Fatal pulmonary aspergillosis presenting as acute eosinophilic pneumonia in a previously healthy child.

A previously healthy boy presented with cough and diffuse pulmonary interstitial infiltrates. Acute eosinophilic pneumonia was diagnosed by bronchoalveolar lavage in the absence of a demonstrable infectious etiologic agent. Corticosteroid therapy resulted in immediate improvement but was followed by respiratory distress and death from invasive aspergillosis and Pseudomonas cepacia sepsis.

Vitreous hemorrhage complicating retinal astrocytic hamartoma.

Tuberous sclerosis classically presents a triad of mental deficiency, seizures and adenoma sebaceum. Among the ocular manifestations are astrocytic hamartomas in the retina. This paper describes the case of a 24-year-old man with tuberous sclerosis who had recurrent vitreous hemorrhage from a large epipapillary astrocytic hamartoma in the left eye. Pars plana vitrectomy cleared the vitreous and bimanual bipolar coagulation of tumor bleeding points was done. Fragments of the friable tumor were obtained with the vitrectomy instrument and were prepared for tissue culture, histology, and electron microscopy. Although pars plana vitrectomy offers certain advantages over other methods of biopsy, it does present a danger of extraocular seeding of malignant cells; therefore, it is not recommended in cases with probable intraocular malignancy.

Characterization and localization of nitric oxide synthase in the human prostate.

OBJECTIVES: To characterize nitric oxide synthase (NOS), which catalyzes nitric oxide (NO) production, in the human prostate using biochemical and immunohistochemical techniques. METHODS: NOS catalytic assay and NOS immunohistochemistry were performed on histologically verified nonmalignant prostate tissue obtained from the peripheral and transition zones of seven radical prostatectomy specimens. RESULTS: Biochemical analysis revealed NOS activity in the human prostate, with a greater amount in the peripheral zone than in the transition zone (P < 0.01). In both prostate zones, NOS was immunohistochemically localized to nerve fibers and ganglia coursing throughout the smooth musculature of the stroma and to subepithelial nerve plexuses. NOS immunoreactivity was also localized to glandular epithelium. CONCLUSIONS: The presence, activity, and distribution of NOS were described in two regions of the human prostate. The present evidence implicates NO in the automatic innervation and physiology of the human prostate. It is proposed that NO may modulate smooth muscle tone and secretory functions in the human prostate, although functional studies are needed to support these hypotheses.

The presence of platelet-activating factor-like activity in human spermatozoa.

Evidence is provided for the existence of platelet-activating factor (PAF)-like activity in the lipid extracts of human spermatozoa. The PAF content of human spermatozoa based on [3H]-serotonin release from washed rabbit platelets was noted to be 1.45 pmol/10(8) sperm cells in highly purified motile spermatozoa. No PAF activity was associated with the seminal fluid. Platelet-activating factor content of spermatozoa may be related to its fertility potential.

The effects of platelet-activating factor on the motility of human spermatozoa.

Our laboratory has recently detected the presence of platelet-activating factor (PAF)-like activity in human spermatozoa. To gain further insight into the role of PAF on the male reproductive system, this study, using videomicroscopy, evaluated the effects of synthetic PAF on the motility of human spermatozoa. Treatment of 20 human semen samples with 3.69 x 10(-7) to 3.69 x 10(-13) M PAF resulted in statistically significant increases in motility. Treatment of spermatozoa with lyso-PAF (the biologically inactive form of PAF) showed no change in motility. Treatment of spermatozoa with PAF in severely asthenozoospermic males may be of therapeutic value.

The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat.

OBJECTIVE: To determine if nitric oxide synthase activity within the male reproductive tract is regulated by androgen. DESIGN: Nitric oxide synthase activity was measured in the reproductive organs of three groups of mature rats: unoperated controls, 1-week castrates, and 1-week castrates given T capsules at the time of surgery. The presence of nitric oxide synthase activity was confirmed by using the nitric oxide synthase-specific inhibitor N-nitro-L-arginine methyl ester (L-NAME). RESULTS: After castration, nitric oxide synthase activity was significantly reduced by 88%, 73%, and 54% in the caput, corpus, and cauda epididymidis, respectively. In the penis, nitric oxide synthase activity decreased 45% and nitric oxide synthase protein decreased 57% after castration. In the seminal vesicle and lateral prostate, nitric oxide synthase activity increased significantly after castration from nondetectable levels in controls. Nitric oxide synthase activity in the coagulating gland and ventral and dorsal prostate did not change after castration. The changes in nitric oxide synthase activity in all organs after castration were prevented by T replacement. Additionally, the activity measured in every organ in all three treatment groups was > 90% inhibited by L-NAME. CONCLUSION: These data demonstrate that androgen differentially affects nitric oxide synthase activity in the male reproductive tract. To the best of our knowledge this is the first time that nitric oxide synthase activity has been shown to be influenced by androgen in any tissue.

