Cerebral blood flow velocity in term newborns following intrapartum fetal asphyxia

Twenty-six term newborns with intrapartum fetal asphyxia, determined biochemically (umbilical artery base deficit < 12mmol/1), were compared with 59 normal newborns to determine the effect of intrapartum fetal asphyxia on newborn blood pressure and cerebral blood flow velocity following delivery. Cerebral blood flow velocity observations with concurrent measures of blood pressure and heart rate were obtained during the 24 h after delivery and after 24 h. After delivery, diastolic blood pressure in the newborns of the asphyxia group was significantly greater than that of the newborns of the normal group and this difference persisted after 24 h. Cerebral blood flow velocity in the newborns of the asphyxia group was of the same order as that of the newborns of the normal group during the 24 h after delivery. However, there was a significant increase in both peak systolic and end-diastolic blood flow velocity after 24 h. The duration of metabolic acidosis may be a factor in the occurrence of this delayed cerebral blood flow velocity response. Observations of cerebral blood flow velocity should be continued for more than 24 h following delivery to determine the effect of intrapartum fetal asphyxia.     

Review of neuropsychological functioning in treated phenylketonuria: an information processing approach

Phenylketonuria is no longer associated with mental retardation and other devastating neurological effects. Nonetheless, learning disabilities and IQ loss are common, even in early-treated individuals. Until recently, IQ was used as the sole measure of mental functioning in this population. As specific academic deficits were recognized and as greater variety of tests became available, evaluation of children with phenylketonuria has included neuropsychological testing. A review of the 21 published reports highlights the areas of consensus and the need for additional well designed studies in the future. Problem solving, particularly abstract reasoning and executive functions, appears to be impaired in children with phenylketonuria. Reaction time, or speed of mental processing, appears to be the other important area affected in PKU. An information processing model is presented as paradigm for further research and development of remedial strategies for children with phenylketonuria.     

Alternative treatment to corticosteroids in steroid sensitive idiopathic nephrotic syndrome

A review was undertaken of the use of alternative immunosuppressive treatment in addition to corticosteroids in a cohort of 429 children with steroid sensitive nephrotic syndrome (SSNS) treated between 1980 and 1994. Two hundred and twenty two children (52%) received at least one course of alternative treatment, 98 (23%) two, and 43 (10%) three. Cyclophosphamide was administered to 196 children (46%); in 181 it was the first course of alternative treatment and in 104 (57%) of those it was also the last ('final course'). Levamisole was given to 56 children (13%) and cyclosporin to 53 (12%). Fifteen children in whom cyclosporin failed were treated with chlorambucil. A few patients received azathioprine or vincristine. Ten children developed secondary steroid resistance, of whom five progressed to chronic renal failure. Acute complications included reversible renal failure, septicaemia, peritonitis, convulsions, and cerebral thrombosis. There were three deaths. It is concluded that half of the referred children with SSNS were deemed to require at least one course of alternative immunosuppressive treatment, and that side effects of the treatment and complications of SSNS are infrequent but occasionally fatal.     

Hysteroscopic Metroplasty

EDITORIAL COMMENT: Septate uterus is a common obstetric problem often first diagnosed during pregnancy when oblique fetal lie with breech presentation is noted in an asymmetrical heart-shaped uterus in the early third trimester. The diagnosis may also be made by hysterosalpingography in patients with habitual abortion, by early second trimester ultrasonography (although sometimes the ultrasonographer cannot identify the septum), or at the time of manual removal of a retained placenta. Most obstetricians have treated many patients with a septate uterus conservatively since the majority reproduce successfully. The question of metroplasty only arises when habitual abortion occurs. The remarkably few published series of metroplasties performed abdominally indicate that the operation is seldom performed. Hysteroscopic metroplasty seems so simple and effective that it appears reasonable to recommend it in any patient who has had 2 or more spontaneous miscarriages, especially if these occurred in the second trimester and resulted in the loss of a normally formed fetus. It is unlikely that a controlled trial on patients with a uterine septum and a history of spontaneous abortion will be performed to determine the extent to which metroplasty improves reproductive performance. In the case reported here readers may question whether the blighted ovum at 9 weeks' gestation, and spontaneous abortion at 9 weeks, were related to the uterine septum. The need for laparoscopy at the time of hysteroscopic metroplasty merits emphasis.     

