Coronavirus disease-2019 (COVID-19) pneumonia is one of the severe and most dreaded forms of illness caused by severe acute respiratory syndrome coronavirus 2. It often progresses to respiratory failure and acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. ARDS can lead to multiple complications while on mechanical ventilation due to positive airway pressures in a fibrotic lung, one such complication is the development of alveolopleural fistula. Alveolopleural fistula has high morbidity and mortality. We used endobronchial valve in a patient with COVID-19-related ARDS with persistent air leak (alveolopleural fistula), which allowed us to remove the chest tube and wean the patient successfully off mechanical ventilation.
After showing that normal skin homografted upon a congenitally agammaglobulinemic child survived for a prolonged period (1), Good and Varco further demonstrated that within certain limits hypogammaglobulinemic patients might be artificially endowed with a system of active immunity through homotransplantation of a reticuloendothelial tissue (2, 3).The present study was designed both to explore the therapeutic possibilities of lymph node homotransplantation and to take advantage of the unique antibody-synthesizing defect in hypogammaglobulinemia to quantitate the immune response of human lymphoid tissue.This No satisfactory method of accurate titration of low (< 1: 10) titers of H-agglutinins was found. Titers of O-agglutinins as low as 1: 2.5, however, could be measured satisfactorily by prior 2-or 4-fold concentration of the serum beta2-globulins through the use of zinc-proteinate reactions based on Cohn plasma fractionation Method 12 (6) as follows:A portion of cold, buffered zinc diglycinate-zinc acetate solution, containing 500 mM Zn++ per L., was added to the serum at 0 to 20 C to a final Zn++ concentration of 20 mM per L. The mixture was allowed to equilibrate 30 minutes and was centrifuged at 0 to 20 C for 15 minutes at 1,400 g. The supernatant was discarded. The precipitate was made up to one-fourth or one-half the original serum volume with 0.3 M sodium citrate at pH 7.2. Recovery of both H-and O-agglutinins appeared to be complete, but the concentrate was suitable for slide agglutination titration of only 0-antibody. The presence of citrate ion apparently inhibited the reaction of H-antigen and antibody; the citrate effect could be reversed by dialysis, but only at the expense of reduced concentration.Titration of tissue antibody. Tissue extracts suitable for titration of H-and 0-agglutinins were prepared as fat-free saline suspensions by the method of Mountain (7).Immunochemical estimation of typhoid 0-antibody. To define a ratio between units of serum typhoid O-agglutinin activity (reciprocal of titer) and micrograms of typhoid O-beta,-globulin nitrogen per ml., the method of analysis of specific precipitates (8, 9) was adapted as follows:The antigen used consisted of a saline suspension of the colonies scraped from a 20-hour agar slant culture 2 See Table III. 405
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