Psychosocial enhancement of immunocompetence in a geriatric population.

This study assessed the enhancement of immunocompetence by relaxation and social contact in 45 geriatric residents of independent-living facilities. Subjects were randomly assigned to one of three protocols: relaxation training, social contact, or no contact. Subjects in the relaxation and social-contact conditions were seen individually three times a week for a month. Blood samples and self-report data were obtained at baseline, at the end of the intervention, and at a 1-month follow-up. At the end of the intervention, the relaxation group showed a significant increase in natural killer cell activity, and significant decreases in antibody titers to Herpes simplex virus and self-rated distress; the other two groups showed nonsignificant changes. There was a general increase in the T-lymphocyte response to phytohemagglutinin stimulation at the end of the intervention, with greater change at lower mitogen concentrations. These data suggest that cellular immunocompetence may be enhanced by psychosocial interventions.

Changes in luminal fluid protein composition in the rat cauda epididymidis following partial sympathetic denervation.

Sympathetic denervation of the rat cauda epididymidis by surgical removal of the inferior mesenteric ganglion (IMG) results in an excessive accumulation of sperm in the cauda epididymidis as well as significant changes in cauda sperm motility and cauda epididymal gross histology. The objective of the present study was to determine if the cauda-specific changes in sperm storage, sperm motility, and epididymal histology following the loss of sympathetic innervation were accompanied by changes in the protein composition of epididymal fluid. One and 4 weeks after surgical IMG removal or sham operations, luminal fluid obtained from the caput and cauda epididymidis and cauda epididymal sperm-associated proteins were subjected to two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) and silver-stained proteins were quantitated. One week after IMG removal, two cauda epididymal fluid (CEF) proteins (2 and 13) had increased 43% and 49%, respectively, whereas four CEF proteins (5, 8, 9, and 19) had decreased between 30% and 73% compared to controls. Four weeks after IMG removal, changes in CEF proteins observed 1 week following surgery were no longer present, but the staining intensities of three additional CEF proteins (11, 12, and 18) were reduced an average of 70% compared to control CEF proteins. By obstructing the cauda epididymidis, we confirmed that the changes in CEF protein composition observed following IMG removal were not the result of sperm accumulation but were due directly to the loss of innervation; the staining intensity of CEF protein 2 increased as a result of excessive sperm accumulation in the cauda epididymidis both in the presence and absence of innervation from the IMG. No significant changes in caput epididymal fluid proteins or cauda epididymal sperm-associated proteins were detected following IMG removal. These data show that the protein composition of rat CEF is significantly affected by the loss of sympathetic innervation and suggest that neuronal input may play an important role in the maintenance of epididymal function.

Partial sympathetic denervation of the rat epididymis permits fertilization but inhibits embryo development.

The rat cauda epididymidis receives sympathetic innervation from the inferior mesenteric ganglion (IMG). We have previously demonstrated that surgical removal of the IMG and proximal hypogastric nerves (IMG denervation) results in significant and cauda-specific changes in epididymal sperm transport, sperm motility, luminal fluid protein composition, and tissue histology. In the present study we used natural mating trials and intrauterine insemination (IUI) techniques to determine whether or not IMG denervation affects male fertility and reproductive capacity. For the initial studies, adult male Sprague Dawley rats were mated with estrous females 1 and 4 weeks following IMG denervation. Nine days after mating, uterine implantation sites and corpora lutea (CL) were counted. In females mated with sham-operated control males, 85.8% of ovulated oocytes were fertilized and subsequently implanted. In contrast, females mated with IMG-denervated males 1 or 4 weeks following surgery had 0% and 3.5%, respectively, of ovulated oocytes fertilized and implanted. For rats maintained 21 days after mating, an average of 13 +/- 1 pups were delivered by each of nine females mated with sham-operated control male rats; whereas, only seven morphologically normal pups were delivered by one of 14 females mated with IMG-denervated male rats. Additional experiments demonstrated that the decrement in offspring was, in part, due to a significant decrease in the number of spermatozoa in the female uterus following mating with IMG-denervated males. To determine whether IMG denervation exerted an additional effect directly on the fertilizing ability of spermatozoa, IUI experiments were performed. Six million cauda epididymal spermatozoa from 1- or 4-week IMG-denervated males were inseminated into the uterine horns of luteinzing hormone-releasing hormone (LHRH)-synchronized females and 9 days later implantation sites and CL were counted. Implantations were observed for 78%, 28%, and 25% of ovulated oocytes following IUI with spermatozoa from sham-operated controls and from 1- and 4-week IMG-denervated rats, respectively. To determine whether the reduction in implantation sites following IUI with spermatozoa from IMG-denervated rats resulted from impaired oocyte fertilization, studies were performed in which oocytes were retrieved and stained 24 hours after IUI. Comparable fertilization rates of 76.5% and 89.0% were observed using cauda epididymal spermatozoa from IMG-denervated and sham-operated control males, respectively, indicating that oocyte fertilization was not affected by the loss of innervation. These studies establish the importance of innervation from the IMG for ejaculatory competence and sperm reproductive capacity in the male rat. These data further suggest that sympathetic innervation in the epididymis critically influences paternal factors associated with embryonic development.

