IMPLICATIONS:We report the successful use of the laryngeal mask airway for percutaneous endoscopic gastrostomy in an adult patient with a known difficult airway and severe cerebral palsy.

Little is known about hepatic T lymphocyte subpopulations in the human liver.The aim of this study was to document the various subpopulations present in the liver and compare them to peripheral T lymphocytes in the same patients.Normal hepatic tissue was obained at time of transplant from five patients, and a single cell suspension of lymphocytes were prepared by standard methods.Ceils were stained with monoclonal antibodies specific for CD8ct and CD8B chains, CD4, CD8, CD3, o~BTCR, and ySTCR, and analyzed by two and three colour flow cytometry.Of the hepatic CD3+ cells, 71% were CD8+ and 25% were CD4+, with a CD4/CD8 ratio of 1:3 in contrast to the peripheral CD4/CD8 ratio of 2:1.18% of the hepatic CD3+ cells expressed ySTCR.Significantly, CD8~ct accounted for 27% [mean] of the total hepatic CD8+ population.Conclusion: There is now evidence that the adult human gut can support extrathymic T cell differentation.A significant population of hepatic CD8txct cells would suggest that the liver is also a site of extrathymic differentiation, which may have important implications for the understanding of autoimmunity and graft tolerance.(0.2) LOCALISED INCREASE

Mortality and morbidity in the neonatal period are inversely proportional to birth weight and gestational age.Pneumothorax and pulmonary interstitial emphysema (P.I.E.) are major adverse factors affecting outcome of V.L.B.W. infants

A RETROSPECTIVE study confirmed the incidence of Edward’s Syndrome to be 1 in 3349-considerably higher than reported in most comparable studies. Median survival of the liveborn infants was four days, with a mean of 17 days, and a range of one hour to ten weeks. Fifty per cent of all liveborn babies with this potentially lethal genetic condition were delivered by caesarean section. The role that prenatal foetal assessment, including foetal karyotyping, might play in identifying such affected foetuses and determining their method of delivery is discussed. This is particularly important in view of the fact that a considerable proportion of the mothers of offspring with this condition are of advanced maternal age and high parity.

It is now accepted that surfactant therapy is effective in prevention and amelioration of the respiratory distress syndrome (Avery et al. 1986). However, the question whether to await establishment of RDS or treat some or all infants at risk prophylactically at birth remains to be answered. The approach ultimately adopted may depend on the risk of mortality and morbidity from RDS in a particular perinatal unit and the efficacy of surfactant in routine clinical practice.

The outcome of very low birth weight (VLBW) infants < 1500 g including those weighing < 1000 g has greatly improved in the last decade.As Caesarean section becomes a safer and more acceptable method of childbirth, it is increasingly performed at earlier stages of gestation.Evidence that Caesarean delivery is effective in reducing intrapartum complications is hard to obtain.We have therefore reviewed our experience in the survival of VLBW infants over a 3 ye3r period.161 infants weighing less than 1500 g were delivered at the obstetric unit and cared for at the Regional Neonatal Intensive Care Unit in Leeds between January 1983 and; December 1985.The hospital survival rate was 63% in 49 infants who weighed 1001-1500 g and 84% in 112 who weighed 1001-1500 g.The survival rate after Caesarean birth was higher than that after vaginal delivtry in the 1001-1500 g group.It is too early to say whether there is a significant difference in the outcome between Caesarean and vaginal births as this requires follow up of these infants at 1 year, 2 years and 5 years.