Active immunization against GnRH in pre-pubertal domestic mammals: testicular morphometry, histopathology and endocrine responses in rabbits, guinea pigs and ram lambs.

Effective tools for male contraception are important in the control of reproduction in animal populations. The aim of the present study was to evaluate the effects of active immunization against gonadotropin-releasing hormone (GnRH) on male reproductive function assessing testicular morphological changes and serum-gonadotropin levels in pre-pubertal rabbits, guinea pigs and ram lambs. An anti-GnRH vaccine was developed by linking a GnRH-homologous molecule to a tetanus clostridial toxoid (Al(OH)3 coadjuvant). After vaccination protocols testicular morphometry, histopathological alterations and endocrine responses (FSH, LH, testosterone and cortisol serum levels) were evaluated. Testicular volume was significantly reduced in vaccinated animals with respect to the control group in rabbits, guinea pigs and ram lambs (P<0.05 to P<0.001). The anti-GnRH vaccine generated a reduction in testicular volume of 15-, 27- and 11-fold, respectively. Tubule diameters decreased in the vaccinated group with respect to the control ~2.0-, 1.2- and 3.5-fold, respectively (P<0.001). Tubule, intertubular and lumen volumes significantly decreased in vaccinated rabbits (P<0.05), guinea pigs and ram lambs (P<0.01). Vaccinated animals of the three species showed significant reductions in spermatogonial numbers (10- to 40-fold; P<0.01). Sperm was absent in all seminiferous tubules of all rabbits, and most individuals of guinea pigs (80%) and ram lambs (60%). No significant differences were observed between vaccinated and control groups regarding FSH and LH during the experiments in the three experimental species/models used. Testosterone, however, was only significantly lower (~22-fold, P<0.01) in vaccinated rabbits. In conclusion, the present study demonstrated that pre-pubertal active immunization against GnRH leads to endocrine disruption and marked differences on testicular morphometry, development and activity among lagomorphs, hystricomorphs and ovine species with species-specific sensitivity regarding the anti-GnRH immune response.

Diagnostic yield of fiberoptic bronchoscopy in evaluating solitary pulmonary nodules.

STUDY OBJECTIVES: To evaluate factors affecting the diagnostic yield of flexible fiberoptic bronchoscopy in evaluating solitary pulmonary nodules (SPNs). DESIGN: Retrospective analysis of bronchoscopies performed over a 4-year period. SETTING: A tertiary teaching hospital. PATIENTS: One hundred seventy-seven patients with pulmonary nodules without endobronchial lesions who underwent bronchoscopy with brushing, washing, and transbronchial biopsy. RESULTS: There were 151 malignant and 26 benign lesions. The diagnostic accuracy of bronchoscopy in malignant and benign lesions were 64% (97 of 151) and 35% (9 of 26), respectively. The yield of bronchoscopy was directly related to lesion size (p < 0.001, chi(2)). When lesions were grouped according to distance from the hilum, yields of bronchoscopy in central, intermediate, and peripherally located lesions were 82, 61, and 53%, respectively (p = 0.05, chi(2)). When we stratified distance from the hilum by lesion size, the difference in yield was not significant. However, lesions

Lysinuric protein intolerance masquerading as celiac disease: a case report.

A 5 1/2-year-old boy presented with delayed growth, chronic diarrhea, and hypoproteinemia. Clinical presentation, initial laboratory data, and evaluation of an intestinal biopsy specimen suggested a diagnosis of celiac disease. Symptoms did not resolve on a gluten-free diet. The development of hyperammonemia prompted further studies that led to the diagnosis of lysinuric protein intolerance. Lysinuric protein intolerance, although a rare disorder, should be included in the differential diagnosis of conditions associated with intestinal villous atrophy.

Endoscopic variceal ligation in pediatric patients with portal hypertension secondary to liver cirrhosis.

BACKGROUND: Endoscopic variceal ligation is the initial treatment of choice in the management of esophageal varices. Few reports include its use in the pediatric population. We review our experience with this therapeutic modality in pediatric patients with end stage liver disease and esophageal varices. METHODS: We reviewed the medical records of pediatric patients with end stage liver disease who underwent endoscopic variceal ligation from January 1994 until December 1996. RESULTS: Thirty-two endoscopic variceal ligation procedures were performed in six pediatric patients during the period of study. In all patients, the esophageal varices classification was improved at the end of treatment. Only one patient had an episode of bleeding from esophageal varices during the period of study; only one patients had a complication associated with endoscopic variceal ligation. CONCLUSIONS: Endoscopic variceal ligation is feasible, safe, and effective for the management of esophageal varices in pediatric patients with end stage liver disease.

