Chylothorax: report of a case complicating orthotopic heart transplantation.

We describe a case of a chylothorax that occurred in a 62-year-old man after orthotopic heart transplantation. Injury to collateral lymphatics in the anterior mediastinal or thymic areas was the probable cause of the chylous fistula. Excessive chyle drainage causes loss of large amounts of fat, protein, electrolytes, and lymphocytes. These losses further compromise the nutritional and immunologic status of the transplant patient. Conservative therapy with chest tube drainage and a strict medium-chain triglyceride diet allowed the chylous fistula to spontaneously close without the need for surgical intervention.

Vancomycin and netilmicin as first line treatment of peritonitis in CAPD patients.

The first line treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in our hospital was recently altered from a combination of gentamicin and clindamycin, given as continuous peritoneal lavage, to one of vancomycin and netilmicin given in peritoneal dialysis fluid with prolonged dwell time (4-6 h). The change was prompted by the emergence of multiply resistant Staphylococcus epidermidis among CAPD patients and nursing staff. In 9 of 19 episodes of peritonitis treated with gentamicin/clindamycin, the infecting organism could still be isolated from peritoneal fluid 5-15 days after commencement of therapy. All of 35 culture verified episodes treated with vancomycin/netilmicin were cleared bacteriologically within 3 days (P less than 0.0005). The vancomycin and netilmicin serum levels achieved were 6.5-37.0 mg/l and 1.0-8.1 mg/l, respectively. Apart from an asthmatic reaction, possibly triggered by vancomycin, no side effects were seen. However, audiometry was not performed regularly and the possible effect of netilmicin on the residual renal function was not systematically investigated.

Nosocomial Klebsiella infections in an intensive care nursery.

Nosocomial infections in an intensive care nursery (ICN) due to kanamycin-resistant Klebsiella pneumoniae during a four-month period with an infection rate of 12% and mortality of 47% are reported. Emergence of this organism was thought to be due to the widespread use of kanamycin. Transmission probably occurred via hands of personnel contaminated during care of colonized or infected infants. Control measures advocated are better handwashing technic and discriminate use of antibiotics. This report emphasizes the need for awareness of this continuous threat and for infection surveillance in an ICN.

[The influence of the geotropic induction on the content and the distribution of auxin in the hypocotyls of Helianthus and on their sensitivity to the growth substance]. / Über den Einfluß der geotropischen Induktion auf den Wuchsstoffgehalt, die Wuchsstoffverteilung und die Wuchsstoffempfindlichkeit von Helianthus-Hypokotylen.

1. Comparative measurements of the geotropic curvature and of the auxin distribution in the same gravitational field were performed to test the relation between the transversal growth substance gradient and the observed tropic reaction. In order to examine whether the extent of the curvature is fully explaned by the asymmetry of the auxin distribution in the opposite halves of the stimulated organ, comparable growth substance gradients were produced in vertical hypocotyls by supplying them asymmetrically with synthetic auxin from external sources. After identical times the auxin content in both halves of the organ was measured and compared with the curvatures produced. The general result of all these experiments, repeated under various conditions, is the finding that a given transversal auxin concentration gradient produces much stronger curvatures in organs exposed to the transversal gravitational field than in those left in the vertical position. This observation confirms our assumption that the geotropic stimulus, in addition to changing the auxin distribution in the stimulated organ, also strongly influences its sensitivity to the growth substance. 2. Further comparative measurements revealed still another drastic effect of the geotropic stimulus. Hypocotyls put in the horizontal position absorb considerably more auxin supplied to them laterally than comparable organs do in the vertical position. This effect concerns chiefly the upper half of the stimulated stem. 3. The last experiments of this research deal with the problem of the de novo production of growth substance under the influence of the geotropic stimulus. In the growing zone of intact seedlings the content of endogenous auxin is considerably increased under the influence of the transversally acting gravitation. This effect, however, is completely missing in plants whose natural auxin sources (cotyledons, plumula) have been removed by decapitation. Therefore the possibility has to be considered that the rise of the auxin-level observed in the geotropicaly stimulated zone may be due not to a de novo formation of growth substance but to the increased absorption capacity of the tissue for auxin already present in its natural sources.

[The geoelectric reactivity of the inflorescence axes of lupinus polyphyllus]. / Über das geoelektrische Reaktionsvermögen der Inflorescenzachsen von Lupinus polyphyllus.

