Can school teachers improve the management and prevention of skin disease? A pilot study based on head louse infestations in Guerrero, Mexico

BACKGROUND

The effect of health education provided by teachers, in three primary schools of Guerrero, Mexico, on the prevalence of head louse infestation was compared.

METHODS

A cross-sectional survey and rapid appraisal methods were performed, including a child questionnaire and qualitative data from teachers and focus groups of mothers in the same schools.

RESULTS

Nine hundred and forty-four students and 33 teachers were interviewed; a focus group discussion with 6-8 mothers per school was performed. In the self-diagnosis of pediculosis, the prevalence was 22% (range, 18%-33%) with a sensitivity of 68% and a specificity of 86%. In one school, 100% of the teachers applied a health program, whereas in the other two schools this percentage was only 20%. A child under 9 years of age who attended a school without information on health was 3.6 times more likely to have head louse infestation (OR = 3.6, CI 95% = 2.1-6) than a child of the same age who attended a school where information was given. In older children the effect and potential impact were lower. The difference between the two age groups is unlikely to be explained by chance (X2 het = 5.7, df = 1, p = 0.01).

CONCLUSIONS

This study emphasizes the potential value of simple, but effective, health education provided by school teaching staff through liaison with patents in the amelioration of endemic disease.

Clinical and laboratory alterations in horses during immunization with snake venoms for the production of polyvalent (Crotalinae) antivenom

Six horses were immunized with the venoms of Bothrops asper, Crotalus durissus durissus and Lachesis muta stenophrys for the production of polyvalent (Crotalinae) antivenom. During the immunization, clinical and laboratory alterations were evaluated in these animals, and the development of humoral immune response was followed. Only moderate local tissue changes (edema, abscesses, fistules and fibrosis) were observed in these animals, whereas no systemic alterations occurred. Regarding laboratory tests, there was a drop in hemoglobin concentration and hematocrit, together with an increment in total serum protein. Horses developed a moderate leukocytosis, with increments in polymorphonuclear leukocytes and lymphocytes. No significant changes were observed in prothrombin time or platelet count. There were no alterations in serum lactic dehydrogenase and gamma glutamyl transferase activities, whereas minor increments in creatine kinase and alanine aminotransferase activities were observed, together with a decrease in aspartate aminotransferase. All these changes occurred after the injection of 9 mg venom, when sodium alginate was first used as adjuvant. Creatinine levels had a small increment, although no changes were observed in urea levels or in the urea/creatinine ratio. An important individual variability was observed in the humoral immune response, as judged not only by enzyme-linked immunosorbent assay, but also by assessing the neutralization of the indirect hemolytic activity of venoms.

[Investigation of corticospinal dysfunction in multiple sclerosis and motoneuron diseases using motor evoked potentials]

INTRODUCTION

The introduction of motor evoked potentials (MEP) into neurological practice has been very useful in the study of motor disorders, especially in patients with motor neurone diseases (MND) and multiple sclerosis (MS).

MATERIAL AND METHODS

Forty patients with MS, twenty with MND and sixty-four apparently normal control were studied, to evaluate the use of MEP in such patients. Bilateral recordings were made from the abductor pollicis brevis and tibialis anterior. The variables studied were: cortical latency, radicular latency, central conduction time, motor excitation threshold coefficients of amplitude, duration and number of phases.

RESULTS

There were significant differences in most variables when the control group and the patients were compared, and also between the two subgroups of patients (Wilk's lambda = 0.4197; p < 0.05). CA analysis significantly increased the sensitivity of the study (90.4%) with respect to analysis of latencies and central conduction times (70.4%). When analysis of the coefficients of duration and of phases was included, specificity increased by approximately 30% in both groups of patients.

CONCLUSIONS

The great sensitivity of MEP as a neurophysiological diagnostic tool in investigation of corticospinal bundle lesions was demonstrated.

Randomized comparison of differing periods of twice-a-day triple therapy for the eradication of Helicobacter pylori

BACKGROUND

We assessed the efficacy, compliance, and tolerability of the twice-a-day triple therapy, amoxycillin, omeprazole, and clarithromycin, for Helicobacter pylori and studied the effect of treatment duration (7, 10 or 14 days) on these factors.

