Asialylated IgG in the serum and synovial fluid of patients with rheumatoid arthritis. A novel enzyme linked immunosorbent assay has been developed that detects an asialylation change in the IgG molecules from patients with rheumatoid arthritis (RA) by the binding of biotinylated RCA 1 (ricin) to capture IgG. Elevated levels of asialylated IgG were detected in paired serum and synovial fluids (SF) of patients with RA. When compared with healthy controls, particularly in the SF (p less than 0.05) correlations of the asialylation change were found in paired samples (p less than 0.01) and between asialylated IgG and rheumatoid factors (p less than 0.01), C-reactive protein (p less than 0.02) and the Lee and Ritchie indices p less than 0.02 and 0.05, respectively. We found the proportion of asialylated IgG was higher in DR4 positive patients, indicating a possible association of these individuals to a sialyl transferase abnormality.


Possible mechanisms of gastroduodenal mucosal damage in volunteers treated with nonsteroidal antiinflammatory drugs--the usefulness of prodrugs. A controlled double blind study on the incidence of nonsteroidal antiinflammatory drug (NSAID) gastropathy was performed in 29 healthy volunteers administered diclofenac Na (10 subjects) or a prodrug (loxoprofen Na in 10 subjects and proglumetacin maleate in 9 subjects). The incidence of NSAID gastropathy was significantly lower in the subjects administered the prodrugs than in those administered diclofenac Na (p less than 0.05), which suggested the clinical usefulness of the prodrugs.


Course of antiphospholipid antibodies in patients with primary antiphospholipid syndrome before, during and after pregnancy treated with low dose aspirin. Relationship of antibody levels to outcome in 7 patients. We studied 7 patients with primary antiphospholipid syndrome (APS), who had had, between them, 28 fetal losses in 30 pregnancies. The 2 successful pregnancies had occurred 14 years previously. The patients had been followed for a mean of 20.5 months with a mean of 6.4 determinations of antiphospholipid antibodies (aPL) before becoming pregnant again. Serial determinations of aPL continued to be done throughout pregnancy. Patients were treated with low dose aspirin only except for one who had prednisone added at the time of an impending abortion. Five patients had successful outcomes and 2 had stillbirths. In the patients who had pregnancy loss, as well as in those who had other obstetric incidents there were abrupt changes in IgG, but not in IgM, levels. Levels of IgG aPL in patients with successful outcomes tended either to decrease gradually or to remain stable throughout. We conclude that patients with primary APS who had repeatedly unsuccessful pregnancies may show changes in their IgG levels during pregnancy that could indicate impending morbidity. In some of them low dose aspirin may prevent pregnancy loss.


The differing patterns of interstitial lung involvement in connective tissue diseases. Connective tissue disorders (CTD) have a relatively high incidence of pulmonary complications but their delineation has been hampered by difficulties inherent in the diagnostic techniques. One fresh approach to this problem is based on a clustering method that uses data from 8 separate investigations to cluster the patients into 4 distinctly separate categories representing normal nonsmoker, normal smokers, those with active interstitial lung disease and those with bronchiolitis. Using this method, a large group of patients with CTD have been examined to assess the nature and extent of their pulmonary complications. Subjects in the first cluster had a normal test profile across all variables, and included no current active smokers. The normal smoking cluster contained only smokers who had a high total lavage cell number with a relative increase in macrophages and a decrease in lymphocytes. In this group, all respiratory variables were normal with the exception of a mildly depressed DLCO, also known to be associated with smoking. The general characteristics of the active interstitial lung disease cluster was a markedly depressed DLCO indicating impaired gas exchange, and elevated gallium index, bronchoalveolar lavage (BAL) cell number and neutrophil and lymphocyte percentages, all indicating an active inflammatory process. However more careful analysis of this group suggested the presence of 2 subgroups, one with a lymphocytic alveolitis, and another with a neutrophilic alveolitis. The bronchiolitis cluster characteristics were a markedly depressed maximal mid expiratory flow rate and raised BAL lymphocyte percentage and gallium index. The distribution of patients within the cluster groupings suggested that Sjögren's syndrome, often an accompaniment of other CTD, is most frequently associated with pulmonary disease.(ABSTRACT TRUNCATED AT 250 WORDS)


Disease patterns of patients with systemic lupus erythematosus as shown by application of factor analysis. Clinical and laboratory test data of 77 patients with systemic lupus erythematosus (SLE) were evaluated by factor analysis. Six factors representing disease patterns were extracted: cutaneous symptoms of alopecia, malar rash, rash and photosensitivity; renal involvement; the anticoagulant syndrome of phlebitis and partial thromboplastic time inversely related to platelet count; lymphopenia; viral or fibromyalgia symptoms of headache, nervousness, joint and muscle pain; and serology of anti-DNA antibodies and complement inversely related. Application of factor analysis reveals various clinical presentations of SLE.


Soluble interleukin 2 receptors in polymyalgia rheumatica/giant cell arteritis. Clinical and laboratory correlations. Serum levels of soluble interleukin 2 receptors (sIL-2R) were measured in 21 patients with polymyalgia rheumatica (PMR)/giant cell arteritis (GCA) prior to steroid treatment. These levels were significantly elevated in patients with PMR/GCA compared with healthy controls (p = 0.002). A significantly longer duration of morning stiffness (p = 0.005) was observed in patients with a high concentration of sIL-2R. A significant correlation was observed at diagnosis between sIL-2R and erythrocyte sedimentation rate (ESR) (p = 0.01) and between ESR and C-reactive protein (CRP) (p = 0.005). We investigated prospectively a group of 10 patients over a period of 6 months of prednisone therapy. At the end of the study sIL-2R levels fell significantly compared to pretreatment values (p = 0.02), but remained significantly higher compared to controls (p = 0.02). ESR and CRP values also fell significantly compared to pretreatment levels (p = 0.0001 in both cases). We observed a significant correlation between the decrease in ESR values and the decrease in sIL-2R and CRP levels after 6 weeks (p = 0.01 in both cases) and after 6 months of therapy (p = 0.002 and p = 0.05). sIL-2R may be considered a useful serologic marker for monitoring response to steroid therapy in patients with PMR/GCA. This laboratory variable correlated more closely with ESR than with CRP. The presence of elevated levels of sIL-2R is likely to reflect T cell activation occurring in PMR/GCA. T lymphocyte activation persisted after 6 months of steroid therapy, despite rapid and continuous control of disease manifestations.


Determinants of synovial fluid lactate concentration. The resting intraarticular pressure and the type of arthropathy [rheumatoid arthritis (RA) or non-RA] have been examined for their importance as determinants of synovial fluid (SF) lactate concentration in patients with knee effusions. SF lactate concentration was higher in RA than in non-RA knees. This difference was not related to the resting intraarticular pressure at the time of sampling. After drainage of SF and saline lavage of the joint, the rate of increase of lactate in a fixed volume of intraarticular saline was examined under resting conditions. The rate of increase of the lactate concentration was significantly greater in RA joints. It is most likely that SF lactate concentration under resting conditions will reflect the lactate concentration during the preceding period of activity which, in turn, is probably a composite function of the extent of synovial hypoxia due to hypoperfusion and the type of arthropathy.


Synovial fluid crystals derived from erythrocyte degradation products. We report 5 patients with bloody effusions containing crystals not previously reported to occur in synovial fluid. In one patient, rectangular hemoglobin-like crystals were found inside red cells previously observed elsewhere. In the other 4 cases, golden brown rhomboid crystals with positive elongation appeared to be hematoidin, a degradation production of hemoglobin, which has been found in nonarticular areas of old hemorrhage. In one patient, hematoidin crystals were identified lying in macrophage vacuoles. Both types of crystals are potential sources of confusion with known pathogenic crystals.


Patients with rheumatoid arthritis are more tender than those with psoriatic arthritis. Articular and nonarticular tenderness was examined in 51 patients with rheumatoid arthritis (RA) and 50 patients with psoriatic arthritis (PsA) by scored palpation and dolorimeter readings. Fifty-seven percent of patients with RA had 10 or more tender fibrositic points vs 24% of patients with PsA (p = 0.0008). Thresholds of tenderness measured by dolorimetry of 6 fibrositic point sites were 3.97 (1.99) [mean (SD)] for RA vs 5.95 (2.28) for PsA (p less than 0.0001). Thresholds over actively inflamed joints were 4.19 (1.53) for RA vs 6.78 (2.55) for PsA (p less than 0.0001). In both RA and PsA, fibrositic sites were more tender than actively inflamed joints (p less than 0.0001). Nonarticular control sites were also more tender in subjects with RA with dolorimeter thresholds at 5.99 (1.96) in RA vs 7.58 (1.60) in PsA (p less than 0.0001). These data demonstrate that actively inflamed joints, fibrositic and control nonarticular sites were all more tender in patients with RA than PsA. Both groups were similar in their disease duration and clinical assessments of joint inflammation and damage. We suggest that there may be a disease specific diffuse increase in tenderness in patients with RA, which is not related to joint inflammation. Similarly, the severity of articular inflammation may be underestimated in subjects with PsA.


Thyroid function in patients with fibromyalgia syndrome. Thyroid function was tested in 13 female patients with primary fibromyalgia syndrome (FS) and 10 healthy age matched controls by intravenous injection of 400 micrograms thyrotropin-releasing hormone (TRH). Basal thyroid hormone levels of both groups were in the normal range. However, patients with primary FS responded with a significantly lower secretion of thyrotropin and thyroid hormones to TRH, within an observation period of 2 h, and reacted with a significantly higher increase of prolactin. Total and free serum calcium and calcitonin levels were significantly lower in patients with primary FS, while both groups exhibited parathyroid hormone levels in the normal range.


Pancreatitis related to antiphospholipid antibody syndrome in a patient with systemic lupus erythematosus. A 39-year-old woman was admitted with abdominal pain and dyspnea, and a diagnosis of systemic lupus erythematosus with renal involvement was established. Laboratory tests revealed highly elevated anticardiolipin antibody, thrombocytopenia and false positive VDRL. Generalized thrombus formation and Libman-Sacks endocarditis were found at postmortem examination. The pancreas showed chronic inflammation with thrombi in pancreatic arteries, but no vasculitic change was observed. Lowering of pancreatic blood flow because of arterial thrombi was a possible cause of pancreatitis in this patient. The spectrum of antiphospholipid antibody associated diseases may be extended to include pancreatitis as a thrombotic complication.


