The development of trigeminal nerve fibers to the oral mucosa, compared with their development to cutaneous surfaces

Small cutaneous branches of all three divisions of the trigeminal nerve pass toward epithelial surfaces in 14 mm human embryos. By 18 mm, such fibers are nearer the epithelium of the upper lip (14 μ., maxillary division) than the lower lip (31μ, mandibular division). At 20.5mm and 20.7mm, the age when Fitzgerald and Windle ('42) and Hooker ('52, '58) first found the perioral area sensitive to stimulation, the nerve fibers are about the same distance from the epithelium of both upper and lower lips (13–14 μ in rima oris area). Maxillomandibular fibers of the trigeminal nerve reach the basement membrane of the oral cavity epithelium earlier in development than they touch the basement membrane of the cutaneous epithelium about the mouth. Nerve fibers also penetrate the basement membrane of oral mucosal surfaces earlier than that of perioral cutaneous surfaces and form crude Merkel's end discs in mucosal epithelium earlier in development (mucosal epithelium, ten weeks; cutaneous epithelium at 12 weeks according to Hogg, '41). Ophthalmic fibers approach the upper eyelid epithelium later in development than the maxillomandibular fibers near perioral areas and touch the basement membrane of the eyelid epithelium a week later than they do that of the lips. Hooker did not observe reflexes from eyelid stimulation before ten weeks, when ophthalmic fibers reach the basement membrane, although reflexes from perioral stimulation were elicited when the nearest nerve fibers identified are still 13–14 μ from the basement membrane of the perioral epithelium. Additional correlations are made between the human fetal reflexes recorded by Hooker and the degree of development of the sensory peripheral nerve fibers.     

Factitious transient neonatal hyperthyrotropinemia

We report an infant with abnormally elevated levels of TSH determined in the Maryland State Laboratory for Neonatal Thyroid Screening, but normal levels in three other laboratories. The TSH level in the infant normalized by six months of age. The mother, who had a history of sarcoidosis, also had factitious hyperthyrotropinemia in the Maryland State Laboratory. Gel chromatography and ammonium sulfate precipitation of maternal serum demonstrated that the factor responsible for the factitious hyperthyrotropinemia was an immunoglobulin G. Maternal TSH levels in the Maryland State Laboratory were normalized by treatment of serum with polyethylene glycol. However, protein electrophoresis, immunoglobulin levels and immunofixation electrophoresis were all normal. We conclude that a subclass of immunoglobulins G, probably resulting from sarcoidosis, interfered with the precipitation of the TSH-antibody complex in the TSH radioimmunoassay of the Maryland State Laboratory.     

5-Hydroxytryptamine contracts human coronary arteries predominantly via 5-HT2 receptor activation

5-Hydroxytryptamine (5-HT) caused contractions of human isolated epicardial coronary arteries which were markedly antagonised by ketanserin (10 nM-1 microM). The antagonism was not competitive. The selective 5-HT1-like receptor agonist, GR43175, caused only small, ketanserin-resistant contractions. These results suggest that the predominant contractile effect of 5-HT in human isolated large coronary arteries is mediated via 5-HT2 receptors but that, in addition, 5-HT1-like receptors contribute to some degree to this response in vitro.     

Torticollis and blepharospasm in systemic lupus erythematosus

A case of torticollis and blepharospasm as the major manifestation of neurological involvement in systemic lupus erythematosis (SLE) is presented. A 56-year-old woman presented with blepharospasm in February 1985 and with torticollis in April 1985. She was diagnosed as having SLE in 1966, on the basis of positive LE cells, when she presented with fever and joint pains. There was no evidence that she had ever been on major tranquilizers. An attempt has been made to correlate the level of antibody titres and exacerbation of these movements with response to steroids. The possibility of an association between blepharospasm, torticollis, and autoimmune disorders has recently been considered.     

Promoting audit in primary care: roles and relationships of medical audit advisory groups and their managers.

OBJECTIVES--To investigate perceptions of family health service authorities and medical audit advisory groups of advisory groups' involvement in clinical audit and wider quality issues; communication with the authorities; and manager satisfaction. DESIGN--National postal questionnaire survey in 1994. SETTING--All family health services authority districts in England and Wales. SUBJECTS--Chief executives or other responsible authority officers and advisory group chairpersons in each district. MAIN MEASURES--Priorities of advisory group and authority for audit; involvement of advisory group in wider quality issues; communication of information to, and contacts with, the authority and its involvement in planning the future work of the advisory group; and authorities' satisfaction. RESULTS--Both groups' views about audit were similar and broadly consistent with current policy. Advisory group involvement in wider quality issues was extensive, and the majority of both groups thought this appropriate. Much of the information about their activities collected by advisory groups was not passed on to the authority. The most frequent contact between the two groups was the advisory group's annual report, but formal personal contact was the most valued. Most authority respondents thought their views had been recognised in the advisory group's planning of future work; only a small minority were not satisfied with their advisory groups. Dissatisfied respondents received less information from their advisory groups, had less contact with them, and thought they had less input into their plans. There was some evidence that advisory groups in the "dissatisfied districts" were less involved in clinical audit and with their authorities in wider quality issues. CONCLUSIONS--Most advisory groups are developing their activities in clinical audit and have expanded their scope of work. The quality and availability of information about progress with audit is a cause for concern to both groups.