Hickman catheter-related infections in neutropenic patients: insertion in the operating theater versus insertion in the radiology suite.

PURPOSE: To determine the influence of microbial air quality during Hickman catheter insertion in the operating theater versus insertion in the radiology suite on the incidence of catheter-related infections (CRIs). PATIENTS AND METHODS: Hemato-oncologic patients with prolonged neutropenia on antimicrobial prophylaxis were entered onto the study. Catheters were inserted by experienced radiologists under sonographic and fluoroscopic guidance. RESULTS: Forty-eight Hickman catheters in 39 patients were inserted (23 in the operating theater, 25 in the radiology suite). CRIs were seen in 16 catheters (33%; six per 1,000 catheter days; eight in each group). Local infections were found in nine catheters (22%; six in the operating theater v three in the radiology suite; not significant [NS]), catheter-related bacteremia was found in 10 (29%; three in the operating theater v seven in the radiology suite; NS). Coagulase-negative staphylococci (CoNS) caused all CRIs. Despite early vancomycin therapy, 11 (69%; four in the operating room group v seven in the radiology suite group; NS) of the catheters with CRIs had to be removed prematurely. At 90 days after insertion, catheter survival was 78% and 60% (NS) for the operating room and radiology suite, respectively. Multivariate analysis showed that neutropenia increased the CRI risk 20-fold (P =.004) and was strongly related to premature catheter removal owing to infection (relative risk = 11.9; P =.009). Neutropenia on the day of insertion was also significantly correlated with CRI (P =.04) and premature catheter removal owing to infection (P =.03). Serial cultures of blood, exit site, and catheter hub did not predict the development of CRI. CONCLUSION: The high incidence of Hickman CRI caused by CoNS was not associated with insertion location (operating theater v radiology suite). Neutropenia, including neutropenia on the day of insertion, was a significant risk factor for CRI and infection-related catheter removal.

Concentrations of carnitine in the seminal fluid of normospermic, vasectomized, and castrated dogs.

Concentrations of total carnitine (free and esterified) were determined in seminal fluids from 12 normospermic dogs before treatment and from the same 12 dogs after assignment to control, vasectomized, or castrated treatment groups (4 dogs each). Before treatment, the mean concentration (+/- SD) of carnitine in seminal fluid was 946 +/- 345 nmol/ml and was not significantly different (P greater than 0.05) among groups on any seminal collection day. After surgery, mean concentrations of carnitine in seminal fluid from vasectomized and castrated dogs were 49 +/- 9 and 14 +/- 5 nmol/ml, respectively and were lower (P less than 0.001) than the mean concentration in control (sexually intact) dogs. Dogs with obstructive azoospermia may be distinguished from those with aspermatogenesis (secretory azoospermia) by measuring seminal carnitine concentration. Seemingly, the epididymis is the major source of carnitine in canine seminal fluid, because the concentration of carnitine in prostatic fluid was only 58 +/- 53 nmol/ml, whereas the concentration of carnitine in 6 pools of epididymal fluid was 18.8 +/- 3.9 mumol/ml.

Efficacy and toxicity of estrogens commonly used to terminate canine pregnancy.

Three groups of bitches were treated with diethylstilbestrol (75 micrograms/kg) orally for 7 days (n = 12), estradiol cypionate intramuscularly once (22 micrograms/kg; n = 12), or estradiol cypionate intramuscularly once (44 micrograms/kg; n = 12). Treatments commenced during late proestrus (n = 4/group), the fourth day of behavioral estrus (n = 4/group), or the second day of diestrus (n = 4/group). All bitches were bred on alternate days throughout estrus to stud dogs of known fertility. Ovariohysterectomies were performed on day 25 of diestrus to diagnose pregnancy and to assess any pathologic changes in the uterus. Eleven bitches treated with diethylstilbestrol, 6 bitches treated with the low dosage of estradiol cypionate, and 4 bitches receiving the high dosage of estradiol cypionate were pregnant at the time of surgery. Ten of the bitches treated with estrogens during proestrus, 6 treated during estrus, and 4 treated during diestrus were pregnant. The serum concentration of progesterone in 2 bitches treated with the high dosage of estradiol cypionate decreased to less than 2 ng/ml by day 25 of diestrus, suggesting premature luteal regression. Diethylstilbestrol appeared to have little efficacy in terminating pregnancy. Estradiol cypionate appeared to have greater efficacy when administered during estrus or early diestrus; however, pyometra developed in 2 bitches treated with this estrogen during diestrus.

Concentrations of progesterone and luteinizing hormone in the serum of diestrous bitches before and after hysterectomy.

