Posttransplant lymphoproliferative disorders and gastrointestinal manifestations of Epstein-Barr virus infection in children following liver transplantation

BACKGROUND

Epstein-Barr virus (EBV) infection is common after liver transplantation in children and is associated with the risk of posttransplant lymphoproliferative disorders (PTLD).

METHODS

This retrospective study examined the frequency of gastrointestinal (GI) symptoms and the risk of PTLD in pediatric liver recipients who developed symptomatic EBV infection. We reviewed 172 children who received orthotopic liver transplants between March 1988 to December 1994. Twenty-two cases were retransplants. The mean age at transplantation was 3.7 years (range, 0.1-17 years). The immunosuppressive regimens consisted of induction therapy with Minnesota antilymphocyte globulin/antithymocyte globulin/OKT3 in most cases and maintenance therapy with prednisone and either cyclosporine or tacrolimus (FK506).

RESULTS

After 1 year of minimum follow-up, 54 of 172 patients had symptomatic EBV infections (confirmed by serology, histology, or whole blood polymerase chain reaction. At the time of infection, 38.5% (21/54) had either diarrhea or GI bleeding or both. PTLD developed in 11 patients (6.4%). The incidence of PTLD was 42.9% (9/21) when GI bleeding or diarrhea was associated with EBV infections, compared with 6.1% (2/33) when EBV infection was not associated with GI symptoms. Seven of 10 (70%) patients with GI bleeding and 2 of 11 (18.2%) with diarrhea developed PTLD. Of seven patients examined by endoscopy for GI bleeding, two had biopsy-proven PTLD of the GI tract, whereas one of two patients examined by endoscopy for diarrhea had biopsy-proven PTLD.

DISCUSSION

In summary, a high incidence of PTLD was found in patients who developed GI bleeding or diarrhea associated with EBV infection after pediatric liver transplantation. In these patients, endoscopy and biopsy may lead to early diagnosis of PTLD.

Current status of living-related liver transplantation

Living-related liver transplantation has come of age. This manuscript addresses the most important facets of the living-related liver transplant procedure including selection of the donor, the recipient operation, immunosuppression and rejection as well as the most common surgical complications. It also describes the results in terms of patient and graft survival, retransplantation and quality of life. Although living-related liver transplantation has not solved the problem of organ shortage, it has provided many children with an opportunity to live and enjoy life.

Aerosol administration of a recombinant adenovirus expressing CFTR to cystic fibrosis patients: a phase I clinical trial

Ad CFTR, a replication-deficient adenovirus expressing the human cystic fibrosis transmembrane conductance regulator (CFTR), was administered by aerosolization in a single escalating dose to three pairs (cohorts) of cystic fibrosis (CF) patients. Buffer only was administered to the nose and lungs 9-14 days before nasal instillation of virus followed the day after by aerosolization of Ad CFTR to the lung. Nasal doses (defined in terms of viral plaque forming units, pfu) were 10(5), 10(7), and 4 x 10(8), whereas aerosolized doses were 10(7), 10(8), 5.4 x 10(8) for each cohort, respectively. No acute toxic effects were observed in the first 4 weeks after virus treatment. Shedding of infectious Ad CFTR was never detected, whereas detection of vector DNA sequences and CFTR expression demonstrated DNA transfer to the nose and airways of patients. No significant deviations in immunological and inflammatory parameters were observed in serum and in bronchoalveolar lavage (BAL). Importantly, for all patients, the serum anti-adenovirus antibody levels did not change significantly from baseline and no antibodies against adenovirus were found in BAL.

Body composition and physical performance in children after renal transplantation

Body composition using standard anthropometric methods and dual-energy X-ray absorptiometry (DEXA) was determined in a cross-sectional study among 26 pediatric renal transplant recipients. At the same time, spiroergometry exam, pulmonary function tests, dynamometry and tremometry exams were performed in all patients. Fat body mass obtained by DEXA correlated inversely with maximal physical load during spiroergometry exam (r2 = 0.51, p = 0.0001). The study demonstrates good tolerance of increased physical load in children after renal transplantation. An inverse relationship was found between fat body mass and physical performance. Exercise training programs for children after renal transplantation are therefore suggested.

