Infant orthotopic cardiac transplantation

Infant orthotopic cardiac transplantation has been recently applied to various forms of congenital heart disease with encouraging short-term results. Between June 1986 and September 1987 we evaluated 16 infants for orthotopic cardiac transplantation. Fourteen had hypoplastic left heart syndrome, one had endocardial fibroelastosis with aortic atresia, and one had anomalous pulmonary arterial origin of the left main coronary. Eight families accepted the treatment program and eight families refused (two because of associated anomalies and six on philosophical grounds). Of the eight patients who were candidates for orthotopic cardiac transplantation, one died 6 hours after diagnosis, one was allowed to die after 60 days because of acquired neurologic complications, and another had congenital cytomegalic virus infection. The remaining five patients (four with hypoplastic left heart syndrome, one with anomalous pulmonary arterial origin of the left main coronary) had orthotopic cardiac transplantation. The operation was performed with absorbable polydioxanone suture with deep hypothermia and circulatory arrest in four neonates for hypoplastic left heart syndrome (average time 47 minutes) and bicaval cannulation and continuous bypass in one 11-month-old infant for anomalous origin of the left main coronary. In-house retrieval was used in all. One neonate died of complications as a result of pretransplant donor heart dysfunction and size discrepancy, whereas the remaining three neonates and one infant survived and are home 23 months, 12 months, and 8 months (the patients with hypoplastic left heart syndrome) and 17 months (the patient with anomalous origin of the left main coronary) postoperatively. Triple-drug immunosuppression included cyclosporine, azathioprine, and prednisone. Rejection was diagnosed by clinical evaluation of child activity and monocyte cell cycle analysis from peripheral blood samples without myocardial biopsies. Routine echocardiograms, electrocardiograms, and chest x-ray films were not helpful. Six episodes of rejection were successfully treated in four patients. Twelve-month postoperative catherization in one patient (hypoplastic left heart syndrome) showed appropriate graft growth, no aortic or pulmonary anastomotic strictures, normal right and left ventricular function, and no coronary artery disease. We conclude that infant orthotopic cardiac transplantation is an acceptable procedure for severe forms of untreatable congenital heart disease. The excellent short-term results warrant continued application of orthotopic cardiac transplantation.

Alpha-interferon (Wellferon) as an adjunct to standard surgical therapy in the management of recurrent respiratory papillomatosis

Ten patients received lymphoblastoid alpha-interferon (Wellferon) in a crossover study so that Wellferon and standard microsurgical laryngeal laser therapy could be compared to laser therapy alone. Wellferon was administered initially at an intravenous high dose of 15 megaunits/m2 for 5 days followed by a daily dose of 2 megaunits/m2 subcutaneously for 6 months. Dosage was adjusted according to predefined toxicity. One patient was withdrawn from the study. Of the others, all but one received over 75% of the planned total dose. At follow-up of the nine assessable patients, complete remission was achieved in two of them, partial remission in four, and no response in the remainder. The two complete remissions were sustained for 2 years, but the four partial remissions were not sustained. Thus, a role for alpha-interferon in the kind of regimen used here remains to be established.

Examining reliability and validity of the Preschool Play Scale with handicapped children

This study examined the reliability and validity of the Preschool Play Scale (PPS), a measure of the developmental level of play, on a sample of 60 handicapped children. Results demonstrated acceptable reliability and validity for the scale as a whole. However, the need for some refinement of the scale was revealed by the findings. Categories of play that can be observed only infrequently need to be reconsidered. The data also suggest that the criteria for deciding whether a behavior is absent or whether there was no opportunity to observe the behavior need to be spelled out more clearly for the scale.

Treatment of nephrogenic diabetes insipidus with prostaglandin synthesis inhibitors

