Survey of Infantile Gastroenteritis-Ironside et al. MBRDICALmJOURNAL deaths occurred immediately after admission, the fourth was from a non-infective cause, and the fifth followed prolonged. non-specific gastroenteritis. So it is suggested that antibiotics are of real value in treating associated infection but play little part in the severe case or in the control or spread of infection.Even in the developed countries gastroenteritis is still one of the commonest diseases of infancy, with a hospital mortality rate of over 1%. It is therefore remarkable that the aetiology is unknown in most cases, that the chemical pathology of the disease is still imperfectly understood, and that there is little agreement on the optimum treatment.We wish to thank Dr. S British Medical Journal, 1970, 3, 24-26 Summary: A case is reported in which severe thrombocytopenia occurred during administration and readministration of rifampicin. The patient's erythrocytes gave a positive direct antiglobulin test due to complement on the red cell surface; in the serum, complement-fixing antibodies were detected which were directed against the drug.Immunological studies showed antibodies, of both IgG and IgM type, capable of fixing complement to both normal and the patient's platelets, but only in the presence of rifampicin. In addition the IgM type of antibody (but not the IgG) was capable of fixing complement to normal red celis; again only in the presence of the drug.

550BRITISH MEDICAL JOURNAL 6 MARCH 1976 waiting time for transplantation-now averaging two years'-are self evident. This series shows the value of HLA matching of donor and recipient for two, three, or four antigens, which was particularly important for the long-term survival of the transplants. As 77°o f transplant failures after 12 months were due to rejection it appears that close HLA matching of donor and recipient confers considerable benefit in decreasing kidney loss due to late rejection. The importance of the first transplant, which had significantly the lowest primary failure rate as compared with second and third transplants, was also evident, despite the second and third transplants being performed only in the absence of recipient cytotoxic and haemagglutinating antibodies to donor tissue. Analysis of the causes of the loss of transplants (table II) shows that rejection was responsible in 520(1 of cases, that the death of the patieUt with a functioning transplant was responsible in 30o0, that renal vascular thrombosis was responsible in 120o, and that miscellaneous causes, including urinary leak and kidney necrosis due to causes other than rejection, were responsible in 60°0. Transplant loss due to renal vascular thrombosis and miscellaneous causes resulted mainly from using cadaver kidneys unsuitable for transplantation. These kidneys, which originated from non-ventilated donors or had vascular anomalies or prolonged ischaemic times, constituted half of the primary failures, and elimination of these high-risk kidneys has been shown to reduce the primary failure rate from 210°overall to 11Q,, which was due mainly to rejection. The incidence of rejection may be reduced by close HLA matching of donor and recipient. When the donor and recipient had two or more antigens in common the three-year kidney survival rate was 460, as opposed to 9 50o for poorer matches. Altogether 21 0°o f the patients died with functioning transplants and 40°,, of the deaths appeared to be due to infections with bacteria sensitive to conventional antibiotics. Intensive antibiotic treatment sometimes failed in the immunosuppressed patient owing to the emergence of resistant bacteria, opportunistic organisms, and infection with several different organisms. The importance of using only low-risk kidneys with the best possible HLA matching and scrupulous patient care is shown by the finding that if the patient survives one year with a functioning transplant there is a 770 chance of surviving to at least three years with satisfactory renal function. Clearly for the results of cadaver kidney transplantation to be improved more kidneys are required from well maintained donors to enable the strict selection of only kidneys that are suitable for transplantation to be made. Then the three-year functioning kidney transplant survival rate should improve to more than 50%' instead of the 3100, reported at present. For this to be achieved changes will be required in both medical and public attitudes that prevail in Britain to cadaver kidne...

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.

Summary. The main diagnostic features of leukaemic reticuloendotheliosis (LRE) are discussed in the light of six patients studied in recent years. A detailed study of the clinical, cytological, cytochemical and histological findings in four cases is presented. Pancytopenia and the presence of mononuclear ‘hairy’ cells in the circulation were the main haematological features. Bone marrow was difficult to aspirate and contained 50–80% of the same abnormal cells as the blood; the reticulin pattern showed increased fibre density. The cytology of the LRE cells was very characteristic, particularly because of their irregular ‘hairy’ edges. Cytochemically they were positive for acid phosphatase (tartrate‐resistant) and PAS and they did not contain lysozyme. Electron‐microscopy demonstrated the irregular cytoplasmic edges and a large ‘ribosome‐lamellae’ complex in 25–30% of cells of the two cases studied. The differential diagnosis of LRE from other lymphocytic and histiocytic proliferative disorders is discussed. It is suggested that LRE should be included in the lymphoproliferative group of disorders. Splenectomy seems to have a definitive place in the management of this condition; three patients out of six did not have splenectomy and died in less than 2 yr of sepsis or haemorrhage; in the other three cases splenectomy was followed by a prolonged improvement in the pancytopenia and a better survival (3 +, 7 and 10+ yr).