METHODS

One-hundred and fifty subjects with H. pylori infection documented by 13C-urea breath test were randomly assigned to a 7, 10 or 14-day course of amoxycillin 1 g b.d., omeprazole 20 mg b.d. and clarithromycin 500 mg b.d. Subjects returned at the end of therapy for pill count and assessment of side-effects. Subjects returned for a repeat 13C-urea breath test 4 weeks after the end of therapy.

RESULTS

Poor compliance (< 80% of medications taken) was seen in 0 subjects at 7 days, 6% at 10 days, and 10% at 14 days (P = 0.03 by chi 2 test for trend; difference for 7 vs. 14 days = 10%; 95% CI, -2% to 18%; P = 0.056). Intention-to-treat eradication rates were 86% at 7 days, 90% at 10 days and 92% at 14 days. Per-protocol eradication rates were 86% at 7 days, 91% at 10 days, and 95% at 14 days (P = 0.11; difference for 7 vs. 14 days = 9%; 95% CI, -2% to 21%; P = 0.17).

CONCLUSIONS

One week of twice-a-day amoxycillin, omeprazole and clarithromycin is well tolerated and provides a good rate of H. pylori eradication. Increasing the duration of therapy decreases compliance but has the potential to modestly improve efficacy if the patient takes the full complement of medication.

A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. The Regional Group on Antivenom Therapy Research (REGATHER)

A randomized double-blind clinical trial in 39 patients envenomed by Bothrops atrox in Antioquia and Chocó, Colombia, was performed to compare the efficacy and safety of 2 equine-derived antivenoms prepared at Instituto Clodomiro Picado, University of Costa Rica. Twenty patients received a monovalent anti-B. atrox antivenom (group A) and 19 patients were treated with a polyvalent (Crotalinae) antivenom (group B). Both antivenoms were equally efficient in the neutralization of the most relevant signs of envenoming (haemorrhage and blood clotting time alteration). Fourteen patients (36%) presented early adverse reactions to antivenoms and no significant difference between the 2 groups was observed. Urticaria (18%) was the most frequent early adverse reaction and there was no life-threatening anaphylactic reaction. Based on clinical criteria and serum venom levels, estimated by an enzyme immunoassay, 15 patients were classified into 2 groups: mild and moderate/severe envenoming. With the antivenom doses used in this study (3, 6 and 9 vials for mild, moderate and severe envenoming, respectively), both antivenoms were equally efficient in clearing serum venom levels within the first hour of treatment, and the levels remained below the lower limit of venom detection for 24 h. Antivenom concentration in serum remained high for up to 24 h after antivenom infusion, suggesting that an excess of antibody in relation to circulating antigen had been administered.

Prospective comparison of commercially available rapid urease tests for the diagnosis of Helicobacter pylori

BACKGROUND

Rapid urease testing is the initial endoscopic test of choice for the diagnosis of Helicobacter pylori. Determination of the relative diagnostic yields and times to a positive test for the different rapid urease tests is important for endoscopists. We compared three commercially available tests using histologic examination and culture as a gold standard.

METHODS

Patients undergoing upper endoscopy had six biopsy specimens taken from the antrum and six from the body with a large-channel biopsy forceps. Each set of six specimens was divided as follows: one each for CLOtest, Hpfast, and Pyloritek rapid urease tests; one for culture; and two for histologic examination (H&E, Genta). All tests were read every 15 minutes for 1 hour; the final reading for Pyloritek was at 1 hour. CLOtest and Hpfast were also read at 4 hours and 24 hours.

RESULTS

One hundred seventy-three sets of biopsy specimens from 87 patients were evaluated; 98 (57%) of the 173 sets were positive for H. pylori by histologic examination and/or culture. The mean and median times to a positive test were significantly less for Pyloritek (0.5 +/- 0.02 hour and 0.5 hour) than for CLOtest (2.0 +/- 0.6 hour and 0.75 hour) or Hpfast (2.2 +/- 0.6 hour and 0.5 hour). The sensitivities at the final readings were similar among the three tests (CLOtest: 93%; Hpfast: 88%; Pyloritek: 89%), but sensitivities at 1 hour were significantly better for Pyloritek (89%) than for CLOtest (71%) or Hpfast (66%). At 4 hours, sensitivities for CLOtest and Hpfast improved significantly and were not significantly different from those of Pyloritek. Specificities were 99% to 100% at all times for all three tests.