The relations between the auxin content, the geotropic reactivity and the geoelectric reactivity of the axes of lupine inflorescences of different age were examined. 1. The stems of young inflorescences put in the horizontal position curve up by 80-85° within 8 hours. The zone of curvature extends from the 4th cm down to the 16th cm below the apex. After fertilization of the flowers the stem looses its geotropic reactivity almost completely. 2. It could be shown that a close relation exists between the geotropic reactivity of the different regions of the stem and their ability to produce the geoelectric "after effect" (GEE2). Under the same experimental conditions a potential difference develops in the middle region of the curvature zone of young stalks which is 4 times as high as in older axes which have almost lost their ability to curve geotropically. 3. In young shoots the ability to produce a strong electric "after effect" is confined to the middle and to the upper region of their curvature zone. In its tropistically inactive basal region the GEE2 induced under the same conditions reaches only about 30% of the effect developing in the upper part. 4. The primary geoelectric effect (GEE1) which has to be attributed to the influence of gravity upon preexisting diffusion potentials depends in its extent but little on the geotropic reactivity of the tested region of the axis. The transversal potential difference developing in the horizontal position of the shoot reaches approximately the same magnitude in all regions of young and old stems examined. 5. In order to decide whether the differences observed in the electric reactivity of the tested zones of young and old stems might be related to their auxin content, their growth substance activity was measured with the coleoptile cylinder test. It appeared that the GEE2 can effectively develop only in the regions of the young stem rich in auxin. The GEE1, however, proved to be almost independent of the auxin level in the organ. The possible reasons why this behaviour differs from that of other plants tested are discussed.

[The influence of growth substances on the development of bioelectric potentials in plant tissues]. / Über den Einfluß von Wuchsstoff auf die Entwicklung bioelektrischer Potentiale in Pflanzengeweben.

With hypocotyls of Helianthus annuus, coleoptiles of Zea mays and radicles of Vicia faba seedlings the relations between auxin distribution and the development of electric potential differences were examined. A. Experiments with Helianthus seedlings. 1. Removal of one of the cotyledons produces a transversal potential difference in the hypocotyl between the intact flank and that without cotyledon. With 10(-3)m KCl as contact solution the positive pole always lies on the intact side. 2. Unilateral supply of synthetic auxins in aqueous solution calls forth a comparable potential difference. The electric effect of the growth substances examined corresponds to their growth promoting power: G.A.<2,4-D

[Experiments in the analysis of the geotropic perception : V. The influence of the gravitational field on the auxin-sensitivity of Helianthus-hypokotyls]. / Versuche zur Analyse der Geotropischen Perzeption : V. Mitteilung Über den Einfluss des Schwerefeldes auf die Auxinempfindlichkeit von Helianthus-Hypokotylen.

Experiments with hypocotyls of decapitated Helianthus seedlings have been carried out to determine whether a change in their sensitivity to growth substances participates in the geotropic reaction chain. As a test for such an influence the elongation of pre-stimulated and of non-stimulated hypocotyls in identical IAA-solutions was compared. 1. First the elongation of the samples in 10(-4) m IAA buffer solution after horizontal exposure of varying duration was examined and compared with the behaviour of vertical controls. In all cases the pre-induction increased the total elongation of the samples. After a 15 min-stimulation the effect was already distinct, and after a 30 min-induction it attained its maximum (+42%); a further prolongation of the exposure time led to a gradual decrease of the effect. 2. In a second series of experiments the influence of the IAA-concentration on the elongation of the samples in the incubation bath was examined after a 1 hour-period of horizontal exposure. The absolute elongation of the stimulated hypocotyls as well as of the vertical controls reached its maximum value in the 10(-4) m-step of the series. A further increase in the IAA-concentration already reduced the elongation in both cases. However, the relative furtherance of the elongation by the gravitational stimulus continued slightly even in the 10(-3) m-step. From this fact it can be concluded that the observed effect of the geoinduction can only be due to an increase of the auxin-sensitivity of the organ. Another conceivable possibility, namely, an increase of the active auxin uptake from the external solution, must be excluded because from the 10(-4) m-step on such an increase would already lead to an accumulation of supraoptimal IAA-concentrations within the tissue. 3. If, after their horizontal exposure, the hypocotyls are split into their upper and lower halves, it can be shown that the geoinduction promotes the elongation of both parts in the auxin solution. However, this effect is considerably more pronounced in the lower halves. This asymmetric change explains the formation of after-curvatures which appear in auxin-depleted hypocotyls symmetrically supplied with IAA after their horizontal exposure. 4. Vertical inverse position also produces in auxin-depleted hypocotyls an increase of their IAA-sensitivity, approximately corresponding to the effect of a horizontal exposure of the same duration. Here again the reaction proved to be an optimum function of the induction time. The maximum, +24,5%, was reached after a 1 hour-inverse position. 5. The gravity-induced increase of the auxin-sensitivity develops only in the presence of oxygen. When the plants were set in an inverse position in an atmosphere of pure nitrogen and were afterwards incubated under aerobic conditions, the effect completely failed to appear. 6. Rotation of the plants on the clinostat parallel to its horizontal axis also causes a rise in the auxin-sensitivity. The strongest effect was observed after a 3 hours' stay on the clinostat: +13,5%. 7. The increase of the auxin-effect brought about by geoinduction can probably be attributed to a spatial shifting in the gravitational field of a cofactor of the growth substance which is available even in the decapitated organ.