Sarcoidosis presenting as an enlarging solitary pulmonary nodule.

Sarcoidosis is generally not considered in the differential diagnosis of solitary pulmonary nodules. We recently encountered a case in which preoperative awareness of this presentation of sarcoidosis allowed a limited pulmonary resection with resultant lower morbidity and potential preservation of lung function to be performed. Although rare, sarcoidosis should be considered in the differential diagnosis of solitary pulmonary nodules.

Minute pulmonary meningothelial-like nodules: thin-section CT appearance.

Minute pulmonary meningothelial-like nodules are often incidentally discovered during pathologic evaluation of pulmonary parenchymal specimens. These lesions were once thought to represent pulmonary chemodectomas, but pathological studies have shown that they are not of neuroendocrine origin. Minute pulmonary meningothelial-like nodules are benign, perhaps reactive in nature, but are occasionally found in association with lung carcinoma. They may appear as randomly distributed well-defined micronodules on thin-section chest CT, and thus may simulate metastatic disease when associated with lung carcinoma.

Characterization of antigenic proteins from Tritrichomonas foetus recognized by antibodies in rabbit serum, bovine serum and bovine cervicovaginal mucus.

Tritrichomonas foetus is an obligate parasite of the bovine urogenital tract and is recognized as 1 of the more common infectious agents causing decreased reproductive efficiency in beef cattle. Infections result in reproductive failure and produce considerable economic loss. Vaccination of heifers with vaccines containing T. foetus induces elevated serological responses to many T. foetus antigens, decreases the rate and/or length of infection with T. foetus, and decreases fetal loss caused by infection. Because T. foetus infections are usually limited to lumen and mucosal surfaces of the reproductive tract, it has been assumed that protection from infection and abortion is partially mediated by immunoglobulins in the uterus and vagina. The objective of this study was to identify and characterize specific antigens of T. foetus that show promise for use in a recombinant vaccine that will generate a protective mucosal immune response in cattle. Surface proteins were identified by using polyclonal rabbit anti-trichomonal sera eluted from paraformaldehyde-fixed cells. Analyses of these proteins, utilizing mucosal antibodies from vaccinated and convalescent cows, have identified proteins involved in generating a local immune response. Western immunoblot analysis indicates that these proteins are well conserved and are excellent candidates for incorporation into a recombinant vaccine.

Double depression: a distinctive subtype of unipolar depression.

Whether depression is a single disease that varies from mild to severe, with varying episode durations and difficult course patterns, or whether it is an umbrella diagnosis representing depressive subtypes with different psychological and biological characteristics has been debated by clinicians and researchers for many years. However, most scientists now agree that understanding the heterogeneous subtypes of depression allows for greater accuracy in describing and differentiating patients suffering from depression and, therefore, greater precision in describing the most efficacious treatment plan. This article will focus on the distinctions between unipolar major depression, double depression and dysthymia, and will review the history of the DSM classifications for these "subtypes" of major depressive disorder, clinicians and researchers continue to subclassify major depression and, particularly, for the purpose of testing the efficacy of new psychopharmocologic and psychosocial treatments. There continues to be a need for future research to more clearly establish the predictive value in terms of course, recovery, rates of relapse and treatment in regard to distinguishing type of depression as well as to validate the current nosology.

Norgestomet implants prevent pregnancy in beef heifers on pasture.

The efficacy of erodible norgestomet implants for preventing pregnancy in postpubertal heifers was evaluated in two experiments at five locations each. Heifers (n = 896) within each study location were stratified by weight and allotted randomly to receive an ear implant containing either 0, 24, 36, or 48 mg of norgestomet (d 0). Heifers were exposed to fertile bulls immediately after implantation for 75 d (d 0 to 74) in Exp. 1 (n = 476) or for 80 d (d 75 to 154) in Exp. 2 (n = 420). Weights were recorded on d 0 and 74 (Exp. 1 and 2) and d 154 (Exp. 2). Each heifer was palpated rectally for pregnancy at the end of each experiment. Pregnancy rates were higher (P < .01) for control heifers (0 mg implant) than for heifers that received 24, 36, or 48 mg of norgestomet. In Exp. 1, pregnancy rates were 96, 29, 6, and 4% for heifers that received 0, 24, 36, and 48 mg implants of norgestomet, respectively. In Exp. 2, pregnancy rates were 85, 36, 19, and 9% for heifers that received 0, 24, 36, and 48 mg implants of norgestomet, respectively. Estrous activity during the first 3 wk of bull exposure was reduced (P < .05) among heifers that received norgestomet implants compared to control heifers but was not completely abolished at any dosage in Exp. 1. During the first 75 d of Exp. 1 and 2, heifers treated with 36 or 48 mg norgestomet implants gained weight faster (P < .05) than control heifers. Combined across both experiments, ADG during the first 74 d were .53, .56, .59, and .60 kg/d for heifers treated with 0, 24, 36, and 48 mg implants of norgestomet, respectively. These data indicate that norgestomet implants increased rate of weight gain, reduced estrous activity, and reduced the occurrence of pregnancy in heifers on pasture.

