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Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit

BACKGROUND

Nosocomial infections due to Pseudomonas aeruginosa have been well described, but the environmental reservoir of the organism varies. We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa infection among infants in a neonatal intensive care unit that was associated with carriage of the organisms on the hands of health care workers.

METHODS

In August 1998, colonization or infection with P. aeruginosa was identified in six infants. Surveillance cultures for P. aeruginosa were obtained from the other 27 infants in the unit, and possible environmental reservoirs were also assessed. The hands of health care workers were inspected and cultured, and risk factors for P. aeruginosa colonization were evaluated. Isolates were analyzed for clonality by pulsed-field gel electrophoresis.

RESULTS

Surveillance cultures showed that three additional infants were colonized with P. aeruginosa. Cultures of environmental specimens were negative, but cultures of the hands of 10 of 165 health care workers (6 percent) were positive for P. aeruginosa. Increasing age (P=0.05) and a history of the use of artificial fingernails or nail wraps (P=0.03) were both risk factors for colonization of the hands. From January 1997 to August 1998, 49 infants were infected or colonized with P. aeruginosa. Pulsed-field gel electrophoresis demonstrated that 17 of these infants and 1 health care worker who had onychomycosis had the same clone. Infants who were exposed to this health care worker in August 1998 were at greater risk of having this clone than infants who were not exposed to this health care worker (odds ratio, 41.2; 95 percent confidence interval, 1.8 to 940.0; P=0.006).

CONCLUSIONS

An increased rate of infection and colonization with P. aeruginosa among infants in neonatal intensive care units should be investigated by assessing potential reservoirs, including environmental sources as well as patients and health care workers.

Atrial fibrillation after radiofrequency ablation of type I atrial flutter: time to onset, determinants, and clinical course

BACKGROUND

The occurrence of atrial fibrillation after ablation of type I atrial flutter remains an important clinical problem. To gain further insight into the pathogenesis and significance of postablation atrial fibrillation, we examined the time to onset, determinants, and clinical course of atrial fibrillation after ablation of type I flutter in a large patient cohort.

METHODS AND RESULTS

Of 110 consecutive patients with ablation of type I atrial flutter, atrial fibrillation was documented in 28 (25%) during a mean follow-up of 20.1+/-9.2 months (cumulative probability of 12% at 1 month, 23% at 1 year, and 30% at 2 years). Among 17 clinical and procedural variables, only a history of spontaneous atrial fibrillation (relative risk 3.9, 95% confidence intervals 1.8 to 8.8, P=0.001) and left ventricular ejection fraction <50% (relative risk 3.8, 95% confidence intervals 1.7 to 8.5, P=0.001) were significant and independent predictors of subsequent atrial fibrillation. The presence of both these characteristics identified a high-risk group with a 74% occurrence of atrial fibrillation. Patients with only 1 of these characteristics were at intermediate risk (20%), and those with neither characteristic were at lowest risk (10%). The determinants and clinical course of atrial fibrillation did not differ between an early (< or = 1 month) compared with a later onset. Atrial fibrillation was persistent and recurrent, requiring long-term therapy in 18 patients, including 12 of 19 (63%) with prior atrial fibrillation and left ventricular dysfunction.

CONCLUSIONS

Atrial fibrillation after type I flutter ablation is primarily determined by the presence of a preexisting structural and electrophysiological substrate. These data should be considered in planning postablation management. The persistent risk of atrial fibrillation in this population also suggests a potentially important role for atrial fibrillation as a trigger rather than a consequence of type I atrial flutter.

Induced hypervolemia and inotropic support for acute cerebral arterial insufficiency: an underused therapy

BACKGROUND

Hypervolemia and induced systemic hypertension are generally considered the standard approach to the treatment of vasospasm. Despite evidence in favor of its efficacy, this therapy is used rarely in acute cerebrovascular occlusion. We present a case supporting this treatment paradigm.

CASE DESCRIPTION

A patient developed aphasia and hemiplegia 8 h after carotid endarterectomy caused by embolic occlusion of the middle cerebral artery. Hyperdynamic/hypervolemic therapy was instituted. Serial angiograms filmed over the next 8 h demonstrated reperfusion of the hemisphere, through collateral flow. The patient's symptoms resolved.

CONCLUSIONS

We believe this case demonstrates the effectiveness of hypervolemia and inotropic support in the treatment of acute embolic stroke by inducing dilatation of the leptomeningeal collateral circulation.