The antidiuretic effect of two prostaglandin synthetase inhibitors, ibuprofen (25 mg/kg/day) and indomethacin (2 mg/kg/day), was studied in patients aged 8 to 18 years with hereditary nephrogenic diabetes insipidus. Ibuprofen (studied in five patients) did not have demonstrable effects on urine volume, free water clearance, or osmolar clearance, but fractional excretion of sodium decreased from a mean of 0.38% to 0.19% (P less than 0.05). In contrast, indomethacin (studied in three patients) was associated with a decrease in mean urine volume from 5.8 to 2.8 mL/min and a decrease in mean free water clearance from 3.1 to 1.1 mL/min (both P less than 0.05). Fractional excretion of sodium decreased from 0.77% to 0.27% (P less than 0.01) and was accompanied by an increase in serum urea nitrogen level (P less than 0.01) and a decrease in urea nitrogen clearance (P less than 0.025). Thus, prostaglandin synthetase inhibitors are not uniformly effective in treatment of nephrogenic diabetes insipidus. The inhibitory effect of indomethacin on urine volume and free water clearance in our patients may have been mediated by an enhancement of antidiuretic hormone (ADH)-stimulated cyclic adenosine monophosphate generation, or by increased ADH-independent water reabsorption resulting from an increase in solute reabsorption and consequent medullary hypertonicity.

Increased frequency of ColV plasmids and mannose-resistant hemagglutinating activity in an Escherichia coli K1 population

The expression of traits linked to pathogenicity was studied in a population of Escherichia coli K1 strains. It was found that E. coli K1 strains isolated from extraintestinal infection harbor the ColV plasmid and express mannose-resistant hemagglutinating activity type VI with a high frequency. The presence of these properties may play a role in the ability of some E. coli K1 serogroups to invade.

Direct Determination of Lead in Evaporated Milk and Apple Juice by Anodic Stripping Voltammetry: Collaborative Study

A method for the direct determination of lead in evaporated milk and in fruit juice with no prior sample digestion was successfully collaborated by 13 laboratories. The anodic stripping voltammetric (ASV) method studied consisted of adding 0.2 mL aliquots of evaporated milk or 0.3 mL aliquots of fruit juice to 2.9 mL of a dechelating reagent, Metexchange. The reagent-sample mixture is then analyzed for lead by ASV with no further sample preparation. Each collaborator received 24 samples, 2 each at 5 different levels (0.07-0.70 ppm for spiked evaporated milk and 0.09-0.87 ppm for spiked apple juice) along with duplicate practice samples of labeled lead content at each of 2 levels for each sample type. All unknowns were coded with random numbers. Approximately 69% of the reporting laboratories had never analyzed either evaporated milk or fruit juice for lead. Average time between receipt of samples and reporting of results was 1.6 days for all laboratories. The pooled variations between duplicate determinations for apple juice and evaporated milk were 0.00059 and 0.00043, respectively. The method was adopted official first action for both fruit juice and evaporated milk.

Laboratory experience with a new autotransfusion device

A new device for collecting and administering blood by intraoperative autotransfusion consists of several novel features: a collection bag that is kept expanded by a vacuum and into which the blood is drawn by suction of a lesser degree than the outside vacuum, a crease in the collection bag that decreases turbulence and foaming, and separation of the infusion element from the retrieval system by a valve that allows pressure infusion and suction continously. The apparatus is inexpensive, quickly assembled, operated by wall suction or suction pump. We have had favorable experience with its use in animals.

Pulmonary artery pressure and lung water during extracorporeal circulation in experimental pulmonary insufficiency

Use of the membrane oxggenator has been advocated in the management of severe respiratory insufficiency. We have compared this method to conventional therapy in an experimental model in which 23 dogs were subjected to aspiration with 0.1 N HC1 and 18 were supported with a volume respirator and positive end-expiratory pressure or placed on partial bypass using a membrane oxygenator for 12 to 24 hours. Adequate oxygenation (POX greater than 100 mm Hg) was achieved with the membrane oxygenator. The increase in lung weight during conventional therapy was significantly greater than during membrane oxygenator support. Extracorporeal support during recovery from severe pulmonary injury allows pulmonary artery pressure to be controlled and reduces the expected increase in lung water.

Atmospheric Effects of Pollutants

We have argued that aerosols are probably the principal agents by which pollutants may affect weather and climate. They are most likely to act by influencing the structure and distribution of clouds. On the local scale, the effects of pollutants on some aspects of weather are unmistakable. The effects of man-made pollutants on global climate are a matter of debate, but they may already be significant.

Mie-theory computations of lidar and nephelometric scattering parameters for power law aerosols

The ratios of lidar backscatter to nephelometric total scattering cross sections have been computed for power law aerosols. Effects were explored of variations of size distributions, indices of refraction, and of radial inhomogeneity of the scattering particles. Reasonable values for these parameters can be chosen so that observed and computed backscatter ratios agree. The general angle-resolved differential scattering problem is discussed briefly with emphasis upon derivable information from scattering measurements in the atmosphere.