Splenectomy as treatment for nonhealing soft tissue defect after total knee arthroplasty in a patient with Felty's syndrome. We describe the apparent remarkable effect of splenectomy on wound healing in a patient with rheumatoid arthritis and Felty's syndrome. The patient had previously undergone a knee replacement with 4 months of failure of the surgical wound site to heal or close. The wound, which had broken down and dehisced on 3 separate occasions after plastic surgical attempts at closure, healed cleanly and without recurrence within 3 weeks of splenectomy and plastic repair at the same operation.


Development of systemic lupus erythematosus after total resection of a thymoma and the adjacent thymic gland. We describe a woman with systemic lupus erythematosus presenting with nephropathy after the complete resection of a thymoma and the adjacent thymic gland. The woman showed no symptoms of autoimmune disorders or nephropathy at operation. One year later, however, she noticed arthralgia, and laboratory examination showed mild proteinuria, leukopenia, a high level of serum antinuclear antibody (1:1280), anti-dsDNA antibody, and a low level of complement. Renal biopsy showed focal necrotizing glomerular lesions, suggestive of lupus involvement. The pathogenesis of lupus erythematosus in our case is briefly discussed in relation to preceding thymoma and its resection.


Malignant angioendotheliomatosis mimicking systemic necrotizing vasculitis. Malignant angioendotheliomatosis is a rare disease characterized by an intravascular proliferation of atypical mononuclear cells. Manifestations result from occlusion of small blood vessels. Multiple organ systems are involved and the clinical presentation resembles a systemic necrotizing vasculitis with skin and central nervous system most commonly involved. The clinical course is characterized by progressive organ failure with death usually within 2 years after presentation. Based on its assumed origin as an intravascular lymphoma, patients may respond to chemotherapy.


Bronchiolitis obliterans organizing pneumonia and scleroderma. Pulmonary involvement in scleroderma is characterized by interstitial fibrosis and pulmonary hypertension. Although bronchiolitis obliterans organizing pneumonia (BOOP) may be associated with a variety of connective tissue diseases and their treatment, there are only rare reports of bronchiolitis associated with scleroderma. We describe 2 patients with scleroderma and rapidly evolving pulmonary infiltrates, which upon biopsy showed histologic findings of BOOP. Each patient had severe restrictive lung disease and markedly diminished diffusion capacity. Treatment with high dose prednisone showed a good response in one patient. The rapid course of pulmonary findings in these patients differs from the usual course of pulmonary fibrosis in scleroderma. Although BOOP is a rare finding in scleroderma, our findings suggest that rapid pulmonary decompensation or atypical findings for pulmonary fibrosis should prompt consideration for an open lung biopsy. Finding a potentially steroid responsive disorder in an otherwise steroid unresponsive disorder has important clinical implications.


Atypical eosinophilic fasciitis localized to the hands and feet: a report of four cases. We describe 4 patients who had episodic localized swelling of an extremity, 2 of the hand and 2 of the foot, in combination with peripheral eosinophilia and a biopsy characteristic of eosinophilic fasciitis (EF). Surgical excision produced marked improvement in the patients' symptoms. Whether these patients, despite a characteristic biopsy, can be included in the spectrum of EF remains uncertain.


Scleroderma with bilateral synovial fistulae. Synovial fistulae developed in an elderly man with rapidly progressive scleroderma. We describe this case and review the literature on synovial fistulae.


Hypertrophic osteoarthropathy and thyroid cancer. We describe a case of aggressive undifferentiated thyroid cancer associated with rapidly evolving hypertrophic osteoarthropathy (HOA) that developed at the time of pulmonary dissemination of the thyroid neoplasm. The syndrome appeared to be paraneoplastic, possibly due to a substance normally cleared by the lungs.


Implications of birth cohort patterns in interpreting trends in breast cancer rates. Most investigations of trends in cancer rates are based on a cross-sectional approach, i.e., an examination of trends in rates by year of diagnosis or death. When there are longitudinal effects (i.e., trends in rates with successive birth cohorts), interpretation of cross-sectional trends can be misleading. Based on cross-sectional comparisons, U.S. breast cancer mortality rates have been reported to be decreasing over the last 20 years in younger women but to be increasing during the same period in older women. To examine the impact of longitudinal effects on the divergence of cross-sectional trends in breast cancer mortality with age, we examined breast cancer mortality rates from 1969 to 1988 by birth cohort for White women in the United States. By using a novel, nonparametric, permutational method to analyze 2-year, age-specific mortality rates for women aged 30-89 years, we identified trends in rates with successive birth cohorts. The divergence in trends with age is shown to be consistent with an increase in breast cancer risk with successive birth cohorts from 1900 to 1916 and with a decrease in breast cancer risk with successive birth cohorts beginning around 1926. Longitudinal effects have a significant impact on cross-sectional trends in breast cancer mortality. Continuation of the birth cohort trend in younger women, which could correspond to changes in reproductive patterns accompanying the "baby boom," would result in decreasing cross-sectional trends in women 60-69 years of age over the next decade and in women 70-79 years of age in the subsequent decade. Longitudinal effects must be taken into consideration when monitoring and evaluating the effects of early detection, treatment, and intervention programs using national rates.


Peanut lectin: a mitogen for normal human colonic epithelium and human HT29 colorectal cancer cells. The protein peanut agglutinin (PNA) is a galactose-binding lectin whose receptor, the Thomsen-Friedenreich (TF) blood-group antigen, shows increased expression in hyperplastic and neoplastic colonic epithelium. Our hypothesis was that, under these conditions, increased lectin receptors could interact with dietary lectins, which would act as tumor promoters by stimulating cell proliferation. This study was designed to confirm whether active PNA is recoverable from feces after ingestion of peanuts and to assess the mitogenic effect of PNA on proliferation of epithelial cells in the colon. Peanut lectin was extracted from feces by lactose-agarose affinity chromatography and was assayed for hemagglutinating activity. Cultured explants of histologically normal biopsy specimens of colonic mucosa from 31 patients were examined. Crypt cell production rate and incorporation of [3H]N-acetylglucosamine into mucin were assessed as indicators of proliferative and metabolic responses to PNA. In addition, we evaluated the separate and combined effects of PNA and epidermal growth factor (EGF) on cell proliferation in human HT29 colorectal cancer cells, by using tritiated thymidine incorporation and cell counts. Peanut lectin extracted from feces showed hemagglutinating activity toward desialylated red blood cells similar to that of a lectin preparation extracted from raw peanuts. Evaluation of biopsy specimens of normal colonic mucosa demonstrated that PNA at a concentration of 25 micrograms/mL caused statistically significant increases in crypt cell production (31% [mean] +/- 5% [SD]; P = .00005) and mucus synthesis (77% +/- 12%; P less than .000001). At 7.5-100 micrograms/mL, PNA was mitogenic for the HT29 colorectal cancer cell line. At 25 micrograms/mL, PNA alone produced a statistically significant increase in thymidine incorporation (44% [mean] +/- 3.7% [SD]; P = .002). For PNA in combination with EGF at 100 pg/mL, the increase was significantly greater (222% +/- 11.2%) than that for EGF alone (57% +/- 5%; P = .003). These results suggest that expression of the PNA receptor, TF antigen, by hyperplastic or neoplastic colonic epithelium may affect cell proliferation. It is possible that dietary lectins such as PNA, which bind to the TF antigen, promote cell proliferation and thus cancerous growth, while galactose-containing vegetable fiber would inhibit this effect by competing for binding by these lectins.


Environmental tobacco smoke and lung cancer risk in nonsmoking women. Exposure to environmental tobacco smoke (passive smoking) has been suggested to be a cause of lung cancer, although early epidemiologic studies have produced inconsistent results. We conducted an epidemiologic case-control study to assess the relationship between exposure to environmental tobacco smoke and lung cancer risk among women who have never smoked (i.e., having smoked for a total of less than 6 months or having smoked less than 100 cigarettes in their lifetimes). Case patients (n = 210) were women with histologically confirmed primary carcinomas of the lung who were lifetime nonsmokers. They were identified through hospital tumor registries and the Florida Cancer Data System of the Statewide Cancer Registry. Community-based control women (n = 301) were also lifetime nonsmokers and were identified through random-digit dialing. Details on childhood and adulthood exposures to environmental tobacco smoke were ascertained through interviews with the study participants themselves or with surrogate respondents. Risks were calculated in terms of smoke-years, defined as the sum of the reported years of exposure to cigarette smoke from each smoker in the household. The risk of lung cancer more than doubled for women who reported 40 or more smoke-years of household exposure during adulthood (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.1-5.3) or 22 or more smoke-years of exposure during childhood and adolescence (OR = 2.4; 95% CI = 1.1-5.4). Risks were highest for non-adenocarcinoma lung cancers, although modest elevations in risk were also observed for adenocarcinomas. When a surrogate respondent other than the patient's husband provided information on exposure, the risk estimates were considerably lower. These findings suggest that long-term exposure to environmental tobacco smoke increases the risk of lung cancer in women who have never smoked.


Second cancers in patients with chronic lymphocytic leukemia. Reports to date have provided widely divergent estimates of the risk of second malignant neoplasms in patients with chronic lymphocytic leukemia (CLL), ranging from cancer deficits to excesses of twofold to threefold. Our purpose was to estimate the risk of second primary cancers following CLL, utilizing population-based tumor registries, and to determine whether site-specific excesses might be associated with type of initial treatment for CLL. We analyzed data for 9456 patients diagnosed with CLL as a first primary cancer between 1973 and 1988, who were reported to one of nine tumor registries participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and who survived 2 or more months. SEER files were searched for invasive primary malignancies that developed at least 2 months after the initial CLL diagnosis. Compared with the general population, CLL patients demonstrated a significantly increased risk of developing all second cancers (840 observed; observed-to-expected ratio [O/E] = 1.28; 95% confidence interval [CI] = 1.19-1.37). Significant excesses were noted for cancers of the lung (O/E = 1.90), brain (O/E = 1.98), and eye (intraocular melanoma) (O/E = 3.97) as well as malignant melanoma (O/E = 2.79) and Hodgkin's disease (O/E = 7.69). Cancer risk, which did not vary according to initial treatment category, was also constant across all time intervals after CLL diagnosis. CLL patients are at a significantly increased risk of developing a second malignant neoplasm. The pattern of cancer excesses suggests a susceptibility state permitting the development of selected second malignancies in patients with CLL, perhaps because of shared etiologic factors, immunologic impairment, and/or other influences. Although our results do not suggest a strong treatment effect, more detailed studies of second tumors in CLL are needed to investigate the role of radiation therapy and chemotherapy.


