Factors affecting the age at onset of puberty, ovulation rate and time of ovulation in Chinese Meishan gilts

Experiments were carried out to study: the effects of season on age at puberty, the influence of reproductive age on ovulation rate, and the time interval from the onset of oestrus to ovulation in Chinese Meishan gilts. Gilts approaching puberty either in the spring (n = 88) or in the autumn (n = 40) were housed indoors under natural daylight conditions and observed daily for oestrous behaviour. Gilts approaching puberty in the spring were younger (P < 0.001) and more likely to reach puberty by 100 days of age (P < 0.01) than were those approaching puberty in the autumn. Ovulation rate was estimated in gilts at second (n = 22), third (n = 24), fourth (n = 18), fifth to ninth (n = 9) and tenth to twenty-first (n = 17) oestrous cycle and in primiparous Meishan sows (n = 12) by counting the number of corpora lutea or corpora albicantia at laparoscopy, laparotomy or at ovarian recovery following slaughter. Ovulation rate increased (P < 0.001) with reproductive age and approached that of primiparous sows only when gilts had experienced > or = 10 oestrous cycles (19.2 versus 21.0). The time interval between the onset of oestrus and ovulation was studied in six naturally cyclic Meishan gilts and nine Meishan gilts administered hCG at the onset of oestrus. All glits were observed six times a day for the commencement of oestrous behaviour and were subsequently examined by laparoscopy at 32 h following onset of oestrous and every 8 h till ovulation, which was a maximum of 56 h.(ABSTRACT TRUNCATED AT 250 WORDS)     

Acute infectious purpura fulminans: pathogenesis and medical management

The aims of this study were to determine: (1) if short-term treatment of Bos indicus heifers with progesterone (P4) while implanted with a s.c. norgestomet implant for 17 days would influence the time interval to oestrus and increase fertility of the synchronised oestrus, and (2) whether the response to treatment with P4 would differ between heifers treated with a norgestomet implant for 17 vs. 11 days when short-term treatment with P4 is applied 3 days prior to implant removal. B. indicus heifers at two separate sites (A and B) were allocated to three groups at each site. Heifers in two groups (NG and NGP4 groups) were given a single s.c. norgestomet implant on the first day of treatment (day 0) while heifers in a third group (NGP4PG group) were implanted on day 6. A single P4 releasing Controlled Internal Drug Release device (CIDR) was inserted on day 14 in heifers in the NGP4 and NGP4PG groups and was removed 23.5 +/- 0.07 h later (day 15). Heifers in the NGP4PG group were administered an analogue of prostaglandin F2 alpha (PGF2 alpha) at the time of CIDR removal to regress corpora lutea. Implants were removed from all heifers on the same day (day 17) and a 400 IU of equine chorionic gonadotrophin (ECG) was administered s.c. Animals were artificially inseminated 11.1 +/- 0.17 h after detection of oestrus, using frozen semen from one bull at site A and one of five bulls at site B. Inseminations were carried out by one of two technicians. Treatment with P4 delayed oestrus and reduced the synchrony of oestrus at site A (hours to oestrus +/- SD: NG group, 39.0 +/- 13.7; NGP4 group, 66.3 +/- 24.4; NGP4PG group, 58.9 +/- 20.5 h; P < 0.05) but not at site B (41.4 +/- 15.2, 42.5 +/- 10.1, 45.4 +/- 10.3 h; P > 0.05). Pregnancy rates 6 weeks after insemination were found to be significantly associated with bull (P < 0.001), treatment group (P = 0.013) and insemination technician (P = 0.033). Pregnancy rates were greater in the heifers in the NGP4 group than heifers in the NG group [50.3% (78/155) vs. 36.4% (60/165); odds ratio = 1.83, 95% CI = 1.14 to 2.96] and similar between heifers in the NGP4 and NGP4PG groups [50.3% (78/155) vs. 51.1% (63/117); odds ratio = 1.06, 95% CI = 0.67 to 1.69]. It was concluded that acute treatment with P4 can improve pregnancy rates in B. indicus heifers treated for 17 days with norgestomet implants. Reducing the duration of norgestomet treatment to 11 days and administration of PGF2 alpha at the time of ending treatment with a CIDR device resulted in no differences in fertility, mean intervals to oestrus or synchrony of oestrus.     

