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In neonates, herpes simplex virus (HSV) infections can lead to severe diseases associated with high mortality. We report a 6-day-old girl who developed clinical signs of fulminant hepatic failure accompanied by infectious-toxic shock and disseminated coagulopathy secondary to HSV type 1 (HSV-1) infection. The diagnosis was performed postmortem by demonstration of HSV-1 DNA in liver tissue as well as by retrospective detection of HSV-specific antibodies.

Because of their localization and function as phagocytes, alveolar macrophages could take part in the catabolism of surfactant, including surfactants used for treatment. Conditions of the ingestion of the surfactant preparation AWD 56-02 by alveolar macrophages in vitro are described in this paper. The surfactant was labeled with rhodaminyl phosphatidylethanolamine and incubated with alveolar macrophages lavaged from rat lungs. Membrane binding and phagocytosis were evaluated by fluorescence microscopy and quantified fluorimetrically after extraction of the dye. The surfactant was phagocytosed only in the presence of rat serum. The opsonins in the serum are related to complement and Fc receptors as demonstrated by the heat lability of the factor and the inhibition by aggregated gamma-globulins. Furthermore, the phagocytosis depends on calcium and on a factor in the surfactant preparation. Experiments with inhibitors and competition with unlabeled surfactant show that the phagocytosis is a specific and energy-dependent process. Catabolism by alveolar macrophages might be an important step in the metabolism of surfactant, especially when administered in pathological conditions characterized by the presence of serum in the airspaces.

The influence of the amphiphilic drugs imipramine (150 mg/kg b. w./day) and chloroquine (75 mg/kg b. w./day) on the phospholipid (PL) -metabolism of rat lung, its PL-content and PL-composition were measured in the cell free lung lavage fluid (alveolar surfactant), in the free alveolar cells (mainly alveolar macrophages), and in the residual lung tissue. In addition to the long-term administration (15 applications during a period of 3 weeks), the influence of short-term administration (2 or 4 applications, resp., during a period of 2 or 4 days) was examined. The alveolar macrophages show the largest increase in PL-content. As revealed by its composition the stored PL are of surfactant origin. In chloroquine treated rats the number of macrophages is increased as well. The concentration of stored PL is higher in macrophages of imipramine treated rats. The excessive accumulation of PL in this animal group possibly impairs the clearance function of alveolar macrophages. This is suggested to be the reason for the accumulation of alveolar surfactant in imipramine treated rats. The influence of the drugs on the PL-content of the residual lung tissue was weak. The results of this study show that amphiphilic drugs cause an accumulation of surfactant-PL within the alveolar macrophages and can promote the alveolar surfactant content even after short-term application. The role of alveolar macrophages in alveolar surfactant catabolism is demonstrated.

Changes in the clotting system, as well as morphological and functional alterations corresponding to that of the pathologic phenomenon of disseminated intravascular coagulation (DIC) or consumption coagulopathy, were produced by thrombin infusion (550 NIH U X kg-1 X h-1) in rats and simultaneous inhibition of fibrinolysis by PAMBA (100 mg/kg). Changes in the fibrinogen level and platelet count as well as the appearances of fibrin monomers and the formation of microthrombi in several organs were evaluated. Simultaneously, the function of the respiratory system was investigated by continuous measurement of oxygen consumption as well as elasticity and water content of the lung. From the time course of the alterations in the several parameters, conclusions can be drawn for the pathogenesis and the possible therapeutic influence on DIC.

The influence of short-term and chronic administration of chlorphentermine (Chlph) on the structure and phospholipid (PL)-content of the lungs was studied in guinea pigs. The drug was given daily in a dose of 40 mg per kg body weight i.p. The PL-content of the whole lung as well as the phosphatidyl choline (PC)-portion were estimated in animals treated with Chlph for 4, 5 and 6 weeks. In a further experiment, the influence of 2, 4 and 28 days application on the PL-content of the lung lavage fluid separated into the acellular and cellular (macrophage) fraction was examined. Morphologic studies of lung, liver, heart, kidney, spleen, brain, and pancreas supplemented the PL-content analysis. The amount of PL in the whole lung increases continuously with the duration of the treatment but only moderately. The PC-fraction of the total PL remains constant throughout the experiment. A substantially greater increase was detected in the lung lavage fluid whereby the cellular fraction is most affected. Very important is the result that the PL-content of the lung lavage fluid reaches its highest level already after two Chlph-injections. After short-term administration the morphological examination of the lung mainly shows inflammatory infiltrations, whereas after long-term application a foam cell reaction is mainly localized in the interstitium. The studies show that an increase of the amount of lung sufactant in guinea pigs is possible following Chlph administration.

Alterations of the lung structure, especially of the pneumocytes type II, of asphyxied newborn rabbits were investigated. Experiments were carried out on pregnant does shocked by thrombin- and Pamba-applications on the 28th, 29th and 30th day of gestation and on their newborns delivered by caesarian section at these days and killed after one or five hours life-time. Histologically, adult rabbits show characteristic alterations in an early phase of the shock. Lung alterations are the main findings in the newborns. Atelectases and, additionally, disturbances of circulation, permeability and also hyaline thrombi are seen. Lamellar bodies within the pneumocytes type II show a significant decrease of the lamellae and the whole osmiophilic material. The alterations of immature newborns are more severe than those of mature animals and also more severe after the longer life-time. These alterations are considered as a result of decreased synthesis of surface active phospholipids.

Alterations of the lung- and lung lavage fluid-phospholipids (PL's) after a maternal thrombin-shock have been studied in 1 and 5 h old newborn rabbits delivered at days 28 and 30 of gestation. In lung wash the amount of PL increases during the period of gestation and during the first hours of life. In asphyxiated mature animals the PL-content is statistically significantly decreased. The very low PL-content of the lung wash in premature born animals is not affected by asphyxia. The amount of phosphatidyl choline (PC) as a percentage of total PL is unchanged in all animals studied. The PL and PC content in the lung tissue follows the same developmental pattern but the differences are not statistically significant. Changes in the lung weight/body weight (LW/BW)--ratio after asphyxia show a disturbed development of the newborn lung, too.

In continuation of previous experiments in adult rats the alteration in content and composition of lung phospholipids (PL) and lung structure of newborn rats of different gestational age was studied after three administrations of the amphiphilic drugs imipramine (75 mg/kg b.w.) and chloroquine (50 mg/kg b.w.). The fetuses were obtained by Cesarean section on day 20, 21, or 22 of gestation. Morphological examinations of the lungs of drug treated 21-day-old fetuses revealed a substantially better aeration than nontreated controls. 20 and 22 days old fetuses showed no differences in aeration between drug and saline treated rats. Analogous results were obtained with respect to the 1 h survival rate of newborns. Furthermore, imipramine and chloroquine cause a premature development of the pneumocytes type II as shown by electron microscopy. An increased PL content as well as disaturated phosphatidylcholine (DSPC) and phosphatidylglycerol (PG) proportion of fetal lungs, especially in animals born on day 21 of gestation, were found after drug treatment. The results suggest an acceleration of maturation of the pneumocytes type II in fetal lungs induced by amphiphilic drugs.