Neonatal fat embolism and agglutination of intralipid

Pulmonary fat embolism in a preterm infant receiving Intralipid intravenously is described. Serum obtained at the time of clinical deterioration agglutinated Intralipid. This coincided with the onset of septicaemia and with a raised serum C reactive protein concentration. Subsequent clinical improvement was associated with reduction in the C reactive protein concentration and nonagglutination of Intralipid.     

Chronic tooth pulp inflammation causes transient and persistent expression of Fos in dynorphin-rich regions of rat brainstem

We have analyzed central Fos immunoreactivity (Fos-IR) brainstems of adult rats after three clinically relevant dental injuries: filled dentin (DF) cavities that cause mild pulp injury and heal within 1-2 weeks; open pulp exposures (PX) that cause gradual pulp loss and subsequent periodontal lesions; and filled pulp exposures (PXF). By 1 week after DF cavities, no Fos-IR remained except for sites such as lateral-ventral periolivary nucleus (LVPO) that had Fos-IR in all rats including controls. PX injury induced (1) a delayed transient expression of Fos at 1-2 weeks at three loci (ipsilateral neurons in dorsomedial nucleus oralis, paratrigeminal nucleus, and trigeminal tract), (2) persistent ipsilateral Fos for at least 4 weeks after injury in dynorphin (Dyn)-rich regions (rostral lateral solitary nucleus, periobex dorsal nucleus caudalis), and (3) late Fos-IR at 2-4 weeks (bilateral superficial cervical dorsal horn, contralateral dorsal nucleus caudalis, contralateral rostral lateral solitary nucleus). Rats with PXF injury were examined at 2 weeks, and they had greater numbers and more extensive rostro-caudal distribution of Fos neurons than the PX group. One week after PX injury, Fos-IR neurons were found in regions with strong Dyn-IR central fibers. Co-expression of Dyn and Fos was found in some unusually large neurons of the ipsilateral rostral lateral solitary nucleus, trigeminal tract, and dorsal nucleus caudalis. Immunocytochemistry for the p75 low affinity neurotrophin receptor (p75NTR) or for calcitonin gene-related peptide (CGRP) showed no consistent change in trigeminal central endings in any Fos-reactive brainstem areas, despite the extensive structural and cytochemical reorganization of the peripheral endings of the dental neurons. The Fos responses of central neurons to tooth injury have some unusual temporal and spatial patterns in adult rats compared to other trigeminal injury models.     

Cholecystokinin turnover in brain

Cholecystokinin octapeptide (CCK-8) occurs in relatively large amounts in some neurons of the cerebral cortex. Unlike most other mammalian neuropeptides, this compound contains a sulfate ester. We injected radiolabelled inorganic sulfate ([³⁵S]sulfate) into rat cerebral cortex and measured the formation and elimination of radiolabelled CCK-8 using HPLC. The data allow the first calculation of the turnover rate of a putative transmitter neuropeptide in brain. The turnover of CCK-8 (half-life = 16 h) is considerably slower than that of the biogenic amines and amino acid neurotransmitters (half-lives less than 4 h).     

Dissociation between drug-induced increases in nerve terminal and non-nerve terminal pools of GABA in vivo.

To examine whether increased GABA levels produced by n-dipropylacetate (DPA) and amino-oxyacetic acid (AOAA) are associated with nerve terminals, we compared the effect of these drugs on the GABA content of substantia nigra (SN) in rats in which the GABAergic afferent projections to SN had been unilaterally destroyed. In the SN largely devoid of GABAergic nerve terminals, AOAA (30 mg/kg) produced a 2-fold increase in GABA, whereas DPA (300 mg/kg) was without effect. Since DPA and AOAA both increased GABA to a similar extent in the intact SN, it appears that the GABA increase produced by DPA is associated with GABAergic nerve terminals, while AOAA primarily elevates GABA in non-nerve terminal components (neural perikarya and glial cells) which are not destroyed by our lesions.