Horner syndrome-A rare complication after thyroidectomy for benign thyroid swelling.

Horner syndrome occurring after thyroidectomy is a rare entity and most of the reported cases have happened after surgeries on malignant thyroid swellings. In the present report, we describe a 27-year-old female who developed ptosis, miosis, enophthalmos, and anhidrosis on the second post-operative day after thyroidectomy for benign goiter. Post-operative ultrasound, computed tomography of neck, nerve conduction study, and electromyography of brachial plexus were unremarkable. Patient was kept on conservative management. She was given short course of Prednisolone orally for 2 weeks and was discharged on 150 mcg thyroxine. She had significant improvement in ptosis, miosis, and enophthalmos after six months. Horner syndrome is a rare but an important complication after thyroidectomy which may lead to cosmetic disfigurement. Surgeons should be well aware of this possibility and its presentation for timely recognition and management postoperatively. Early intervention should be done for any reversible cause, i.e., hematoma and oral steroids should be initiated as early as possible.

Femoral pseudoaneurysm in drug addicts--excision without revascularization is a viable option.

PURPOSE: To present a series of patients presenting with femoral pseudoaneurysm. RESULTS: Seventeen patients who presented with a femoral pseudoaneurysm during a 1 year period were included in this study. Parenteral drug abuse was the most common aetiological factor. The femoral artery was most commonly involved at its bifurcation. Sixteen patients (94%) had excision of the pseudoaneurysm with ligation of vessel and debridement without any revascularization and one patient (6%) had reverse saphenous grafting after excision and ligation of vessels. Four amputations (23%) were performed. Three (17%) were major limb amputations, which included one above knee and two below knee amputations. Four patients (23%) developed intermittent claudication. CONCLUSION: Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment.

Dietary arginine intake alters avian leukocyte population distribution during infectious bronchitis challenge.

Although dietary arginine is a factor in immune function and disease resistance, the full range of effects has yet to be described. In this study, the effects of dietary arginine on leukocyte population changes were examined in the peripheral blood and the respiratory tract of chickens inoculated with infectious bronchitis virus (IBV) strain M41. At 2 wk of age, female line P2a White Leghorn-type chickens were randomly assigned to one of three diets with different arginine levels: a marginally deficient diet (0.5%), an adequate diet (1.0%), and a diet containing a high level of arginine (3.0%). All birds were inoculated with IBV at 4 wk of age, and then the peripheral blood and the respiratory lavage were collected at 1 and 7 d postinfection (DPI). The growth rate of birds that received 0.5% arginine was significantly lower than that of birds receiving 1.0 or 3.0% arginine, whereas the growth of the latter groups did not differ. The percentage and absolute number of heterophil (H) and the H/lymphocyte (L) ratio in the peripheral blood at 1 DPI significantly increased as dietary arginine increased. In the respiratory lavage at 1 DPI, the percentage of H also increased with dietary arginine increase. At 7 DPI, the percentage of CD8+ cells from birds fed the deficient diet was lower than those from birds fed the adequate diet and the diet containing a high level of arginine, whereas the cell surface density of CD8 antigen did not vary among groups. These results show that dietary arginine influences the character of the chicken cellular response to IBV and the distribution of responding leukocyte subpopulations in a target tissue for the infection.

Genetic and antigenic diversity in avian infectious bronchitis virus isolates of the 1940s.

In order to verify a commonly held assumption that only Massachusetts (Mass) serotype of infectious bronchitis virus (IBV) was prevalent in the United States between the 1930s (when IBV was first isolated) and the 1950s (when the use of commercial IBV vaccines began), we examined 40 IBV field isolates from the 1940s. Thirty-eight of those isolates were recognized as Mass serotype viruses based on their reactivity to Mass-specific monoclonal antibody (Mab) and neutralization by Mass-specific chicken serum. The remaining two isolates, N-M24 and N-M39, that did not react with Mass-specific Mab, resisted neutralization by Mass-specific chicken serum, and were neutralized only by homologous chicken antibody were identified as non-Mass IBV. When the first 900 nucleotides (nt) from the 5'-end of the spike (S1) glycoprotein gene and their deduced amino acid (aa) sequences were compared, the two non-Mass isolates differed from each other by 24% and 28%, respectively. In a similar comparison, the non-Mass viruses N-M24 and N-M39 differed from M28, a Mass-type isolate from the 1940s, by 21% and 22% (nt) and 28% and 27% (aa), respectively. These data indicate that antigenic and genetic diversity among IBV isolates existed even in the 1940s. Interestingly, when the N-terminal region of the S1 of M28 was compared to that of M41, a prototype Mass virus that has undergone countless number of in vivo and in vitro host passages, the two viruses differed by only 2% (nt) and 4% (aa). This finding suggests that frequent genetic changes are not inherent in all IBV genomes.

