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Gastric fluid pH was measured in five adult horses following nasogastric administration of famotidine, 0.5, 1.0, and 2.0 mg/kg bodyweight (bwt); ranitidine, 4.4 and 6.6 mg/kg bwt and an antacid containing magnesium hydroxide (40 mg/ml) and aluminium hydroxide (45 mg/ml), 120 and 180 ml. Fluid was aspirated through a 16 French nasogastric feeding tube at 15 min intervals, and pH was measured using a pH meter. Basal gastric fluid pH was measured at 20 min intervals for 6 h in each horse and, with the exception of two measurements of 4.66 and 4.17, ranged from 1.42 to 2.41, with a mean pH of 1.88 +/- 0.18. The response to both ranitidine and famotidine was variable between horses and between dosages. The mean gastric fluid pH values following administration of a single dose of famotidine or ranitidine were famotidine, 0.5 mg/kg bwt, 3.63 +/- 1.72; famotidine, 1.0 mg/kg bwt, 3.41 +/- 1.40; famotidine, 2.0 mg/kg bwt, 4.18 +/- 2.06; ranitidine, 4.4 mg/kg bwt, 4.07 +/- 1.25; ranitidine 6.6 mg/kg bwt, 5.34 +/- 1.12. Differences in mean gastric fluid pH between famotidine dose levels and between ranitidine dose levels were not significant (P > 0.10). Gastric fluid pH increased to greater than 6 in three horses receiving 0.5 mg/kg bwt, five horses receiving 1.0 mg/kg bwt and three horses receiving 2.0 mg/kg bwt famotidine. Gastric fluid pH increased to greater than 6 in each of the five horses receiving 6.6 mg/kg bwt ranitidine and in four of five horses receiving 4.4 mg/kg bwt ranitidine. During the 6 h post administration, ranitidine tended to increase gastric fluid pH greater than 6 longer (166 +/- 106 mins) than famotidine (98 +/- 110 mins) and this difference was nearly significant (P = 0.054). The response to antacid was variable and consistently short-lived. The mean gastric fluid pH values for 6 h after administration of 120 ml or 180 ml were 2.42 +/- 0.71 and 2.44 +/- 0.47, respectively. Gastric fluid pH increased to greater than 6 in only two horses, for 15 and 30 mins, respectively. The increase in gastric fluid pH was significantly greater for ranitidine (P < 0.001) and famotidine (P < 0.02) than for antacid. The duration of the effect was significantly longer for ranitidine doses (P < 0.001) and nearly so for famotidine doses (P < 0.055) than for antacid.

Summary This study examined whether a product containing a pectin-lecithin complex (Pronutrin)1 could prevent gastric lesions induced in the equine gastric squamous epithelial mucosa using a protocol of intermittent feed deprivation that resulted in prolonged increased gastric acidity (Murray and Eichorn 1996). Eight ponies were used and served as theirown controls in 2 trials in which there were 72 h cumulative deprivation (alternating 24 h with no feed, then 24 h free choice hay), with a 4-week interval between trials. Ponies were assigned randomly to receive either 250 g Pronutrin plus 200 g pelleted feed, or 450 g pelleted feed only. Ponies were conditioned to each treatment for 7 days and received Pronutrin and pellets oronly pellets once daily during the feed deprivation protocol. Gastroscopy was performed at the beginning and conclusion of the feed deprivation protocol. The endoscopist (M.J.M.) was blinded as to treatments, and lesion severity was scored on a scale of 0–5. Gastroscopy revealed normal-appearing gastric mucosa at the beginning of feed deprivation, with the exception of 2 ponies which had focal squamous mucosal erosion and 1 pony with focal glandularmucosal erosion. After 72 h cumulative feed deprivation, each pony, except 1 pony in one of the trials, developed erosions or ulcers in the gastric squamous mucosa. There was no difference (P = 0.6) in the presence or severity of gastric lesions between treatments. Lesions did not develop in the gastric glandular mucosa as a result of the intermittent feed deprivation with either treatment. In this study, the pectin-lecithin complex in Pronutrin failed to prevent lesions in the gastric squamous mucosa induced by intermittent feed deprivation.

Summary The objective of the study reported here was to characterise the microscopic appearance of peptic-injured equine gastric squamous epithelium in relation to the duration of peptic injury. Erosions and ulcers were induced in equine gastric squamous epithelium using a feed deprivation protocol that results in prolonged increased gastric acidity. Specimens of normal gastric mucosa and mucosa with lesions created after 48 and 96 h of feed deprivation were compared for characteristics associated with angiogenesis and mucosal proliferation. Fifteen mature horses, 9 geldings and 6 mares, age 3–20 years, were divided into 3 groups. Group 1 (n = 5) had normal-appearing gastric squamous mucosal epithelium and had been killed due to problems unrelated to the gastrointestinal tract. Groups 2 (n = 5) and 3 (n = 5) had lesions induced in the gastric squamous epithelium by alternating 24 h periods of feed deprivation and ad libitum access to hay, for totals of 48 and 96 h feed deprivation, respectively. Following lethal injection of barbiturate, stomachs were removed and fixed by filling with 4–6 l 10% buffered formalin. Sections were made from lesions in the gastric squamous epithelium adjacent to the margo plicatus along the right side of the stomach/greatercurvature and the lesser curvature. Measurements of total epithelial thickness, keratinised epithelium, nonkeratinised epithelium, epithelial projections, capillary extension into the epithelium and lamina propria thickness were made. The cross-sectional areas of arterial and venous vascularstructures in the lamina propria at the lesions and theirmargins were measured using image analysis software. All horses, except one, in Group 2 developed erosions or ulcers in the gastric squamous epithelium after feed deprivation. There were several changes in the epithelium adjacent to erosions and ulcers, compared to normal epithelium, from horses in Groups 2 and 3: total epithelial thickness was significantly (P

Leukaemia and lymphoma may present with symptoms and signs mimicking common respiratory conditions of childhood such as asthma or croup. The UK National Institute for Clinical Excellence guidelines for referral for suspected cancer state that "the primary healthcare professional should be ready to review the initial diagnosis in patients in whom common symptoms do not resolve as expected" and "must be alert to the possibility of cancer when confronted by unusual symptom patterns" (National Institute for Health and Clinical Excellence, 2005).A child with an undiagnosed mediastinal mass presenting with signs and symptoms suggestive of asthma or croup may be given oral systemic steroids. We report four such illustrative cases presenting to a single institution within the last 3 years.We highlight key points from the history and examination findings which should lead to review of the original diagnosis, the benefit of early chest X-ray in such cases and the dangers of steroid pretreatment.