Up-regulation of rat adrenomedullin gene expression by endotoxin: relation to nitric oxide synthesis

The effect of bacterial endotoxin (LPS) on adrenomedullin (AM) gene expression was investigated in cultured rat aortic vascular smooth muscle (VSM) cells and in tissues from anesthetized rats. The addition of LPS together with interferon-gamma to VSM cells resulted in a marked increase in the abundance of AM mRNA as well as the appearance of mRNA for the inducible isoform of nitric oxide (NO) synthase (iNOS). Intravenous injection of LPS into rats also increased AM mRNA abundance and induced iNOS mRNA in lung, heart, liver, and kidney. AM significantly enhanced NO synthesis evoked by LPS and interferon-gamma in cultured VSM cells. These data suggest that AM may contribute to circulatory failure during endotoxin shock, in part, by modulating NO synthesis.

Expression of cytokines and immune mediators during chronic liver allograft rejection

To determine the immune processes involved in chronic liver allograft rejection (CR) we examined in situ cytokine production in tissue from 15 patients with both clinical and histopathological diagnoses of CR. Total RNA was isolated from liver samples, reverse-transcribed and analyzed by RT-PCR for the production of proinflammatory cytokines and immunoregulatory mediators. Transcripts for the Th1-like cytokines IL-2 and IFN-gamma were detected in 53.3% and 46.7% of CR grafts, while they were detected in only 16% and 0% of stable grafts, respectively. The cytotoxic T cell mediator granzyme B was expressed in the majority of liver grafts undergoing CR, but was expressed only in a minority of stable grafts (80% vs. 16%, P < 0.05). The T cell product IL-5 was also significantly upregulated in CR as compared with stable livers (80% vs. 16%, P < 0.01). Other Th2 cytokines--IL-4 and IL-10--and macrophage products--IL-1 beta, IL-6, IL-8, TGF-beta, and TNF-alpha--were not substantially upregulated in CR grafts as compared with stable grafts. PDGF-beta transcripts were detected in the majority of the CR grafts, but were not detected in stable liver grafts (73% vs. 0, P < 0.05). By immunohistochemical staining, we observed that CD3+CD4+, and CD3+CD4- T cells were detected in CR grafts along with CD20+ B cells and CD68+ macrophages. There was, however, a predominant infiltration of CD3+CD4+ lymphocytes. Taken together, these data suggest that infiltrating cells produce proinflammatory and immunoregulatory cytokines that have a role in mediating graft damage in CR.

Effects of calcium channel antagonists on the induction of nitric oxide synthase in cultured cells by immunostimulants

We investigated whether calcium channel antagonists would alter the induction of nitric oxide (NO) synthesis by bacterial lipopolysaccharide (LPS) alone or in combination with interferon-gamma (IFN gamma) in cultured J774 macrophages, rat vascular smooth muscle cells, rat renal mesangial cells, and rat cardiac myocytes. The induction of NO synthesis was determined by measuring nitrite, the stable end-product. The dihydropyridine calcium channel antagonists, nifedipine, manidipine, nitrendipine, benidipine, barnidipine, perdipine, and nilvadipine all reduced the LPS-induced nitrite production in a dose-dependent manner, each with a differing half-maximal inhibitory concentration, in cultured J774 macrophages. Nifedipine also inhibited nitrite production in vascular smooth muscle cells, mesangial cells, and cardiac myocytes. The half-maximal inhibitory concentrations of nifedipine were ranked as follows: smooth muscle cells < mesangial cells < cardiac myocytes. Diltiazem, at nontoxic concentrations, had no effect on the nitrite formation in the three cell types. Verapamil markedly increased the formation of nitrite in cardiac myocytes in response to LPS and IFN gamma, but not in vascular smooth muscle or mesangial cells. Exposure of cardiac myocytes to LPS and IFN gamma caused the expression of NO synthase mRNA that was significantly increased by verapamil. Thus, certain calcium channel antagonists modulate NO synthesis by altering the induction of NO synthase.

Vesnarinone inhibits induction of nitric oxide synthase in J774 macrophages and rat cardiac myocytes in culture

OBJECTIVE

We investigated whether vesnarinone alters the induction of nitric oxide (NO) synthesis by bacterial lipopolysaccharide (LPS) or in combination with interferon-gamma in cultured J774 macrophages and rat cardiac myocytes.

METHODS

The induction of NO synthesis was determined by measuring the stable end-product nitrite. The cytotoxic effect of vesnarinone was assessed by measuring cell respiration. Any change in mRNA levels for NO synthase (NOS) was determined by RT-PCR.

