with other illnesses necessitating intensive monitoring of numerical data,9 and to the evaluation of series of data collected in the course of research. We thank Professor Roger Blamey, Dr Richard Burden, and the many other colleagues who helped in the care of these patients and in their investigations. The study was supported by grants from the Medical Research Council and the Nottingham and Nottinghamshire Kidney Fund. References Cosimi AB, Colvin RB, Burton RC, et al. Monoclonal antibodies for immunological monitoring and treatment in recipients of renal allografts.

Fundus autofluorescence (FAF), a relatively new imaging modality, focuses on the fluorescent properties of pigments in the retina to generate images that help us view various disease processes from a different perspective. It aids us in the understanding of the pathophysiology of different retinal disorders. Recently, FAF imaging is being used commonly to help us in the diagnosis, prognosis as well as in determining the treatment response of various retinal disorders. It generates an image based on the distribution pattern of a fluorescent pigment called lipofuscin. Knowing the distribution pattern of lipofuscin in the normal retina is key to understanding an FAF image representing a retinal pathology. Like most other imaging modalities, FAF comes with its own limitations, taking steps to overcome these limitations will be of utmost importance in using this imaging modality to its fullest potential.

Objectives: Patients with cannabinoid hyperemesis syndrome (CHS) present frequently to the emergency department. Previous case studies suggest dramatic symptomatic improvement with topical capsaicin treatment. This exploratory study examined the potential effectiveness of topical capsaicin in patients with nausea and vomiting due to a suspected CHS exacerbation. Methods: This was a double-blind, randomized placebo-controlled pilot trial. Adults who presented with vomiting suspected to be from CHS were eligible for enrollment. We excluded pregnant women and those with resolution of symptoms. Following randomization, topical 0.1% capsaicin or placebo cream was applied to the anterior abdomen in a uniform manner. The primary outcome was the severity of nausea on a visual analog scale (VAS) of 0 to 10 cm assessed at 30 minutes. Secondary outcomes were adverse events, occurrence of posttreatment vomiting, nausea by VAS at 60 minutes, and hospital admission. Results: This pilot trial enrolled 30 patients, 17 in the capsaicin arm and 13 in the placebo arm. One patient in the capsaicin arm did not tolerate treatment due to skin irritation. Mean AE SD nausea severity at 30 minutes was 4.1 AE 2.3 cm in the capsaicin arm and 6.1 AE 3.3 cm in the placebo arm (difference = À2.0 cm, 95% confidence interval [CI] = 0.2 to À4.2 cm). At 60 minutes, mean AE SD nausea severity was 3.2 AE 3.2 cm versus 6.4 AE 2.8 cm (difference = À3.2 cm, 95% CI = À0.9 to À5.4 cm). The percent reduction in nausea at 60 minutes from baseline was 46.0% in the capsaicin arm and 24.9% in the placebo arm (difference = 21.1%, 95% CI = À5.6% to 47.9%). A higher proportion of capsaicin group patients (29.4% vs. 0%) had complete resolution of nausea (relative risk = 3.4, 95% CI = 1.6 to 7.1). Conclusion: In this pilot trial, the application of topical capsaicin cream was associated with a significant reduction in nausea at 60 minutes but not at 30 minutes and provided more complete relief of nausea. C annabinoid hyperemesis syndrome (CHS), thought to be a variant of cyclic vomiting syndrome (CVS), is characterized by the chronic use of cannabis, intractable nausea, recurrent vomiting episodes, and diffuse abdominal pain. Duration and quantification of cannabis use is variable and minimally involves weekly use. 1-4 One particular unique feature of this syndrome, which differentiates it from

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