Neurologic complications in critically ill pregnant patients.

Neurologic complications in a critically ill pregnant woman are uncommon but some of the complications (such as eclampsia) are unique to pregnancy and the puerperal period. Other neurologic complications (such as seizures in the setting of epilepsy) may worsen during pregnancy. Clinical signs and symptoms such as seizure, headache, weakness, focal neurologic deficits, and decreased level of consciousness require careful consideration of potential causes to ensure prompt treatment measures are instituted to prevent ongoing neurologic injury. Clinicians should be familiar with syndromes such as pre-eclampsia, eclampsia, stroke, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome. Necessary imaging studies can usually be performed safely in pregnancy. Scoring systems for predicting maternal mortality are inadequate, as are recommendations for neurorehabilitation. Tensions can arise when there is conflict between the interests of the mother and the interests of the fetus, but in general maternal health is prioritized. The complexity of care requires a multidisciplinary and multiprofessional approach to achieve best outcome in an often unexpected situation.

Nosocomial Candida. Epidemiology, transmission, and prevention.

The NNIS and the newly established SCOPE data indicate that the relative proportion of organisms causing nosocomial bloodstream infections has changed over the last decade, with Candida species now being firmly established as one of the most frequent agents. The epidemiology of nosocomial candidemia is continually being refined, but established predisposing factors including immunosuppression and malignancies, use of broad spectrum antibiotics, and use of indwelling central catheters remain as significant risk factors. The high cost of health care and greater attention to continuous quality improvement will stimulate better and more effective ways of diagnosing and treating candida infections using combined clinical and microbiologic acumen. There is room for optimism as newer antifungal agents with reduced toxicities have impact on therapy of candidal infections. Aggressive development of still more agents and reformulations of older agents continue in earnest. Even greater consolation comes from the increased awareness of lay and medical personnel alike regarding the appropriate and judicious use of antimicrobial agents.

Effects of the serotonin receptor agonists 8-OH-DPAT and TFMPP on learning as assessed using a novel water maze.

We evaluated the effects of two drugs active at serotonin receptors, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT, a 5-HT1A agonist) and N-3-trifluoromethylphenyl)piperazine hydrochloride (TFMPP, a 5-HT2C agonist) on learning using a novel water maze previously characterized in our laboratory. The water maze utilized is a traditional type of maze with alleyways and doors through which the rats learn to swim to reach a platform, unlike the open pool Morris water maze task. Performance is assessed by swim time required to reach the platform and errors committed. Following initial training on maze configuration A, rats were assigned to saline, TFMPP and 8-OH-DPAT treatment groups and tested for performance once per dose, 30 min after administration of drug (0.25, 0.5, and 1.0 mg/kg IP). Swim times were significantly increased as compared to saline for all doses for both drugs. The error rate was increased for 8-OH-DPAT at all doses, while TFMPP had no effect on error rate at any dose. Next, rats were challenged to learn new mazes following daily administration of 0.25 or 0.5 mg/kg of each drug 30 min prior to each daily swim trial. Rats given 0.25 mg/kg of 8-OH-DPAT learned new maze C more slowly than saline-treated rats, while TFMPP had no effect at this dose. At the higher dose of 0.5 mg/kg, tested on new maze B, TFMPP administration significantly increased swim times but not errors, while this dose of 8-OH-DPAT markedly increased both swim time and errors. Finally, rats from all groups were tested on maze E after drug administration was discontinued, and there were no performance differences among groups. These data suggest that serotonin1A receptors may inhibit learning.

Effects of chronic stress on sleep in rats.

The present study was conducted to determine the effects of chronic stress on sleep using a rodent paradigm of around-the-clock signalled intermittent foot shock in which some rats can pull a chain to avoid/escape shock while another group of rats is yoked to the first group. We measured sleep using telemetry; four-channel EEG was collected 24 h/day in rats during 2 prestress days; days 1, 2, 3, 7, and 14 during chronic stress; and 3 poststress days. States of REM sleep, non-REM (NREM) sleep, and waking were scored for each 15-s period of the EEG recordings. During the prestress period, rats slept (REM plus NREM) 55% of available time during the light hours and 34% of the dark hours with the remainder represented by waking. On the first day of stress, total sleep and, especially REM sleep, decreased markedly. By the second day of stress, only REM sleep in the controllable stress group (but not the uncontrollable stress group) was still significantly decreased compared to prestress levels, and REM sleep returned to baseline levels by day 7 of stress. The recovery of sleep quantity was accomplished by increased sleep during the dark hours, resulting in a long-lasting disruption of normal circadian sleep patterning.