RESULTS

Stimulation by LPS or in combination with interferon-gamma increased the accumulation of nitrite in the supernatant of J774 macrophages or cardiac myocytes. NOS induction accounted for this accumulation of nitrite, as dexamethasone, NG-methyl-L-arginine, and cycloheximide each reduced the production of nitrite in both types of cells. Vesnarinone produced a significant decline in the cumulative production of nitrite in both types of cells without evidence of cytotoxicity. However, the addition of vesnarinone after induction of NOS did not inhibit nitrite production. Treatment with LPS or in combination with interferon-gamma led to a significant expression of NOS mRNA in both types of cells that was significantly reduced by vesnarinone.

CONCLUSIONS

Vesnarinone inhibited NO synthesis by inhibiting the induction of NOS in J774 macrophages and cardiac myocytes. This drug may exert a beneficial effect in patients with heart failure, in part, by attenuating the production of NO.

Long-term airway considerations after treatment of severe pediatric laryngotracheal stenosis in five children

After initial treatment of severe laryngotracheal stenosis (LTS), we evaluated subsequent airway function. Five children between 2 and 11 years were treated previously for severe LTS by T-tube stenting. One case underwent subsequent laryngotracheal reconstruction. All patients demonstrated dyspnea, the severity of which increased with age and duration of time after completion of stenosis treatment. In the most severe cases, magnetic resonance imaging and endoscopy revealed secondary subglottic stenosis. Ventilatory function tests disclosed obstruction of both extrathoracic and pulmonary origin. These findings raise questions regarding the treatment of the initial stenosing tissue and of the secondary stenoses.

Differential patterns of circulating intercellular adhesion molecule-1 (cICAM-1) and vascular cell adhesion molecule-1 (cVCAM-1) during liver allograft rejection

During allograft rejection, adhesion molecules play an integral role in infiltration, activation, and binding of effector cells to target tissue. Some adhesion molecules, including ICAM-1 and VCAM-1, exist in soluble, circulating forms that retain ligand-binding activity. In the present study the levels of circulating ICAM-1 (cICAM-1) and VCAM-1 (cVCAM-1) were compared in the serum and bile of pediatric liver recipients. The cICAM-1 was significantly elevated in the serum during allograft rejection and infection relative to periods when no rejection was apparent. Biliary cICAM-1, however, was specifically elevated during rejection and not during infection or when no rejection was apparent. The cVCAM-1 levels were elevated in the serum during rejection compared with levels when no rejection was evident. In contrast, cVCAM-1 was not detected in the bile. Serum levels of both cICAM-1 and cVCAM-1 decreased rapidly following successful treatment for rejection, whereas elevated levels persisted, or increased, in ongoing rejection. The differential patterns of the circulating forms of ICAM-1 and cVCAM-1 were consistent with the membrane expression of these molecules during graft rejection. ICAM-1 expression was extensive on bile duct epithelium, endothelium, hepatocytes, and infiltrating leukocytes during rejection, while VCAM-1 was restricted to endothelium. These findings indicate that the release of circulating adhesion molecules is a prominent feature of liver allograft rejection. Measurement of these markers may be useful in distinguishing rejection from infection and in determining the efficacy of treatment for rejection.

Different growth control of the two human thyroid cell lines of adenomatous goiter and papillary carcinoma

To study the growth control of human thyroid cells in different stages of differentiation, we established two human thyroid cell lines of adenomatous goiter and papillary carcinoma. A 59-year-old female patient with adenomatous goiter was operated in September 1991, and a 27-year-old female patient with papillary carcinoma in May 1990. The thyroid cell lines were established by successive passage without cellular or genetic manipulations such as fusing other cell lines or oncogenic viral infection. These cell lines, human adenomatous goiter cells (hAG) and human papillary thyroid carcinoma cells (hPTC), exhibited a flattened polygonal shape and proliferated as a monolayer in cell culture. The doubling time of the hAG cells was 60 h in Ham's F12 medium supplemented with 10% fetal bovine serum, and that of the hPTC cells, 18 h in the same medium. Both cell lines expressed mRNA for TSH receptor and secreted cAMP into the medium during incubation with thyrotropin (TSH) at concentrations as low as 0.01 mU/mL. The effects of activators of protein kinase A (PKA), protein kinase C (PKC), tyrosine kinase (TK), and estradiol (E2) on proliferation of the hAG cells and the hPTC cells were assessed by measuring cellular DNA content in 24-well plates with diaminobenzoic acid. TSH stimulated proliferation of the hAG cells, but it inhibited proliferation of the hPTC cells. Since TSH activates two signaling pathways, the adenyl cyclase-PKA system and phospholipase C-PKC system, we tested effects of dibutylyl cAMP (dBC) and phorbol myristate 13-acetate (PMA), separately. dBC stimulated proliferation of the hAG cells, but it inhibited that of the hPTC cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute liver allograft rejection in the rat. An analysis of the immune response