Armadillo and dTCF: a marriage made in the nucleus

Within the past year, Armadillo and beta-catenin's role in transducing the Wingless/Wnt signal has been substantially clarified. It is now clear that Armadillo and beta-catenin bind directly to members of the T-cell factor/lymphoid enhancer factor subfamily of HMG box DNA-binding proteins, forming bipartite transcription factors that regulate Wingless/Wnt responsive genes in both Drosophila and vertebrates. These partners not only play key roles in a variety of cell fate decisions during normal development but, when inappropriately activated, contribute to both colon cancer and melanoma.

Conduction properties of the inferior vena cava-tricuspid annular isthmus in patients with typical atrial flutter

INTRODUCTION

A functional region of slow conduction located in the inferior right atrium has been postulated to be critical to the induction and maintenance of typical human atrial flutter. We reexamined the potential role of functional conduction delay in the annular isthmus between the tricuspid valve and the inferior vena cava; it is within this region that such delays have been postulated to occur, and where interruption of conduction by radiofrequency energy application has been shown to eliminate typical flutter.

METHODS AND RESULTS

Thirty patients with type I atrial flutter (30 counterclockwise, 14 clockwise) were studied. Counterclockwise and clockwise isthmus activation times adjacent and parallel to the tricuspid valve were measured during three conditions: (1) atrial pacing in sinus rhythm, (2) atrial flutter, and (3) entrainment of atrial flutter. During pacing in sinus rhythm at progressively shorter cycle lengths, both counterclockwise and clockwise isthmus activation times remained unchanged; decremental conduction prior to flutter induction or loss of capture was not observed. Counterclockwise isthmus activation time did not significantly differ during flutter (68 +/- 23 msec), inferolateral tricuspid annulus pacing (71 +/- 23 msec), or entrainment of flutter (72 +/- 23 msec). Similarly, clockwise isthmus activation times did not significantly differ between flutter (65 +/- 22 msec), proximal coronary sinus pacing (73 +/- 21 msec), or entrainment of flutter (64 +/- 15 msec).

CONCLUSION

Decremental conduction is not characteristic of activation through the isthmus when activation is assessed parallel and adjacent to the tricuspid annulus. Functional slowing or conduction delay does not develop in this region during typical atrial flutter.

Patterns of Cryptosporidium antigen and oocyst excretion in calves studied by reverse passive haemagglutination and light microscopy

A reverse passive haemagglutination (RPH) assay incorporating a monoclonal antibody against Cryptosporidium parvum oocysts was used to follow Cryptosporidium coproantigen excretion by calves. RPH detected soluble antigen that passed 0.22 micron filters. Non-specific reactions that occurred in some samples were markedly reduced by heat treatment of the faecal specimens and were abolished by filtration after heat treatment. Results were compared with oocyst counts performed by microscopy of modified Ziehl-Neelsen (MZN) stained faecal smears. Five hundred and thirty-two daily specimens were examined from 30 calves. The mean age at which positive results for both oocysts and antigen was detected was 9 days (range 5-15 days), and excretion lasted for 5-11 days with some cycling of positive reactions in some calves. The occasional cycling to a negative reaction demonstrates a need to take samples from consecutive days to ensure diagnosis. Two hundred and ninety-one (54.7%) specimens were negative in both tests, 178 (33.5%) were positive in both, 14 (2.6%) were positive only by microscopy, and 49 (9.2%) were positive only by RPH. By these criteria the kappa coefficient of agreement between the tests was good (0.753). Compared with MZN, the sensitivity of RPH is 92.7%, specificity 85.6%, positive predictive value 78.4% and negative predictive value 95.4%. The method is simple, objective, has ease of quality control, and either single samples or batches can be processed.

Pedal ectrodactyly: a biomechanical approach to management

The authors offer a brief review of pedal ectrodactyly and associated conditions. Discussion of the biomechanical aspects of this abnormality are presented. A case study is also illustrated.