CONCLUSION

The three rapid urease tests, CLOtest, Hpfast, and Pyloritek, provide comparable results, with sensitivities around 90% and specificities around 100%. The Pyloritek becomes positive more rapidly than the CLOtest or Hpfast. If a reading is desired within 1 hour, the Pyloritek provides a greater sensitivity than the CLOtest or Hpfast without any sacrifice in specificity.

The influence of warming on rapid urease test results: a prospective evaluation

BACKGROUND

A rapid urease test is the initial test of choice for the diagnosis of Helicobacter pylori at endoscopy. Incubating the CLOtest at 30 degrees to 40 degrees C is recommended, but this decreases simplicity and requires the purchase of additional equipment. We compared results of testing at room temperature versus incubation at 37 degrees C.

METHODS

Four biopsy specimens were taken from the same portion of the antrum in 200 patients undergoing upper endoscopy. One was placed in each of two CLOtests and two were sent for histologic examination. One CLOtest was incubated at 37 degrees C while the other remained at room temperature (22 degrees to 24 degrees C). Tests were checked every 15 minutes for the first 3 hours, every 1 hour from 3 to 6 hours, and at 24 hours.

RESULTS

One hundred twenty one (61%) of 200 patients had H. pylori on histologic examination. Median time to a positive test was 3/4 hour at 37 degrees C and 1 hour at room temperature (p < 0.0001). Sensitivities were greater at 37 degrees C at 1 hour (70% vs 49%; p = 0.001) and 2 hours (86% vs 76%, p = 0.07), but were nearly identical thereafter. Specificities, identical at the two temperatures, were 99% to 100% at 1 to 6 hours and 95% at 24 hours. The CLOtest became positive more rapidly at 37 degrees C in 72% of patients: more than 1/2 hour faster in 42%; and more than 1 hour faster in 16% of patients.

CONCLUSIONS

Incubation of the CLOtest at 37 degrees C hastens the time to a positive test in most patients, although the time saved is usually less than 1 hour. Sensitivity is improved when the test is read at 1 to 2 hours, but no improvement is seen beyond this time. Specificity is not influenced by warming. CLOtest incubation at 37 degrees C should be done if a final reading of the CLOtest is desired within 1 to 2 hours of biopsy.

Calcofluor white stain for the detection of Pneumocystis carinii in transbronchial lung biopsy specimens: a study of 68 cases

Calcofluor white (CFW), a chemofluorescent agent, has proven effective in the recognition of Pneumocystis carinii cysts in respiratory fluids and secretions. However, its usefulness in the recognition of P. carinii cysts in tissue preparations has not been established. We studied 68 formalin-fixed, paraffin-embedded, transbronchial tissue biopsy specimens from individuals seropositive for the human immunodeficiency virus and stained them with the CFW stain and the conventional Gomori methenamine silver (GMS) stain to determine the concordance rate of the two stains. CFW-positive specimens showed light peripheral staining and a unique double parenthesis-like structure near the center of the cysts. Thirty-six (52.9%) of the 68 specimens were CFW and GMS positive, whereas 27 (39.7%) of the specimens were negative by both techniques, yielding a concordance rate of 92.6%. Five (7.4%) of the 68 specimens showed disparate results, and, of these, four (5.9%) were CFW positive and GMS negative, whereas one (1.5%) was CFW negative and GMS positive. We conclude that the CFW stain is suitable and useful for the demonstration of P. carinii cysts in tissue preparations.

Prospective evaluation of the macrolide antibiotic dirithromycin for the treatment of Helicobacter pylori

BACKGROUND

Macrolide antibiotics are active in vitro and in vivo against Helicobacter pylori. We assessed a newer macrolide, dirithromycin, for the treatment of H. pylori in two separate studies.

