Effect of Intrathecal Bupivacaine Dose on the Success of External Cephalic Version for Breech Presentation: A Prospective, Randomized, Blinded Clinical Trial.

Background: Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose-response effect.

Correlation of probability scores of placenta accreta on magnetic resonance imaging with hemorrhagic morbidity.

Study Objective And Design: To evaluate the hypothesis that assigning grades to magnetic resonance imaging (MRI) findings of suspected placenta accreta will correlate with hemorrhagic outcomes. We chose a single-center, retrospective, observational design.

Setting, Patients, And Measurements: Nulliparous or multiparous women who had antenatal placental MRI performed at a tertiary level academic hospital were included.

How to Manage Allergic Reactions to Contrast Agent in Pregnant Patients.

Objective: This article reviews optimal treatment of allergic reactions to iodinated contrast material in pregnant patients. Initial evaluation and treatment of a pregnant patient is similar to that for a nonpregnant patient. However, additional steps, including assessment for uterine cramping, using left uterine displacement to improve venous return, and maintaining blood pressure to ensure placental perfusion, may be required.

Anesthetic management of external cephalic version.

Breech presentation is common at term and its reduction through external cephalic version represents a noninvasive opportunity to avoid cesarean delivery and the associated maternal morbidity. In addition to uterine relaxants, neuraxial anesthesia is associated with increased success of version procedures when surgical anesthetic dosing is used. The intervention is likely cost effective given the effect size and the avoided high costs of cesarean delivery.

Naturally occurring Tyzzer's disease in cotton-top tamarins (Saguinus oedipus).

We noted naturally occurring infection with Clostridium piliforme (Tyzzer's disease) in 2 captive-reared cotton-top tamarins (Saguinus oedipus). Spontaneous Tyzzer's disease has been reported in multiple species of laboratory, domestic, and wild animals but is extremely rare in humans and nonhuman primates. Distinct from idiopathic colitis, which is common in cotton-top tamarins, these 2 tamarins had severe, transmural, necrotizing typhlocolitis accompanied by myocarditis and hepatitis.

Campylobacter-induced enteritis and diarrhea in captive cotton-top tamarins (Saguinus oedipus) during the first year of life.

A prospective study of 43 cotton-top tamarins, from infancy to 6 to 17 months of age, was conducted to determine the epidemiology of Campylobacter spp. infection. Nine infants followed for one year in an isolation unit, where attendants wore protective clothing, did not become infected.

Induction of an AIDS virus-related tuberculosis-like disease in macaques: a model of simian immunodeficiency virus- mycobacterium coinfection.

The mechanism by which human immunodeficiency virus (HIV)-Mycobacterium tuberculosis coinfection facilitates development of HIV-related tuberculosis is poorly characterized. Macaque models of simian immunodeficiency virus (SIV(mac))-Mycobacterium bovis BCG coinfection were employed to explore the pathogenesis of AIDS virus-related tuberculosis. Following BCG coinfection, SIV (SIV)-infected macaques with high viral loads developed an SIV-related tuberculosis-like disease.

Antiretroviral agents restore Mycobacterium-specific T-cell immune responses and facilitate controlling a fatal tuberculosis-like disease in Macaques coinfected with simian immunodeficiency virus and Mycobacterium bovis BCG.

The contribution of immune reconstitution following antiretroviral treatment to the prevention or treatment of human immunodeficiency virus-related primary or reactivation tuberculosis remains unknown. Macaque models of simian immunodeficiency virus-Mycobacterium bovis BCG (SIV/BCG) coinfection were employed to determine the extent to which anti-Mycobacterium tuberculosis immunity can be restored by antiretroviral therapy. Both SIV-infected macaques with active BCG reinfection and naive animals with simultaneous SIV/BCG coinfection were evaluated.

Pulmonary cryptosporidiosis in simian immunodeficiency virus-infected rhesus macaques.

