Pregnancy rate and reproductive hormones in humpback whale blubber: Dominant form of progesterone differs during pregnancy.

To better understand reproductive physiology of humpback whales Megaptera novaeangliae that reside in Hawai'i and Alaska, enzyme immunoassays were validated for both progesterone and testosterone in free-ranging and stranded animals (n = 185 biopsies). Concentrations were analyzed between different depths of large segments of blubber taken from skin to muscle layers of stranded female (n = 2, 1 pregnant, 1 non-pregnant) and male (n = 1) whales. Additionally, progesterone metabolites were identified between pregnant (n = 1) and non-pregnant (n = 3) females using high pressure liquid chromatography (HPLC). Progesterone concentrations were compared between juvenile (i.e., sexually immature), lactating, and pregnant females, and male whales, and pregnancy rates of sexually mature females were calculated. Based on replicate samples from ship struck animals collected at 7 depth locations, blubber containing the highest concentration of progesterone was located 1 cm below the skin for females, and the highest concentration of testosterone was in the skin layer of one male whale. HPLC of blubber samples of pregnant and non-pregnant females contain different immunoreactive progesterone metabolites, with the non-pregnant female eluate comprised of a more polar, and possibly conjugated, form of progesterone than the pregnant female. In females, concentrations of progesterone were highest in the blubber of pregnant (n = 28, 28.6 ± 6.9 ng/g), followed by lactating (n = 16, 0.9 ± 0.1 ng/g), and female juvenile (n = 5, 1.0 ± 0.2 ng/g) whales. Progesterone concentrations in male (n = 24, 0.6 ng/g ± 0.1 ng/g) tissues were the lowest all groups, and not different from lactating or juvenile females. Estimated summer season pregnancy rate among sexually mature females from the Hawai'i stock of humpback whales was 0.562 (95 % confidence interval 0.528-0.605). For lactating females, the year-round pregnancy rate was 0.243 (0.09-0.59), and varies depending on the threshold of progesterone assumed for pregnancy in the range between 3.1 and 28.5 ng/g. Our results demonstrate the synergistic value added when combining immunoreactive assays, HPLC, and long-term sighting histories to further knowledge of humpback whale reproductive physiology.

Host factors in bacteremia.

Host factors in bacteremia can be divided into nonspecific and specific immune responses. The main components of the nonspecific immune response of the host are phagocytes and complement, and those of the specific response are immunoglobulin and cell-mediated immunity. All of these factors work in concert to protect against bacteria in the bloodstream. Immunoprophylaxis and immunotherapy have come about as a result of growing awareness of the importance of natural host defenses in combating serious bacterial infections. Although the prognosis for patients with bacteremia has improved substantially with recent advances in antibiotic therapy and supportive care, morbidity and mortality rates remain significant. Modulation of the immune system appears to be a promising means of improving the survival rate of patients with bacteremia.

Second episodes of Haemophilus influenzae type b disease following rifampin prophylaxis of the index patients.

Patients treated for Haemophilus influenzae type b disease frequently remain nasopharyngeal carriers of that organism and fail to develop protective concentrations of serum antibody. It has been suggested that rifampin prophylaxis of the index patient may prevent recurrence of disease by eliminating type b Haemophilus carriage. We report nine children who developed second episodes of disease 1 week or more after receiving rifampin prophylaxis. The median interval between the last dose of rifampin and admission to the hospital for the second episode was 70 days (range, 9 to 138). Analysis of biotypes and outer membrane protein polyacrylamide gel electrophoresis patterns of paired isolates from eight cases revealed that the second episodes in two of the children were caused by acquisition of new type b Haemophilus strains, whereas the second episodes in the remaining six children were caused by isolates which were indistinguishable from the respective isolates from the first episodes. Rifampin prophylaxis of the index patient may prevent some episodes of recurrent disease. However, in some patients who have received prophylaxis, second episodes can occur, probably as a result of reacquisition of the organism from contacts who did not receive rifampin or from acquisition of new type b strains.

Clinical considerations in the diagnosis of viral respiratory infections.

