In utero infection with Treponema pallidum in early pregnancy.

Amniocentesis was performed under sonographic guidance in gravidas (< 20 weeks' gestation) with untreated syphilis. Five to ten millilitres of amniotic fluid from each patient was used for rabbit infectivity testing (RIT) and polymerase chain reaction (PCR) to detect amniotic fluid infection with Treponema pallidum. Gravidas were treated with benzathine penicillin G. Newborns were examined for clinical and laboratory signs of congenital syphilis including immunoglobulin M (IgM) antibody to T. pallidum by Western blotting (immunoblotting). Eleven patients were enrolled at a mean gestational age of 16.8 weeks. T. pallidum was recovered from amniotic fluid by RIT in four cases (36 per cent), and PCR was positive in three of the amniotic fluid specimens (27 per cent). There were no false-positive PCR results. None of the newborns had clinical evidence of congenital syphilis and their sera lacked IgM reactivity to T. pallidum antigens by immunoblotting. These findings confirm in utero infection with T. pallidum in continuing early pregnancy and indicate that in utero treponemal infection can be eradicated by maternal treatment.

Randomized investigation of antimicrobials for the prevention of preterm birth.

OBJECTIVE: Occult amniotic fluid infection has emerged as a possible cause of many heretofore unexplained preterm births. We sought to determine whether antimicrobial therapy is effective in preventing preterm delivery. STUDY DESIGN: A double-blind, placebo-controlled, randomized trial was conducted to study the efficacy of ampicillin-sulbactam and amoxicillin-clavulanic acid in women hospitalized for preterm labor between 24 and 34 weeks' gestation. During this investigation no tocolytics or steroids were used. RESULTS: Thirty-nine women with preterm labor received antimicrobial therapy and 39 received placebos. The mean gestational ages at study entry were 29.8 +/- 0.4 weeks (SEM) and 30.6 +/- 0.3 weeks in the antimicrobial and placebo groups, respectively (not significant). Similarly, the mean gestational ages at delivery were 34.2 +/- 0.7 and 34.1 +/- 0.6 weeks, respectively (not significant). Other index values of pregnancy outcome, for example, birth weight, neonatal morbidity, and prenatal death, were not significantly improved by antimicrobial therapy given to the mother in preterm labor. CONCLUSION: We find that antimicrobial therapy given to women in preterm labor is ineffective in the prevention of preterm birth.

A new placental enzyme in the metabolism of cocaine: an in vitro animal model.

OBJECTIVE: The aim of this study was to analyze placental metabolism in a genetically controlled in vitro animal model. STUDY DESIGN: Placentas from Sprague-Dawley rats were centrifuged, and microsomes were isolated. Four treatment groups were incubated with cocaine over four time periods: placental microsomes + cocaine, placental microsomes + diisopropyl fluorophosphate (an anticholinesterase) + cocaine, placental microsomes + cocaine + butyrylcholinesterase, and a blank (cocaine only). Gas chromatography was used to quantify cocaine (Limit of quantitation = 19 ng/ml) and metabolites. Gas chromatography/mass spectrometry was used to verify the identity of the metabolites. RESULTS: Butyrylcholinesterase enhanced cocaine metabolism to ecgonine methyl ester. More than 40% of cocaine was metabolized to norcocaine by rat placental when diisopropyl fluorophosphate suppressed cocaine. Norcocaine is produced by hepatic N-demethylase action on methyl-bearing nitrogen in cocaine, suggesting that placenta and liver have this capacity. Gas chromatography/mass spectrometry was essential to the identification of norcocaine, because norcocaine is frequently not identified. CONCLUSIONS: This biotransformation of cocaine to norcocaine may be a primary metabolic pathway induced in the cholinesterase-deficient placenta. This has clinical implications because norcocaine is ninefold more active physiologically than cocaine or ecgononine methylesterase.

Subcutaneous tissue: to suture or not to suture at cesarean section.

OBJECTIVE: The null hypothesis for this investigation was that there was no difference in the frequency of wound disruption between women who had their subcutaneous tissues approximated with suture and those who did not during cesarean section. METHODS: During alternating months, consecutive women delivered by cesarean section either did (N = 716) or did not (N = 693) have their subcutaneous tissues closed with suture. All data were analyzed using chi square, Student's t-test, Fisher's exact probability test, analysis of variance, or logistic regression. RESULTS: A 32% decrease in the frequency of wound disruption was observed when subcutaneous tissues were brought into apposition with suture at cesarean section (P = 0.03). CONCLUSIONS: Closure of Scarpa's and Camper's fascia with suture during cesarean section significantly decreased the frequency of wound disruption in this population.

Seroprevalence and risk factors for hepatitis C virus antibody in pregnant women.