Oestrus, ovulation and peri-ovulatory hormone profiles in tethered and loose-housed sows

Multiparous sows that had been tethered during lactation were put in two different housing conditions after weaning (Day 0); the sows were either tethered by neck chain, or individually housed in a pen of approximately 6 m2. After two months, ten tethered and eleven loose housed sows were used to assess stress and reproductive parameters. Stereotypic behaviour after the afternoon feeding was assessed from Day 18 onwards; at Day 53 stereotypic behaviour tended to occur during a higher percentage of time in the tethered sows (P = 0.11) and at Day 66, the differences were significant (tethered, 78 +/- 5 vs. loose-housed, 40 +/- 10% of time (mean +/- sem); P = 0.03). At Day 35 and 55, cortisol profiles after afternoon feeding were similar for the two groups of sows (P > 0.10). Around oestrus (approximately Day 64), the profiles of oestradiol-17 beta, luteinizing hormone and progesterone were measured and proved to be similar for both treatment groups (P > 0.10). The duration of oestrus was shorter in the tethered sows (42 +/- 4 vs. 63 +/- 2 h; P < 0.001) and, consequently, the timing of ovulation during oestrus (h after onset of oestrus) was advanced in the tethered sows (28 +/- 2 vs. 41 +/- 2; P < 0.001). The duration of ovulation did not differ (tethered, 2.9 +/- 0.5 vs. loose-housed, 2.1 +/- 0.2 h; P = 0.16). The sows were sacrificed at Day 5 after ovulation; ovulation rate, fertilization rate, embryo development and embryo diversity were similar for the two groups, as were adrenal weight and size of adrenal cortex. Duration of oestrus and the levels of stereotypies at Day 60 tended to be negatively related in the tethered sows (P = 0.07), but not in the loose-housed sows (P = 0.65). In conclusion, sows that had been tethered during pregnancy and lactation, and were housed loose or were tethered again at weaning within two months differed both in stereotypic behaviour and in duration of oestrus, without apparent effects on reproductive hormones.     

Artificial insemination of Bos indicus heifers: the effects of body weight, condition score, ovarian cyclic status and insemination regimen on pregnancy rate

Effects of body weight, condition score, ovarian cyclic status and insemination regimen on pregnancy rates were investigated in 164 Bos indicus heifers synchronised with norgestomet-oestradiol and pregnant mare serum gonadotrophin (PMSG). Oestrus detection techniques were also compared. Heifers were inseminated at either a fixed time (group 1, n = 83) of 48.0 +/- 0.2 h (mean +/- SEM) after implant removal or at 8.9 +/- 0.5 h after oestrus was detected (group 2, n = 81). Group 2 heifers that were not detected in oestrus by 72 h after implant removal were inseminated at that time. Oestrus was detected for the purpose of insemination using heatmount detectors. Tail-paint and oestrogen treated, chin-ball harnessed steers were used to compare the efficiency of oestrus detection. The probability of ovarian cyclicity increased with increasing body weight and condition score (P < 0.001). A higher proportion of heifers that were acyclic at the commencement of treatment, compared with cyclic heifers, were detected in oestrus at the time of insemination in the fixed-time inseminated group (P < 0.01). Analysis of covariance revealed that intervals from implant removal to oestrus were influenced by ovarian cyclic status (P < 0.01) and insemination group (P < 0.05). A higher pregnancy rate (% +/- SEM) was obtained in acyclic compared with cyclic heifers in the group 1 heifers (50.0 +/- 10 vs 28.1 +/- 6; P = 0.055) but not among the group 2 heifers (45.8 +/- 10 vs 49.1 +/- 7; P = 0.787). The probability of pregnancy was found to be associated negatively with body weight (P = 0.01) while a higher pregnancy rate was obtained in the group 2 compared with group 1 heifers (48.2% vs 34.9%; P = 0.093). The efficiency of oestrus detection was highest using heatmount detectors compared with tail-paint and chin-ball harnessed steers (90.7% vs 37.0% and 23.5%, respectively; P < 0.0001). We conclude that pregnancy rates can be increased in extensive environments when insemination follows oestrus detection using heatmount detectors compared with a fixed-time insemination. The fertility of heifers inseminated at a fixed time is influenced by ovarian cyclic status due to its influence on oestrus-to-insemination intervals.     