Objective—To determine the effects of 8 days of light to heavy exercise on gastric ulcer development in horses and determine the efficacy of omeprazole paste in preventing gastric ulceration. Design—Randomized, controlled, multicenter clinical trial. Animals—102 horses with normal-appearing gastric mucosa on endoscopic examination that were in light to heavy training. Procedures—Horses at 4 trial locations were allocated into replicates and sham dosed orally (empty syringe) or treated with a paste formulation of omeprazole (1 mg/kg [0.45 mg/ lb], PO) once daily for 8 days. Training regimens varied among locations and included early training for western performance events; walking, trotting, and cantering in a mechanical exerciser; and race training (2 locations). Prevalences of gastric ulceration at the completion of the 8-day treatment period were compared between groups. Results—At the end of the 8-day treatment period, the proportion of omeprazole-treated horses free from gastric ulceration (88%) was significantly higher than the proportion of sham-dosed horses free from gastric ulceration (27%). Conclusions and Clinical Relevance—Results showed that horses in light to heavy training for as short as 8 days were at risk of developing gastric ulcers and that administration of omeprazole paste decreased the incidence of gastric ulcers.

Of 17 foals born on a Thoroughbred breeding farm between March and April 1995, infection with equine herpesvirus type 1 (EHV-1) was associated with neonatal morbidity in 5 foals, 3 of which died or were euthanized. Morbidity and mortality were associated with pulmonary inflammation, and EHV-1 was identified in the lungs of the 3 foals that died. All neonatal EHV-1 infections occurred in foals of mares housed in the same pasture and barn. No other clinical manifestations of EHV-1 infection (e.g., abortion, neurologic disease, or respiratory disease) occurred during this outbreak. Three foals were treated with acyclovir (1 died, 2 survived), which may have influenced the clinical outcome in the surviving foals.

Summary Whole blood and serum were collected from foals to determine the prevalence of Equine herpesvirus type 2 (EHV2) infection in foals, age at which infection can first be identified and serological responses to infection. Equine herpesvirus type 2 was isolated from peripheral blood mononuclear cells (PBMC) from 68 of 69 foals, 1–8-months-old, sampled once. Virus isolation was performed twice at intervals of 2–7 months on PBMCs from 33 foals and EHV2 was isolated on both occasions in all but one foal (negative, then positive). Regression analysis of log2-transformed reciprocal serum EHV2 virus neutralising (VN) titres revealed that in foals age 1–7 months, EHV2 VN antibody titre was positively correlated with age (r = 0.94). Paired serum samples were obtained from 58 foals, with the first samples collected age 1–6 months and the second samples collected 2–4 months later. There were significant (P

Summary Gastroscopic examinations were performed on 67 Thoroughbred horses in training at a race track and repeat examinations performed in 35 horses, 2 to 3 months later. Horses were age 2–9 years and included 16 two-year-olds, 32 three-year-olds and 19 horses ≥ 4-years-old. Forty-two of the 67 horses had raced within the 2 months before the initial examination and the remaining 25 horses were in training. Sixty-two of the 67 horses (93%) had one or more lesions present in the gastric mucosa and lesions were present in all of the 42 horses that had raced. Thirty-two of the 35 horses, examined twice (91%), had gastric lesions on the first examination and all had lesions on the second examination. Four sites of the gastric squamous epithelium were graded for lesion severity on a scale of 0 to 10 and the mean maximum squamous mucosal lesion score was significantly (P

Despite extensive study, evidence to support a direct relationship between diseases of the thyroid and breast has not been established. In this study thyroid volume was assessed by ultrasound in 200 patients with breast cancer and 354 with benign breast disease. Results were compared to appropriate female control groups. Both mean thyroid volume (21.1 +/- 1.4 mL) and the percentage of individual patients with enlarged (> 18.0 mL) thyroid glands (41.5%) were significantly greater in the breast cancer group than equivalent values (13.2 +/- 0.5 mL and 10.5%, respectively) in age-matched controls (P < 0.01 in both cases). The mean thyroid volume of 14.5 +/- 0.34 mL in patients with benign breast disease was also significantly greater than that of 12.5 +/- 0.38 mL in younger controls (P < 0.01). The results support a direct association between breast cancer and increased thyroid volume as mean thyroid volumes and the percentage of individual patients with enlarged thyroid glands were similar in those studied both before (20.8 +/- 1.3 mL and 43.0%) and after (21.4 +/- 1.6 mL and 40.0%) therapies for breast cancer. Although there is no evidence that thyroid enlargement represents a risk factor for breast cancer, the results emphasize the importance of raising the consciousness of the coincidence of both disorders.