METHODS

Volunteers with H. pylori infection (by 13C-urea breath test) were randomly assigned to 2-week treatment regimens. Study 1: dirithromycin 500 mg q.d.s., dirithromycin 500 mg q.d.s. plus omeprazole 40 mg q.d.s., or dirithromycin 500 mg q.d.s. plus metronidazole 500 mg t.d.s. Study 2: dirithromycin 500 mg q.d.s. plus omeprazole 20 mg b.d., dirithromycin 1000 mg q.d.s. plus omeprazole 20 mg b.d., or amoxycillin 500 mg q.d.s. plus omepirazole 20 mg b.d. Four weeks after the completion of therapy a repeat 13C-urea breath test was done to assess for cure.

RESULTS

No patient taking dirithromycin alone (n = 6) or in combination with omeprazole (n = 26) achieved cure of their infection. Eradication of H. pylori was seen in one of seven patients taking dirithromycin plus metronidazole. Five of 10 patients taking omeprazole-amoxycillin dual therapy had their H. pylori infection cured (P = 0.0007 vs. patients taking dirithromycin plus omeprazole). Eleven (47%) of 32 patients taking dirithromycin alone or combined with omeprazole reported side-effects, but only two (6%) stopped therapy prematurely as a result of side-effects.

CONCLUSION

No subject taking dirithromycin alone or in combination with omeprazole had their H. pylori infection cured. Dirithromycin, in the regimen used, shows little promise in the treatment of patients with H. pylori infection.

The effect of mannitol on intracranial pressure in relation to serum osmolality in a cat model of cerebral edema

OBJECTIVE

To determine whether intravenous mannitol administration reduces intracranial pressure (ICP) in a cat model of brain edema by changing serum osmolality.

DESIGN

Prospective, controlled study.

SETTING

Pediatric intensive care unit laboratory in a university hospital.

INTERVENTIONS

Intraparenchymal ICP monitors were placed in 12 adult cats which subsequently underwent 60 min of continuous arteriovenous hemofiltration with countercurrent dialysis (CAVH-D), using sterile water with potassium chloride as a dialysate. The ultrafiltrate was replaced with a hypotonic solution causing a rapid reduction in serum osmolality while maintaining a euvolemic state. In six cats (control group) no further interventions were instituted, while in the six other cats (mannitol group) 1g/kg mannitol was administered intravenously immediately after CAVH-D had been discontinued. ICP was monitored continuously, and serum osmolality was determined at 15-min intervals during CAVH-D and for 30 min thereafter.

RESULTS

ICP increased significantly in both the control and mannitol groups during 60 min of CAVH-D. After CAVH-D, ICP was reduced in the mannitol group while ICP remained significantly higher in the control group. An inverse linear correlation was demonstrated between serum osmolality and ICP values in the control group throughout the experiment, as well as during the first 60 min in the mannitol group. However, no such correlation existed in the mannitol group after mannitol administration, as no significant changes in serum osmolality were observed while a marked reduction in ICP values occurred.

CONCLUSION

Mannitol is effective in reducing increased ICP in this model of euvolemic brain edema. However, 15 min after mannitol administration, no relationship between a continued decrease in ICP and a change in serum osmolality could be established. We postulate that the beneficial effect on ICP by mannitol outlasts its possible instantaneous and short-lived effect on serum osmolality.

Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections

We evaluated the results of treatment for ninety-seven patients (106 infections in ninety-eight hips) who had had either an infection after a total hip arthroplasty or positive intraoperative cultures of specimens obtained during revision of a total hip arthroplasty for presumed aseptic loosening. The patients were managed according to various protocols on the basis of the clinical setting (positive intraoperative cultures, early postoperative infection, late chronic infection, or acute hematogenous infection). Aerobic gram-positive cocci accounted for 109 (74 per cent) of the 147 microbial isolates; gram-negative bacilli, for twenty-one (14 per cent); and anaerobes, for twelve (8 per cent). The white blood-cell count and erythrocyte sedimentation rate were elevated in association with seventeen (16 per cent) and sixty-seven (63 per cent) of the 106 infections, respectively. The mean duration of follow-up was 3.8 years (range, 0.3 to eleven years). A good result was noted after the initial treatment of twenty-eight (90 per cent) of the thirty-one infections that had been diagnosed on the basis of positive intraoperative cultures at the time of the revision, twenty-five (71 per cent) of the thirty-five early postoperative infections, twenty-nine (85 per cent) of the thirty-four late chronic infections, and three of the six acute hematogenous infections. Of the twenty++-one infections for which the initial therapy failed, twelve eventually were eradicated after additional treatment and the hip had a functional prosthesis at the time of follow-up. Of the ninety-seven infections that were treated successfully (there was a functional retained or exchange prosthesis in place at the time of the most recent follow-up and infection had not recurred at least two years after the discontinuation of antibiotic therapy), nine were associated with subsequent aseptic loosening of the prosthesis. The factors associated with recurrent infection were retained bone cement, the number of previous operations, potential immunocompromise, and early postoperative infection after arthroplasty without cement.

Modification of the fungi-fluor and the genetic systems fluorescent antibody methods for detection of Pneumocystis carinii in bronchoalveolar lavage specimens

Four hundred forty-five bronchoalveolar lavage specimens from patients with the human immunodeficiency virus were preserved in Saccomano's fixative and stained for Pneumocystis carinii cysts by a modified method with Fungi-Fluor Solution A (Polysciences, Warrington, Pa) and the Genetic Systems Pneumocystis carinii Immunofluorescence Antibody (Genetic Systems Corp, Seattle, Wash). The majority of patients had been treated for suspected P carinii pneumonia for a few days prior to collection of bronchoalveolar lavage specimens. P carinii cysts were detected in 194 (43.6%) specimens. Both stains identified P carinii in 166 (37.3%) specimens and were negative in 251 (56.4%), yielding a concordance rate of 93.7%. P carinii cysts were detected in 25 (5.6%) specimens by the Genetic Systems stain only, and in 3 (0.7%) specimens by the Fungi-Fluor stain only. The sensitivity for detecting cysts of P carinii was significantly greater with the Genetic Systems stain (P < .01).

Protein reverse staining: high-efficiency microanalysis of unmodified proteins detected on electrophoresis gels

A methodology is presented for efficiently gaining structural information from electrophoresed proteins after on-gel detection by imidazole-sodium dodecyl sulfate-zinc reverse staining. As a consequence of reverse staining, (a) protein bands arise transparent against a deep white-stained background, limits of detection being in the femtomole range; (b) there is no loss of image when the gel is kept in distilled water (even during years); and (c) protein bands result immobilized, i.e., they do not diffuse upon gel storage. To recover reverse-stained proteins or fragments thereof from the gel, the immobilization of bands must first be abrogated by chelating the zinc ions from stain (protein mobilization). We had originally described mobilization at low pH by using citric acid. Here, we improve this procedure regarding the protein electrotransfer. We demonstrate that mobilization is efficiently done at neutral to alkaline pH by short-term (5 to 10 min) incubation of the gel in a buffer containing glycine or dithiothreitol prior to transfer. Moreover, mobilization was most simply performed by just adding the zinc chelating agent to the transfer buffer. Reverse staining and the new mobilization procedure made electrotransferring single protein bands from gel onto small-sized (13 x 5 mm2) PVDF membrane pieces in mini sandwich-like assemblies practical. Equipment is described for the protein electroblotting in such minisandwiches. Microsequence analysis of the electroblotted proteins showed initial yields in the range of those achieved when the transfer was done from unstained control gels. Protein bands kept in the reverse-stained gel for prolonged time periods (even for as long as 2 years) could be similarly analyzed.(ABSTRACT TRUNCATED AT 250 WORDS)

Ectopic pregnancy with undetectable serum and urine beta-hCG levels and detection of beta-hCG in the ectopic trophoblast by immunocytochemical evaluation

BACKGROUND

Ectopic pregnancies associated with negative urine or serum pregnancy test by radioimmunoassay usually demonstrate either nonviable trophoblast or absent production of beta-hCG by the ectopic pregnancy.