Cryptosporidium antigen detection in human feces by reverse passive hemagglutination assay

A reverse passive hemagglutination (RPH) assay was developed for Cryptosporidium oocyst antigen with an antioocyst monoclonal antibody (MAb; MAb-C1) coupled to stabilized sheep erythrocytes. RPH was compared with microscopy of auramine-phenol-stained smears of 56 oocyst-positive fecal samples, each of which was tested blindly by RPH with two oocyst-negative samples received on the same day (a total of 112 controls). Thirty-nine additional fecal samples from human immunodeficiency virus type 1 antibody-positive patients with diarrhea (10 of which were positive in auramine-phenol-stained smears) were stored at -20 degrees C before testing. Thirty specimens with a variety of other fecal pathogens (all negative for oocysts) were also tested. Of the 237 samples tested, 69 were positive by one or both methods: 65 by RPH and 66 by microscopy. The kappa coefficient of agreement between the methods was very high at 0.926. The sensitivity of RPH was 93.9%, the specificity was 98.2%, the positive predictive value was 95.4%, and the negative predictive value was 97.7%. Visible oocyst numbers and RPH titers were measured after storage of fecal samples and oocyst concentrates for 8 days at 4 degrees C. Oocyst morphology was generally poor in specimens from the human immunodeficiency virus type 1 antibody-positive group, and it degenerated during the 8-day storage experiments. MAb-C1-reactive antigen eluted from oocysts to give progressively higher reciprocal titers during storage, and it was partially removed from the oocysts by concentration. RPH is a promising technique for the detection of Cryptosporidium antigen in human feces and may be useful when specimens are stored before testing. Studies of the sensitivity of Cryptosporidium immunoassays should take into account the possible release of antigen from oocysts.

Pigmentary lines of the newborn

We report three cases of infants born with extensive linear and retiform pigmentation on the trunk and extremities. In none of these cases was there an associated underlying medical disorder, and in all cases the pigmentation resolved by 6 months of age. It appears that the treatment of choice for this transient disorder is reassurance.

Antigen detection in pneumococcal pneumonia

Streptococcus pneumoniae remains the commonest proven cause of community-acquired pneumonia in patients admitted to hospital, but no currently available diagnostic method can be regarded as a gold standard. Microscopy of sputum is usually considered insensitive and poorly specific, and more invasively-obtained specimens are not routinely collected. Cultures of blood and respiratory secretions, and countercurrent immunoelectrophoresis (CIE) and particle agglutination-based assays for capsular polysaccharides in serum and urine specimens, are specific but less than ideally sensitive. Some workers have reported specificity problems when immunoassays are applied to respiratory secretions. New diagnostic methods include detection of pneumococcal C polysaccharide in sputum and urine by ELISA and particle-agglutination assays, and these appear promisingly sensitive and specific in preliminary studies. Clinical assessments are now required to define the role of these techniques in guiding the treatment of individual patients.

Streptococci from primary isolation plates grouped by reverse passive haemagglutination

Reverse passive haemagglutination, a novel microtitre based assay, was compared with the Streptex (Wellcome UK) latex slide agglutination kit for streptococcal grouping in a diagnostic microbiology laboratory. Three hundred and fifty two extracts from 349 consecutive primary isolation plates were assayed by both methods. Reverse passive haemagglutination gave identical grouping results for 98.0% of the 345 streptococci identified by Streptex, and the kappa coefficient of agreement between the methods for all 352 extracts tested was 0.973. Cross reactions with Listeria spp seen with Streptex were not found by reverse passive haemagglutination. In the reverse passive haemagglutination method 11 streptococci could be grouped on each 96-well plate and most reactions were stable for at least 30 minutes. Reverse passive haemagglutination is more rapid to perform than latex slide agglutination when many organisms are to be grouped, and the patterns of haemagglutination are easily recognised. If the method was taken into routine use in a diagnostic laboratory, the persistence of reverse passive haemagglutination reactions would enable grouping results to be checked for quality control purposes.

Exfoliative dermatitis secondary to tobramycin sulfate

We report a case of exfoliative dermatitis clearly linked to intravenous and intraperitoneal administration of tobramycin. Despite the complicated drug regimen with which the patient was treated, tobramycin was implicated by rechallenge with the drug once before its role was understood and again at an outside hospital.

Aplasia cutis congenita associated with syndactyly and supernumerary nipples: report of a second family with similar clinical findings

Aplasia cutis congenita (ACC) is a rare disorder characterized by localized absence of skin at birth. A subtype consisting of a solitary scalp defect in association with limb abnormalities has been described. We report a case of ACC in association with 3,4 syndactyly and supernumerary nipples with an apparent autosomal dominant inheritance pattern.

An audit of the clinical use of magnetic resonance imaging of the head and spine

An audit was undertaken of the use of magnetic resonance imaging for clinical problems of the head and spine. Using a form of simulation, two consultant clinicians were asked to assess a sequential series of 200 patients referred for magnetic resonance. The clinicians considered that 200 magnetic resonance studies could replace about 330 other imaging and neurophysiology investigations; the cost of the alternative tests approximated the cost of magnetic resonance. However, there was considerable variation between cases in the costs of investigations potentially replaced by the procedure under audit, and this variation suggests ways in which magnetic resonance might be used more cost-effectively in the future.