Increasing incidence of cutaneous melanoma in Queensland, Australia. Queensland, Australia, had the world's highest incidence rates of invasive cutaneous melanoma in the 1970s. The purpose of this study was to monitor trends in melanoma incidence in Queensland. We studied two time periods in which ascertainment was comparable. In the 7.5 years up to 1987, the incidence of invasive melanoma in Queensland increased by more than one half in women (to 42.89 per 100,000) and more than doubled in men (to 55.81 per 100,000), with the most dramatic increase seen in men over age 50 years. This higher increase in men is a reversal of the previously higher rates in women. In Queensland, cumulative risks of total cutaneous melanoma (in persons aged 0-74 years), including preinvasive melanoma, have increased to one in 14 in men and to one in 17 in women. There were large increases in age-standardized incidence rates of thin lesions (less than 0.75 mm) in both sexes but not of in situ lesions, and there were also increases in thicker lesions, especially on the backs of males. Although increased awareness and earlier diagnosis appear to have accompanied increased incidence, increased exposure to solar UV radiation during the past 50 years appears to be the most likely explanation for the rise in incidence rates. A better understanding is needed of the causes of melanoma and of the complex relationships between constitutional factors, ambient UV radiation, and sun-exposure behavior.


Deaf culture and alcohol and substance abuse. Alcohol and substance abuse problems are now of concern among persons who are deaf. The problems of cultural influence, prevalence of the problem, and factors contributing to isolation and denial are addressed in this article. In addition, the issues of accessibility and service delivery are explored. Current programs that are accessible and provide alcohol and substance abuse recovery are identified.


Psychoanalysis of a man with active alcoholism. Psychoanalysis of a man with active alcoholism, who is able to resume recreational drinking, has never been described. Mr. A. began treatment in denial of his alcoholism. Analysis demonstrated an underlying splitting between his experiencing and observing ego. His analyst received a projection of his observing ego, the part that was worried about his drinking. Because this split was resolved within a therapeutic alliance, Mr. A. decided that he had been attacking and punishing himself with alcohol, and he elected to abstain from alcohol entirely. The first key event that lead up to this dramatic decision was a sense that his analyst was a separate person. The second, arriving for discussion within the analysis through a dream, was his conviction that he would have to choose either to continue to drink with loss of control at the cost of his analysis or that he would have to choose to continue analysis at the expense of having to stop drinking. Mr. A. then came to feel that his analyst was attacking and punishing him with a fee increase. After 15 months of complete abstinence, Mr. A. found that he could drink with rare symptoms, but he still felt saddled with an abusive analyst. Mr. A.'s rages about the fee came up most commonly right after weekend or vacation breaks in the analysis. But the interpretation of these rages as related to missing me were contemptuously regarded as attempts to force him into my psychoanalytic schema rather than regarding his experience as valid. There was a dramatic shift of our alliance when Mr. A. was given complete control over the fee. I was freed to interpret and reconstruct the underlying early relationship with his parents. The final part of this article describes Mr. A.'s working-through process, which stabilized his sense of autonomy and which reconstructed his early relationship with his parents. Mr. A. became convinced that it was up to him exactly how, when, and how much to drink. Drinking too much led to consequences that he chose not to endure.


Two cases of clonidine abuse/dependence in methadone-maintained patients. Clonidine has been used to assist opiate detoxification in the past 10 years. This substance is known to have multiple effects on the central nervous system and to cause withdrawal symptoms when stopped abruptly. The combination of these two effects could result in clonidine having a potential for abuse. Two cases of clonidine abuse/dependence in methadone-maintained patients are presented. Nonmedical use of clonidine in opioid-dependent persons has never been evaluated.


Habituation to zipeprol hydrochloride during pregnancy. Zipeprol hydrochloride is a synthetic antitussive agent that has shown little evidence of addictive potential in animal studies. Despite this, several reports of abuse and abuse-related over-dosage have been published. Abuse of this drug has now become a problem in the United States-Mexico border region. We report the specific case of a pregnant woman habituated to zipeprol without evidence of other drug abuse and an abstinence syndrome observed in her newborn infant.


Use of the Dementia Rating Scale as a test for neuropsychological dysfunction in HIV-positive i.v. drug abusers. Intravenous drug abusers (IVDAs) represent an increasing proportion of the HIV epidemic. Forty-three IVDA's (22 HIV-negative, 21 HIV-positive) were studied using the Mattis Dementia Rating Scale (DRS). All subjects had used intravenous heroin, but reported that they were drug-free at the time of testing. HIV-positive subjects were predominantly symptomatic and were dichotomized into AIDS and non-AIDS groups. All subjects with abnormal DRS scores were HIV-positive (57% of all HIV-positives). All HIV-negative subjects had normal DRS scores while 43% of the positive group obtained such scores. The DRS reliably identifies neuropsychological impairment, and may be a useful screening tool in this population.


Maternal bereavement in the perinatal substance abuser. Maternal bereavement has been reported in involuntary perinatal loss and voluntary custody relinquishment. Since child custody loss is common among childbearing chemically dependent women, maternal bereavement was investigated in a small pilot sample of obstetric substance abusers. Findings suggest that grief in anticipation of possible postnatal custody loss is common. Unresolved grief from previous custody loss was also common. Clinical features, treatment considerations, and public health concerns are discussed.


The effectiveness of treatment for substance abuse. Reasons for optimism. Reviews of treatment research have sometimes drawn gloomy conclusions which clash with the experience of clinicians. Yet the same literature provides reasons for optimism about the future of substance abuse treatment. There are treatment strategies with encouraging evidence of effectiveness that are only beginning to be applied in practice. Furthermore, research is clarifying the mechanisms and reasons for successful treatment, pointing to factors to be emphasized in therapy. Approaches that yield even short-term advantages can promote more rapid recovery, and may provide clues for how to prevent relapse. In difficult economic times, hope is also provided by evidence that even relatively brief treatment can be substantially more effective than none at all. Recent evidence also supports the importance of matching clients to alternative treatment strategies. To the extent that practitioners can keep abreast of such developments and adjust their clinical work accordingly, there is reason to believe that the effectiveness of substance abuse treatment can be greatly increased.


Prolonged toxicity with intermediate syndrome after combined parathion and methyl parathion poisoning. A prolonged type of organophosphate toxicity, previously characterized as the Intermediate Syndrome, has been recognized in 6 out of 7 prospectively studied patients poisoned by insecticide containing parathion and methyl parathion in equal proportions. The clinical characteristics included respiratory paresis, weakness in the territories of several motor cranial nerves, neck flexors and proximal limb muscles, and depressed tendon reflexes, all lasting for several days or weeks. Electromyography in the early stages disclosed diverse types of impaired neuromuscular transmission. EMG normalization preceded clinical recovery. Severe plasma butyrylcholinesterase and erythrocyte acetylcholinesterase inhibition persisted along with the occurrence of Intermediate Syndrome-related symptoms. We conclude that combined parathion and methyl parathion poisoning is more likely to induce Intermediate Syndrome than parathion poisoning alone. The mechanisms underlying this difference remain obscure. The Intermediate Syndrome shows clinical and electromyographic hallmarks of combined postsynaptic impairment of neuromuscular transmission.


The adsorption of isopropanol and acetone by activated charcoal. This study was performed to determine the adsorption of isopropanol and acetone by activated charcoal over a range of charcoal:solvent ratios. The charcoal binding of isopropanol was studied in both hydrochloric acid and water solutions, while acetone was analyzed in water. Gram ratios of charcoal to solvent ranged from 1:1 to 20:1. After the addition of charcoal the solution was agitated and centrifuged. The supernatant was then analyzed by gas chromatography. Each increment in charcoal dose increased the percent adsorption of both isopropanol and acetone. At the 20:1 ratio 87-92% of the solvent was bound by activated charcoal. In vivo study is needed to determine if activated charcoal therapy can shorten the half-life of isopropanol and acetone and decrease the duration of supportive care needed following ingestions of these solvents.


Duration of QRS disturbances after severe tricyclic antidepressant intoxication. While the clinical toxicity of tricyclic antidepressants, particularly the development of seizures and arrhythmias, has been strongly correlated with a QRS interval of greater than or equal to 100 msec on electrocardiography, the resolution pattern of QRS abnormalities remains poorly defined. We prospectively monitored 22 consecutive patients who were referred to a regional poison center after a tricyclic antidepressant ingestion associated with a QRS interval of greater than 100 msec. An ECG was obtained every 6-8 h in all patients until the QRS interval was less than 100 msec. Among enrolled patients the mean maximal QRS interval was 145 msec. Ten patients (45.5%) developed seizures while 6 (27%) developed cardiac arrhythmias. The time from ingestion to the last ECG demonstrating a widened QRS interval was a median 12.3 h (range 1-70 h); the time from ingestion to the first ECG with a QRS less than 100 msec was a median 19.3 h (range 3-78 h). No patients developed seizures or life-threatening cardiac arrhythmias after the QRS interval was less than 100 msec. Ten patients received sodium bicarbonate while 12 did not. There were no significant differences in the duration of QRS widening between the two groups. These data suggest that the typical period of QRS prolongation after severe tricyclic antidepressant ingestion is 12-18 h but may be as long 3 d. The factors which determine the duration of QRS widening are unclear. Sodium bicarbonate may not reduce the total duration of QRS disturbances.


Cardiac monitoring during medical management of cocaine body packers. The cardiac risk of cocaine body packing was studied by means of continuous ECG monitoring in 13 cocaine body-packers during spontaneous elimination. The packages were all well manufactured bundles (McCarron type 2) not susceptible to spontaneous breakage. At the beginning of the Holter study, packages were still present in the bowel of twelve patients (range: 2 to 196). The mean time of Holter recording was 46 h (range 16 h to 75 h). Ten patients eliminated all their packages during the time of Holter recording. No ECG modifications were recorded for all of the patients in regard to usually admitted standard requirements of the American Heart Association. While initial cardiac frequencies were within the normal range, a significant decrease of pulse rates was associated with the elimination of bundles. We conclude that the McCarron type 2 cocaine body-packers are not in impending danger of cardiac acute events allowing a non-surgical management of these individuals.