CASE

We report a patient with intra-abdominal hemorrhage caused by a ruptured ampullary ectopic pregnancy who had undetectable serum and urine beta-hCG levels (less than 5 mIU/mL). Immunoperoxidase staining of the ectopic trophoblastic tissue obtained at surgery revealed both beta-hCG and placental alkaline phosphatase.

CONCLUSION

Negative serum and urine pregnancy tests can occur even though beta-hCG produced by the viable ectopic trophoblastic tissue can be demonstrated by immunoperoxidase staining.

Soluble CD23 in human immunodeficiency virus type 1 infected patients

The level of sCD23 produced in the course of human immunodeficiency virus (HIV) infection was measured in patients grouped according to the Centers for Disease Control by using an immunoradiometric assay. Soluble CD23 was evaluated in supernatants of peripheral blood mononuclear cell (PBMC) (10(6) cells/ml) stimulated by phytohemagglutinin (PHA). Compared with healthy controls (m +/- S.D. = 1.0 +/- 0.34 U/ml, n = 7), higher values were observed in some of the patients of group II (asymptomatic) (m +/- S.D. = 2 +/- 1.33, n = 9) and some of the patients of group IV (AIDS) (m +/- S.D. = 1.3 +/- 1.40, n = 8). Those results prompted us to compare the plasma levels of sCD23 in group II and group IV HIV-infected patients and in healthy individuals. Soluble CD23 plasma levels in healthy patients (n = 42) ranged from 0 to 1.5 U/ml (m +/- S.D. = 0.9 +/- 0.33), in group II patients (n = 17) from 0 to 3 U/ml (m +/- S.D. = 0.92 +/- 0.83) and in group IV patients (n = 73) from 0 to 2.9 U/ml (m +/- S.D. = 1.15 +/- 0.71). The differences between the patients and the healthy individuals were not statistically significant but individual sCD23 values higher than 2 U/ml were obtained in 6% of the group II patients and 16.7% of the group IV patients. Increased values of sCD23 were obtained in plasma from patients with secondary infectious diseases (groups IV-Cl and IV-C2) and from patients without secondary infectious diseases (group II, group IV-A and group IV-B).(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of positive tests for cytomegalovirus in AIDS patients: endoscopic lesions compared with normal mucosa

Ten patients with the acquired immunodeficiency syndrome and an endoscopic erosive/ulcerative lesion in esophagus (4), stomach (3), or colon (3) were prospectively studied with multiple biopsies (244 biopsies from 33 sites) to determine: 1) the frequency of positive tests for cytomegalovirus (CMV) in the lesions versus normal mucosa, 2) the influence of number of biopsies on the rate of positivity. As seen on histology, five out of 10 lesions had cytomegalic cells, but only six of 45 (13%) of the biopsies taken from lesions that were positive showed the diagnostic changes. Immunoperoxidase was positive in two of the lesions with cytomegalic cells, but the positive staining occurred in only three of 35 (9%) biopsies from the histologically positive lesions. Culture was positive in one of 10 lesions, and the rate of positivity did not depend on number of cultures sent or number of biopsies per culture. Polymerase chain reaction was positive in six of 10 lesions, including all lesions positive by either histology (5), immunoperoxidase stain (2), or culture (1). The frequency of a biopsy being positive for CMV in normal mucosa was found to be 4%, 0%, 17%, and 28% by histology, immunoperoxidase stain, culture, and polymerase chain reaction, respectively. In AIDS patients at high risk for CMV, histologic evidence of CMV infection is uncommon in normal mucosa but is frequent in suspicious lesions. However, the frequency of diagnostic histology is highly dependent on the number of biopsies taken and the diligence of the pathologist. Polymerase chain reaction has the potential to become a rapid test to rule out CMV infection in gastrointestinal tissue.

Benign vulvar melanosis

Large melanotic lesions of the vulva are uncommon, but they may present a diagnostic problem. Eleven cases of benign vulvar melanosis are reported. The clinical features, histologic characteristics and differential diagnosis are described and analyzed.

