We compared nonbronchoscopic bronchoalveolar lavage (NB-BAL) with open lung biopsy to determine the etiological diagnosis of lung infiltrates in patients requiring mechanical ventilation. NB-BAL was performed via a cuffed reusable 7F catheter generally used for right heart catheterization (BAL-C). In 13 patients, BAL-C and open lung biopsy were performed in the same lobe immediately after death when the ventilator was still functioning. No organism was cultured from BAL-C cultures when histopathologic examination of the lung showed no pneumonia and lung culture isolated no organism. Among the 10 positive BAL-C cultures, lung biopsy showed histologic pneumonia in 9 cases. Among these 9 pneumonia cases, 14 organisms were isolated in lung cultures and BAL-C correctly identified the causative agent in 13 cases. BAL-C appears to be an effective and safe procedure in the diagnosis of pulmonary infections in patients under mechanical ventilation who have previously received antibiotic therapy.

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Liver disease during chemotherapy and after its completion was studied in 103 leukemic children in long‐term remission. Seventy developed chronic liver disease during therapy; 22 out of 56 with adequate follow‐up showed persisting abnormality or deterioration of liver function after stopping therapy. In 38 studied prospectively, biopsies were obtained at treatment withdrawal. Five showed chronic lobular, 17 chronic persistent, 9 chronic active hepatitis whereas 7 had minimal changes. These children had transiently detectable serum hepatitis‐B virus (HBV) markers during (44.4%), at completion of (7.8%) and subsequent to (48.3%) chemotherapy. Serum HBV markers correlated significantly with both severity of histologic changes (P < 0.05) and persistent biochemical abnormalities for over 6 months after treatment suspension (P < 0.001). No direct relationship was found between drug administration and liver damage. The data from the study suggest that in leukemic children viral infections contribute to chronic liver damage, which can jeopardize the long‐term prognosis of acute leukemia.

SYNOPSIS In intermittent acute porphyria there are no specific alterations in the ultrastructure of the liver. In contrast, the constant characteristic of porphyria cutanea tarda is siderosis of the hepatocytes and Kupffer cells. Therefore, between the two types of hepatic porphyria there are no similar ultrastructural lesions. It is still doubtful whether the presence of hepatosiderosis in porphyria cutanea tarda is connected with the hepatopathy or is secondary to an alteration in the porphyrinic metabolism. The role played by lysosomes is discussed.