Effects of selective dopamine-1 receptor activation on intraocular pressure in man

The lack of specific agonists and antagonists has, until recently, precluded investigation of a role for dopamine receptors in the control of intraocular pressure. In the present study, we have examined the effects of fenoldopam, a novel selective dopamine1 (DA1) receptor agonist, on intraocular pressure, in eight healthy human volunteers. Fenoldopam, infused intravenously at 0.5 micrograms kg-1 min-1, increased intraocular pressure from 14.6 +/- 0.9 to 17.6 +/- 1.4 mmHg (P less than 0.05) while a control saline infusion had no effect. Pupil diameter and blood pressure did not change. In the same subjects, i.v. norepinephrine or angiotensin II both increased intraocular pressure--from 13.8 +/- 1.4- to 17.6 +/- 1.4 mmHg and from 13.4 +/- 1.3- to 17.5 +/- 1.7 mmHg respectively (P less than 0.05), and mean arterial pressure by about 20 mmHg. These data suggest that: (1) DA1 receptor activation can modulate intraocular pressure; (2) the intraocular pressure effects of the DA1 receptor agonist, fenoldopam, are independent of changes in systemic blood pressure, in contrast to those of norepinephrine or angiotensin II where intraocular and systemic blood pressures increase in parallel; (3) the ability of a DA1 receptor antagonist to lower intraocular pressure merits investigation.     

Bilateral facial paralysis: a case presentation and literature review.

Bilateral facial paralysis is a diagnostic challenge, which may manifest itself as either a simultaneous or alternating form, occurring in 0.3-2.0% of patients that present with facial paralysis. The differential diagnosis of facial paralysis includes congenital, traumatic, neurologic, infectious, metabolic, neoplastic, toxic, iatrogenic and idiopathic etiologies. While idiopathic facial paralysis is the most common diagnosis, a comprehensive evaluation must be completed prior to this diagnosis in patients with bilateral facial paralysis. A representative case of simultaneous bilateral facial paralysis is presented. The literature is reviewed and discussed. A diagnostic protocol for the evaluation of bilateral facial paralysis is proposed. Bilateral facial paralysis requires a thorough evaluation and may prove to be a diagnostic dilemma.     

The complications of immobility in the elderly stroke patient.

BACKGROUND: Approximately 500,000 persons in the United States suffer a stroke each year; the majority of these individuals are 65 years of age or older. The neurological impairment occurring as the result of stroke can lead to both acute and chronic disability. Further medical complication and disability are often the result of immobility-related illness that occurs while the patient is still in the hospital. METHODS: A MEDLINE search for articles published from 1980 to 1990 was made using the key words immobilization and stroke rehabilitation. The bibliographies of these articles, key rehabilitation and geriatric textbooks, the bibliographies of these textbooks, and the authors' personal files were also sources of information. RESULTS AND CONCLUSIONS: Immobility-related medical complication and disability can be substantially reduced by identifying risk factors and applying preventive measures. As long-term providers of medical care, family physicians are in a position to devise a preventive care plan for immobility-related disability and to appreciate the beneficial effects of such a plan on patient outcome.     

CT-guided brachial plexus biopsy.

We describe a technique for conducting a CT-guided biopsy of the brachial plexus region, report two illustrative cases, discuss potential complications, and conclude that, in selected cases, biopsy of lesions in the region of the brachial plexus can be performed safely with CT guidance.     

Spina Bifida: The Transition into Adulthood Begins in Infancy

Many concerns surround the preparation of a person with spina bifida for a successful transition into adult life and responsibilities. A model of intervention must be based on developmental concerns and timely issues from infancy through all stages of development to young-adult life. This article discusses, within a developmental framework, issues of transition in relation to physical, social, emotional, and educational/vocational needs; it also presents a conceptual framework for the transition into adulthood. Guidelines were developed by incorporating expected outcomes of people with spina bifida and using a philosophical framework that encompasses the achievement of a balance among dependence, independence, and interdependence. This model is based on developmental issues from infancy through all stages of development to young-adult life. Using this framework for care, the rehabilitation nurse can feel confident that the needs of clients with spina bifida and similar chronic conditions are being met.     

Sample size determination for an exponential survival model with an unrestricted covariate

We derive formulae for estimating sample size and power for detecting the effect of an unrestricted covariate on survival time. These are useful in designing survival studies with different patterns of recruitment and follow-up when survival time is exponentially distributed. We use the asymptotic covariance matrix, conditional expectation and Taylor's expansion techniques to develop these formulae. Computer simulations indicate that the asymptotic approximations used in developing the formulae are good over a range of parameter values and different patterns of recruitment and follow-up that are relevant to survival studies.     

Burns from electric fire-guards.

Nine children with burns caused by contact with electric fire-guards are presented. A method of preventing such injuries is recommended.     

Alcohol stimulates the release of dopamine in the ventral pallidum but not in the globus pallidus: a dual-probe microdialysis study.

The mesoaccumbens dopamine system has been hypothesized to be a common neural substrate mediating the actions of various drugs of abuse, including ethanol. However, the involvement of the mesopallidal dopamine system has received very little attention. The present study examined the effects of intraperitoneal (IP) ethanol administration on the extracellular levels of dopamine in the ventral pallidum (VP) and globus pallidus (GP) of Wistar rats. Rats were bilaterally implanted with microdialysis probes aimed at the VP and GP or nucleus accumbens (NAc) and dorsal striatum (dSTR). During microdialysis testing, rats with probes located in the VP and GP were injected IP with sterile saline or 15% (v/v) ethanol in saline at doses of 0.75, 1.5, or 2.25 g/kg. Rats with NAc and dSTR probes were injected with saline or 2.25 g/kg ethanol. The IP administration of 1.5 and 2.25 g/kg ethanol significantly (p <0.05) elevated the extracellular levels of dopamine in the VP (maximal increase: 136 and 182% of baseline, respectively) but not in the GP. No effects on extracellular dopamine levels were observed following the IP injections of 0.75 g/kg ethanol or saline. The IP administration of 2.25 g/kg ethanol significantly (p <0.05) elevated the extracellular levels of dopamine in the NAc (maximal increase: 198% of baseline) and dSTR (maximal increase: 155% of baseline). Analysis of the effects of 2.25 g/kg ethanol on dopamine release revealed greater increases in the VP, NAc, and dSTR compared to the GP. The data suggest that the mesopallidal, mesoaccumbens, and nigrostriatal dopamine systems are more sensitive to the effects of ethanol than the nigropallidal dopamine system.