Screening helical CT for evaluation of blunt traumatic injury in the pregnant patient.

Pregnant patients who sustain severe blunt trauma are infrequently encountered in most practices. However, detection of internal injuries including those to the gravid uterus is essential since maternal disability or fetal loss are physical and psychologic catastrophes that have long-term effects on the mother and her family. Computed tomography (CT) is commonly used to detect blunt traumatic injuries and can play an important role in the screening of the injured pregnant woman.

Efficacy of targeted chemoradiation and planned selective neck dissection to control bulky nodal disease in advanced head and neck cancer.

Purpose: To determine the efficacy of targeted chemoradiation with the radiation plus platinum (RADPLAT) protocol and planned selective neck dissection in patients with N2 to N3 nodal disease associated with upper aerodigestive tract carcinoma.

Methods: Analysis of 52 patients with N2a, N2b, or N3 disease involving 60 heminecks treated with intraarterial cisplatin, 150 mg/m2, and intravenous sodium thiosulfate, 9 g/m2, on days 1, 8, 15, and 22; radiation therapy, 180 to 200 cGy per fraction for 35 fractions (total dose, 68-74 Gy); and planned neck dissection (33 of 35 procedures were selective).

Results: Of the 56 evaluable heminecks, a clinical complete response was achieved in 33 (59%).

Phenotypic and state-dependent expression of the electrical and morphological properties of oxytocin and vasopressin neurones.

Oxytocin and vasopressin secreting neurones of the hypothalamic supraoptic nucleus share many membrane characteristics and a roughly similar morphology. However, these two neurone types differ in the relative expression of some intrinsic and synaptic currents, and in the extent of their respective dendritic arbors. Spike depolarizing afterpotentials are present in both types, but more frequently give rise to prolonged burst discharges in vasopressin neurones.

Electrophysiological distinctions between oxytocin and vasopressin neurons in the supraoptic nucleus.

Oxytocin and vasopressin neurons can be differentiated from one another, and from neurons in the immediately adjacent perinuclear zone, by their electrophysiological properties. In both sexes, oxytocin and vasopressin neurons are characterized by a prominent transient outward rectification which is conspicuously lacking in most perinuclear neurons. In addition, perinuclear neurons, some of which project to the supraoptic nucleus, exhibit a transient depolarization which underlies short bursts of spikes.

Expression of rat target of the antiproliferative antibody (TAPA) in the developing brain.

The present study defines the expression pattern of TAPA (target of the antiproliferative antibody, also known as CD81) in the developing rat brain. TAPA is a member of the tetramembrane spanning family of proteins, and like other members of this family it appears to be associated with the stabilization of cellular contacts (Geisert et al. [1996] J.

Subclavian artery injuries.

Thirty-two consecutive patients with subclavian artery injuries were evaluated to assess the mechanism of injury, types of repair, and results. In this series, most wounds were from firearms. Although the mortality was high (19%), most patients had the vessel repaired successfully.

Astrocytes and extracellular matrix following intracerebral transplantation of embryonic ventral mesencephalon or lateral ganglionic eminence.

Transplantation of embryonic neurons to the adult mammalian central nervous system (CNS) offers the possibility of re-establishing neural functions lost after traumatic injuries or neurodegenerative disease. In the adult CNS, however, transplanted neurons and their growing neurites can become confined to the graft region, and there may also be a relative paucity of afferents innervating grafted neurons. Because glia may influence the development and regeneration of CNS neurons, the present study has characterized the distribution of astrocytes and developmentally regulated glycoconjugates (chondroitin-6-sulfate proteoglycan and tenascin) within regions of the embryonic mouse CNS used as donor tissues, and in and around these grafts to the adult striatum and substantia nigra.

Digit removal leads to discrepancies between the structural and functional organization of the forepaw barrel subfield in layer IV of rat primary somatosensory cortex.

The physiological representation of the forepaw in rat primary somatosensory cortex (SI) is topographically organized. This representation is associated with the unique arrangement of barrels in layer IV of the forepaw barrel subfield (FBS) in SI and provides an example of a relationship between cortical structure and function. It has been reported that removal of peripheral afferent input to the FBS prior to postnatal day 5 or 6 results in a disorganized FBS, while deafferentation at later times produces little or no alteration of the FBS.

Neuropeptide Y suppresses prolactin secretion from rat anterior pituitary cells: evidence for interactions with dopamine through inhibitory coupling to calcium entry.

