Correlation of near infrared spectroscopy cerebral blood flow estimations and microsphere quantitations in newborn piglets

We compared cerebral blood flow (CBF) estimated using transmission mode near infrared spectroscopy (NIRS) and a modification of the Fick principle with CBF quantitations by radioactive microspheres (MSs) in newborn piglets. Thirteen piglets were studied during steady state, ischemia, and during two reflow periods. NIRS and MS flows were not significantly different during any measurement period. NIRS flows were compared to total brain blood flows and to regional brain blood flows quantitated with MSs and correlated best with temporal cortical flows. Linear regression analysis of the NIRS flows plotted against MS-quantitated temporal cortical flows showed r = 0.71. Thus, CBFs obtained with NIRS were not significantly different from, showed the same directional changes, and correlated acceptably with flows quantitated by MSs.

Resting energy expenditure and nitrogen balance in critically ill pediatric patients on mechanical ventilation

Nutritional support is important in critically ill patients, with variable energy and nitrogen requirements (e.g., sepsis, trauma, postsurgical state) in this population. This study investigates how age, severity of illness, and mechanical ventilation are related to resting energy expenditure (REE) and nitrogen balance. Nineteen critically ill children (mean age, 8 +/- 6 [SD] y and range 0.4-17.0 y) receiving total parenteral nutrition (TPN) were enrolled. We used indirect calorimetry to measure REE. Expected energy requirements (EER) were obtained from Talbot tables. Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) score were calculated. Total urinary nitrogen was measured using the Kjeldahl method. PRISM and TISS scores were 9 +/- 5 and 31 +/- 6 points, respectively. REE was 62 +/- 25 kcal.kg-1.d-1, EER was 42 +/- 11 kcal.kg-1. d-1, and caloric intake was 49 +/- 22 kcal.kg-1.d-1. Nitrogen intake was 279 +/- 125 mg.kg-1.d-1, total urinary nitrogen was 324 +/- 133 mg.kg-1.d-1, and nitrogen balance was -120 +/- 153 mg.kg-1.d-1. The protein requirement in this population was approximately 2.8 g.kg-1.d-1. These critically ill children were hypermetabolic, with REE 48% higher (20 kcal.kg-1.d-1) than expected. Nitrogen balance significantly correlated with caloric and protein intake, urinary nitrogen, and age, but not with severity of illness scores or ventilatory parameters.

The clinical engineer: a ghost hunter or manager of EMI

The management of EMI and risk control in the clinical environment presents the clinical engineer with new challenges and responsibilities. The keys to successfully meeting these challenges and responsibilities are education, cooperation, and the ability to be creative in the quest for solutions to problems of ever-increasing complexity. Experience in detecting and analyzing test results, which is gained over time, enhances the skills that clinical engineering professionals bring to this challenge. Attention to EMI risks has been influenced by a number of factors, including a spirit of cooperation between manufacturers and users, concerns over patient care and perceived product efficacy, and an increasing number of regulations by European and U.S. regulatory agencies. As a result, device emissions are being reduced and device immunity to EMI is improving. Further improvements in device immunity are still needed. The radio spectrum with regard to intentional radiators is in a continual state of flux. As industry attempts to improve labor efficiency through the use of radio communications, new and higher-powered sources of RF--both internal and external to the physical plant--appear each day in the clinical environment. Since the distance between intentional radiators and potentially susceptible devices is usually beyond the control of an institution, industry must continue to reduce device susceptibility. There should be a stronger dialogue between institutions (even if they do not have proactive EMI reduction programs) and manufacturers to identify ways to improve device immunity to EMI and to increase product designers' and users' awareness of potential problems.

Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values

The use of prediction equations has been recommended for calculating energy expenditure. We evaluated two equations that predict energy expenditure, each of which were corrected for two different stress factors, and compared the values obtained with those calculated by indirect calorimetry. The subjects were 55 critically ill children on mechanical ventilation. Basal metabolic rates were calculated with the Harris-Benedict and Talbot methods. Measured resting energy expenditure was 4.72 +/- 2.53 MJ/d. The average difference between measured resting energy expenditure and the Harris-Benedict prediction with a stress factor of 1.5 was -0.98 MJ/d, with an SD delta of 1.56 MJ/d and limits of agreement from -4.12 to 2.15; for a stress factor of 1.3 the average difference was -0.22 MJ/d, with an SD delta of 1.57 MJ/d and limits of agreement from -3.37 to 2.93. The average difference between measured resting energy expenditure and the Talbot prediction with a stress factor of 1.5 was -0.23 MJ/d, with an SD delta of 1.36 MJ/d and limits of agreement from -2.95 to 2.48; for a stress factor of 1.3, it was 0.42 MJ/d, with an SD delta of 1.24 MJ/d and limits of agreement from -2.04 to 2.92. These limits of agreement indicate large differences in energy expenditure between the measured value and the prediction estimated for some patients. Therefore, neither the Harris-Benedict nor the Talbot method will predict resting energy expenditure with acceptable precision for clinical use. Indirect calorimetry appears to be the only useful way of determining resting energy expenditure in these patients.

EMC(electromagnetic compatibility): how to manage the challenge

The significant changes in health care and telecommunications has produced an emergence of new and exciting technologies. Clinical engineers must continue to safeguard patient safety by adequately refurbishing their arsenal of technical knowledge of electromagnetic compatibility (EMC). This document examines the methodology and the tools for managing the technical changes in the telecommunications and biomedical equipment areas.

Nutrition requirements in patients with toxic epidermal necrolysis

Patients with toxic epidermal necrolysis, a severe, exfoliative skin disorder, have clinical features similar to those of partial-thickness burn patients. The literature suggests that they also have similar nutritional requirements. We report two patients diagnosed with toxic epidermal necrolysis on mechanical ventilation, in whom resting energy expenditure and respiratory quotient were measured by indirect calorimetry. The patients were treated using standard burn protocols. Nitrogen balance was calculated by measuring total urinary nitrogen in urine samples obtained over 24 hours. These measurements were done while the patients were on mechanical ventilation and receiving total parenteral nutrition. As in burn patients, early in their course the two patients had resting energy expenditure values twice that predicted. After 12 days of hospitalization, nitrogen balance was negative in patient 1 and positive in patient 2. Energy and protein requirements appear to have been related to the amount of body surface affected.

Action of steroid hormones on growth and differentiation of CNS and spinal cord organotypic cultures

During the prenatal period, gonadal steroid environment induces dramatic sexually dimorphic changes in the nervous system. We have used in vitro methods to study the mechanism and timing of hormonal influences on neuronal sprouting and myelination during the prenatal period. Organotypic cultures of hypothalamus and lumbar spinal cord (SC) slices from rat fetuses were grown on plasma clot or in hyaluronic acid and exposed to estrogen (17 beta estradiol) and testosterone (T) during cultivation. Both steroid hormones were active: 17 beta estradiol enhanced sprouting of hypothalamic neuronal fibers and increased the amount of synapses. In SC cultures T induced regeneration of thick nerve processes and an early onset of myelination, mainly of peripheral myelin.

Testing for EMC (electromagnetic compatibility) in the clinical environment

Testing for electromagnetic compatibility (EMC) in the clinical environment introduces a host of complex conditions not normally encountered under laboratory conditions. In the clinical environment, various radio-frequency (RF) sources of electromagnetic interference (EMI) may be present throughout the entire spectrum of interest. Isolating and analyzing the impact from the sources of interference to medical devices involves a multidisciplinary approach based on training in, and knowledge of, the following: operation of medical devices and their susceptibility to EMI; RF propagation modalities and interaction theory; spectrum analysis systems and techniques (preferably with signature analysis capabilities) and calibrated antennas; the investigation methodology of suspected EMC problems, and testing protocols and standards. Using combinations of standard test procedures adapted for the clinical environment with personnel that have an understanding of radio-frequency behavior increases the probability of controlling, proactively, EMI in the clinical environment, thus providing for a safe and more effective patient care environment.