Maternal antibody to infectious bronchitis virus: its role in protection against infection and development of active immunity to vaccine.

Chicks hatched with high levels of maternal antibody had excellent protection (>95%) against infectious bronchitis virus (IBV) challenge at 1 day of age, but not at 7 days (<30%). This protection significantly (P<0.05) correlated with levels of local respiratory antibody and not with serum antibody.A high percentage of both maternal antibody-positive (Mab+) and maternal antibody-negative (Mab-) chicks failed to produce IBV antibody when vaccinated at 1 day of age by the intraocular route. In addition, Mab+ chickens had a weaker virus-neutralizing antibody response to a second IBV vaccination compared to Mab- birds (P<0.05). Mab+ chicks experienced a more rapid decline (P<0.01) in maternal antibody after 1-day-of-age vaccination compared to their unvaccinated counterparts.A monoclonal antibody-based blocking ELISA that measured antibody levels specific to S1 glycoprotein of IBV correlated well with virus-neutralizing antibody titers.

Isolation and characterization of a novel antigenic subtype of infectious bronchitis virus serotype DE072.

Three infectious bronchitis virus (IBV) isolates, CU82792, CU82805, and CU82808, were recovered from sentinel chickens placed with three different layer flocks of a large commercial poultry farm in New York State. The three isolates were classified as members of the DE072 serotype on the basis of 1) their S1 genes could be amplified with only a modified primer designed for the DE072 serotype and 2) their restriction fragment length polymorphism patterns, after digestion with endonucleases HaeIII, BstyI and XcmI, were indistinguishable from that of DE072 virus. Additional characterization of one of the isolates, CU82805, revealed that its S1 gene bears approximately 96% identity at the nucleotide level and 94% identity at the amino acid level with DE072. Yet, in an in vitro reciprocal virus neutralization test, only a one-way neutralization was observed, i.e., antiserum to CU82805 neutralized DE072, whereas CU82805 was not neutralized by DE072 antiserum. Implications of these findings with regard to IBV diagnosis and immunization are discussed.

Sequence analysis of gene 3, gene 4 and gene 5 of avian infectious bronchitis virus strain CU-T2.

We have previously reported the nucleotide sequences of gene 2 (spike (S) protein gene), gene 6 (nucleocapsid (N) protein gene), and the 3' end untranslated region of a novel avian infectious bronchitis virus (IBV) strain, CU-T2 [Jia et al. (1995) Arch. Virol. 140, 259 271]. In the present report we describe the sequences of the remaining genes of this strain (gene 3, 4 and 5) with the exception of gene 1 (RNA polymerase gene). Gene 3 contained three open reading frames (ORFs), 3a, 3b and 3c of 174, 195 and 282 nucleotides (nt), respectively. Gene 4 (membrane (M) protein gene) consisted of 749 nt with a single ORF of 687 nt. Gene 5 contained two ORFs, 5a and 5b, with 198 and 249 nt, respectively. Thus, in total, there were 7349 nt from the 5' end of S protein gene to the 3' end of the CU-T2 genome. The overall nt sequence homologies between gene 3, 4, and 5 of CU-T2 and those of other strains were between 84.1-90.8%, 85.8-88.8% and 90.4 96.4%, respectively. The predicted amino acid (aa) sequence homologies revealed that gene 3b and 5b were more conserved than 3a, 3c and 5a. Each individual gene of CU-T2 strain (with the exception of the RNA polymerase gene) had a different level of homology with the homologous gene of other strains, suggesting that the evolution of IBV strains in general has been a complex, and as yet, poorly understood process.

Analysis of the serotype-specific epitopes of avian infectious bronchitis virus strains Ark99 and Mass41.

The Ark and Mass serotype-specific epitopes of infectious bronchitis virus were studied by immunofluorescence and immunoprecipitation of mutant and recombinant spike glycoproteins (S protein) expressed in mouse L cells. Serotype-specific monoclonal antibodies could bind to the recombinant proteins of Ark99 and Mass41 expressed from the chimeras in which the N-terminal thirds of the S1 sequences were reciprocally exchanged. Therefore, it appears that the respective serotype-specific epitopes of both strains were localized within the C-terminal two-thirds of the S1 proteins. Deletion and insertion of a five-amino-acid fragment on the S1 proteins of Ark99 and Mass41, altered the serotype-specific epitopes. This result implies that the five-amino-acid insertion on the S1 protein of the Ark serotype was involved in determining the conformation of the protein, probably acting as a spacer. In addition, it appears that an interaction between sequences of the N-terminal third and the remaining portion of the S1 protein determines the tertiary structure of the protein as well as the conformation of the serotype-specific epitope.

