Glutamate-like immunoreactivity in retinal terminals in the nucleus of the optic tract in rabbits.

The ultrastructural organization of retinal terminals within the nucleus of the optic tract of rabbits was investigated with a combination of anterograde tracing and immunocytochemistry. The anterogradely transported WGA-HRP injected in the vitreous of the eye was visualized with the sensitive gold-substituted silver peroxidase (GSSP) method. Glutamate and GABA immunoreactivity were identified with postembedding colloidal gold particles. Retinal ganglion cell terminals (R-terminals) in the nucleus of the optic tract formed asymmetric synapses and contained spherical vesicles and electron lucent mitochondria. R-terminals were observed in large clusters in the neuropil and in synaptic contact with large initial dendrites and somata. Within the clusters of neuropil the R-terminals formed two types of glomeruluslike arrangements: (1) an R-terminal centrally located and surrounded by small dendritic and axonal profiles and (2) several R-terminals surrounding a single dendrite or a group of dendritic profiles, presumably of interneuronal origin. All R-terminals identified with WGA-HRP as well as those exhibiting similar ultrastructural characteristics showed high levels of glutamate immunoreactivity, but no GABA immunoreactivity. The presence of glutamate and the absence of GABA in R-terminals suggest that glutamate is involved in neurotransmission in the pathway from retina to the nucleus of the optic tract of rabbits.     

Racial Differences in Drug Response: Isoproterenol Effects Before and After Propranolol

The aim of this study was to determine in young, healthy men the relative contribution of pharmacodynamic factors inherent between two groups known to respond differently to hypertensive therapy. Black (n = 10) and white (n = 10) men received an isoproterenol sensitivity test before and after propranolol (0.1 mg/kg, then 50 µg/min). There were greater increases (twofold) in systolic BP following the 1.0- and 1.5-µg isoproterenol dose (P < 0.05) in the black group. During propranolol there were no differences in free (1)-propranolol concentrations between the groups; however, propranolol decreased resting heart rate in the white group more than in the black group (P < 0.05). Cardiac index decreased less in the black group compared to the white group (P < 0.05). Following the second isoproterenol challenge, there again were greater increases in systolic BP in the black group at both the 10- and the 20-µg isoproterenol dose (P < 0.05). Our study has highlighted the importance of cross-racial studies in evaluating drug effects.     

Prolonged pregnancy: the management debate

A prospective trial was conducted to compare the effects of conservative management of prolonged pregnancy (conservative group) with routine induction of labour at 42 weeks' gestation (active group) in otherwise uncomplicated pregnancies. Of the 402 pregnancies studied, 207 (51%) were allocated to conservative management and 195 (49%) were allocated to have labour induced. The groups were well matched for age, parity, and smoking habits. One hundred and sixty six (80%) of the patients in the conservative group went into spontaneous labour. Of the remainder, two underwent elective caesarean section, 19 had labour induced because of clinical concern, and the remaining 20 had labour induced at the patient's own request. One hundred and twenty five (64%) of the patients in the planned active group underwent induction of labour. Of the remaining 70, 49 went into spontaneous labour and 21 (11%) asked that they should not have labour induced. Comparison of the two groups showed no difference in the length of the first stage of labour but a trend towards an increased need for intervention for fetal distress (p less than 0.06) in the active group. There were no differences in the length of the second stage, the need for intervention, or the mode of delivery. In terms of Apgar scores the neonatal outcome was not significantly different between the two groups, but a greater proportion of the babies (15% v 8%) in the active group required intubation. Umbilical cord venous pH estimated in the last 183 consecutive deliveries in the study showed a significantly lower mean value in the active group (p less than 0.05). There was no difference in birth weight between the two groups. Two deaths occurred in the study. There was a stillbirth in the conservative group at 292 days after massive abruption, and one neonatal death in the active group owing to multiple congenital abnormalities. The outcome for mother and baby in patients from both groups who went into spontaneous labour was generally good. The outcome for patients for whom conservative management was planned but induction became necessary was no different from that of patients who underwent planned induction at term. Thus from our results we can find no evidence to support the view that women with normal prolonged pregnancy should undergo routine induction of labour at 42 weeks' gestation.     

Dysphagia as the Sole Manifestation of Bilateral Strokes

Dysphagia can be caused by a host of factors, most of which are structural or functional. However, despite extensive evaluations, a certain number of patients have unexplained dysphagia. We present an extremely unusual case whereby a patient with an acute left hemispheric cerebral vascular accident presents with dysphagia as his sole complaint and after extensive neurological, gastroenterological, and radiographic examinations is found to have cricopharyngeal dysfunction. The etiology of this defect was not at all clinically apparent and, ultimately, magnetic resonance imaging (MRI) was performed which revealed a chronic infarction of the right frontal lobe and a smaller acute infarction in the same location of the left. This case demonstrates that swallowing disorders may be the sole presentation of stroke and that, if extensive evaluations of such patients fail to yield an etiology, one must strongly consider MRI as a tool for diagnosis, even if a CT scan is negative.     

Qualifying a quantitative approach to women’s expectations of continence surgery

Introduction and hypothesis  The objective of this study is to explore expectations and goals of women undergoing continence surgery using a combined quantitative and qualitative approach. Methods  Women with urinary incontinence, recruited from the waiting list, were assessed with a structured clinical interview, and these data were transcribed and analysed thematically (grounded theory). The Kings Health Questionnaire (KHQ) was used to determine incontinence impact on patient’s life. Results  Incontinence was objectively quantified using videocystourethrography. KHQ quantitative analysis suggested that the main domains affected were incontinence impact on life and physical limitations. However, qualitative analysis based on the interview found women were most affected by incontinence impact on physical or social limitation, sexual function, emotions and body image. Conclusion  Whilst disease-specific QoL questionnaires allow broad comparisons to be made assessing patient bother; they lack sensitivity to assess individual symptoms. A qualitative approach may individualise patient care and improve patient satisfaction and overall outcome.