A new organotypic culture method to study the actions of steroid hormones on the nervous system

A new organotypic culture method for growing slices of nervous system tissue, based on the use of hyaluronic acid as a growth supporting milieu, is described. This method allows cultures derived from either fetuses or newborns to grow and develop with markedly reduced amounts of added serum. Organotypic cultures from fetal rat hypothalamus were exposed to 17 beta estradiol and compared to control cultures exposed to the ethanol vehicle. When exposed to estradiol, cultures showed an outgrowth of thick nerve fibers that was accompanied by an elevation in the number of microtubules present in the neuronal processes, an increment in the number of synapses, and an increased morphological differentiation of synaptic terminals. Freeze-fracture analysis of neuronal membranes from estradiol-treated cultures revealed a significant increase in the number of exoendocytotic images and a decrease in the number of intramembranous particles. Estradiol's effects parallel those found in in vivo studies, indicating that hyaluronic acid-based organotypic cultures represent an appropriate model to study hormonal influences on the developing nervous system.

Prosthetic fitting and ambulation in a paraplegic patient with an above-knee amputation

The combination of paraplegia with an above-knee amputation is a complex injury that makes the rehabilitation process difficult. This article describes a case of T12 paraplegia and an above-knee amputation. After the rehabilitation course, the patient achieved full ambulatory independence with an ischial containment, contoured adducted trochanteric controlled alignment method (CATCAM) prosthesis and a knee ankle foot orthosis (KAFO). Difficulties in fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed.

Electromagnetic interference: causes and concerns in the health care environment

In the past 15 years there has been a dramatic increase in the number of radio frequency emission sources that have entered medical treatment areas. Personal computers, digital pagers, hand-held radios, cellular phones, and wireless input devices have all become more prevalent in the contemporary clinical environment. Because of the productivity gains these devices promise, it is unlikely that the use of electronic instrumentation and wireless technologies will diminish--in fact greater uses are projected. Along with the benefits these devices provide, they also create a greater opportunity for increased electromagnetic interference among devices. It is important that engineering and professional staff are aware of some of the complex interactions these devices can create. Managing this emerging problem should be a concern for the medical community. Engineering staff should be able to communicate effectively with medical staff, patients, and visitors regarding potential interactions and how to recognize them and mitigate their consequences.

A new method to evaluate cardiovascular response in anesthetized rats. Hypertension after variable intensity, brief electrical stimuli

To establish and standardize a nociceptive response in anesthetized rats, the hypertensive responses to defined electrical and mechanical stimuli were studied. Rats (n = 7) were given etomidate, 3.8 mg/kg/hr intravenously (i.v.) 2 hr following carotid artery and jugular vein cannulation. At 15 min after beginning the infusion, four types of noxious stimuli were administered sequentially at 1-min intervals (14 stimuli total): Type 1: Square electrical waves, 125 cps, 1.6 msec, 2-sec train duration, varying current from 0.4 to 12 mA (11 stimuli); Type 2: A single 10-mA electrical stimulus, 5-sec train duration; Type 3: Tail clamping; and, Type 4: Skin incision. After each stimulus, maximum change in systolic blood pressure (delta SBP) was measured. delta SBP after the most intense stimuli was as follows: Type 1 (12 mA, 2 sec), 32.1 +/- 2.14 mmHg; Type 2 (10 mA 5 sec), 42.9 +/- 2.4 mmHg; Type 3 (tail-clamping), 34.3 +/- 3.3 mmHg; Type 4 (skin incision), 14.2 +/- 2.8 mmHg. For the multiple Type-2 stimuli, a relationship between current and delta SBP was present. The authors believe that characterized graded electrical stimulation will allow a more quantitative evaluation of the hypertensive response to noxious stimuli in etomidate anesthetized rats, as compared to observing a single response to a single stimulus. The characterization of the electrical stimulation by amplitude, frequency, and wave form makes research work on nociception under anesthesia easily reproducible.

