Glutamate hypothesis in schizophrenia

Schizophrenia is a chronic and severe psychiatric disorder that has profound impact on an individual’s life and on society. Thus, developing more effective therapeutic interventions is essential. Over the past quarter‐century, an abundance of evidence from pharmacologic challenges, post‐mortem studies, brain imaging, and genetic studies supports the role of glutamatergic dysregulation in the pathophysiology of schizophrenia, and the results of recent randomized clinical trials based on this evidence have yielded promising results. In this article, we review the evidence that alterations in glutamatergic neurotransmission, especially focusing on the N‐methyl‐d ‐aspartate receptor (NMDAR) function, may be a critical causative feature of schizophrenia, how this contributes to pathologic circuit function in the brain, and how these insights are revealing whole new avenues for treatment development that could reduce treatment‐resistant symptoms, which account for persistent disability.     

The effect of cephalothin prophylaxis on postoperative ventriculoperitoneal shunt infections.

Postoperative infection is an important complication after insertion of a ventriculoperitoneal (VP) shunt in children with hydrocephalus. A randomized double-blind placebo-controlled study was performed to determine the efficacy of cephalothin in preventing postoperative shunt infection. Sixty-three children who presented for elective VP shunt insertion between January 1982 and December 1985 and who did not have a history of shunt infections were randomly assigned to receive four doses of prophylactic cephalothin, 25 mg/kg (32 patients), or of a multivitamin placebo (31 patients). Postoperative infection developed in 6% of the treatment group, compared with 10% of the placebo group, a difference that was not statistically significant, although a clinical significance may have been masked by the small sample size. A large multicentre trial is needed to determine the efficacy of antibiotic prophylaxis in reducing the incidence of postoperative VP shunt infections.     

Costs and benefits of routine follow-up after curative treatment for endometrial cancer

OBJECTIVE: To examine the costs of routine outpatient follow-up after curative treatment of endometrial cancer, and to determine whether this leads to early detection of recurrence or survival. The impact of specific disease characteristics on survival is examined. DESIGN: Retrospective chart review, and calculation of costs. SETTING: Ottawa Regional Cancer Centre-Civic Division (ORCC-C). PATIENTS: All 432 patients referred to the ORCC-C with endometrial cancer between 1982 and 1991 who received treatment with curative intent and who continued with routine follow-up. RESULTS: Cancer recurred in 50 patients (11.57%). There was no statistically significant difference in overall survival between patients with symptomatic and asymptomatic recurrences, or between those with recurrences detected during routine follow-up visits or in the interval between routine visits. Of 4830 Papanicolaou (Pap) smears performed routinely, cancer was detected in 6 cases. The mean cost of the routine follow-up procedures for each patient with a recurrence was $19,200. CONCLUSION: Intensive follow-up of women with endometrial cancer does not result in improved survival. A prospective randomized study is warranted to evaluate other potential benefits of follow-up, such as improved quality of life or decreased morbidity. There is no economic or clinical justification for the routine use of the Pap smear in the follow-up of patients with endometrial cancer. The potential benefits of routine follow-up in endometrial cancer and other types of cancer with favourable prognoses warrant critical evaluation.     

Enteroviruses in recreational waters of Northern Ireland.

Virus surveillance of Northern Ireland recreational waters, between April 1986 and May 1989 demonstrated widespread enteroviral contamination of coastal and inland waters. In 1986, enteroviruses were detected in 4 of 46 (8.7%) water samples, collected from 6 coastal bathing waters. In 1987, 49 of 107 (45.8%) samples, from 16 coastal bathing waters, yielded enteroviruses; 33 of the enterovirus positive samples passed one or both of the coliform standards outlined by the European Economic Community (EEC) bathing water directive (76/160/EEC). Enteroviruses were also detected in 33 of 39 (84.6%) samples tested from 3 inland recreational waters.     

Characteristics of chloride-dependent incorporation of glutamate into brain membranes argue against a receptor binding site

Although membrane sites from brain, labelled with [3H]glutamate (Glu) under sodium-free conditions, are thought to represent excitatory receptors, certain anomalous characteristics of the kinetics of apparent binding raised the question of whether transport might contribute to this process, prompting a closer examination of it. Hyperosmolar media and low incubation temperatures (4 degrees C) both led to decreases in the apparent specific binding of [3H]glutamate to membranes from the brain of the rat in the presence of chloride. Furthermore, only 15% of the [3H]glutamate, bound at 37 degrees C, was dissociable when the membranes were then cooled to 4 degrees C. The binding of [3H]glutamate was increased in the presence of certain dipeptides such as L-phenylalanyl-L-glutamate (Phe-Glu); and the binding augmented by the presence of Phe-Glu, was also sensitive to temperature and osmolarity of the incubation buffer. Sonication of membranes in 5 mM glutamate increased the apparent binding of [3H]glutamate and abolished the stimulatory effect of Phe-Glu. These findings are consistent with the hypothesis that chloride-dependent association of [3H]glutamate with membranes from brain reflects, in part, a sequestration process, which may be driven by glutamate exchange.     

Hand infections. Bacteriology and treatment: a prospective study

In a prospective, double-blind study, 193 patients hospitalized for established hand infections were randomized to receive either cefamandole intravenously followed by cephalexin by mouth or methicillin intravenously followed by dicloxacillin by mouth. Careful aerobic and anaerobic cultures were performed. Multiple organisms grew in cultures from 84% of the patients (over three isolates per infection on average). Human bite wounds contained anaerobes 43% of the time compared with 12% for other wounds. The majority of wounds (72%) required operative treatment. In 128 patients assessable for treatment outcome, results were unsatisfactory in 11 (9%). There was no difference in outcome between cefamandole (6/59, 10%) and methicillin (5/59, 8%). The presence of anaerobes, Eikenella corrodens, human bites, or an increasing number of organisms was associated with an unsatisfactory response. The presence of Staphylococcus aureus and/or beta-hemolytic streptococci was associated with a favorable response. The incidence of antibiotic-resistant isolates did not correlate with outcome.     

Eales' disease presenting as stroke in the young adult

Eales' disease is an uncommon idiopathic disorder characterized by retinal perivasculitis and recurrent vitreous hemorrhages in young males. Associated neurological involvement is rare. We report a 38-year-old man who presented with stroke attributed to Eales' disease.