Search

Purpose:Management of patients with cancer, specifically carboplatin dosing, requires accurate knowledge of glomerular filtration rate (GFR). Direct measurement of GFR is resource limited. Available models for estimated GFR (eGFR) are optimized for patients without cancer and either isotope dilution mass spectrometry (IDMS)- or non-IDMS–standardized creatinine measurements. We present an eGFR model for patients with cancer compatible with both creatinine measurement methods.Experimental Design:GFR measurements, biometrics, and IDMS- or non-IDMS–standardized creatinine values were collected for adult patients from three cancer centers. Using statistical modeling, an IDMS and non-IDMS creatinine-compatible eGFR model (CamGFR v2) was developed. Its performance was compared with that of the existing models Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Full Age Spectrum (FAS), Lund–Malmö revised, and CamGFR v1, using statistics for bias, precision, accuracy, and clinical robustness.Results:A total of 3,083 IDMS- and 4,612 non-IDMS–standardized creatinine measurements were obtained from 7,240 patients. IDMS-standardized creatinine values were lower than non-IDMS–standardized values in within-center comparisons (13.8% lower in Cambridge; P < 0.0001 and 19.3% lower in Manchester; P < 0.0001), and more consistent between centers. CamGFR v2 was the most accurate [root-mean-squared error for IDMS, 14.97 mL/minute (95% confidence interval, 13.84–16.13) and non-IDMS, 15.74 mL/minute (14.86–16.63)], most clinically robust [proportion with >20% error of calculated carboplatin dose for IDMS, 0.12 (0.09–0.14) and non-IDMS, 0.17 (0.15–0.2)], and least biased [median residual for IDMS, 0.73 mL/minute (−0.68 to 2.2) and non-IDMS, −0.43 mL/minute (−1.48 to 0.91)] eGFR model, particularly when eGFR was larger than 60 ml/minute.Conclusions:CamGFR v2 can utilize IDMS- and non-IDMS–standardized creatinine measurements and outperforms previous models. CamGFR v2 should be examined prospectively as a practice-changing standard of care for eGFR-based carboplatin dosing.

CamGFR v2 App Screenshot

Excel file containing Tables S7, S9-15, S18

Background & Aims Sorafenib has been the standard of care for patients with advanced hepatocellular carcinoma and although immunotherapeutic approaches are now challenging this position, it retains an advantage in HCV-seropositive patients. We aimed to quantify the rate of tumour progression in patients receiving sorafenib and relate this figure to survival, both overall, and according to viral status. Methods Using serial data from an international clinical trial we applied a joint model to combine survival and progression over time in order to estimate the rate of tumour growth as assessed by tumour burden and serum alpha-fetoprotein, and the impact of treatment on liver function. Results High tumour burden at baseline was associated with an increased risk of death. In patients still alive at the end of the study, the progression in relation to tumour burden was very low compared to those who died within the study. Overall, the change in mean tumour burden was 0.12 mm per day or an absolute growth rate of 3.6 mm/month. Median doubling time was 665 days. For those who progressed above 0.12 mm per day or the 12% rate, median survival was 234 days compared to 384 days if the rate was below 12%. Tumour growth rate and serum alpha-fetoprotein rise were significantly lower in those who were HCV seropositive as was the rate of decline in liver function. These results were replicated in 2 independent patient groups. Conclusion Our analysis suggests that sorafenib treatment is associated with improved survival in patients with advanced hepatocellular carcinoma mainly by decreasing the rate of tumour growth and liver function deterioration among patients with HCV infection. Lay summary Among patients receiving sorafenib for advanced hepatocellular carcinoma the rate of tumour growth (as assessed by changes in tumour size and the biomarker alpha-fetoprotein) and the deterioration of liver function is less in those who have the hepatitis C virus, than in those who do not.

