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Triple-therapy (low-dose cyclosporine-azathioprine-prednisone) immunosuppression regimen was compared with double-therapy (cyclosporine-prednisone) in 91 consecutive nonrandomized adult cadaveric renal transplant recipients. Both groups were comparable with respect to ethnic diversity, prior transplants, and diabetes. The majority of patients with delayed function (ATN) were maintained on triple therapy, and the use of antilymphocyte agents was more common in the triple-therapy group (52% vs. 7%; P = 0.0001). Triple-therapy patients experienced increased acute rejection episodes (1.4 vs. 0.8 per patient, P = 0.03), required more courses of additional steroid pulse therapy (4.3 vs. 1.6 per patient; P = 0.001), and developed serious infections more frequently (37% vs. 15%; P = 0.05), especially CMV infections (17% vs. 0; P = 0.03), compared with double-therapy patients. However, the increased overall infection rate and CMV infection rate were observed only in those patients who received antilymphocyte agents compared with those who did not (46% vs. 21%; P = 0.02 for all infections, 26% vs. 4%; P = 0.006 for CMV). Additional steroid pulse therapy was associated with increased CMV infections (24% vs. 0; P = 0.03) but not with overall infections. One-year allograft and patient survival were equivalent in both groups. Exclusion of ATN patients from analysis did not alter the findings. This experience confirms the overall efficacy of triple-therapy immunosuppression in renal transplant recipients but suggests that triple therapy may be associated with more acute rejection episodes, greater immunosuppression requirements, and a resultant increase in infections, especially CMV.

Nuclear submariners live and work in an atmosphere composed of approximately 80% naturally occurring nitrogen, 19% oxygen (manufactured aboard ship), and a complex mixture of inorganic and organic contaminants. The concentrations of contaminants exist as a balance between the rates of production from human and operational activities and the rate of removal by engineering systems. The biological effects of inorganic gases, particularly carbon dioxide, have been extensively studied. Investigators are now attempting to define the composition and concentration of volatile organic compounds that accumulate during 90-day submergences. Medical studies have not conclusively shown that crewmembers incur adverse health effects from continuous exposures to the sealed atmospheres of nuclear submarines.

The Naval Air Development Center's Human Centrifuge was used to assess the effects of repeated exposures to a simulated Air Combat Maneuvering (ACM) environment on various measures of physiological function and psychomotor performance. The environment consisted of a realistic ACM profile that included associated noise, high speed/stall buffet conditions, and increased intra-cockpit temperatures. The effects of varying the subject's seatback angle, as a function of the environment, was also measured. Analysis of the various physiological and performance data revealed the following: 1) heart rate was negatively correlated with tracking accuracy under the combined stress conditions of this study, 2) test conditions that included acceleration and buffet resulted in a significant decrement in tracking accuracy, 3) the addition of increased intra-cocpit temperatures, when combined with acceleration and/or buffet, produced a significant decrease in tracking accuracy, 4) increasing the seatback angle from the vertical partially ameliorated the effects of the other stressors. Details of these findings, as well as results of various biochemical analyses, are discussed.