Engraftment potential of peripheral and cord blood stem cells evaluated by a long-term culture system

The experiment was performed in an attempt to seek a suitable indicator of allogeneic transplantation using cord blood cells. The number of colony-forming cells (CFC) recovered after 5 weeks of culture represents that of primitive progenitors present in the initiating cell population. In this study of nine children who underwent autologous peripheral blood stem cell transplantation (PBSCT), we measured the amount of colony-forming units-granulocyte/macrophage (CFU-GM) and total CFC output after 5 weeks in long-term culture (LTC-CFC) contained in the infused grafts and compared them to the speed of hematopoietic recovery after marrow ablation. In this patient population, we found a significant negative correlation between the number of infused CFU-GM/kg body weight and the time to achieve an absolute granulocyte count (AGC) of 0.5 x 10(9)/L (r = -0.867, p < 0.01), but not with the time to achieve a platelet count of 50 x 10(9)/L (r = -0.700, p = 0.05). Although the number of infused LTC-CFC/kg did not correlate with the early phase of granulocyte recovery, a significant correlation was observed with platelet recovery speed (r = -0.930, p < 0.01) and with the time to regain an absolute granulocyte count of 2 x 10(9)/L after the nadir of the transient decrease in the number of AGC, which occurred 3 to 7 weeks following PBSCT (r = 0.967, p < 0.01). On the other hand, CFU-GM/kg showed no significant correlation with this late engraftment speed. Thus, LTC assay may reflect the kinetics of immature progenitor cells which are capable of reconstituting stable hematopoiesis after marrow ablative therapy. The data were then used in a comparative analysis of the transplantation potential of peripheral vs. cord blood stem cells. The numbers of LTC-CFC and CFU-GM per mononuclear cell (MNC) from cord blood were 2.5-fold and two-fold greater than those from peripheral blood cells, respectively. These results suggest the advantage of cord blood as an additional stem cell source in transplantation.

New modification of a mammary artery retractor

A new accessory instrument to the self-retaining internal mammary artery retractor was developed. This instrument presses the chest wall inward, relieves the concavity of the inner surface of the chest wall, and provides good exposure of the internal mammary artery.

Evaluation of biological characteristics of lung cancer by the human 28 kDa vitamin D-dependent calcium binding protein, calbindin-D28k

We evaluated the biological characteristics of lung cancer by measuring their contents of human 28 kDa vitamin D-dependent calcium binding protein (calbindin-D). Calbindin-D concentrations were determined in tumor tissue and normal lung tissue extracts from patients with lung cancer by enzyme immunoassay. The percentage of high calbindin-D containing tissues in small cell lung cancer (SCLC) was significantly higher than that in non-small cell lung cancer (NSCLC) and the calbindin-D concentration was low in normal lung extracts. In addition, most of the NSCLC which had a significantly high level of calbindin-D were at the advanced cancer stage with lymph node metastasis. Calbindin-D concentrations were also determined in lung cancer cell lines. The percentage of high calbindin-D containing cell lines was high in classic type SCLC, followed in order by variant type SCLC and NSCLC. In addition, in order to examine the usefulness of calbindin-D as a marker of neuroendocrine properties of lung cancer, we compared the sensitivity and specificity of calbindin-D for distinguishing classic from variant type SCLC with neuron-specific enolase (NSE) and aromatic L-amino acid decarboxylase (AADC) by relative operating characteristic curves. The diagnostic accuracy of AADC was the highest of the three and that of calbindin-D was as high as that of NSE. These findings suggest calbindin-D to be related to the neuroendocrine properties of lung cancer.

Antibodies inactivating mGluR1 metabotropic glutamate receptor block long-term depression in cultured Purkinje cells

Antibodies were raised against two distinct extracellular sequences of the rat mGluR1 metabotropic glutamate receptor expressed as bacterial fusion proteins. Both antibodies specifically reacted with mGluR1 in the rat cerebellum and inhibited the mGluR1 activity as assessed by the analysis of glutamate-stimulated inositol phosphate formation in CHO cells expressing mGluR1. Using these antibodies, we examined the role of mGluR1 in the induction of long-term depression in cultured Purkinje cells. In voltage-clamped Purkinje cells, current induced by iontophoretically applied glutamate was persistently depressed by depolarization of the Purkinje cells in conjunction with the glutamate application. The mGluR1 antibodies completely blocked the depression of glutamate-induced current. The results indicate that activation of mGluR1 is necessary for the induction of cerebellar long-term depression and that these mGluR1 antibodies can be used as selective antagonists.

