Survival after major burn complicated by gas gangrene, acute renal failure, and toxic myocarditis.

with childhood malignant disease in general. We found that in children of mothers with epilepsy six of the 39 tumours were lymphomas (ICD, ninth revision, categories 200-202); of these six children, one was classified as having Letterer-Siwe disease and two were brothers whose tumours were classified as familial histiocytosis. If the proportion of lymphomas had been the same as that in the study as a whole, four cases would have been expected; similarly, in the children of mothers reporting tuberculosis five of the 27 tumours were lymphomas, whereas two would have been expected. Li et a16 suggested that there is an association between phenytoin and lymphomas; in this study, however, five of the mothers whose children developed lymphomas had been treated with phenobarbitone during pregnancy and none had received phenytoin. While the slight excess of lymphomas found in the present study is of some anecdotal interest, the results reported here do not really provide any evidence of a transplacental drug effect in the aetiology of childhood cancer. Other illnesses during pregnancy may possibly have been treated by drugs that are carcinogenic to the fetus. Some degree of reassurance, however, may be derived from the present study, since we considered two of the illnesses most likely to yield positive results yet found no association between drugs used to treat them and cancer in children. SHORT REPORTS Survival after major burn complicated by gas gangrene, acute renal failure, and toxic myocarditis Patients with burns who develop acute renal failure or gas gangrene rarely survive. We describe a patient who survived both these complications and believe that with early and aggressive treatment the outlook in such cases may be improved. Case report A 36-year-old man sustained a 53 % burn (30 % full-thickness) of trunk, thighs, and left arm from burning petrol. After resuscitation he was transferred to the McIndoe Burns Unit. Relieving incisions through the deep circumferential burn of the arm were performed immediately, and on the fourth day this burn was excised and grafted (see figure). Over the next