Blood was collected from 6 adult bitches (3 pregnant and 3 nonpregnant) daily for 59 days after the onset of diestrus, and serum progesterone concentrations were determined. The bitches were hysterectomized at various times during diestrus [diestrus day (DD) 5, 15, or 25] to determine whether the uterus has a role in maintaining luteal function in the pregnant or nonpregnant bitch. Concentrations of serum luteinizing hormone (LH) were also measured to determine whether LH concentrations decrease when luteal function abates (experiment 1). All 6 bitches in experiment 1 had progesterone concentrations greater than 1.0 ng/ml during the 2-month period, indicating that neither the pregnant nor nonpregnant uterus was necessary for maintaining luteal function in the bitch. Concentrations of LH appeared to increase in the serum of 5 of the 6 bitches when progesterone concentrations were declining, indicating that cessation of luteal function does not appear to result from a lack of LH. Blood was collected from the 6 bitches used in experiment 1 twice weekly during the 2nd diestrus after hysterectomy (experiment 2) to determine whether alterations in luteal function that might be observed during experiment 1 were due to some aspect of the surgical procedure, rather than to absence of a uterus. Progesterone concentrations in the serum were lower (P less than 0.05) during the 10 days after surgery in the 2 bitches hysterectomized on DD 5 than in the 4 bitches remaining intact during this period (experiment 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Validation of radioimmunoassays to measure prostaglandins F2 alpha and E2 in canine endometrium and plasma.

Equilibrium, double-antibody radioimmunoassay (RIA) procedures were validated to measure concentrations of prostaglandin (PG) F2 alpha, and E2 in canine plasma and endometrium. The procedure for measuring PGF2 alpha or PGE2 used [125I]PGF2 alpha or [3H]PGE2, respectively, as radiolabeled antigens. Specificity was demonstrated by determining the relative potency of selected PG. Relative potencies were calculated by dividing the mass of PGF2 alpha or PGE2 producing 50% inhibition of maximum bound tubes (Bo) by the quantity of test PG producing 50% inhibition in the same assay. Only PGF1 alpha and PGE1 had relative potencies of greater than 1.0% in the PGF2 alpha and PGE2 RIA, respectively. To assess the accuracy of the 2 assay systems, known amounts of authentic hormone were added to plasma, tissue, or 0.05M phosphate-buffered saline solution containing 0.1% gelatin (gel-PBSS). When increasing amounts of PGF2 alpha or PGE2 were added to plasma, tissue, or gel-PBSS, concentrations of PG assayed from extracted or extracted plus chromatographed samples were similar. Additionally, PGF1 alpha or PGE1 was not detected in canine plasma or tissue; therefore, extraction was the only purification needed before analysis of PGF2 alpha or PGE2. The intra-assay precision of 10 assay replicates for a low (70% Bo) and high (27% Bo) sample was 16.0% and 6.7% (coefficient of variation), respectively, for the PGF2 alpha assay. The intra-assay precision of 3 assay replicates for a low (80% Bo) and high (32% Bo) sample was 7.6% and 4.4%, respectively, for the PGE2 assay.(ABSTRACT TRUNCATED AT 250 WORDS)

Concentrations of testosterone in canine serum during late anestrus, proestrus, estrus, and early diestrus.

Serum testosterone concentrations in samples collected daily from 6 bitches for at least 60 days before the onset of diestrus were determined by radioimmunoassay. Mean serum concentrations (+/- SEM) of testosterone ranged from 31 +/- 11 to 141 +/- 63 pg/ml during late anestrus. Mean testosterone concentrations during proestrus ranged from 106 +/- 29 to 239 +/- 113 pg/ml, with the highest concentration (526 +/- 225 pg/ml) occurring the day of the preovulatory surge of luteinizing hormone. Although the ovaries may be sites of production during late anestrus, proestrus, estrus, and early diestrus, further investigation is necessary to determine whether testosterone has an important physiologic or endocrinologic function in the bitch (ie, sexual behavior, vaginal hypertrophy, and luteinizing hormone surge).

Concentrations of reproductive hormones in canine serum throughout late anestrus, proestrus and estrus.

Concentrations of estradiol, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin in serum from 6 bitches bled daily for at least 45 days before the onset of proestrus, during proestrus and estrus were determined by radioimmunoassay. Mean concentrations of estradiol in serum were high early in the sampling period (20 to 46 pg/ml) and appeared to decrease prior to the onset of proestrus (8 to 19 pg/ml). There were sporadic increases in serum concentrations of LH throughout the sampling period in each bitch. Five of the 6 bitches sampled had increased serum concentrations of LH following the low mean concentration of estradiol just before the onset of proestrus. Mean concentrations of FSH were highest during anestrus (240 to 294 ng/ml) and near the time of the preovulatory surge of LH (297 ng/ml) and were lowest during proestrus (131 to 200 ng/ml). The mean concentration of progesterone for the 6 bitches remained at less than 1.0 ng/ml throughout late anestrus, but increased to greater than 1.0 ng/ml the day of the maximum mean concentration of LH (preovulatory LH surge). Mean concentrations of prolactin were variable throughout the sampling period and demonstrated no consistent pattern among bitches. The results of the current investigation suggest that neither the canine ovary nor pituitary are quiescent during anestrus. The bitch appears to have sufficient FSH present during anestrus for follicular growth. Serum concentrations of LH appear to increase prior to the onset of proestrus when concentrations of estradiol are lowest, possibly inducing a new follicular phase. Progesterone and prolactin do not appear to be involved in the termination of anestrus in the bitch.