Exceptional performance in heart preservation with an amino acid—Containing perfusion fluid

This is a report of a study aimed at putting into practice a new theory for hypothermic preservation of viable organs. A perfusion fluid elaborated according to this theory was applied in preservation of the heart, and resulted in storage of the heart for up to 72 hours with preservation of its functions (rhythm, presystolic ventricular pressure, systolic ventricular pressure, cardiac work, coronary blood pressure, sensitivity to drugs) and its morphology. An important finding was that repeated heart storage for 24 hours alternating with functional testing for 5–7 hours could be performed without irreversible alterations of cardiac function and fine structure. Furthermore, during functional testing following storage the hearts consistently demonstrated improvement of function in time, suggesting that the preserved myocardial tissues were able to rapidly achieve metabolic reequilibration. The results of this study provide the possibility of developing a system for efficient ex vivo heart conditioning before transplantation.

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Résumé Nous avons testé la valeur d'une nouvelle théorie sur la préservation d'organes en hypothermie. Un liquide de perfusion conforme à cette théorie a été utilisé pour la préservation cardiaque. Il permet de conserver le coeur pendant 72 heures, sans altérations de ses fonctions (rythme, pression ventriculaire pré-systolique et systolique, travail cardiaque, pression coronaire, sensibilité aux médicaments) ni de sa morphologie. De plus, le coeur peut-être, à plusieurs reprises, conservé pendant 24 heures, avec des intervalles de reprise fonctionnelle de 5–7 heures, sans que sa fonction ni sa structure fine ne soient altérées de façon irréversible. Enfin, l'étude fonctionnelle montre qu'après conservation la fonction cardiaque s'améliore avec le temps, suggérant donc une rééquilibration métabolique rapide du tissu myocardique. Les résultats de cette étude permettront la mise au point d'un système efficace de conservation cardiaque ex-vivo en vue de la transplantation.

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Supported by the German Heart Center, Munich, and the German Academy Department for Foreign Scientific Relationships, Bonn.     

Intracerebral haematoma in an infant with haemophilia A

Summary A nine-weeks-old infant with haemophilia A developed an intracerebral haematoma. Intracranial operation and removal of the haematoma were performed safely under the cover of highly potent AHF cryoprecipitate. Computerized tomography of the brain is very useful for neurosurgical care of the haemophiliac patients as a noninvasive and atraumatic method of examination. The literature of intracranial operations in infants with haemophilia A under the age of one year is reviewed.     

Cystoid macular edema in anterior chamber lens implantation following posterior capsule rupture

By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacine (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.Abbreviations AC-IOL anterior chamber intraocular lens - CME cystoid macular edema - ECCE extracapsular cataract extraction - ICCE intracapsular cataract extraction - IOL intraocular lens - PC-IOL posterior chamber intraocular lens     

No interference of rheumatoid factor(s) with toxoplasmosis IgM determination in infancy

Sera from 263 newborns and infants suspected of congenital toxoplasmosis were tested for the presence of rheumatoid factor (RF) by the latex agglutination test, of which 40 were also tested by the enzyme-linked immunosorbent assay (ELISA). RF was detected in only one serum sample (0.38%), suggesting that false-positive results of the IgM-indirect fluorescent antibody test and the IgM-ELISA due to RF is most unusual in infancy.     

The pharmacology of aggressive behavioural phenomena elicited by muscarine injected into the cerebral ventricles of conscious cats

Atropine and scopolamine, injected intraventricularly, abolished typical emotional behaviour with aggression and autonomic and motor phenomena, as well as with clonic-tonic convulsions of intraventricularly injected muscarine. On the other hand, adrenergic and dopaminergic blocking agents, antihistamines, 5-hydroxytryptamine antagonists, antiepileptic drugs, and 5-hydroxytryptamine, administered intraventricularly, failed to antagonize the gross behavioural effects of intraventricular muscarine. However, ganglionic and sometimes neuromuscular blocking agents, as well as catecholamines and histamine injected intraventricularly, antagonized the emotional behaviour with aggression and depressed the autonomic and motor phenomena of small doses of intraventricular muscarine. In addition, emotional behaviour with aggression and autonomic and motor phenomena evoked by high doses of intraventricular muscarine were resistant to these antagonists administered intraventricularly. From these experiments it is concluded that the sites activated by muscarine in the CNS producing aggressive behaviour have the following characteristics: in high doses muscarine acted on muscarinic cholinoceptive sites, while in small doses it activated the cholinoceptive sites having muscarinic and nicotinic characteristics. Finally, the ability of single intraventricular injections of muscarine to trigger and to maintain the long-lasting gross behavioural effects cannot be ascribed to a rapid detonator transmission, but rather to an action that differs from a conventional transmitter function.     

Th1 dominance in HAM/TSP and the optico-spinal form of multiple sclerosis versus Th2 dominance in mite antigen-specific IgE myelitis

To clarify the Th1/Th2 balance in spinal cord inflammation, we used ELISA to measure the total and allergen-specific IgE in 69 patients with clinically definite multiple sclerosis (MS), including 24 patients with the optico-spinal form of MS, 45 with HAM/TSP, 30 HTLV-I carriers without HAM/TSP, 40 patients with acute myelitis, 43 with neurodegenerative disorders, and 42 healthy subjects, and flow cytometry to study the intracellular IFNgamma-positive versus IL-4-positive cell ratio (intracellular IFNgamma/IL-4 ratio) in peripheral blood CD4(+) T cells in 40 patients with MS, including 17 patients with the optico-spinal form of MS, 23 with HAM/TSP, 22 with acute myelitis, 23 with neurodegenerative disorders, and 36 healthy subjects. Patients with HAM/TSP showed a significantly higher intracellular IFNgamma/IL-4 ratio, lower IL-4(+)/IFN-gamma(-) cell percentages, lower total IgE level, and lower frequency of cedar pollen-specific IgE than did the controls. The patients with optico-spinal MS showed a significantly higher intracellular IFNgamma/IL-4 ratio and higher IL-4(-)/IFN-gamma(+) cell percentages than the controls even at remission or in the convalescence phase. In contrast, in the patients with acute myelitis, the total serum IgE level and the frequency of mite antigen-specific IgE were significantly elevated in comparison to the controls, while those having mite antigen-specific IgE myelitis showed a significantly lower IFNgamma/IL-4 ratio in the CD4(+) T cells in comparison to the controls. These findings suggest that the Th1 cell response is predominant in HAM/TSP and optico-spinal MS, whereas the Th2 cell response is predominant in mite antigen-specific IgE myelitis.