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A technique to diagnose subependymal hemorrhage (SEH), intraventricular hemorrhage (IVH), intracerebral hemorrhage, and posthemorrhage hydrocephalus in tiny infants, using real time ultrasound studies of the brain ventricular system, is described. This is a bedside technique that visualizes the brain through the fontanelles and the sutures, in three planes: coronal, sagittal, and horizontal. Excellent visualization of the ventricular system, caudate nuclei, the thalamus, the choroid plexus, the corpus callosum, and the foramen of Monro is obtained. This method has good definition using high frequency transducers since there is no bone interference. The ultrasound diagnosis correlated well with computed tomography (CT) and with direct pathologic studies. This technique was more sensitive in diagnosing small IVH/SEH and organized clots than were CT studies. IVH/SEH were found in 90% of 113 infants less than or equal to 34 weeks of gestation; 49% of the hemorrhages were large and 41% were small. Most hemorrhages were found in the first scan, usually shortly after birth. Twenty-one premature infants who never had perinatal asphyxia or respiratory distress syndrome had IVH/SEH. The hemorrhages were followed until disappearance, usually in one to three months in cases of large hemorrhages.

The paucity of data regarding phagocytosis in the newborn is reviewed. A method of evaluating phagocytosis in the human is presented, in which the proportion of "effective phagocytes" (cells containing 10 or more carbon particles) is scored, rather than the total number of cells engulfing particles. Employing the criteria described, we have found significant differences in phagocytic ability between the blood of premature infants and that of adults or full-term infants. Differences observed between full-term infants and adults in respect to phagocytic capacity of leukocytes were not clearly significant. In general, increasing phagocytosis was observed, approaching adult levels with increase in birth weight. Addition of fresh, normal adult serum to invitro preparations of premature infants' blood significantly enhanced phagocytosis. The substances in serum which stimulated phagocytosis were identified by electrophoresis to be in the fractions generally known as α1-, α2-, and β-globulin. A possible therapeutic use for adult serum in the premature is postulated and is being studied.

Dr. Roux is correct; the procedure he outlines and executes which is his own modification is neither valid nor reliable. We use Silica Gel H containing (NH4)2SO4 (Dr. Roux did not) which gives a different chromatographic separation from his. His statements about Eastman chromatogram sheets No. 6061 do not apply; these cannot be charred. His application of a large overload of phospholipids (0.5 mg) gives poor separation on TLC; we use about 30 µg. We long ago advised Dr. Roux that we stopped spraying with H2SO4 since this chars less uniformly than does the heated (NH4)2SO4-Silica Gel H plate.

The authors have prepared a timely and up-to-date treatise on two major but interdigitating areas in medicine as their title suggests and have done a thorough but concise and work-man-like job of presenting the material in out-line form. Frequently outline books are either too sketchy or they are so concise that they are of little value.