A comparison of amrinone and glucagon therapy for cardiovascular depression associated with propranolol toxicity in a canine model. This study's objective is to evaluate the ability of glucagon and amrinone to reverse propranolol induced cardiovascular depression in a canine model, compared to a control of normal saline. The study design included 18 animals which received intravenous propranolol (10 mg/kg) resulting in significant depression in heart rate, cardiac output, mean arterial pressure, maximal ventricular dP/dt and stroke volume. Each canine was randomly assigned to one of three treatment groups; controls (normal saline only), glucagon (20 micrograms/kg bolus) and amrinone (4 mg/kg bolus). Cardiovascular parameters were monitored at 1, 6, 11, 21 and 31 min after treatment was rendered. Multiple comparison procedures at each time period controlled the overall alpha-level at .05. Compared to control animals, both amrinone and glucagon were effective in reversing propranolol-induced depression of dP/dtmax at 6 and 11 min for glucagon and 11 min for amrinone and cardiac output at 1, 6 and 11 min for glucagon and 1 min for amrinone. Amrinone and glucagon significantly increased stroke volume over control values at 1 min and tended to do so at the remaining time periods. The two days caused a similar degree of arteriolar vasodilation which was significantly greater than that seen in control animals at 1 and 6 min. Beta blocker induced bradycardia did not respond significantly to amrinone while glucagon induced a tachycardia which is unique to canines. It is concluded that in this canine model, amrinone appears to be an effective therapeutic alternative to glucagon for reversing depressed dP/dtmax, cardiac output and stoke volume induced by propranolol toxicity. Unlike glucagon, amrinone appears to lack positive chronotropic activity which may limit its clinical utility in the treatment of beta blocker overdose.


Rapid onset of seizures following aspiration of viscous lidocaine. A 2 year-old drank from a bottle of viscous lidocaine. Coughing and choking were prompt, and seizures began within 10 to 15 seconds. Intraosseous phenobarbital 40 mg/kg stopped seizures temporarily, 30 mg/kg more plus lorazepam 20 mg/kg were needed for complete control. Suctioning of the airway revealed viscous material compatible with the drug. Bilateral hilar pneumonia ensued rapidly. The syndrome of inappropriate antidiuretic hormone secretion occurred and was countered appropriately. Intubation, performed on admission, could not be discontinued. The adult respiratory distress syndrome, characterized by a typical diffuse X-ray pattern and poor oxygenation, developed. Bilateral pneumothoraces complicated care. The patient required 14 days of extracorporeal membrane oxygenation before recovery. A lidocaine level was obtained at 4 h post-ingestion and was 0.5 micrograms/mL (2 mumol/L). The rapid onset of seizures suggests that the drug was absorbed from the pulmonary bed. This possibility is supported by the finding of viscous-lidocaine-like material in the trachea, the rapid development of aspiration pneumonia, and the development of adult respiratory distress syndrome, which has been observed in adults when lidocaine was used in the trachea for procedures.


Mercury clearance from human plasma during in vitro dialysis: screening systems for chelating agents. Two in vitro systems were evaluated as potential screening methods for determining the most effective chelating agents for use in patients with inorganic mercury poisoning undergoing hemodialysis. The first system consisted of an in vitro clinical hemodialysis unit and the second system consisted of an in vitro equilibrium dialysis procedure. Both systems utilized pooled human plasma. Ten chelating agents were evaluated in these systems to determine their ability to enhance mercury clearance from human plasma. In the absence of chelators, plasma clearance of mercury was negligible. Of the chelating agents tested, 2,3-dimercaptopropanolol, which enhances biliary and fecal excretion of mercury poisoning, and dithiothreitol did not enhance mercury clearance at 90 min in the hemodialysis system. N-acetylcysteine appeared to be the most effective chelating agent of those tested in the hemodialysis system. N-acetylcysteine produced a 73% decrease in perfusate mercury concentration at 90 min. The results of equilibrium dialysis mirrored those of the hemodialysis in that N-acetylcysteine significantly enhanced mercury transfer across the dialysis membrane into the dialysate whereas dithiothreitol did not. If in vivo experiments confirm the present findings, then in vitro dialysis from pooled human plasma either using a standard clinical hemodialyzer or equilibrium dialysis system will be useful screening tools. Our results suggest that equilibrium dialysis may be a convenient and cost effective method to screen potential chelating agents as complementary to hemodialysis for the treatment of inorganic mercury poisoning.


Rhabdomyolysis and acute renal failure following carbon monoxide poisoning: two case reports with muscle histopathology and enzyme activities. Two patients with carbon monoxide poisoning are presented, both of whom suffered rhabdomyolysis complicated by acute renal failure. One patient, an attempted suicide, developed a compartment syndrome of the right thigh that required fasciotomy and recovered after a period of hemofiltration and hemodialysis. Muscle biopsy appearances were consistent with partial muscle infarction. The other patient, rescued from a smoke filled room, exhibited raised creatine kinase but no evidence of muscle swelling. He developed anuric renal failure and adult respiratory distress syndrome and died despite maximum intensive care. Muscle biopsy showed early evidence of muscle necrosis. In both cases there was a marked reduction of enzyme activities in the muscle biopsy consistent with metabolic derangement. Although there was a clinical compartment syndrome in the first case, there was no muscle swelling at the time of biopsy or subsequently in the second case. A direct toxic effect of carbon monoxide may thus have been an important mechanism contributing to the muscle necrosis in the second case, although local ischemia may have been an exacerbating factor in the first case.


A case of barbiturate poisoning with a readily-accessible laboratory reagent. We report a patient with barbiturate intoxication due to surreptitious ingestion of barbital buffer from a clinical laboratory. Although detected in the urine toxicology screening test using an immunologic technique, this agent was not recognized in the more specific serum analysis done by gas-liquid chromatography. Barbital buffer is an effective long-acting sedative-hypnotic and is widely available from the laboratory shelf. It may not be reported by very specific analytical methods.


Use of the scan statistic to detect temporal clustering of poisonings. The purpose of this study is to explore the use of the scan test to detect temporal clustering of poison control center data. We applied the scan test to a computerized data set consisting of all cases of carbon monoxide poisoning reported to our Poison Control Center in 1988. Using a time window of three days, the scan test identified three statistically significant temporal clusters. A review of case and climatologic data revealed that two of the clusters were due to family outbreaks and one was due to a sudden cold spell. We conclude that the scan test is a potentially useful surveillance tool which can be easily applied to poison control center data.


Periodicity of presentations of drugs of abuse and overdose in an emergency department. In order to determine whether temporal factors impact on drugs of abuse and overdose presentations to an urban emergency department, we studied the records of 630 consecutive drug overdose presentations over a period from October 1987 to March 1990. Particular note was made of the time of day of presentation along with the nature of the drug(s) ingested. A significant curve (p less than 0.0005) was obtained for a 24 h period with a peak time of presentation being 6:32 pm (95% confidence interval of 1 h 54 min). Significant periodic rhythms were noted for cocaine, opiates, alcohol, analgesics, marijuana, and benzodiazepines. A 4.8 h periodic rhythm was demonstrated for cocaine, marijuana and alcohol-in-combination. We conclude that the emergency department should be most prepared to treat the drug overdose patient in the early evening and emergency department staffing should reflect this peak in demand.


Endopyelotomy: comparison of ureteroscopic retrograde and antegrade percutaneous techniques. To date 2 approaches have been developed for performing endopyelotomy, that is the antegrade and retrograde approaches. Experience with antegrade transnephrostomy endopyelotomy is quite large and the results have been excellent. However, the need for percutaneous nephrostomy and prolonged hospitalization have been 2 drawbacks to this approach. In contrast, experience with retrograde transureteral endopyelotomy is scant. However, a ureteroscopic approach is attractive from the standpoint of eliminating the need for a large nephrostomy tube and because of the possibility of performing this procedure on an outpatient basis or during a short hospital stay. We report our experience with antegrade and retrograde endopyelotomy in 41 patients. The hospital stay (3.4 versus 4.0 days), nephrostomy tube size (8F to 10F versus 20F to 22F) and nephrostomy tube duration (2.9 versus 3.8 days) were all less with the retrograde approach. The initial success rate was similar between the 2 methods: 79% (retrograde) versus 78% (antegrade). However, the analgesic requirements (5.3 versus 3.5 doses) and the occurrence of significant complications (that is late ureteral stricture in 20%) were greater with the ureteroscopic approach. With the methods currently available, we believe that antegrade endopyelotomy is the preferred approach for endopyelotomy.


Treatment of osseous metastases secondary to renal cell carcinoma. Osseous metastases occur in 25 to 50% of the patients with metastatic renal cell carcinoma. We retrospectively reviewed our experience with 14 patients who underwent 20 palliative orthopedic procedures for treatment of bony metastases secondary to renal cell carcinoma. Of the patients 6 presented after nephrectomy (group 1) and 8 presented initially with osseous metastases (group 2). Only 1 of the group 2 patients underwent adjunctive nephrectomy. Overall, 5 of 14 patients (36%) presented with fracture and 9 of 14 (64%) presented with impending fracture. Five patients required multiple procedures. A total of 7 lesions had been previously treated with external radiation. Of the 20 orthopedic procedures 17 (85%) resulted in significant functional improvement and 18 (90%) resulted in significant relief of pain. There were 4 major complications in the series, including 2 culminating in amputation. Average survival after palliative orthopedic procedures was 22 months (range 7 to 64 months) with a 1-year survival rate of 58%. Orthopedic palliation of osseous metastases from renal cell carcinoma is effective, and our experience indicates that the majority of renal cancer patients with bone metastases will survive long enough to benefit from palliative orthopedic procedures.


A community study of bladder cancer screening by the detection of occult urinary bleeding. A possible method of improving the prognosis of bladder cancer may be the widespread introduction of screening. We investigated the ability of urine dipsticks to detect early bladder cancer in a group of men in the community. In 2,356 men more than 60 years old the urine was tested with a dipstick for the presence of blood. The subjects then tested their own urine on 10 subsequent occasions. Of the men 474 (20%) had dipstick hematuria and 319 agreed to undergo urological investigation. An asymptomatic bladder tumor was found in 17 men, associated in 10 with abnormal urine cytological findings. Urine dipsticks for the detection of red cells provided an inexpensive, simple and acceptable screening test for bladder cancer. However, introduction of generalized population screening by this method would produce large numbers requiring investigation. Combining urine cytology with dipstick hematuria results may provide a realistic alternative and further evaluation of the effectiveness of screening for bladder cancer in the community is required.