Purpose: Management of patients with cancer, specifically carboplatin dosing, requires accurate knowledge of glomerular filtration rate (GFR). Direct measurement of GFR is resource limited. Available models for estimated GFR (eGFR) are optimized for patients without cancer and either isotope dilution mass spectrometry (IDMS)- or non-IDMS–standardized creatinine measurements. We present an eGFR model for patients with cancer compatible with both creatinine measurement methods. Experimental Design: GFR measurements, biometrics, and IDMS- or non-IDMS–standardized creatinine values were collected for adult patients from three cancer centers. Using statistical modeling, an IDMS and non-IDMS creatinine-compatible eGFR model (CamGFR v2) was developed. Its performance was compared with that of the existing models Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Full Age Spectrum (FAS), Lund–Malmö revised, and CamGFR v1, using statistics for bias, precision, accuracy, and clinical robustness. Results: A total of 3,083 IDMS- and 4,612 non-IDMS–standardized creatinine measurements were obtained from 7,240 patients. IDMS-standardized creatinine values were lower than non-IDMS–standardized values in within-center comparisons (13.8% lower in Cambridge; P < 0.0001 and 19.3% lower in Manchester; P < 0.0001), and more consistent between centers. CamGFR v2 was the most accurate [root-mean-squared error for IDMS, 14.97 mL/minute (95% confidence interval, 13.84–16.13) and non-IDMS, 15.74 mL/minute (14.86–16.63)], most clinically robust [proportion with >20% error of calculated carboplatin dose for IDMS, 0.12 (0.09–0.14) and non-IDMS, 0.17 (0.15–0.2)], and least biased [median residual for IDMS, 0.73 mL/minute (−0.68 to 2.2) and non-IDMS, −0.43 mL/minute (−1.48 to 0.91)] eGFR model, particularly when eGFR was larger than 60 ml/minute. Conclusions: CamGFR v2 can utilize IDMS- and non-IDMS–standardized creatinine measurements and outperforms previous models. CamGFR v2 should be examined prospectively as a practice-changing standard of care for eGFR-based carboplatin dosing.

This work was supported by Cancer Research UK (EHW, TJ: C42738/A24868); National Institute of Health Research Cambridge Biomedical Research Centre (HE); National Institute of Health Research UK Academic Clinical Fellowship (CMC); and National Institutes of Health USA Cancer Center support grant (TJ: 5P30CA045508-31). Important oncological management decisions rely on kidney function assessed by serum creatinine-based estimated glomerular filtration rate (eGFR). However, no large-scale multicentre comparison of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry (non-IDMS), we studied 3,620 patients with cancer and 166 without cancer who had their GFR measured with an exogenous nuclear tracer at one of seven clinical centres. The mean measured GFR was 86 ml/min. Accuracy of all models was centre-dependent, reflecting inter-centre variability of non-IDMS creatinine measurements. CamGFR was the most accurate model for eGFR (root-mean-squared-error (RMSE) 17.3 ml/min) followed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) model (RMSE 18.2 ml/min).Important oncological management decisions rely on kidney function assessed by serum creatinine-based estimated glomerular filtration rate (eGFR). However, no large-scale multicentre comparison of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry (non-IDMS), we studied 3,620 patients with cancer and 166 without cancer who had their GFR measured with an exogenous nuclear tracer at one of seven clinical centres. The mean measured GFR was 86 ml/min. Accuracy of all models was centre-dependent, reflecting inter-centre variability of non-IDMS creatinine measurements. CamGFR was the most accurate model for eGFR (root-mean-squared-error (RMSE) 17.3 ml/min) followed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) model (RMSE 18.2 ml/min).Important oncological management decisions rely on kidney function assessed by serum creatinine–based estimated glomerular filtration rate (eGFR). However, no large-scale multicenter comparisons of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry, we studied 3620 patients with cancer and 166 without cancer who had their glomerular filtration rate (GFR) measured with an exogenous nuclear tracer at one of seven clinical centers. The mean measured GFR was 86 mL/min. Accuracy of all models was center dependent, reflecting intercenter variability of isotope dilution mass spectrometry–creatinine measurements. CamGFR was the most accurate model for eGFR (root-mean-squared error 17.3 mL/min) followed by the Chronic Kidney Disease Epidemiology Collaboration model (root-mean-squared error 18.2 mL/min). Publisher PDF

This brief communication presents a quantitative assessment of the inclusion of immune‐related response criteria and immunological biomarker response monitoring in the registration details of T‐cell checkpoint‐targeted cancer immunotherapy trials in solid malignancies., Immune‐related radiological and biomarker monitoring in cancer immunotherapy trials permits interrogation of efficacy and reasons for therapeutic failure. We report the results from a cross‐sectional analysis of response monitoring in 685 T‐cell checkpoint‐targeted cancer immunotherapy trials in solid malignancies, as registered on the U.S. National Institutes of Health trial registry by October 2016. Immune‐related radiological response criteria were registered for only 25% of clinical trials. Only 38% of trials registered an exploratory immunological biomarker, and registration of immunological biomarkers has decreased over the last 15 years. We suggest that increasing the utilization of immune‐related response monitoring across cancer immunotherapy trials will improve analysis of outcomes and facilitate translational efforts to extend the benefit of immunotherapy to a greater proportion of patients with cancer.

