Extracorporeal rewarming with an extracorporeal membrane oxygenation system allows prolonged cardiorespiratory support after initial resuscitation. Our data indicate that prolonged extracorporeal membrane oxygenation support reduces the risk of intractable cardiorespiratory failure commonly observed after rewarming.

Abstract-In earlier studies, our group has established a new "immunological" hypothesis for atherogenesis supported by experimental and clinical studies showing that inflammatory immunological reactions against heat shock protein 60 initiate the development of atherosclerosis. In the present study, we describe the discovery of a so-far-unknown network of dendritic cells in the innermost layer of arteries, the intima, but not veins of healthy humans and rabbits. The number of these dendritic cells is comparable to that of Langerhans cells in the skin, and dendritic cells show a similar phenotype (CD1a ϩ S-100 ϩ lag ϩ CD31 Ϫ CD83 Ϫ CD86 Ϫ and no staining for von Willebrand factor or smooth muscle cell myosin). These vascular-associated dendritic cells accumulate most densely in those arterial regions that are subjected to major hemodynamic stress by turbulent flow conditions and are known to be predisposed for the later development of atherosclerosis. These results open new perspectives for the activation of the immune system within the arterial wall.

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In recent years our laboratory has developed an immunological hypothesis for the pathogenesis of atherosclerosis. We have shown that cellular and humoral immune reactions against heat shock proteins (Hsps) 60/65 expressed on the surface of stressed endothelial cells comprise the initial event in the pathogenesis of this disease. In the course of these studies, we also investigated normal, unaffected arteries for control purposes (carotid bifurcations from children aged 8 weeks to 10 years). This investigation led to the unexpected and previously unknown finding that mononuclear cells pre-exist in the intima at bifurcation sites. Our findings can be summarized as follows: Mononuclear cells are always found in the intima, primarily at sites subjected to major hemodynamic stress. Although the proportion of macrophages vs CD3(+) T-cells differs, overall the latter clearly predominate. Most of the T-cells express the T-cell receptor (TCR)alpha/beta, but TCRgamma/delta cells are also present. We also identified dendritic cells and mast cells in the intima. Analogous to the mucosa-associated lymphoid tissue (MALT) we coined the designation "vascular-associated lymphoid tissue" (VALT) for these newly discovered cellular aggregates in the arterial intima.

Complications arising from techniques of cardiopulmonary resuscitation (CPR) were reviewed by analysing the autopsy protocols of 25 patients who died after standard (Std) CPR and 31 who died after active compression-decompression (ACD) CPR, 15 of them preceded by Std CPR. The results can be summarised as follows: After Std CPR (n = 25) rib fractures were detected in 28%, sternal fractures in 16%, and no injuries in 68%. After ACD-CPR (n = 16) rib fractures occurred in 68%, sternal fractures in 68% and no injuries in 25%. After ACD-CPR following Std CPR(n = 15) rib fractures were detected in 93%, sternal fractures in 93%, and no patients were without thoracic fracture. In two patients severe cardiac injuries occurred clearly attributable to CPR. In conclusion cardiopulmonary resuscitation by the ACD-technique caused rib and sternal fractures more often than Std CPR and has a higher risk for iatrogenic cardiac and possible fatal injury.

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Summary. Samples of lung tissues were obtained and analysed for Aspergillus carriage in 56 patients undergoing thoracic surgical intervention and 18 people who had an unexpected death. Out of 74 samples, 46 (63%) had evidence of pulmonary fungal colonization. The surgery population had a rate of 62% of fungal growth, Aspergillus was present in 39%. The autopsy population had a rate of 61% of fungal colonization, Aspergillus was present in 41%.In these cases eradication of fungal spores residing in the lung prior to aggressive chemotherapy and prevention of further spore uptake during hospitalization is indispensable in preventing pulmonary aspergillosis.Keywords: Aspergillus species, fungal colonization, aspergillosis prevention, neutropenia, antifungal therapy.Fungal pathogens are recognized as a major and increasing source of life-threatening infections in the immunocompromised host (Denning et al, 1991). Infections due to Aspergillus species are among the most common causes of nosocomial pneumonia and associated with an extremely high mortality rate of 85% (Pfaller, 1992). The use of highefficiency particulate air (HEPA) filtration sytems during hospitalization represents the current standard in invasive pulmonary aspergillosis (IPA) prevention (Rhame, 1991), but cases of Aspergillus pneumonia in this setting still occur. Rhame et al (1984) reported the results of bi-weekly nasal and pharyngeal cultures of 205 BMT recipients; 11 patients developed invasive aspergillosis without positive cultures. Since in an earlier study in which Aspergillus spore counts in hospitals and private homes were compared we found equal and sometimes even higher amounts of spores in private settings (unpublished information), we wanted to clarify whether patients were already loaded with Aspergillus spores in their lungs prior to hospitalization. In order to investigate in more detail the fungal colonization of the lower respiratory tract as a possible source of endogenous spread, we examined lung tissues received from surgical intervention and autopsy. PATIENTS AND METHODSPatients. 56 patients who underwent surgical intervention such as lobectomy or pneumonectomy due to malignant tumours and 18 people who had a sudden unexpected death and were undergoing examination to clarify the cause of death, were investigated.The patients had had no previous chemotherapy, no immediate foregoing hospitalization and no other underlying disease of the pulmonary system. Two samples of resected material with no damage to lung architecture were examined from each patient.The primarily peripheral lungs, size 1 cm 3 , were taken under aseptic conditions to avoid contamination; all the instruments and gloves were changed before obtaining the blocks of tissue.Cultures. The samples were directly transferred into Sabouraud 4% fluid containing chloramphenicol and gentamycin (Merck, 6100 Darmstadt, Germany) and incubated at 35ЊC for 5 d. The test media were subjected a visual control for growth. The fungal isolates were plated onto Saboraud glucose agar (...