ACh and 5-HT stimulated thermogenesis at different core temperatures in the He-Cold hypothermic hamster

Hamsters in deep experimentally induced hypothermia, at body temperatures between 7 degrees C and 11.5 degrees C, were microinjected with 5-HT and ACh at brain sites in the anterior-preoptic area of the hypothalamus (AH/POA). ACh or 5-HT was injected into an AH/POA site at different starting core temperatures in different groups of hypothermic hamsters. Colonic temperatures (Tc) were maintained, following He-Cold induction, in a temperature controlled environmental chamber and measured with a YSI thermister probe and YSI telethermometer. Injections of either 5-HT or ACh at Tc's between 7.0 degrees C and 9.0 degrees C elicited only modest increases in Tc i.e., 0.3 degrees C--0.6 degrees C, respectively. As Tc increased, however, to ranges between 9.1 degrees C--10.0 degrees C and in different animals to greater than 10 degrees C both ACh and 5-HT at the same sites elicited significant increases in Tc, 1.5 degrees C for 5-HT and 2.2 degrees C for ACh compared to saline injections. These data suggest that at the lowest Tc's we are observing a "cold block" of temperature sensitive sites in the AH/POA. Increasing the starting Tc beyond 9.0 degrees C however, evokes significant increases in heat-gain following AH/POA injection of either ACh or 5-HT. These data are consistent with Myers' observations concerning the organization of heat-gain mechanisms at AH/POA sites. In addition, they suggest that both the afferent limb of the heat-gain circuit (5-HT) and the efferent limb of the circuit (ACh) are functionally impaired when Tc is close to the physiological limit in the He-Cold hypothermic hamster.     

The central projection of muscle afferent fibres to the lower medulla and upper spinal cord: an anatomical study in the cat with the transganglionic transport method

The projection of muscle afferent fibres to the medulla oblongata and upper spinal cord was studied in the cat by using transganglionic transport of wheat germ agglutinin-horseradish peroxidase conjugate. The results demonstrate a precise, musculotopic termination pattern in the external cuneate nucleus; thus, fibres from the intrinsic muscles of the paw terminate medially; those from forearm, arm, and shoulder muscles terminate progressively more laterally; and those from neck and thoracic muscles terminate in the ventrolateral and dorsolateral parts, respectively. Muscle afferent fibres to the main cuneate nucleus terminate in the ventral "reticular" region of the nucleus, with a sparse projection also to the ventral part of the rostral and caudal regions, including the base of the dorsal horn. Fibres from the neck muscles terminate slightly more laterally in the ventral region than do those from the limb muscles, but otherwise, and thus contrary to the case in the external cuneate nucleus, no topographic organization was detected. In the spinal cord, projection was found to laminae I and V, and from the musculature of the back of the neck to the central cervical nucleus.     

Successful navigation of late career transitions

The purpose of this educational review was to describe the challenges that may face the anesthesiologist near the end of their career and to propose strategies that will enable the individual to continue to be a productive and valued member of their Department, both clinically and by other contributions.     

Monitoring Health Care for Children with Chronic Conditions in a Managed Care Environment

Objective: Children with chronic health conditions face special issues in their interactions with managed care. These children often require additional and more varied services than do other children. Managed care plans increasingly include these children, especially with the growth of Medicaid managed care. This article examines the special issues facing children with chronic conditions and develops strategies for monitoring their care in managed care settings. Methods: The project staff conducted an extensive review of the research and policy literature related to managed care and the special needs of families with children with chronic conditions. The project also reviewed current and proposed plans of federal, state, and private groups for monitoring and, working with parents and other outside groups, identified key issues to consider in developing monitoring plans. Results: The relative rarity of many childhood conditions and the complex interactions among child, family, and community over time make assessment of their care difficult. We describe these child and family characteristics, outline essential features and domains for monitoring systems, and describe population-based and plan-based monitoring systems to assess managed care for these children and their families. Conclusions: Monitoring for children with chronic conditions in managed care arrangements will require public health agencies and health providers to define populations systematically, assess across a variety of conditions, and monitor several domains central to the health of these families.     

Quality of diabetes care in a university health center in Lebanon.

