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Liver function and histology, together with the haematological changes, were investigated in 12 patients with Felty's syndrome. Six of them were anaemic. The red cell mass was either normal or increased, and the anaemia was due to a considerable increase in the plasma volume. Two patients had increased haemolysis associated with red cell sequestration by the enlarged spleens.In eight patients liver function tests were abnormal, while in five the liver histology showed lymphocytic infiltration of the sinusoids and portal tracts together with portal tract fibrosis. One of these was later found to have a macronodular cirrhosis. In another there were apparent nodules without a true cirrhosis, and this appearance was also seen in two other patients with Felty's syndrome in whom histology was available. An increased blood flow through the spleen was found in the two patients examined.

Of 48 patients with fulminant hepatic failure who progressed to grade III or IV encephalopathy 38 showed evidence of renal impairment. In 32 of these patients the underlying cause could be placed initially into one of three categories-prerenal uraemia (4 patients), acute tubular necrosis (16), and "functional renal failure" (12). The latter differed in several respects from that seen with liver failure secondary to cirrhosis. The frequency and type of renal impairment was the same in those patients in whom the fulminant hepatic failure had resulted from an overdose of paracetamol as in the other aetiological groups.Abnormalities in plasma electrolytes were common-in particular hypernatraemia occurred in 11 patients from an osmotic diuresis precipitated by hypertonic dextrose or fructose given intravenously, and from the sodium in the fresh frozen plasma used to correct the coagulation disturbance when renal excretion of this ion was inappropriately low.

The size of the liver and spleen of 32 patients was assessed by four clinicians from a clinical examination and by four radiologists from a plain radiograph of the abdomen. The latter assessment was found to be subject to less variation than the former, particularly in regard to the liver. Large livers and spleens were more easily seen radiologically than small ones. Most of the variation among the radiologists arose because of the 6% and 24% of cases in which the liver and spleen, respectively, were poorly seen on the radiograph. It is concluded that a plain radiograph of the abdomen, including the diaphragm and with the costal margin indicated, is a useful adjunct to clinical examination.