Recent advances are allowing the transfer of sensitive and precise rapid viral antigen detection technology from sophisticated research laboratories to standardly equipped clinical diagnostic facilities. It is now possible to identify many viral respiratory pathogens directly from clinical specimens in less than 1 hr. Rapid antigen detection promises to be of the most value in the identification of respiratory viruses 1) for which antiviral therapy is available, 2) which can be prevented by employing isolation precautions, chemoprophylaxis, and/or immunization, 3) whose presence usually is associated with acute respiratory disease, not just asymptomatic colonization, and 4) which ordinarily are not associated with concomitant bacterial infection, and thus, whose early detection may allow withholding or withdrawing antibiotics. Based on these considerations, the relative usefulness of rapid viral antigen detection of commonly encountered respiratory pathogens will be discussed. In addition, the role of rapid viral detection in diagnosis of respiratory infections in high risk versus otherwise healthy individuals will be explored.

Use of rapidly generated results in patient management.

The usefulness of a rapid diagnostic test in patient management depends on the sensitivity of the test, the clinical consequences of false-negative or false-positive results, the ease and cost of performance, and the timely availability of results. A test that is sensitive, specific, inexpensive, and rapid is presumed to be useful clinically. However, there has been surprisingly little effort to measure the actual impact of the results on patient care. Since antigen detection for Haemophilus influenzae type b disease has been available for more than a decade, it will be used as a model to illustrate several factors that help determine the benefits, limitations, and pitfalls of antigen detection in the management of patients with serious bacterial infections. Herein we will compare the use of antigen detection in meningitis with that in other Haemophilus influenzae type b diseases. We also will review our experience with the impact of rapid diagnosis on the treatment of bacterial meningitis. Finally, other factors that influence the usefulness of antigen detection on patient care will be explored by comparing the potential consequences of laboratory error on the management of patients with Haemophilus influenzae type b infections with that of management of other kinds of infections, such as streptococcal pharyngitis, sexually transmitted diseases, and viral respiratory infections.

Neutrophil chemotaxis in patients with atopic dermatitis without infection.

Atopic dermatitis has been associated with recurrent infection and impaired neutrophil chemotaxis in some patients. In order to determine if dermatitis per se could decrease polymorphonuclear leukocyte (PMN) chemotaxis, we investigated chemotaxis in 13 patients with atopic dermatitis and no clinical or historical evidence of recurrent or severe infections. Most patients had extensive, but mild, disease. Leukocyte chemotaxis was measured by the Boyden chamber and agarose techniques; There was no difference between patient and control neutrophil chemoatactic activity. These findings suggest that atopic dermatitis is not ordinarily associated with impaired PMN chemotaxis in the absence of generalized erythroderma or increased susceptibility to infection.

Polymorphonuclear leukocyte function during otitis media.

Polymorphonuclear leukocyte (PMN) function was evaluated in children with serous (SOM) and mucoid otitis media (MOM) and in an experimental model of acute purulent otitis media due to Streptococcus pneumoniae using chinchillas. Twenty-three of 100 children with SOM or MOM had depressed peripheral blood PMN chemotactic, bactericidal or chemiluminescence activity. Depressed PMN chemotactic activity was observed in 17(18%) of 97 children. Children whose middle ear effusions cultured Hemophilus influenzae were more than twice as likely to have depressed PMN chemotactic activity as children whose effusions were sterile. Depressed PMN bactericidal activity was observed in seven (23%) of 30 children, and depressed PMN chemiluminescence activity was found in three (16%) of 19 children. Combined chemotactic and bactericidal dysfunction was observed in four (13%) of 30 children. All seven of the chinchillas with pneumococcal otitis media showed significantly depressed PMN chemotactic activity during the first week after inoculation, while only two of ten uninfected control chinchillas showed the same degree of chemotactic depression (P = .002). The association of H. influenzae and S. pneumoniae with depressed PMN function suggested that bacterial components of these microbes might have functional similarities. Both bacteria are surrounded by capsular polysaccharides which are known to persist in mammalian tissues for an extended period. It is possible that these or other components of H. influenzae and S. pneumoniae, or even host factors generated during middle ear infection and inflammation, impair the PMN response to middle ear infection resulting in delayed bacterial killing and persistent middle ear effusion.

Transient lymphoblastosis and thrombocytopenia in Gianotti-Crosti syndrome.