The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage

The Segond fracture is a small vertical avulsion injury of the lateral aspect of the proximal tibia just distal to the plateau. It results from excessive internal rotation and varus stress. The plain film and arthrographic findings were studied in nine patients with the fracture. Although previous publications have relied primarily on the anteroposterior projection for diagnosis, the injury was apparent only on the tunnel view in two of our cases. The arthrogram was particularly important in identifying abnormalities of the anterior cruciate ligament (nine of nine cases) and/or meniscal tears (six of nine cases). The arthrographic findings related to the lateral ligamentous damage depended on the severity of the injury and on the interval between the injury and the arthrogram. In our series, the Segond fracture was uniformly associated with detachment of the capsular portion of the lateral collateral ligament and tears of the anterior cruciate ligament. In the majority of cases, there were associated injuries of the menisci and other supporting ligaments.

Mother-daughter in vitro fertilization triplet surrogate pregnancy

A successful triplet pregnancy has been established in a surrogate gestational mother following the transfer of five embryos fertilized in vitro. The oocytes were donated by her biological daughter, and the sperm obtained from the daughter's husband. The daughter's infertility followed a total abdominal hysterectomy performed for a postpartum hemorrhage as a result of a placenta accreta. Synchronization of both their menstrual cycles was obtained using oral contraceptive suppression for 2 months, followed by stimulation of both the surrogate gestational mother and her daughter such that embryo transfer would occur at least 48 hr after the surrogate gestational mother's own ovulation. This case raises a number of medical, social, psychological, and ethical issues.

Cost-benefit evaluation of body computed tomography

Cambridge Health Authority accepted the gift of a whole body computed tomography (CT) scanner and radiotherapy planning system for Addenbrooke's Hospital (AH) from a local charity in 1981. The charity was to provide funds for the maintenance and all running costs for the first 5 years. Acceptance of the gift was conditional on an evaluation of the use of body CT before any decision about subsequent funding was made. The results of this evaluation are presented here. A detailed assessment fo 150 consecutive CT studies was performed together with an audit of CT use. The costs of running the CT unit and an indirect measurement of the benefits brought about by body CT were evaluated. In 86% of patients the CT findings were considered likely to have a great contribution to clinical management; in less than 10% was little or no benefit likely. In most patients (68%) CT was considered to have been more useful than any alternative test(s) would have been. The total cost of CT during the financial year 1983-84 was 219,163 pounds and the average cost per CT study was 73 pounds. The assessment indicated annual benefits fo 673,385 pounds including the saving of 3,880 inpatient bed days, 760 outpatient visits and alternative tests costing 290,684 pounds p.a. Some corroborative evidence that these benefits have occurred is presented. This study suggests a cost benefit ratio of 1:3.07.

Multiple cutaneous granular cell tumors in children

Multiple cutaneous granular cell tumors are rare in childhood. We cared for two children with 15 and 6 tumors respectively. The tumors were asymptomatic nodules in the skin. Histologically, they consisted of large cells containing granules that were positive on periodic acid-Schiff stain and diastase resistant.

Effects of tumor promoters on sodium ion transport across frog skin

Phorbol esters are tumor promoters and mitogens whose effects may be mediated by changes in ion transport across membranes. Clarification of the transport effects of these agents should be facilitated by using a well-characterized model epithelial system whose intracellular and transmural parameters are readily measurable. The current results constitute a preliminary study of the effects of 12-O-tetradecanoylphorbol-13-acetate (TPA), phorbol-12,13-dibutyrate (PDBU), and phorbol on the short-circuit current (Isc) across frog skin. TPA produced two effects: a stimulation of Isc of variable magnitude and a far more constant inhibition of the natriferic action of vasopressin. These effects appear related to the action of TPA as a tumor promoter insofar as PDBU (an active ester) also inhibited the natriferic response to vasopressin, whereas phorbol (inactive as a tumor promoter) had no significant effect. TPA is largely active from the mucosal medium, inhibits the natriferic response to adenosine 3',5'-cyclic monophosphate (cAMP) as well as that to vasopressin, and does not stimulate Isc in the presence of 10(-4) M mucosal amiloride. Inhibition of prostaglandin E1 production by indomethacin had no effect on the actions of TPA. The results indicate that frog skin is a promising model for studying the transport effects of the phorbol esters. The data further suggest that TPA acts on frog skin by activating the physiological amiloride- and cAMP-sensitive channels gating apical Na+ entry from the mucosal medium into the epithelial cells.