2565Background: Estimation of glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing. However, the most accurate method to estimate GFR in patients with cancer is unknown...

This paper studies rigorous statistical techniques for modelling long term reliability of demand and supply of electrical power given uncertain variability in the generation and availability of wind power and conventional generation. In doing so, we take care to validate statistical assumptions, using historical observations, as well as our intuition about the actual underlying real-world statistical process. Where assumptions could not be easily validated, we say so explicitly. In particular, we aim to improve existing statistical models through sensitivity analysis of ill-known parameters: we propose models for wind power and conventional generation, estimate their parameters from historical wind power data and conventional availability data, and finally combine them with historical demand data to build a full robust joint time-dependent model of energy not served. Bounds on some useful indices from this model are then calculated, such as expected energy not served, and expected number of continuous outage periods-the latter cannot be estimated from a purely time collapsed model because time collapsed models necessarily do not model correlations across time. We compare our careful model with a naive model that ignores deviations from normality, and find that this results in substantial differences: in this specific study, the naive model overestimates the risk roughly by a factor 2. This justifies the care and caution by which model assumptions must be verified, and the effort that must be taken to adapt the model accordingly.

Two patients with severe left ventricular failure (New York Heart Association's class 4) secondary to acute mitral insufficiency underwent mitral valve replacement after their condition had been stabilized by intra-aortic balloon counterpulsation. The need for hemodynamic support declined rapidly following valve replacement in both cases, but when the frequency of balloon counterpulsation was reduced, the immediate onset of life-threatening arrhythmias was noted. The resumption of 1:1 intra-aortic balloon counterpulsation always immediately abolished the arrhythmia. The dependency upon counterpulsation for arrhythmia suppression gradually diminished, and after a week the intra-aortic balloon was removed from the second patient, who subsequently made a complete recovery. The intra-aortic balloon was removed from the first patient four days after surgery and one day after its antiarrhythmic effect had been noted. Twenty-four hours later, this patient succumbed to a ventricular tachycardia which terminated in ventricular fibrillation. When no surgically correctable lesion is present, prolonged use of the intra-aortic balloon is recommended for all patients who develop ventricular or low nodal arrhythmias in response to decreasing the frequency of counterpulsation. As in our second patient, this will on occasion save a very high-risk patient.

Past studies have not established the optimal myocardial temperature range for hyperkalemic arrest but have generated controversy regarding the safety of exposing the myocardium to more profound levels of hypothermia. We therefore used the isolated working rat heart model of ischemic arrest to study the metabolic and functional effects of cardioplegia at the full range of temperatures pertinent clinically. Experimental conditions were designed to reliably control and maintain myocardial temperature during the 60 minute arrest period. We found that nearly full recovery of function occurred when hearts were arrested at or below 16° C. High-energy phosphate levels measured immediately after arrest were better maintained at 4° and 8° C, despite evidence of decreased anaerobic glycolysis. When measured after the recovery period, high-energy phosphate levels returned to somewhat less than control levels in all groups arrested at or below 24° C. Myocardial glucose utilization was best preserved in hearts arrested at or below 12° C. We found no evidence that greater myocardial edema resulted from arrest at colder temperatures. Severe and permanent damage was observed when hearts were arrested at or above 28° C. In this model, therefore, the best overall metabolic and functional protection occurred when hearts were maintained at 12° C or below during potassium-induced cardioplegia. Our results support the idea that cold injury to the heart does not occur and that colder temperatures provide better protection from ischemic myocardial injury.

During reperfusion, functional and metabolic recovery of the isolated working rat heart from one hour of ischemia was best in hearts selectively cooled at the onset of the ischemic interval by perfusion with 5 to 10 ml. of 10° C. or 15° C. Krebs-Henseleit buffer. Hearts similarly perfused at 4° C., 20° C., and 37° C. recovered significantly less well or not at all. Immediately after the hour of ischemia and prior to reperfusion, the absolute levels of glycogen and high-energy phosphates were best in the hearts perfused at 4° C. However, metabolic function was best preserved in those perfused at 10° C. and 15° C., as evidenced by rapid recovery of high-energy phosphates and glycogen to control levels compared to metabolic deterioration in the 4° C. group.

