Aorto-iliac Occlusion-7ohnstone et al.- MEDICAL JOURNAL 977 no part in the genesis of this lactate, and infusion of A.C.D. bank blood had been stopped previously.The quantities of lactate and pyruvate circulating during the immediate post-operative period amount to 4 mEq/l. at maximum. No significant change occurs in hydrogen-ion concentrations as a result of these metabolites, and although the reason for their continued production is at present obscure they do not appear to be harmful per se. SummarySix cases have been studied during reconstructive surgery for aorto-iliac disease. Infrarenal aortic occlusion produces severe desaturation of blood in the lower limb, leading to anaerobic production of lactate. The change in hydrogen-ion concentration produced is small, transient, and not significant at normothermia.Alterations in hydrogen-ion concentration due to release of anoxic metabolites does not appear to be the cause of systemic hypotension after release of aortic clamps.

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When lichen planus strikes families, a very rare happening, it is likely to afflict younger members, to erupt more acutely, extensively, and gravely, attacking also nails and mucous membranes, and to recur. Ten patients with familial lichen planus, two each from five distinct Caucasian families, the parents of whom were unrelated by birth, were found to be carrying HLA-B7 statistically more frequently than in the normal population or in those with the characteristic forms of lichen planus. We hint that their genotype might have rendered them susceptible to a pathogen that precipitated their disease.

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SUMMARY Antibodies against the cytoplasm of malignant melanoma cells have been found formerly to be circulating in our patients with primary malignant melanoma before metastases had developed. We have found now this same antibody in fifteen patients with resolving halo naevi. It disappears once resolution of the naevus is complete or after a solitary active halo naevus has been excised. However, cytoplasmic antibody has not been detected in the serum of any other patients with cutaneous pigmentary disorders: including fifty‐six with various pigmented tumours or naevi, many of them referred to us as suspected malignant melanoma; forty‐seven with vitiligo unassociated with halo naevi; and six with benign juvenile melanoma. We postulate that: Halo naevus represents an accelerated and successful rejection phase of a pigmented mole developing malignant change. There are at least two aetiological types of vitiligo, the common variety and another one associated specifically with halo naevus, perhaps initiated by the same immunological stimulus or its sequelae. Juvenile (benign) melanoma is not related immunologically to malignant melanoma.

A double-blind placebo controlled trial of 5% 5-aminosalicylic acid (5-ASA) cream for the treatment of oral aphthous ulcers was carried out on 22 subjects. The cream or a placebo (11 patients each) was applied to the ulcers three times daily for up to 14 days. Daily discomfort was reduced by half (P less than 0.01) and less pain (P less than 0.05) was experienced by the treated group. Treatment with 5-ASA shortened healing time (7 vs. 11 days, P less than 0.01) and reduced the difficulty in eating (P less than 0.05). No significant side-effects were reported. We believe 5-ASA cream to be an effective treatment for aphthous ulcers.

The clinical sign of livedo reticularis derives from stasis of blood in the superficial venous drainage systems of the skin. Many factors can delay the flow of de-oxygenated blood away from the skin, notably hyperviscosity of the blood itself and obstruction due to disease affecting dermal arteries, capillaries, or venules.