The role of thoracoscopic biopsies in the diagnosis of pleural tuberculosis.

Tuberculosis (TB) is a significant public health problem in many developing countries. In many cases, tuberculosis may present a significant diagnostic challenge. A 32-year-old male Chinese immigrant presented to our institution with a fever and non-productive cough. He was found to have a right pleural effusion, for which a chest drain was inserted. His tuberculin skin test was unreactive (0mm) although he was not immunocompromised (HIV negative). All cultures were negative, and 3 sputum samples and his pleural fluid sample tested negative for acid-fast bacilli. A computed tomography (CT) scan of his chest revealed features suggestive of an early empyema. There was no evidence suggestive of a malignant effusion. In an effort to attain a diagnosis, he underwent a video-assisted thoracoscopy (VATS) procedure with pleural drainage and biopsies. Anti-tuberculosis therapy (ATT) was commenced due to a high level of suspicion after failure of empirical therapy. Although the Ziehl-Neelsen stain for acid fast bacilli was negative, pleural biopsies demonstrated active chronic granulomatous pleuritis with many Langerhans type giant cells highly suggestive of tuberculosis. He was responsive to treatment and completed 6 months of ATT with complete clinical resolution. In young, immunocompetent patients with an exudative, culture-negative effusion, the diagnosis of pleural tuberculosis must be considered. Pleural biopsy is the gold standard for diagnosing pleural TB but demonstration of acid-fast bacilli or necrotizing granulomas in the specimen are not absolutely necessary to make the diagnosis.

Modern approaches to the treatment of human infertility through assisted reproduction.

Medical statistics from the United States show approximately 15 percent of all couples of reproductive age are unable to conceive naturally. In recent years, the numbers of couples with reproductive problems has increased, principally due to changes in life style and delayed childbearing. Only 13 years after the birth of the first "test tube baby", advances in the field of human reproduction have created a wide range of alternatives to help infertile couples conceive a healthy infant. Together, these techniques are called Assisted Reproductive Technology (ART) and include: in vitro fertilization (IVF), intratubal transfer of gametes (GIFT), intratubal transfer of zygotes (ZIFT), tubal transfer of preimplantation embryos (TET), gamete or embryo donation, cryopreservtion, and micromanipulation. The application of these techniques is presented here. While much remains to be learned, the ability to fertilize ova in vitro and sustain early embryonic life outside the body is now a reality. Contrary to the idea that these techniques create life in vitro, they simply remove barriers caused by different forms of infertility which impede the creation of life. More than 30,000 infants have now been produced world-wide through ART. In the future, new developments in the field of assisted reproduction promise to bring new hope to the growing numbers of infertile couples around the world.

Serological survey for viral diseases in the Cayo Santiago rhesus macaque population.

The free-ranging population of rhesus monkeys (Macaca mulatta) on Cayo Santiago was sero-surveyed for human measles, simian virus 40, B virus (Herpes simiae), rhesus cytomegalovirus, human and simian retroviruses and encephalomyocarditis virus to determine the prevalence of these viruses in the colony. The results of this study indicate that the colony is free of SV40, HTLVIII (HIV-1), STLVIII (SIV) and SRV1; has a low prevalence of measles and EMCV; and high prevalence rates for B virus, CMV and HTLVI.

Cholesterol and dominance rank in the Cayo Santiago macaques.

The relationship between serum total cholesterol (STC) and social dominance rank was investigated in adult (greater than or equal to 5 year old) males of a single, naturally-formed free-ranging troop of rhesus monkeys (Macaca mulatta) on Cayo Santiago, Puerto Rico. Dominance rank, age and body weight were not correlated with STC, nor was rank correlated with age or body weight. The mean (+/- 1 SD) STC was 154.0 +/- 27.0 mg/dl. Seven of the 34 males sampled had STC levels (189.1 +/- 4.3 mg/dl) greater than 1 SD above the mean for all males. These monkeys did not differ significantly in age or body weight from each other or the remaining males in the study, but 5 of the 7 monkeys with high STC were high-ranking in the group and 7 of 8 monkeys with STC (115.6 +/- 5.8 mg/dl) 1 SD or more below the mean for all males were low-ranking. The difference was significant (p less than .05, Fisher's Exact Test).