The clinical course of a patient with bioprosthetic failure of aortic and mitral Ionescu-Shiley valves (which contain bovine pericardial leaflets) is presented. Failure occurred in less than 4 months and was due to infection that resulted in calcification and severe stenosis. On examination of tissue specimens under light and electron microscopes, the pathological process was seen to be similar o that occurring with infected porcine prostheses.

Shortly after severe blunt chest trauma, a young man experienced neurological symptoms suggestive of a spinal cord lesion at the lower thoracic level. The symptoms resolved at first, but then recurred 3 years later and progressed slowly. Neurological workup failed to define the cause until a thoracic aortogram showed an aneurysm in the middle portion of the descending aorta in close proximity to a vessel supplying the anterior spinal artery. After the operative repair with precautions taken to avoid further neurological injury, the neurologic deficit resolved partially. Because of the potential for symptomatic spinal cord ischemia resulting from lesions of the aorta, angiographic delineation of the spinal cord blood supply is valuable in planning operative repair.

A ventricular inhibited demand cardiac pacemaker was inhibited in the presence of intimate contact between the active temporary bipolar electrode ring and a retained inactive permanent bipolar electrode tip. Electromagnetic interference effects, lack of insulation, lead breaks, and loose connections were all ruled out as the cause of pacemaker suppression.

For 80 elective clinical cardiopulmonary bypasses we alternately used either a commercial microporous Teflon membrane oxygenator or a commercial hybrid bubble-film oxygenator. Setup time was a little longer with the membrane unit (20 minutes), but priming volume (2,250 ml) was the same. No problems were encountered with the hybrid oxygenator. However, despite our monitoring of additional variables, including shim and inlet pressure and recirculation flow, gas exchange abnormalities were encountered in 5 patients on whom the membrane oxygenator was used; in 4 of these cases the abnormalities were encountered prior to our recognition of the potential for occasional internal shunting with this device. There were no hospital deaths. When the two groups, matched except for oxygenator selection, were compared, there were no significant differences clinically or hematologically. For cardiopulmonary bypass of 2 hours or less, both oxygenators studied are definite improvements over previous silicone membrane and high-gas-flow bubble oxygenators. However, lower cost and reduced complexity favor the hybrid oxygenator.

The modalities of 25 mEq. per liter potassium-induced arrest in a simulated extracellular fluid, and 15° C. perfusion hypothermia were combined and used exclusively for myocardial protection during cardiac surgery in 108 consecutive patients. Over half of the patients had impaired preoperative myocardial function, as assessed by a subnormal ejection fraction and by New York Heart Association Class IV status. Ten patients were semiemergencies and eight were emergencies, including three in cardiogenic shock. The 30-day operative mortality rate was 4.6 percent, and during a mean follow-up of 9 months there were two late deaths-both cerebrovascular. The excellence of the myocardial protection is attested to by spontaneous defibrillation in over 50 percent of the patients, the very infrequent use of pressors, the immediate postoperative improvement in cardiac output, the early improvement in postoperative functional status of almost all of patients, and the very low level of specific myocardial isoenzyme released following the open heart procedures. The significant advantages of 15° C. potassium-induced arrest are (1) simplified high-volume temperature and pressure-monitored aortic root perfusion, effective even with aortic insufficiency, (2) the preclusion of the “calcium paradox,” (3) minimization of defibrillator induced myocardial injury, (4) operating conditions superior to normothermic ischemic arrest or topical hypothermia, (5) avoidance of coronary artery trauma, high and low perfusion pressure injuries, low-flow/high-energy demand situations and low-temperature injury, and (6) extensive clinical and experimental evidence of superior myocardial protection.

Cardiac myocytes from adult rat ventricles were isolated by perfusion and incubation with buffer containing collagenase and hyaluronidase. This method gave a high yield of viable cells with normal morphology and metabolic properties. The isolated cells can tolerate 2.5 m m extracellular calcium and have physiologic levels of ATP (20 μmol/g protein). The cells metabolized glucose at a linear rate up to 4 h. Glucose utilization was stimulated by insulin and anoxia. Protein synthesis was maintained at a steady rate for 3 h and was significantly stimulated by insulin. A reasonably constant rate of protein degradation was observed for 3 h. Insulin significantly inhibited the rate of protein degradation.