Bleeding from a Meckel's diverticulum after the use of ibuprofen

A Meckel's diverticulum is an unusual site of gastrointestinal bleeding in adults. Bleeding often results from ulceration of ileal mucosa that lies adjacent to ectopic gastric mucosa. We report on a 27-yr-old man who bled from a Meckel's diverticulum after receiving oral ibuprofen, a nonsteroidal antiinflammatory drug. Examination of the resected diverticulum revealed fundal-type gastric mucosa with inflammation, submucosal hemorrhages, erosions and ulceration in the absence of Helicobacter pylori. The ileal mucosa was spared in this patient. These features suggest that oral ibuprofen caused damage to the ectopic gastric mucosa, precipitating significant hemorrhage. This is the first report in the English literature of such an occurrence.

Effects of pregnant mare's serum gonadotropin treatment on follicular populations and ovulation rates in prepuberal gilts with two morphologically different ovarian types

Two experiments were conducted to determine the effects of pregnant mare's serum gonadotropin (PMSG) on follicular populations and ovulation rates in prepuberal gilts with grape-type (GT) and honeycomb-type (HT) ovaries. The follicular populations were determined at 170 d of age (d 0) and 19 d after PMSG (d 19). In Exp. 1, the mean number of macroscopic follicles of Classes 2 and 3 was greater (P less than .05) in GT (n = 11) than in HT (n = 32) ovaries at d 0, whereas the mean number of those of Class 1 was greater (P less than .05) in HT ovaries. At d 19, no difference was observed between the two ovarian types for any class of follicles. The PMSG-induced ovulation rates were comparable between the two ovarian types (8.3 vs 7.9, GT vs HT, respectively; P greater than .10). In Exp. 2, the microscopic follicular populations were determined on right and left ovaries removed, respectively, on d 0 and 19. At d 0, GT ovaries (n = 5) contained a greater number of Class 5 nonatretic (P less than .01) and atretic (P less than .02) follicles than did HT ovaries (n = 5), whereas at d 19 the mean number was not statistically different between the two ovarian types (P greater than .10). In contrast, gilts with HT ovaries contained a greater (P less than .01) number of Class 4 atretic follicles than gilts with GT ovaries at d 0, whereas at d 19 the mean number was not statistically different between the two ovarian types (P greater than .10).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hematologic values and serum enzymes in horses inoculated with snake venoms for the production of antivenins in Costa Rica]

Blood components were studied in six horses immunized with snake venoms for the production of polyvalent antivenom in Costa Rica. No significant changes in hemoglobin or hematocrit throughout the immunization period were observed, whereas a significant increment in total serum proteins occurred in the second half of the immunization process, probably due to an increased synthesis of immunoglobulins. There were no significant changes in creatine kinase, but a slight increment was detected in both transaminases, although they did not exceed normal limits. These findings suggest the absence of relevant tissue damage in skeletal muscle, cardiac muscle and liver. In agreement with these results, horses did not develop signs of systemic poisoning, presenting only minor alterations at the site of venom injection, such as oedema, abscesses and fistulas. The development of anti-phospholipase A2 antibody response showed a prominent individual variability, as previously described.

Prevalence of active Chlamydia trachomatis infection at the time of exploratory laparotomy for ectopic pregnancy

Cultures of the fallopian tube, cul-de-sac, and cervix were obtained from 50 patients undergoing exploratory laparotomy for ectopic pregnancy. Chlamydia trachomatis was cultured from the cervix in four patients (8%). All the cultures from the fallopian tube or cul-de-sac were negative. Immunofluorescent stain of deparaffinized cross-sections of fallopian tube at the site of tubal involvement with the ectopic pregnancy failed to reveal any C trachomatis inclusions.

Severe cholestatic jaundice associated with piroxicam

A 62-year-old man with rheumatoid arthritis developed jaundice while taking piroxicam. A full evaluation including ultrasound, computerized tomography, endoscopic cholangiography, and liver biopsy confirmed the diagnosis of intrahepatic cholestasis. The patient's jaundice and all other liver function abnormalities normalized 4 months after he discontinued taking piroxicam. This is the first case report in the United States of severe liver toxicity associated with piroxicam. The six cases in the English-language literature are reviewed, featuring the presentation, patterns of liver injury, and outcome in each. Piroxicam should be considered as a potential cause of cholestatic jaundice when other more common etiologies have been excluded.