P Pu ul lm mo on na ar ry y h he er rp pe es s s si im mp pl le ex x i in n b bu ur rn ns s p pa at ti ie en nt ts s R.J. Byers*, P.S. Hasleton + , A. Quigley + , C. Dennett* ABSTRACT: In this study we aimed to determine the incidence of herpes simplex virus (HSV) in the lungs of burns patients, and its association with the presence of adult respiratory distress syndrome (ARDS) and pneumonia. Haematoxylin and eosin (H&E), and immunohistochemical (IHC) staining for HSV was performed on lung tissue from 54 patients who had died following burn injury and from nine control cases. Polymerase chain reaction (PCR) for HSV deoxyribonucleic acid (DNA) was performed on a subset both of burns cases and controls.No viral inclusions were detected in H&E sections, but 50% of the burns cases were positive for HSV by IHC staining; no control cases were positive. Nuclear and cytoplasmic immunopositivity for HSV was seen in macrophages and epithelial lining cells. HSV was strongly associated with ARDS (p=0.007), but not with pneumonia (p=0.577). The relative risk of HSV infection was higher for cases with ARDS (2.21) than for those with pneumonia (1.26). PCR for HSV DNA was positive in three out of five burns cases, and in one out of five control cases.Immunohistochemical staining is more sensitive for the detection of herpes simplex virus than haematoxylin and eosin staining for detection of viral inclusions. Burns cases have a high incidence of pulmonary herpes simplex virus infection. Polymerase chain reaction results may not be fully representative due to problems of tissue necrosis postmortem. Pulmonary herpes simplex virus is strongly associated with adult respiratory distress syndrome and the two may be causally linked. Early detection and treatment of pulmonary herpes simplex virus in burns patients may reduce pulmonary complications and mortality.

Macrophages are important in inflammatory processes in heart disease and in transplantation rejection. A resurgence of interest in the macrophage has emanated from recent evidence implicating it as an effector cell in atherosclerosis and transplantation rejection. The detailed distribution of the macrophage within the normal human heart is unknown. We quantified macrophage numbers in the different chambers of the heart. Large tissue blocks (1.5-2.0 cm$) were removed from specific sites in 5 ' normal ' control hearts (2 males, 3 females, age range 19-46 y). Paraffin-embedded sections were stained with a CD68 pan macrophage marker. Positive cells were enumerated within 20 random fields. Results were analysed using a generalised linear modelling method using the Poisson distribution. Macrophages were identified within septa, and often close to blood vessels, in the myocardium, and in the majority of areas in all hearts. Macrophage numbers varied significantly between areas (range 0-6 cells\high power field ; P 0.001), and between the 5 hearts analysed (P 0.001). In general, there were significantly more macrophages in the ventricles (RV P 0.01, LV P 0.05), but these differences were affected by heart differences. This study provides a baseline for the range of macrophage numbers within normal hearts, thus enabling comparisons with macrophage numbers within diseased and transplanted hearts.

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Visual reinforcement audiometry (VRA) with insert-earphone stimulus delivery provides a means of obtaining early ear-specific information on the auditory status of infants. The aim of this study was to investigate the efficacy of VRA in young infants, and to compare the use of sound field and insert-earphone stimulus presentation. VRA was performed on 41 normally developing infants aged between 20 and 42 weeks. Infants were tested in the sound field (n=22) and with insert earphones (n=19). Results showed significantly more minimum response levels (MRLs) obtained with sound field testing, and with older children. Nevertheless, in the insert-earphone group, 36% of those aged 32 weeks or more gave two or more MRLs, and 25% of the infants aged 25 weeks or less gave one or more MRLs. This study provides data from developmentally normal infants which confirms the efficacy of insert-earphones as well as sound field VRA with 32-42-week-olds, with reasonable expectation of success. The data in this study also suggest that VRA could be usefully employed for younger infants aged approximately 20-26 weeks where information, although less easily obtained, may be of particular value to early diagnosis and habilitation.

SUMMARY This report describes a patient with both ulcerative colitis and sarcoidosis. This association is of interest because of the anergy for cellular immunity which was characteristic of the sarcoidosis and the cytotoxic effect of the patient's lymphocytes for allogenic colon epithelial cells which characterized the ulcerative colitis. This concordance of immunological findings suggests that the cytotoxic effect may have a basis other than cellular immunity.The role of cellular immunity in the development of ulcerative colitis is uncertain although the conspicuous presence of lymphocytes in the affected tissues and the demonstration of a cytotoxic effect of circulating lymphocytes for colon epithelial cells has provided at least tangential evidence in support of this view (Perlmann and Broberger, 1963; Shorter, Spencer, Huizenger, and Hallenbeek, 1968;Watson, Quigley, and Bolt, 1966). On the other hand, the frequent presence of anergy for cellular immune reactions in patients with sarcoidosis is a well documented feature of this disorder (Isreal, 1965).The simultaneous occurrence of ulcerative colitis and sarcoidosis is, therefore, more than curious and provides an opportunity for studying the presence of possible tissue-directed cellular immunity in a situation in vivo characterized by anergy for this type of immune response. The association of these two disorders has been reported previously (Trujillo, Halstead, and Ticktin, 1967;Jalan, MacLean, Ross, Sircus, and Butterworth, 1969) but no detailed studies of cellular immunity or the behaviour of lymphocytes from such a patient have been undertaken.We would like to report a patient with well documented sarcoidosis and ulcerative colitis in whom a high degree of anergy for cellular immunity was nonetheless associated with lymphocyte cytotoxicity for human colon epithelial cells.