Evidence for defects in V(D)J rearrangements in patients with severe combined immunodeficiency

We investigated the patterns of DNA rearrangements at loci for Ig JH genes in patients with severe combined immunodeficiency (SCID). Four SCID patients without B cells (B- SCID) and four SCID patients with B cells (B+ SCID) were examined. Bone marrow cells of these patients were transformed with EBV. The majority of the transformed cells from three B- SCID patients had the germline configuration at their JH gene loci. The rearranged fragments from one patient were analyzed extensively. The rearranged regions in all of the fragments had a common structure wherein two fragments derived from the JH-S mu region were connected inversely. The possible presence of rearranged forms of VHDJH and DHQ52JH sequences in bone marrow cells of two B- SCID patients were examined directly by the polymerase chain reaction (PCR) method. In one patient, we found neither a VHDJH sequence nor a DHQ52JH sequence within the range of sensitivity of the PCR method. In another patient, we found a VHDJH sequence at an extremely low level and DHQ52JH sequences at a relatively low level. Either RAG-1 or RAG-2 gene was not expressed in the B- SCID-derived cell lines. B+ SCID patients did not show any abnormalities in terms of VHDJH rearrangements. These results indicate that B- SCID may be caused by defects in factors involved in V(D)J rearrangements.

[Detection of group C rotavirus in the day care center]

Group C rotavirus was detected in stools of four patients from February to April, 1993. Of these patients, three were infants who were attendants of the day care center of the hospital. Although the route of viral infection has not been determined, the virus might have been spread within the center. Because the clinical symptoms of acute gastroenteritis caused by group C rotavirus were vomiting, serious anorexia and subsequent difficulty of oral intake of food, patients often required fluid administration therapy at the outpatient clinic. The symptoms continued 1 to 2 days. Diarrhea occurred 1.7 times daily for 1.2 days. Watery stool was found in 3 cases of patients, but no whitish stool was discovered. Vomiting developed 2.2 times daily for 1.2 days. These symptoms were less severe than those of gastroenteritis by group A rotaviral infection. The electrophoretic RNA pattern of group C rotavirus detected in the four cases were the same. However it was different from that of the virus strains previously isolated.

Comparative analysis of engraftment after cryopreservation of peripheral blood stem cell autografts by controlled- versus uncontrolled-rate methods

Peripheral blood stem/progenitor cells (PBSC) were cryopreserved by different methods and their clonogenic viabilities were compared. The traditional cryopreservation method involves controlled-rate freezing with 10% dimethyl sulfoxide (DMSO) and a programmed freezer (PF). The alternative method incorporates 6% hydroxyethyl starch and 5% DMSO without PF. In this non-randomized study, we analyzed the data of 24 patients (aged 1-17 years) who were in their first complete remission and who had undergone PBSC autograft (PBSCT) for high-risk acute lymphoblastic leukemia, to determine the effects of these two different methods of cryopreservation on time to engraftment and transfusion requirements after PBSCT. In all patients, PBSC were collected within 5 months of diagnosis and all had been conditioned with the high-dose MCVAC regimen (MCNU, cytosine arabinoside, etoposide and cyclophosphamide) without total body irradiation. Twelve patients received PBSC that had been cryopreserved by the uncontrolled method without PF and the data were compared by actuarial analysis to those of 12 historical controls whose cells had been frozen by PF. No difference was observed in the time to engraftment of granulocytes and platelets or the transfusion requirements between the two groups. Our results indicate that, in terms of preserving engraftment potential, the simplified uncontrolled-rate cryopreservation method is at least as effective as the traditional controlled-rate freezing procedure with PF.

Respiratory muscle function during emesis in awake canines

Emesis requires a coordinated differential recruitment of gastrointestinal smooth muscle, upper airway muscles, and several muscles involved in respiration. In seven awake intact canines we measured the electrical activity (electromyogram) and shortening of costal and crural diaphragm segments, parasternal intercostal, and transversus abdominis during emesis that was induced by instillation of apomorphine into the lower conjunctival fornix. The process of emesis was tightly coordinated with ventilation and showed four respiratory phases: baseline ventilation (Base), initial preemetic hyperventilation (Hyperv), prodromal ventilation associated with salivation and probable nausea (Prodrome), and finally retching and expulsion (Expel) of gastric contents. Ventilation was suppressed during expulsive events, but a small inspiratory airflow was interjected between expulsions. Resting electromyogram of all four muscles increased during the process of emesis, with costal and crural segments showing a marked decrease in resting length through Prodrome and Expel. To produce an expulsive maneuver, both inspiratory and expiratory muscles were activated synchronously, unlike their usual sequential activation during ventilation, with costal and crural segments and transversus abdominis showing the most shortening. The crural segment showed a biphasic length change with initial shortening and then lengthening to assist esophageal sphincter function during Expel. These results indicate a strong coordinated interaction between brain stem centers responsible for control of respiration and of emesis.