Background : Our earlier uncontrolled observations during primary famine and subsequent refeeding did not suggest that severe undernutrition inevitably increases vulnerability to infection. Some infections appeared suppressed by famine but reactivated by refeeding. Aims : To examine prospectively the occurrence of infections in a large cohort of primary famine victims before and during refeeding. Methods : From 1973 to 1993, 4382 famine victims aged 14 or more with an estimated weight loss greater than 25% were weighed and examined for infection before and after one, two, three and four weeks ofrefeeding. In 137, serum C-reactive protein was measured in an effort to detect latent asymptomatic infections before and after two weeks ofrefeeding. Refeeding diets included wheat, sorghum, millet, ghee and milk powder. Results : Mean weight loss ± SD was 28.7 ± 2.3%. Before refeeding overt infections were found in 4.9%, an incidence rising to 29.1% at two weeks of refeeding and declining after four. Those developing infections gained more weight at two weeks, 4.6 3 ± 0.81 kg, than those never infected, 3.94 ± 0.76 (p = < 0.001 t test). C-reactive protein levels confirmed the presence of latent infections before refeeding. Conclusions : Severe undernutrition can suppress certain infections, mostly those due to intracellular pathogens and especially P. falciparum. Refeeding reactivates suppressed infection and can increase vulnerability to certain new infections especially ofviral origin. Those gaining weight the most rapidly may be at greatest risk. Refeeding with foods alien to local culture could play a role in reactivating latent infections. Our findings may be limited to severe undernutrition and not apply to lesser forms or secondary undernutrition in hospital patients. These studies were done during charitable provision of medical care to famine victims.

Ulceration of the gastric squamous epithelial mucosa was induced in 10 horses using a feeding protocol previously shown to expose the gastric mucosa to repeated periods of high acidity. The feeding protocol consisted of alternating feed deprivation with free access to hay. Over a period of seven days, each horse was provided hay for 84 hr and deprived of hay for 84 hr. Hay was never withheld for longer than 24 hr at a time. Gastroscopy was performed on each horse at the beginning of the protocol after 12 hr of feed deprivation, and after a total of 36 hr, 60 hr, and 84 hr of feed deprivation. All horses had normal esophageal and gastric mucosa at the beginning of the protocol. Alternating periods of feeding and feed deprivation resulted in progressive ulceration of the gastric squamous epithelial mucosa in all but one of the horses. Lesions progressed from erosions to ulceration within 36-72 hr of feed deprivation, and by 84 hr of feed deprivation ulcers had developed thickened, raised margins. Esophageal mucosa appeared normal in all horses throughout the study. The protocol of alternating feeding with feed deprivation in horses consistently produced gastric squamous epithelial ulceration and provided a useful model for characterizing temporal transitions in peptic-injured alimentary squamous epithelia.

α-Fetoprotein (AFP) measurements have clinical implications in fetal medicine and, in infants and older children, in detection, differential diagnosis and monitoring of malignant disease. Maternal serum AFP levels constitute part of a multiple-marker test used in early second-trimester screening to predict risk of fetal chromosomal abnormalities. Those individuals with increased risk are offered further definitive diagnostic investigation. Second-trimester screening is now increasingly being superseded by first-trimester screening with other serum markers and ultrasound. As AFP is only produced physiologically during fetal development, elevated serum levels after the first two post-natal years usually indicate the presence of a malignant disease process. Before this time, levels may be purely physiological and therefore serial values should be plotted on a logarithmic chart to ensure that they are falling appropriately, with a typical half-life of ∼5-6 days. If not, further investigation should be undertaken. Serum AFP is raised in a significant proportion of germ cell tumours (GCTs), hepatoblastoma and hepatocellular carcinoma (HCC). In suspected cases of GCT, serum human choriogonadotropin (HCG) estimation should also be performed. For possible intracranial GCTs, both serum and cerebrospinal fluid levels of AFP and HCG should be measured, ideally before neurosurgical biopsy. In malignant conditions, serum AFP may be used for diagnosis, treatment monitoring, surveillance for disease recurrence and prognostication. Immunohistochemistry for AFP using antibody staining is routinely used to assist pathological diagnosis on tissue sections where the differential includes GCT, hepatoblastoma and/or HCC. Elevations of serum AFP also occur in non-malignant conditions such as chronic liver disease.

A glass combined pH-reference electrode was placed in the stomachs of 5 adult horses and pH was recorded every 6 mins for 24 h while (1) feed and all bedding materials were withheld for 24 h (unfed), (2) horses had free access to Timothy grass hay for 24 h (fed), and (3) horses had free access to Timothy grass hay and were treated with ranitidine, 6.6 mg/kg body weight, orally, every 8 h for 48 h (fed + ranitidine). There was a significant (P = 0.007) difference in median 24-h gastric pH amongst the 3 protocols, the value being 3.1 in fed horses and 1.55 in unfed horses (P = 0.05) and 4.6 in fed + ranitidine horses (P = 0.05 compared with fed horses). The percentage of pH readings2.0 was significantly greater (P = 0.05) in unfed (76%) than in fed (30%) horses, and in fed horses than in fed + ranitidine (9%) horses. The percentage of readings2.0, 3.0, 4.0, 5.0 and 6.0 were each significantly (P = 0.05) greater in fed + ranitidine horses than in fed horses, and in fed than in unfed horses. There was no difference (P = 0.13) between median gastric pH values from different times of day in unfed horses (00:00 to 06:00 h, 1.5; 06:00 to 12:00 h, 1.6; 12:00 to 18:00 h, 1.7; and 18:00 to 24:00 h, 1.5). We conclude that gastric acidity is greatest when horses do not have access to feed material and that ranitidine effectively suppresses gastric acidity in horses under conditions of free access to hay.

