairy’ cells were less active than normal or leukaemic monocytes in respect of adhesion to glass, transformation to macrophages and phagocytosis and killing of Candida; they also lacked IgG and C3 receptors for immune phagocytosis. Surface‐bound immunoglobulins were demonstrated in a high proportion of ‘hairy’ cells; and they did not form rosettes with sheep red cells. Similar results were obtained with the lymphocytes of chronic lymphocytic and prolymphocytic leukaemia. In addition, the majority of the ‘hairy’ cells in one case were found to have C3 receptors for immune complexes. The ‘hairy’ cells of three patients did not respond to phytohaemagglutinin (PHA) or to pokeweed mitogen (PWM) but, in another case, half the cells transformed normally with PHA. It is concluded that the ‘hairy’ cell is of lymphocytic origin (resembling B lymphocytes) and that LRE should be included within the lymphoproliferative disorders and differentiated from histiocytic‐cell disorders.

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SYNOPSIS The PAS and acid phosphatase reactions showed a different pattern of positivity in the cells of lymphoproliferative disorders according to their B or T cell nature. In B-cell leukaemias (chronic lymphocytic and prolymphocytic) a low proportion of lymphocytes gave a positive result with the acid phosphatase reaction, while the majority were PAS positive in granular form. In contrast, in the T-prolymphocytic and T-lymphoblastic leukaemias the acid phosphatase reaction was positive in the majority of cells, while the PAS reaction was only positive in a minority. The significance of these findings, particularly for the recognition of a distinct T-cell variant of acute lymphoblastic leukaemia, is discussed.

A high proportion of peripheral-blood lymphocytes formed spontaneous rosettes with mouse red cells in 22 out of 23 cases of chronic lymphocytic leukaemia (CLL); the proportion was significantly higher than in 19 cases of other B-lymphoproliferative disorders (non-CLL group) and in 19 normal controls. Intermediate findings were obtained in 10 cases of "hairy" cell leukaemia. Blast cells from various types of acute leukaemia did not bind mouse red cells. Pre-treatment of the lymphocytes with neuraminidase led to a significant increase in the proportion of rosettes in CLL only. This test may prove useful in distinguishing CLL from other B-lymphoproliferative disorders, particularly prolymphocytic leukaemia.

The relation between M.M. and A.M.L., which involve distinct cell lines, remains puzzling. Long-term chemotherapy may have only a triggering role in patients with M.M. and some kind of pre-leukaemia state.We thank Dr. Jean-Louis Preud'Homme for performing the immunofluorescence examinations. These studies were supported by I.N.S.E.R.M. (U 108).

A 52-year-old woman and a 56-year-old man who were receiving carbamazepine experienced markedly elevated levels of its active metabolite, carbamazepine-10,11-epoxide (CBZ-E), after starting quetiapine therapy. The CBZ-E:carbamazepine ratio increased 3-4-fold in each patient. Levels of CBZ-E returned to baseline after discontinuing this drug combination. The metabolite can accumulate and cause neurotoxicity. The woman experienced ataxia and agitation while receiving quetiapine, which resolved after carbamazepine was switched to oxcarbazepine. The man was asymptomatic. To our knowledge, these are the first two case reports describing this interaction. Quetiapine may inhibit epoxide hydrolase and/or glucuronidation of carbamazepine-10,11-trans-diol in the same way as valproate and possibly lamotrigine do. If carbamazepine and quetiapine are administered concurrently, clinicians should consider monitoring CBZ-E concentrations.

Intravenous access cannot always be promptly obtained when treating status epilepticus outside the hospital. We compared the efficacy and safety of diazepam rectal gel to IV lorazepam in our long-term care facility for adults with developmental disabilities. Diazepam rectal gel was given more quickly and reliably, reducing total seizure time, potential neuronal injury and other complications. A treatment protocol for treating status epilepticus with diazepam rectal gel is given.