Supplemental cracked corn or wheat bran for steers grazing endophyte-free fescue pasture: effects on live weight gain, nutrient quality, forage intake, particulate and fluid kinetics, ruminal fermentation, and digestion.

Two experiments were conducted with beef steers (Exp. 1, average BW of 580 kg; Exp. 2, average BW of 247 kg) to evaluate the use of no supplements (CON) or daily supplementation with (OM basis) .34% of BW of cracked corn (CORN), .34% of BW of wheat bran (WBBW), or .48% of BW of wheat bran (WBISO; calculated to be isocaloric to CORN) on digestive responses (Exp. 1) and live weight gain (Exp. 2). In Exp. 1, type of supplement did not affect (P > .10) the dietary fiber or N constituents, but in vitro OM disappearance of the forage differed (P < .10) with supplementation and type of supplement fed. Supplemented steers consumed less (P < .05) forage and total OM. Particulate passage, fluid passage, and ruminal pH were not affected (P > .10) by supplementation. Ruminal NH3 N concentration showed (P < .05) a treatment x sampling time interaction and, in general, WBBW and WBISO steers had greater ruminal NH3 N than CORN and CON steers. Total VFA concentrations and molar proportions of propionate were lower (P < .10) in CON steers than in supplemented steers; no differences were noted (P > .10) among supplemented steers. Molar proportions of acetate were lower (P = .01) in supplemented steers than in CON steers and were greater (P = .03) in WBBW steers than in WBISO steers. Butyrate molar proportions were lower (P < .05) in CON steers than in supplemented steers and differed (P < .10) with type and quantity of supplement supplied. In situ forage NDF disappearance at 6, 9, and 24 h after feeding and rate of disappearance were greater (P < .05) in CON steers than in supplemented steers. In Exp. 2, CON steers weighed less (P = .01) than supplemented steers, CORN steers weighed more (P = .08) than wheat bran-supplemented steers, and WBISO steers weighed more (P = .02) than WBBW steers; ADG for 90 d followed a similar response. Results suggest that supplementation of wheat bran rather than corn did not seem to stop the reduction in forage intake or OM digestion associated with corn supplementation.

Summary of the DSM-IV mood disorders field trial and issue overview.

The DSM-IV Mood Disorders Field Trial addressed several issues concerning the relationship among major depression, dysthymia, recurrent brief depression, minor depression, and depressive personality disorder. The Mood Disorders Field Trial is a naturalistic, multisite study that investigated the diagnostic criteria for dysthymia, the reliability and validity of longitudinal course modifiers, the nosology of minor and recurrent brief depression, and the relationship between depressive personality disorder and dysthymia. Research on the nosology of chronic depressive disorders will, it is hoped, contribute to a better understanding of pathophysiology, etiology, and treatment. This article presents findings from the Field Trial as well as brief reviews of the other nine articles in this issue.

Fine-needle aspiration diagnosis of HIV-related conditions.

The authors highlight the more common conditions that can be diagnosed by FNA, offering examples to illustrate how material obtained from FNA can be triaged for effective patient management. They also discuss the HIV-related changes found in body fluids and other cytologic specimens, such as those from bronchoalveolar lavage and induced sputum.

Sono-urethrography in the evaluation of anterior urethral strictures.