Effect of nutritional management, trace mineral supplementation, and norgestomet implant on attainment of puberty in beef heifers

We conducted a study to evaluate the influences of nutritional management, trace mineral supplementation, and exogenous progesterone on attainment of puberty in beef heifers. Heifers (n = 180) were assigned at weaning to blocks and treatments. Treatments included two dietary regimens (corn silage vs pasture + oatlage), trace mineral supplementation, and puberty induction strategy (with or without progestin implant). Heifers that received pasture + oatlage were managed on grass-legume pastures from October 14 until December 14 and were then placed in pens and fed an oatlage-based diet through May 1994. Heifers fed the corn silage-based diet were housed in pens throughout the study. Norgestomet was implanted in half of the heifers on April 11 for 10 d. Progestin implant increased (P < .05) the number of heifers that had attained puberty by the end of the study, compared with nonimplanted heifers (89% vs 71%). Trace mineral supplementation did not affect percentage of heifers that reached puberty before the implant period. Plasma copper levels were below recommended levels in heifers fed oatlage-based diets without trace minerals. We conclude that heifers can be placed on regrowth in irrigated pastures during the fall and still make acceptable gains for attainment of puberty the following spring and that progestin treatment can aid in inducing heifers to reach puberty.     

Increase in plasma leptin and Lep mRNA concentrations by food intake is dependent on insulin

The difference in pregnancy rates following intrauterine insemination (IUI) for 1 vs. 2 days in the periovulatory period has been reported as either inconsequential or favoring the use of two consecutive inseminations, 24 hours apart. Our study compared the monthly fecundity and cumulative probability of pregnancy in a large group of women (n = 123) undergoing controlled ovarian hyperstimulation and 1- or 2-day inseminations with donor sperm prepared from frozen-thawed samples. All patients underwent controlled ovarian hyperstimulation employing either clomiphene citrate in 217 cycles or human menopausal gonadotropin in 185 cycles. The choice of single or double insemination was decided by the day of the week each patient received human chorionic gonadotropin for ovulation induction. Approximately 80% of all the patients underwent both single and double insemination treatments during the 2.5-year study period. Ninety-three patients received single inseminations in 180 cycles, whereas 103 patients received double inseminations in 222 cycles. Nine clinical pregnancies were achieved in the 1-day group (5% per cycle, 9.7% per patient), while 39 pregnancies occurred in the 2-day group (17.9% per cycle, 37.9% per patient). Two and five spontaneous abortions occurred in the 1- and 2-day groups, yielding take-home baby rates of 3.9% per cycle (7.5% per patient) and 15.3% per cycle (33.0% per patient), respectively. The cumulative probability of conception over 15 cycles of treatment was consistently twice as high or higher for the 2-day group. The results of this study support the use of 2-day IUI treatment cycles when using frozen-thawed donor sperm.     

Idiopathic hirsutism or polycystic ovary syndrome?

Polycystic ovaries (PCO) were detected using ultrasound imaging in a series of 173 women who presented with significant hirsutism and in some cases with irregular menstruation. Patients were divided into 3 groups. Those with hirsutism and regular menstruation (cycles > 8 per year, Group 1, n = 96); those with hirsutism and oligomenorrhoea (cycles < 8 per year, Group 2, n = 44) and those with hirsutism and amenorrhoea (cycles < 2 per year, group 3, n = 33). These 3 groups were compared with subjects with normal ovaries and regular cycles of 26-34 days and without hirsutism (n = 29) and also with a group of women with PCO and regular cycles who had no sign of hirsutism (n = 90). PCO were found in 86% of Group 1, 97% of Group 2 and 94% of women within Group 3. The results suggest that the term 'idiopathic hirsutism' may not be appropriate. An abnormal biochemical test consisting of a luteinizing hormone level > 9 U/L, testosterone level > 2.2 nmol/L, sex hormone binding globulin < 32 nmol/L or free androgen index > 4.5 was 100%, 91% and 76% sensitive for detecting PCO amongst women with amenorrhoea, oligomenorrhoea and idiopathic hirsutism respectively.     