Katie, an 11-year-old, previously healthy Caucasian girl presents to her general practitioner (GP) with a 2-month history of being generally unwell with lethargy, loss of appetite, anorexia and aching legs. Past medical history reveals febrile convulsions as a young child but nothing else of note. Katie was born at term by normal delivery, is fully immunised and is on no current medication. Examination is unremarkable save for some small, shotty 1 cm diameter cervical and inguinal lymph nodes. Weight is 45 kg (75–90th centile) and height is 155 cm (90–95th centile). The GP is concerned about a possible diagnosis of malignancy, particularly given the history. She therefore decides that further investigation is warranted and requests a full blood count (FBC). FBC reveals haemoglobin 10.3 g/dl, white cell count (WCC) 45.5×109/l and platelets 128×109/l. Blood film reveals the presence of circulating lymphoblasts, suggestive of acute lymphoblastic leukaemia (ALL). Katie is referred to the tertiary paediatric oncology centre, where the diagnosis is confirmed by bone marrow examination and induction chemotherapy commenced according to the current ALL protocol. A central venous catheter is inserted for administering chemotherapy, other medication and blood sampling. She receives co-trimoxazole (septrin) routinely for Pneumocystis carinii pneumonia (PCP) prophylaxis. At the end of the 28-day induction phase, repeat bone marrow examination confirms that Katie is in morphological remission. Katie tolerates the subsequent blocks of chemotherapy well (consolidation followed by two alternating courses of interim maintenance and delayed intensification). Shared care is provided by her local district general hospital and she starts maintenance chemotherapy at week 46 of treatment, as per the protocol. Her central venous catheter is removed at this stage as it is only required infrequently for chemotherapy now and is considered to be an ongoing infection risk. At week 90, Katie develops intermittent …

When a congenital diaphragmatic hernia (CDH) is left-sided, radiographic diagnosis is usually straightforward. Right-sided CDH is clinically and radiographically more difficult.

Growth factors are important in healing and restoration of injured gastrointestinal tissues and, therefore, we characterised temporally the distribution and density of epidermal growth factor receptor (EGFr) in normal and peptic-injured gastric squamous epithelium of horses. Lesions were induced in the equine gastric squamous epithelium using a feed deprivation protocol that results in prolonged increased gastric acidity. Fifteen mature horses, 9 geldings and 6 mares, age 3 to 20 years, were used and divided into 3 groups: Group 1 (n = 5) were subjected to euthanasia for problems unrelated to the gastrointestinal tract and had normal-appearing gastric squamous mucosal epithelium; Groups 2 (n = 5) and 3 (n = 5) had lesions induced in the gastric squamous epithelium by alternating 24 h periods of feed deprivation and ad libitum access to hay, for a total of 48 h and 96 h, respectively. Following lethal injection of a barbiturate, stomachs were removed and fixed by filling with 4- 6 l 10% buffered formalin. Sections were made from normal stomachs and lesions in the gastric squamous epithelium adjacent to the margo plicatus along the right side of the stomach/greater curvature and the lesser curvature. A modified avidin-biotin immunoperoxidase technique was used to stain the formalin-fixed tissue specimens for EGFr. A computerised image analysis system was used to measure area occupied by EGFr (EGFr area) and mean EGFr density in 4 zones within the epithelium extending from the basal cell layers toward the lumen. Measurements were made of epithelium in an erosion bed, at the margin of an ulcer or erosion, and 10-15 mm distant from the lesion margin. Additionally, EGFr area and density were measured in epithelial cells adjacent to capillaries in the epithelium. Intermittent feed deprivation resulted in erosion and ulceration of the gastric squamous epithelium of each horse. Mean EGFr area and density were greatest (P

Medical records and endoscopy images were examined for 209 horses that had gastroscopic examinations performed with a 2.5- or 3-m-long endoscope by one of the authors (MJM) during a 4-year period (1996-2000). The antrum and pylorus were viewed in 162 horses, and the duodenum was viewed in 94 horses. Of these 162 horses, the gastric squamous mucosa was seen in 157 horses and 50% or more of the glandular mucosa of the body of the stomach was seen in 156 horses. Erosions or ulcers were seen in the gastric squamous mucosa in 91 (58%) horses. Erosions or ulcers were seen in the glandular mucosa of the body of the stomach in only 8% of the horses. Lesions consisting of erosion or ulceration were seen in the antrum or pylorus in 94 (58%) horses. Lesions consisting of hyperemia and a rough or "bumpy" appearance were seen in the mucosa of the duodenum of 16 horses. An association between the presence of lesions in the squamous mucosa and the presence of lesions in the mucosa of the antrum/pylorus was examined by Fisher's exact test, and the linear association of lesion severity scores between the squamous mucosa and the mucosa of the antrum/pylorus was tested using a Monte Carlo estimate for linear-by-linear association. There was no association (P = .88) between these sites for presence of lesions or lesion severity scores. Similarly, there was no association between scores for the glandular mucosa in the gastric body and those in the antrum/pylorus. Because of the high prevalence of lesions in the antrum and pylorus of the stomachs of adult horses examined in a hospital setting, the entire stomach should be viewed during a gastroscopic examination.

We recently described the expression of ebaf, a novel member of the transforming growth factor-beta superfamily in human endometrium. ebaf messenger ribonucleic acid was expressed in late secretory and menstrual endometria. Here, we show that ebaf is secreted as 42-, 34-, 28-, and 14-kDa proteins into the conditioned medium of transfected cells, endometrial fluid, and serum. The amount of secreted proteins was markedly reduced during the implantation window in the endometria and sera of normal fertile subjects. The expression of ebaf was dysregulated in the endometria of a subset of women with infertility during the receptive phase of the menstrual cycle. Abundant secreted protein was present in the endometria of these women during the implantation window. During the critical period of endometrial receptivity, ebaf protein was more abundant in patients with endometriosis who did not conceive than in patients who became pregnant. These findings show that ebaf is a secreted product and is released into body fluids. Some types of infertility are associated with dysregulated expression of ebaf in human endometrium, suggesting that a molecular defect in uterine receptivity may be identified using such a marker protein.

