SummaryTen pairs of twin lambs 118-122 days of gestation were given either natural surfactant or diluent endotracheally before the first breath. By using the premature twin lamb model, we have been able to show that instillation of natural surfactant produced 100% survival for the duration of the study period (2 hr); stable blood gases on room air, lungs that became increasingly compliant while on the respirator, generally well aerated lungs at autopsy; good lung pressure-volume relationships; normal lung surface tension measurements; and histologic evidence of good alveolar expansion with large amounts of free intraluminal phospholipid, no epithelial damage, and no hyaline membranes. It is concluded that tracheal instillation of natural surfactant into the premature lamb protects the lungs from developing many features characteristic of the respiratory distress syndrome.Our recent studies (25) using surfactant depleted adult rat lungs suggest that nebulization of either synthetic DPL or natural surfactant is not a n effective way to restore lung pressure-volume characteristics, but that direct tracheal instillation of natural surfactant is very effective. Along these lines of investigation, Enhorning and his collaborators (18,20) have shown that tracheal deposition of surfactant into premature rabbit fetuses before the first breath enhanced air intake and improved the pressure-volume relationships of the lungs; it also increased the survival time (18). Similar results were obtained with pharyngeal deposition of surfactant before the onset of respiration in rabbits (19).The purpose of our present investigations was to determine in a more extensive way if the direct tracheal instillation of natural surfactant into a prematurely delivered lamb has a favorable effect on its clinical status and postmortem findings. The twin lamb model was chosen because of the larger size of the animals which " permits measurement of more parameters and the use of one as a Speculation control and the other as the experimental lamb, thus reducing the ~h~ success of these esperiments is possibly due to the use of problems associated with variations in gestational age, nutritional ..,,hole" rather than some of its state, size, and other factors. Moreover, it appeared to us that if ~h~ precise biochemistry and physical ,.hemistry of the results were favorable in lambs weighing 1-2 kg, a more direct surfactant is very controversial, and for therapeutic purposes, it be made lhe lreatment Or prevention RDS might be best for the moment to concentrate on the natural in human premature babies. biologic product. MATERIALS AND METHODSIt has been demonstrated that the lungs of infants dying of PROTOCOL FOR ANIMALS respiratory distress syndrome (RDS) possess abnormal surface properties (5) and low levels of phospholipids (2.9. 10). It has also Ten pregnant ewes between 1 18 and 122 days of gestation been shown that the quantity and quality of surface-active phos-known by x-ray examination to possess twin fetuses were used. pholipids (surfactant) ...

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The prevalence of respiratory allergies and their effects on the course of cystic fibrosis (CF) were studied in 63 patients. Fifteen patients (24%) had respiratory allergies as defined by history, physical examination, positive allergy skin tests, nasal and peripheral eosinophilia, and reversible airway obstruction. Serum immunoglobulins on these 15 allergic CF and 22 nonallergic CF patients were elevated when compared with those in normal age-matched controls. The allergic CF patients had significantly higher IgE levels (mean 598 international units [IU] compared to 281 IU); IgG, IgM, and IgA levels were similar in the two CF groups.The clinical condition of the allergic CF patients, (Shwachman score) was better than the nonallergic, suggesting some modulating effect of respiratory allergy on the severity of the disease.Cystic fibrosis (CF) has many features in common with res¬ piratory allergy, including chronic cough, wheezing, rhinitis, nasal polyps, and nasal obstruction. These conditions may coexist and, in fact, (Dr. Stiehm). before a diagnosis of CF is estab¬ lished. In the normal population, 10% to 20% suffer from nasal allergy and 4% to 15% from asthma. There is a re¬ ported prevalence of 10% to 16% of respiratory allergies in CF patients.14 The purpose of this study was to define the prevalence of respiratory allergies in our CF patients and to evaluate their effects on the course of the disease. In addition, the se¬ rum immunoglobulins, including IgE, were assessed in order to determine their relationship, if any, to the sever¬ ity of CF and to the type and severity of respiratory allergy. Materials and MethodsA total of 63 cases of patients with CF were evaluated at the UCLA Medical Cen¬ ter from July 1, 1972, to June 30, 1973. The diagnosis of CF had been established by a characteristic clinical course and a positive sweat test. All patients had sweat chloride concentrations exceeding 60 mEq/liter. All 63 CF patients were examined for al¬ lergy by means of a standard allergy his¬ tory form and a complete physical exami¬ nation. The history was designed to elicit information regarding (1) allergic rhinitis with associated nasal itchiness, stuffiness, and discharge with or without eye symp¬ toms, such as itchiness and lacrimation; (2) the presence of chronic post nasal drip, sinusitis, or polyps; (3) the presence of chronic ear infections and hearing diffi¬ culties; and (4) asthmatic symptoms, such as wheezing, cough, or exercise-induced bronchospasm. Seasonal and environmental factors were noted. In addition, history of skin allergy, food sensitivities, drug re¬ actions, and neonatal difficulties (ie, colic) were noted. Detailed family histories of al¬ lergic disease were elicited. Those with suggestive findings of allergy were tested with 60 skin test antigens, including the following groups: dust, fungi, epidermoids, pollens (grasses, weeds, and trees), and foods. These allergens were the same used to test the patients seen in the allergy clinic. A positive skin test was one that was at least 3+ (...

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