During a 7-year period 123 paired urethrographic and sono-urethrographic studies were performed on 101 patients with 110 urethral strictures. In all but 3 cases the urethra was subsequently evaluated either cystoscopically or at open operation. Sono-urethrography readily identified urethral calculi, diverticula and false passages. It correctly identified the stricture and its site in every case. There was a significant difference between stricture length as measured by urethrography compared to that measured by sono-urethrography (p < 0.003). However, if the strictures were grouped based on anatomical location, there was good correlation and no significant difference in the penile urethra (correlation coefficient = 0.94, p = 0.74) but poor correlation and the significant difference remained in the urethral bulb (correlation coefficient = 0.64, p < 0.007). Similarly, when urethrographic and sono-urethrographic stricture lengths were compared with operative lengths, in the penile urethra the correlation coefficients were close (correlation coefficient = 0.91 versus 0.98) but in the urethral bulb the poor correlation persisted (correlation coefficient = 0.69 versus 0.89). Although sono-urethrography certainly identifies periurethral tissue, it was unreliable in predicting the depth of spongiofibrosis when compared with full depth biopsies in 36 patients with histopathological correlation. Finally, in 16% of the patients sono-urethrography correctly indicated a reconstructive procedure different from that originally suggested by conventional urethrography. Sono-urethrography is a dynamic 3-dimensional study that accurately identifies stricture site, number and caliber. Compared with conventional urethrography, it more accurately measures stricture length and diameter, and identifies periurethral tissue, making it a valuable adjunct in the evaluation of patients with suspected anterior urethral strictures.

Specific antibodies in serum and vaginal mucus of heifers inoculated with a vaccine containing Tritrichomonas foetus.

Thirty-five heifers were allotted to 3 groups. Group 1 (control) consisted of 10 heifers that were not vaccinated and were challenge exposed by breeding to infected bulls. Group 2 (natural challenge exposure) consisted of 10 heifers that were vaccinated and challenge exposed by breeding to infected bulls. Group 3 (experimental challenge exposure) consisted of 15 heifers that were vaccinated and challenge exposed by breeding to infected bulls and by intravaginal inoculation with 10(7) Tritrichomonas foetus. Total immunoglobulin concentrations and specific trichomonal antibodies were determined in serum and vaginal secretions of heifers, using radial immunodiffusion and ELISA procedures. Control heifers remained infected for a mean of 10.6 weeks (range, 0 to 18 weeks), and heifers of the natural and experimental challenge-exposure groups remained infected for 3.2 and 5.0 weeks, respectively (range, 0 to 12 weeks). Total serum and cervicovaginal mucus concentrations of IgM, IgA, IgG1, and IgG2 did not change significantly after vaccination or challenge exposure. However, ELISA titers of total trichomonal antibodies increased up to 1:10,000 (range, 1:400 to 1:10,000) in serum after vaccination, and increased approximately tenfold above background in cervicovaginal mucus. In serum, the predominant trichomonal antibody isotype was IgG1, although trichomonal IgA and IgM antibodies also increased. The predominant trichomonal antibody detected in cervicovaginal mucus was IgA. Antibody titers in serum and cervicovaginal mucus of vaccinated heifers were not increased by infection. However, in control heifers, the total local trichomonal antibody response increased three- to fivefold after infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Anxiety symptom relief in depression treatment outcomes.

Depressive and anxiety disorders have a high lifetime prevalence--8% and 15%, respectively. Unipolar depression has a 5% lifetime prevalence, whereas the prevalence rate for all depressive disorders is between 6% to 8% at a minimum. Each disorder has also been found to have a high rate of chronicity and recurrence. It has become increasingly apparent over the past decade that within episodes of depression, anxiety symptoms often exist. Whether this phenomenon indicates two separate but comorbid illnesses or that the presence of anxiety symptoms is part of the course of depression is of particular significance for diagnosis and treatment. The author focuses on the issues of differential diagnosis, including physical and emotional manifestations of the illness. The consequences of comorbid anxiety and depression can be serious, ranging from social and physical disability to suicidal ideation and behavior. Anxiety has been found to be a predictor of suicide in depressed patients, and since anxiety symptoms respond to intervention, they can also serve as an indication of type of treatment. Antidepressants should be used in treating anxiety or panic symptoms when depression is also present. In studies comparing benzodiazepines, monoamine oxidase inhibitors (MAOIs), serotonin selective reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs) in the treatment of concurrent anxiety and depression, all have some measure of success depending on the degree of depression and the type of anxiety disorder. SSRIs may have the least amount of side effects, but more long-term studies are needed to determine the long-term efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

The natural history and heterogeneity of depressive disorders: implications for rational antidepressant therapy.