Analysis of cytoplasmic and surface antigens in childhood T-cell acute lymphoblastic leukaemias: clinical relevance of cytoplasmic TCR beta chain expression

Expression of surface and cytoplasmic antigens on the blasts from 42 cases of childhood T-cell acute lymphoblastic leukaemia (T-ALL) were analysed. All with childhood T-ALL, except for one case expressing cytoplasmic TCR delta chain, were classified on the basis of differential expression of cytoplasmic CD3 (cCD3), TCR beta chain (cTCR beta) and surface CD3 (sCD3) into the following three groups: group I (cCD3+, cTCR beta-, sCD3-), eight cases (19.5%); group II (cCD3+, cTCR beta +, sCD3-), 23 cases (56.1%); group III (cCD3+, cTCR beta +/-, sCD3+), 10 cases (24.4%). Each group defines the stepwise maturational stage of the CD3/TCR complex along the intrathymic T-cell differentiation. Group I had the lowest initial WBC count among the three groups (P < 0.05) and showed significantly (P < 0.05) a higher event-free survival (0.75) than those of group II (0.33). There was no significant difference in both the initial WBC count and the event-free survival between groups II and III. Thus, the absence of cTCR beta in sCD3-negative T-ALL appears to be a good prognostic factor, suggesting that this classification provides a useful tool to predict the prognosis of childhood T-ALL. This is the first report, to our knowledge, studying the relationship between the expression of cytoplasmic CD3/TCR antigens and the clinical features in T-ALL.

[Surgical treatment and long-term results of congenital heart disease in adults: early and late follow-up studies in 231 cases]

In a past one decade from January 1981 to August 1991, 231 patients over 18 years old with congenital heart disease (CHD) including 65 patients with cyanotic (C) and 166 with acyanotic (AC) diseases, were surgically treated. There were one operative death (0.6 percent mortality) and three late deaths (1.9%) in 166 patients with AC diseases, whereas there were four operative (6.1%), and four late deaths (6.1%) in 65 patients with C. These patients were followed for 3 to 124 months (the mean of 46.4 +/- 11.9) after the operation. Compared with group AC, group C showed a high rate of early postoperative deaths or late deaths. Group AC comprised patients in their forties (95 patients with ASD and 15 with PDA) and those in their thirties (26 with VSD and 13 with ECD) at the operation. On the contrary, except 5 patients with Ebstein disease, a mean age of patients of group C at the operation lay in their twenties. Surgical outcomes for adult patients of group C still pose much problems compared with AC group in terms of decreased heart function, development of collateral circulatory pathway, and impaired hepatic and renal functions by long lasting hypoxemia. In group C decreased heart function or association of abscess of the brain might be the main cause of postoperative LOS. These findings indicate that early diagnosis, recent advanced operative procedure and appropriate postoperative care can provide symptomatic remission for even adult patients with severe CHD with a low mortality.

[Effects of diltiazem hydrochloride on blood gases]

The effects of diltiazem, Ca ion channel blocker, on arterial blood gases were evaluated in 50 patients (G-I: 24 patients undergoing abdominal surgery, G-II: 26 patients undergoing non-abdominal surgery). Diltiazem hydrochloride was administered to prevent intraoperative hypertension as a bolus (5 mg) followed by a continuous infusion (5-10 micrograms.kg-1.min-1). Arterial blood gases were analyzed just before, as well as 5 and 15 min after the administration of diltiazem. In G-I, arterial blood oxygen tension decreased significantly (P < 0.001) from 210.8 +/- 42.4 to 197.7 +/- 50.2 mmHg 5 min after infusion, and to 193.2 +/- 53.4 mmHg 15 min after; while there was no significant difference in G-II. Diltiazem infusion may deteriorate oxygenation in patients undergoing abdominal surgery, and therefore oxygenation should be carefully monitored.

