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A simple spectrophotometric method was developed to measure serum and urinary methionine concentrations. Serum methionine concentrations of greater than 200 mumol/L were found only in patients who were suffering from severe liver failure. In patients who died because of severe liver failure, a continuing increase in the methionine concentration was associated with a deteriorating mental state, while in patients who recovered the serum methionine concentration remained below 200 mumol/L during the coma stage. Urinary methionine to creatinine ratios above 300 were found only in specimens from patients who died. Sera and urine specimens from patients who were suffering from uncomplicated viral hepatitis showed no increase in methionine concentrations, while sera from patients with renal impairment and urinary specimens from patients who were suffering from chronic active hepatitis showed normal or only mildly elevated methionine concentrations.

This article outlines an approach to counselling a patient before a HIV test. Preparing such a patient for the possibility of a positive test, and all it means, is essential. It is also important to discuss with a seronegative patient measures to avoid infection. This feature, which presents the latest information on infectious diseases, is an adaptation of material presented in the Alfred Hospital Infectious Diseases Newsletter, edited by Dr Denis Spelman, Physician in Bacteriology.

Two cases of respiratory syncytial virus pneumonitis in adults area described. In both patients, the clinical picture of the adult respiratory distress syndrome, with marked tachypnoea. hypoxaemia and bilateral diffuse pulmonary infiltrates, was present. One patient had systemic lupus erythematosus, while the other had chronic obstructive lung disease and was a heavy drinker of alcohol. Both patients survived and recovered after a prolonged stay in hospital.

During the winter of 1982 concurrent outbreaks of influenza A and influenza B occurred. The epidemiology and clinical features of 151 cases referred during this time are described, and patients are discussed according to age and presenting clinical syndrome: croup was the commonest presentation in young children, a typical influenza syndrome predominated in young adults, while older patients were more likely to have lower respiratory tract infection. There was no significant difference between the clinical features of influenza A and influenza B. Unusual clinical features include rash, exudative tonsillitis and the need for myringotomy during the course of influenza.