Symptomatic coccidioidomycosis following a severe natural dust storm. An outbreak at the Naval Air Station, Lemoore, Calif.

Eighteen newly diagnosed cases of symptomatic cocidioidomycosis developed two to four weeks following exposure to a severe natural dust storm. The population at risk consisted of 26,000 residents of the San Joaquin Valley with access to health care at the Naval Hospital, Lemoore, Calif. Eight patients were white, and ten were nonwhite. The number of cases per 100,000 was estimated to be 36 for the white group and 254 for the nonwhite group. The disease was disseminated in four patients, and all were from the nonwhite group. One patient with disseminated disease, a black man, died. These data suggest that nonwhites may be relatively more susceptible to acquiring primary disease, in addition to developing disseminated disease. Dust storms of this magnitude must be considered a threat to health for populations living within areas endemic for coccidioidomycosis.

Growth factor receptor messenger RNA expression in human fetal brain regions.

OBJECTIVE: To analyze growth factor receptor expression in the human fetal brain. METHODS: Messenger RNA was prepared from six regions of the fetal brain from three 21-22-week abortuses and used as templates for reverse transcription. Polymerase chain reaction (PCR) was used to amplify the complementary DNA for each of the six brain regions. Amplified PCR DNA fragments were analyzed by agarose gel electrophoresis. Restriction endonuclease digestion was used to confirm the identity of the amplified PCR fragments. RESULTS: Polymerase chain reaction amplified DNA fragments consistent with expression of the insulin, insulin-like growth factors I and II, fibroblast growth factor (FGF), transforming growth factor-beta, and epidermal growth factor receptors were detected in each area of the human fetal brain studied. Of the two known insulin receptor subtype sequences, only the smaller (exon 11-) form was detected. We detected both the intact and the 267 base-deleted alternatively spliced forms of the FGF receptor. CONCLUSION: All six of the receptor messenger RNAs studied were detected in the second-trimester human fetal brain. In addition, alternative splicing of the messenger RNA was noted for the FGF and insulin receptors. This report demonstrates growth factor receptor expression and alternate splicing in specific regions of the human fetal brain. These data suggest that growth factor influence on fetal brain development may be mediated through specific growth factor receptors.

First pregnancies after preconception diagnosis of translocations of maternal origin.

OBJECTIVE: To develop an approach to preimplantation diagnosis of translocations that would not require the use of specific DNA probes for each translocation type. DESIGN: Retrospective analysis. SETTING: Clinic. PATIENT(S): Two patients with 45XX,der(13;14)(q10;q10) karyotypes and one patient with a 46XX,t(4;14)(p15;q24) karyotype. INTERVENTION(S): Based on the observation that first polar body chromosomes remain at the metaphase stage for a few hours after oocyte retrieval, fluorescence in situ hybridization with chromosome-painting probes was used to perform preconception genetic diagnosis of translocation of maternal origin. MAIN OUTCOME MEASURE(S): Oocyte FISH analysis. RESULT(S): A total of 31 mature oocytes were produced, and results were obtained in 23 first polar bodies. After IVF-ET, all three patients became pregnant, preconception diagnoses being confirmed by prenatal diagnosis or birth. CONCLUSION(S): Preconception diagnosis of translocations may reduce significantly the risk of chromosomally unbalanced offspring and pregnancy loss. This method is simpler than previous approaches because the need to develop specific DNA probes for each translocation type is avoided.

Ruptured pelvic abscess after intrauterine insemination: a case report.

This case reports a serious but previously unreported complication of IUI. Further reports of serious infection would warrant consideration of antibiotic prophylaxis in some cases.

Transverse Witzel-T-tube feeding jejunostomy.

BACKGROUND: In patients prone to recurrent aspiration, a feeding jejunostomy is only performed to ensure adequate nutrition. A popular method for placement of the jejunostomy tube is the Witzel procedure, employing a sersosal tunnel on the antimesenteric border. The Witzel procedure, however, frequently suffers from the complication of tube dislodgement and obstruction due to narrowing of the intestinal lumen. METHODS: To minimize the complications associated with the standard Witzel method, we modified the procedure wherein a T-tube is substituted for a standard French rubber catheter, and transversely sutured to the mesenteric border. We believe that the placement of the Witzel line in the transverse plane minimizes the risk of obstruction, and substitution of a T-tube for a standard French catheter should reduce the incidence of tube dislodgement. RESULTS: The Transverse Witzel T-tube feeding jejunostomy has been performed successfully in 30 patients without any complications of tube dislodgement or leaks, and no tube to date has been difficult to remove. Length of tube use has ranged from 1 to 6 months, and no postoperative complications have been observed in this group. CONCLUSIONS: The Transverse Witzel T-tube jejunostomy is an effective and rapid technique for placement of a feeding tube. No serious complications have been observed, and the complication of tube dislodgement appears to be decreased compared to the standard Witzel procedure.