A novel variant of avian infectious bronchitis virus resulting from recombination among three different strains.

An antigenic variant of avian infectious bronchitis virus (IBV), a coronavirus, was isolated and characterized. This strain, CU-T2, possesses a number of unusual features, which have not been previously observed in IBV. The S1 glycoprotein of CU-T2 carries virus-neutralizing and serotype-specific epitopes of two IBV serotypes, Arkansas (Ark) and Massachusetts (Mass). Sequence analysis revealed that the virus, originally an Ark serotype, has acquired the Mass-specific epitope by mutation(s). This provides evidence that point mutations may lead to generation of IBV antigenic variants in the field. It was further observed that two independent recombination events involving three different IBV strains had occurred in the S2 glycoprotein gene and N protein gene of CU-T2, indicating that genomic RNA recombination in IBV may occur in multiple genes in nature. It was especially significant that a sequence of Holland 52 (a vaccine strain) had replaced half of the N gene of CU-T2. This proves that recombination among vaccine strains is contributing to the generation of IBV variants in the field. Based on these observations it is predicted that every IBV field isolate could have unique genetic nature. Therefore, several recently reported diagnostic and serotyping methods of IBV which are based on dot-blot hybridization, restriction fragment length polymorphism (RFLP), and polymerase chain reaction (PCR), may not reveal the true antigenic and/or genetic nature of IBV isolates, and may in fact yield misleading information.

A monoclonal antibody-based antigen capture enzyme-linked immunosorbent assay for identification of infectious bronchitis virus serotypes.

An antigen-capture enzyme-linked immunosorbent assay (C-ELISA) was developed for detection and identification of infectious bronchitis virus (IBV) serotypes Arkansas, Connecticut, and Massachusetts using monoclonal antibodies (MAbs) specific to the S1 glycoprotein of the respective serotype. The assay (designed as a double-antibody sandwich assay) gave the best results when the S1-specific MAb, antigen, and chicken serum were of the same serotype. However, when a group-specific (M glycoprotein-specific) MAb was used for antigen capture, a distinctive pattern of cross-reactivity was observed between the antigens and heterologous chicken sera, suggesting a complex distribution of epitopes on the IBV M glycoproteins. Treatment of antigen with NP40 enhanced the ELISA signal only when the M glycoprotein-specific MAb was used for antigen capture. Although C-ELISA was inconsistent in detecting IBV in chicken tissue homogenates, it was highly effective in detecting the virus in allantoic fluid after the homogenates were given one chicken embryo passage.

Detection of viral antigen following exposure of one-day-old chickens to the Holland 52 strain of infectious bronchitis virus.

One-day-old specific-pathogen-free single comb White Leghorn chickens were inoculated by eyedrop with either 0.1 ml of phosphate buffered saline containing 10(4.3) EID50 of the Holland 52 strain of infectious bronchitis virus or normal allantoic fluid. Trachea, caecal tonsils and kidneys were removed from randomly selected birds at 0, 3, 5, 7 and 10 days post-inoculation (pi) and the presence or absence of viral antigen was detected utilizing virus isolation (VI), an indirect fluorescent antibody technique (IFA), or a streptavidin-biotin immunohistochemical (IH) technique. The presence of viral antigen as detected by the IH technique was also compared to histopathological changes in serial sections stained with haematoxylin and eosin. Detection of viral antigen occurred more frequently with VI than with IFA or IH. The IFA and IH techniques detected viral antigen with about the same frequency. Viral antigen was detected in the mucosa and submucosa of the trachea as early as 3 days pi, reached maximum levels at 5 days pi, and could still be detected in the mucosa at 10 days pi. In the kidney, viral antigen was not detectable by IFA or IH at 3 days pi, but could be visualized in distal convoluted tubules and collecting tubules at 5 days pi. At 7 days pi, antigen was detectable in the proximal convoluted tubules also. The presence of antigen in the caecal tonsils was sporadic, but it was detected in histiocytic cells and, occasionally, lymphoid cells of that organ.

A monoclonal antibody-based immunoperoxidase procedure for rapid detection of infectious bronchitis virus in infected tissues.

