Several reports have suggested that there is an increasing incidence of infantile hypertrophic pyloric stenosis (IHPS). We examined the incidence of IHPS in a stable population in the West of Ireland over a ten year period (1981-1990). During the 10 years of the study the number of live births per year did not alter significantly. The incidence of IHPS increased significantly from 0.87/1000 live births in 1981 to 5.10/1000 in 1990 (p < 0.001, Student's test), peaking in 1989 at 6.8/1000. There was no statistical correlation between the increasing incidence and feeding habits, birth rank, family history or gender distribution. The reason(s) for this increase remain unclear.

A unique characteristic of the autoimmune liver disease primary biliary cirrhosis (PBC) is the presence of high-titer and extremely specific autoantibodies to the E2 component of the pyruvate dehydrogenase complex (PDC-E2). Autoantibodies to PDC-E2 antigen have only been detected in patients with disease or in those who subsequently develop PBC. One exception has been a subgroup of patients with multiple myeloma (MM) who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and received donor lymphocyte infusions (DLIs) after transplantation. These patients developed high-titer antibodies to a variety of myeloma-associated antigens, including PDC-E2, coincident with rejection of myeloma cells in vivo. To examine the specificity of autoantibodies to PDC in these patients, we screened sera from patients with MM, chronic leukemias, monoclonal gammopathy of unknown significance (MGUS), PBC, and healthy donors. Three of 11 patients with MM (27%) and 2 of 6 patients with chronic leukemias (33%) developed anti-PDC-E2 antibodies in association with DLI response; 2 of 12 (17%) patients in the MGUS pretreatment control population also had detectable anti-PDC responses. Interestingly, the epitope specificity of these PDC-E2 autoantibodies was distinctive, suggesting that the mechanisms leading to loss of tolerance in the transplantation patients are distinct from PBC. (Blood.

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Letters to the Editor 703diseased cusps, as well as to the aortic annulus and made aortic repair impossible; aortic replacement was the only choice. This finding confirms that transoesophageal echocardiography is mandatory in the aetiological examination of stroke. Nevertheless, this tumour is rare and an unusual cause of stroke.

SUMMARY One hundred and twenty infants with infantile hypertrophic pyloric stenosis were operated on by two consultant general surgeons over a 13‐year period. General anaesthetic and a standard surgical approach was used in all cases. No mortality was recorded and there were no wound dehiscences. The overall postoperative wound infection rate was 9.2%. Prior to 1985 the infection rate was 15%. Following attention to a number of details including care of the umbilicus, the incidence decreased after 1985 to 4%. The most common postoperative complication was vomiting, which occurred in 25% of infants. There was one negative laparotomy in the 13‐year study period. Two children required a second procedure for persistent vomiting. The argument in favour of specialisation in managing this condition is questioned along with the need for intensive diagnostic investigation.