Maintaining the patency of peripherally inserted central catheters with 10 units/cc heparin.

To maintain the patency of a peripherally inserted central catheter (PICC) line, it has been common practice to use 100 units of heparin as a flush. In this study, it was hypothesized that 10 units of heparin would maintain the patency of the PICC line as effectively as 100 units. To test this hypothesis, 46 patients who had PICC lines placed were retrospectively identified. Twenty patients received 100 units of heparin and had a PICC indwelling time ranging from 4 to 52 days (mean = 12 days) for a total of 314 indwelling days. Twenty-six patients received 10 units of heparin and had PICC indwelling time ranging from 2 to 54 days (mean = 11 days) for a total of 440 indwelling days. In two patients who received 100 units of heparin, PICC lines clotted after 2 days and 16 days, respectively. In four patients who received 10 units of heparin, PICC lines clotted after 5, 9, 29, and 36 days, respectively. Given the fact that this study was retrospective and uncontrolled, a statistical analysis was inappropriate; however, as a descriptive study, there appears to be evidence to support the original hypothesis. A controlled, blinded study must be performed to test the hypothesis statistically.

Smith-Lemli-Opitz syndrome-type II: multiple congenital anomalies with male pseudohermaphroditism and frequent early lethality.

In 1964, Smith et al described a syndrome of microcephaly, growth and mental retardation, unusual facial appearance, syndactyly of toes 2 and 3, and genital abnormalities. Major structural malformations and early death have been uncommon in the many subsequent literature reports. We report on 19 infants with a phenotype we propose to call Smith-Lemli-Opitz syndrome (SLOS)-Type II, in which major structural abnormalities, male pseudohermaphroditism, and early lethality are common. Of these 19 patients, 18 had postaxial hexadactyly, 16 had congenital heart defect, 13 had cleft palate, and 10 had cataracts. Unusual findings seen in these patients at autopsy included Hirschsprung "disease" in five patients, unilobated lungs in six, large adrenals in four, and pancreatic islet cell hyperplasia in three. Comparison of our cases to 19 similar literature cases suggests the existence of a distinct phenotype that may be separate from SLOS as originally described. It is also inherited as an autosomal recessive, as documented by occurrence in one pair of sibs in this study and recurrence in three reported families.

Comparative studies of interferon and three antiviral agents on neurotropic and oncogenic herpesviruses.

The antiviral effects of four compounds, phosphonoacetate, phosphonoformate, acycloguanosine, and purified human lymphoblastic interferon, were tested against two neurotropic herpesviruses, herpesvirus platyrrhine and herpes simplex virus, and two oncogenic herpesviruses, herpesvirus saimiri and herpesvirus ateles. All four compounds induced different degrees of inhibition of these herpesviruses. Phosphonoacetate and phosphonoformate at concentrations of 50 micrograms/ml or greater showed powerful antiviral activities. Interferon was more effective against herpesvirus saimiri and herpesvirus ateles, the two oncogenic viruses. Herpes simplex virus and the oncogenic herpesviruses were effectively inhibited by acycloguanosine, whereas herpesvirus platyrrhine proved to be resistant. The simian herpesviruses required a higher concentration of phosphonoformate, phosphonoacetate, and acycloguanosine for antiviral action. The antiviral action of all four compounds was contingent on the continued presence of the compounds in the infected cell culture medium.