Interleukin-6 activity in urine and serum in patients with bladder carcinoma. To investigate the correlation between interleukin-6 and urothelial neoplasms, interleukin-6 activities in blood and urine samples of patients with bladder carcinoma were measured with a proliferation assay using an interleukin-6 dependent murine hybridoma clone, MH60.BSF2. A total of 43 patients and 15 normal volunteers were entered into this study. All of the patients were examined preoperatively and 26 were reexamined more than 6 days postoperatively to eliminate the effect of surgical injury on interleukin-6 secretion. The interleukin-6 titers in urine and serum increased in accordance with the progression of the tumor stage, and tumor removal induced a remarkable decrease in the titer of urinary interleukin-6. Although the interleukin-6-producing site has not been elucidated yet, our study suggests that interleukin-6 activity in bladder carcinoma patients may reflect the immunoreaction against the tumor in local urothelium.


Intravesical lidocaine: topical anesthesia for bladder mucosal biopsies. The intravesical instillation of lidocaine solution has been used as a topical form of anesthesia for bladder biopsies. We performed 63 ambulatory procedures in which multiple cold-cup biopsies were obtained during cystoscopy. There was no need for electrocautery. All patients tolerated the procedure well and were discharged from the office immediately thereafter. There were no changes in heart rate or blood pressure during the procedures. Serum concentrations of lidocaine were measured in 10 patients at 5, 10 and 30 minutes, and they were clinically insignificant. This simple office procedure can be used for the diagnosis and followup of patients with carcinoma in situ of the bladder.


Management of stage T1 superficial bladder cancer with intravesical bacillus Calmette-Guerin therapy. We reviewed our results with 86 patients who had a pretreatment history of a stage T1 tumor. All patients were treated with transurethral resection of all visible tumor followed by intravesical bacillus Calmette-Guerin (BCG) and many patients received additional maintenance therapy. Local recurrences were treated with repeat transurethral resection followed by additional BCG. Median followup was 59 months, with a range of 9 to 149 months. Overall, 78 of 86 patients (91%) were free of tumor recurrence with BCG therapy. This result includes 69% of the patients who responded to the initial transurethral resection and intravesical BCG, and 22% who ceased having tumors after additional treatments for local recurrences. Only 7% of the patients had progression to stage T2 tumors after BCG therapy. Grade of the stage T1 tumor, concurrent carcinoma in situ and tumor multiplicity before BCG did not predict tumor recurrence or progression. Of patients with recurrences after BCG therapy, those with stage T1 tumors had a higher rate of progression compared to those with stage Ta tumors but the difference was not statistically significant (p = 0.086). These data clearly support the efficacy of transurethral resection plus intravesical BCG immunotherapy in the treatment of stage T1 tumors as well as in the prevention of disease progression.


Distribution of 486P 3/12 antigen, ABO(H) blood group antigen and T antigen in cystectomy specimens from patients with stage T2 transitional cell carcinoma of the bladder. We used monoclonal antibody 486P 3/12, anti-ABO(H) antibodies and anti-T antigen lectins to detect malignant transformation in cystectomy specimens from patients with stage T2 transitional cell carcinoma of the bladder. We used an immunoperoxidase technique to do extensive chessboard-like mapping studies in 6 cystectomy bladders with stage T2 lesions and 1 normal bladder from a multiorgan donor as control to characterize antigen expression. Increased 486P 3/12 antigen expression, decreased ABO(H) expression and T antigen deletion were detectable not only in the tumor area but also in tumor-surrounding areas classified as benign. We believe that cells with abnormal antigen expression are a source of tumor recurrence and can be identified with our method of quantitative immunocytology.


Late decompensation of neobladder.

Late decompensation of neobladder. We report on 6 patients in whom we constructed detubularized ileocolonic neobladders in conjunction with cystectomy to treat invasive transitional cell carcinoma of the bladder. The patients had delayed complete or partial decompensation of the neobladder after an initial interval of normal voiding. Two patients experienced complete decompensation with inability to empty in the absence of urodynamic, cystoscopic or radiographic evidence of outlet obstruction. The other 4 patients had greater than 400 cc residual urine without evidence of outlet obstruction. The mean interval to decompensation after the initial period of normal voiding was 12.8 months (range 4 to 21). All 6 patients had a reservoir capacity of greater than 800 cc. We also constructed neobladders in 3 other patients for similar indications. These 3 patients have a neobladder capacity of less than 800 cc and all are voiding to completion with followup of 19 to 32 months. We hypothesize that neobladder decompensation is due either to creation of an excessively large pouch alone or in combination with a poor Valsalva ability. Until we know the neobladder capacity required for continence that will simultaneously allow for complete emptying, all patients should be advised of the possible need for intermittent self-catheterization. Urological followup should include monitoring of post-void residual urine volume to detect failure to empty early before irreversible decompensation occurs.


Reproducibility in monitoring nocturnal penile tumescence and rigidity. The evaluation of sexual dysfunction has improved with the advent of methods to test nocturnal penile tumescence that also monitor penile rigidity. Earlier techniques may not have recorded abnormal rigidity despite normal tumescence. To test the reproducibility of penile tumescence and rigidity, the results of initial and repeat tracings performed a mean of 39 days apart were compared in 17 patients (median age 62 years). Three nocturnal patterns were identified. 1) Among the 17 patients the initial penile tumescence and rigidity pattern was reproduced on repeat testing in 15. 2) Patterns that were not reproduced in the other 2 patients were explained by the ingestion of alcohol or because of a febrile illness during the period monitored. 3) Nocturnal penile rigidity and tumescence tracings from these patients reproduced previous patterns. Monitoring of nocturnal penile tumescence and rigidity is a useful and reproducible tool in the evaluation of male sexual dysfunction.


Preliminary report: penile vein occlusion therapy: selection criteria and methods used for the transcatheter treatment of impotence caused by venous-sinusoidal incompetence. Penile vein occlusion therapy is a fluoroscopic guided technique developed for treating venous-sinusoidal incompetence in patients with erectile dysfunction. We report our experience with 22 patients who have been followed for greater than 1 year. Catheterization of the veins draining the penis was technically possible in 20 of 22 patients (91%). Of these 20 patients 5 (25%) were cured and 9 (45%) had significantly improved erectile function. All 5 patients (100%) with venous-sinusoidal incompetence plus normal cavernous arterial flow, no glans or corpus spongiosal shunts, and bilateral complete coil occlusion of the crural and common crural veins were cured. No deterioration of function was noted at 1 and 2 years. Patient selection and bilateral occlusion of the penile veins are essential to achieve successful penile vein occlusion therapy.


A screening study of prostate cancer in high risk families. In a study of the familial risk of prostate cancer 17 sets of 2 brothers with prostate cancer were identified. A total of 34 first-degree relatives of these probands (sons and brothers, 55 to 80 years old) underwent an intensive screening examination that included prostate specific antigen, digital rectal examination, transrectal ultrasound and systematic as well as clinically directed core needle biopsies. Previously unsuspected and clinically relevant cancers were found in 8 men (24%), compared to the approximately 1 expected (p less than 0.01). Of these cancers 2 were detected by the systematic biopsies. This study emphasizes the importance of thorough screening in first-degree relatives of prostate cancer patients.


Deoxyribonucleic acid cytometry and histological findings before and after 125iodine implantation of primary prostate cancer. Deoxyribonucleic acid (DNA) flow cytometry and light microscopy were performed in pre-radiotherapy and post-radiotherapy biopsies obtained from the primary tumor in 31 patients with prostate cancer. Radiotherapy was applied by means of transperineal 125iodine (125I) implantation. Of the patients 21 had pretreatment biopsies and in 19 of these biopsies also were performed 1 and/or 1 1/2 years after the 125I implantation. Posttreatment biopsies were available for DNA flow cytometry in 12 additional patients without pretreatment DNA flow cytometry assessment. Of the 21 pretreatment biopsies 7 were diploid, 6 tetraploid and 8 aneuploid. All 31 posttreatment biopsies were either tetraploid (21) or aneuploid (10). All 6 pretreatment diploid tumors became tetraploid after radiotherapy. At 1 and/or 1 1/2 years after 125I implantation residual tumors were found in 28 of 31 prostatic glands. The high frequency of nondiploid DNA stemlines 1 or more years after 125I implantation and the high rate of residual tumor leave some doubt about the radiocurability of prostate cancer by the chosen radiotherapy technique.


Moni's window operation: a new surgical technique to create a sperm reservoir in congenital vasal agenesis. A new surgical technique to create a sperm reservoir in bilateral congenital vasal agenesis is described. The technique is simple to perform and sperm recovery is easy. Of the 4 cases treated with this technique between 1989 and 1990 pregnancy has resulted in 1 (25%). In all 4 cases (100%) motile sperm could be aspirated from the spermatocele created.


The Raz bladder neck suspension: results in 206 patients. We reviewed the charts of 206 patients who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 15 months. Overall, our results demonstrated a successful outcome (cure or rare stress urinary incontinence not requiring protection) in 186 of 206 patients (90.3%). Cox multivariant analysis showed that the only predictor of outcome was the degree of preoperative stress urinary incontinence (mild, moderate or severe, p less than 0.001). When the results were stratified by degree of incontinence preoperatively 20 of 21 patients (95%) with mild, 151 of 162 (93%) with moderate and 15 of 23 (65%) with severe incontinence had a successful outcome. No statistical correlation was found with patient age, number of prior operations, hysterectomy, urgency incontinence or menopause. For the patients who failed, the mean interval to recurrent stress urinary incontinence was 5 months. Significant urgency incontinence was present preoperatively in 58 of the 204 patients (29%), with postoperative resolution in 66%. De novo urgency incontinence occurred in 7.5%. Complications included secondary prolapse (6% of the patients), prolonged retention (2.5%) and suprapubic pain (3%). In summary, the Raz bladder neck suspension for correction of stress urinary incontinence has been successful in more than 90% of this patient population.


The Cantwell-Ransley technique for repair of epispadias. A total of 26 boys with bladder exstrophy (20) and epispadias (6) underwent initial urethral reconstruction between 1988 and 1991 using the Cantwell-Ransley technique. Penile reconstruction included wide mobilization of the urethral plate from the underlying corpora based on a mesentery from the ventral penoscrotal skin, corporeal lengthening by dividing the suspensory ligaments and attachments to the undersurface of the pubis, urethral and glandular tubularization, chordee correction by medial incision of the corpora with anastomosis dorsal to the urethra and penile skin coverage. All exstrophy patients had adequate phallic length, with 13 having an intact urethral plate and 13 having had prior paraexstrophy skin flap interposition. Postoperatively, repairs were intubated with silicone stents for 10 days. Two urethrocutaneous fistulas developed, 1 of which closed spontaneously. One patient had a small degree of penile skin loss that did not affect the neourethra. All patients currently have a cosmetically acceptable penis and all but 1 (previously diverted) are voiding per urethram. The neourethra in such patients allows for easier access for endoscopy and the ventral position aids in maintaining correction of the dorsal chordee. The low complication rate of this procedure coupled with the better anatomical configuration of the neourethra makes it useful for urethral and penile reconstruction in the exstrophy and epispadias patient.