Hormonal therapy for sows weaned during fall and winter.

Sows from five commercial herds were weaned in the fall and winter and used to ascertain the potential application of hormonal therapy to stimulate subsequent litter size born. At weaning sows within parity (1, 2, and 3 through 6) and lactation length classification (early weaned, < or = 14 d; conventionally weaned, > 14 d) were randomly assigned to treatment. Treatments were injection with P.G. 600 (400 IU PMSG with 200 IU hCG) at weaning or no treatment. Sows were individually observed for estrus and mated following protocol for each herd. Breeding, culling, and farrowing data were collected. Treatment with P.G. 600 did not change subsequent rebreeding performance for sows at parity 1 or parities 3 through 6. However, conventionally weaned parity-2 sows treated with P.G. 600 were more likely (P < .05) to return to estrus than conventionally weaned controls (99.0 vs 93.6%, respectively). For parity-1 and parity-2 sows, treatment did not significantly change the likelihood for farrow percentage. However, the likelihood to farrow a litter was greater (P < .05) among P.G. 600-treated sows at parities 3 to 6 that were conventionally weaned (84.4 vs 71.3%, respectively). Subsequent litter birth weight for parity-1 sows treated with P.G. 600 was lower (P < .02) than for controls (15.6 vs 16.6 kg, respectively). Subsequent litter size at birth was not affected by treatment for parity-1 or parity-2 sows compared with controls. However, early-weaned sows at parities 3 through 6 treated with P.G. 600 had more (P < .06) total number born than controls (12.4 vs 10.6, respectively). Treatment with P.G. 600 improved reproductive function within specific parity and lactation length classification for sows weaned in the fall and winter.

Post-prandial compositional changes of fluid- and particle-associated ruminal microorganisms.

Two ruminally cannulated cows were fed a diet containing 65% alfalfa haylage and 35% concentrate every 12 h. During two collection periods, whole ruminal contents were sampled before feeding, when feed not eaten was removed (1 h after initiation of feeding) and 1, 2, 3, 4, 6, 8, 10 and 12 h after removal. At each sampling, fluid-associated microorganisms were obtained by straining whole ruminal contents through eight layers of cheesecloth. A portion of the particle-associated population was obtained by chilling squeezed particles before seven successive extractions with saline solution. Microbial ash concentrations ranged from 9.9 to 16.6% of dry matter, with differences due to population (P less than .01) and to time after feeding for both fluid- (P less than .05) and particle-associated (P less than .01) microorganisms. Within 1 h after initiation of feeding, N decreased (P less than .05) from a pre-feeding concentration of 9.5% of organic matter to 7.7% for fluid-associated microorganisms, and from 9.2 to 6.7% for particle-associated microorganisms. Both populations did not return to pre-feeding concentrations until 6 h after feed removal. Nucleic acid concentrations decreased (P less than .05) in both populations after feeding, and did not return to pre-feeding concentrations until 6 h for fluid-associated and 4 h for particle-associated microorganisms. Nucleic acid-to-N ratios were higher (P less than .01) in the fluid- than particle-associated organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Opportunity costs associated with long decision making.

In certain cases, prompt utilization of an already negotiated group purchasing agreement will save a hospital more money than bidding out the same products. This occurs because there are large opportunity costs associated with not taking savings immediately. Savings can be further enhanced by redeploying staff to contract for items not covered by group agreements.