The older person in prison

Through an extensive review of the literature a profile of the older prisoner is described. Psychologically, the elderly inmate is insecure, fearful, and becomes 'sedated' (giving up). Sociologically, the process of prisonization is examined and the concept of institutional neurosis occasionally appears and is manifested in older prisoners not wanting to leave prison. The elderly are also associated with social control as persons not likely to riot and serving as a stabilizing force. The issues of age-integrated versus age-segregated environments are discussed with alternative living patterns suggested. The research methodology in criminal justice studies are critiqued and recommendations are made for more effective study.

Upper gastrointestinal barium studies in the elderly: follow-up in 101 patients

A A retrospective study of 101 elderly patients who were referred for upper gastrointestinal barium studies showed that this led to a change of management in 36 patients. The commonest management change was endoscopic referral (10 patients). However, in only on patient did this sequence lead to surgery and this was merely palliative. Dysphagia, vomiting and weight loss were shown to be the presenting features most likely to result in an abnormal barium study. The most frequently detected abnormalities were hiatus hernia, reflux, oesophageal stricture, peptic ulcer and gastric carcinoma.

Screening investigations in the elderly

The study evaluates the usefulness of some commonly used screening investigations in the management of elderly acutely ill medical patients. It was performed on 50 consecutive admissions to one ward and all patients received a full blood count, ESR, urea and electrolyte estimation, liver function tests, thyroid function tests, examination of a mid-stream urine specimen and P-A chest X-ray examination. When performed in the absence of clinical indication these tests were considered to be screening tests. On assessing the tests performed prospectively, it was shown that only a full blood count, urea and electrolyte estimation, ward testing of urine, and, possibly, a P-A chest X-ray examination are worthwhile screening investigations in this patient population. The ESR and liver function tests and mid-stream urine specimens seem to be of little value in the absence of clinical indication.

Pressure-induced deformation in immature airways

The effect of positive pressure ventilation on the highly compliant fetal airways was evaluated utilizing fetal rabbit tracheal segments. The degree of mechanical and dimensional deformation was quantified to the pressure applied intermittently (IPP) or continuously (CPAP) for 60 min. Excised tracheal segments were obtained at 21, 27, and 31 days fetal rabbit gestation (term = 31 days) and from 18 +/- 6-month-old adults. Internal diameter, resting length, and volume of the tracheal segments were measured, and their pressure-volume relationships were determined by plethysmography. Tracheal specific compliance at deflation pressure of 0 to 10 cm H2O was calculated from these data. In all fetal groups, the application of positive pressure resulted in a decrease of both tracheal distensibility and the slope of the pressure-volume curves; in addition, a highly significant decrease in tracheal specific compliance was documented. At 21 days gestation, the tracheal specific compliance decreased from 0.089 to 0.034 cm H20-1 (P less than 0.001) after CPAP and to 0.025 cm H2O (P less than 0.001) after IPP. For the same group, the resting tracheal volume increased by a dramatic 89% (P less than 0.001) after CPAP and by 124% (P less than 0.001) after IPP. The magnitude of these alterations decreased as gestational age advanced; the changes were not significant by adulthood. These data indicate that significant pressure-induced deformation (barotrauma) is sustained by susceptible immature airways.

Secretion of cholesterol-rich lipoproteins by perfused livers of hypercholesterolemic rats

Rats maintained on a high-fat diet supplemented with propylthiouracil develop a hypercholesterolemia, an increased serum level of apolipoprotein (apo) E, abnormal very low density lipoproteins (VLDL) and low density lipoproteins (LDL), and a fatty liver which contains cholesterol ester as its major lipid. The fatty liver secretes apoE into a recirculating perfusate at a significantly higher rate and produces cholesterol ester-rich, apoC-deficient VLDL with slower electrophoretic mobility than the triacylglycerol-rich VLDL produced by perfused normal livers. LDL, secreted in significant quantities by the perfused fatty liver, but not by the normal liver, is also cholesterol rich and contains apoE as well as apoB. The incorporation of [(3)H]leucine into apoVLDL and apoLDL secreted by the livers of the hypercholesterolemic animals and the apoVLDL secreted by the normal liver corresponds to the pattern visualized when the apoproteins are separated by polyacrylamide gel electrophoresis. Similar patterns are noted when non-recirculating perfusates are studied. These results indicate that the cholesterol ester-rich, apoC-deficient VLDL and the apoE-containing LDL found in the serum of hypercholesterolemic rats are not solely catabolic remnants of VLDL and chylomicrons but are secreted by the liver. Separation of the perfusate lipoproteins by agarose gel filtration revealed that most of the apoE secreted by the livers of hypercholesterolemic rats is found in the VLDL and LDL, whereas apoE secreted by the normal livers is distributed equally between VLDL, high density lipoproteins, and a low molecular weight fraction which corresponds to the virtually delipidated apoprotein. Thus the distribution of apoE among the lipoprotein fractions may be related to the total amount of cholesterol being transported in the circulation.