A monoclonal antibody (MAb)-based indirect immunoperoxidase (IP) procedure was applied to detect infectious bronchitis virus (IBV) antigen in frozen tissue sections. With this procedure, IBV antigen could be detected in chorioallantoic membranes (CAMs) within 15 hr postinoculation and in the respiratory tissues of chickens within 96 hr postinoculation. Endogenous peroxidases in chicken tissues were removed by treatment with periodic acid. The IP technique was highly sensitive, convenient, and economical. It allowed simultaneous evaluation of antigen-bearing cells and the general tissue morphology. The IP-stained slides also provided a permanent record.

Serological and molecular characterization of three enteric isolates of infectious bronchitis virus of chickens.

Three coronaviruses isolated from the intestines of laying chickens were partially characterized. Serological and molecular assays indicated that the enteric coronaviruses are infectious bronchitis virus (IBV) isolates. Although the three isolates were recovered from three unrelated chicken flocks, their RNase T1-resistant oligonucleotide fingerprints were almost identical. The three isolates were not neutralized by antisera specific to IBV serotype Connecticut, but their RNase T1-resistant oligonucleotide fingerprints closely matched the fingerprints of strain Conn-46, a Connecticut serotype. This and the co-fingerprinting data suggested that the three field isolates may have emerged from the Connecticut virus through mutation(s). The mutation(s) apparently involved the S1 protein gene that determines the virus serotype.

Immunologic effects of low levels of ochratoxin A in ovo: utilization of a chicken embryo model.

Ochratoxin A (OA) was administered to 13-day-old chicken embryos via the chorioallantoic membrane. The 7-day LD50 value (day 20 incubation) of OA was calculated at 7.9 micrograms of OA. Ochratoxin-treated embryos (2.5 micrograms) had slight but significant changes in numbers of immunoglobulin-bearing cells in the bursa but not in the spleen. Chicks hatched from in ovo-treated eggs were challenged with 9 X 10(4) colony-forming units (CFU) of beta-hemolytic Escherichia coli (O1:K1) at 7 days of age via the thoracic air sac. Lesion scores of OA-treated chicks were equal to or less severe than those of controls. Hatchmates of the above chicks were vaccinated with a homologous killed E. coli bacterin (O1:K1) at both 2 and 4 weeks of age and challenged with 10(4) CFU of E. coli at 7 weeks. Post-challenge lesions were present in three vaccinated untreated controls and no OA-treated chicks. We conclude that although in ovo exposure to OA may marginally suppress immunoglobulin-bearing cells of bursa, chicks hatched from OA-treated eggs respond as well as controls to an antigen and resist infection by a virulent organism.

Distribution of immunoglobulin-bearing cells in the gut-associated lymphoid tissues of the turkey: effect of antibiotics.

Distribution of immunoglobulin (Ig)-bearing cells in the gut-associated lymphoid tissues of antibiotic treated and untreated control turkeys (Meleagris gallopavo) was compared. Antibiotic treatment was similar to a regimen used in commercial turkey production, which included preincubation dipping of fertile eggs in gentamicin solution, injection of turkeys with gentamicin at hatching, and inclusion of chlortetracycline in the diet. Tissues were examined from turkeys at 3, 7, 14, and 21 days of age with a direct immunofluorescence procedure. Cell distribution in control turkeys was as follows: In the bursa of Fabricius, IgA-carrying cells predominated at 3 days of age, but at later intervals, the 3 classes of Ig-bearing cells were in equal numbers. In the cecal tonsils, IgM- and IgA-bearing cells were in larger numbers at 3 days of age, whereas, the IgG-bearing cells were sparsely distributed. By 7 days of age, IgM cells became more numerous in the cecal tonsils and remained numerous until 21 days of age. At 3 days of age, IgA cells predominated in the small intestines and IgM cells predominated in the large intestine. At 7 and 14 days of age, IgM cells were more numerous in the small and large intestines, but by 21 days of age, IgA cell population equaled that of IgM. The IgG cells were generally sparse in the intestines. Antibiotic treatment often resulted in lower numbers of Ig-positive cells, especially those bearing IgM and IgA. Normal development of the bursa of Fabricius was also retarded in this group.

Distribution of immunoglobulin-bearing cells in the gut-associated lymphoid tissues of the turkey: effect of oral treatment with intestinal microflora.

One-day-old turkeys (Meleagris gallopavo) were orally inoculated with the intestinal contents of an adult turkey, and the intestinal tissues were studied by immunofluorescence for immunoglobulin (Ig)-bearing cells at 3, 7, 14, and 21 days of age. Microflora inoculation increased numbers of Ig-bearing cells in the gut-associated lymphoid tissues; the most uniform effects were observed at 3 days of age. As the birds grew older, this uniformity in response to the microflora inoculation was not evident in all the tissues. In the bursa of Fabricius and the large intestine of the inoculated birds, IgM-bearing cells were more numerous throughout the study period. Compared with noninoculated control turkeys, IgA-bearing cells in the cecal tonsils, and IgG- and IgA-bearing cells in the small intestine were increased at all age intervals.