Liver allografts are vigorously rejected in 9-12 days in Lewis recipients of fully histoincompatible DA livers. The purpose of this study was to examine the initial events in this cascade, specifically the role of CD4+ T helper cells. Lewis recipients of DA or Lewis livers were killed at days 1, 2, 3, 4, and 7 days after transplant. Indicators of acute liver rejection, including a marked inflammatory infiltrate and decreased liver function, progressed in untreated recipients of allografts. Splenocytes taken from allogeneic recipients on days 1-4 and 7 proliferated in response to donor and third-party stimulators, whereas graft-infiltrating cells did not respond to donor and third-party antigens until day 3 after transplant, but thereafter maintained a good response. To further characterize the host T helper cell response to liver allografts, cytokine expression was analyzed in graft tissue and in the periphery. IL-4 mRNA was present in both syngeneic and allogeneic liver grafts, while message for IL-10 was present early in all liver grafts but persisted only in allografts. In contrast, IL-2 and IFN-gamma transcripts were specific to rejecting allografts. Similar patterns of cytokine expression were observed in the spleen, indicating the immune response to the graft involves the peripheral lymphoid organs. Thus, the cytokine profile detected during liver allograft rejection is extremely similar to that observed in other experimental models of transplantation.

Growth regulation of the human papillary thyroid cancer cell line by protein tyrosine kinase and cAMP-dependent protein kinase

We established a cell line (hPTC) from the tissue of papillary thyroid cancer surgically excised from a 27-year-old female patient. Synthesis of cAMP by the hPTC cells was stimulated by TSH. This cell line has continued to divide as a monolayer in a tissue culture for three years. We assessed growth regulation of the hPTC cells by protein tyrosine kinase and cAMP-dependent protein kinase by measuring the DNA content of the hPTC cells in 24-well plates with 3,5-diaminobenzoic acid after incubation in various growth factors. Basic fibroblast growth factor (FGF), epidermal growth factor (EGF), and insulin-like growth factor-1 (IGF-1), all of which bind to their respective receptors with tyrosine kinase activity, stimulated DNA synthesis in the hPTC cells. Neutralizing antibodies to basic FGF and EGF suppressed the growth stimulation by basic FGF and EGF, respectively. Genistein, a specific protein tyrosine kinase inhibitor, inhibited proliferation of the hPTC cells. On the other hand, thyrotropin, dibutyryl cAMP (dBC) and forskolin inhibited proliferation. KT5720, a specific cAMP-dependent protein kinase inhibitor, restored the growth of the hPTC cells even in the presence of dBC. This study shows that stimulation of the protein tyrosine kinase activity by basic FGF, EGF, and IGF-1 promoted DNA replication by the human thyroid cancer cell line. However, activation of the cAMP-dependent protein kinase inhibited proliferation of this cell line.

Prevention of rejection and graft loss with an aggressive quadruple immunosuppressive therapy regimen in children and adolescents

During the two-year period May 1991 to April 1993, 36 kidney transplants were performed in children less than 18 years of age at California Pacific Medical Center using an aggressive quadruple-therapy regimen of immunosuppression. The regimen consisted of induction with an antilymphocyte preparation (MALG in 21, OKT3 in 2, ATGAM in 12, none in 1), initial moderate-dose steroid therapy, early intravenous cyclosporine therapy, and azathioprine. Twenty living-related graft recipients were pretreated with donor-specific transfusions. Long-term cyclosporine was dosed by levels to keep through whole-blood levels (RIA) at 200-300 ng/ml. Twenty-five grafts were from living-related donors, two from living unrelated donors, and nine from cadaveric donors. Eleven (30%) recipients were five years old or under at the time of transplantation. Of these recipients 44% had complex congenital urologic disease and required urologic surgery prior to or at the time of transplantation. Patients have been followed for a mean of one year, with actual patient and graft survivals of 100% and 97%, respectively. Only one graft has been lost, to severe, early recurrent focal segmental glomerulosclerosis. Four of the 36 patients have had one rejection episode each, all reversed completely. Graft function is stable, with serum creatinine proportionate to age--mean serum creatinine in the children under two years old being 0.4 mg/dl, and in the adolescents 1.3 mg/dl, with two adolescent boys having the highest creatinine levels at 1.8 mg/dl. We conclude that an aggressive approach to immunosuppressive therapy in the early posttransplant period with MALG/OKT3/ATGAM induction and rapid achievement of therapeutic cyclosporine levels prevents rejection and results in excellent patient and graft survival with subsequent stable good graft function.