Cryptosporidiosis is a common opportunistic infection in the gastrointestinal tract of human and nonhuman primates with AIDS. Pulmonary infection associated with Cryptosporidium spp. has not been previously reported in monkeys.

Enterocytozoon bieneusi as a cause of proliferative serositis in simian immunodeficiency virus-infected immunodeficient macaques (Macaca mulatta).

Context: Enterocytozoon bieneusi is the most frequent microsporidian parasite of human patients with acquired immunodeficiency syndrome and is a significant cause of diarrhea and wasting. Recently, this organism has also been recognized as a spontaneous infection of several species of captive macaques. As in humans, E bieneusi frequently causes enteropathy and cholangiohepatitis in immunodeficient simian immunodeficiency virus (SIV)-infected macaques.

Identifying the target cell in primary simian immunodeficiency virus (SIV) infection: highly activated memory CD4(+) T cells are rapidly eliminated in early SIV infection in vivo.

It has recently been shown that rapid and profound CD4(+) T-cell depletion occurs almost exclusively within the intestinal tract of simian immunodeficiency virus (SIV)-infected macaques within days of infection. Here we demonstrate (by three- and four-color flow cytometry) that this depletion is specific to a definable subset of CD4(+) T cells, namely, those having both a highly and/or acutely activated (CD69(+) CD38(+) HLA-DR(+)) and memory (CD45RA(-) Leu8(-)) phenotype. Moreover, we demonstrate that this subset of helper T cells is found primarily within the intestinal lamina propria.

Mycobacterium bovis bacille Calmette-Guérin enhances pathogenicity of simian immunodeficiency virus infection and accelerates progression to AIDS in macaques: a role of persistent T cell activation in AIDS pathogenesis.

It has recently been proposed that Mycobacterium tuberculosis may enhance the pathogenicity of HIV infections and accelerate the course of HIV disease. This hypothesis has been tested in the present study using a simian immunodeficiency virus of macaques (SIVmac)/Mycobacterium bovis bacille Calmette-Guérin (BCG)-coinfected macaque model. Naive and chronically SIVmac-infected monkeys were evaluated.

Ultrastructural morphology of Enterocytozoon bieneusi in biliary epithelium of rhesus macaques (Macaca mulatta).

Enterocytozoon bieneusi is the most common microsporidian parasite found in humans with acquired immunodeficiency syndrome. A nearly identical organism was recently recognized in rhesus macaques (Macaca mulatta). Ultrastructural examination of this microsporidian parasite in biliary epithelium of rhesus macaques reveals characteristics unique to E.

Localization of persistent Enterocytozoon bieneusi infection in normal rhesus macaques (Macaca mulatta) to the hepatobiliary tree.

Enterocytozoon bieneusi is the most common microsporidian parasite recognized in human patients with AIDS. Recently, we identified a virtually identical organism causing a spontaneous infection associated with hepatobiliary and intestinal disease in simian immunodeficiency virus (SIV)-infected macaques. To examine the natural history of the infection, we examined captive rhesus macaques for E.

Gastrointestinal tract as a major site of CD4+ T cell depletion and viral replication in SIV infection.

Human and simian immunodeficiency virus (HIV and SIV) replicate optimally in activated memory CD4(+) T cells, a cell type that is abundant in the intestine. SIV infection of rhesus monkeys resulted in profound and selective depletion of CD4+ T cells in the intestine within days of infection, before any such changes in peripheral lymphoid tissues. The loss of CD4+ T cells in the intestine occurred coincident with productive infection of large numbers of mononuclear cells at this site.

Five spontaneous deaths associated with Clostridium difficile in a colony of cotton-top tamarins (Saguinus oedipus).

Clostridium difficile toxin was detected in the feces of five cotton-top tamarins (Saguinus oedipus) that died spontaneously over a period of 10 weeks. Deaths occurred subsequent to antibiotic therapy for infectious diarrhea associated with Campylobacter spp. Relevant clinical signs of disease prior to death included weight loss, watery diarrhea, hematochezia, weakness, and sudden collapse.

