Because the value of usual immune globulin preparations in preventing Type B hepatitis is doubtful, we carried out a double-blind comparison of a control human immune globulin preparation with one--identified as HBIG--that had a high concentration (442 mug per milliliter) of antibodies to surface components of hepatitis B virus. Effectiveness was tested in spouses of patients with acute Type B hepatitis. Within 150 days after injection, nine of 33 spouses in the control group had symptomatic Type B hepatitis, compared with one of 25 spouses receiving HBIG. One non-B case also occurred in the HBIG group. Five control globulin recipients had evidence of subclinical hepatitis B infection, compared with one HBIG recipient. Thus, HBIG appeared effective in suppressing not only disease, but also infection itself. Prophylactic value has been demonstrated in persons who should now be recognized as being at exceptionally high risk.
By using cloned types 1 and 2 herpes simplex virus, obtained by selecting large and small plaques produced by material from human lesions, studies were performed to compare properties between preparations of each type. Regarding the rate of inactivation by ultraviolet light, no differences were found between the two antigenic types and none between the preparations obtained from either type. In contrast, type 1 preparations were found to be more readily inactivated at 45 C than type 2. Plaque size of cloned preparations changed by passage in cell culture. A broader range of plaque sizes was obtained, and average plaque size was larger. After 20 passages, preparations obtained from different types gave rise to one of three kinds of cytopathic effect. The cytopathic effect produced by type 1 preparations remained as before 20 passages and consisted of round cells in a compact central mass. For type 2, two kinds of cytopathic effect were seen in cloned preparations. This consisted of aggregates of round cells (seen in preparations before 20 passages) or of large, loose aggregates of round cells of various sizes. Results from neutralization studies using virus before and after 20 passages in cell culture versus antisera prepared against live or ultraviolet-inactivated virus showed no differences between cloned preparations obtained from a given type.
Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.
V A R I C E L L A -Z O S T E RARICELLA-ZOSTER (V-Z) encephalomyelitis is relatively uncommon. Detailed morphologic and virologic studies on such cases are extremely few. Our recent studies of two patients on whom complete autopsies were done, form the basis of this study. In one of these patients V-Z virus was cultured from the brain. Electron microscopic demonstration of virus particles in the brain was obtained on both cases. We believe this to be the first reported isolation of the V-Z virus and the first electron microscopic demonstration of the virus in human brain.Type A intranuclear inclusion bodies were seen in the brain and spinal cord of both patients. We are aware of no recorded observations of type A inclusions in the central nervous system (CNS) in patients with clinical herpes zoster and only one such report in a case of disseminated varicella. The literature, insofar as it is pertinent, is reviewed and a synthesis of our observations and those of others attempted. Report of CasesCase 1.-A 414-year-old boy with acute lymphocytic leukemia, diagnosed in September 1967 when his peripheral white blood cell count (WBC) was 500,000/cu mm, with 95% lymphoblasts, was admitted to the University of Iowa Hospital on Dec 12, 1968 because of diarrhea, nausea, vomiting, and irritability of one week's duration.During the past year he had received prednisone, vincristine sulfate, mercaptopurine, methotrexate (intrathecal 4-amino-N10-methyl pteroylglutamic acid), cyclophosphamide (Cytoxan), and cranial and mediastinal radiation. His illness had been complicated in November 1967 by varicella, which he contracted after exposure to an infected sibling. In March 1968, the patient developed seizures, headaches, and spinal fluid pleocytosis for which he received intrathecal methotrexate and cranial irradia¬ tion. From Nov 20 to 26, he received radiation to the left side of the chest and right cervical regions. At the time of admission he was re¬ ceiving cyclophosphamide (36 mg daily) and prednisone (15 mg daily).Physical examination revealed a chronically ill, irritable child, with alopecia. There was bilateral papilledema. There were decreased breath sounds over the entire left hemithorax, and the liver was palpable 1.5 cm below the right costal margin. No enlarged lymph nodes were palpable. The neurologic examination was within normal limits except for generalized irritability.An admission hemogram revealed a WBC of 2,600/cu mm, with 43% lymphocytes and 43% myelocytes, a hemoglobin level of 13.5 gm/100 ml, and a platelet count of 55,000.On the day after admission he had a rightsided motor seizure. The cyclophosphamide was discontinued and cranial radiation and in¬ trathecal methotrexate were instituted. The last dose of intrathecal methotrexate was given
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