aplastic anaemia is characterised by anaemia, leucopenia, and thrombocytopenia. The defect is cellular with an increased tendency to infection and bleeding.4 Although prejudicial to the success of skin grafting, it is not a contraindication provided deficiencies are corrected perioperatively, haemostasis is achieved before grafting, and the formation of haematoma is avoided afterwards.Each of these children had a chronic cutaneous manifestation ofa haematological or immunodeficiency disease. Healing was assumed to be abnormal because of a defect in either humoral or cellular defence mechanisms. This assumption delayed referral for surgery by some months in each case, but debridement followed by split skin grafting produced rapid healing.We thank Professor J M Chessels and Dr D A Atherton for their permission to report on patients under their care. Case 2-A 16 year old army recruit was admitted on the same date with a four day history of malaise, vomiting, sore throat, blistering around the mouth, dry cough, and pleuritic pain on the left side. He had also developed central abdominal pain. On examination he had a fever, with a temperature of 39 2°C. Respiratory examination disclosed signs of left basal consolidation, which was confirmed by chest radiography, and abdominal examination showed epigastric and umbilical tenderness and tenderness in the right iliac fossa, with rebound tenderness. He was treated with penicillin and erythromycin, and his temperature settled within 24 hours. The tenderness in his right iliac fossa persisted for three days; the presumptive diagnosis was mesenteric adenitis. He was discharged after one week.

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AND SummaryA case of congenital heart block complicated by Adams-Stokes attacks treated by the insertion of a permanent fixed-rate transvenous cardiac pacemaker is reported. No special difficulties were encountered during pregnancy, labour or puerperium except that the site of implantation of the pacemaker battery required revision. With the development of cardiac pacing there is little contra-indication to pregnancy in such cases. The prognosis is worse in cases of acquired rather than congenital complete heart block.

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The clinical and haemodynamic responses to mitral valve replacement were studied in 36 patients with a pulmonary vascular resistance of 4 units or above. In

Summary:We describe the occurrence of primary hyperaldosteronism in two sisters. Although this is only the second published report of familial Conn's syndrome, it does have implications for the relatives of patients with Conn's syndrome and these are discussed.

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