Characterization of gut-associated lymphoid tissue (GALT) of normal rhesus macaques.

This study characterizes the gut-associated lymphoid tissue (GALT) of normal healthy rhesus macaques and compares the percentages of T and B cell subsets to those of systemic lymphoid tissue. Lymphocytes from the systemic lymphoid tissue (spleen, axillary, and inguinal lymph nodes), mesenteric lymph nodes (MLN), and intestinal epithelium (IEL) and lamina propria (LPL) of the jejunum, ileum, and colon were examined from both adult and juvenile, normal rhesus macaques. Lymphocytes were analyzed for expression of CD2, CD3, CD4, CD8, CD25, gamma delta TCR, and CD20 by two- or three-color flow cytometric analysis.

Induction of lymphocyte proliferation and severe gastrointestinal disease in macaques by a nef gene variant SIVmac239.

The molecularly cloned virus known as SIVmac239/YEnef causes extensive lymphocyte activation in unstimulated peripheral mononuclear cell cultures and induces an acute disease syndrome in macaque monkeys. Here we describe the histopathological and immunophenotypic changes and viral localization in peripheral lymph nodes, spleen, and gastrointestinal tract (including the gut-associated lymphoid tissue (GALT) in rhesus monkeys inoculated with SIVmac239/YEnet beginning at day 3 postinoculation (pi). The findings are compared with those of rhesus monkeys inoculated with the same dose of parental SIVmac239.

A spontaneous squamous cell carcinoma of the oral cavity in a squirrel monkey (Saimiri sciureus).

A spontaneous squamous cell carcinoma was diagnosed in the oral cavity of an adult female squirrel monkey (Saimiri sciureus). Immunohistochemical analysis of the neoplasm demonstrated cytokeratin and vimentin, but not S100 or desmin in the neoplastic epithelial cells.

Arteriopathy in macaques infected with simian immunodeficiency virus.

Background: An arteriopathy characterized by intimal and medial thickening and fibrosis was seen in 19 of 85 rhesus monkeys infected with simian immunodeficiency virus (SIV), a lentivirus with morphologic, genetic, and biologic similarities to HIV-1 and HIV-2.

Experimental Design: All cases of simian AIDS in rhesus monkeys at the New England Regional Primate Research Center, resulting from either experimental or naturally acquired SIV infection, were retrospectively examined for evidence of histopathologic changes to the vasculature. Of the 85 SIV-related deaths recorded in the pathology files to date, tissues from 19 animals were chosen for further study because of thickening, disruption, inflammation, or other abnormality to any layer of the vascular wall.

Pathologic features of SIV-induced disease and the association of macrophage infection with disease evolution.

Since the original isolation of simian immunodeficiency virus (SIV) from a macaque with an AIDS-like disease, numerous studies have demonstrated the close biologic and genetic relationship of the SIVs to the HIVs. Probably most important, the clinical spectrum of disease associated with SIVmac/SIVsmm infection in rhesus monkeys is strikingly similar to AIDS in HIV-1-infected human beings. Herein are summarized the pathologic features of SIVmac-induced disease in a cohort of rhesus monkeys, with special reference to the role of infected macrophages in the development of AIDS-related manifestations.

An activated CD8+ lymphocyte appears in lymph nodes of rhesus monkeys early after infection with simian immunodeficiency virus.

Although alterations in T lymphocyte subset distribution and function in the peripheral blood of HIV-infected humans are well defined, the extent to which these reflect changes in other lymphoid compartments is unclear. We have characterized the coincident changes in PBL and lymph nodes (LN)1 after simian immunodeficiency virus of macaques (SIVmac) infection of rhesus monkeys. Whereas no consistent change in CD8+ PBL was noted during the first 60 d after infection, CD8+ lymphocytes increased significantly in number in LN.