Minimal tourniquet pressure to maintain arterial closure in upper limb surgery

Complications of the pneumatic tourniquet used during limb surgery result from excessive direct pressure. Traditional recommendations suggests parameters for maximum pressure and time limits rather than the minimal effective pressure to achieve a bloodless field. A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate haemostasis in the upper limb. The correlations between several possible influencing parameters (age, sex, arm fat thickness, extremity length, systolic, diastolic, and mean blood pressures) and the minimal pneumatic tourniquet pressure at which the peripheral pulse reappeared were studied in 50 patients undergoing surgery, using a Doppler stethoscope. The average Doppler Opening Pressure was 168.5 +/- 42.7 mmHg and the only significant clinical variable was the mean blood pressure. From these results an equation was derived to predict the minimal effective tourniquet pressure. The mean calculated tourniquet pressure was 202.3 +/- 34.2 mmHg, well below the 250 to 300 mmHg previously recommended. The technique consisted of inflating the tourniquet to a pressure of 300 mmHg, then reducing it to the calculated value. A bloodless field was maintained in all patients.

Technology evaluation in a US hospital: the role of clinical engineering

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, containment of cost, and an increased access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programmes that need pertinent information and methods for new equipment planning as well as for reduction in the ownership costs of existing equipment. Clinical engineers can identify new medical equipment, review their institution's technological position, develop equipment-selection criteria, supervise installations and monitor postprocurement performance to meet their hospital's programme's objectives. This programme, together with cost accounting analysis, will objectively guide the capital assets decisionmaking process. The result of systematic planning and execution, the programme will assure the lowest life-cycle costs at the best performance. The clinical engineer's skills and expertise are needed to facilitate the adoption of an objective methodology for implementing the programme, thus improving the match between the hospital's needs and budget projections, equipment performance and cost of ownership.

Management of malignant air leak in a child with a neonatal high-frequency oscillatory ventilator

A 10-year-old, 36-kg child with a malignant air leak who failed conventional mechanical ventilation and high-frequency jet ventilation was successfully treated with a neonatal high-frequency oscillatory ventilator for 31 days. Since the air leak resolved with minimal hemodynamic compromise, this technique may have application in the management of respiratory failure and air leak in the older and larger child for prolonged periods of time.

Spinal cord slices with attached dorsal root ganglia: a culture model for the study of pathogenicity of encephalitic viruses

We describe here a culture system for long-term growth of organotypic slices of spinal cord, with attached dorsal root ganglia (DRG) derived from 13-14 day mouse fetuses. This is a unique in vitro tool in which both central and peripheral nervous tissue grow and differentiate in culture to become heavily myelinated. During cultivation the slices and the ganglia become flattened so as to allow microscopical and immunocytochemical staining. When both central and peripheral myelin had been formed (usually around the third week of cultivation), cultures were infected with 5 x 10(6) PFU of West Nile Virus (WNV). Progeny virions appeared first in about 10% of the neurons and were subsequently observed between lamellae in the central myelin sheath of several axons. Such viral arrangement in relation to myelin membranes, might provide a novel concept for a possible mechanism underlying slow viral infection.

