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I Rosas(*); S M Studer; J C Conte; S Yang; M Borja; S P Gaine and J B Orens. Divisions of Pulmonary & Critical Care Medicine, The Johns Hopkins University, [...]

Lung transplant recipients have one of the highest rates of invasive aspergillosis (IA) in solid organ transplantation. We used a single center, nonrandomized, retrospective, sequential study design to evaluate fungal infection rates in lung transplant recipients who were managed with either universal prophylaxis with voriconazole (n 65) or targeted prophylaxis (n 30) with itraconazole ± inhaled amphotericin in patients at high risk (pre- or posttransplant Aspergilluscolonization except Aspergillus niger). The rate of IA at 1 year was better in lung transplant recipients receiving voriconazole prophylaxis as compared to the cohort managed with targeted prophylaxis (1.5 vs. 23; p 0.001). Twenty-nine percent of cases in the targeted prophylaxis group were in patients colonized with A. nigerwho did not receive itraconazole. A threefold or higher increase in liver enzymes was noted in 37-60 of patients receiving voriconazole prophylaxis as compared to 15-41 of patients in the targeted prophylaxis cohort. Fourteen percent in the voriconazole group as compared to 8 in the targeted prophylaxis group had to discontinue antifungal medications due to side effects. Voriconazole prophylaxis can be used in preventing IA in lung transplant recipients. Regular monitoring of liver enzymes and serum concentrations of calcineurin inhibitors are required to avoid hepatotoxicity and nephrotoxicity.

PRO‐T lymphocyte clones, which have the T cell receptor (TCR) alpha, beta, gamma and delta genes in germline configuration and heterogeneous T cell precursors freshly isolated from bone marrow of athymic nude mice, gave rise to single positive L3T4+ TCR alpha,beta+ and double negative (L3T4‐LyT2‐) TCR alpha,beta+ or TCR gamma,delta+ cells, but not to any cells expressing LyT2, when co‐cultured with the thymic epithelial clone ET. The T cell progenitors were able to develop into cells expressing LyT2 only when cocultured with heterogeneous thymic epithelial cell preparations. The progeny of the induced PRO‐T clones included cells bearing V beta 8, V beta 17 and V gamma 3 gene family products. The presence of cells expressing a TCR gamma, delta/T3 receptor complex in the cultures was also documented by the expression of RNA transcripts from the TCR delta and TCR gamma genes by induced PRO‐T cells. The TCR/T3+ cells generated in the cultures expressed functionally competent T cell receptor complexes. Our results show that: (i) the same PRO‐T clone can give rise to all major subsets of thymocytes upon interaction with the appropriate thymic epithelial cells; (ii) both TCR alpha,beta+ and TCR gamma,delta+ cells may originate from a common T cell progenitor; (iii) L3T4+ TCR alpha, beta+ and L3T4‐LyT2‐ TCR alpha,beta+ cells do not necessarily pass through a L3T4+LyT2+ intermediate stage of development; and (iv) different types of thymic epithelial cells play an essential role in the differentiation of PRO‐T cells into either L3T4+ TCR alpha,beta+ L3T4‐LyT2‐ TCR alpha,beta+ or L3T4+LyT2+ and LyT2+ TCR alpha, beta+ cells in vitro. Finally, we have attempted to integrate our results and those of others in a suggested model of T cell development within the thymus.

A clinical study was undertaken, in twenty-four patients with atrophic vaginal changes, to assess the efficacy and the acceptability of treatment with Ortho-Gynest vaginal suppositories, which have as their active constituent the naturally occurring substance oestriol.A regenerative effect on the vaginal epithelium could be objectively demonstrated by an increase in the proportion of superficial cells following treatment. Changes in the vaginal epithelium were accompanied by a diminution in the incidence of infection and inflammation.Subjective complaints such as dyspareunia, pruritis and kraurosis vulvae, which could also be ascribed to a relative oestrogen deficiency, responded well to treatment.

To assess the prevalence of antibodies to hepatitis A virus (anti-HAV) in future travellers, all visitors to the Zurich University Vaccination Center in July/August 1990 were invited to participate in a cross-sectional study. A total of 1126 future travellers were recruited to have a blood sample drawn and to complete a brief questionnaire. Among these, 35 refused or were excluded, thus 1091 were evaluated. The overall prevalence of anti-HAV was 16.5%. This rate was 5.9% in future travellers born in or after 1961,11.8% in those born 1951-60, 21.4% in those born 1941-50 and exceeded 49% in all decades born in or before 1940. Risk factors for significantly elevated anti-HAV rates were place of birth or a stay exceeding one year in tropical, subtropical or Southern European countries and travel for occupational reasons. Compared with findings from earlier surveys conducted mainly among blood donors in Switzerland and elsewhere in Europe, the results of the present study show lower anti-HAV prevalence rates. In conclusion, it seems unnecessary to test future travellers for anti-HAV except if they are born before 1944, or have a history of jaundice or of prolonged stay in the tropics, subtropics or in Southern Europe.

This project deals with the man-machine interface and its applications to control problems. The objective was a program which allows the user to define any physical system like heat exchangers or turbines in an efficient and simple way for simulation. Systems defined by a block diagram can simply and efficiently be entered by use of a special CAD program. This efficiency results in using graphic symbols instead of differential equations. With an inital menu, predefined elements can be chosen and are placed by a cursor to compose the system. Another menu containing a selection of functions is used to give each element its functional meaning. There is no need for typing in differential equations and a very clear documentation is produced by the computer. The two-dimensional block diagram is then transformed into a one-dimensional instruction sequence controlling the simulation. Different systems can be stored as permanent files for reuse or modification. Various stored systems can be freely combined to form a new one. An extended version of the program package is able to do real time simulation and process control.