Pharmacologically defined M1 and M2 muscarinic cholinergic binding sites in the cat's substantia nigra: development and maturity

Muscarinic cholinergic binding in the substantia nigra of the cat was documented during development and at maturity with autoradiographic methods by labeling the pharmacologically defined M1 and M2 subtypes of muscarinic binding sites. In cats from age embryonic day 40 to postnatal day 6 and at adulthood, M1 sites were labeled with [3H]pirenzepine and M2 sites were labeled with [3H]N-methylscopolamine in competition with pirenzepine. Comparisons were made among binding site distributions, acetylcholinesterase staining and tyrosine hydroxylase-like immunoreactivity in serial or neighboring nigral tissue sections. M1 and M2 binding sites were present in the substantia nigra at all ages studied. Qualitative comparisons showed that M1 binding delineated the substantia nigra more distinctly than did M2 binding. For M1 binding sites in particular, the embryonic pars reticulata of the substantia nigra was more prominently labeled than the pars compacta. At adulthood both nigral subdivisions clearly exhibited M1 and M2 binding, with the pars compacta demonstrating some internal heterogeneity of binding density. These findings provide further evidence that the substantia nigra is a site of cholinergic transmission and suggest that the functional balance between acetylcholine and dopamine in the basal ganglia acts here as well as in the striatum.     

Cervical intramedullary cavernous angioma with MRI-proven haemorrhages

Summary Two contrasting cases of cervical intramedullary cavernous angioma in young female patients are reported. One patient had a 3-year course of step-wise progressive tetraparesis; at each of the five events intramedullary bleeding from a cryptic vascular malformation at C6–7 level was diagnosed by MRI. The other patient presented with one episode which led to MRI diagnosis of a vascular malformation at the C2 level. Both patients eventually underwent complete surgical excision of the angioma with subsequent steady improvement of the neurological deficit.     

Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. CHS Collaborative Research Group

Carotid sonography is being performed on more than 5,000 participants in the Cardiovascular Health Study, a prospective, multicenter study of cardiovascular disease in men and women aged 65 years and older. The sonographic methods used to examine and measure the extracranial carotid arteries are described. Initial validation studies were performed on 61 subjects with a mean age of 68.6 years. Analysis of within- and between-sonographer differences and between-reader differences were performed for selected variables. In general, the mean absolute differences for within- and between-sonographer comparisons were small, with even less variability between readers. Variability was less for the common carotid artery than for the internal carotid artery. These data suggest that carotid sonography is a reliable and reproducible method for use in the study of carotid atherosclerosis in population studies.     

Bilateral anterior cerebral artery infarction resulting from explosion-type injury to the head and neck

A 43-year-old woman suffered a blast-type injury to the head and neck. She subsequently developed bilateral internal carotid artery occlusion and bilateral anterior cerebral artery infarction not demonstrated by magnetic resonance imaging scan 24 hours after the explosion, but confirmed by a second scan 8 days after the explosion. In patients with blast-type injury to the head and neck who develop coma with a nonfocal neurological exam, the possibility of bilateral carotid artery occlusion and bilateral ischemic infarction should be considered.     

Klebsiella pneumoniae liver abscess with septic endophthalmitis. The role of computed tomography

Klebsiella pneumoniae liver abscess associated with septic endophthalmitis is a rare observation. To our knowledge, only 10 cases have been reported in the international literature. We report a further case of complication occurring in an adult woman with hypothyroidism, and comment on the role of CT for the work-up.     

Primary care intervention and management for adults with early HIV infection.

Recent clinical drug trials have demonstrated that early intervention with zidovudine will delay disease progression in asymptomatic or minimally symptomatic HIV-infected individuals. These trials will encourage larger numbers of seropositive persons to seek access to primary care, overloading specialized clinics for AIDS and HIV care. The care of early HIV-infected individuals will need to be delivered by mainstream primary care providers. This article discusses the initiation and management of zidovudine, and chemoprophylaxis against Pneumocystis carinii pneumonia in early HIV infection.