BACKGROUND:There are over 15 million children who have cardiac anomalies around the world, resulting in a signifi cant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments. METHODS:Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven fi rst-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening (PECS)". RESULTS:Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specifi city of 100%. A single patient was identifi ed by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer. CONCLUSIONS:In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.

The percentage of peripheral blood Total T, Active T and B-Rosette Forming Cells (RFC) were determined serially (Day 0, 1, 2, 7, and 21) following administration of single (SAT) versus multiple (MAT) agent chemotherapy. SAT caused essentially a decrease in the percentage of B-RFC. MAT resulted in profound decrease of Active T and B-RFC and to a lesser degree of Total T-RFC percentages with nadirs being reached in 48 hours. The most striking decrease involved the percentage of Active T-RFC which remained 15% below pretreatment level 7th posttreatment day. The posttreatment changes in the absolute numbers of Total T, Active T and B-RFCs following MAT were similar to that noted on the RFC percentage. Effects of the two most commonly used multiple agent treatments (COBAM and DOMF) were comparable. MAT causes a more profound decrease in the percentage of various RFCs than SAT. The differences between the nadirs of various RFC reached Day 1 and 2 with MAT versus SAT are statistically significant (p < .001). We conclude that the effects of chemotherapy on peripheral RFC may be best evidenced by serial determination of their percentage rather than their absolute numbers. Subpopulation of the T-RFC which has been labeled Active T-RFC appears to be the best indicator of the chemotherapy effects on the lymphocyte pop ulation since they demonstrate the most profound and persistent changes.Cancer 422234-2243, 1978. OR SEVERAL DECADES clinicians have ob-

We report the presence of a rosette inhibiting factor (RIF) in the plasma of patients with active Hodgkin's disease. This factor suppresses the rosette forming ability of autologous Active T, Total T, and B lymphocytes with sheep red blood cells, and tends to disappear when clinical remission is achieved. To a lesser extent, the RIF also lowers the Active T, Total T and B-RFC percentages of lymphocytes obtained from normal donors. Although carcinoma and non-Hodgkin's lymphoma patients, as a group, did not exhibit rosette inhibitive properties, certain individuals with these diagnoses did show isolated RIF activity. The RIF could be adsorbed out of plasma using peripheral blood lymphocytes (PBL) from normal controls and appears to be a large heat stable molecule which does not affect PBL viability.Cancer 44:106-111, 1979.