An adult female southern black rhinoceros (Diceros bicornis minor) experienced intermittent periods of regurgitation while eating, suggesting an esophageal disorder. Endoscopy for evaluation of the trachea, esophagus, and stomach revealed a 30-mm nasopharyngeal orifice with associated recess located in the caudodorsal pharynx and a 10-cm dilated segment of the distal esophagus that was presumably the cause of regurgitation. Dietary management of esophageal dilation through short-term utilization of a "soft feed" program successfully eliminated the regurgitation. This is the first report of esophageal dysfunction in a rhinoceros.

The prevalence of thyroid peroxidase autoantibodies (TPO.Ab) was assessed in patients with either breast carcinoma or benign breast disease, and its association with disease outcome in breast carcinoma was studied. TPO.Ab were detected by direct RIA in serum from 121/356 (34.0%) of patients with breast carcinoma, compared with 36/194 (18.5%) of controls (P0.001); and in 31/108 (28.7%) with benign breast disease, compared with 12/88 (13.6%) of controls (P0.05). Survival analysis in a group of 142 women with breast carcinoma demonstrated that TPO.Ab titresor = 0.3 U/mL were associated with a significantly better disease-free [relative risk (RR) = 1.84, P0.05] and overall survival (RR = 3.46, P0.02), compared with those who were TPO.Ab-negative. Better outcome associated with higher TPO.Ab titres was confined to those who had thyroid volumes within the intermediate range (10.1-18.8 mL) and did not further enhance the good outcome recorded when volumes wereor = 10.0 mL or18.8 mL. Multivariate survival analysis showed that both TPO.Ab and thyroid volume were independently associated with prognosis in breast carcinoma and that RRs for disease-free survival were of a similar order of magnitude to well-established prognostic indices such as axillary nodal status or tumor size. These findings supply evidence that manifestations of thyroid autoimmunity are associated with a beneficial effect on disease outcome in breast carcinoma and provide the strongest evidence to date of a biological link between breast carcinoma and thyroid disease.

Seventeen Thoroughbred horses with moderate to severe gastric ulceration were purchased from a race track within 10 days of racing and were treated once daily with either omeprazole (9 horses) or vehicle (8 horses) and evaluated gastroscopically for ulcer healing. Horses were administered omeprazole (1.5 mg/kg bwt/day) or vehicle by nasogastric tube once daily. Gastroscopic examination was performed on Days 0, 4, 7, 11, 14, 17, 21, 24 and 28, until lesions healed completely. Selected images of gastric lesions were captured by computer at each endoscopic examination, with a measuring caliper included in captured images. The area and perimeter of lesions were measured by computer and healing rates of specific lesions were determined by calculating the rate of linear advance of the margins toward the centre of the lesion. Additionally, the number of days to complete healing of the entire gastric squamous mucosa was compared between treatment groups. Gastric lesions healed at a significantly faster rate in horses receiving omeprazole than in vehicle-treated horses (P < 0.001). Complete healing of the entire stomach occurred in 10-21 days in omeprazole-treated horses, and 14-28 days in 3 of 8 vehicle-treated horses, with the remaining vehicle-treated horses having unhealed lesions on Day 28. In addition, 5 vehicle-treated horses developed new lesions in the squamous epithelial mucosa during the trial; no new lesions were observed in the omeprazole-treated group.

To determine the effect of decreasing gastric acidity in a feed-deprivation protocol on induction of gastric ulcers, and to determine whether stall confinement may be a factor contributing to gastric ulceration in horses.8 adult horses, 4 geldings and 4 mares, 3 to 8 years old, and 7 adult horses, 5 geldings and 2 mares, 4 to 11 years old.Gastric ulceration was induced in horses by alternating 24-hour periods of feed deprivation and ad libitum access to hay, for a total of 96 hours' feed deprivation. This protocol was repeated with the horses receiving the histamine type-2 receptor (H2) antagonist ranitidine (6.6 mg/kg of body weight, PO, q 8 h). In another group of horses, severity of gastric lesions was compared after 7 days' pasture turnout and 7 days' stall confinement with ad libitum access to hay. Gastroscopy was performed after each feed-deprivation protocol was completed, and total lesion area in the gastric squamous epithelial mucosa was measured. Gastroscopy was performed at the beginning and end of 7 days' pasture turnout and 7 days' stall confinement.Alternating periods of feed deprivation resulted in erosion and ulceration of the gastric squamous epithelial mucosa of each horse. Concurrent treatment with ranitidine resulted in significantly (P0.05) less area of ulceration in the gastric squamous epithelial mucosa. After 7 days' stall confinement, 6 of 7 horses had ulceration in the gastric squamous epithelial mucosa, and 1 horse had a lesion in the glandular mucosa, whereas after 7 days' pasture turnout, 2 horses had reddening of the gastric squamous mucosa along the lesser curvature (P0.05).Severe ulceration of the gastric squamous epithelial mucosa, caused by excess acidity, can develop rapidly in horses deprived of feed or not consuming feed. Suppression of gastric acidity with the histamine type-2 receptor antagonist ranitidine effectively minimized the area of ulceration caused by feed deprivation. Compared with being turned out to pasture, stall confinement alone appears to be an important factor in the development of gastric ulcers in horses, probably as a result of altered eating behavior.

Oestrogen and progesterone are promoters of uterine leiomyoma growth: oestrogen receptors (ER) and progesterone receptors (PR) are over-expressed in these tumours. Paradoxically, there is a heterogeneity in responsiveness of leiomyoma growth to oestrogen and progesterone in culture. In this study, leiomyoma and adjacent myometrium were obtained at hysterectomy. The effect of oestrogen and progesterone on steroid receptor maintenance was examined using minced explants. Quantitative enzyme-linked immunoassay and Northern analysis were performed to assess ER and PR protein and mRNA content respectively. There was an approximately 75% decrease in ER and PR protein content within 8 h of incubation in both leiomyoma and myometrium. The presence or absence of oestrogen and/or progesterone had no effect on receptor protein loss. Northern analysis indicated a parallel loss of ER and PR mRNA transcripts. These findings suggest that the ER and PR expression in leiomyoma may require other extracellular factors. In-vitro studies designed to test the effects of sex steroids and their respective inhibitors on growth and function of leiomyoma and myometrial cells should consider this phenomenon.

