Effects of high dietary crude protein on the characteristics of preovulatory follicles in dairy heifers.

The objectives were to examine the effect of high dietary crude protein on characteristics of preovulatory follicles in dairy heifers. Eight Israeli-Holstein heifers, 4 fitted with rumen fistula and 4 intact, were assigned to 1 of 3 treatments in a replicated (n=2) 4 × 3 incomplete Latin square design with 39-d periods. Treatments were: low (6.0%; LP), moderate (13.0%; MP), and high (20.0%; HP) crude-protein diets, containing 1.27 Mcal NE(L)/kg dry matter. Diets were based on approximately 66% wheat straw and various proportions of ground corn grain and soybean meal. The estrous cycles of the heifers were synchronized, and 14 d after behavioral estrus, heifers received PGF(2 α) injections. After a further 40 h, at d 39 of each period, follicular fluid (FF) was aspirated from follicles of diameter >7 mm. The intake of the LP diet was 9% lower than that of MP and HP diets. Rumen ammonia and plasma urea nitrogen concentrations were highest in the HP and lowest in the LP, with intermediate levels in MP diets. No differences were found between treatments in plasma and FF concentrations of glucose and nonesterified fatty acids. High-protein diets increased urea concentrations very similarly in preovulatory FF and in plasma. No differences were observed between diets, in preovulatory follicle diameters and concentrations of androstenedione. However, higher estradiol and progesterone concentrations in FF were observed under the HP than under the MP diet, with no difference between diets in estrogen to progesterone ratio. It can be concluded that high concentrations of urea in plasma, caused by high dietary crude protein, penetrated into preovulatory follicles, but did not impair preovulatory characteristics. This lack of detrimental effects might be attributed to the use in this study of nonlactating heifers, which have fewer nutritional and physiological constraints and eliminate negative effects of potential interactions with high urea on dairy cows' reproductive systems.

Electron beam computed tomography screening of the coronary arteries: experience with 3,263 patients at Walter Reed Army Medical Center.

The U.S. Department of Defense desires to reduce the impact of coronary atherosclerosis on its active duty, retired, and dependent populations. Electron beam computed tomography (EBCT) is currently the best way to noninvasively image the coronary arteries directly. Between August 1997 and February 1999, a total of 3,263 patients were scanned by EBCT in the Radiology Department at Walter Reed Army Medical Center. Scans were performed on 2,415 men (74%) and 848 women (26%). The most common age group was 50 to 54 years (25%). Coronary calcification was found in approximately half of the patients (46%), and the magnitude of the score was strongly associated with age and male gender. Average scores increased exponentially with age, doubling every 7 years. In men, average scores ranged from 17 units in those aged 35 to 39 years to 842 in those older than 70 years old. In women, average scores ranged from 1 in those 35 to 39 years to 162 in those older than 70 years. Significant numbers of patients fell into the high-risk categories, with 8% of men in their 40s, 20% of men in their 50s, 33% of men in their 60s, and 49% of men in their 70s with high scores. Scores of more than 400 units were seen in 368 patients (8%) overall. There is a large amount of coronary calcium present in military personnel and their dependents, in patterns that are consistent with previous studies. Many patients had very high scores that are consistent with advanced coronary artery disease. EBCT should play a central role in the identification of occult calcific atherosclerosis of the coronary arteries in military, retired, and dependent patients.

The contribution of ego psychology to understanding the process of termination in psychoanalysis and psychotherapy.

Ego psychology is presented as an integrated psychoanalytic developmental theory, including a theory of object relations. The process of termination is employed as one of the many possible illustrations of the usefulness of this theory. Termination is regarded as a process that pervades the treatment from the outset, rather than as the final phase of treatment only, because the treatment process, whether psychoanalysis or psychotherapy, includes continuous promotion of ever-increasing autonomy. Ideally, by the time termination proper takes place, maximum autonomy has been attained. To the definition of autonomy as intersystemic, involving relative independence of the ego from the drives (and from the super-ego), an object-relations dimension is added which extends that definition to include an intrasystemic consideration--namely, relative independence of the self-representation from the object representations. Especially in the treatment of the borderline conditions is the intrasystemic factor cogent because borderline states are characterized by varying degrees of incompletely differentiated self- and object representations. The objective, in the psychoanalysis of neurosis, where self- and object constancy already exist to a large degree, is ego autonomy in the intersystemic sense. In the psychotherapy of the borderline conditions, the objective is greater differentiation of the self-representation from the object representations.

[Brown-Séquard syndrome after closed injury of the cervical spine]. / Syndrome de Brown-Séquard après traumatisme fermé du rachis cervical.

The case of a Brown-Séquard syndrome at the C5 level, in a 21-year-old young man after a traffic accident is reported. Initially, the symptoms of spinal injury were concealed by those related to head and face trauma. The neurologic assessment showed a hemiplegia located in the same side as the medullar injury with a controlateral thermo-algesic anaesthesia. X-rays, CT-scan and MRI of the cervical spine confirmed the diagnosis. The treatment included the immobilization of the spine combined with i.v. methylprednisolone (bolus of 30 mg.kg-1 followed by a continuous infusion at a rate of 5 mg.kg-1.h-1 for 23 hours). The outcome was favourable. Six weeks later, the patient was again able to walk. However the thermo-algesic anaesthesia remained unchanged. This case report underlines the necessity of a careful and complete neurologic assessment of trauma patients and reminds of the possibility of occurrence of a Brown-Séquard syndrome in them.

Hepatitis B antigen and antibody in heroin users.

Hepatitis B surface antigen (HBsAg) and antibody (anti-HBsAg) were determined on 442 asymptomatic heroin users and 246 controls. Of the drug-taking group, 124 used heroin intravenously and 318 nonintravenously (smoking, sniffing). Twenty-three (5.2%) heroin users were HBsAg positive and 118 (26.7%) anti-HBsAg positive, compared to three (1.2%) HBsAg positive and 28 (11.4%) anti-HBsAg positive controls, both statistically significant. HBsAg was positive in eight (6.5%) intravenous heroin users and statistically identical to 15 (4.7%) HBsAg positive nonintravenous users. Positive anti-HBsAg in 55 (44.4%) intravenous heroin users compared to 63 (19.8%) nonintravenous users, however, is statistically significicant.

Immunoglobulins in heroin users.

Concentrations of the serum immunoglobulins IgG, IgM, and IgA as well as rheumatoid factor were studied in a group of 80 intravenous and non-parenteral heroin users who were US soldiers serving in Vietnam and who were unique in their use of unadulterated heroin. Significant elevations of IgM out of normal range and IgG above controls were found in intravenous heroin users, while significant elevations of IgA above controls were found in non-parenteral heroin users. Rheumatoid factor was not found in either group. Evidence is presented to support the hypothesis that IgM elevation may be due to bacterial or other contamination but not to liver disease. The higher IgA in non-parenteral heroin users is postulated to reflect local antibody synthesis. The failure to detect rheumatoid factor in this study supports the view that the stimulation of rheumatoid factor is due to excipients or contaminants not found in the "uncut" drug.

Meningeal involvement in IgD myeloma with cerebrospinal fluid paraprotein analysis.

Myelomatous meningitis is a rare occurrence in multiple myeloma. We report 2 cases of documented IgD myeloma with cytologic evidence of meningeal involvement in 1 and detailed paraprotein analysis in both. The occurrence of meningeal involvement in this rare form of plasma cell neoplasm may be more common than previously thought.