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Uldall, P. R., Khan, H. A., Ennis, J. E., McCallum, R. I., and Grimson, T. A. (1970). Brit. J. industr. Med., 27, 372-377. Renal damage from industrial arsine poisoning. An incident is reported in which three men were accidentally poisoned by arsine (A s H 3 ) in an industrial chemical plant. Two mildly affected individuals recovered quickly-without treatment but the third, who was severely poisoned, developed oliguric renal failure. Though this patient recovered after repeated peritoneal dialysis he was left with a legacy of chronic renal insufficiency and hypertension. This severe case drew attention to a previous incident in the same factory involving three other men, the cause of which had not hitherto been suspected. The previous reports of arsine-induced renal failure treated by dialysis have been reviewed and certain common features are apparent. Dangerous uraemia may persist long after the onset of the diuretic phase. Dialysis provides a high chance for recovery in what was previously a universally fatal condition, but permanent renal interstitial damage is a likely sequel. There are strong reasons for the prompt use of exchange transfusion in the severely affected patient with oliguria. Mild arsine poisoning unaccompanied by oliguria may remain unrecognized and should therefore be considered in the differential diagnosis of any patient presenting with haematuria or jaundice, particularly if his occupation brings him in contact with acids and metals.

Ten adults with minimal-change nephrotic syndrome, eight of whom had failed to respond satisfactorily to steroid therapy, have been treated with cyclophosphamide. Eight patients are now in remission with protein-free urine 2-46 months after withdrawal of all treatment. The remaining two patients have had a partial remission. The only serious side-effect was permanent secondary amenorrhoœa in a 31-year-old woman treated with cyclophosphamide for 20 months. It is suggested that cyclophosphamide should be tried in any adult with minimal-change nephrotic syndrome who does not respond to prednisone within 2 months.

• Using the clearance of microaggregated iodinated human serum albumin reticuloendothialial system (RES) phagocytic function was tested in 48 long-term renal allograft recipients and was found to be defective at the time of testing in 70%. Depression of RES phagocytosis could be related to total steroid dosage in the previous year and to the patients liability to bacterial infections. Evidence from this test does not suggest an immunosuppressive effect of cytomegalovirus. However, three patients are discussed who have developed chronic active hepatitis that is not due to type B virus. ( Arch Surg 111:1368-1371, 1976)