Differential response of the luteal phase and fertility in cattle following ovulation of the first-wave follicle with human chorionic gonadotropin or an agonist of gonadotropin-releasing hormone.

A series of experiments with Holstein heifers was conducted to develop the capability of inducing accessory corpus luteum (CL) with a GnRH agonist (Buserelin, 8 micrograms; GnRHa) or hCG (3,000 IU) to increase plasma progesterone concentrations (Exp. 1, 2, and 3) and to test whether induction of accessory CL with hCG will increase conception rates in heifers (Exp. 4) and lactating cows (Exp. 5). In Exp. 1, heifers were treated on d 5 after estrus with GnRHa (n = 8) or saline (n = 7); heifers in Exp. 2 received hCG (n = 5) or saline (n = 4) on d 5. Experiment 3 allowed a contemporary evaluation of heifers treated on d 5 with GnRHa (n = 6), hCG (n = 6), saline (n = 6), or GnRHa at d 5 and hCG at the time of the induced ovulation (n = 5). The GnRHa and hCG were equally effective in inducing an accessory CL (93% induction rate), but the subsequent increase in progesterone concentrations was greater in hCG-treated heifers. A greater half life of hCG may provide longer LH-like stimulation of the first-wave follicle and subsequent developing accessory CL or a greater luteotropic effect on the original CL. Induction of an accessory CL with hCG on d 5 or 6 after insemination did not increase pregnancy rates in fertile heifers (Exp. 4: hCG = 64.8% vs control = 62.9%; n = 243) or lactating dairy cows during summer heat stress (Exp. 5: hCG = 24.2% vs control = 23.5%; n = 201).

Primary lymphocutaneous Nocardia brasiliensis infection: three case reports and a review of the literature.

The occurrence of human nocardiosis is increasing in both immunocompetent as well as immunosuppressed patients. We report three rare cases of primary lymphocutaneous Nocardia brasiliensis infection. The mode of inoculation in each case was that of a puncture wound that occurred 1-3 wk prior to the development of the clinically apparent infections. The original clinical diagnosis was erroneous in each case. A review of 16 previously reported cases is presented as well as a discussion of appropriate medical therapy.

Hypersensitivity pneumonitis caused by Cladosporium in an enclosed hot-tub area.

A 48-year-old woman had an 18-month history of malaise and chronic cough with intermittent episodes of fever, chills, and pneumonic infiltrates. Transbronchial biopsy findings were consistent with hypersensitivity pneumonitis. Cultures of fungus from a hot-tub room in her home were positive for Cladosporium species. Serum precipitins were weakly positive for Cladosporium cladosporioides. Removal of the patient from the home environment led to a resolution of symptoms within 1 week. Within 4 hours of re-exposure to the hot-tub room, symptoms and signs and changes in leukocyte count and spirometric values again occurred. Bronchial provocation with a commercial extract of C. cladosporioides led to a similar pattern 5 hours after the initial challenge. This case identifies a previously unreported etiologic agent and environmental site for hypersensitivity pneumonitis.

Improvement of granulocyte adherence and in vivo granulocyte delivery by ascorbic acid in renal transplant patients.

Delivery of polymorphonuclear cells (PMN) to sites of bacterial invasion is a critical step in host defense. Renal transplant patients have a defect in PMN delivery caused by glucocorticoid immunosuppressive therapy that leads to increased susceptibility to infection. Because inhibited granulocyte adherence is often associated with poor delivery, the effects of propranolol and of ascorbic acid were measured for both of these functions. Propranolol caused a short-lived increase in adherence and no change in delivery in normal volunteers, so it was not studied in transplant patients. Ascorbic acid also failed to affect adherence in normal controls, but increased depressed adherence in transplant patients from a mean value of 27.7% to 48.0% when given daily for 3-4 weeks. PMN delivery increased to normal following 3-6 weeks of ascorbic acid, 4 g/day in a similar group of patients with low adherence prior to treatment. Pretreatment delivery was 3.06 X 10(5) and rose to 1.18 X 10(6) PMN after treatment (P less than 0.02), with no change noted in graft function. Thus, ascorbic acid treatment may improve PMN host defense in renal transplant patients.

The use of health services by civilian beneficiaries of the military health care system. A comparative study.

The military Health Care System provides comprehensive health care to entitled beneficiaries in a dual system consisting of hospitals and clinics at military installations, and an insurance like program (CHAMPUS) which pays for care in civilian facilities. Utilization by civilian beneficiaries was studied and compared with utilization by members of the Kaiser-Permanente Plan in Northern California, and the Non-Institutionalized Population of the United States. Hospital use rates for beneficiaries under CHAMPUS and in military facilities were calculated, and rough order of magnitude data were developed for utilization of hospitals outside of the Military Health Care System. Rates within the system were found to be lower than those of the noninstitutionalized population of the United States, partly because of utilization of hospitals outside of the Military Health Care System by entitled beneficiaries. However, rates were generally higher than those of Kaiser-Permanente (northern California) enrollees, despite the high use of hospital care by beneficiaries outside of the Military System. Systems factors impinging on hospital utilization rates are discussed. Ambulatory visit rates for beneficiaries in northern California to all types of providers were found to closely approximate those of the Kaiser-Permanente system, when all sources of care (within and outside of the system) are considered. Utilization within the Military Health Care System, however, is less than utilization by Kaiser beneficiaries. In general, civilian beneficiaries of the Military Health Care System were found not to be taking full advantage of their entitlement to health care.