Expression of neuropeptide Y (NPY) in the medial basal hypothalamus is increased during lactation, and at least part of this increase is due to the appearance of the peptide in hypothalamic tuberoinfundibular dopamine neurons, a cell population that does not exhibit NPY expression in other physiological conditions. The present studies tested the hypothesis that NPY affects PRL secretion by modulating the action of dopamine (DA) at the lactotroph. In static incubations of cultured anterior pituitary (AP) cells, the addition of either NPY or DA in concentrations of 0.

The subependymal zone: "brain marrow".

From all of the studies of developmentally regulated molecules as well as the impressive proliferation of cells within the SEZ, we would like to propose that the SEZ of the adult brain, from the lateral ventricles of the cerebrum to the central canal of the spinal cord, represents a potential "brain marrow" from which stem and progenitor cells can be further studied and exploited for cell replacement and circuitry repair paradigms for neurological disease. Without question the SEZ is not as regenerative or pleuripotential as bone marrow or other hematopoietic systems, but there are definitely some elements in common. Bone marrow contains a pleuripotent stem cell that under certain conditions (e.

Central stimulation of oxytocin release in the lactating rat by N-methyl-D-aspartate: requirement for coactivation through non-NMDA glutamate receptors or the glycine coagonist site.

Excitatory amino acid (EAA) neurotransmitters participate in the regulation of secretion of several neuropeptides, including oxytocin (OT), via actions at different receptors. In earlier studies, release of OT could be achieved reliably by injection into the supraoptic nucleus (SON) of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)/kainate receptor agonists, but not by treatment with N-methyl-D-aspartate (NMDA) alone. This prompted further examination of the possible role of NMDA receptors in OT release following central coapplication of NMDA and AMPA-site agonists, or of NMDA and agonists active at the glycine coagonist site.

Hearing loss. A plan for individualized management.

Because some cases of hearing loss demand urgent attention, an approach to patients with hearing loss should be adopted in the primary care setting that allows for systematic institution of an individualized and appropriate treatment plan. Workup is enhanced by categorizing the hearing loss as acute or chronic and conductive or sensorineural. The Rinne and Weber tuning fork tests are the most important tools in distinguishing between conductive and sensorineural hearing loss.

Inherited liver diseases in adults.

Important inherited disorders causing acute and chronic liver disease include hemochromatosis, Wilson's disease, alpha 1-antiprotease (antitrypsin) deficiency, and cystic fibrosis. The detection of an index case has implications for screening family members. A normal life span can be expected with treatment in asymptomatic patients with Wilson's disease and hemochromatosis.

Neonatal exposure to estradiol prevents the expression of ovarian hormone-induced luteinizing hormone and prolactin surges in adulthood but not antecedent changes in neuropeptide Y or adrenergic transmitter activity: implications for sexual differentiation of gonadotropin secretion.

Sex differences in adult patterns of mating behavior and gonadotropin secretion in rats are determined in part by the presence or absence of gonadal steroids during a perinatal critical period. For example, male rats and female rats exposed neonatally to androgen do not exhibit LH surge patterns when treated appropriately with ovarian hormones in adulthood, and there is evidence that this may be due to a failure of ovarian hormones to activate the hypothalamic neuronal systems that stimulate LH secretion in such animals. Because considerable evidence suggests that estradiol formed centrally from testosterone is responsible for the permanent defeminization of mating behavior and gonadotropin secretion, the present studies compared normal females with normal males and with females treated neonatally with estradiol on the ability of ovarian hormones to induce several important neurochemical changes antecedent to the LH surge, including changes in neuropeptide Y (NPY) and LH-releasing hormone (LHRH) concentrations in the median eminence, as well as changes in turnover rates for catecholamine transmitters in the medial basal hypothalamus and medial preoptic area.

The corpus callosum provides a massive transitory input to the visual cortex of cat and rat during early postnatal development.

Studies of corpus callosum development in cat revealed that the callosum must be intact during postnatal month 1 if normal visual development is to occur [11-20,25]. The use of DiI, a lipophilic carbocyanine dye that is an in vitro membrane tracer, permits a detailed search for morphological evidence to account for these functional results because many cells can be simultaneously labeled in their entirety. To search for morphological evidence, the corpus callosum was labeled in vitro with DiI in tissue from cats aged 2-277 days old [21].

Glottic configuration after arytenoid adduction.

It has been recently noted that laryngeal paralysis results in a complex alteration of the glottis. The membranous segment of the paralyzed vocal fold is shortened, and, during phonation, patients use hyperfunction to shorten the normal vocal fold to about the same length. Additionally, if the paralyzed vocal fold is not near the midline, the angle between the membranous and cartilaginous segments of the vocal fold is decreased, resulting in a "posterior" gap which cannot be closed by hyperadduction of the normal side.