[An experience with a continent appendix stoma]

The submucosally embedded in situ appendix guarantees an ideal continence mechanism in patients with ileocecal urinary reservoirs. To date this modification of the Mainz pouch technique was performed successfully in 10 patients between September 1990 and October 1992. Pouch capacity ranged from 350 ml to 900 ml (mean: 565 ml), frequency of intermittent self-catheterization ranged from 3 to 7 times per day (mean: 4.4-5.4 times) and complete urinary continence without difficulty of self-catheterization was obtained in eight patients. Two patients with stomal stenosis needed to indwell a catheter. The follow up periods ranged from 3 to 24 months (mean: 14.7 months). The main advantages of appendix stoma technique are shorter operation time, a short ileal segment, no risk of nipple gliding or prolapse, no need for staples, thereby decreasing significantly the risk of stone formation, and facilitating easy catheterization. This method seemed to be valuable for continent urinary reservoir assuring patients of high quality of life.

Three-dimensional SEM study of arteriovenous anastomoses in the dog's tongue using corrosive resin casts

Arteriovenous anastomoses (AVAs) participate in the regulation of blood flow. Although it has been speculated that AVAs in the dog's tongue play a role in the regulation of the body temperature, no published work is available on the structural characteristics of AVAs in the dog's tongue. The purpose of the present investigation was therefore to determine the frequency of AVAs and their structural characteristics by the fabrication of vascular corrosive resin casts and examination under a scanning electron microscope. This method permitted not only the visualization of the three-dimensional characteristics of AVAs, but also a clear differentiation between arterioles and venules. The total number of AVAs in the mucosal lamina propria of the dorsum of the left tongue half was 2,292. Several essential types such as S-shaped, hook-shaped, straight, bibranching and Y-shaped AVAs were observed, of which the S-shaped and similar types constituted the overwhelming majority; Y-shaped types have never been reported heretofore. This study also revealed that the locations where AVAs were most often distributed were, in descending order of frequency, the tip, the corpus and the root area of the tongue. This high frequency and strategic location of AVAs in the tongue strongly indicate that AVAs of the dog's tongue participate in the thermal regulation.

Hematoporphyrin derivative photocytotoxicity of human glioblastoma in cell culture

The parameters of hematoporphyrin-derivative (HpD) photocytotoxicity of human glioma cells in cell culture were studied to determine the optimum wavelength and power density of light, to investigate the influence of tissue oxygenation, and to evaluate the role of singlet oxygen and free radicals in producing cell death. Cell survival curves demonstrated a relative killing efficiency of 12:1 for violet compared to red light. Eighty joules of red light were required to produce 100% cell kill at an HpD concentration of 10 micrograms/ml, a level of HpD that has been quantitated in biopsies from patients receiving HpD photoradiation therapy. No difference in cellular killing efficiency was observed for power densities of red light varying from 10 to 100 mW/cm2. Cytotoxicity was directly related to O2 tension from 12 to 490 torr with a slight but consistent increase in cell kill at O2 tensions from 7 to 12 torr. Cytotoxicity was effectively quenched by beta-carotene, whereas mannitol had no effect, indicating that cytotoxicity is probably mediated via a mechanism involving singlet oxygen. This information may serve as a basis for more effective application of HpD photoradiation therapy and for designing protocols to study the efficacy of such therapy.

Phagocytosis of different matrix components by different cell types at bone-forming sites in cultured mouse calvariae

Sites of bone formation on fragments of parietal bone of fetal-mice cultured for 10 days were examined by electron microscopy after addition of either ruthenium red or ferrocyanide to the postfixation fluid. Osteoclasts, osteoblast-like cells, and macrophages were the principal active cells at these formation sites. The mononuclear cells (osteoblast-like cells and macrophages) in the osteoid tissue showed evidence of having incorporated elements of calcified tissue. Osteoblast-like cells had phagocytized collagen fibrils and calcified bone matrix. This occurred more frequently in the calcifying area. Mononuclear macrophages showed not only phagocytosis and digestion of cellular debris and bone spicules in the osteoid, but also active incorporation of calcified bone matrix that had been detached from its surroundings by its pseudopod-like projections from long cytoplasmic processes. Collagen fibrils were seldom observed within the macrophages. These observations suggest that in our culture system osteoblast-like cells and macrophages at bone formation sites have a phagocytic role in bone remodeling.