Multifactorial interactions involved in linear self-transport distance estimate: a place for time.

As the vestibular system is the only sensory organ whose primary function is self-motion detection, we examined the conditions under which the otoliths, which detect the linear acceleration of the head, could be used to estimate traveled distance. In order to isolate the contribution of the otoliths (with the somatosensory system) from contributions of the visual and motor systems subjects were transported in darkness. We initially hypothesized that self-transport with continuously varying linear velocity should facilitate distance computation by continuously stimulating the otoliths, and that active control of self-motion should also help subjects estimate the distance traveled. However, it was found that the distance covered during self-motion is actually better estimated when transport velocity is quasi-constant. Nevertheless, such estimates strongly depend upon velocity magnitude; subjects show an idiosyncratic preferred self-motion velocity for which distance measurements are most accurate. Furthermore, the active control of self-transport improves estimates of self-motion mainly because the subjects can then adopt a constant velocity, and more precisely their preferred one. It was finally found that subjects mentally count in order to assess their displacement length, and that time perception is indeed disturbed by varying self-motion velocity.

Inferior alveolar nerve damage following removal of mandibular third molar teeth. A prospective study using panoramic radiography.

Permanent alteration of sensation in the lip after the removal of mandibular third molar teeth is an unusual but important complication. Studies have been performed to assess the risk of nerve damage but most of these have been retrospective and poorly controlled. This prospective trial predicted the outcome of altered sensation prior to surgery based on assessment of a panoramic radiograph and correlated this with the result postoperatively in the consecutive removal of 479 third molar teeth. Results indicated that 5.2 per cent had transient alteration in sensation but only one patient (0.2 per cent) had prolonged anaesthesia. As 94.8 per cent of teeth extracted had no neurological sequelae the figures for prediction were skewed and a kappa statistical analysis of 0.27 illustrated a fair level of agreement between prediction and outcome. This study supports previously reported levels of neurological damage and confirms that panoramic radiography is the optimum method for radiological assessment for mandibular third molar teeth prior to their removal.

Gamete segregation in female carriers of Robertsonian translocations.

Eleven female carriers of either 45,XX,der(13;14) (q10;q10) or 45,XX, der(14;21)(q10;q10) underwent hormonal stimulation with the purpose of producing enough oocytes for in-vitro fertilization and preimplantation genetic diagnosis. Polar body biopsy was performed in those oocytes and FISH with painting probes was applied in their metaphase-like first polar body chromosomes. In this way, unbalanced, normal and balanced oocytes could be distinguished and segregation modes ascertained. der(14;21)(q10;q10) produced 42% unbalanced, 37% normal and 21% balanced oocytes (n = 86) while der(13;14)(q10;q10) generated 33% unbalanced, 51% normal and 16% balanced oocytes (n = 69). In both translocations the number of normal oocytes was significantly higher than the number of balanced oocytes. However, while the frequency of unbalanced events involving chromosome 13 and 14 was similar in der(13;14)(q10;q10), there were significantly more abnormalities involving chromosome 21 than 14 in the der(14;21) (q10;q10) cases. When comparing survival rates to term, trisomies from Robertsonian origin seem to survive more often than those originated by non-disjunction in non-translocation carriers. The meiotic segregation patterns found in female Robertsonian translocations are different from those described in male carriers, with higher rates of unbalanced gametes in females than in males.

Dexamethasone during ovulation induction for in-vitro fertilization: a pilot study.

The purpose of the present study was to determine whether adrenal androgen suppression with dexamethasone (DEX) during ovulation induction improves the outcome of in-vitro fertilization (IVF) cycles. A total of 25 patients with serum dehydroepiandrosterone sulphate (DHEAS) concentrations > 2.5 micrograms/ml were randomized to receive either 0.5 mg DEX daily or placebo during ovulation induction with leuprolide acetate down-regulation plus human menopausal gonadotrophins (HMG). Nine patients undergoing a subsequent IVF cycle were crossed over to the other treatment group. Ovarian responsiveness and IVF outcome variables analysed included number of follicles > 12 mm in diameter, serum oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) administration, number of ampoules of HMG administered, number of oocytes retrieved, percentage of oocytes fertilized, number of embryos transferred, implantation rate and numbers of clinical pregnancies and live birth pregnancies. The 31 randomized IVF cycles revealed a trend towards a higher implantation rate for the placebo-treated group compared to the DEX-treated group (24 versus 10%; P = 0.07). The remainder of the IVF cycle variables revealed no statistically significant differences. In conclusion, the suppression of adrenal androgens with DEX in women with DHEAS concentrations > 2.5 micrograms/ml appears to have no beneficial effects on ovarian responsiveness or clinical or live birth pregnancy rates.