Initial splanchnic extraction of ingested glucose in normal man

Estimates of initial splanchnic uptake of ingested glucose and the concomitant suppression of endogenous glucose production were obtained in man by validated tracer techniques for non--steady-state turnover measurement. Nine normal volunteers (18--44 yr old) fasted overnight received intravenous infusions of tracer (3-3H-glucose or 1-14C-glucose) and a low (45 +/- 1 g) or high (96 +/- 5 g) oral load of glucose labeled with an alternative tracer (1-14C-glucose or 2-2H-glucose). A two-compartment model was used to derive rates of peripheral appearance (Ra) of glucose from all sources (total) and the Ra of ingested glucose. Ra (total glucose) and Ra (ingested glucose) were integrated from the first appearance of ingested glucose until the basal Ra (total glucose) or 116 +/- 6 (SEM) mg/min was reattained. The total amount of glucose reaching the systemic pool in this time was 95 +/- 4 g and 46 +/- 3 g with high and low doses, respectively. Of these quantities 86 +/- 4 g and 40 +/- 3 g originated in the oral glucose, representing 90% +/- 4% of the administered glucose. The remainder (11% +/- 2% of the total) represented endogenous production, suppressed by 66% +/- 6% relative to basal. Sequestration of ingested glucose and subsequent release did not take place during the study since identical results were obtained with ingested 1-14C-glucose or 2-3H-glucose. The latter label would have been lost if the glucose had entered the hexose--phosphate pool. Thus, in normal man approximately 90% of an ingested glucose load is absorbed and passes through the liver to appear in the systemic pool.

The Gianotti-Crosti syndrome

The Gianotti-Crosti syndrome is an infrequently recognized disorder with distinctive characteristics. The eruption, which lasts for two to eight weeks, consists of large, flat-topped, nonpruritic papules on the face, buttocks, and limbs. Its onset may be preceded by fever and upper respiratory tract symptoms. Associated findings include generalized lymphadenopathy, anicteric hepatitis, and HBs antigenemia. Two children with the syndrome are described to bring this entity to the attention of pediatricians.

Triad of lichen planus, myasthenia gravis, and thymoma

Myasthenia gravis in a woman was followed by the development of severe erosive lichen planus and thymoma. Lichen planus is not ordinarily associated with other cutaneous or systemic disorders. The reported immunologic findings in some patients with lichen planus and especially the occasional association of lichen planus with certain disorders linked with immunologic disturbances suggest an autoimmune pathogenesis for this disorder.

Gaseous exchange and acid-base balance in premature lambs during liquid ventilation since birth

Nine distressed premature lambs were studied before, during, and after ventilation with fluorocarbon liquid (FC-80). It was found that premature lambs, delivered by cesarean section, could be adequately ventilated with oxygenated liquid for period up to 3 hr. Using fluarocarbon liquid in conjunction with the described liquid breathing system, it was possible to maintain remarkably good pulmonary gas exchange and acid-base balance during normothermic conditions. In addition, peak intratracheal pressures measured during recovery from liquid ventilation were significanly reduced (P is less than 0.001) as compared with preliquid ventilation values. This improvement in lung function is in direct contrast to the deterioration in that of the adult animal following liquid ventilation as reported previously.

The maintenance of liver cells in vitro for virological and other studies

Cells from the livers of rats and monkeys were dispersed by enzyme treatment and maintained for weeks in roller tube cultures. Rat liver cells were shown to synthesize urea and monkey cells apparently synthesized RNA and protein—rat cells supported the growth of Sendai virus and monkey cells supported yellow fever virus. Organ cultures of human embryo liver supported the growth of adenovirus type 5 and herpes simplex virus. The Australia antigen serum hepatitis agent failed to grow in human or monkey liver cultures.