Analysis of mutations and expression of GAP-related domain of the neurofibromatosis type 1 (NF1) gene in the progression of chronic myelogenous leukemia

We investigated mutations in the GTPase activating protein-related domain of the neurofibromatosis type 1 gene (NF1-GRD) and its expression in each phase of chronic myelogenous leukemia (CML). Samples from 45 cases in chronic phase (CP), 41 in acute phase, and four CML cell lines were examined for mutations in the NF1-GRD by single-strand conformation polymorphism (SSCP) analysis and allele specific restriction analysis (ASRA). No mutations were detected in the exon where frequent mutations have recently been reported in human tumors, namely the FLR exon. We also examined for point mutations of the N-ras gene but found no mutations either. In 23 samples from CML cases and four CML cell lines, expression of two types of the NF1-GRD transcripts, type I and type II, were examined by NF1-GRD-specific polymerase chain reaction-based densitometric analysis and by the quantitative assay with coamplification of the NF1-GRD and beta-actin transcripts. Consequently, although expression level of type I transcripts varied among the samples, type II expression was increased in CML cell lines and a minor increase in type II expression was observed in the samples in acute phase compared with CP. However, this difference in type II expression between CP and acute phase was so small that changes of NF1-GRD transcripts as well as NF1-GRD or N-ras mutations might not be responsible for the progression of CML.

[Mitral valve aneurysm in a patient with mitral regurgitation: a case report]

A 66-year-old man admitted to our hospital complaining of severe dyspnea. Echocardiography demonstrated severe mitral regurgitation and an abnormal echo at the anterior leaflet of the mitral valve. It was a persistent bulge that protruded toward the left atrium throughout systole and diastole. Left ventriculography also demonstrated the same abnormal shadow of the mitral valve. At the operation, it was seen that two of the chordae tendineae of the anterior leaflet had ruptured and a small aneurysm, approximately 10 mm in length, originated from the lateral part of the leaflet. The aneurysm protruded into the left atrium and had neither rupture nor perforation. Because the aneurysm of the mitral valve was too large to resect and repair the valve, it was replaced with St. Jude Medical Valve (29 M). IABP was needed at the weaning from cardiopulmonary bypass, but he recovered gradually well afterwards. The excised anterior leaflet showed myxomatous degeneration, but had no vegetation and rheumatic change. Microscopic examination of the valve aslo revealed myxomatous degeneration and no signs of the inflammation.

Evidence for defects in V(D)J rearrangements in patients with severe combined immunodeficiency

We investigated the patterns of DNA rearrangements at loci for Ig JH genes in patients with severe combined immunodeficiency (SCID). Four SCID patients without B cells (B- SCID) and four SCID patients with B cells (B+ SCID) were examined. Bone marrow cells of these patients were transformed with EBV. The majority of the transformed cells from three B- SCID patients had the germline configuration at their JH gene loci. The rearranged fragments from one patient were analyzed extensively. The rearranged regions in all of the fragments had a common structure wherein two fragments derived from the JH-S mu region were connected inversely. The possible presence of rearranged forms of VHDJH and DHQ52JH sequences in bone marrow cells of two B- SCID patients were examined directly by the polymerase chain reaction (PCR) method. In one patient, we found neither a VHDJH sequence nor a DHQ52JH sequence within the range of sensitivity of the PCR method. In another patient, we found a VHDJH sequence at an extremely low level and DHQ52JH sequences at a relatively low level. Either RAG-1 or RAG-2 gene was not expressed in the B- SCID-derived cell lines. B+ SCID patients did not show any abnormalities in terms of VHDJH rearrangements. These results indicate that B- SCID may be caused by defects in factors involved in V(D)J rearrangements.

Detection of 14q32 translocations in B-cell malignancies by in situ hybridization with yeast artificial chromosome clones containing the human IgH gene locus

Partner sites of 14q32 translocations found in B-cell malignancies were detected by fluorescence in situ hybridization (FISH) using yeast artificial chromosome (YAC) clones, Y20 and Y6, containing the human Ig heavy chain (IgH) gene locus. Y20 spans a 160-kb upstream and 40-kb downstream region of the JH segments on chromosome band 14q32.33. Y6 is 300-kb upstream of Y20, and spans a further 320-kb telomeric region. The human DNA sequences amplified by Alu polymerase chain reaction of the YAC clones were used as probes for FISH to study six patients with non-Hodgkin's lymphoma (NHL), one patient with acute lymphoblastic leukemia, and one cell line FR4 established from a plasmacytoma. Three telomeric YAC clones each specific for 3q, 8q, and 18q were also used to further characterize 14q32 translocations. The IgH YACs were successfully applied to detect cytogenetically invisible subtelomeric translocation of the IgH gene locus to each partner site in t(14;18), t(8;14), and t(14;19), and to identify t(3;14) (q27;q32.33) in three patients with 14q32 translocation of unknown origin. Furthermore, complex translocations involving more than three chromosomes were detected in an NHL patient with t(8;14), and t(3;12), and in the FR4 with der(14)t(8;14), der(8)dic(1;8), and del(1)(q21). The technique would be a useful tool in elucidating the mechanisms of a 14q32 translocation in B-cell malignancies.