Factors associated with limb loss despite a patent infrainguinal bypass graft

Lower-extremity limb salvage should parallel infrainguinal bypass graft patency. To determine factors associated with limb loss despite a patent bypass, we reviewed 191 consecutive infrainguinal bypasses in 158 patients followed prospectively over 42 months. In this series of 176 (92%) vein grafts, 15 (8%) expanded polytetrafluoroethylene grafts, 122 (64%) tibial artery bypasses, and 170 (89%) bypasses placed for limb salvage, 29 major lower-extremity (above-knee or below-knee) amputations were performed in 29 patients, 12 because of ischemia after graft thrombosis and 17 (9% of series) due to progression of soft tissue infection/necrosis despite a functioning bypass. Primary and secondary 36-month vein graft patencies by life-table analysis were 61 per cent and 81 per cent, respectively. When the 17 cases of limb loss were compared to the rest of the series, nonstatistically significant variables included male sex [11 (65%) vs 79 (56%); P = 0.608] and diabetes [12 (71%) vs 80 (57%); P = 0.310]. Statistically significant variables included black race [9 (53%) vs 39 (28%); P = 0.048]; chronic renal failure [6 (35%) vs 12 (9%); P = 0.005], placement to a tibial/pedal artery [15 (88%) vs 107 (62%); P = 0.034], distal anastomosis to the anterior tibial/dorsalis pedis (AT/DP) artery [8 (47%) vs 27 (16%); P = 0.004], and grafts requiring late revision [7 (41%) vs 22 (13%); P = 0.006]. Thirteen (76%) extremities had an intact pedal arch. Nine amputations were performed within 30 days (early group), and eight were performed from 45 days to 20 months (median, 8 months) after bypass placement (late group). The most common primary causes of limb loss in the early group were overwhelming progression of soft-tissue infection despite patent bypass (n = 4; 44%) and insufficient runoff in the foot (n = 3; 33%). In the late group, amputation most often followed long treatment of a chronic proximal diabetic neuropathic foot ulcer with osteomyelitis. Five (63%) grafts in this group were anastomosed to the AT/DP arteries. These data suggest that patients with chronic renal failure, chronic neuropathic heel ulcers, and an AT/DP bypass are at greater risk for amputation despite a working bypass, especially if the graft develops a hemodynamically significant stenosis. Careful judgment and patient selection under these circumstances are thus justified.     

Protein supplementation of ammoniated wheat straw: effect on performance and forage utilization of beef cattle

We studied the effects of supplement CP concentration on performance and forage use of cattle allowed ad libitum access to ammoniated wheat straw. During two consecutive winters, crossbred beef cows in late gestation (n = 87 in 1990-1991, n = 84 in 1991-1992) were used in a randomized complete block design with three pens per treatment. Cows were stratified by weight, body condition score (BCS), age, and breed and randomly assigned within strata to 1) control (C, no supplement), or 2 kg/d of 2) low-protein (LP) supplement (12% CP), 3) moderate-protein (MP) supplement (20.1% CP), or 4) high-protein (HP) supplement (31.7% CP) (DM basis). The feeding period was 84 d in 1990-1991 and 60 d in 1991-1992. Supplementation (C vs LP, MP, or HP) increased (P < .01) cow weight gains (32.7 vs 60.7, 62.8, and 72.4 kg, respectively) and improved (P < .01) BCS. Calf birth weights, weaning weights, and ADG were not affected by treatment (P > or = .20). Average calving date, percentage of cows cycling at the start of the breeding season and percentage pregnant after a 60-d breeding season were also similar (P > .20) among treatments. Sixteen ruminally fistulated steers (482 kg, four steers per treatment) were blocked by weight and assigned to the same four supplements in a 30-d digestion trial. Supplementation increased (P < .01) digestible DMI and forage DMI (P < or = .04) and tended (P = .09) to increase digestible NDF intake but did not alter (P > or = .15) apparent DM or NDF digestibility.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cytotoxic effect of accelerated carbon beams on glioblastoma cell lines with p53 mutation: clonogenic survival and cell-cycle analysis