Gianotti-Crosti Syndrome, or papular acrodermatitis of childhood, represents a characteristic rash that is irregularly associated with hepatitis B infection. The authors report papular acrodermatitis in a 10-month-old child with leukopenia, thrombocytopenia, circulating lymphoblasts, and acute anicteric hepatitis B. Physical examination revealed a densely distributed papular rash on the patient's extremities and face and neck, but not on his trunk, buttocks, palms, or soles. Laboratory investigation revealed a normal bone marrow and positive hepatitis B serology. This case reinforces the fact that hematologic findings should not dissuade the work-up of papular acrodermatitis for hepatitis B or other less commonly associated viruses.

Reducing employee injuries through preventing at-risk behaviors.

This article presents the experiences of officials at two medical centers in successfully reducing and preventing employee injuries. Guidance is also provided from psychologists and employee safety experts on ways to approach the problem.

Clinical conditions associated with defective polymorphonuclear leukocyte chemotaxis.

Impressive numbers of clinical conditions are associated with defective leukocyte chemotaxis. In many, this cellular dysfunction is associated with other abnormalities of the immune response, but in others abnormal chemotactic responsiveness of leukocytes is the only abnormality of function identified in the laboratory. Patients are usually selected for study because of unusually severe, recurrent infections or poor response to antimicrobial agents, and therefore a frequent association between abnormality of chemotaxis and infection would be expected. Many patients demonstrate abnormal chemotaxis during remissions as well as during infections, and there seems little doubt that abnormality of chemotaxis is related to susceptibility to infections. Partial classification of disorders of chemotaxis was attempted. Major abnormalities are found when there is a primary cellular disorder or cell-directed inhibitors of chemotaxis are found. Less marked abnormalities are found when chemotactic factors are deficient.

Neutrophil chemotaxis in patients with Staphylococcus aureus furunculosis.

Neutrophil chemotaxis was evaluated in patients with staphylococcal furunculosis using a modified Boyden chamber assay. Neutrophil chemotactic response to Staphylococcus aureus-derived chemotactic factor was compared with response to Escherichia coli-derived chemotactic factor and zymosan-activated serum. Twenty-one patients with active furunculosis were compared with 29 patients with a history of furunculosis but no recent infection and with 29 healthy control subjects. Chemotactic response to the staphylococcal chemotactic factor was significantly higher in patients with active furunculosis (mean 61.6) than in patients with a history of furunculosis (mean 36.4) or controls (mean 31.4), P less than 0.001. Neutrophils from patients with active staphylococcal infections also had higher chemotactic activity toward E. coli chemotactic factor, but not significantly so (P = 0.09). Chemotactic response to zymosan-activated serum and background neutrophil motility was comparable among the three groups. The increased neutrophil chemotactic response of patients with active infection to bacterial factors, but not zymosan-activated serum, may represent a specific neutrophil response to products of infecting organisms. The differential response of the patients' neutrophils to these attractants supports evidence for the presence of separate categories of chemotaxin receptor on the surface of neutrophils.

Serum opsonic activity after immunization of adults with Haemophilus influenzae type b-diphtheria toxoid conjugate vaccine.

We measured the uptake of radiolabeled Haemophilus influenzae type b by human polymorphonuclear leukocytes. Haemophilus influenzae type b strains were preopsonized in individual sera from six adults immunized with type b polysaccharide vaccine (PRP) or six adults immunized with PRP covalently coupled to diphtheria toxoid (PRP-D vaccine). Serum was heat inactivated before use, and exogenous human complement was added. Of the 12 subjects, 3 had high levels of opsonic activity (greater than 40% of immune control) in their preimmunization serum. This activity did not correlate with the concentrations of anti-PRP antibody and was unaffected by absorption of anti-PRP antibody. At 1 month after vaccination, the serum of PRP-D subjects had higher opsonic activity than that from subjects who received PRP (5% serum, mean PRP-D = 86%, mean PRP = 53%, P = 0.001). After 12 months, both groups had higher serum opsonic activity than before immunization (P less than 0.02), but there was no difference between the two groups (mean PRP-D = 48%, mean PRP = 51%). In postimmunization serum, opsonic activity induced by PRP-D or PRP vaccines correlated directly with anti-PRP antibody concentrations as measured by a radioantigen binding assay. We conclude that both vaccines induce opsonic activity, opsonic activity induced by immunization of adults correlates well with the concentration of anti-PRP antibody achieved, and in preimmune sera with low concentrations of anti-PRP antibody, factors other than anti-PRP antibody contribute to opsonic activity.

Pediatric family care: an interdisciplinary team approach.