To determine, using a sensitive glucose assay, whether monitoring of tracheal aspirate glucose concentration could serve as a marker of aspiration of enteral feedings.Prospective, controlled trial.Intensive care units of a tertiary care hospital.Fifteen enterally fed and 15 nonenterally fed, tracheally intubated patients who had normal lung fields on a routine chest radiograph.Patients with endotracheal tubes undergoing routine tracheal suctioning had tracheal secretions collected three times per day with a minimum of 4 hrs between samples for up to 5 days. Daily chest radiographs were reviewed for evidence of the development of pneumonitis using defined criteria.Glucose concentrations in five commonly used commercial feeding formulas, as well as in the medications patients were receiving enterally or as an oral wash, were measured. Tracheal secretion glucose concentrations were 66 +/- 54 (SD) mg/dL (3.7 +/- 3.0 mmol/L) and 105 +/- 70 mg/dL (5.8 +/- 3.9 mmol/L) in the enterally fed and nonenterally fed patients, respectively (p = NS). Of the medications administered, the majority contained negligible glucose, but ten had3 mg/dose of glucose. However, there was no correlation between administration of these medications and the tracheal glucose concentrations. Tracheal glucose concentrations were similar in patients who received medications containing glucose and patients who received either no medications or medications with negligible glucose content. A small but significant correlation between blood glucose and tracheal secretion glucose concentrations (r2 = .15, p.05) was observed. None of the patients developed aspiration pneumonitis. Glucose concentrations in widely used commercial formulas (44 to 202 mg/dL; 2.4 to 11.2 mmol/L) overlapped considerably with glucose concentrations in tracheal secretions in the absence of aspiration and were for the most part within 2 SD of mean values in tracheal secretions.Tracheal secretions contain high glucose concentrations, both in enterally fed patients without evidence of aspiration pneumonitis and in nonenterally fed patients. The concentration of glucose in tracheal secretions appears to be determined, in part, by ambient extracellular glucose concentrations. We conclude that measurement of glucose in tracheal secretions is unlikely to be useful in monitoring for tube feeding aspiration in tracheally intubated, enterally fed patients.

Although the association between advanced paternal age and serious birth defects has received less attention than the effect of maternal age on such defects, this association has been demonstrated. This, as well as the potential decline in fertility among older men, should be borne in mind by men electing to defer establishing a family.

This article explores the relationship between depression and category learning. We predicted that depression would impair categorization performance on criteria-attribute tasks, which require systematic hypothesis testing, but not on family-resemblance tasks, which allow processing strategies that are likely preserved in depression. These predictions were confirmed in 2 experiments using different stimuli, tasks, and S populations. We discuss some implications of the empirical connections among depression, the use of less sophisticated cognitive strategies, and category learning.

Epidermal growth factor (EGF)-like activity was measured in mares' colostrum and milk by radioreceptor assay. Milk samples were collected from 22 mares 1 or more times during early lactation. Samples of colostrum were taken after parturition and before the foal first suckled (presuckle), within 6 hours after the foal first suckled (postsuckle), and on days 1, 2, 4, and 8 of lactation. In the 5 mares from which milk samples were obtained at each sampling time, presuckle colostral mean EGF-like activity (17.8 ng/ml) was greatest (P less than 0.05). The mean values for EGF-like activity at all other sampling times were not significantly different from each other (postsuckle colostrum, 9.7 ng/ml; day 1, 9.6 ng/ml; day 2, 8.5 ng/ml; day 4, 8.0 ng/ml; day 8, 7.8 ng/ml).

A large fibrotic mass originating from the cecal base was discovered upon surgical exploration of the abdomen in a Thoroughbred mare with a history of chronic colic and weight loss. The mass protruded intraluminally resulting in partial obstruction. Surgical excision was not feasible due to the location of the mass and the inability to exteriorize it adequately from the abdominal cavity. The mass was fibrous with a shiny, gelatinous material present throughout the neoplasm. Histologically, large confluent spaces filled with mucopolysaccharides were identified by staining with Alcian blue. The diagnosis of myxosarcoma was based upon finding of atypical fibroblastic cells, mucinous stroma, local invasiveness, and metastasis to the regional lymph nodes. Myxomatous tumors have not previously been documented to occur in the equine intestinal tract.

Hypothyroidism was diagnosed in a neonatal Thoroughbred foal that was weak, hypothermic, and septicemic. Administration of thyroid-releasing hormone elicited attenuated increases in concentrations of free and total triiodothyronine and thyroxine, as compared with a clinically normal, age-matched foal. The foal died of apparent respiratory insufficiency, pre- and postmortem findings compatible with hypothyroidism included hypothermia, large thyroid glands with distended, colloid-filled follicles, and severe, diffuse atelectasis, with thickened alveolar septae and degenerating alveolar squamous epithelial cells.