This study investigated the effects of feeding the orally active progestagen, altrenogest (Regumate) post-weaning on the subsequent reproductive performance of early weaned sows. Ninety (90) Large White/Landrace first parity sows were randomly assigned to three treatments. Treatment 1 (EW) and treatment 3 (CW) sows were weaned on day 12 and day 24 post-partum, respectively while treatment 2 sows (EW-R) were weaned on day 12 post-partum and received an individual daily dose of 20 mg of Regumate on days 13 to 24 post-partum inclusive. Each sow was mated naturally at least twice at the first post-weaning or post-treatment oestrus and slaughtered on days 25-28 of pregnancy to determine the number of corpora lutea and embryos. Regumate-to-oestrus and weaning-to-oestrus intervals were similar for EW-R and CW sows (6.2 vs. 5.6 days). However, both intervals were significantly shorter (P < 0.01) than the weaning-to-oestrus interval of EW sows (7.3 days). An excellent synchronization of oestrus was achieved with Regumate treatment with 97% of treated sows in oestrus within 7 days of Regumate withdrawal compared with 64% for EW sows (P < 0.01) and 87% for CW sows (P > 0.05). Treatment with Regumate resulted in a significant increase in ovulation rate (16.9 vs. 15.4 and 14.9 for treatments EW-R, EW and CW, respectively; P < 0.05) and a non-significant increase in early embryonic survival (77% vs. 68% vs. 68% for treatments EW-R, EW and CW, respectively; P > 0.05). These results indicate that Regumate feeding is a potential management tool to alleviate the diminished reproductive performance associated with early weaning regimes since it leads to successful control of oestrus, higher ovulation and embryo survival rates and thus a greater potential litter size.     

Important microsatellite markers in the investigation of replication errors (RER) in colorectal carcinomas

PURPOSE: Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients. METHODS: All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34-36 hr after hCG administration followed by a 48-hr transcervical ET. RESULTS: No differences were seen in cycles the day prior to (d-1) and the day of a spontaneous LH surge, (n = 18) or hCG (d-0)(n = 17) in group I or group II with respect to lead follicular diameter (d-1, 15.3 +/- 0.6 vs. 14.2 +/- 0.9 mm; d-0, 17.4 +/- 0.8 vs. 17.8 +/- 0.6 mm) and serum estradiol (d-1, 148 +/- 15 vs. 150 +/- 15 pg/ml; d-0, 218 +/- 15 vs. 199 +/- 16 pg/ml), respectively. However, serum progesterone was significantly elevated in group I compared with group II on d-1 (0.82 +/- 0.6 vs. 0.48 +/- 0.04 ng/ml; P < 0.05) and d-0 (1.1 +/- 0.12 vs. 0.63 +/- 0.08 ng/ml; P < 0.05). Inhibin A was significantly greater on d-1 in group I (24 +/- 2.5 vs. 15 +/- 2.2 pg/ml; P < 0.05). In group II, cycles that resulted in an ET (n = 10) compared with group II cycles that did not (n = 7) revealed a significant difference in serum progesterone (0.51 +/- 0.05 vs. 0.7 +/- 0.07 ng/ml; P < 0.05) and inhibin A (15 +/- 2.5 vs. 37.3 +/- 5 pg/ml; P < 0.05) the day of hCG. CONCLUSIONS: The possible application of serum progesterone and inhibin A in managing natural-cycle IVF-ET is suggested. These assays may predict women who should be set up for egg retrieval, while cancelling others in spite of the absence of an LH surge.     

Effect of feed restriction and season on LH and prolactin secretion, adrenal response, insulin and FFA in group housed pregnant gilts

A trial was designed to determine the effect of season and feed restriction on LH and prolactin secretion, adrenal response, insulin and FFA in the early pregnant gilt. Groups of cross bred gilts (n = 24) were mated and allocated to two feeding levels; a non-restricted group received close to ad libitum feeding of 3.6 kg whereas, the restricted group received 1.8 kg as recommended by the NRC. The trial was carried out in winter-spring and repeated in summer-autumn to investigate the effects of season. The feeding regimen were fed to the group housed animals for the first two weeks of pregnancy. A 12 h period of blood sampling every 15 min thereafter revealed higher amplitude LH pulses with larger area under the curve in winter compared with summer (1.17 +/- 0.03 vs. 0.69 +/- 0.03 ng ml(-1) and 65.09 +/- 1.46 vs. 33.60 +/- 1.25, P < 0.05). Overall, feed restriction reduced LH pulse frequency (2.5 +/- 0.1 and 1.6 +/- 0.1 pulses/12 h for high and low feeding levels, P < 0.05), but the difference was large in winter and no difference was detected in summer. An ACTH challenge test carried out the day after the frequent sampling revealed greater response to the ACTH challenge in winter in comparison with summer. Plasma prolactin values were generally very low and ranged from 1 to 4.5 ng/ml with highest values detected in the feed restricted group in summer. Plasma FFA and insulin concentrations showed greater pre- versus post-prandial variation in the feed restricted groups. It was concluded, that feed restriction and season affected LH secretion and those effects appeared to be related to the metabolic changes in the early pregnant group housed gilt.     

