To identify potential alternatives to Epstein-Barr virus (EBV)-specific cytotoxic T-cell responses, peripheral lymphocyte subsets (PLS) (CD4+, CD8+, CD3+, CD19+, CD56+) were measured by flow cytometry in children with abdominal transplants (n = 22) and heart transplants (n = 2), with (n = 14) and without (n = 10, group C) post-transplant lymphoproliferative disorder (PTLD). PTLD resolved with reduced immunosuppression and antiviral therapy in eight children (group B). Recalcitrant PTLD was observed in six children (group A). Recalcitrant PTLD followed prior antilymphocyte therapy [monoclonal anti-CD3 antibody (OKT3) and thymoglobin (n = 3) and thymoglobin (n = 1)] for refractory rejection in four of these six children, and resolved after treatment with rituximab (anti-CD20 monoclonal antibody). Ten children without PTLD served as a control group (group C). Between group comparisons showed a numeric increase in CD8 + cells and significantly lower CD4:CD8 ratios in both PTLD groups (A and B) compared with group C. Group A children also demonstrated significant depletion of natural killer (NK) cells, and post-rituximab depletion of B-cells compared with group B (no rituximab treatment). We conclude that NK cell depletion with a reversed CD4:CD8 ratio may represent a persistent immunosuppressed state, which may result from prior antilymphocyte therapy and may predispose to recalcitrant EBV-PTLD. Clinical remission with rituximab is accompanied by B-cell depletion. Serial monitoring of PLS from the time of diagnosis of PTLD will be necessary to confirm these observations.

Although he was not the first to use ether as an anesthetic, it was not until William Thomas Green Morton's demonstration of the efficacy of ether anesthesia that its use spread rapidly throughout the world. Full identities of the first anesthetized patients of William Edward Clarke and Horace Wells are not known, but we are quite certain that Crawford Williamson Long correctly identified James Venable as his first patient to receive anesthesia. Using municipal records, historical accounts, and recent analyses of Morton's unsavory side, we undertook this study to explore three questions. First, we examine how Morton refined the technique of administering anesthesia based on Wells' failed attempt. Second, we describe the circumstances under which Morton encountered his first patient to receive anesthesia. Third, we offer an explanation as to why Morton insisted on bringing along this patient to attend the grand event we celebrate as Ether Day. This is an essay about William Thomas Green Morton and Ebenezer Hopkins Frost. Although she is believed to be related to one of two fellow medical students Joseph C. Hobbie or Allen Hobbey, no further information about Miss Hobbie has been found. 1-3After administering ether to James Venable on March 30, 1842, Crawford Williamson Long (1815-1878) delayed publishing his experience until 1849. 4,5 We are fairly certain that Venable was his first patient to receive general anesthesia. Horace Wells conceived of using nitrous oxide as an analgesic during a demonstration by Gardner Quincy Colton at Union Hall in Hartford, Connecticut, on December 10, 1844.6 Wells persuaded his colleague John M. Riggs (1811-1887) to remove one of Wells' own teeth the next day, while Colton administered nitrous oxide.7-9 Thereafter, Wells administered nitrous oxide on innumerable occasions, but the identity of the first patient he anesthetized is not known.The first patient to receive anesthesia at the hands of William Thomas Green Morton (1819 -1868) has previously been identified as Eben Frost. 10,11 We examined municipal records and historical accounts to learn more about Frost. In addition, we provide detailed information about circumstances on the night of September 30, 1846, the fateful day their paths first crossed.Vandam has suggested that Frost was present during the ether demonstration to reassure the patient, Edward Gilbert Abbott (1825-1855). 12 We suggest an alternate hypothesis based on information from Morton's past that would suggest a less noble motive. We begin by highlighting undesirable traits displayed by Morton since childhood, and comment on his interactions with Wells and Charles Thomas Jackson (1805-1880). Next, we describe how Morton began and continued work with ether. We establish, with partial success, the identity of Morton's first patient to receive topical anesthesia with ether, and then describe the events of September 30, 1846. We conclude by examining the life of Frost and briefly review the salient details of Ether Day. sdesai@partners.org. Information o...