To examine the effects of recombinant growth factors in vivo, impaired wound healing was studied in genetically diabetic C57BL/KsJ-db/db mice. Large full-thickness skin wounds made on the backs of these mice exhibited significant delays in the entry of inflammatory cells into the wound, the formation of granulation tissue, and in wound closure when compared to their nondiabetic littermates. Recombinant human platelet-derived growth factor (rPDGF-BB, 1 or 10 micrograms), recombinant human basic fibroblast growth factor (rbFGF, 1 micrograms), or combinations of both were applied topically to the wounds for 5 to 14 days after wounding. Diabetic mouse wounds treated with rPDGF-BB or rbFGF had many more fibroblasts and capillaries in the wound bed at 10 and 21 days than did wounds treated with the vehicle alone. The animals treated with growth factors also had significantly greater wound closure at 21 days than those treated with the vehicle. Combinations of rPDGF-BB and rbFGF improved all parameters of healing but not to a greater extent than either growth factor alone. The effectiveness of rPDGF-BB and rbFGF suggest that recombinant growth factors may be useful in the treatment of patients with deficient wound repair.

Gastroendoscopic examinations were conducted on 75 Thoroughbred foals aged two to 85 days on seven breeding farms in England and Ireland. The foals showed no signs of gastric disease. There was no significant difference between lesion prevalence in foals in England (16 of 28 foals; 57 per cent) or Ireland (22 of 47 foals; 47 per cent). Neither was there any sex predilection (18 of 36 males; 20 of 39 females). Lesions were most prevalent in foals under 10 days old (8 of 9) and least prevalent in foals older than 70 days (3 of 10). Lesions occurred most frequently in the squamous mucosa immediately adjacent to the margo plicatus along the greater curvature (34 foals), whereas lesions in the squamous fundus, the glandular fundus, and the lesser curvature were observed in 11, six and three foals, respectively. Lesions were not observed in the squamous mucosa surrounding the cardia. Gastric lesions were more prevalent in foals with a previous disorder than in those without (68 vs 43 per cent) and particularly with a history of recent or concurrent diarrhoea (9 of 14).

The interrelationship of malaria and severe ascariasiswas studied in Anjouan children with a previously described syndrome of enlarged parotids,localizedforehead edema, heavy infestationwith Ascaris lumbricoides, and unusual freedom from malaria.Aftertreatmentof 37 such children with the ascaricidepiperazine,35 had resolutionof parotid enlargement and forehead edema, but 19 developed attacks of malaria. Children treated with placebo had neither resolution of clinical fmdings nor attacks of malaria. We propose that suppression of the malaria in these children is a nutritional consequence of severe ascariasis and may represent an ecological balance for optimum co-survival of the host and the two parasites. Am. J. Clin. Nutr. 31: 1363-1366, 1978. The suppression of one infection by an

The nature and incidence of infections were studied in two groups of Turkana living in the same area but eating different diets; one consumed milk only and the other a combination of fish and milk. The only apparent and significant nutritional difference between the two groups was mild iron deficiency in the milk drinkers. Episodes of fever, symptomatic infection with malaria and brucellosis, molluscum contagiosum and common warts, episodes of diarrhea, and serological evidence of infection with Entamoeba histolytica were significantly increased in Turkana eating fish. We suggest that this phenomenon may result from a disruption of a long-standing ecological compromise between the all-milk diet of the Turkana and the pathogenic organisms.

Tissue iron deficiency as measured by liver non-haem iron levels was produced in rats by iron-poor diets and bleeding. Studies on gastric secretion with the Shay technique revealed significant changes in pH, total acid and acid concentration in the iron deficient rats when compared with control normals and control anaemic animals.

The incidence of infections was studied in 137 iron-deficient Somali nomads, 67 of whom were treated with placebo and 71 with iron. Seven episodes of infection occurred in the placebo group and 36 in the group treated with iron; these 36 episodes included activation of pre-existing malaria, brucellosis, and tuberculosis. This difference suggested that host defence against these infections was better during iron deficiency than during iron repletion. Iron deficiency among Somali nomads may be part of an ecological compromise, permitting optimum co-survival of host and infecting agent.

In a study of the effect of feeding pancreas powder on the absorption of Fe59 by rats with fatty liver induced by choline deficiency, control groups fed bromelin and choline plus iron were studied in parallel. No significant depression of iron absorption was observed in any of these groups. Thus, pancreas extracts appeared unable to depress increased Fe59 absorption in rats with fatty liver induced by choline deficiency.

PULMONARY edema is usually the result of heart disease. When it occurs in patients with established or suspected heart disease there is little reason to look beyond the heart for a cause. There are conditions, however, that may present a clinical picture resembling pulmonary edema. They include bronchial or pulmonary infections, pulmonary embolism and sensitivity reactions in the lung. If any of these occur in patients with existing heart disease they may be overlooked as a cause of symptoms. Sensitivity reactions of the lung to drugs are uncommon and usually take the form of pulmonary infiltration, with eosinophilia. Rarely do . . .

An epidemic of molluscum contagiosum and oro-genital herpes simplex was observed in Maasai pastoralists of the Rift Valley. It coincided with a period of refeeding following famine, when the relief diet was different from normal milk fare. We propose that refeeding may be an important mechanism for activation of certain viral infections previously suppressed by famine.

A 6-month-old Clydesdale filly had chronic abdominal distention and intermittent febrile episodes. Abdominal surgery revealed impaction of the right dorsal colon, which was relieved by evacuation of contents through an enterotomy. Four days after surgery, abdominal distention recurred and progressed. The filly was euthanatized. Necropsy revealed the right dorsal colon to be markedly distended with digesta. Microscopically, there was a marked reduction in myenteric ganglion cells in the right dorsal colon and cecum and mild to moderate reduction of myenteric ganglion cells in the left ventral and transverse colon.

