Leg oedema due to a rheumatoid cyst in the pelvis.

We describe a case in which chronic oedema of a leg was due to pressure on the external iliac vein from an intrapelvic rheumatoid cyst. Ultrasound and CT scanning gave the clues to diagnosis.     

Endogenous opioids tonically inhibit the depressor neurones in the caudal ventrolateral medulla of rabbits: mediation through delta- and kappa-receptors.

In the present studies, an attempt was made to elucidate the role of endogenous opioid inputs to the depressor region of the caudal ventrolateral medulla in the tonic regulation of arterial pressure and to examine the subtype(s) of receptor underlying any observed effects by use of receptor-specific antagonists. The depressor region of the caudal ventrolateral medulla in chloralose-anesthetized, artificially ventilated rabbits was functionally identified by injection of l-glutamate (5 nmol). Bilateral injection of the non-selective opioid antagonist naloxone (0.3, 5 and 20 nmol) into the caudal ventrolateral medulla produced a dose-dependent depressor response, accompanied by a bradycardia, suggesting a tonically active inhibitory opioid input to this region. Bilateral injection of the selective delta-receptor antagonist ICI 174,864 (0.3 nmol) or of the kappa-receptor antagonist nor-binaltorphimine (1 nmol), also markedly reduced both arterial pressure and heart rate. In contrast, injection of the mu-selective antagonist beta-funaltrexamine (0.3-0.6 nmol) produced no effect on arterial pressure or heart rate. These data support the hypothesis that tonically active endogenous opioid inputs, possibly enkephalinergic and/or dynorphinergic, inhibit the depressor neurones of the caudal ventrolateral medulla in the rabbit through activation of delta- and kappa-receptors. Surprisingly, injection of the opioid agonists leu-enkephalin (1 nmol) or dynorphin 1-13 (0.1 nmol), but not the selective mu-receptor agonist DAGO (1 nmol), in the depressor area of the caudal ventrolateral medulla also induced naloxone-sensitive (5 mg/kg, i.v.) decreases in both arterial pressure and heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)     

New Zealand's Injury Prevention Research Unit: reducing sport and recreational injury.

The Injury Prevention Research Unit was established in 1990 to reduce the incidence, severity and consequences of injury. Research into sport and recreational injury is one of five major areas of research being undertaken. National data sources have been used to estimate the overall size of the problem and to describe the nature and circumstances of injury associated with a variety of sport and recreational activities. Analytical studies are now being undertaken to identify significant risk and protective factors. Research activity is being directed toward the development, implementation and evaluation of preventive measures.     

Dr. Tom Chalmers, 1917-1995: the tribulations of a trialist. Interview by Malcolm Maclure.

This article is the second part of an interview Dr. Malcolm Maclure had with Dr. Thomas Chalmers shortly before Chalmers' death late in 1995. It probes his role as a champion of randomized clinical trials.     

Age differences in the stress patterns of dentists

The present study is a comparison of the stress patterns of older and younger dentists in private practice. Dentists responded to a questionnaire which sought to elicit their responses to a number of situations and events that typically occur in their professional lives. These included financial difficulties, patient-management problems, time issues and uncertainty about their professional status. The groups compared were dentists over 54 years (n = 36) with dentists below the age of 35 years (n = 41), where both the frequency and intensity of their responses were measured. The findings suggested that overall, the older dentists are less stressed than their younger counterparts. Some issues, those concerned with finance and patient-management, appear to affect both groups more or less equally, which suggests that these issues are of global, rather than specific concern. From a theoretical point of view, the findings tend to contradict the generally-held belief that getting older is automatically accompanied by degeneration and problems of adaptation to life changes. On the contrary, seemingly favourable adaptation and low levels of stress are evident in most of the older respondents.     

Utilization of the resolvedl-isomer of 2-amino-6-phosphonohexanoic acid (l-AP6) as a selective agonist for a quisqualate-sensitized site in hippocampal CA1 pyramidal neurons

Brief exposure of rat hippocampal slices to quisqualic acid (QUIS) sensitizes neurons to depolarization by the α-amino-ω-phosphonate excitatory amino acid (EAA) analogues AP4, AP5 and AP6. These phosphonates interact with a novel QUIS-sensitized site. Whereasl-AP4 andd-AP5 cross-react with other EAA receptors,dl-AP6 has been shown to be relatively selective for the QUIS-sensitized site. This specificity ofdl-AP6, in conjuction with the apparent preference of this site forl-isomers, suggested that the hitherto unavailablel-isomer of AP6 would be a potent and specific agonist. We report the resolution of thed- andl-enantiomers of AP6 by fractional crystallization of thel-lysine salt ofdl-AP6. We also report the pharmacological responses of kainate / AMPA, NMDA, lateral perforant pathl-AP4 receptors and the CA1 QUIS-sensitized site tod- andl-AP6, and compare these responses to thed- andl-isomers of AP3, AP4, AP5 and AP7. Thed-isomers of AP4, AP5 and AP6 were 5-, 3- and 14-fold less potent for the QUIS-sensitized site than their respectivel-isomers. Whilel-AP4 andl-AP5 cross-reacted with NMDA andl-AP4 receptors,l-AP6 was found to be highly potent and specific for the QUIS-sensitized site (IC₅₀ = 40 μM). Its IC₅₀ values for kainate / AMPA, NMDA andl-AP4 receptors were > 10, 3 and 0.8 mM, respectively. As with AP4 and AP5, sensitization tol-AP6 was reversed byl-α-aminoadipate.     

CENTRAL NEURONS AND NEUROTRANSMITTERS IN THE CONTROL OF BLOOD PRESSURE

1. In this paper we review recent work from our laboratory on two major pathways important in the central control of blood pressure. 2. We report experiments on the sympatho-excitatory bulbospinal pathway from the rostral ventral medulla. Here we focus particularly on the role of excitatory amino acids. 3. We review studies on the short inhibitory or depressor pathway ascending from the caudal to the rostral ventral medulla, which is thought to use γ-aminobutyric acid (GABA) as its neurotransmitter. We report on experiments with the immediate early gene, c-fos, demonstrating that its expression in the bulbospinal pressor neurons is increased by stimuli that activate these nerves, and that this expression can be blocked in vivo by treatment with an antisense oligonucleotide. We also show that basal and stimulated expression of the c-fos gene is important in the central control of blood pressure.     

Preventive work with families: issues facing public health nurses

This paper examines the issues that nurses experience when entering the family system to work preventively. The theoretical basis of family-centered nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice. Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems. The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined. The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns. The authors support the general structure of public health practice as of value for preventive work with families. However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family-centred nursing.