Identification of anovulation and transient luteal function using a urinary pregnanediol-3-glucuronide ratio algorithm

The sensitivity and specificity of a urinary pregnanediol-3-glucuronide (PdG) ratio algorithm to identify anovulatory cycles was studied prospectively in two independent populations of women. Urinary hormone data from the first group was used to develop the algorithm, and data from the second group was used for its validation. PdG ratios were calculated by a cycles method in which daily PdG concentrations indexed by creatinine (CR) from cycle day 11 onward were divided by a baseline PdG (average PdG/Cr concentration for cycle days 6-10). In the interval method, daily PdG/CR concentrations from day 1 onward were divided by baseline PdG (lowest 5-day average of PdG/CR values throughout the collection period). Evaluation of the first study population (n = 6) resulted in cycles with PdG ratios > or = 3 for > or = 3 consecutive days being classified as ovulatory; otherwise they were anovulatory. The sensitivity and specificity of the PdG ratio algorithm to identify anovulatory cycles in the second population were 75% and 89.5%, respectively, for all cycles (n = 88); 50% and 88.3% for first cycles (n = 40) using the cycles method; 75% and 92.2%, respectively, for all cycles (n = 89); and 50% and 94.1% for first cycles (n = 40) using the interval method. The "gold standard" for anovulation was weekly serum samples < or = 2 ng/ml progesterone. The sensitivity values for all cycles and for the first cycle using both methods were underestimated because of apparent misclassification of cycles using serum progesterone due to infrequent blood collection. Blood collection more than once a week would have greatly improved the sensitivity and modestly improved the specificity of the algorithm. The PdG ratio algorithm provides an efficient approach for screening urine samples collected in epidemiologic studies of reproductive health in women.     

Intrapartum prophylaxis with ceftriaxone decreases rates of bacterial colonization and early-onset infection in newborns

Because of high rates of neonatal gram-negative sepsis in many Latin American countries, we prospectively enrolled 784 high-risk pregnant women in a study designed to evaluate the effect of a single 1-g dose of ceftriaxone (n = 390) vs. that of no antibiotic prophylaxis (n = 394) on oral, rectal, and umbilical colonization and fatality rates among newborn infants. The mean ceftriaxone concentration in cord blood samples was 26 microgram/mL (range, 9-40 microgram/mL). Compared with infants of untreated mothers, children born to women who were given ceftriaxone were colonized at a lesser rate by gram-negative bacilli (54% vs. 35%; P < .001) and by group B streptococci (54% vs. 21%; P = .03) and endured significantly fewer sepsis-like illnesses in the first 5 days of life (8.1% vs. 3.1%; P = .004). There was also a tendency for them to have fewer episodes of culture-proven early-onset sepsis (2.8% vs. 0.5%; P = .06). Sepsis-related case-fatality rates (0.8% and 0.3%, respectively) were not significantly different. Although intrapartum administration of a single dose of ceftriaxone to high-risk mothers could be a safe and potentially useful strategy for reducing early-onset neonatal infections, additional information is required before this approach can be recommended for routine prophylaxis.     

Risk factors for coronary atherosclerosis. Comparison between two Argentine regions