Effect of beta-adrenergic blockade on circulating catecholamines and dopamine-beta-hydroxylase activity during exercise in normal subjects.

We investigated the effects of beta-adrenergic blockade with propranolol (P) on circulating catecholamines at rest and during isometric and dynamic exercise. By means of a radioenzymatic assay, we measured plasma norepinephrine (NE) and epinephrine (E) concentrations in nine normal, sedentary men, aged 22 to 34 years. Measurements were made during resting conditions, at 3 minutes of 30% maximal isometric handgrip exercise (IHE), and during submaximal and maximal dynamic treadmill exercise. Measurements were repeated one week later after the subjects received P in doses ranging from 40 to 80 mg four times a day (plasma P levels at the time of exercise ranged from 96 to 303 ng/ml with a mean of 178 ng/ml). We also measured serum dopamine-beta-hydroxylase (DBH) activity to detect changes in chronic sympathetic tone. Changes in NE from rest to exercise were significant (p less than 0.01) at all exercise loads with or without P. Changes in E from rest to exercise were significant (p less than 0.01) at all exercise loads with or without P except for submaximal dynamic exercise during the control study (p greater than 0.05). For NE, there were no significant differences between the control and P values either at rest or during any form of exercise. For E, there were no significant changes between the control and p values at rest or at maximal dynamic exercise, although there were mild increases (p less than 0.05) with IHE and submaximal dynamic exercise. DBH activity increased significantly (p less than 0.01) from rest to exercise for all exercise points with and without P, but there were no significant differences between the control and p values either at rest or during any form of exercise. In conclusion, we have demonstrated that competitive blockade of beta-adrenergic receptors at the tissue level does not alter neural release of NE or DBH and has little effect on adrenal release of E.

Effect of aerobic conditioning on cardiovascular response to isometric exercise.

The response to isometric handgrip exercise (IHE) and isometric quadriceps exercise (IQE) (30% maximum voluntary contraction held 3 min) was studied before and after 5 wk of aerobic training. Training exercises involved only the lower extremities. Seventeen healthy unconditioned males aged 21--35 yr were subjects. During training nine subjects received propranolol in doses that provided a high degree of beta-adrenergic blockade; eight received a placebo. All subjects were tested before training or drug and after training, 3--5 days off drug. With IGE after training, the placebo group had lower maximum heart rate (91 +/- 4 to 79 +/- 5 beats/min, P less than 0.05), systolic blood pressure (151 +/- 5 to 139 +/- 4 mmHg, P less than 0.05), and double product (heart rate x systolic blood pressure) (138 +/- 10 x 10(2) to 110 +/- 7 x 10(2), P less than 0.05). The response to IQE in the propranolol group was unchanged after training. Heart rate, systolic blood pressure, and double product with IHE was unchanged in either group after training. Aerobic conditioning can modify the hemodynamic response to isometric exercise. This effect is specific for the trained muscle group and is prevented by beta-adrenergic blockade.

Histological evidence of an inflammatory reaction to suture material in the dog vas deferens.

OBJECTIVE: To evaluate changes in histology and semen variables after using an elastomeric-hydrogel matrix plug as a reversible vasectomy device in dogs, and to determine the potential applications for improving fertility after vasectomy reversal. MATERIALS AND METHODS: Semen samples from six adult male dogs were obtained after left vasal ligation, placement of the plug in the right vas deferens, and subsequent removal of the plug. The vasa, epididymides and testes were evaluated histologically in four of the dogs after removal of the implant. RESULTS: No sperm were present in the ejaculate after the plug was removed. Histological sections showed intraluminal spermatids in areas where the plug had been placed. The lumen was occluded, secondary to foreign-body giant-cell reaction, at the vasotomy suture site, but other areas of the was previously containing the implant remained patent after it was removed. CONCLUSIONS: There were no sperm in the ejaculate after the plug was removed because the vasal lumen was occluded as a result of an inflammatory reaction to the suture material. In contrast, areas that had contained the implant but without a vasotomy suture were not inflamed. We suggest that further trials comparing various suture materials are carried out to determine if patency rates can be improved during vasotomy closure or vasovasotomy.