Review of previous Investigations. The part of Pennsylvania described in this paper was allotted in the recent state survey to Professor Frederick Prime, junior, and in 1874 he made his first report (D), on page 62 of which the state geologist notes that Professor Prime “ has wisely said nothing in his report about his observations on supposed glacial drift.” He further notes that Mr Chance found, in the spring of 1875, a moraine behind the Lehigh Gap. In Professor Prime’s second report, DD, in 1878, he devotes chapter xxiv to “ The Glacial Epoch,” and states that his efforts to follow the lines of bowlders was “ a hopeless one and had to be abandoned.” He further notes the finding of vegetable remains in what must have been sub-glacial till, and characterizes the filling of a great range of limonite mines as “drift.” In his third report, D3, volume . . .

From October 1970 to May 1977, a total of 212 pacemakers were implanted at the Milton S. Hershey Medical Center of Pennsylvania State University, Hershey. During this period, we encountered five patients with symptomatic thrombosis of the subclavian vein, a rate for this complication of approximately 2 percent. Although this complication was reported only rarely prior to 1976, we believe that symptomatic subclavian thrombosis after insertion of a transvenous pacemaker electrode occurs more frequently than previously suspected. The etiology, pathogenesis, and treatment of this interesting condition are discussed.

Publisher Summary This chapter illustrates the techniques for studying the cell-free synthesis of the major lens fiber membrane polypeptide. The lens provides a unique system for the study of plasma membrane differentiation. It contains two major cell types—epithelial and fiber cells. The epithelial cells are roughly cuboidal and form a monolayer that covers the anterior surface of the lens. On division, they move inward and differentiate into fiber cells. The chapter discusses the fractionation and extraction of lens RNA with the intent of enrichment for messenger RNA (mRNA) specific for the major fiber junction protein, MP-26. The chapter describes the immunoprecipitation procedure that is used to identify MP-26 as a cell-free translation product. The procedure for establishing primary cultures of bovine lens epithelial cells is also discussed. Both the rabbit reticulocyte and wheat germ lysate systems are employed for translating lens RNA. The cell-free translation reaction is terminated by adding one-twentieth volume of 20% sodium dodecyl sulfate sodium dodecyl sulfate (SDS).

With exposed metal at the electrode tissue interface (8 mm2, 28 mm2, 57 mm2), myocardial threshold stimulation impedance increased as pulse duration was lengthened, with left ventricular intramyocardial stimulation, and with the smaller surface area electrode. An 0.5 mm2 differential-current-density electrode, which eliminated direct metal-to-tissue contact at the electrode-myocardial interface, was associated with notably higher impedances than each of the three metal tip electrodes and did not show increasing impedance levels with changes in pulse duration, confirming the minimization of polarization energy losses with this device. The majority of electrode, electrode tissue interface, and myocardial variables that are characterized by high threshold stimulation impedance are associated with low threshold energy requirements for pacing and reduced pacemaker power source drain. No accurate information about sensing impedances can be derived from current knowledge of pacing impedance.

There is mounting evidence suggesting functional and structural alterations in the retinal pigment epithelium (RPE) in experimental and clinical diabetes. In this study we examined the effect of high glucose concentrations on human RPE cells in vitro. After 24-hr incubation in media supplemented with glucose (19·5 m M , 25·5 m M , and 45·5 m M ) and prepared both with and without osmotic adjustment, there was no significant effect on [ 3 H]thymidine or [ 3 H]uridine incorporation into TCA-precipitable material. There was, however, a significant decrease in [ 35 S]methionine incorporation which became more marked with increasing glucose concentrations. This could not be attributed to increased osmolarity caused by the additional glucose as it occurred in isosmolar high glucose media. 3- 0 -methyl glucose, a non-metabolized glucose analog, did not have the same effect, suggesting that metabolism of glucose may be important. Resolution of newly synthesized proteins by gel electrophoresis and autoradiography suggests a generalized decrease in protein synthesis. These data suggest that elevated glucose levels cause a significant metabolic alteration in RPE cells in vitro.

Twelve patients with tuberculous pericarditis were found among 1,194 patients with tuberculosis treated at the University of Texas Medical Branch over a 10-year period, an incidence of 1%. Surgical treatment was undertaken in 4 patients, and the rest were treated medically. The surgically treated patients had no major complications, and none of them died. In the medically treated group, however, 1 patient died, 1 had an anaerobic empyema, and 1 experienced respiratory arrest. In addition, the average hospital stay was 33 days less in the surgically treated group. Early surgical intervention should be carried out in patients with tuberculous pericarditis who do not respond promptly to adequate antituberculosis chemotherapy.