OBJECTIVE: To assess the quality of care provided to diabetic patients by family physicians in a university health clinic, using measures of glycemic and cardiovascular risk control as well as documentation of and adherence to World Health Organization (WHO) guidelines for diabetes primary care. DESIGN: Chart review of the previous year's medical notes for all identified diabetics in the practice over 2.5 years. RESULTS: Two-hundred and four diabetic patients were identified, with an estimated prevalence of 4.1%. The majority was type II diabetics, on oral hypoglycemic agents. Glycosylated hemoglobin was documented in 39.7% of patients, fasting plasma glucose in 99%, cholesterol in 93.1%, triglycerides in 91.2% and blood pressure in 85.8%; optimal control of these indicators was noted in 28.4%, 17.8%, 34%, 29.6% and 55.4% respectively. Fifty percent of the diabetics were referred for retinal checks. Physicians documented the presence of nephropathy in 46.8% and neuropathy in 59.6%; however, they documented patient instruction on foot care, diet, exercise and diabetes self-care poorly. CONCLUSION: There is a need for interventions to improve management and documentation in diabetes care in order to achieve early detection and prevention of complications. Developing a protocol for the clinic based on standard guidelines, and the use of flow sheets may be helpful in improving these intermediate indicators of quality of care.     

Single-handed practices – their contribution to an undergraduate teaching network in the first year of the new curriculum

OBJECTIVES: The new curriculum at King's College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5 years of their medical education. DESIGN: This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King's teaching network. SETTING: King's College School of Medicine and Dentistry. SUBJECTS: Medical undergraduates. RESULTS: The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. CONCLUSIONS: The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise.     

A reevaluation of the functional organization and cytoarchitecture of the feline lateral posterior complex, with observations on adjoining cell groups

The organization of the cat's lateral posterior complex was reevaluated and its cytoarchitecture described. Analysis of visual representations within the complex confirmed that the pulvinar, lateral zone (LPL), and interjacent zone (LPi) correspond to separate representations of the visual field and established that the zones exhibit heterogeneous connections as a result of retinotopic interconnections with extrastriate areas which represent varying amounts of the visual field. A common system of visual representation extending through layers with differing anatomical connections was identified within zone LPL. The concept of an "isorepresentation cord" was introduced to describe these variable correspondences between sensory representations and connectional relationships. Isorepresentation cords are conceived as holding in common representation of a common locus on a sensory surface without functioning as a unit with respect to connections. Visual representations within the lateral posterior complex consist of many such cords arranged in orderly array. Zone LPm (medial) was also delineated more accurately on the basis of its connections with the ectosylvian visual area. Analysis of termination patterns which occupy boundary regions adjacent to and between the principal zones further established the existence of a collection of cell groups which form a thin, irregular shell investing the principal zones. The identification of these additional cell groups and the recognition of connectional heterogeneity within the principal zones of the complex made it possible to identify and describe the subtle cytoarchitectural differences which characterize the subdivisions of the lateral posterior complex and their boundaries with adjoining nuclear groups. The present findings are discussed with respect to the functions of the lateral posterior complex in interconnecting cortical visual and visuomotor areas, and with respect to the conceptual issues raised by variable correspondences between sensory representations and connectional relationships within thalamus.     

Rigid immobilization alters matrix organization in the injured rat medial collateral ligament.

The effects of mobilization on matrix reorganization and density after ligament injury were studied in rat medial collateral ligaments using scanning electron microscopy (SEM). Both medial collateral ligaments of 14 Sprague-Dawley rats were sharply incised transversely at their midpoint. A 1.14-mm threaded Kirschner wire was driven through the tibia and into the femur of the right leg (through the knee) to immobilize that knee at 90 degrees of flexion. Four additional rats were used as controls. The right medial collateral ligament of the control rats was exposed in the same manner as the experimental rats and the wound closed without damaging the ligament. Rats were sacrificed on the 7th and 14th days postinjury and the ligaments evaluated by SEM. The electron micrographs from this study demonstrated that early on, the tissue at the injury site is disorganized on a gross scale with large bundles of poorly organized matrix. Large "defects" were present between bundles in the substance of the ligament and appeared as holes in the ligament around the injury site. As healing progressed, the matrix in the mobilized specimens appeared to bridge the injury site more rapidly and completely with fewer "defects" and thus higher density than the immobilized specimens.     