Spontaneous abortions are reduced after preconception diagnosis of translocations.

PURPOSE: Preimplantation genetic diagnosis of translocations has seldom been attempted. Recently, a genetic test based on analyzing polar bodies at the methaphase stage, following fluorescent in situ hybridization with commercially available whole-chromosome painting DNA probes has been presented. Here we report the use of this method in seven couples in whom the female was a carrier of one of these balanced translocations: 45,XX,der (13q;14q)(q10;q10) (two cases), 46,XX,t(4;14)(p15.3;q24), 45,XX,der(14q;21q) (q10;q10), 46,XX,t(7;20)(q22;q11.2), 46,XX,t(9,11)(p24;q12), 46,XX,t(14;18)(q22;q11), and 46,XX,t(3;8)(q11;q11). METHODS: The original method was improved in two ways. First, centromeric probes for one or both chromosomes involved in the translocation were added to avoid misdiagnosis caused by possible confusion of first polar body monovalent chromosomes (with two chromatids each) with single chromatids. Second, for cases with terminal translocations where commercially available probes do not cover telomere sequences, a telomere probe labeling the translocated fragment was added. RESULTS: A total of 26 abnormal, 18 balanced, and 22 normal eggs was detected. Nine normal and seven balanced embryos were transferred, resulting in eight (50%) implanting, of which one spontaneously aborted. To date, the remainder have produced karyotypically normal or balanced babies and ongoing pregnancies. The rate of spontaneous abortions after preimplantation genetic diagnosis (12.5%) was significantly reduced (P < 0.001) compared to natural cycles in the same patients (95%). CONCLUSIONS: With the above improvements, the test can characterize any translocation of maternal origin and produce a high pregnancy rate and an apparently low frequency of spontaneous abortion.

Immunologic responsiveness and safety associated with the Coccidioides immitis spherule vaccine in volunteers of white, black, and Filipino ancestry.

A trial of the killed Coccidioides immitis spherule vaccine was undertaken with 151 healthy skin test negative adult volunteers and controls to evaluate the safety of selected regimens, the induction of humoral and cell-mediated immune responses, and to determine if there were immunogenetic differences in these responses. The vaccine was given as three intra-deltoid doses over 8 weeks. No severe systemic symptoms were noted, although 3% of 3.5 mg doses (but no 1.75 mg doses) were associated with severe local reactions. Half the vaccinees had skin test conversions, which generally persisted greater than or equal to 6 months, two-thirds showed boosting of lymphocyte transformation in vitro, and 16% given three 3.5 mg doses developed antibody. There was an association between degree of local adverse vaccine reaction and immunostimulation, and a trend to immune response in persons of O blood type and with some HLA phenotypes. There was no evidence of deficient response to vaccination in subpopulations known to respond to coccidioidal infection poorly. A regimen of three 1.75 mg doses appears to be safe and without reduced immunogenicity, and there is no evidence dosage modification for certain subpopulations would be necessary in efficacy studies.

Positive outcome after preimplantation diagnosis of aneuploidy in human embryos.

usromosomal abnormalities are responsible for a great deal of embryo wastage, which is reflected, at least partially, in decreased implantation and increased miscarriage in older women. To address this problem the transfer of only chromosomally normal embryos previously selected by preimplantation genetic diagnosis (PGD) has been proposed. We designed a multi-centre in-vitro fertilization (IVF) study to compare controls and a test group that underwent embryo biopsy and PGD for aneuploidy. Patients were matched retrospectively, but blindly, for average maternal age, number of previous IVF cycles, duration of stimulation, oestradiol concentrations on day +1, and average mature follicles. All these parameters were similar in test and control groups. Only embryos classified as normal for those chromosomes were transferred after PGD. The results showed that the rates of fetal heart beat (FHB)/embryo transferred between the control and test groups were similar. However, spontaneous abortions, measured as FHB aborted/FHB detected, decreased after PGD (P < 0.05), and ongoing pregnancies and delivered babies increased (P < 0.05) in the PGD group of patients. Two conclusions were obtained: (i) PGD of aneuploidy reduced embryo loss after implantation; (ii) implantation rates were not significantly improved, but the proportion of ongoing and delivered babies was increased.