To evaluate the effect of a cardioplegic solution on the endothelium of the saphenous vein, portions of this vein were harvested from each of 5 patients undergoing coronary artery bypass operation. Each sample was divided into five segments. One segment was distended with heparinized saline solution, one with heparinized blood, and one with heparinized cardioplegic solution (25 mEq of potassium per liter). All of the distending solutions were kept at 10°C, and pressure was carefully limited to 200 mm Hg. The fourth segment of vein was distended with heparinized saline solution but no effort was made to limit distending pressure, and the fifth segment was not distended. All samples were then examined with light and scanning electron microscopy. There were no great morphological differences in the endothelium of veins distended to 200 mm Hg with saline solution, blood, or cardioplegic solution. The morphology of these samples compared favorably with the control vein endothelium although scattered areas of endothelial disruption were present in every sample. Veins distended without pressure control showed massive endothelial disruption. The particular solution used to distend the saphenous veins is not as important as limiting the distending pressure.

The clinical findings in this series of 22 cases of subclavian steal syndrome showed a predominance of men (13:9), a mean age of 51 years, and a predominance of left subclavian artery obstruction. There was a blood pressure differential of more than 20 mm Hg and diminished pulses ipsilaterally in most. Main indications for surgical repair were transient neurologic symptoms. Twenty-one of our patients had surgical repair of the subclavian steal syndrome; six had concomitant carotid artery surgery. The most common surgical procedure performed consisted of a carotid subclavian bypass graft. One patient had only carotid revascularization; 19 patients have had good long-term results. One patient, with tetralogy, died and three had complications. The asymptomatic or mildly symptomatic patient may be given a trial of medical treatment. Symptomatic patients can have extrathoracic bypass with a very low risk. Surgery is indicated if significant associated carotid lesions are present.

We used intrapleural instillation of quinacrine hydrochloride in 20 patients (Group A) with recurrent spontaneous pneumothorax (one bilateral) and compared their clinical course with 19 patients who underwent thoracotomy and scarification or pleurectomy (Group B) and 63 patients treated by tube thoracostomy alone (Group C). In Group A, there was one complication of treatment, a pneumothorax immediately following tube removal, which necessitated repeat tube thoracostomy, and there was one late ipsilateral recurrence 2 years after treatment. These 20 patients with 21 recurrent spontaneous pneumothoraces treated with intrapleurally administered quinacrine have been followed for from 6 months to more than 4 years with only one late recurrence on the treated side. Eight patients in Group B had postoperative complications: 2 patients who had had pleurectomy required reoperation for postoperative bleeding; lobar pneumonia developed in 3; 1 had lack of total expansion of the lung; an intrathoracic hematoma developed in 1; and an ipsilateral pneumothorax necessitating tube thoracostomy developed in 1. In Group C, the rate of recurrence of pneumothorax was 23% during the first year following treatment. Intrapleural instillation of quinacrine is a simple, low-risk, reliable, and effective treatment for recurrent spontaneous pneumothorax, and is equally as effective as thoracotomy and scarification.

Events of synthesis and degradation of water-soluble and -insoluble rat lens proteins were examined during a 21-day period of galactose-induced cataractogenesis. Epithelial cells continued to synthesize both fractions of proteins throughout the duration of the experiment. There were few qualitative changes in the pattern of proteins expressed and the rate of synthesis did not decrease. In contrast, synthesis of both water-soluble and -insoluble proteins by the cortical cells decreased and then became totally inhibited indicating no selective or differential inhibition of synthesis of one protein fraction, but that both water-soluble and -insoluble proteins in the cortical cells are equally affected by the metabolic changes associated with galactose-induced cataractogenesis. The cells within the nuclear region of control lenses were capable of incorporating [35S]-methionine into protein. This synthesis was completely abolished in 7- and 14-day nuclear cells. Labeled proteins were found to be present in the 21-day nuclear preparation to a level almost three times greater than that observed in the control nucleus. Degradation was minimal in both fractions of epithelial proteins, whereas selective degradation of proteins from both fractions was apparent in 14- and 21-day cortical cells. At day 14, the water-soluble protein profile from nuclear cells became less complex with the loss of several major bands, but these bands as well as some unique bands appeared at day 21. The profile of water-insoluble nuclear proteins remained unchanged over 21 days.

A case of human pulmonary dirofilariasis had positive serologic testing postoperatively. Increased awareness of this entity as a cause of solitary pulmonary nodules may lead to preoperative serologic and intradermal testing, and to the possibility of arriving at a preoperative diagnosis.