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To the Editor: The letter by Asrani et al. (May 2 issue)1 reports cases of hepatocellular carcinoma in patients who have undergone Fontan palliation for univentricular hearts. Our practice includes yearly screening for adult patients who have undergone Fontan palliation, including imaging and testing of the alpha-fetoprotein level. We report on a 51-year-old man with a univentricular heart (double-inlet left ventricle) who underwent a classic atriopulmonary Fontan procedure in 1982. Progressive dyspnea, atrial arrhythmias, ascites, and pleural effusions developed in the context of normal ventricular systolic function. Evaluation of the liver, including biopsy and magnetic resonance imaging (MRI), showed congestive . . .

In this epidemic, Paracolobactrum aerogenoides, an organism which is seldom pathogenic, appeared to have developed virulence, particularly against the brain and meninges of premature infants. Of the 22 infants with various manifestations of infection, 11 died with meningitis and 8 showed hemorrhagic encephalitis. The epidemic seemed at an end on several occasions, only to break out again months later. It appeared that the organisms might survive for long periods of time in the incubators due to the difficulty of disinfecting these mechines; the epidemic was not finally brought under control until an exhaustive cleaning technique was instituted.