Neuronal input from the inferior mesenteric ganglion (IMG) affects sperm transport within the rat cauda epididymis.

Sympathetic nerves emanating from the inferior mesenteric ganglion (IMG) innervate the mammalian epididymis and vas deferens. We have reported previously that surgical removal of the rat IMG results in excessive accumulation of spermatozoa within the cauda epididymis. The objective of the present study was to determine whether sperm accumulation following IMG removal was due to a denervation-induced change in the rate of sperm transport within the cauda epididymis. In these studies epididymal sperm numbers were counted and used as a measure of sperm transport within the epididymis. In order to examine sperm transport within the cauda epididymis specifically, efferent duct ligation (EDL) was used to prevent further entry of testicular spermatozoa into the epididymis. Rats were divided into four treatment groups: sham-operated control, EDL alone for 7 days (EDL + 7), EDL alone for 14 days (EDL + 14), or EDL for 7 days at which time the IMG was removed and the rats were maintained for an additional 7 days (EDL + IMG). Epididymides were homogenized and the number of spermatozoa in the caput and cauda epididymis was counted. In EDL + 7 rats, the caput epididymis was devoid of spermatozoa. The rate of transit of spermatozoa through the cauda epididymis of EDL + 7 rats was approximately 3.43 million/day. The total number of cauda epididymal spermatozoa in EDL + 7 rats was reduced by 20% compared to sham-operated control rats. In EDL + 14 rats, spermatozoa transited the cauda epididymis at a rate of approximately 9.57 million/day, and the total number of spermatozoa in the cauda epididymis was reduced by 73% compared to sham-operated controls. If the IMG was removed 7 days following EDL, spermatozoa transited the cauda epididymis at a rate comparable to that observed in EDL + 7 rats (3.39 million/day). Following IMG denervation of EDL + 7 rats, cauda epididymal sperm numbers were maintained at levels observed in the EDL + 7 rats. These data demonstrate that the transport of spermatozoa through the cauda epididymis is influenced significantly by neuronal input from the IMG.

Quantitation of microorganisms associated with the particulate phase of ruminal ingesta.

Microbial organic matter associated with rumen particulate and fluid phases was quantified using 15N as the microbial marker in two rumen fistulated cows fed a 65% alfalfa haylage diet. During two collection periods, feed was removed 1 h after initiation of feeding, and cows were dosed with (15NH4)2SO4. Whole rumen contents were sampled before feeding and at various times up to 12 h after feeding. Fluid microorganisms were those that passed through eight layers of cheesecloth. Particle-associated microorganisms were obtained by chilling squeezed particles prior to seven successive extractions with saline solution. The amount of microorganisms removed from particles ranged from 32.1 to 59.9% as measured by 15N. Organic matter (mg/mL strained rumen fluid equivalent) of fluid and particle-associated microorganisms was respectively: 10.7 and 47.5; 12.5 and 35.5; 12.2 and 30.1; 10.7 and 26.1; 10.9 and 26.7; and 8.9 and 20.6, at 2, 3, 4, 7, 9 and 11 h after initiation of feeding. These ratios indicated that 70-80% of microbial organic matter in whole rumen contents was associated with the particulate phase and that particle-associated microbial organic matter was greatest soon after feeding. Analysis of 15N in extracted rumen particles indicated that 50-65% of particle nitrogen and 17-27% of particle dry matter was of microbial origin. These results provide evidence that particle-associated microorganisms make up a major proportion of the total microorganisms in ruminal ingesta and that a large proportion of ingesta particle N can be of microbial origin.

Acute renal failure with glomerular thrombosis in a patient with chronic scleroderma.

A 48-year-old woman with a 20-year history of scleroderma presented with malignant hypertension, thrombocytopenia, and acute renal failure. Renal biopsy demonstrated vascular changes consistent with scleroderma and glomerular thrombi. Her clinical course was consistent with hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP)-like syndrome. Plasma exchange therapy was associated with an improvement in renal function and rise in platelet count. This case suggests that acute renal failure in patients with scleroderma can be associated with glomerular thrombi and may improve with plasma exchange therapy.

Treatment of sperm with high-ionic strength medium increases microsurgical fertilization rates of rabbit oocytes fertilized by subzonal placement of sperm.

