Transcranial Doppler blood flow measurement during cesarean section in two patients with cerebral vascular disease.

We present two cases of neurovascular disease in pregnancy in which transcranial Doppler was used to assess the status of the cerebral circulation during cesarean section under regional anesthesia. One woman had been found to have moyamoya disease, following a series of transient ischemic attacks during her first pregnancy, which ended in spontaneous abortion. On this occasion she was delivered by cesarean section under slowly-induced epidural anesthesia, using ephedrine to maintain the blood pressure, and transcranial Doppler revealed no change in signal in her left middle cerebral artery. Both mother and baby had an uneventful post natal course. The second case involved a primiparous woman with a large arteriovenous malformation that had been detected following generalized seizures, which were treated with valproic acid. Her cesarean section was conducted under spinal anesthesia, and her blood pressure maintained with ephedrine. Again transcranial Doppler revealed no change in signal in her middle cerebral artery during the procedure. We believe this is a potentially useful technique to monitor the cerebral circulation intraoperatively in the presence of cerebrovascular disease.

Nasal-associated lymphoid tissue is an inductive site for rat tear IgA antibody responses.

The role of nasal-associated lymphoid tissue (NALT) as a mucosal inductive site for tear IgA antibody responses was investigated in the rat model. Fluorescent microspheres were shown to access and be taken up by NALT after intranasal of ocular-topical administration, although fewer microspheres were found in the latter case. Tear IgA anti-DNP antibody responses to dinitrophenylated Streptococcus pneumoniae were 6 micrograms/ml at day 7, 10 micrograms/ml at day 10, and were still detectable on day 21 (5 micrograms/ml) following ocular or gastrointestinal immunization. Intranasal immunization induced tear IgA responses which were 1.7-fold higher at day 7 (10 micrograms/ml), peaked by day 10 (14 micrograms/ml) and were still 1.6-fold higher (8 micrograms/ml) at day 21 than responses of ocular or gastrointestinal groups. These findings suggest that intranasal immunization may be more effective than ocular or gastrointestinal administration in eliciting tear IgA antibody responses and, taken together with the microsphere data, indicate that NALT can serve as an inductive site for ocular mucosal IgA responses.

Erythropoietin: a review.

The fact that a plasma factor was responsible for the stimulation of red cell production has been known for more than 35 years. However, it is only recently that the gene responsible for its production and its molecular structure has been identified. Furthermore, recombinant human erythropoietin is now available for clinical use. This article details the molecular biology and clinical pharmacology of this remarkable growth factor.

Urinary urge incontinence--selection of patients for surgery.

A modification of the fluid-bridge test was performed on 43 patients with urinary urge incontinence. The 'functional' length of the urethra was found to be reduced significantly in some patients and surgery which increased it produced subjective and objective cure of symptoms. It is concluded that some patients with a history suggestive of motor detrusor instability will benefit from a primary surgical procedure, contrary to current management practice.