Depression is a chronic, recurrent illness that affects approximately 8% of the U.S. population. There are several types of depressive disorders including major depression, unipolar depression, bipolar depression, double depression, and dysthymia. For those afflicted, each type of depressive disorder can cause a loss of productivity, job status, and income and can result in poor health and suicide. Depression also has a high rate of comorbidity with other disorders, especially anxiety disorders and alcoholism; yet, depression is still undertreated and underrecognized by most physicians. This is particularly unfortunate because there are many antidepressant medications currently available that are effective in treating this insidious illness. To continue to combat this dangerous illness, more clinical trials are needed to help us maximize the benefits and minimize the risks associated with current antidepressant medications.

Supplemental protein for beef cattle grazing dormant intermediate wheatgrass pasture: effects on nutrient quality, forage intake, digesta kinetics, grazing behavior, ruminal fermentation, and digestion.

Sixteen ruminally cannulated yearling beef cattle (British x British; average BW = 295 +/- 25 kg; three steers and one heifer per treatment) grazing dormant intermediate wheatgrass (Thinopyrum intermedium Host) were allotted to four treatments: 1) no supplement (CON); 2) alfalfa hay (ALF; .52% of BW); 3) cottonseed meal (CSM; .22% of BW); and 4) corn gluten meal-wheat bran feed (CGMWBF; .36% of BW). Supplements were formulated (DM basis) so that intakes were isonitrogenous and were provided once daily (0700). Sampling periods were in February (FEB; .96% N in masticate), March (MAR; 1.06% N in masticate), and April (APR; 1.12% N in masticate) following an initial 21-d adaptation period. Daily grazing time was 1.1 to 1.5 h longer (P < .05) for CON cattle than for supplemented cattle. Forage OM intake (OMI) was not altered (P > .15) by supplemental protein; however, total OMI was greater (P < .04) for supplemented than for unsupplemented cattle. Harvesting efficiency (grams of OM intake-kilogram of BW-1.minute spent grazing-1) was greater (P < .05) for cattle fed CSM than for those fed CGF or CON; cattle fed ALF were intermediate in harvesting efficiency. Ruminal fluid kinetics, in situ rate and extent of NDF digestion, and total VFA concentration were not influenced (P > .10) by type of supplemental protein. Ruminal NH3 N concentration exhibited a treatment x sampling time interaction (P < .05). Type of protein supplement did not seem to affect most digestion measures; however, harvesting efficiency was influenced by supplement type.

Effects of pregnancy on digesta kinetics and ruminal fermentation in beef cows.

Four pregnant and four nonpregnant, ruminally cannulated beef cows were used to evaluate the effects of the last trimester of pregnancy on digesta kinetics and ruminal fermentation. Before breeding, cows were allotted randomly either to pregnant (PR) or to nonpregnant (NP) groups; PR cows were bred at the first estrus after synchronization. All cows were fed long-stem fescue hay at 15 g of DM/kg of BW based on BW 120 d before parturition of pregnant cows (average BW of 642 kg). Collection periods, each lasting 9 d, began at 96, 68, 41, and 10 +/- 1.3 d before parturition. Particulate passage rate was greater (P < .05) and retention times and gastrointestinal fill were less (P < .05) for PR than for NP cows. Apparent total tract DM digestion, rate and extent (96-h in situ incubation) of NDF disappearance, and ruminal fluid kinetics were not affected (P > .10) by pregnancy. A physiological state x sampling day interaction was noted (P < .05) for ruminal NH3 N, total VFA concentrations, and molar proportions of butyrate. Ruminal pH and individual VFA proportions, however, did not differ (P > .10) between PR and NP cows, except for valerate, which was less (P < .05) for PR than NP cows. Results suggest that in late pregnancy with restricted feeding, passage rate of particulates increases without substantial changes in fermentation or extent of digestion.

Papillary carcinoma of the male breast. Report of a case diagnosed by fine needle aspiration cytology.

An 81-year-old male with prostatic carcinoma presented with a large right breast mass and underwent a fine needle aspiration biopsy, which revealed a primary papillary carcinoma of the breast. This lesion was unrelated to the patient's prostatic carcinoma and is the first case of papillary carcinoma of the male breast, to our knowledge, diagnosed by fine needle aspiration cytology. This case is described, and previous literature on the cytologic features of papillary breast carcinoma and carcinoma of the male breast is briefly reviewed.