We have studied the differential cytology of BAL fluid in 48 children aged 3-16 years (mean age±SD 7.9±3.5 yrs) undergoing elective surgery for nonpulmonary illnesses. A flexible bronchoscope (Pentax 3.5 or 4.9 mm) was wedged in the middle lobe or one of its segments. BAL was performed with 3×1 ml·kg -1 body weight of normal saline warmed to body temperature. The first sample was studied separately; subsequent samples were pooled for analysis.The mean recovery was 58±15%. Significantly more granulocytes and less lymphocytes were found in the first, as compared to the pooled, sample. Total cell counts were highly variable and ranged from 0.5-57.1 × 10 4 ·ml -1 . Macrophages were the predominant cell type, with a mean percentage of 81.2±12.7%. The relative proportion of lymphocytes was higher than that reported in most studies of adult volunteers (16.1±2.4%). No age dependency was observed for either cell type. The mean percentage of granulocytes was 2.5±3.3%. Absolute granulocyte counts were significantly higher in children under 8 yrs of age.This study provides the first reference data on BAL differential cytology in children without pulmonary disease and will be the basis for future investigations of BAL in paediatric lung diseases.
Studies of 16 adults with nephrotic edema reveal a spectrum of disease, the extremes of which suggest two different pathophysiologic forms. Patients with the "classic" form--vasoconstriction or hypovolemic nephrosis--have high renin and aldosterone levels that are stimulated rather than suppressed by salt-loading but become lower before steroid diuresis. These patients have minimal lesion disease and, perhaps from diffuse capillary damage, tend to have hypovolemia with renin-induced vasoconstriction. Patients with the second, and heretofore undescribed, form--hypervolemic or overfilling nephrosis--have low renin and aldosterone values that rise normally after sodium depletion. Hypertension, mild renal insufficiency, hypervolemia, and steroid resistance with chronic glomerulonephritis are seen histologically. This form appears volume overloaded from impaired renal sodium excretion. In remission of either type, renin system deviations tend towards normal, but one form does not convert to the other. Renin-sodium profiling may help reveal the two forms and predict steroid responsiveness.
Indocyanine green is a water-soluble tricarbocyanine dye developed by Brooker and introduced by Fox et aZ.(l,2) for measurement of cardiac output by the indicator dilution technic. For this purpose its absorption spectrum and protein-binding characteristics ( 1 ) are ideally suited. The results of the present investigation indicate that the dye may also be of great value in study of hepatic function.Methods. All studies were conducted on 2 trained unanesthetized female dogs weighing 18.9 and 2 2 . 0 kg. Several months previously each had undergone splenectomy, cholecystectomy, and preparation of a permanent duodenal fistula using the device described by Thomas(3), which permitted access to the common bile duct. The dogs remained in good health, and hepatic function, as judged by repeated measurements of sulfobromophthalein (BSP) transfer maximum ( 4 ) , continued unimpaired. At the time of each study an olive-tipped ureteral catheter (5 or 6 Fr.) was inserted through the ampulla of Vater and advanced about 5 to 6 cm into the common bile duct. The dogs were then placed upright in a sling and bile was collected by gravity or, when it was particularly viscous, by gentle *This work was made possible by grants from the New York Heart Assn. and the Department of the Army (Contract DA-49-007-MD-205). t MarkIe Scholar in Medical Science. $ Rockefeller Travelling Fellow in Medicine,aspiration with a tuberculin syringe. Intravenous injections were given through a polyethylene catheter introduced through a large bore needle in a vein of the foreleg and advanced to the region of the right atrium.Indocyanine green$ was made up to 2 5 0 mg% in distilled water for injections. In one study a continuous infusion of the dye was given. This was prepared by mixing 2 4 ml of SO0 mg% indocyanine green with 51 ml of normal saline and 5 ml of dog plasma. (Indocyanine green is unstable on standing in aqueous solution, and the presence of plasma was found empirically to retard its breakdown.) Concentration of indocyanine green in plasma was measured in a Beckman DU spectrophotometer at 8 1 0 mp after 1 1 -fold dilution with normal saline. Concentration standards for this determination were also prepared in dog plasma. (Dilute aqueous standards are unsatisfactory because of marked instability.) Bile samples were diluted 25 to 100 times with water. One ml of diluted bile was then added to 1 ml of dog plasma and 9 ml of normal saline and the absorption measured at 8 1 0 mp. Although the dye is quite stable in bile even when diluted, the addition of plasma, for reasons not apparent, was necessary for full color development. BSP concentrations 0 Kindly supplied as "Cardio-Green" by Hynson, Westcott and Dunning, Inc., Baltimore, Md., through the courtesy of Dr.
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