The histological features of the flexor tendon sheath in the spontaneous carpal tunnel syndrome were studied. The main differences between our findings and previous studies were twofold. Firstly a striking absence of inflammation in our material and secondly the diversity of the pathological changes encountered--alterations in the connective tissue especially the collagen; proliferation with thickening of the tissues of the tendon sheath; fibrosis; amyloid deposition; oedema; vascular lesions including thickening of vessels walls, intimal hyperplasia, and thrombosis; and a foreign body giant cell reaction. Although the lesions described here may not be significant in every case in which they are encountered, they do appear to support the view that pressure in the carpal tunnel and ischaemia are the important factors in a majority of cases of the spontaneous carpal tunnel syndrome.

Renal ischaemia for one hour in two groups of Gunn rats, one with and the other without bile-duct ligation, produced comparable reversible renal tubular lesions in both groups. Since Gunn rats have an unconjugated hyperbilirubinaemia, which is unaffected by bile-duct ligation, it seems likely that the high levels of bilirubin glucuronide are responsible for sensitizing the renal tubules to ischaemia, possibly by depressing cell respiration.

A disease characterized by ascites and hepatomegaly was described in Jamaica by McFarlane and Branday in 1945, and later studied by Hill and his colleagues (Hill, Rhodes, Stafford and Aub, 1953), and by Bras, Jelliffe and Stuart (1954). Bras and his co-workers demonstrated occlusion of the small hepatic veins and accordingly named the condition 'Veno-occlusive disease of the liver' (V.O.D.). The exact nature of the occlusions has not been ascertained, although Bras and his colleagues likened some of them to an obliterating endophlebitis, and others to organized mural thrombi.The death of three children early in the disease, one three days, another five days and a third 21 days after the onset of symptoms has prompted us to reinvestigate the pathogenesis of what are believed to be early lesions. Materials and MethodsFormal-saline fixed liver tissue was available from all three cases. Paraffin sections were prepared in the usual way and stained with haematoxylin and eosin (H. and E.). Other staining methods used were Mallory's trichrome (M.T.), Mallory's phosphotungstic acid haematoxylin (M.P.A.H.), and Wilder's method for reticulin. One block from each case was sectioned serially, and initially every fifth section was stained. Other sections were stained when indicated.Fresh material was available from the case dying at 21 days permitting the use of the immuno-histochemical techniques described by Coons, Creech, Jones andBerliner (1942), andCoons and Kaplan (1950). Blocks of liver tissue were frozen in a dry-ice alcohol mixture and stored at -20°C. Sections were cut in a cryostat at temperatures between -20°C. to -10°C. and mounted in the cold on glass slides. They were washed with two changes of phosphate buffer, pH 7*2, and covered with rabbit anti-human fibrin serum conjugated with fluorescein isocyanate. After staining for 30 minutes they were washed repeatedly in the phosphate buffer and mounted in buffered glycerol (pH 8 0). The anti-human fibrin serum was prepared by immunizing rabbits with human fibrin. The fibrin was * Present address: King's College Hospital, London S.E.5. teased, cut into fine fragments, suspended in Freund's adjuvant and injected subcutaneously. Three doses of 1 g. fibrin were given at intervals of 10 days, and the rabbits were bled three days after the last injection. The globulins were precipitated from the rabbit serum by saturation with anhydrous sodium-sulphate and the precipitate redissolved in distilled water and transferred to a dialysing bag and the sodium sulphate removed. The globulin was then coupled with fluorescein isocyanate and the labelled antiserum treated with powdered rat liver to reduce non-specific staining. The specificity of the antiserum was checked by demonstrating a single precipitation band in an Ouchterlony plate; by staining obvious fibrin deposits in placental tissue; and by treating duplicate sections with fluorescein-coupled antihuman fibrin serum absorbed with washed human fibrin. The sections were examined with the fluorescent microscope, photographe...

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