Fibrinolytic activity of middle ear fluid in otitis media with effusion

In order to investigate the prolonged factors of otitis media with effusion, hydrolytic activities for specific substrates of plasmin and plasminogen activator (P.G.-activator) and the activity for fibrin degradation (fibrinolysis) were measured. Materials were middle ear fluids of 36 cases diagnosed as unilateral otitis media with effusion. Age of the patients were from 28 to 88 years old (mean: 61.3). Using specific substrates, determinations of P.G.-activator activity and plasmin activity were made by the method of Claeson et al. and fibrinolysis was determined by the standard fibrin plate. The results are shown below: 1) Both activities for decomposition of amide against the specific substrates of plasmin and of P.G.-activator were revealed. 2) Concerning fibrinolysis in all cases, we divided them into 3 groups; fibrinolysis (-) group of 8 cases (22.2%) which could not dissolve fibrin at all, fibrinolysis (+) group of 17 cases (47.2%) which could dissolve fibrin. Fibrinolysis (+/-) group of 11 cases (30.6%) of which the presence of fibrin dissolution was unknown. 3) The progress of fibrinolysis was observed by serial collection of middle ear fluid in the same side ear of 5 cases out of 17 cases having much activity for fibrin degradation, and lowering of fibrinolytic activity was revealed in 4 out of these 5 cases as the result. On the basis of these results, we discussed on the process of prolongation in this disease from the standpoint of the presence of fibrinolytic activity in the middle ear fluid.

Postprandial plasma secretin response in patients following gastrectomy

Endogenous secretin release and luminal pH changes after a test meal were investigated in five normal persons and in 22 patients after gastrectomy and various anatomic reconstructions, such as Billroth I and II anastomoses after subtotal gastrectomy and Roux-en-Y and interposed jejunal anastomosis after total gastrectomy. In patients in the Billroth I group, the response of postprandial secretin was good if the duodenal pH was below 4.5 but it was less than that of normal persons. After the Billroth II operation, even when the jejunal pH was below 4.0, the response was much less than that for the Billroth I group. After the complete abolishment of gastric acid secretion by total gastrectomy, no postprandial secretin response was noted in patients with the Roux-en-Y anastomosis. However, a response was seen in patients with interposed jejunal anastomosis, even though it was less than that for those in the Billroth I group and in normal persons. We conclude that the impairment of endogenous secretin release may be an important factor in pancreatic dysfunction after gastrectomy, and we suggest that a Billroth I operation after subtotal gastrectomy and interposed jejunal anastomosis after total gastrectomy are better procedures than the Billroth II or Roux-en-Y anastomoses to obtain endogenous secretin release.

Flow-volume curves in children in health and disease

Pulmonary function studies were done in 136 children (5.5-17 yr old) of whom 39 had allergic type asthma, 26 chronic bronchorrhea, and 13 mucoviscidosis; the remaining 58 subjects were healthy. The children having respiratory problems were studied when they were clinically free from wheezing and pulmonary infection. Measurements of forced expiration were made with a pneumotachograph; the data were stored on a magnetic tape and analysed with a Hewlett-Packard programmed computer. Standards for the different ventilatory parameters were established for the healthy children. A step by step discriminant linear analysis of the data and application of the Kolmogorov-Smirnov test demonstrated that V25, V50 and MMEF measurements were the best discriminating parameters of pulmonary function abnormalities in the respiratory problem children.

HBV markers in Chinese in Hong Kong

A study was carried out on 779 hospital patients in the Orthopaedic and Paediatric Unit of Queen Mary Hospital, Hong Kong. Patients who had no clinical evidence of liver disease, previous history of transfusion with blood or blood products and no major surgery in the past were entered into the study. Markers of previous exposure to Hepatitis B virus (HBV) were HBsAg, anti-HBc and anti-HBs (radioimmunoassay) were done. The results showed that (a) Chinese living in Hong Kong are exposed to HBV infection throughout life (b) horizontal transmission is the dominant mode of transmission and (c) cpronic HBsAg carriers probably do not carry HBV for life but may clear HBs antigenaemia with age.