OBJECTIVE: To better understand hepatitis C viropathies and seroprevalence by performing an epidemiologic analysis of pregnant women seropositive for antibody against hepatitis C. METHODS: We studied 1013 consecutive obstetric patients at Parkland Memorial Hospital who gave informed consent for detailed interviews and serotesting. Sera were analyzed for antibody to the hepatitis C virus using both C100-3 and RIBA-4 assays. Neonatal assessment was carried out in the immediate postpartum period. RESULTS: Hepatitis C antibody was detected in 2.28% (N = 23) of the 1005 women in whom analysis was completed. Factors associated with seropositivity included intravenous (IV) drug use, sexually transmitted diseases, hepatitis B infection, maternal age greater than 22.5 years, increased parity (eg, greater than 2.1), history of transfusion, and three or more different lifetime sexual partners or a sexual partner who used IV drugs. Maternal and neonatal outcome was not different between hepatitis C antibody-positive and -negative groups. CONCLUSIONS: Epidemiologic data are consistent with sexual and parenteral modes of transmission. Women with hepatitis C antibody did not have excessive perinatal complications compared with antibody-negative women. A model protocol and cost analysis for screening pregnant women for hepatitis C infection are presented. However, routine screening for hepatitis C is not advocated.

Influence of ruminal or duodenal soybean oil infusion on intake, ruminal fermentation, site and extent of digestion, and microbial protein synthesis in beef heifers consuming grass hay.

Six heifers (two Hereford X Jersey, four Hereford X Longhorn; average BW 278 kg) cannulated at the rumen and duodenum and fed a grass hay (fescue/orchardgrass) diet were used in a replicated 3 X 3 Latin square. Treatments were either no infusion (C), 150 ml of duodenally infused soybean oil (DI), or 150 ml of ruminally infused soybean oil (RI)/heifer twice daily for a total daily infusion of 300 ml of soybean oil. Periods of the Latin square included 18 d for adaptation and 5 d for collection. Forage OM, ADF, NDF, and N intakes were not affected (P greater than .10) by soybean oil infusion. Ruminal (P = .11) and total tract (P less than .10) OM digestibilities were decreased by RI compared with C or DI, but ADF and NDF digestibilities were not affected by treatment. Duodenal N (P less than .05) and microbial N flows were increased (P less than .10) for C and RI compared with DI. Microbial efficiency (g of N/kg of OM truly fermented) was improved (P less than .10) by RI compared with DI but did not differ (P greater than .10) from C. Ruminal pH was lower (P less than .05) with RI than with either C or DI. Ruminal NH3 N, total VFA, and acetate were not affected (P greater than .10) by treatment. Propionate (mol/100 mol) was greater (P less than .05) with RI than with DI and C, but the proportion of butyrate did not differ among treatments. These data indicate minimal direct benefits for improving forage usage as a result of soybean oil infusion with a 100% grass diet; however, animals should realize benefits from additional dietary energy provided by infused lipid.

Supralethal magnesemia with patient survival.

We report a patient with supralethal magnesemia of 38.7 mg/dL who survived. Our treatment consisted of assisted ventilation with intubation, accompanied by calcium chloride infusion and forced diuresis with mannitol.

The toxicology and composition of bovine tissues after parenteral administration of high levels of copper salts.

Copper toxicity was observed when crossbred cows were injected with 480 mg copper sc. Five head died after copper disodium EDTA (edetate) injections but no losses occurred with copper glycinate. Necropsy, histopathology and plasma enzyme values indicated severe hepatic necrosis in the affected cattle. Plasma copper levels peaked 2 hr postinjection (3.82 micrograms/ml) in cattle that lived after EDTA injections, but about half this level (2.00 micrograms/ml) of copper was observed in the animals that died and 0.65 in the glycinate-treated animals (P less than .01). Ceruloplasmin levels were low in all cattle (2.1 to 7.2 IU/L). Plasma iron increased between 2 (179 micrograms/dl) to 4 (422 micrograms/dl) hr after injection for all cattle and remained high at 8 hr (501 micrograms/dl postinjection; P less than .01). After copper was administered, plasma zinc decreased 45 to 75% of pre-injection levels (P less than .01). Plasma urea nitrogen was not modified by the treatments. Hemolysis was not observed in any of the animals.

Interaction of molybdenum, sulfate and alfalfa in the bovine.

Thirty-two weanling Hereford heifers were assigned to treatments in a 2(3) factorial arrangement involving two levels of Mo (0 and 100 ppm added inorganic Mo), two levels of SO4 (0 and .5% added inorganic SO4) and two levels of alfalfa pellets (0 and 2.72 kg daily). A basal diet of hay and salt ad libitum and 454 g milo pellets (92% milo and 8% molasses) was fed daily. All animals were fed individually for 11 mo. Added dietary Mo created severe symptoms of Mo toxicity that included scouring, achromotrichia, anemia and weight loss. Five of the 16 animals that received Mo died within 2 wk after the study was terminated. Molybdenum accumulated in all tissues sampled during the first 8 mo and decreased thereafter. Molybdenum also elevated plasma Cu. Balance data indicated that 100 ppm of added dietary Mo led to daily retention of 105 mg Mo and reduced the rate of liver Cu depreciation. Added Mo did not influence feed intake, digestibility or metabolizable energy (ME) when calculated per unit of metabolic size. Added inorganic SO4 lowered plasma Cu and Mo, but did not alter digestibility, ME or Cu and Mo balance. Added protein supplied by alfalfa pellets increased feed intake and digestibility of dry matter, crude protein and energy but did not prevent Mo toxicity symptoms. Alfalfa also increased ME, P, S and N balance and was involved with certain interactions with both Mo and SO4. Plasma Mo is a good indicator of Mo intake and is more useful than tissue Cu levels. Urinary Mo may also be useful to evaluate Mo intake under field conditions.