Adverse effects of antibiotics on the development of gut-associated lymphoid tissues and the serum immunoglobulins in chickens.

Study was done of the distribution and relative densities of immunoglobulin (Ig)M-, IgG-, and IgA-producing cells in the gut-associated lymphoid tissues and the spleen (SP) of control and antibiotic-treated chickens between 3 and 28 days of age. Specific Ig in the serum also were quantitated simultaneously. Antibiotic treatment included preincubation dipping of fertile eggs in gentamicin solution (500 mg/L), injection of chicks with gentamicin (0.2 mg/chick, subcutaneously), and inclusion of chlortetracycline in the diet (200 mg/kg). At 3 days, the gut-associated lymphoid tissues of control chicks carried few Ig-positive cells, except the bursa of Fabricius in which all 3 classes of Ig-bearing cells were present in relatively large numbers. The SP had few,but equal, numbers of IgM- and IgA-positive cells at this age. As control birds grew older, IgM-positive cells dominated in the SP, followed by the IgA cells. Cell populations fluctuated in the bursa of Fabricius of chicks until 21 days of age when IgM and IgA cells stabilized at a higher density than the IgG-positive cells. The cecal tonsils had no Ig-positive cells at 3 days, mostly IgM cells by 7 days, but equal numbers of the 3 types of cells by 28 days. The large intestines had few IgM-positive cells at 3 days and no IgG cells at 3 or 7 days. The numbers of IgM and IgA cells were approximately equal in the large intestine of the chicks from 7 days until 28 days. Maternally acquired IgG predominated in sera of chicks until 14 days of age, followed by the IgM. At 28 days, 'there was more IgM in the serum than IgG. Serum IgA was not detectable until 14 days of age, and its concentration remained at a lower level than IgM or IgG values. Antibiotic-treated chickens generally carried lower densities of Ig cells than did the respective controls. However, statistically significant (P < 0.05) differences were apparent only with respect to Ig cell populations in the cecal tonsils and the large intestines. The treated chickens also had significantly lower serum IgM concentrations at 28 days of age.

Maternal antibody and its effect on infectious bursal disease immunization.

Chickens vaccinated with infectious bursal disease virus (IBDV) early in life and revaccinated with an inactivated, oil-adjuvant IBDV vaccine at 18 weeks of age produced and maintained high levels of virus-neutralizing (VN) antibody through 10 months of lay. VN-antibody titers of chicks hatched from eggs laid during the same period closely matched the average VN-antibody titers of the dams. A sequential study of the decline rates of IBDV maternal antibody (MAB) in unvaccinated and IBDV-vaccinated chicks showed that the vaccine virus did not accelerate the antibody depletion rate in vaccinated chicks. Chicks carrying high IBDV MAB showed no active immune response to vaccination with commercial IBDV vaccines. They were also refractory to a pathogenic field isolate of IBDV (FV). However, chicks with low levels of MAB responded to both vaccine virus and the FV, although their response to vaccine virus was milder and delayed.

Bacterial antibiotic resistance: frequency of gentamicin-resistant strains of Escherichia coli in the fecal microflora of commercial turkeys.

The relationship of subtherapeutic feeding and parenteral injection of antibiotics to the presence of antibiotic resistant strains of Escherichia coli in the fecal microflora of commercial turkeys has been investigated. Cloacal swabs collected from 137 commercial turkeys were examined for E coli resistant to gentamicin. Gentamicin-resistant E coli organisms were isolated and tested for resistance to ampicillin, chloramphenicol, kanamycin, streptomycin, and tetracycline. Strains of E coli resistant to gentamicin were identified in 118 of 137 (86.1%) specimens evaluated. There were 5 different antibiotic resistance patterns exhibited by the gentamicin-resistant strains of E coli. All strains showed a common antibiotic resistance pattern of gentamicin, kanamycin, and streptomycin. The results of the antibiotic susceptibility tests were compared to the known history of antibiotic usage in each flock. There was no significant correlation between the use of subtherapeutic concentrations of antibiotics and the frequency of gentamicin resistant E coli. However, the frequency of gentamicin-resistant E coli was closely related to the age of the bird, with birds less than 12 weeks of age being most likely to harbor E coli resistant to gentamicin. This age-dependent frequency of gentamicin-resistant E coli was associated with the common practice of dipping eggs in gentamicin and injecting newly hatched poults with gentamicin, but not with the feeding of subtherapeutic concentrations of antibiotics.