Incidence of perioperative myocardial ischemia detected by different electrocardiographic systems

To determine the extent to which different electrocardiographic systems account for differences in reported incidence of perioperative myocardial ischemia, the authors simultaneously recorded in 109 patients undergoing coronary artery bypass grafting (CABG) the V5 or modified CM5 lead on five ECG systems by means of a specially constructed common V5 lead. The systems included a Spacelabs Alpha 14 Model Series 3200 ECG Cardule at bandwidths of 0.05-125 Hz and 0.5-30 Hz (a typical operating room monitor), a Marquette Electronics MAC II ECG at 0.05-40 Hz and 0.05-100 Hz (a standard ECG), and a Del Mar Holter recorder at 0.1-100 Hz. Relative ST-segment position and incidence of new ischemia compared to the preoperative ECG were determined in 109 sets of preinduction traces and 877 sets of intraoperative traces. ST-segment position on the three recording systems conforming with the American Heart Association (AHA) low-frequency response recommendations (0.05 Hz) were similar. Compared to the standard ECG, ST-segment position on the Spacelabs at 0.5-30 Hz was consistently more negative. Displacement on the Holter was consistently less negative and less positive. By the 0.1-mV displacement criterion for diagnosis of myocardial ischemia on any one ECG system, 16.5% of patients on arrival and 32.1% of patients intraoperatively suffered new myocardial ischemia. Based on the operating room monitor, arrival and intraoperative ischemia were present in 15.6 and 27.5% of patients, respectively. Ischemia at the same periods was less frequent by the standard ECG system (5.5 and 12.8%, respectively) and least frequent by the Holter recorder (4.6 and 8.3%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Selective adherence of neurons and glial cells from dissociated cerebral and spinal cord microcarrier cultures

In stationary cultures of dissociated brain and spinal cord grown on microcarriers (MCs), the neuronal and ependymal cells attached to the MCs forming floating aggregates in which they grow in a three-dimensional pattern. The glial and meningeal elements on the contrary, tend to dissociate from the aggregates and adhere to the plastic dish where they divide to form a monolayer. This different behavior of CNS components is not observed in rotating cultures in which all CNS cells remain attached to the MCs and develop into mature floating structures. This cell separation in stationary MC-cultures which is documented here by SEM and immunocytochemistry, may be useful for analysis and evaluation of the metabolic biochemical events of each of the cellular components derived from the same culture.

West Nile virions aligned along myelin lamellae in organotypic spinal cord cultures

Organotypic spinal cord cultures infected with West Nile Virus (WNV) exhibited a remarkable arrangement of virions among lamellae of the myelin sheath. Virions were first observed in neurons and only at day 4 after infection appeared within the myelin lamellae. Virions were observed only in the central myelin, aligned along the interperiod lines and therefore attached to the outer side of the oligodendrocyte membrane. In spite of this peculiar location of the virions, their presence was not associated with severe damage to the axon or to the myelin sheath. The causes of the formation of this viral pattern, its morphological features, and the role which it might have in viral infection in vivo are considered.

Different pathogenicity of encephalitic togaviruses in organotypic cultures of spinal cord slices

The pathogenicity of two encephalitic Togaviruses, Sindbis virus (SV), an alphavirus, and West Nile virus (WNV), a flavivirus, was studied in organotypic cultures of fetal mouse spinal cord slices grown in roller tubes. After about 3 weeks in vitro, during which time the cultures became abundantly myelinated, they were infected either by 5 X 10(5) PFU SV or by 5 X 10(6) PFU WNV per culture. The viruses caused different patterns of cytopathogenicity: SV induced severe cytotoxicity in all glia cells and neurons with concomitant demyelination within 48 hr. In contrast, WNV, even 4 days after infection, caused only mild cytopathic effects mainly to neurons and astrocytes and a slight degree of damage to the myelin sheath. A most remarkable finding was the entrapment of WNV particles in the interperiod lines of the myelin sheaths. Treatment of cultures with mouse alpha and beta interferon prior to their infection with either virus protected the cultures from any viral damage. Long-term exposure of non-infected control organotypic cultures of fetal spinal cord slices to mouse interferons had no significant effect on neuronal and glial differentiation, and myelin formation.

