Biomedical subjects
Publications and source records attributed to R Neiger.
Crenosomiasis is a pulmonary parasitic disease of the dog, endemically occurring in Switzerland, which is to differentiate from other forms of therapy-resistant chronic cough. The diagnosis is obtained by fecal examination (larval migration, Bearman's technic) or by cytologic examination of the tracheobronchial mucus. Levamisole is the drug of choice for the treatment of this disease.
The effect of aging on plasma prolactin (PRL) levels, hypothalamic tuberonifundibular dopaminergic (TIDA) neurons and pituitary lactotropes was evaluated in prolactinoma-free young (5-month-old) and old (23- to 24-month-old) Long-Evans rats of either sex. The young female rats were in diestrus, the old ones in recurrent pseudo-pregnancy. The tyrosine hydroxylase (TH)-labelled neurons in the arcuate nucleus (AN) and axons in the median eminence (ME) as well as the PRL-labelled lactotropes in the pituitary gland were studied by morphometry and densitometric immunohistochemistry. Further, we investigated the secretory function of isolated lactotropes by reverse hemolytic plaque assay (RHPA) and by cell culture in comparable animal groups. Compared with young animals, the plasma PRL levels of old rats of both sexes were similar or reduced. All morphometric and densitometric measurements of the AN neurons, ME axons (except number) and pituitary lactotropes were comparable in young and old female rats. In old male rats the AN and ME measurements were mostly decreased, while the lactotropes remained almost unchanged. The RHPA generally showed a reduced PRL release from lactotropes of old animals of both sexes. The PRL release from the cultured lactotropes, on the contrary, was greatly increased in old female rats and unchanged in old male rats. Our functional and morphological data suggest that the in vivo function of lactotropes in old prolactinoma-free female and male rats does not seem to be strongly influenced by the mildly reduced TIDA neuron activity, yet emphasize the differences of the aging process in the two sexes.
The purpose of this study was to examine whether women with first trimester uterine bleeding and low serum folate have a higher incidence of spontaneous abortions and adverse perinatal outcome compared with women whose folate levels are normal. Serum folate and vitamin B12 levels were obtained on 225 women who presented with first trimester vaginal bleeding; pregnancy outcomes of those whose folate or vitamin B12 levels were low were compared with those with normal levels using the chi-square test. Of the 151 women included, 52 had low folate levels (less than 4.0 ng/ml). Their spontaneous abortion rate and perinatal outcomes were similar to those whose folate levels were normal. We concluded that in pregnancies complicated by first trimester vaginal bleeding, low folate levels do not appear to be associated with an increased risk of pregnancy loss and adverse outcome.
Late in 1991, an enveloped RNA virus (now called porcine reproductive and respiratory syndrome [PRRS] virus) was identified as the etiologic agent for mystery swine disease. In 1992, laboratory procedures for the diagnosis of this disease evolved rapidly, and veterinary diagnosticians started applying these tests to field cases. This report is written from the perspective of veterinary laboratory diagnosticians and utilizes 3 case studies to define the advantages and disadvantages of the various available diagnostic laboratory PRRS test procedures in different clinical situations. The diagnostic procedures currently used in our laboratory for investigating PRRS are pathologic examination, serologic testing, fluorescent antibody (FA) testing, and virus isolation. Interstitial pneumonia, characterized by mononuclear cell infiltration of alveolar walls with normal airway epithelium, is a hallmark lesion for the disease, especially in neonatal pigs with respiratory distress. Interstitial pneumonia is not a specific lesion and must be coupled with other tests to verify PRRS virus infection. Demonstration of seroconversion is helpful, especially in sows that have experienced reproductive failure. The indirect FA test detects antibody sooner than the serum neutralization test and will likely become the serologic test of choice. The direct FA test on fresh tissue utilizes monoclonal antibody and is useful for investigating PRRS virus-associated pneumonia. Virus isolation utilizing swine alveolar macrophages has also been a useful diagnostic procedure. All of the above tests have been universally unrewarding when applied to aborted, mummified, or stillborn piglets.
Eleven cases of systemic Pasteurella haemolytica infection in cattle were identified from routine diagnostic laboratory submissions during the falls of 1988, 1989, and 1991. All cases came with a history of recent vaccination with an avirulent live culture P. haemolytica product. Nine of 11 cases involved cattle vaccinated between 2 and 18 days previously with this product. Ten of 11 cases involved 182-227-kg beef calves that were vaccinated between September and November during routine processing for entry into feedlots. The morbidity and mortality was generally low. The major pathologic findings included meningitis, injection site abscessation and/or cellulitis, and polyarthritis. Systemic infection was indicated in all cases by the isolation of P. haemolytica from 2 or more organs or distinct anatomical sites. In 6 cases, the vaccine injection site was cultured, and in all 6 cases, P. haemolytica was isolated. Three separate P. haemolytica isolates from 2 cases were further studied by restriction enzyme analysis (REA). These isolates were from tissues with suppurative inflammation, including the brain, joint, and injection site. The REA patterns of each of these 3 isolates were identical to the REA pattern of the vaccine masterseed, which strongly suggested that the organisms causing systemic infection were the same as the organism used to produce the vaccine. Because the overall incidence was quite low, other factors, such as stress, probably played a major role in the expression of this syndrome.
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The diagnosis of gestational diabetes requires that two of the four 100 gm, 3-hour oral glucose tolerance test values be elevated. Our report evaluates the usefulness of repeating the oral glucose tolerance test in patients who have only one abnormal value. One hundred six patients who had abnormal results of diabetes screening tests (glucose level greater than or equal to 130 mg/dl) and whose glucose tolerance test had one abnormal value underwent repeat glucose tolerance testing at an average of 4.6 weeks later. Thirty-six patients (34%) had two abnormal values on the repeat test and were classified as having gestational diabetes. Our results indicate that the finding of one abnormal value on a glucose tolerance test denotes a significant risk for the development of gestational diabetes.