Respiratory muscle coordination in acute spinal dogs.

Our objectives were (1) to test whether respiratory muscles of spinal dogs can generate the alternating pattern of activation seen in intact animals and (2) to characterize the responsiveness of spinal rhythms to mechanical ventilation. We recorded the electromyographic activities of inspiratory muscles (diaphragm and parasternal intercostals) and expiratory muscles (triangularis sterni and transversus abdominis) in ten anesthetized dogs before and after transection of the cervical cord at levels C1-C2 (n = 2), C2-C3 (n = 6), and C8 (n = 2). In 9/10 dogs, we observed short lasting (3-4 min) rhythmic ventilatory muscle activity for up to 3 h after transection. Inspiratory and expiratory muscles contracted simultaneously, suggesting an absence of mechanism(s) responsible for reciprocal muscle activation on a spinal level. Five of ten dogs showed tonic rib cage activity during apnea that was phasically modulated during mechanical ventilation. From the absence of alternating inspiratory and expiratory muscle activity in acute spinalized dogs, we conclude that dogs do not have a spinal pattern generator for respiration.

Interrupter mechanics of patients admitted to a chronic ventilator dependency unit.

We analyzed the results of interrupter mechanics tests of 73 consecutive patients who were admitted to a chronic ventilator dependency unit. The purposes of this study were (1) to establish guidelines for grading the severity of airway obstruction based on interrupter mechanics measurements; (2) to estimate the prevalence of airway obstruction in this population; (3) to compare interrupter test results with the clinical assessment of airway function; and (4) to characterize the distribution of bronchodilator-induced changes in isorecoil flow. Measurements from 65 of 73 patients (89%) were considered technically adequate. Of 65 patients, 29 (45%) showed signs of flow limitation during passive expiration. All patients with severe obstruction documented with spirometry during clinical stability were flow-limited and achieved maximal flows < or = 0.45 L/s at recoil pressures of 10 cm H2O. In contrast to measures of expiratory dynamics, the inspiratory resistance of the respiratory system was a poor index of severity of obstruction. In seven of 12 patients, interrupter testing failed to substantiate a clinical diagnosis of severe obstruction while revealing unsuspected obstruction in six of 25 (24%) patients. The administration of 270 micrograms of albuterol increased flows at comparable recoil pressures by > or = 0.1 L/s in 29% of 41 patients. Changes in flow were unimodally distributed and were not correlated with severity of obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Body plethysmography in the evaluation of intrathoracic airway abnormalities.

A patient with a previously unsuspected intrathoracic tracheal malignancy presented with symptoms suggestive of asthma and an unusual pattern seen by conventional PFTs. Reduced expiratory flows with a large difference between FVC and SVC, normal inspiratory flows and high MVV/FEV1 were found. Body plethysmography using normal and panting efforts with increasing tidal volume and flow helped define the lesion as a variable intrathoracic obstruction and document its regression after palliative therapy.

Lung disease associated with orally administered mesalamine for ulcerative colitis.

Pulmonary symptoms, bilateral interstitial infiltrates and gas exchange abnormalities developed in a patient with ulcerative colitis treated with orally administered mesalamine. Improvement of symptoms and objective findings occurred after drug discontinuation. To the best of our knowledge, this is the first report of lung toxicity associated with orally administered mesalamine.

[The efficacy of propafenone in preventing recurrent auricular fibrillation and flutter]. / Eficacia de la propafenona en la prevención de fibrilación y flúter auricular recurrente.

In order to investigate the efficacy of propafenone in the prevention of paroxysmal flutter or fibrillation, we treated 21 patients without left ventricular disfunction. Age was 60 +/- 14 (mean +/- sd) years, left atrial diameter by echocardiography 37 +/- 7 mm, cardiothoracic index 0.48 +/- 0.05 (0.41-0.57) and P wave duration 100 +/- 17 ms. The frequency of recurrences before treatment was: daily in five (23%), weekly or more in eight (38%), monthly-weekly in seven (33%) and quarterly-monthly in one (5%). Propafenone (671 +/- 187 mg/24 h) was given after recurrences were demonstrated under treatment with 1-3 antiarrhythmic drugs per patient. During 8.9 +/- 3.5 months of follow-up (range 6-19) 5 patients (23%) were completely free of recurrences; in seven (33%) the incidence decreased by greater than 50% with a marked decrease in duration. Side effects appeared in 12 cases (57%), leading to its discontinuation in four (19%). Arrhythmogenic effects were observed in 2 cases (9%). Propafenone is effective in greater than 50% of patients with paroxysmal atrial flutter or fibrillation, resistant to other antiarrhythmic agents. The incidence of side effects is high, but they are usually not severe and reversible.