The prevalence of risk factors for coronary atherosclerosis were studied in two population samples, Northeast (Posadas, n = 498) and South (Viedma, C. Rivadavia and Cipolletti, n = 652) of 20 years and older, males and females. The diet in the Northeast (n = 102) contained more monounsaturated acids and polyunsaturated acids than the one in the South (n = 62), 9.5 +/- 4.1 vs. 8.1 +/- 3.5% TCV (Total Caloric Value) (P < 0.02) and 8.1 +/- 4.1 vs. 6.2 +/- 3.0% TCV (P < 0.001) respectively. The P/S relationship was greater in the Northeast, 1.02 +/- 0.44 vs. 0.85 +/- 0.50 (P < 0.001). Total cholesterol (TC) in the Northeast was less than in the South, in males 176 +/- 41 vs. 213 +/- 43 mg/dl (P < 0.001); CLDL (LDL cholesterol) 109 +/- 37 vs. 141 +/- 41 mg/dl (P < 0.001). The most frequent risk factors in the South vs. Northeast (males) were: TC > or = 240 mg/dl, 26.7% vs. 9.5% (P < 0.001); LDL-C > or = 160 mg/dl, 30.3% vs. 10.9% (P < 0.001); Cig > or = 10/d (equal or more than 10 cigarettes per day), 30.0% vs. 16.4% (P < 0.001). The hypertension prevalence (HTA, 160/95), in males, was higher in the Northeast than in the South, 23.7% vs. 11.5% (P < 0.001). BMI > 27 Kg/m2 was higher in the women of Northeast than in the South, 38.4% vs. 24.2% (P < 0.001). In the males of the Northeast, the combination Cig > or = 10/d and HTA, 4.1 vs 0.9% was more common; in the South Cig > or = 10/d and LDL-C > or = 160 mg/d, 8.2% vs. 1.8% (P < 0.001) was more common. The differences in the prevalence of the risk factors between the population samples indicate the need to plan the prevention of coronary atherosclerosis locally.     

Efficacy of brompheniramine maleate for the treatment of rhinovirus colds

We tested the efficacy of brompheniramine maleate in a large randomized, controlled trial of volunteers with experimental rhinovirus colds. Brompheniramine (12 mg) or placebo was administered at 8:00 A.M. and 8:00 P.M. for < or = 4 days after the onset of symptoms (24, 36, or 48 hours after virus challenge). During the first 3 days of treatment (the first 4 days after virus challenge), nasal secretion weights were lower for infected evaluable subjects receiving brompheniramine (n = 113) than for controls (day 1: 4.3 g vs. 6.8 g; day 2: 4.8 g vs. 7.7 g; and day 3: 3.3 g vs. 5.3 g) (P < or = .03), as were rhinorrhea scores (day 1: 0.6 vs. 0.8; day 2: 0.5 vs. 0.8; and day 3: 0.3 vs. 0.5) (P < .03), sneeze counts (day 1: 1.8 vs. 3.6; day 2: 2.1 vs. 5.1; and day 3: 1.3 vs. 3.3) (P < or = .001), and sneeze severity scores (day 1: 0.3 vs. 0.6; day 2: 0.25 vs. 0.7; and day 3: 0.2 vs. 0.4) (P < .001) (n = 112). Cough counts were lower after day 1 of treatment for the brompheniramine group than for controls (4.7 vs. 7.9) (P = .05) (day 2 after virus challenge), and other symptoms were modestly reduced or were unaffected in the brompheniramine group. Total symptom scores were also lower for the brompheniramine group than for controls on treatment days 1 (4.8 vs. 6.0) (P = .03) and 2 (4.1 vs. 5.6) (days 2 and 3 after virus challenge) (P = .003). Treatment with brompheniramine was associated with the adverse effects of somnolence (n = 3) and confusion (n = 1). Brompheniramine was efficacious treatment for the sneezing, rhinorrhea, and cough associated with rhinovirus colds.     

Characteristics and outcome of stroke patients discharged from hospitals in an urban area of Japan

The efficacy and tolerance of short-term immunotherapy (STI) by seven preseasonal injections of tree-pollen allergens (ALK7 Frühblühermischung) was investigated in a double-blind, placebo-controlled, multicenter study with 111 rhinoconjunctivitis patients. Nasal and bronchial symptoms simultaneously analyzed, and nasal symptoms as a single end point, but not the overall score of nasal, bronchial, and conjunctival symptoms, showed a significantly lower increase with STI during birch-pollen exposure (both P=0.033, n=105, Mann-Whitney U-test). However, a selective analysis with patients from centers with high recruitment figures (n> or =10 patients, n=29 STI, n=32 placebo) showed a significantly lower increase of nasal, bronchial, and overall symptom score (STI 11.0 vs placebo 18.0, P=0.001, U-test). STI had equidirected effects on conjunctival, nasal, and bronchial symptoms analyzed as multiple end points, although conjunctival symptoms were not significantly different as a single end point. The seasonal increase in drug use was reduced by 62% in the STI group compared with placebo (P=0.032, t-test). Specific IgG4 increased only after STI (P<0.001); IgE was not significantly different. Eosinophil cationic protein remained unchanged with STI, but significantly increased with placebo in the pollen season (P=0.003). STI was well tolerated. In conclusion, STI was shown to be efficacious and safe for the treatment of patients with tree-pollen rhinoconjunctivitis.     

