Using aggressive surveillance of blood, bronchoalveolar lavage (BAL) fluid, and lung tissue, we sought to determine the incidence of cytomegalovirus (CMV) pneumonitis in isolated lung transplant recipients and to characterize its impact on pulmonary function, chronic rejection, and survival. Forty-six lung transplant recipients who survived greater than 30 days had prospective documentation of CMV infection in blood and BAL fluid and regular surveillance with transbronchial lung biopsy. CMV infection was documented in 92% of patients who were D-/R+, D+/R+, or D+/R-, and the incidence of histologically confirmed CMV pneumonitis among these patients was 75%. No D-/R- patient experienced CMV infection or disease. D+/R- patients experienced more frequent and severe episodes, and ganciclovir prophylaxis during the first 2 wk was not useful. CMV pneumonitis was accompanied by detectable radiographic changes in less than one third of cases. The detection of CMV in BAL fluid was not predictive of CMV pneumonitis on biopsy, except in D+/R- patients during the first 90 days after transplantation. There was no evidence of an adverse impact because of CMV infection on pulmonary function during the first year after transplantation. A relationship between CMV infection and bronchiolitis obliterans could not be documented; however, D+/R- patients had higher morbidity and a trend toward lower survival. In a multivariate analysis, D+/R- status was an independent predictor of death.

The use of fluorescent-labeled microspheres (FM) for measurement of regional blood flow is an attractive alternative to the use of radioactive-labeled microspheres. In the FM method the FM have to be completely recovered from the tissue samples in a time- and labor-intensive process. For this reason, a considerable loss of FM is possible. The aim of this study was to develop a filtration device that allows the tissue sample to remain in a single container throughout the procedure to make the process easier and to avoid the loss of FM. The core of the sample-processing unit (SPU) is a single-tube filtration device with a polyamide wire mesh. The protocol for processing tissue from different organs (heart, kidney, liver, spleen, intestine, muscle, bone, lung, brain) was modified and thus shortened significantly. Furthermore, the SPU allows direct filtration of the blood reference sample without previous digestion. Different experiments showed that the SPU in combination with the new protocol excludes the loss of 15-μm FM. The modifications of the whole procedure render it faster and highly standardized.

A b s t r a c t Few studies have compared long-term follow-up and risk for invasive cancer in women with atypical squamous cells of undetermined significance (ASCUSFollow-up should depend on the relative risk in a woman with ASCUS to have or develop invasive cervical cancer. This risk depends primarily on the number of squamous intraepithelial lesions (SIL), in particular high-grade SIL (HSIL), that lurk in or develop from an ASCUS lesion. -10 If the number of SIL is high and these SIL would progress to invasive cancer before the next Pap smear, aggressive followup is warranted. Short-term follow-up studies (less than 2 years) demonstrate conflicting results, with follow-up SIL rates ranging from 10% to 40%. 2_1° Long-term populationbased follow-up studies measuring patient outcomes, not only including follow-up SIL rates but also per-patient costs and risk for HSIL, are lacking.We attempted to define the risks associated with an ASCUS diagnosis by measuring long-term follow-up (up to 6 years) in all women with Pap smears diagnosed as ASCUS at the University of Iowa during calender year 1992. Materials and MethodsIn 1992 at the University of Iowa, 19,912 cases were screened; the diagnoses" were 0.3% unsatisfactory for diagnosis, 88.5% benign, 5.0% atypical, 4% low-grade SIL

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Fluorescent microspheres (FM) have become an attractive alternative to radioactive microspheres (RM) for the measurement of regional blood flow (RBF). The aim of the present study was to investigate the comparability of both methods by measuring RBF with FM and RM. Eight anaesthetised pigs received simultaneous, left atrial injections of FM and RM with a diameter of 15 µm at six different time points. Blood reference samples were collected from the descending aorta. RBF was determined in tissue samples of the myocardium, spleen and kidneys of all 8 animals. After radioactivity of the tissue samples was determined, the samples were processed automatically for measuring fluorescence using a recently developed filter device (SPU). RBF was calculated with both the isotope and spectrometric data of both methods for each sample resulting in a total of 10,512 blood flow values. The comparison of the RBF values yielded high linear correlation (mean r² = 0.95 ± 0.03 to 0.97 ± 0.02) and excellent agreement (bias 5.4–6.7%, precision 9.9– 16.5%) of both methods. Our results indicate the validity of MS and of the automated tissue processing technique by means of the SPU.