Uptake and distribution of lidocaine in fetal lambs

The fetal uptake of lidocaine was measured continually and quantitatively during and after a constant rate intravenous (iv) maternal infusion into five chronically prepared pregnant ewes. Lidocaine, 6 mg/kg (base), was infused at a constant rate for 1 h and measurements continued to 5 h. Rate of fetal uptake was determined from the product of the umbilical venous (UV) and fetal aortic (FA) concentration difference and umbilical blood flow (Qu). Total fetal uptake was determined by integrating fetal uptake rate with respect to time. Maternal and fetal protein binding was determined, and its effect on fetal blood concentrations was evaluated. Mean total fetal uptake as it related to time and infused dose increased linearly (r = 0.998, P less than 0.001) with a constant, weight-normalized fetal-maternal dose fraction of 0.45 during the infusion. Despite rapidly declining blood concentrations after the infusion, uptake increased an additional 17%. The sevenfold variation in uptake appeared to be inversely related to the biodegradation rate of lidocaine. Fetal-maternal concentration ratios (F/M) increased during declining blood concentrations. Protein binding determinations for maternal and fetal blood were 43.6 +/- 2.48% and 26.9 +/- 1.59%, respectively. These values were used to calculate the F/M in conjunction with the maternal and fetal pH. At maternal-fetal equilibrium the calculated F/M, 1.0 +/- 0.05, closely approximated the observed, 1.0 +/- 0.03. Variations in lidocaine concentrations among the vital organs 4 h after the infusion were small, but high concentrations of metabolites were found in the lungs and kidneys. The results challenge the validity of placental transfer estimates commonly based on the F/M and umbilical cord blood concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphological alterations in cultured neuromuscular tissue induced by two anesthetic agents

A diversity of pathogenic effects was observed in two complementary culture systems following their exposure to the anesthetic agents. Thiopental sodium and ketamine hydrochloride. The cytotoxic effects of both agents in these two culture types were reversible and dose-related. In organotypic spinal cord slice cultures, thiopental sodium caused general toxicity but no demyelination, while ketamine hydrochloride induced, to a varied extent, damage of the myelin sheath and degeneration of mitochondria into multilamellar bodies. In autologous nerve-muscle co-cultures both anaesthetic agents caused the arrest of muscle contractions. However, when added to skeletal muscle cultures, the drugs differed in their effect. Thiopental sodium did not inhibit spontaneous muscle contractions indicating, as in the case of Tubocurarine, a direct effect of the drug on the neuromuscular junction. Ketamine hydrochloride, in contrast, arrested spontaneous muscle contractions, implying that it did not directly affect the neuromuscular synapse.

Ethical issues in the clinical engineering profession

The growing concern among biomedical engineers who practice in the clinical environment regarding the degree of professionalism and personal commitment that is being demonstrated by the engineering discipline is examined. Issues that will assist in shaping the characteristics of professional excellence are addressed. The characteristics that are present to varying degrees in every group commonly recognized to be a profession are described. Three levels and six stages of ethical conduct are identified.

Clinical engineering program productivity and measurements

The health care delivery system is undergoing evolutionary changes that are also affecting Clinical Engineering. The integration of engineering and the life sciences created an industry whose "product" must be quality patient care. The utilization of technologies in the clinical environment is perpetually growing, and has created a need for professional technical management. The present changing environment requires Clinical Engineers to become effective leaders and efficient managers. The efficient consumption of an organization's resources is dependent on its managers' abilities to assess and optimize their operations under dynamic conditions. This paper describes some means for monitoring the clinical engineering department "output" and for measuring and reporting the relative changes in output, thus enhancing progress toward achievement of established goals. The tools and techniques offered here are not an end in themselves, but are rather a part of the process of maximizing productivity with a commitment to program output quality.