This study was conducted to investigate the requirement for sperm processing in microsurgical subzonal placement of sperm in rabbit oocytes. Fertilization rates with standard in vitro fertilization and microsurgical subzonal sperm placement were found to be similar (56 and 55%) when sperm treated with high-ionic strength Brackett's defined medium to initiate capacitation were used. Statistically significant reductions in fertilization rates for both standard in vitro fertilization and subzonal placement were noted when twice-washed spermatozoa were used. Initiation of capacitation of spermatozoa results in higher fertilization results even when the zona pellucida is bypassed during fertilization.

Patient-reported urinary continence and sexual function after anatomic radical prostatectomy.

OBJECTIVES: After radical prostatectomy, the rates for recovery of urinary continence and sexual function reported by experienced surgeons are much higher than the patient-reported outcomes from other centers. It is uncertain whether this represents differences in surgical technique or in the collection of data. This study was performed to determine patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon at a high-volume referral center for the treatment of localized prostate cancer. METHODS: Sixty-four men with localized prostate cancer who were potent preoperatively and who had sexual partners underwent anatomic radical prostatectomy between March 1997 and January 1998. A validated disease-targeted quality-of-life survey that assesses function and bother in two organ systems (urinary and sexual) was administered preoperatively and at 3, 6, 12, and 18 months postoperatively. RESULTS: Urinary continence, which was defined as wearing no pads, gradually improved during the first 12 months after surgery, and at 1 2 and 18 months, 93% of the patients were dry. Throughout the study, 93% to 98% of the patients characterized their urinary bother as none or small. Potency, defined as the ability to have unassisted intercourse with or without the use of sildenafil, improved gradually, and by 18 months, 86% of patients were potent and 84% considered sexual bother as none or small. Although one third of patients at 18 months were using sildenafil intermittently, only 2 patients were not able to have intercourse without its use. CONCLUSIONS: Patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon are high.

Use of intraoperative video documentation to improve sexual function after radical retropubic prostatectomy.

OBJECTIVES: To determine whether arbitrary minor variances in surgical technique can have a major impact on the recovery of sexual function after radical retropubic prostatectomy. METHODS: The surgical procedures of 62 potent men were videotaped prospectively. Eighteen months after the study was initiated, the videotapes were reviewed and specific steps in the surgical procedure correlated with patient-reported potency rates. RESULTS: Four steps were identified that appeared to correlate with the recovery of sexual function: over-sewing back-bleeders from the proximal dorsal vein on the anterior surface of the prostate, division of the striated sphincter when placing urethral sutures, division of the posterior striated sphincter, and hemostasis at the end of the case. CONCLUSIONS: We believe that retrospective review of intraoperative videotapes has great promise. Because many surgeons use different techniques, it is likely that each individual may be able to identify other important arbitrary variations that may improve their patients' outcomes. Similarly, for surgeons with less than optimal outcomes, the review of early successful cases may enable them to identify ways that modification of their surgical technique can improve the outcome of future patients. To the best of our knowledge, the use of retrospective review of intraoperative videotapes has not been commonly used in any other surgical field.

Serum C3 levels are diagnostically more sensitive and specific for systemic lupus erythematosus activity than are serum C4 levels. The Lupus Nephritis Collaborative Study Group.

To determine whether serum C3 or C4 is more likely to be normal during systemic lupus erythematosus (SLE) remission and abnormal during SLE relapse we studied twelve SLE patients who presented with severe nephritis. The patients were followed long term (12 to 77 months) through multiple relapses (N = 41) and remissions (N = 13) defined by protocol. A total of 471 serum samples were obtained at defined intervals during these relapses and remissions and were analyzed for C3 and C4 levels by two different methods: nephelometry (N) and radial immunodiffusion (R). During SLE remission (defined by protocol and without reference to serum complement levels), C3 measured by N-assay (C3N) and by R-assay (C3R) tended to be normal (specificity of 93% and 71%, respectively). By contrast, C4 measured by N-assay (C4N) and by R-assay (C4R) showed no such tendency (specificity of 50% for both C4N and C4R). During SLE relapse (defined by protocol and without reference to serum complement levels), C3N and C3R were more likely to be abnormal (sensitivity 95% and 85%, respectively) compared with C4N and C4R (sensitivity 56% and 54%, respectively, P less than 0.001 compared with corresponding values for the C3 assay). Analysis by receiver-operator characteristic (ROC) curves demonstrated that the reduced diagnostic sensitivity of C4 versus C3 is not explained by use of an inappropriate lower limits of normal (LLN) for C4.(ABSTRACT TRUNCATED AT 250 WORDS)