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Direct immunofluorescent (IF) examinations and elutions were performed on native kidneys and allografts of 24 patients undergoing renal transplantation. Immunoglobulins (Ig) were detected by IF on native kidneys of 12 of the 24; 11 of the 12 later had Ig localized to allograft glomeruli by direct IF. In addition, three other patients also developed Ig deposition on allograft glomeruli, although direct IF of native kidneys was negative. Elution studies indicated: (a) that linear Ig deposition on allograft glomeruli was the result of antiglomerular basement membrane (GBM) antibodies, (b) Ig localizing to allograft glomeruli in many of these patients was the result of persistent immunopathogenetic mechanisms existing at the time of allograft placement, and (c) occasionally, kidneys negative for Ig localization by direct IF contain elutable nephritogenic antibodies.

Summary Early awareness of the diagnosis of necrotizing enterocolitis in infants led to immediate nasogastric drainage, placement of a central venous catheter, and initiation of antibiotics. Blood pressure and urine output were vigorously supported by colloid administration. The same physician followed the clinical course of these infants at hourly intervals, and abdominal roentgenograms were obtained every four hours to rule out perforation. These measures led to steadily improving nonoperative survival. The indications for surgery included: (1) perforation, (2) sudden clinical deterioration, and (3) failure to improve within forty-eight hours. Clinical observations are made in forty-five infants with necrotizing enterocolitis, the last thirty of whom came under the specific regimen just outlined. Of these, twenty-four (80 per cent) survived. Etiologic factors are considered.

Eighty to 100 per cent oxygen, breathed by lambs one or two weeks of age, is lethal after two to four days. Artificial ventilation did not aggravate or significantly ameliorate the pulmonary response. Lambs ventilated with air on respirators for comparable periods had no significant pulmonary damage. The cause of death of the oxygen-treated lambs was the pulmonary injury, characterized by edema. Studies of the excised lungs showed that the lesion was spotty, that the normal-appearing portions of the lung were normally distensible, and no significant alterations in pulmonary surfactant occurred. Several methods of assessment of the mechanical derangements are presented.

Twenty-eight children with lymphadenitis of mycobacterial origin were studied and tested with PPD-B (Battey) and PPD-S (Standard). Eleven were seen in 1963, the others from 1956 to 1962. Unclassified mycobacteria were most likely the etiological agents in 22 children, including 6 with proved cultures. Complete excision was curative, but other surgical procedures were not. The effect of antituberculous drugs could not be defined. Twenty of 135 school children in Cambridge, Massachusetts, with a history of sensitivity to PPD-S had significantly greater reactions to PPD-B than to PPD-S. This number included 23 per cent of the children given antituberculous chemoprophylaxis because of recent tuberculin conversion. Most of the “Battey reactors” in both groups were lifelong residents of Massachusetts, only a few having been in areas previously described as endemic for unclassified mycobacteria.

Adrenal cortical steroids have been advocated as adjuncts to the treatment of severe bacterial infection, including meningitis. A double-blind controlled trial of the effect of large doses of methylprednisolone showed no significant differences between treated and placebo groups either at discharge from the hospital or 1 to 4 years later. There was a surprisingly large number (31%) of survivors who showed sequelae-mostly subtle perceptual motor problems.Methylprednisolone does not offer benefit to the usual patient with bacterial meningitis.

An electron microscopical study was made of the seventh and tenth ventral and dorsal spinal nerve roots and peripheral nerves of adult frogs, to determine whether or not tunicated and sheathed nerve fibers extend into the spinal cord and into the periphery. The nerves were exposed under urethane anesthesia, fixed in 1%, veronal acetate-buffered osmium tetroxide (pH-7.6) plus 0.495 gr/10 ml sucrose, and refrigerated over two hours. Thin cross and longitudinal sections were made and examined with a Siemens electron microscope. A few tunicated fibers were found in the peripheral nerve, but not in the spinal nerve roots which consisted of myelinated and unmyelinated (Gasser-type) axons. Therefore, tunicated and sheathed nerve fibers were restricted to sympathetic ganglia. This was the more likely, because intrinsic neurons are absent in the sympathetic, and nearly all axons are myelinated in caudal rami communicantes. It was further suggested that preganglionic fibers, after entering, and postganglionic fibers before leaving the sympathetic ganglion changed their myelin sheaths, and appeared as tunicated and sheathed fibers. No structural differences between afferent and efferent cholinergic or adrenergic fibers could be detected in spinal roots. Large vesicles with dark centers, probably containing catecholamine, and dense punctate granules, occurring in sympathetic fibers, were virtually absent in spinal root fibers.

An electron microscopic study has been made of the sympathetic ganglia of a 15 and a 17 week old male human fetus. The fetal sympathetic neurons were densely packed in a scanty connective tissue matrix which also contained blood vessels. The fetal sympathetic neurons had a large, electron-light nucleus with one or two nucleoli, and was of a somewhat mottled appearance due to irregularly dispersed aggregates of fine and coarse granules. The perikaryon usually formed a thin envelope around the nucleus and contained, except for large pigment granules, all intracytoplasmic structures which were also found in mature sympathetic neurons. Adjacent sympathetic cells were either in immediate contact, or slightly separated by a wedge of electron-light satellite expansions, or lined by primitive axons. The satellite cells were in the early state of development. Electron-dense axons either stood side by side with, or were slightly engulfed by light Schwann cell expansions and formed distinct bundles surrounded by a common basement membrane. There was practically no trace of myelin formation or Schwann cell wrapping characteristic for unmyelinated fibers as seen in the adult.

To determine if there might be a relationship between oral feedings and necrotizing enterocolitis, 30 newborn goats were divided into 3 groups and fed 3 separate formulae. Ten received mother's milk, ten received mother's milk dialyzed to raise its osmolarity to 1.5 times normal and 10 received a standard 20 calorie/oz. commercial formula. Half of the goats in each formula group were artificially colonized with E. Coli. No animal fed unmodified mother's milk developed any significant abnormality. All of the goats fed hypertonic mother's milk developed diarrhea; 6 had milena; 8 had emesis. In this study group mucosal necrosis was seen in all animals at post mortem examination and 4 of the 5 animals colonized with E. Coli developed pneumatosis intestinalis. All of the newborn goats deprived of mother's milk died of sepsis. These studies suggest that both mucosal damage and colonization with gas-forming bacteria are necessary for the development of necrotizing enterocolitis. One pathway leading to mucosal damage may be the ingestion of hypertonic formula.

The respiratory center of the in situ fetus is responsive only to extremes of acidemia and hypercarbia. Recent observation by Frady (Peds:50, 219, 1972) suggest that apnea in the immature newborn is related to hypoxia.

At a first glance, Dr. Spock's most recent effort appears to be a collection of self-evident facts, well-worn clichés and repetitions—the reader has the feeling that he has heard all of this before. However, when the reviewer reread the opening sentences and realized that the text is aimed, not at the pediatrician or trained worker in the field, but at the guilty, anxious, and often desperate parent, then the full value of this work became apparent.

All too often it has been assumed that children are in reality small adults and, hence, that pediatric procedures are merely adult techniques with smaller equipment. This, as has been discovered by countless students and house officers, is obviously not the case. Hughes, in a clear and concise manner, and with obvious concern for the welfare of the patient, offers a blueprint for the performance of most of the standard pediatric procedures. The directions are easily understood and both advantages and disadvantages are discussed for each technique.