[Effect of nasal-CPAP and hypercapnia on human abdominal muscles]

The effect of nasal continuous positive airway pressure (nasal-CPAP) and hypercapnia on abdominal muscles was investigated in 10 healthy volunteers in the supine position. Pairs of fine wire electrodes were inserted into the rectus abdominis, external oblique, internal oblique and transversus abdominis under direct vision provided by high resolution ultrasound echography. Ultrasound provided clear visualization of the individual muscle layers and the guide needle for electrode insertion. Monitoring end tidal CO2 (ETCO2), 1) nasal-CPAP of 15 cmH2O was applied, 2) CO2 was then added to the inspiratory limb of the nasal-CPAP system, and 3) CO2 rebreathing was also performed without nasal-CPAP. Electromyograms (EMG) were sampled and integrated. Peak values of integrated EMG were measured under the following three conditions, normocapnia, 7% ETCO2, and 9% ETCO2, with and without nasal-CPAP. In each abdominal muscle, the percentage of patients with expiratory EMG activity increased with increasing ETCO2, regardless of nasal-CPAP. Among the four muscles, the transversus abdominis was recruited most frequently, the rectus abdominis least frequently. The EMG from each muscle was activated by nasal-CPAP of 15 cmH2O under each of the three conditions. We conclude that in humans 1) nasal-CPAP and hypercapnia synergistically activate abdominal muscles, 2) the transversus abdominis is the primary expiratory muscle, and 3) the rectus abdominis is an accessory expiratory muscle.

Dissecting aneurysm in the proximal region of the posterior inferior cerebellar artery presenting as Wallenberg's syndrome--case report

A 29-year-old female presented with an unusual case of Wallenberg's syndrome due to a dissecting aneurysm of the posterior inferior cerebellar artery (PICA) manifesting as a sensation of heaviness in the occipital region and vertigo. Magnetic resonance imaging revealed infarction of the lateral aspect of the medulla oblongata. Digital subtraction angiography (DSA) revealed a spindle-shaped dilatation of irregular contour in the proximal portion of the left PICA. Pooling of contrast medium was noted in the venous phase but not double lumen sign. A suboccipital craniectomy confirmed these findings macroscopically. Blood flow meter monitoring before and after proximal clipping of the diseased vessel ensured the safety of the procedure. Follow-up DSA 3 years after surgery revealed no evidence of aneurysm recurrence.

[Quantitation of regional cerebral blood flow by single photon emission computed tomography of CBF-tracer combined with whole-brain CBF: a comparison between 123I-IMP and 99mTc-HMPAO in healthy volunteers]

A simple, noninvasive method of measuring cerebral blood flow (CBF) that uses single-photon emission computed tomography (SPECT) of CBF-tracer and whole brain CBF obtained by xenon-133 (133Xe) clearance technique was developed. In nine healthy volunteers, SPECT data were normalized to the count density of 123I-IMP or 99mTc-HMPAO uptake in the whole-brain, and then converted to the absolute units of CBF by multiplying average 133Xe-CBF in the whole brain. The CBF values measured by 99mTc-HMPAO CBF-SPECT was significantly lower in the high flow regions of cortical gray matter (bilateral frontal lobe; p < 0.05 and right occipital lobe; p < 0.05), and was significantly higher in the bilateral white matter (p < 0.05 or 0.01) and the cerebellum (p < 0.005) compared with the flow values measured by 123I-IMP CBF-SPECT. Whereas, the IMP-CBF values were significantly lower in the bilateral striatum (p < 0.02 or 0.05) compared with the HMPAO-CBF values. Good correlations were found between IMP-CBF and the HMPAO-CBF values in the cortical gray matter (rs = 0.761; p < 0.001, n = 108), the white matter (rs = 0.739; p < 0.001, n = 18) and the cerebellum (rs = 0.731; p < 0.001, n = 18). In the striatum (rs = 0.58; p < 0.05, n = 18) and the thalamus (rs = 0.628; p < 0.05, n = 18), the correlations between IMP-CBF and HMPAO-CBF values were inferior to those of the other three regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative experimental study between retrograde cerebral perfusion and circulatory arrest