Cryopreserved arterial allografts in the treatment of major vascular infection: a comparison with conventional surgical techniques

OBJECTIVE: Recent findings with cryopreserved heart valve allografts in the treatment of infectious endocarditis suggest that the use of cryopreserved arterial allografts may improve the outcome in patients with vascular infections. METHODS: Seventy-two patients with mycotic aneurysms (n = 29) or infected vascular prostheses (n = 43) of the thoracic (n = 26) or abdominal aorta (n = 46) were treated with in situ repair and extra-anatomic reconstruction using prosthetic material (n = 38) or implantation of a cryopreserved arterial allograft (n = 34). Disease-related survival and survival free of reoperation were assessed. Morbidity, cumulative lengths of intensive care, hospitalization, antibiotic treatment, and costs were calculated per year of follow-up. RESULTS: The use of cryopreserved arterial allografts was superior to conventional surgery in terms of disease-related survival (P =.008), disease-related survival free of reoperation (P =.0001), duration of intensive care per year of follow-up (median 1 vs 11 days; range 1 to 42 vs 2 to 120 days; P =.001), hospitalization (14 vs 30 days; range 7 to 150 vs 15 to 240 days; P =.002), duration of postoperative antibiotic therapy (21 vs 40 days; range 21 to 90 vs 60 to 365 days; P =.002), incidence of complications (24% vs 63%; P =.005), and elimination of infection (91% vs 53%; P =.001). In addition, costs were 40% lower in the group treated by allografts (P =.005). CONCLUSIONS: The use of cryopreserved arterial allografts is a more effective treatment for mycotic aneurysms and infected vascular prostheses than conventional surgical techniques.     

Menstrual abnormalities in women with Cushing's disease are correlated with hypercortisolemia rather than raised circulating androgen levels

Menstrual irregularity is a common complaint at presentation in women with Cushing's syndrome, although the etiology has been little studied. We have assessed 45 female patients (median age, 32 yr; range, 16-41 yr) with newly diagnosed pituitary-dependent Cushing's syndrome. Patients were subdivided into 4 groups according to the duration of their menstrual cycle: normal cycles (NC; 26-30 days), oligomenorrhea (OL; 31-120 days), amenorrhea (AM; > 120 days), and polymenorrhea (PM; < 26 days). Blood was taken at 0900 h for measurement of LH, FSH, PRL, testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol (E2), sex hormone-binding globulin (SHBG), and ACTH; cortisol was sampled at 0900, 1800, and 2400 h. The LH and FSH responses to 100 micrograms GnRH were analyzed in 23 patients. Statistical analysis was performed using the nonparametric Mann-Whitney U and Spearman tests. Only 9 patients had NC (20%), 14 had OL (31.1%), 15 had AM (33.3%), and 4 had PM (8.8%), whereas 3 had variable cycles (6.7%). By group, AM patients had lower serum E2 levels (median, 110 pmol/L) than OL patients (225 pmol/L; P < 0.05) or NC patients (279 pmol/L; P < 0.05), and higher serum cortisol levels at 0900 h (800 vs. 602 and 580 nmol/L, respectively; P < 0.05) and 1800 h (816 vs. 557 and 523 nmol/L, respectively; P < 0.05) and higher mean values from 6 samples obtained through the day (753 vs. 491 and 459 nmol/L, respectively; P < 0.05). For the whole group of patients there was a negative correlation between serum E2 and cortisol at 0900 h (r = -0.50; P < 0.01) and 1800 h (r = -0.56; P < 0.01) and with mean cortisol (r = -0.46; P < 0.05). No significant correlation was found between any serum androgen and E2 or cortisol. The LH response to GnRH was normal in 43.5% of the patients, exaggerated in 52.1%, and decreased in 4.4%, but there were no significant differences among the menstrual groups. No differences were found in any other parameter. In summary, in our study 80% of patients with Cushing's syndrome had menstrual irregularity, and this was most closely related to serum cortisol rather than to circulating androgens. Patients with AM had higher levels of cortisol and lower levels of E2, while the GnRH response was either normal or exaggerated. Our data suggest that the menstrual irregularity in Cushing's disease appears to be the result of hypercortisolemic inhibition of gonadotropin release acting at a hypothalamic level, rather than raised circulating androgen levels.