Biomedical subjects
Publications and source records attributed to T S Hall.
A substernal goiter may descend into the thorax. However, a truly aberrant intrathoracic thyroid represents a rare and anatomically different entity that requires appropriate modifications in approach and surgical technique.
The significance of dynamic changes in energy state during lung harvesting and preservation has not been extensively studied. Phosphorus 31 nuclear magnetic resonance spectra at 81 MHz were obtained from degassed rabbit lungs. Changes in the adenosine 5'-triphosphate-to-inorganic phosphate peak-intensity ratios were used to measure changes in energy state. Two groups of rabbit preparations were studied to evaluate the effect of hypothermia during the initial 120 minutes of harvesting (n = 8 at 36 degrees C and n = 5 at 4 degrees C). The significance of these changes was assessed in a second experiment in which lungs were reperfused in vitro at selected intervals of hypothermia (5, 12, and 24 hours) and assessed for injury. Hypothermic preservation sustained a significantly higher energy state. The depletion of energy state was correlated with injury, particularly as measured by lung edema (r2 = -0.715). Short periods of warm ischemia (30 minutes) result in a significant depletion of energy state, which may be a component of pulmonary injury during harvesting and preservation.
In a retrospective review, 28 open lung biopsies from 27 oncology patients with acute pulmonary infiltrates were evaluated. The operative complication rate was 28%, and the operative mortality 4%. Infection caused 57% of the infiltrates (16 cases); 87% of the infections were secondary to either Pneumocystis carinii or a viral infection. Two patients had bacterial pneumonia. Sixteen of these cases survived (37%). All but one survivor had Pneumocystis carinii. A nonspecific pneumonitis either with or without associated fibrosis caused 39% of the infiltrates (11 cases). Four of these patients survived (36%). Two patients had histologic evidence of residual tumor, one secondary to leukemia and the other to a lymphoma. One of these patients who also had Pneumocystis carinii survived. This study confirms the results of several other studies. Open lung biopsy in the oncology patient with an acute pulmonary infiltrate rarely establishes the presence of a treatable lesion other than Pneumocystis carinii, a diagnosis that can usually be established by bronchoscopy. The indications for open lung biopsy are therefore limited.
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We have used immature commercial swine (13-25 kg) successfully in a variety of experimental cardiopulmonary surgical procedures in our laboratories since 1981. Multiple drug anesthetic protocols using barbiturates, narcotics, paralytic and antiarrhythmic agents have been employed in over 400 procedures per year. Complications, including fatal cardiac arrhythmias, have been greatly reduced by anesthetic protocols and surgical procedures developed through experience.
In lung preservation, as well as in other forms of pulmonary disease, injury is associated with sequestration of leukocytes. We hypothesized that leukocyte depletion could prevent reperfusion injury and prolong the period of safe lung preservation. The heart-lung block from 39 New Zealand white rabbits were harvested, flushed with 100 ml of a modified Collins solution, stored at 4 degrees C in a 30% inflation state, and reperfused with either whole blood or leukocyte depleted blood. Leukocyte depletion was accomplished using a blood filter and verified with selected leukocyte counts. Leukocyte readdition specimens were obtained from whole blood, the separation being done with hydroxyethyl starch and centrifugation at 4,000 rpm for five minutes. Six groups of rabbit lungs were studied. Group 1 consisted of control lungs that were not preserved and were reperfused with whole blood. Lungs in Group 2 underwent five-hour preservation and whole blood reperfusion. Lungs in Group 3 underwent five-hour preservation and leukocyte depleted blood reperfusion. Lungs in Group 4 underwent 24-hour preservation and leukocyte depleted blood reperfusion. Lungs in Group 5 also underwent 24-hour preservation, leukocyte depleted blood reperfusion, but with leukocyte readded at the onset of reperfusion. Lastly, lungs in Group 6 underwent 24-hour preservation, leukocyte depleted blood reperfusion, with leukocyte readdition after one hour of reperfusion. Group 5 showed pulmonary edema and complete reservoir emptying within the first hour of reperfusion. Group 2 had comparable poor results. Groups 3, 4, and 6 showed no significant differences from the control lungs in regard to pressure or reservoir loss.(ABSTRACT TRUNCATED AT 250 WORDS)
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Isoprinosine (NPT-10381) was given orally to a group of 22 volunteers at a daily dose of 6 g for 7 days; a control group of 23 volunteers received placebo. Volunteers were inoculated intranasally with both rhinovirus type 9 and rhinovirus type 31, and the clinical picture, extent of virus shedding, and serological responses were assessed. There was no evidence that the compound had useful antiviral activity under the conditions of this trial.
The hemagglutination-inhibition (HI) test for antirhinovirus antibody was carried out on paired sera from volunteers inoculated with rhinovirus type 3 or type 4 (RV4). The HI test gave results which paralleled the neutralization test and was at least as sensitive as a microneutralization method for detection of serotype-specific antibody. Although high levels of HI antibody in the serum were associated with protection from infection, in the case of RV4 low serum HI antibody levels did not necessarily imply susceptibility to challenge with small doses of virus. HI activity could be measured in concentrated nasal-washing fluids, and this antibody also seemed relevant to protection against infection.
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An illness consisting of vomiting, fever, and mild diarrhoea after a short incubation period was observed in a boarding school and reproduced in volunteers who received filtered extracts of faeces from a typical case. The main discriminatory diagnostic feature of the illness in volunteers was vomiting. The faeces contained no pathogenic bacteria nor any virus that could be detected in tissue cultures and there was no evidence that an infective agent could be grown in organ cultures of human intestine. The agent was shown to be ether stable and passed a 50-nm filter. Laboratory studies on another agent of uncertain significance and obtained in other epidemics are briefly described.
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An influenzavirus of swine origin (swine/Taiwan/7310/70) antigenically closely related to the human A/Hong Kong/68 virus readily infected human volunteers. Those infected developed antihaemagglutinin and antineuraminidase antibodies to the human A/Hong Kong/68 virus as well as to the swine/Taiwan virus. The clinical reactions produced by the swine/Taiwan virus were, however, milder than those produced in volunteers infected with A/Hong Kong/68. In contrast, two other "classical" swine viruses (strains antigenically related to the prototype swine/Iowa/15/30 strain), immunologically distinct from the Hong Kong/68 virus, possessed low infectivity for man.
The infection of volunteers with five hybrid influenza-A viruses is described. Four of these were produced in Great Britain by recombining an Ao virus, non-infective for man, with a wild Hong Kong like strain. The fifth was the American recombinant, X-31, derived from similar parents and widely used in the manufacture of killed vaccines. All five viruses had the haemagglutinin and neuraminidase of A2/Hong Kong/68. Two of the viruses were not attenuated and induced symptoms of clinical influenza. The other three were appreciably attenuated and were infective and antigenic. It seems that recombination is a rapid and effective way of producing live vaccine viruses to specification. It is also the quickest known method of attenuation.
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