Isolated segments of left dorsal colon and a side-to-side colocolostomy (between the left ventral colon and left dorsal colon) were surgically created in 6 adult ponies. Four segments, each separated by an empty segment, were inoculated (20 ml) with 1 of the following 4 solutions: phosphate buffered saline solution (PBSS)/1% polyethylene glycol (PEG); purified cholera toxin in PBSS/1% PEG (5 micrograms cholera toxin/ml of PBSS/1% PEG); lyophilized Salmonella typhimurium UCD 1755 culture lysate, reconstituted in PBSS/1% PEG; and viable S typhimurium UCD 1755 (10(8) organisms/ml of PBSS/1% PEG). Twenty hours following inoculation of the treatment solutions into the isolated colon segments, the ponies were reanesthetized. Fluid accumulation in the isolated segments was measured, and tissue samples from isolated segments were taken for examination by light microscopy and electron microscopy, and for measurement of mucosal cyclic adenosine monophosphate levels. There was fluid accumulation in segments inoculated with cholera toxin in 4 ponies (29.5 +/- 12.7 ml), and in segments inoculated with S typhimurium UCD 1755 culture lysate in 3 ponies (14.0 +/- 8.7 ml). There was no fluid accumulation in segments inoculated with either the control solution (PBSS/1% PEG) or viable S typhimurium UCD 1755. There was significantly (P less than 0.05) less cyclic adenosine monophosphate in segments inoculated with cholera toxin, Salmonella lysate, and viable Salmonella, compared with control segments. Histologically, there were minimal changes in control segments, consisting of mild to moderate submucosal edema and capillary congestion.(ABSTRACT TRUNCATED AT 250 WORDS)

During the Central African (Sahelian) drought, attacks of falciparum malaria were common in patients and their relatives shortly after their arrival in a hospital in Eastern Niger. A prospective study of 72 adult patients not admitted for malaria and 109 accompanying relatives was undertaken to investigate this observation. 23 attacks occurred in patients and 51 in relatives, with a peak frequency five days after arrival. On arrival, parasitaemia was low but reached a maximum by five days. Serum-iron and percentage saturation of transferrin were moderately increased initially, rose dramatically within forty-eight hours with near maximum saturation, and were falling by the fifth day. It is suggested that the early hyperferraemia, apparently related to refeeding, led to rapid multiplication of existing parasites and attacks of malaria. The results of experimental malarial infection of Wistar rats, half of which had been given intramuscular iron, supported this hypothesis.

Bilateral painless enlargement of the parotids, a curiously localized edema of the forehead and relative freedom from malaria were striking findings in children of Anjouan but not of Grande Comore, two neighboring islands of the Comorro group in the Indian Ocean. Compared with those of Grande Comore, Anjouan children were heavily infested with Ascaris lumbricoides. We suggest that the clinical findings may be the nutritional consequence of severe ascariasis and that the low incidence of malaria in Anjouan children may be an example of the delicate ecological balance between the host, the Ascaris, and the plasmoidum. Am. J. Clin.Nutr. 30: 2117-2121, 1977.

Traditional methods for toxicological assessment have implicated the immune system as a frequent target organ of toxic insult following chronic exposure to certain environmental chemicals, radiation or therapeutic drugs (xenobiotics). Immunotoxicity is expressed as autoimmunity, chemical hypersensitivity or immunosuppression. A tiered approach for characterizing chemical and drug-induced immunomodulation has been developed and validated in laboratory animals. Polycyclic aromatic hydrocarbons (PAH) have been studied because of their ubiquitous presence in the environment and carcinogenic potential. Since immunosuppression induced by PAH carcinogens has been implicated as an epigenetic mechanism in the outgrowth of initiated cells, this tiered approach was used to characterize the mechanism of PAH immunosuppressive capacity. Previously, studies in this laboratory have demonstrated that subchronic exposure of B6C3F1 mice to PAH carcinogens suppresses both humoral immunity (HI) and cell-mediated immunity (CMI), concurrently with decreased resistance to tumor challenge. The potent carcinogenic PAH, 7,12-dimethylbenz[a]anthracene (DMBA) was subchronically administered subcutaneously at 5, 50, or 100 micrograms/g of body weight. Natural killer (NK) cell tumor cytolysis, generation of cytotoxic T-cells (CTL), and lymphoproliferation to mitogens and allogeneic splenocytes in mixed leukocyte cultures (MLC) were quantitated 3-5 days after exposure to assess CMI. Mitogen and alloantigen-induced proliferation (MLC) of splenocytes was suppressed up to 90%. CTL and NK tumor cytolysis of radiolabelled target cells were similarly depressed up to 88 and 82%, respectively. Impairment of MLC or CTL responses correlated with increased susceptibility to challenge with PYB6 sarcoma cells. HI was measured by quantitating the number of antibody (IgM) plaque-forming cells (PFC) produced in response to T-cell dependent antigen challenge (sheep erythrocytes) and was similarly suppressed up to 95%. To understand the mechanism of PAH-induced immunotoxicity, splenocytes from DMBA-exposed mice were sensitized to alloantigens in the presence of interleukin-2 (IL-2) because there were indications that T-helper cell function was suppressed. In these preliminary studies, CTL suppression could be completely restored by the addition of the T-cell growth supporting lymphokine (IL-2) during the inductive phase of CTL generation, suggesting that DMBA exposure directly or indirectly induced deficits in T-helper cell function.

1. Within the limits of this study, neither maternal iron deficiency nor Fe-overload as measured at term appeared to affect the complement of Fe received by the foetus.2. Infants feeding entirely on breast milk appeared to have normal Fe status 6 months postpartum regardless of the Fe status of the mother.3. No relationship could be demonstrated between the Fe content of breast milk and the Fe status of the mother.

We have investigated the effects of gastric and intestinal secretions from normal human subjects and those with iron-deficiency anaemia and haemochromatosis on the in vitro uptake of 59Fe by everted rat gut segments. Whereas gastric secretions from normal subjects did not potentiate the uptake, intestinal secretions did. This effect was more marked with gastric and intestinal secretions obtained from patients with iron-deficiency anaemia and haemochromatosis, but it disappeared with prior heating. These findings suggest that gastric and intestinal secretions play a role in the regulation of iron absorption.