Reproductive performance, population dynamics and anthropometrics of the free-ranging Cayo Santiago rhesus macaques.

This report summarizes demographic data collected on the Cayo Santiago colony of rhesus monkeys from 1976-1983 and compares the results with those from 1959-1964 [8,9]. For males and nonpregnant/nonlactating, pregnant, and lactating females mean (+/- 1 SD), body weights, crown-rump lengths, and ponderal indices are tabulated for each age on a large (n = 586) single sampling of this free-ranging population of macaques.

Intestinal parasites of the free-ranging Cayo Santiago rhesus monkeys (Macaca mulatta).

Free-ranging rhesus macaques on the island of Cayo Santiago, Puerto Rico, were surveyed for intestinal parasites for the first time in over 40 years. Results were compared with the only previous study, and the relationships between the prevalence of Strongyloides and dominance rank, body weight, age, and matriline examined in the sampled population.

Congenital and hereditary anomalies in the rhesus monkeys (Macaca mulatta) of Cayo Santiago.

During seven annual birth seasons, from January 1976 to July 1982, 963 infants were born in the Cayo Santiago, Puerto Rico, colony of free-ranging rhesus monkeys (Macaca mulatta). The reproductive rate for mature females, 4 years of age and older, ranged between 74.1% and 84.7%, with a cumulative mean of 80.8% over 7 years. Live births comprised 95.3% of the total and the secondary sex ratio was 109 male to 100 female births. No twinning was observed. Aborted and stillborn monkeys represented 4.7% of all births. The percentage of stillborn females was greater than that of males (4.0% vs. 3.1%). Neonatal death, defined as mortality within 48 hours postpartum, occurred in 0.8% of the live births. Two cases of congenital abnormalities were observed. The first was an anencephalic, acranial female and the second a congenitally blind male. Both infants were born to matrilineally unrelated 7-and 8-year-old multiparous females with no prior history of delivering malformed offspring. The incidence of each defect, based on 963 births, was 0.10%, with a cumulative incidence of 0.20% for all teratisms seen during the study. Multiple occurrences of a rare, nonpathological and nonlethal hereditary anomaly were also seen. Five "golden" macaques were born into two genetically distinct social groups within the last 2 years of observation. The incidence of this phenotype, based on five cases, was 0.52%, 52 times the expected rate (.01%).

Blood values of free-ranging patas monkeys (Erythrocebus patas).

Free-ranging patas monkeys (Erythrocebus patas) from El Guayacán island, Puerto Rico, were surveyed to establish values for the hemogram, serum biochemicals, calcium, and phosphorus. Results were tabulated for males and nonpregnant/nonlactating, pregnant, and lactating females. A summary of blood values from previous studies on captive patas monkeys was also tabulated for comparison.

Age- and pregnancy-related changes in serum total cholesterol and triglyceride levels in the Cayo Santiago rhesus macaques.

Ninety-six free-ranging rhesus monkeys were evaluated for age-, sex-, and pregnancy-related changes in total serum cholesterol and triglyceride levels and compared with previous studies. Our findings indicate that pregnancy depresses total cholesterol in females and that cholesterol levels tend to increase in males with age. Triglycerides decreased significantly with advancing age in males. The Cayo Santiago monkeys represent a unique opportunity to study the effects of age on population of nearly 1200 nonhuman primates on which there is accurate data on birth date, lineage, behavior, reproduction and post-mortem morphology (skeletons). Further gerontological studies are necessary to take full advantage of this resource and to increase the presently-scant body of information on aging in monkeys for comparative studies on humans and for the development of animal models of gerontological diseases of humans.