The barrelettes--architectonic vibrissal representations in the brainstem trigeminal complex of the mouse. I. Normal structural organization.

The organization of the brainstem trigeminal complex (BTC) of the mouse is described, with emphasis on the normal organization of the vibrissal representations. Thionin staining for Nissal substance was employed to reveal the cytoarchitecture. Cytochrome oxidase histochemistry was used to reveal the chemoarchitecture. Golgi impregnation methods, in combination with thionin staining, were used to examine the neuronal dendritic morphology within a defined cytoarchitectonic context. An in vitro horseradish peroxidase labelling method was used to study the distribution and morphology of primary trigeminal afferent terminals within the BTC. The BTC consists of four distinct subnuclei: principalis (nVp), oralis (nVo), interpolaris (nVi), and caudalis (nVc). The present study shows that these sub-nuclei can be distinguished from each other on the basis of several anatomical criteria, including the distribution and density of neuronal size classes, histochemical staining intensity, morphology and orientation of neuronal dendrites, and size and texture of primary afferent terminal arbors. Anatomical manifestation of vibrissal representations within the BTC can be described in nVp, nVi, and nVc, but not in nVo. Within the three subnuclei where they are found, anatomical vibrissal representations are composed to architectural subunits that form an overall pattern homeomorphic to the pattern of vibrissae on the face of the animal. Each sub-unit forms a cylindrical tube running in a rostrocaudal orientation within the BTC. These sub-units will be called barrelettes. Cytologically, each barrelette consists of cell-dense "sides," surrounding a practically cell-free "hollow." Individual sub-units are separated by narrow, cell-free "septa." Histochemically, each subunit is manifested as a discrete patch of positive-staining reaction products. Differential interference contrast optics shows that these patches correspond precisely to the barrelette hollows. Evidence is presented to show that the barrelettes are the functional units for the processing of vibrissal sensory information. Terminal arborizations of individual primary afferents seem to be confined to the hollow of single barrelettes. The majority of neurons that form the sides of a barrelette have bitufted dendritic arbors, which project predominantly into the barrelette hollow, although a minority of neurons, particularly in nVi and nVc, also extend part of their dendritic arbors into adjacent barrelette hollows. The barrelette hollows are thus the principal neuropil region in which primary afferents and their target neurons interact. Contacts are made mainly between en passant varicosities and terminal boutons on primary afferent collaterals and dendritic spines and shafts of second order neurons.(ABSTRACT TRUNCATED AT 400 WORDS)     

How to organize gynecologic oncology in the future: Results of an internationalquestionnaire

Vergote IB, de Oliveira CF, Dargent D. How to organize gynecologic oncologyin the future: Results of an international questionnaire. Int J GynecolCancer 1997; 7: 368–375.
A questionnaire was sent to 93 gynecologic oncologists from 54 countriesabout the way in which gynecologic oncology was organized in their country, orif the (sub)speciality wasnot yet recognized, how they thought it should be organized. The questionnairewas answered by 64 persons from 42 different countries. The subspecialty wasrecognised in 17 (41%) of the countries. Fifty-five respondents (86%) thought thatgynecologic oncology should be a subspecialty of obstetrics and gynecology. Themedian duration of the gynecologiconcologic fellowship program was 30 months. Diagnosis and surgery accounted forabout 58% of the duration of the program. In 52% of the answersfrom countries with boardcertification, the fellows had to pass a theoretical and practical examination,and in addition 22% of the candidates had to defend a thesis to qualifyfor certification.Training centers in countries that recognized gynecologic oncology had amedian number of 142 new cases per year (for 1 fellow). The median number ofgynecologic oncologogistsand fellows per 10⁽⁷⁾ inhabitants in countries with boardcertification in gynecologic oncology was 42 and 6, respectively. Finally, theimportant role of internationalsocieties (like the International Gynecologic Cancer Society and the EuropeanSociety of Gynaecological Oncology) in supporting the countries withoutrecognized GynecologicOncology was stressed by the respondents. The setting up of internationalstandards for training programs, training centers, board certification, and theorganization ofinternational exchange programs for fellows seemed to be equally important,according to the questionnaire responses.