Circumcision in hemophilia: the use of fibrin glue for local hemostasis. Circumcision can be fatal in hemophilia patients unless they are treated with the missing coagulation factor. We describe 10 severe hemophilia patients in whom circumcision was performed with local fibrin glue instead of infusion of factor concentrate. Of the 10 patients 3 had postoperative bleeding and only 2 of them required infusion of factor VIII concentrate. Fibrin glue is a useful treatment modality for circumcision in patients with bleeding diathesis, and it is safer and cheaper than the infusion of factor concentrate.


Giant ureteral stone.

Giant ureteral stone. A 58-year-old man presented with left flank pain and a high grade fever. Investigations revealed left pyonephrosis with a left renal stone and a giant left ureteral stone. Nephroureterectomy was performed. The ureteral stone measured 13 cm. long and weighed 90 gm.


Ureteroarterial fistula: a case report.

Ureteroarterial fistula: a case report. Ureteroarterial fistulas are rare, with less than 20 well documented cases reported. We report a case of a fistula between the left external iliac artery and the left ureter in a patient who underwent a previous operation for bladder cancer. The diagnostic and therapeutic approaches in these rare but high risk patients are discussed.


Levator hernia.

Levator hernia. We report a case of a hernia through the pelvic floor presenting as a paravaginal mass following a transvaginal fascial sling procedure. At exploration herniation through a defect in the pelvic floor was identified and repaired. To our knowledge this is the first reported case of levator hernia. The clinical and radiological findings and anatomy are presented, and treatment recommendations and etiology are discussed.


Clozapine-induced priapism.

Clozapine-induced priapism. Priapism may be a side effect of certain medications. We present a case of priapism associated with the nonphenothiazine antipsychotic drug clozapine. The possible mechanism for the drug-induced priapism is discussed.


A new therapeutic concept for long-lasting iatrogenic priapism: a case report. In a therapeutic attempt on an 18-year-old patient with iatrogenic priapism lasting for more than 2 weeks after internal urethrotomy, intracavernous lysis was commenced with 80,000 IU streptokinase per hour. Following a dosage of 300,000 IU streptokinase the lysis was stopped because of severe bleeding from the urethrotomy scar. At 4 weeks after the patient was discharged from the hospital he reported normal erections and intercourse, while single potential analysis of cavernous electrical activity and ultrasound returned to normal. Provided there are no contraindications, intracavernous lysis seems to be an effective treatment for long-lasting priapism induced by intracavernous thrombosis.


Primary carcinoid tumor of the testicle: a case report and management schema. A case of primary testicular carcinoid is presented in which extensive testing for peptide hormones was done. None was found suggesting that such tumors may be nonfunctional. A systematic approach to the evaluation and treatment of testicular carcinoid is presented.


Sertoli-Leydig cell testicular tumor: case report and review of sex cord/gonadal stromal tumor histogenesis. We describe a case of well differentiated Sertoli-Leydig cell tumor in a testicle. Previously, this tumor has only been illustrated histologically. The existence of a male homologue to the female arrhenoblastoma containing Sertoli and Leydig cells again supports the current hypothesis of gonadal development, and the common steps found in the male and female pathways.


Crossed ectopia of left vas deferens, leaving ipsilateral seminal vesicle in normal position. A 19-year-old man with crossed ectopia of the vas deferens was investigated with special reference to right hydronephrosis and renal dysfunction. There was no vesicoureteral reflux. The left kidney was hypoplastic or dysplastic and the left ureter emptied into the left seminal vesicle. The right malrotated hydronephrotic kidney was in the lumbar position. The right lower ureter communicated with either the right seminal vesicle or the ampullary portion of the left vas deferens and drained into the bladder at the normal site. The end of the right vas deferens was dilated. The left vas deferens crossed the midline and opened into the right seminal vesicle, leaving the ipsilateral seminal vesicle in the normal position. A search of the literature failed to reveal any similar anomalies.


Cryptococcal prostatic abscess associated with the acquired immunodeficiency syndrome. A case of cryptococcal prostatic abscess in a 28-year old man with the acquired immunodeficiency syndrome is presented. This is a unique presentation of a cryptococcal prostatic infection and of a prostatic abscess. The diagnosis and management are discussed, and the literature is reviewed.


The history of research training and career awards in urological science supported in the National Institute of Diabetes and Digestive and Kidney Diseases. Urology research and training grants were placed into a separate research program in 1979. Research emphasis and the context of training programs have changed from a focus on urolithiasis in the 1970s to a broader range of urological disorders in the 1980s. From 1977 to 1990, 49 applications were submitted by 47 applicants for research training/career development support and 39% of the applications were successful. From 1977 to 1987 medical doctors applying for research/career training had a 75% success rate in subsequent National Institutes of Health research grant applications, and basic scientists had a 67% success rate. Of the 33 former trainees supported on institutional training grants during the last 14 years 76% were medical doctors and 24% were basic scientists. From 1977 to 1987, no former medical doctors or basic scientists from institutional training grants have a record of applying to the National Institutes of Health for research grant support. The urology community needs to capitalize on the available opportunities to expand the training programs to increase the number of physician and urological research scientists.


Bacillus Calmette-Guerin abrogates in vitro invasion and motility of human bladder tumor cells via fibronectin interaction. Intravesical bacillus Calmette-Guerin (BCG) has been shown to be an effective treatment for superficial transitional cell carcinoma of the bladder (TCC). The mechanisms by which BCG limits tumor cell activity have thus far been unclear. We investigated the interaction between BCG and invasive human TCC cell line EJ in an in vitro invasion assay. We observed that BCG inhibited the invasion of EJ cells through an artificial basement membrane. In terms of the steps involved in tumor cell invasion, i.e. attachment, proteolysis, and motility, BCG was found to limit tumor cell motility. Attachment and proliferation of tumor cells were not affected by BCG. The effects of BCG on tumor cell migration were mediated by fibronectin (FN), a basement membrane glycoprotein component. Abrogation of BCG-FN-tumor cell interactions with anti-FN antibodies eliminated the ability of BCG to block tumor cell invasion. Fibronectin appears to link BCG and tumor cells via independent FN binding receptors to separate domains of the FN molecule. The molecular mechanism by which BCG may limit tumor cell motility may be its ability to protect against the formation of specific FN sequences as a result of protease cathepsin B digestion. A 31 kD and 27 kD FN band were absent from purified or tumor cell associated cathepsin B digestion when incubated in the presence of BCG, but present in the absence of BCG. Furthermore when purified from SDS polyacrylamide gel electrophoresis, the fragments were shown to have motility stimulating activity for the invasive EJ cells. These findings suggest that BCG functions as a potent inhibitor of tumor cell invasion. We conclude that BCG-fibronectin-tumor cell interactions may have a direct influence on the invasive mechanisms, such as motility, of tumor cells.


Suramin inhibits growth factor binding and proliferation by urothelial carcinoma cell cultures. Suramin is a polyanionic compound recently noted to inhibit growth factor action and proliferation of several types of neoplastic cells in vitro. Data from clinical trials show antineoplastic activity against some prostatic and adrenal cortical carcinomas. Suramin is excreted unmetabolized into the urine suggesting possible application in treatment of urothelial carcinoma and prompting us to examine the drug's effect on growth factor binding and cell proliferation by two urothelial carcinoma cell lines. Half-maximal inhibition of 125I-epidermal growth factor (EGF) binding to T24 and HT1376 cells was produced by suramin concentration of approximately 300 and 100 microM, respectively. The corresponding value for 125I-insulin-like growth factor 1 (IGF1) binding was 60 microM for both cell lines. Inhibition of T24 and HT1376 growth was virtually complete at suramin concentrations in the range achievable clinically.


The influence of ovariectomy and estradiol replacement on urinary bladder function in rats. Female Fischer 344 rats were ovariectomized or sham operated and treated with oil or estradiol cypionate (100 mg./100 gm./month) for two or four months. Rats were then placed in metabolism cages for measurement of micturition characteristics, and bladders were removed for bladder strip studies. Ovariectomy had no effects on micturition characteristics. However, estradiol treatment of ovariectomized rats caused significant increases in water consumption and urine excretion, and in mean and maximal micturition volumes compared to both ovariectomized and sham-operated rats. These effects were more pronounced at four months. Estradiol treatment also caused significant increases in bladder body mass, while ovariectomy was without effect. Two months after ovariectomy and/or estradiol treatment, there were no differences in contractile responses of bladder body or base strips to contractile agents when compared to shams. However, after four months, ovariectomy caused significant decreases in contractile responsiveness to nerve stimulation. ATP, carbachol, and KCl compared to sham-operated rats. Estradiol treatment caused increased responsiveness to nerve stimulation, ATP, carbachol, and KCl compared to ovariectomized rats, and to carbachol compared to sham operated rats. Possible causes for the effects of ovariectomy on bladder contractility include decreases in calcium influx. Although estradiol reversed the effects of ovariectomy on bladder function, in addition we observed some indirect effects which were probably the result of estradiol-induced polyuria and increases in bladder mass.


Intravesical electrical stimulation--an experimental analysis of the mechanism of action. The working mechanism of intravesical electrical stimulation (IVES) was evaluated in alpha-chloralose anaesthetized cats and rats. IVES involved a direct activation of bladder mechanoreceptor afferents of the A delta type and as a consequence a central reflex activation of the detrusor. The detrusor response was abolished by bilateral transection of the S1-S3 dorsal roots and by intravesical instillation of lidocaine. The optimal stimulation frequency was 20 Hz. The results offer a theoretical rationale for the use of IVES as treatment of weak detrusor contractility in man.


Response of bladder, urethral and intracavernous pressure to ventral lumbosacral root stimulation in Sprague-Dawley and Wistar rats. Six Sprague-Dawley and six Wistar rats were used for electrostimulation of the L5 to S2 ventral roots. Landmarks for identification of the roots were developed; bladder, urethral and intracavernous pressures were recorded; and tail and leg movements were checked. Urethral sphincter contraction was elicited by stimulation of the L5-L6 ventral roots, while bladder contraction and penile erection were mediated by the L6-S1 ventral roots. The best sphincteric response and intracavernous pressure rise were obtained by stimulation of the L6 ventral root, and the highest bladder pressures by stimulation of the S1 ventral root. Stimulation of the S1-S2 ventral roots provoked ipsilateral tail movement; of L6, tail movement, hindleg muscle twitch, and slight toe spread; and of L5, hindleg stretch and plantar flexion. No significant differences were found between the two strains of rats, although a higher bladder pressure was recorded during stimulation of the L6 ventral root in Sprague-Dawley rats, which might be explained by a small caudal shift of the sacral parasympathetic nucleus in the Wistar strain.