Providing adequate psychosocial support for hospitalized pediatric patients and their families is sometimes difficult. An interdisciplinary team can help caregivers to assess needs and develop strategies for working with difficult patients and families. This paper describes the development of a pediatric family care team that has been effective in one hospital, outlining the general steps followed in establishing the team. A review of practical considerations related to team membership, costs, and procedures is followed by a discussion of the problems encountered. A case study demonstrates how the team helped meet the psychosocial needs of one pediatric patient.

Longitudinal development of specific and functional antibody in very low birth weight premature infants.

We evaluated the formation of specific and functional antibody in preterm infants born weighing less than 1500 g (mean 1088 g) and less than 32 wk gestational age (mean 28.8 wk). Plasma IgG antibody against tetanus and diphtheria toxoids were measured by an enzyme-linked immunosorbent assay. Opsonic activity of heat-inactivated plasma was measured using radiolabeled bacteria, adult polymorphonuclear leukocytes and exogenous human complement. In the presence of complement, the strain of coagulase negative staphylococcus used was opsonized by IgG antibody, and the strain of Escherichia coli by IgM. Geometric mean plasma levels of tetanus and diphtheria IgG antibody fell from birth to 4 months chronological age, but rose significantly by 9 months (approximately 2 months after the third dose of diphtheria, tetanus, pertussis vaccine). However, at 9 months they remained lower than the respective geometric mean levels in 9-month-old term infants (tetanus: p less than 0.001; diphtheria: p = 0.02). The preterm infants' mean plasma IgG staphylococcal opsonic activity fell from birth to 2.5 months, but by 9 months was comparable to that of term infants of the same age. Mean IgM opsonic activity for E. coli was very low at birth in both preterm and term infants. It rose with chronological age, correlating with the rise in total IgM (r = 0.48, p less than 0.001) and by 9 months the mean preterm and term infants' levels of IgM opsonic activity for E. coli were comparable.(ABSTRACT TRUNCATED AT 250 WORDS)

C4B deficiency is not associated with meningitis or bacteremia with encapsulated bacteria.

The two isotypes of the fourth complement component are C4A and C4B. C4B forms ester bonds more efficiently than C4A and so, in theory, is more likely than C4A to bind to polysaccharide capsules of encapsulated bacteria. Two studies have reported homozygous C4B deficiency in patients with meningitis or bacteremia caused by encapsulated organisms. In the present study the association between C4B deficiency and these disorders was evaluated in four groups: patients with bacteremia, those with meningitis, those who developed Haemophilus influenzae type b (Hib) disease after Hib polysaccharide vaccination, and patients less than 1 year old with meningitis. Healthy adults served as controls. Of the 257 patients, 2.3% had homozygous C4B deficiency compared with 3.7% of 349 controls. According to these data, there is no increase in homozygous C4B deficiency among patients with bacteremia or meningitis caused by encapsulated bacteria.

Cell-directed inhibition of polymorphonuclear leukocyte chemotaxis in a patient with mucocutaneous candidiasis.

A patient with mucocutaneous candidiasis and impaired polymorphonuclear leukocyte (PMN) chemotaxis is described. The patient's PMN chemotaxis was markedly decreased in the presence of autologous plasma but normal in control plasma. Cell-directed inhibitory activity was found in whole patient plasma as well as the 40% ammonium sulfate precipitate fraction of both the patient's and the control plasma. The inhibitor was heat stable, reversible, nondialyzable, eluted from DEAE cellulose with 0.005 M sodium phosphate buffer, and migrated with IgG on immunoelectrophoresis. The supernate from 40% ammonium sulfate-fractionated patient and control plasma contained a cell-directed enhancer of PMN chemotaxis that antagonized the cell-directed inhibitor activity. It is possible that the patient's chemotactic defect may be caused by imbalance between plasma factors that regulate chemotaxis.

Successful autogenous corticocancellous grafting of a radial defect complicating acute hematogenous osteomyelitis in an infant.

Recurrent osteomyelitis of the radius during infancy after initial hematogenous onset is rare. When encountered, this lesion may result in a segmental defect associated with limitation of forearm motion and progressive deformity. A 10-month-old girl developed distal radial osteomyelitis following bilateral otitis media. A radial defect developed and was treated successfully with autogenous tibial corticocancellous grafting. The surgical management of radial shaft defects is reviewed.