To evaluate the efficacy of retrograde cerebral perfusion in protecting the brain, we comparatively studied retrograde cerebral perfusion and total circulatory arrest in 18 hypothermic (20 degrees C) mongrel dogs (retrograde cerebral perfusion, n = 10; total circulatory arrest, n = 8). Retrograde cerebral perfusion was performed, maintaining an external jugular venous pressure of 25 mm Hg for 60 minutes. Retrograde cerebral perfusion provided half the cerebral blood flow and a third of the oxygen that was supplied during hypothermic cardiopulmonary bypass, which had a flow rate of 100 ml/min per kilogram. Oxygen consumption and carbon dioxide exudation did not increase on resuming cardiopulmonary bypass after retrograde cerebral perfusion, whereas they increased after total circulatory arrest (oxygen consumption 10.7 +/- 5.3 versus 19.1 +/- 8.6 ml/min, p < 0.05; carbon dioxide exudation, 0.92 +/- 0.54 versus 1.64 +/- 0.78 mmol/min, p < 0.05). Therefore, oxygen debt during retrograde cerebral perfusion was smaller than during total circulatory arrest. Retrograde cerebral perfusion also cooled the brain better than did total circulatory arrest (20.4 degrees +/- 1.5 degrees C versus 22.7 degrees +/- 0.7 degrees C, p < 0.01). Cerebral tissue oxygen tension decreased slightly (27.5 +/- 7.7 versus 12.3 +/- 3.0 mm Hg, p < 0.01), and cerebral tissue carbon dioxide tension increased slowly during retrograde cerebral perfusion (95 +/- 34 versus 147 +/- 44 mm Hg, p < 0.05). These changes were smaller than those seen in total circulatory arrest. Tissue concentrations of adenosine triphosphate in the brain remained relatively high during retrograde cerebral perfusion but decreased rapidly during total circulatory arrest (0.49 +/- 0.16 versus 0.21 +/- 0.05 mmol/gm, p < 0.01, just before resuming cardiopulmonary bypass). Retrograde cerebral perfusion cannot maintain aerobic metabolism but may reduce ischemic damage of the brain and may safely extend the cerebral circulation interruption time.

Long-term results of primary closure for ventricular septal defects in the first year of life

The long-term results of primary closure for large ventricular septal defects (VSDs) in infants under 1 year of age with severe symptoms were studied over a period of more than 10 years. Between January, 1971 and March, 1982, 49 infants underwent primary closure of a VSD through a right ventriculotomy using complete cardiopulmonary bypass with mild hypothermia. There were four hospital deaths but no late deaths. Two of four infants with residual shunts had a left ventricular-right atrial shunt which necessitated reoperation. Surgical heart block occurred in two infants who recovered sinus rhythm in the late period. The cardiothoracic ratio decreased from 60.5% preoperatively to 50.6% in the late postoperative period. Examination by cardiac catheterization revealed that the pulmonary-to-systemic pressure ratio (Pp/Ps) of 23 patients with a Pp/Ps of over 0.75 fell from 0.89 +/- 0.09 preoperatively to 0.42 +/- 0.12 by 1 month postoperatively, then to 0.27 +/- 0.05 in the late postoperative period. The latest values for the cardiac index and left ventricular ejection fraction were 3.4 l/min per m2 and 64.4%, respectively. More than 10 years after their operation, all the survivors were growing normally and maintaining a good quality of life, which supports our recommendation that primary repair should be performed in the first year of life for infants with large VSDs.

[Reaction of the retina to injected subretinal fluids]

Experimental retinal detachment was produced by injecting various fluids into the subretinal space in pigmented rabbits. We selected autologous aqueous humor, autologous vitreous, and autoserum as substitutes for subretinal fluid. Retinal detachment disappeared within 24 hours. The eyes were enucleated 7 days after surgery for histopathological study. Destructive changes in photoreceptor layer occurred most severely when the eye was treated with serum. There was a decrease in the number of outer nuclear layer cells. Macrophages and fibroblastic cells had migrated into the subretinal space. Histopathological changes with vitreous were less pronounced than with serum. The cytoplasm of Mueller cells appeared to compensate for the loss of photoreceptor cells in the outer nuclear layer. Mild decrease in the number of photoreceptor cells was the sole pathological feature when the eye was treated with aqueous humor. The retina thus showed different reactions to the subretinal fluids of differing nature.