Urinary bladder function in rats with hereditary diabetes insipidus; a cystometrical and in vitro evaluation. Bladder function was investigated in female rats with hereditary diabetes insipidus (DI) and in healthy controls, in vivo by means of recordings of micturition pattern and cystometry, and in vitro in organ bath experiments. Rats with DI exhibited bladder hypertrophy, the weight of the bladder in these rats being two times that of controls. Recordings of micturition pattern showed that DI-rats had an increased 24 hour diuresis and micturition volume, and decreased micturition interval in comparison with controls. Cystometry recordings revealed increased bladder capacity and micturition volume in DI-rats. However, in these rats basal bladder pressure and threshold pressure were lower than in controls. No significant changes in micturition pressure or bladder compliance were observed, and none of the rats had residual urine. In organ bath studies, a lower maximal response to electrical field stimulation was obtained in bladder strips from DI-rats, than in the control strips, when expressed relative to the response elicited by K(+)-solution. When activated by field stimulation, the DI-bladder strips and the control strips had similar sensitivity to muscarinic receptor blockade with scopolamine at all stimulation frequencies. The sensitivity to carbachol was similar in the two groups. The results suggest that the increased functional demands of DI on the detrusor do not result in major changes pre- or postjunctionally. Further, several of the previously reported urinary bladder changes observed in rats with diabetes mellitus (DM) are similar to those now reported in rats with DI, emphasizing the importance of an increased diuresis per se for the development of alterations in bladder function. However, in contrast to the findings in DM rats, the sensitivity to electrical stimulation of nerves during blockade of muscarinic receptors was similar in DI-rats and their controls. This supports our previous suggestion that the increased resistance to muscarinic receptor blockade of the bladder in DM-rats at low stimulation frequencies is induced by the disease (diabetes mellitus) as such and not by the increased diuresis.


Studies on experimental bladder outlet obstruction in the cat: long-term functional effects. Experimental bladder outlet obstruction in cats induces a significant increase in the in vivo leakage pressure. The effects of obstruction on the detrusor function were analyzed, using control, 3, 6 and 12 month obstructed cats. The in vivo leakage pressures were substantially increased in all obstructed groups. From a previous study on the short-term effects of obstruction in the cat; although there was an immediate increase in pressure, there were no significant differences between control bladders and two week obstructed bladders in: bladder weight, peak pressure response to field stimulation and bethanechol, and emptying of the in vitro whole bladder model. In this current study, although there was no direct relationship between duration of obstruction and severity of the impaired pharmacological response of the isolated whole bladder, there was a direct relationship between the magnitude of the increase in bladder weight, leakage pressure, and impaired functional response of the in vitro whole bladder. In this regard the cats were separated into four groups: controls and shams (average bladder weight 2.95 gm.), obstructed group 1 with bladder weights less than 6.0 gm. obstructed group 2 with bladder weights between 6 and 10 gm., and obstructed group 3 with bladder weights greater than 10 gm. The results can be summarized as follows: A) In vivo leakage pressures were significantly increased in all obstructed groups, and progressively higher in proportion to the bladder weights. B) Bladder capacity significantly increased in all, being greatest in obstructed group 3. C) The magnitude of the response to field stimulation of obstructed groups 1 and 2 were significantly greater than the response of control bladders at virtually all frequencies. The frequency response curve of obstructed group 3 was similar to control. D) The ability of the bladder to empty in response to field stimulation was significantly reduced in all obstructed groups. The magnitude of the decrease was proportional to the increase in bladder weight. E) There were no differences between control and obstructed bladders in the pressure response to bethanechol or KCl; the ability of both bethanechol and KCl to empty the bladder was reduced in the obstructed groups. In general, the presence of bladder enlargement was accompanied by significant alterations in the ability of the in vitro bladder to empty in response to field stimulation, bethanechol, and KCl.(ABSTRACT TRUNCATED AT 400 WORDS)


Correlation of contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction--an in vitro whole bladder study. The present study investigated the correlation between contractile function and passive properties of rabbit urinary bladder subjected to outlet obstruction. Mild bladder outlet obstruction was induced by placing silicone rings (7 mm. diameter) around the bladder necks of male New Zealand rabbits. The animals were sacrificed after 2 weeks of obstruction. Contractile function was evaluated by measuring the response of the in vitro whole bladder to 500 microM bethanechol administration. Passive properties was assessed by performing in vitro cystometry and stress-relaxation techniques utilizing six different infusion rates. When the intravesical pressure reached 30 cm. H2O the infusion was stopped, allowing the bladder to relax and intravesical pressure to drop to a steady state level. The results can be summarized as follows: 1) Although the intravesical pressure response to bethanechol was about the same in control (13.3 cm. H2O) and obstructed (12.4 cm. H2O) bladder, the obstructed bladder emptied significantly less than control (20.4 vs 89.3%); 2) the results of the passive properties study showed that bladder stiffness was significantly higher at all infusion rates in the obstructed bladder, 3) the obstructed bladder showed significantly less relaxation after rapid stretching of the whole bladder by high speed fluid infusion; 4) histological examination of obstructed bladders revealed marked fibrous thickening of the serosal layer, interstitial fibrosis of the muscle layers, and hypertrophic and/or degenerative changes of the muscle fibers. In summary, 2 weeks after mild outlet obstruction of the urinary bladder the emptying ability, but not pressure generation, was reduced along with increased bladder stiffness and diminished capacity for stress-relaxation. Interstitial fibrosis and changing the properties of the smooth muscle cells might be involved in the functional impairment and deranged viscoelasticity of the urinary bladder after outlet obstruction.


Electrical stimulation induced sphincter fatigue during voiding. The stimulation of the sacral nerves to induce voiding is often associated with simultaneous contraction of the striated sphincter rendering micturition difficult or impossible. Rhizotomy of some sacral nerves was found to be necessary to facilitate voiding with stimulation. An main objective in the present experiment was to evaluate the feasibility of achieving the same result using electrical stimulation to fatigue the sphincter. In order to compare the effect of rhizotomy and fatiguing striated sphincter, the bladder outlet resistance was measured. S2 nerves were stimulated with 3 V, 35 Hz and 100 microseconds duration for 5 to 10 sec. Following S2 nerves stimulation the pudendal nerve was stimulated till we obtained sphincteric fatigue. The optimal parameter to induce sphincter fatigue were 3 V, 100-500 Hz and 100 microseconds. for 15-20 sec. The combined pressure-flow studies showed that fatiguing the sphincter via the pudendal nerve using these parameters was as good as cutting it in achieving bladder emptying with stimulation.


Serologic survey for brucellosis in feral swine, wild ruminants, and black bear of California, 1977 to 1989. A retrospective analysis of brucellosis serologic testing results in eight wildlife species in California from 1977 to 1989 was done. Samples were collected from 5,398 live-captured or hunter-killed animals and tested by combinations of up to six serologic tests for antibodies to Brucella spp. Twenty-three of 611 (3.8%) feral swine (Sus scrofa), one of 180 (0.6%) black bear (Ursus americanus), one of 355 (0.3%) California mule deer (Odocoileus hemionus californicus), and one of 1,613 (0.06%) blacktail deer (Odocoileus hemionus columbianus) samples were considered reactors. Suspect serologic reactions occurred in three of 619 (0.5%) desert bighorn sheep (Ovis canadensis nelsoni) and one of 355 (0.3%) California mule deer samples. Brucellosis is not considered an important wildlife health problem in California except in feral swine.


Borrelia burgdorferi infection in white-footed mice (Peromyscus leucopus) in hemlock (Tsuga canadensis) habitat in western Pennsylvania. White-footed mice (Peromyscus leucopus) were captured and their tissues sampled from 27 sites in seven counties of western Pennsylvania in 1990 for isolation and identification of Borrelia burgdorferi. Two hundred sixty mice were captured from which there were 27 isolations. Significantly more mice were captured and significantly more isolations made from hemlock (Tsuga canadensis) habitat than from deciduous species forest. Hemlock habitat is sparse and focal but evidently increases winter survival of mice, and thus possibly results in increased infection rates in mice.


Epidemiology of raccoon rabies in Virginia, 1984 to 1989. Geographical and temporal trends in reports of rabid raccoons (Procyon lotor) in Virginia were summarized for 1984 to 1989; 3,256 raccoons were submitted for rabies testing, of which 1,053 (32.3%) had rabies. Both the absolute number of rabid raccoons and the percent of rabid raccoons (number rabid divided by number submitted) were examined for seasonal and yearly trends. Geographically, the epidemic moved eastward and southward in the state. The seasonal trend showed bimodal peaks in late winter and early fall and a seasonal low in summer. The percent of rabies positive raccoons peaked 1 mo earlier than the absolute number of rabies positive raccoons. The peak in the number of rabies positive raccoons occurred in 1987, while the percent of rabies positive raccoons peaked in 1986. These trends were used to recommend timing and placement of oral vaccine as one strategy to control raccoon rabies in wildlife.


Demonstration of rabies virus-specific antibody in the sera of free-ranging Iowa raccoons (Procyon lotor). Between 1984 and 1988, a study was conducted to evaluate the frequency of rabies virus neutralizing antibodies in raccoons (Procyon lotor) in two counties in Iowa. Nine hundred eighty five raccoons were trapped and tagged in Guthrie and Cerro Gordo counties during the spring, summer and fall of each year. Sex, age and weight were recorded for each animal and a blood sample was collected. Serum samples were tested for the presence of serum neutralizing antibodies (SNA) by the rapid fluorescent focus inhibition test (RFFIT), mouse serum neutralization test (MSN), and an indirect fluorescent antibody (IFA) technique for detecting immunoglobulin G. Fifty-one raccoons (5%) were found to have SNA by the RFFIT. Thirty-six serum samples (24 with RFFIT antibody titer greater than 3.0, and 12 less than 3.0) were also tested by the MSN, with results correlating well with the RFFIT results (r = 0.86, P less than 0.01, Kappa = 0.93). In 35 raccoons with SNA by the RFFIT, six individuals had immunoglobulin G binding activity by the IFA test. These results provided serologic evidence of exposure of raccoons to rabies virus in an area free of enzootic raccoon rabies.