Injectable copper and tissue composition of cattle.

Copper in blood plasma and liver and tissue reactions were compared for cattle injected with various amounts of copper salts of glycine or edetate. In young Holstein calves, initial concentrations of copper in blood plasma were normal (89 micrograms/dl). At 1 h postinjection, concentrations in plasma and the change were higher for the edetate group than for the glycinate group. Thereafter no differences of plasma copper occurred between forms of copper. Differences between concentrations of copper in plasma, especially for higher injections, occurred during the first 24 h but only occasionally thereafter. Hemolysis was severe during the 1st wk when 240 mg of copper edetate was administered but without mortality. Copper edetate caused less tissue irritation than equivalent copper from glycinate. Calves apparently mobilize injected copper rapidly from the subcutaneous site of injection, especially copper edetate, but concentrations in plasma are only increased temporarily. Copper is stored rapidly in the liver postinjection and probably serves to minimize toxic hemoconcentrations of copper.

Wheat pasture poisoning. II. Tissue composition of cattle grazing cereal forages and related to tetany.

Thirty-two aged Hereford and Angus cows (avg 10.2 yr old) grazed mixed cereal (wheat and rye) pastures from December 6, 1979 to April 23, 1980 (138 d). On d 104 (March 19), five cows developed tetany. On the day of tetany, the mean plasma Ca of the cows with tetany was 4.1 mg/dl. Cows with tetany had plasma Mg concentrations of 1.7 mg/dl on the day of tetany, but 15 d before tetany and 6 d post-tetany, levels were lower (1.2 mg/dl). Cows with tetany had large increases in plasma parathyroid hormone (PHT) as well as vitamin 1, 25 dihydroxy D3 [1,25(OH)2D], plasma glucose, lactic acid and beta-hydroxybutyric acid. Plasma K of these cows followed a similar trend as plant K, except it was not as pronounced. Plasma inorganic P of these same cows was exceedingly low, less than 3 mg/dl several times, although the forage P did not indicate a P deficiency. Levels of plasma hydroxyproline in these cows indicated that bone resorption may have been low during most of the grazing season, even though levels of plasma hydroxyproline were initially high and high subsequent to tetany. High levels of plasma glucose and lactic acid were associated with the time of tetany. Apparently, cows developed inappetence around the time of tetany, as suggested by the high levels of plasma beta-hydroxybutyric acid. Cows with wheat pasture poisoning appeared to respond to the severe hypocalcemia with large increases in plasma 1,25(OH)2D. Plasma 1,25(OH)2D changes were similar to plasma hydroxyproline changes (and possible bone resorption rates) and seemed inversely proportional to plasma Ca and directly proportional to plasma PTH concentrations. Generally, cerebrospinal fluid (CSF) composition was not affected as much as plasma composition, except for the low levels of CSF Ca. These data indicate that a metabolic deficiency of Ca (hypocalcemia) was the cause of tetany.

Wheat pasture poisoning. I. An evaluation of cereal pastures as related to tetany in beef cows.

Forage samples were obtained from three wheat and rye mixed pastures (replications) from December 1979, to April 1980 (140 d), while they were being grazed by mature cows at the Southwestern Livestock and Forage Research Station, El Reno, Oklahoma. These samples were taken three times during December, twice monthly in January and February and weekly in March and April. Samples were analyzed for dry matter, ash, N, K, Ca, Mg, P, ash alkalinity, aconitic, malic and citric acids, total lipids, NO3-N, Na and total nonstructural carbohydrates (TNC). In vitro digestibility was also determined. The N:TNC ratio, estimated plasma Mg levels and K:(Ca + Mg) ratio (tetany ratio) were calculated. On d 105 (March 19), 16% (five of 32 head) of the cows developed tetany. At tetany, the forage K, protein, digestibility, ash alkalinity, aconitic acid and total lipids increased suddenly and markedly. Forage dry matter, TNC and ash decreased. Forage Ca and Mg were slightly below or equal to the animals' requirements and remained relatively constant during the period of tetany. Forage P increased about 2 wk before tetany and decreased after tetany occurred. The levels of forage NO3-N and Na did not appear to be related to the incidence of tetany. The N:TNC ratios exceeded .4 immediately before tetany and two sampling periods thereafter. The estimated plasma Mg levels were lowest at tetany and shortly thereafter and tetany ratio exceeded 2.2 during most of the study, with peaks of 3.2 in December, at tetany and in early April.