One hundred three women with gestational diabetes diagnosed by the criteria used at Women and Infants' Hospital were followed through the prenatal course. Sixty-four also met the current ACOG criteria. Ten of the 39 (26%) who met only the hospital's criteria required insulin therapy, a proportion not different from that in the group who met the ACOG criteria (19 of 64, 30%). The degree of abnormality of the glucose tolerance test (GTT) did not predict subsequent need for insulin treatment. The ACOG GTT criteria may fail to detect a proportion of women with gestational diabetes whose carbohydrate metabolism abnormality is severe enough to require insulin therapy.
Frozen section evaluations of cervical cone biopsy specimens were performed at the time of hysterectomy to exclude invasive cervical cancer. During a two-year period we prospectively evaluated 43 cone biopsy specimens. We found all the diagnoses made with frozen sections to be accurate when compared with prospective permanent sections, and all patients received appropriate therapy. Thirty-eight cases showed no evidence of invasion. Two patients had invasive squamous cell cervical cancer, one had invasive cervical adenocarcinoma extending to the endometrial cavity, and two had microinvasion. All invasive cancers were diagnosed correctly with frozen sections and confirmed with permanent sections. When hysterectomy immediately followed conization, no complications occurred, and no significant increase in blood loss was noted. We found frozen section evaluation of a cone biopsy specimen at the time of hysterectomy to be a reliable procedure that saves time, eliminates the risk of additional anesthesia and decreases patients' costs.
The average time until the resolution of thrombocytopenia, which as a part of HELLP syndrome accompanies 4-16% of cases of severe preeclampsia, has not been defined previously. We followed 25 patients with severe preeclampsia, platelet counts below 100,000/microL, and elevated liver enzymes until their platelet counts returned to levels above 100,000/microL. Among severe preeclamptics who did not receive platelet transfusions, the average time from delivery to the resolution of thrombocytopenia was 60 hours, and all had platelet counts above 100,000/microL by 95 hours. Seven patients were followed after their platelet counts exceeded 340,000/microL; all showed a rebound phenomenon, with platelet counts reaching values of 413,000-871,000/microL.
Antepartum cervical Chlamydia trachomatis infection is associated with an increased risk of peripartum maternal and neonatal morbidity. Chronic chlamydial salpingitis has been described in asymptomatic women. We studied the incidence of asymptomatic chlamydial colonization of the fallopian tubes during pregnancy, and the influence of such infection on the patients' clinical course, by culturing the fallopian tubes of 53 asymptomatic women who underwent tubal ligation in the immediate postpartum period. One patient had a positive chlamydial culture in one of her tubes, and two others had histologic evidence of acute and chronic salpingitis. These patients had no infectious morbidity during the antepartum, intrapartum, or postpartum periods. Our findings suggest that asymptomatic chlamydial colonization and inflammatory processes may exist in the fallopian tubes during the peripartum period.
Cytogenetic study is an important part of the evaluation of intrauterine fetal death. Many tissue cultures fail to grow because of maceration and autolysis of the fetal tissues. We evaluated eight amniotic fluid cytogenetic cultures from patients whose fetus had died. All patients had sonographic evidence of Spalding's sign. In four patients, urea and PGF2 alpha were simultaneously injected into the amniotic cavity. Seven amniotic cultures, gestational age 19 to 33 weeks, grew successfully, even when a tissue culture obtained after delivery failed to grow. One culture, gestational age 36.5 weeks, failed to grow and could not be analyzed. The use of amniotic fluid culture for cytogenetic evaluation of fetal death, obtained at the time of diagnosis, is superior to culture of fetal tissue obtained after delivery. The amniocentesis may also serve for intra-amniotic induction of labor.
The influence of increased seismic activity on pregnancy outcome was evaluated. A significant increase in delivery rate was noted during the 48 hours following an earthquake on all instances. In two out of five events, a significant increase in premature delivery rate was noted (p less than 0.05). Possible signs of fetal distress in utero were documented following these events.
Severe hydrocephalus secondary to a massive teratoma occupying the left lateral ventricle and protruding from the left orbit was diagnosed in a newborn infant. A craniofacial mass had been initially detected during labor by ultrasound examination. The pathophysiology of teratomas and the clinical course and ethical issues in management of this child are discussed.
A new technique was developed for transvaginal ultrasound scanning in the routine evaluation of women with suspected early ectopic pregnancy. This approach enables us to detect early pregnancies that could not be visualized previously with routine abdominal ultrasound. Transvaginal scanning shows the location of the gestational sac very clearly, whether it is within or outside the uterus. Our introduction of this technique into the evaluation process has reduced patients' risk by minimizing delays in diagnosis and treatment and also has shortened hospital stays, thereby reducing costs.
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Fifty obstetric patients with asymptomatic bacteriuria were treated by single-dose antimicrobial therapy. The immediate cure rate was 84% and the recurrence rate was 12%. Seven of the eight patients in whom single-dose treatment failed responded to subsequent 7-day therapy with the same drug, indicating renal involvement. A 50% recurrence rate in the group of patients in whom single-dose treatment failed was compared with a 5% recurrence rate in the group cured by single-dose therapy, which indicates that failure with single-dose antimicrobial therapy can serve as a therapeutic test to identify patients at high risk for recurrent bacteriuria and its sequelae during pregnancy. It is concluded that single-dose antimicrobial therapy is a safe and effective way to treat asymptomatic bacteriuria in pregnant patients without urologic problems in their history.