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In order to find out whether the response rate and survival in epithelial ovarian cancer can be improved by aid of sensitivity testing with the subrenal capsule assay (SRCA), 196 patients with FIGO Stage II-IV epithelial ovarian cancer were randomized to be treated with either cyclophosphamide-doxorubicin-cisplatin (CAP) or SRCA-guided chemotherapy. The drug combinations tested with the SRCA were (1) cyclophosphamide-doxorubicin-carboplatin (CACAR), (2) CAP, (3) carboquone-methotrexate-tegafur (CQ-MTX-TEG), (4) cisplatin-etoposide-hexamethyl-melamine (P-VP-HXM), and (5) bleomycin-epirubicin-cisplatin (BEP). A total of 132 patients (CAP, 69; SRCA, 63) were eligible for efficacy analysis based on relaparotomy findings. The overall response rate was 59% in the CAP arm and 62% in the SRCA arm. In the SRCA arm, 16 patients were treated with CACAR, 24 with CAP, 10 with CQ-MTX-TEG, 11 with P-VP-HXM, and 2 with BEP. The response rate to CACAR was 63% and to SRCA-CAP was 75%. The number of complete responses was higher when CAP was given as guided by the assay than when given at random (14/24 vs 23/69; P = 0.03, Pearson chi 2). Survival curves as estimated by Kaplan-Meier method gave a median survival of 24 (SE = 4) months to the SRCA arm and 28 (SE = 5) for the CAP arm (P = 0.7; log-rank test). Because no survival benefit was achieved, the SRCA obviously needs further development before it can be routinely recommended in the choice of first-line chemotherapy for patients with ovarian cancer.

Summary Twenty-seven deaths in premature infants weighing less than 1 250 g who were treated with intermittent positive pressure respiration are reported. The major pulmonary abnormalities were hyaline membrane formation, infection, and hemorrhage occurring‘ alone or in combination with intraverticular hemorrhage. Hyaline membranes were associated with severe clinical features of respiratory distress, whereas infection was not. Prolonged treatment resulted in “bronchopulmonary dysplasia” in only 1 case where severe clinical respiratory distress was associated with the finding of hyaline membranes at post mortem.

Summary Clinical findings and results of treatment in a series of 49 premature infants with birth weights between 850 and 1250 g are presented. The “intensive care” included nursing in incubators with high environmental humidity maintaining skin temperature at 36.5°C, umbilical catheterisation (both arterial and venous), intravenous glucose infusions, correction of metabolic acidosis by rapid sodium bicarbonate infusions, oxygen therapy and finally endotracheal intubation and mechanical ventilation. The series was divided into 3 categories according to the severity of respiratory symptoms. There was only one survivor out of 12 cases in the category of severe RD, whereas 14 of 21 with moderate RD and 9 of 16 with slight or no RD survived. The overall survival rate was 45%. The correlation between clinical findings, arterial blood gases and pH, chest X-rays, response to treatment and outcome in each of the 3 categories is discussed. The preliminary data from our follow-up studies indicate that there are only a few cases showing signs of permanent brain injury at the age of two years.

Baroreceptor response have been observed in exteriorized fetal lambs, but ther have been no quantitative studies of changes with maturation in fetuses in utero. In 9 fetal and 3 newborn lambs an inflatable balloon catheter was passed from the femoral artery into the descending aorta. In 7 other fetuses inflatable balloons were placed around the pulmonary artery (PA) or the aortic isthmus. Vinyl catheters were positioned in a brachial or carotid artery, and catheters and ECG leads were exteriorized. Arterial pH, PCO2 and PO2 were normal in all studies. Reflex bradycardia in response to blood pressure elevation by balloon inflation was measured repeatedly for several weeks. Baroreceptor sensitivity was expressed as the regression coefficient of the beat-to-beat relationship between systolic (SP) and pulse (PP) pressure, and the subsequent R-R interval (R-R) or heart rate (HR). In over 100 observations we found: (1) elevation of systemic but not main PA pressure elicits reflex bradycardia; (2) reflex bradycardia could be elicite in all animals but was frequently absent in fetuses less than 120 days gestation; (3) reflex bradycardia was blocked by atropine but not influenced by propranolol; (4) in fetuse the regression coefficients of SP or PP vs. R-R increased with gestational age, but not when SP or PP was correlated with HR because of the lower initial HR in older fetuses; (5) lambs had significantly higher regression coefficients for all correlations than fetuses. We have not yet evaluated if baroreceptor response depend on gestational age and initial HR in combination.

Sympathetic and parasympathetic activity have been studied in exteriorized fetal lambs but not in intact fetuses in utero. We placed vinyl catheters in a systemic artery and hindlimb vein in 20 fetuses from 92 days of gestation to term and also in 3 newborn lambs. The animals were allowed to recover from surgery for 2–3 days and then studied daily for several weeks. Maternal and fetal pH, PCO2 and PO2 were normal in all experiments. The blood pressure (BP) and heart rate (HR) responses to selective intravenous injection of propranolol (1 mg/kg), practolol (1–2 mg/kg), atropine (1.0 mg/kg), phentolamine (0.1 mg/kg), phenoxybenzamine (5 mg/kg) and tyramine (0.25 mg/kg) were recorded. The adequacy of autonomic blockade was confirmed by absence of response to acetylcholine (5–15 μg/kg), isoproterenol (0.1 μg/kg) or methoxamine (50 μg/kg). Change in HR from resting levels without significant BP change were observed as follows: propranolol 5–25% decrease, practolol 8–22% decrease and atropine 0–64% increase. Response to beta-adrenergic blockade did not vary significantly with gestational age. Phentolamine and phenoxybenzamine decreased systolic BP 2-14 and diastolic BP 2-12 mm Hg in 19/21 animals and tyramine increased systolic BP 7-60 and diastolic BP 10-46 mm Hg in 7/7 animals. No significant difference in sympathetic responses were observed in fetal and newborn lambs, indicating HR and BP to be under similar autonomic control at all ages studied.