Rodents are not a source of endogenously-produced, fecally-transmitted Caryospora bigenetica oocysts. Fifteen Swiss-Webster mice (Mus musculus) and eight cotton rats (Sigmodon hispidus) were inoculated orally with Caryospora bigenetica oocysts. Feces from these animals were collected from 0 to 180 days postinoculation (DPI) and examined for endogenously-produced oocysts using Nomarski microscopy. Oocysts were recovered from mouse feces at 0, 1, 2, 3, 5, 7, 8, 10, and 14 DPI, and from cotton rat feces at 1, 2, and 9 DPI. The recovered oocysts were determined to be from the original inocula due to the presence of thick walls, polar granules, and Stieda and substieda bodies. All animals exhibited clinical signs at 8 DPI. Developmental stages of C. bigenetica were identified in various tissues of seven cotton rats found dead at 9, 10, 11, 12, and 13 DPI. Caryocysts were found in muzzle, tongue, footpad, scrotum, and rectum of mice and cotton rats at 30 DPI. Fecal samples collected from mice on 0, 8, 10, 12, 14, 16, and 18 DPI, and from cotton rats on 0, 9, 11, 13, 15, and 17 DPI were injected subcutaneously into 13 mice. Of the 13 mice, a Caryospora infection was observed only in the mouse inoculated with 0 DPI mouse feces. We propose that endogenously-produced C. bigenetica oocysts are not fecally-transmitted by Swiss-Webster mice or cotton rats.


Cause-specific mortality of white-tailed deer as influenced by military training activities in southwestern Oklahoma. Radio-telemetry was used to monitor movements and mortality of 56 white-tailed deer (Odocoileus virginianus) in response to intensive military training activities on West Range (18,000 ha), Fort Sill Military Reservation, Oklahoma. Cause-specific mortality was determined for 22 radio-collared deer, including adults (greater than or equal to 2.0-yr-old), yearlings (0.6-1.9-yr-old), and fawns (less than or equal to 75-day-old age group) from 1987 to 1989. Winter home ranges were largely confined to a 14,411 ha impact area centrally located on West Range. The mean annual mortality rate was 0.50 for adults and yearlings combined. Fifty percent of all adult and yearling mortality was attributed to military training activities, 28% to hunting, 16% to collisions with automobiles, and 6% to unknown causes. The mean monthly mortality rate was 0.61 for neonatal fawns and predation accounted for three of four mortalities. All captured deer in the greater than or equal to 2.6-yr-old, 82% in the 1.6-yr-old, 10% in the 0.6-yr-old, and all deer in the less than 7-day-old age groups were seropositive for bluetongue virus (BTV). Our study strongly suggests that the consequences of military training activities should be considered in the management of white-tailed deer herds on military installations.


Blood profiles for a wild population of green turtles (Chelonia mydas) in the southern Bahamas: size-specific and sex-specific relationships. Blood biochemical profiles and packed cell volumes were determined for 100 juvenile green turtles, Chelonia mydas, from a wild population in the southern Bahamas. There was a significant correlation of body size to 13 of the 26 blood parameters measured. Only plasma uric acid and cholesterol were significantly different between male and female turtles. The relationship between total plasma proteins and plasma refractive index was significant. The equation for converting refractive index (Y) to total plasma proteins (X) is Y = 1.34 + 0.00217(X).


Serum chemistry values of the endangered San Joaquin kit fox (Vulpes macrotis mutica). Serum chemistry values were obtained from 64 adult San Joaquin kit foxes (Vulpes macrotis mutica) in western Kern County, California (USA). The goal of the study was to establish normal chemistry values for this endangered species. No significant differences were found for mean values of alanine aminotransferase (217.1 IU/l), alkaline phosphatase (44.2 IU/l), cholesterol (145.6 mg/dl), total protein (5.8 g/dl), creatinine (0.63 mg/dl), calcium (8.2 mg/dl), albumin (3.0 g/dl), glucose (129.2 mg/dl), amylase (196.8 IU/l), sodium (153.7 mEq/l) and phosphorus (5.42 mg/dl) between sexes or seasons. Significant differences were noted for aspartate aminotransferase, blood urea nitrogen and potassium between seasons. Possible disturbances in normal hepatic and renal functions were noted.


Ophthalmologic examination of the normal eye of the koala. The ophthalmic examination of the koala (Phascolarctos cinereus) was undertaken to describe the normal in vivo structure. Twenty-two of 28 koalas examined were found to have normal eyes. Slit-lamp examination revealed unusual lamellae in the cornea, and mean keratometric readings were 59.3 +/- 3 diopters, corneal endothelial cell area of 381.4 microns2 +/- with a standard deviation of 46.8 microns2. No particular features were seen which would explain the susceptibility of this animal to ocular infection by Chlamydia psittaci.


Pathological findings in the Hawaiian monk seal. Postmortem examinations were performed on 45 Hawaiian monk seals (Monachus schauinslandi) collected during field research on the beaches of the Northwestern Hawaiian Islands (USA) from 1981 to 1985. Both males and females of all age groups, perinatal through adult, were examined. Frequent findings included parasites, trauma, cardiovascular disease (congenital and acquired), and respiratory infections. Emaciation was a common condition. All animals except neonates were infected with parasites; infection was severe in several cases. Splenic hematopoiesis was a universal histopathologic finding. Some cases exhibited lesions consistent with renal, gastrointestinal, and toxic disorders; ectopic tissue calcification; gallstones; and ophthalmologic and dental problems.


Serologic survey for selected arboviruses and other potential pathogens in wildlife from Mexico. During 1988 and 1989, a serologic survey of wildlife was conducted in northeastern Mexico to determine the presence, prevalence, and distribution of arboviruses and other selected disease agents. Eighty mammal specimens were tested. Antibodies to vesicular stomatitis-Indiana, Venezuelan equine encephalitis-Mena II, Rio Grande virus, and vesicular stomatitis-New Jersey were detected predominantly in small mammals. Deer and mouflon (Ovis musimon) had antibodies to bluetongue and epizootic hemorrhagic disease. Two species had serologic evidence of recent exposure to Francisella tularensis. A white-tailed deer (Odocoileus virginianus) had antibodies to Anaplasma marginale. All specimens tested for antibodies against Yersinia pestis and Brucella abortus were negative. Sera from 315 birds were tested for antibody against five equine encephalitis viruses and six avian pathogens. During 1988, antibodies to Venezuelan equine encephalitis-Mena II, Venezuelan equine encephalitis-TC83, St. Louis encephalitis, eastern equine encephalitis, and western equine encephalitis were detected in birds of several species. Antibodies to Pasteurella multocida and Newcastle disease virus were also detected. Birds from five species presented antibodies to Mycoplasma meleagridis. Specimens tested for M. gallisepticum, M. synoviae, and Chlamydia psittaci were negative. To the best of our knowledge, this survey represents the first serologic evidence of bluetongue, Cache Valley virus, epizootic hemorrhagic disease, Jamestown Canyon virus, vesicular stomatitis-Indiana, vesicular stomatitis-New Jersey, Rio Grande virus, and tularemia reported among wildlife in Mexico.


Antibody response to canine distemper vaccine in African wild dogs. Antibody levels against canine distemper virus were measured by means of an immunofluorescent antibody test prior to, and after, administration of a modified-live virus booster vaccine to seven African wild dogs (Lycaon pictus). Positive seroconversion with no harmful side-effects was seen in all the animals.


Prevalence of antibody titers to Leptospira spp. in Minnesota white-tailed deer. Serum samples (n = 204) from 124 white-tailed deer (Odocoileus virginianus) in northeastern Minnesota (USA) were collected from 1984 through 1989 and tested for antibodies to six serovars of Leptospira interrogans (bratislava, canicola, grippotyphosa, hardjo, icterohemorrhagiae, and pomona) using a microtiter agglutination test. Eighty-eight (43%) sera were positive at greater than or equal to 1:100 for antibodies against serovars pomona and/or bratislava; none was positive for any of the other four serovars. None of the 31 sera collected in 1984-85 was positive, whereas all 54 sera collected from 1986 through 1988 had titers of greater than or equal to 1:100. During 1989, only 34 (29%) of 119 sera had titers of greater than or equal to 1:100. Based on these results, we believe there to be wide variability in exposure of Minnesota deer to Leptospira interrogans.


Borrelia sp. in ticks recovered from white-tailed deer in Alabama. Six hundred sixty-five hunter-killed white-tailed deer (Odocoileus virginianus) from 18 counties in Alabama (USA) were examined for ticks. Most of the collections were made at state-operated wildlife management areas. Four species of ticks (n = 4,527) were recovered: the lone star tick Amblyomma americanum (n = 482); the Gulf Coast tick A. maculatum (n = 11); the winter tick Dermacentor albipictus (n = 1,242); and the black-legged tick Ixodes scapularis (n = 2,792). Fifty-six percent of the ticks (n = 2,555) were examined for Borrelia sp. spirochetes using an immunofluorescent, polyclonal antibody assay. Spirochetes were detected in I. scapularis (five females, seven males) from Barbour, Butler, Coosa, and Lee counties and A. americanum (four males, four nymphs) from Hale, Lee, and Wilcox counties. Area-specific prevalences in ticks were as high as 3.3% for I. scapularis and 3.8% for A. americanum.


The activity of ceftiofur sodium for Aeromonas spp. isolated from ornamental fish. Our objective was to determine the activity of ceftiofur sodium against Aeromonas hydrophila and A. sobria isolated from a variety of domestic and imported tropical fish. Twelve antimicrobial drugs were tested for effectiveness against these aeromonads using the Kirby-Bauer Disk Diffusion technique and minimum inhibitory concentration determinations. Ceftiofur sodium was highly effective in vitro against aeromonads isolated from ornamental fish. Of the 42 isolates of Aeromonas spp. tested, none were resistant to ceftiofur sodium; however, all isolates were resistant to ampicillin, and 71% were resistant to tetracycline.


Monthly incidence of Theileria cervi and seroconversion to Babesia odocoilei in white-tailed deer (Odocoileus virginianus) in Texas. Monthly monitoring of fawns collected from an area in Texas endemic for Theileria cervi and Babesia odocoilei showed that transmission of T. cervi occurred during July and August, a time period consistent with the occurrence of Amblyomma americanum. Seroconversion to B. odocoilei occurred during October to December and possibly continued through January and February. The time of seroconversion was more suggestive of transmission of B. odocoilei by Ixodes scapularis than by Amblyomma americanum.