Uptake and distribution of bupivacaine in fetal lambs

Direct continual measurement of placental drug transfer was introduced to evaluate more precisely the fetal uptake of a commonly used local anesthetic in obstetrics. Bupivacaine, 2.7 mg X kg-1 (base), was infused at a constant rate over 1 h into a maternal jugular vein of five chronically prepared pregnant ewes. Blood was sampled simultaneously from the umbilical vein (UV), fetal aorta (FA), and a maternal artery (MA). Fetal uptake rate was determined from the product of the bupivacaine UV-FA blood concentration difference and the umbilical flow rate (Qu). Total fetal accumulation was determined by integrating uptake rate over 5 h. Correlation of total fetal uptake and the infused mean maternal dose (r = 0.993, P less than 0.001) indicated that during the infusion, mean fetal uptake was a constant fraction (0.16) of the maternal infused dose. Total fetal uptake was linear despite wide individual changes in Qu, suggesting that within limits fetal accumulation is not Qu-dependent. Mean ovine protein binding of bupivacaine by maternal and fetal whole blood was 85.49% +/- 2.61 (SD) and by fetal blood, 40.43% +/- 9.60 (SD). Back-transfer of bupivacaine to the mother proceeded against a higher total bupivacaine concentration because unbound unionized drug concentrations in maternal blood were less than in fetal blood. At maternal-fetal equilibrium when UV and FA total blood concentrations were equal, the calculated fetal/maternal concentration ratio (f/m) (0.36) determined from the maternal and fetal protein binding and pH closely approximated the observed (0.35). The f/m increased during both fetal uptake and back-transfer and cannot be considered a good index of placental transfer.(ABSTRACT TRUNCATED AT 250 WORDS)

Theiler's virus replication in isolated Schwann cell cultures

Theiler's murine encephalomyelitis viruses causing both fatal encephalitis (GDVII virus) and chronic demyelinating disease (WW virus) are capable of replicating in isolated Schwann cell cultures. Light microscopy combined with immunohistochemical staining of viral antigens revealed that large numbers of Schwann cells infected with the two viruses show cytopathic effect (rounding) and contain viral antigens. Electron microscopy of virus-infected Schwann cells shows that the morphological alterations that the cells undergo following infection by the two virus isolates are different. In the early stages of GDVII and WW virus infection, different inclusion bodies are formed in the cells cytoplasm. At late stages of the infection GDVII virions are found in all infected cells and are arranged in crystalline arrays around inclusion bodies. In contrast, in WW virus-infected Schwann cells only in few cells virions were observed and they appeared aligned between two membrane units.

In vitro cytotoxicity and demyelination induced by Theiler viruses in cultures of spinal cord slices

The cytopathic effects caused by Theiler viruses to myelinated organotypic spinal cord cultures was studied by light and electron microscopy. Heavily myelinated cultures, 2-3 weeks in vitro were infected with WW and GD VII viruses. Mock infection served as control. On light microscopy cytopathic effects and demyelination became evident about 16-17 hr after infection. Demyelination observed in WW virus-infected cultures was much more pronounced than in cultures infected with GD VII viruses. The myelin in mock-infected cultures remained undamaged. Electron microscopy revealed that in control cultures cells were intact, exhibiting numerous synapses and a network of axons enwrapped by multilayered myelin sheaths. Virus-infected spinal cord slices showed that a more severe cytotoxicity was caused by GD VII virus than by WW virus. The cytopathology included accumulation of cytoplasmatic vacuoles, margination of chromatin, synapse and cell disintegration, and various degrees of demyelination. Several GD VII virions were observed, arranged in crystalline arrays, mainly in electron-opaque cells, but not within axons. WW virions on the other hand were only occasionally encountered.

The story of diagnostic related groups

1. Today's method of reimbursement has an immediate and significant effect on the services hospitals provide. The present Prospective Payment System, however, presently does not address the issues associated with capital equipment or the introduction of new technologies or procedures. 2. After a generation of emphasis on access to and quality of care, present legislation emphasizes cost containment. 3. Further definition and modification of the PPS reimbursement progrm is expected, with all segment of the health care delivery network affected.