Relationship of calbindin D-28k with afferent neurons to the rostral ventrolateral medulla in the rat.

The phenylethanolamine-N-methyltransferase (PNMT)-containing neurons in the rostral ventrolateral medulla (RVLM) (the C1 adrenergic group) have been implicated in the generation of the tonic sympathetic nerve activity. Using a double-labeling immunohistofluorescence technique, we found that 34.6 +/- 11.

Distention arthrography in the treatment of adhesive capsulitis of the shoulder.

Purpose: Adhesive capsulitis involving the glenohumeral joint (frozen shoulder) is an insidious and painful condition that results in gradual loss of joint motion. Recovery is frequently prolonged despite multiple therapeutic maneuvers. The authors investigate the mechanism of action and the long-term clinical result of distention arthrography for the treatment of patients with frozen shoulder.

The morphology of globus pallidus projection neurons in the rat: an intracellular staining study.

The morphology of 23 intracellularly stained projection neurons of rat globus pallidus (GP) was studied in light microscopic preparations. The somatic size of these projection neurons was highly variable. The somatic area ranged from 78 to 353 microns 2.

Stimulation of oxytocin release in the lactating rat by a central interaction of alpha 1-adrenergic and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid-sensitive excitatory amino acid mechanisms.

These studies tested for a facilitatory interaction between noradrenergic and excitatory amino acid mechanisms controlling oxytocin (OT) release in the lactating rat. Lactating females were cannulated in the supraoptic nucleus of the hypothalamus (SON) or into the third ventricle and treated with the alpha 1-agonist phenylephrine (PHE) or the glutamate receptor agonist alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA), either alone or together. Treatment with PHE increased plasma OT dose dependently after microinjection into the SON area; strong stimulation also occurred after third ventricle injection of the drug.

Low-osmolar contrast media in the 1990s. Guidelines for urography in a cost-sensitive environment.

Objectives: The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmolar contrast media for patients undergoing urographic and other radiologic studies.

Methods: A comprehensive review of the literature since the introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble contrast agents.

Results: Compared with high-osmolar ionic contrast media, routine use of low-osmolar agents for intravascular injection during diagnostic imaging results in fewer idiosyncratic reactions in patients and potentially less renal injury in a subgroup of critically ill patients.

Response characteristics of subthalamic neurons to the stimulation of the sensorimotor cortex in the rat.

Responses of the subthalamic nucleus (STH) neurons to the stimulation of the sensorimotor cortex (Cx) were recorded in intact rats and in those which received lesions in the pallidum, the neostriatum, the brainstem, or the corpus callosum. Most of the STH units (78%) exhibited two excitatory peaks which were interrupted by a brief period of inhibition. Some of units which were located in the peripheral part of the STH tended to lack the brief inhibitory component and exhibited a long period of excitation.

Central stimulation of oxytocin release in the lactating rat: interaction of neuropeptide Y with alpha-1-adrenergic mechanisms.

The possible cooperation of neuropeptide Y (NPY) and alpha-1-adrenergic mechanisms in the release of oxytocin (OT) in conscious, nonsuckled lactating rats was examined following microinjections of NPY and its analogs and/or alpha-adrenergic drugs into the supraoptic nucleus (SON) or anterior paraventricular nucleus/anterior commissural nucleus (PVN/ACN). The alpha-1-adrenergic agonist phenylephrine dose dependently increased plasma OT after injection into the SON or the PVN/ACN, and this was prevented by treatment with the specific alpha-alpha-1-adrenergic receptor antagonist prazosin, but not by the alpha-2 antagonist rauwolscine. The alpha-2-adrenergic agonist clonidine did not increase plasma OT.

Activation of central D-1 dopamine receptors stimulates oxytocin release in the lactating rat: evidence for involvement of the hypothalamic paraventricular and supraoptic nuclei.

The stimulatory effect of dopamine (DA) on the release of oxytocin (OT) in lactating rats is exerted at the D-1 DA receptor subtype. Because the neural loci mediating this effect have not been identified, the objective of the present studies was to test whether OT release in the lactating rat would be elevated after central administration of a D-1 DA receptor agonist into the third ventricle (3V) or directly into either the rostral paraventricular/anterior commissural nucleus area (PVN/ACN), the central paraventricular nucleus area, or the supraoptic nucleus (SON), all of which contain OT neurosecretory cells. Lactating rats were implanted with a stainless steel cannula directed into one of the above areas or into the arcuate-ventromedial region of the medial basal hypothalamus (MBH), or sites dorsal to the PVN/ACN or SON, which served as anatomical controls.