1. Infection in the neonatal period is difficult to diagnose and is a significant cause of morbidity and mortality in preterm infants. 2. We investigated prospectively the predictive value of plasma measurement of bacterial endotoxin (lipopolysaccharide), tumour necrosis factor-alpha, interleukin-6, interleukin-8, intercellular adhesion molecule-1 and C-reactive protein in 60 consecutive newborn infants suspected of having neonatal infection. Plasma samples were taken at the time of acute clinical deterioration. Sixty-two cord blood samples were studied as controls taken at elective Caesarean section. 3. Forty-three infants had confirmed infections, 25 with positive blood cultures. Tumour necrosis factor-alpha and bacterial endotoxin levels were not significantly elevated over controls, whereas interleukin-6, interleukin-8 and intercellular adhesion molecule-1 levels were all significantly increased in the infected group compared with controls (all P < 0.001). 4. Increased plasma intercellular adhesion molecule-1 levels were a highly sensitive (88%) indicator of clinical infection and were independent of C-reactive protein. Use of these two assays in combination improved the diagnostic sensitivity to 95% and gave a negative predictive value of 97%. addition of interleukin-6 or interleukin-8 measurements failed to further significantly enhance the prediction of infection. 5. Measurement of intercellular adhesion molecule-1 level may have a clinical role in rapidly confirming, or predicting, the likely diagnosis in cases of suspected neonatal infection.

Four children, from two families, suffered from fatal degeneration of the cerebral grey matter. Their disease was characterised by intractable epilepsy, epilepsia partialis continua, progressive deterioration, and terminal hepatic dysfunction. EEG showed marked and distinctive slow wave abnormality, visual evoked responses were diminished, and cerebral atrophy was seen on CT scan. Pathological findings were of neuronal loss and hepatic cirrhosis. The combination of cerebral degeneration, hepatic disease and familial occurrence suggests an inborn error of metabolism with autosomal recessive inheritance. The features described are those of Alpers syndrome, especially the recently delineated subgroup with progressive neuronal degeneration and liver disease.

A histopathological scoring system which grades drug effects on cellular infiltration, pannus formation, cartilage degradation and bone resorption in L. casei-induced polyarthritis in rats is described. Reference anti-rheumatic and anti-inflammatory agents administered on days 2-60 after induction of arthritis were evaluated for effects on paw swelling weekly and graded histopathologic changes on day 60. This animal model affords a tool to evaluated therapeutic agents on the joint destruction resulting from chronic inflammation.

In a recent article Levy (1951) records the treatment with an anti-histamine (Phenergan) of a small number of cases of infective arthritis and arthritis in Reiter's disease treated in a military hospital in Singapore. In his series of seven cases, six had a recent previous history of purulent urethritis, one having pyuria in addition, and the seventh had a recent previous history of bacillary dysentery and had developed the classical symptoms of Reiter's disease. Clinical improvement in the joints appeared in all cases in 7 days on a dosage of 150 mg. Phenergan daily, and all cases eventually returned to duty. Four of the patients had erythrocyte sedimentation rates varying from 46 to 97 mm. in one hour, and these all returned to normal at intervals varying from 21 days upwards. Broadly speaking, these cases had one aetiological factor in common, namely, a recent or present frank bacterial infection. This factor does not obtain in the aetiology of rheumatoid arthritis, but in view of the uniformly satisfactory results in these cases it was considered that the effect of Phenergan should be ascertained.

Hepatic enzymes and organ weights were measured in LEW/N female rats during the acute and the chronic phases of L. casei-induced arthritis on day 3 and days 30 and 59, respectively. In the acute phase, day 3, adrenal and spleen weights were increased and thymus weights were decreased in L. casei arthritic rats as compared to normal control rats. Adrenal, liver, kidney, spleen and thymus weights of arthritic rats were in the normal range on days 30 and 59. Liver cytochrome P450, aminopyrine N-demethylase and analine hydroxylase were reduced in livers of L. casei-treated rats on day 3 as compared to normal controls. On days 30 and 59 hepatic enzymes in L. casei-arthritic rats were in the normal range. Unlike adjuvant arthritis in which changes in liver enzymes alter drug metabolism; after the acute onset of L. casei-induced arthritis, hepatic enzymes return to the normal range.