Effects of MK-801 on learning and memory as assessed using a novel water maze.

The effects of the NMDA receptor antagonist MK-801 [(+)-10,11-dihydro-5-methyl-5H-dibenzo [a,d]-cyclohepten-5,10 imine hydrogen maleate] on learning and memory were assessed using a water maze. The maze was a traditional type of maze with alleys and choices between various paths, but set inside a pool of water to a height of 25 cm. Different mazes could be configured by altering the arrangement of open vs. closed doors. Both the time required to reach an out-of-the-water exit platform and the errors made during the swim from start to finish were recorded. Learning was assessed during the first 10 to 20 trials in a new maze configuration, while memory was tested after the maze was well learned. Three experiments, some with several phases, were performed. These experiments compared the effects of 0.1 mg/kg of either (+)-MK-801, or (-)-MK-801 vs. saline on learning new maze configurations as well as swimming well-learned mazes. Neither of the MK-801 isomers impaired performance of a previously learned maze. (+)-MK-801 clearly slowed learning of new mazes as measured by both maze completion time and errors committed, while (-)-MK-801 had a significant but smaller effect on learning. Rats given (+)- or (-)-MK-801 (0.1 mg/kg) for 16 days while learning one maze and then challenged to learn a new maze without drug administration performed no differently on the new maze than controls, suggesting that the acute effect of MK-801 on learning is not long lasting.

Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy.

Ancillary procedures associated with extracorporeal shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out-patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.

Factors associated with sexual dysfunction following transurethral resection of the prostate.

A retrospective analysis of 62 consecutive potent patients undergoing transurethral resection of the prostate is described. Each patient was interviewed a minimum of six months following surgery. Potency was retained in 89% of patients but 57% of these experienced a decrease from their preoperative level of function. Three factors were found to be significantly associated with a reduction in postoperative potency. These were systemic disease (p less than 0.001), small prostatic resections (p less than 0.001) and a reduced level of potency preoperatively (p less than 0.01). Of those men retaining a degree of potency, 90% achieved their first erection within two months of the procedure. The full extent of sexual dysfunction following transurethral resection of the prostate has not previously been appreciated, nor have the factors associated with this dysfunction.

Intracavernosal injection therapy for impotence: preliminary results.

Intracavernosal injection of vasoactive agents is a new technique for inducing penile erection. It has applications in the counselling, diagnosis and treatment of sexual dysfunction. Nineteen patients are reviewed representing our initial experience with this technique. Thirteen men (68%) achieved a full erection with this treatment and a further three (16%) had a partial response. The applications, method and complications are discussed.

In vitro tensile bond strength of reconditioned brackets.

This study evaluated the effects of four rebonding procedures on in vitro tensile bond strength of four filled diacrylate adhesives on orthodontic brackets. The four procedures were thermal reconditioning, chemical reconditioning, removal of residual adhesive with a green stone, and grinding the mesh base with a green stone. The mesh-base, stainless steel brackets were bonded to plastic cylinders and the tensile bond force necessary to cause bond failure was recorded. The initial bond strengths for the no-mix adhesive and both two-paste systems were significantly greater than the tensile bond strengths for any rebonding condition. Different rebonding conditions reduced tensile bone strength to differing degrees, using each of these three adhesives. The initial bond strength for the visible, light-cured adhesive was not significantly different from three of the four rebonding conditions and was lower than the initial bond strength of the other three adhesives.

The meatal problem with TUR prostate: the value of post-operative self-dilatation.

In a preliminary retrospective study, we found that 37% of patients about to undergo a transurethral resection of the prostate had an external meatus too small to admit a 26 F resectoscope sheath. In a prospective study, a formal meatotomy was compared with an Otis urethrotomy for patients with a narrow meatus. This study was stopped because 71% of cases having a meatotomy developed strictures compared with 29% having an internal urethrotomy. In a further study of 59 patients, regular self-dilatation of the cut meatus with a plastic spigot was compared with internal urethrotomy of the meatus alone. Seven per cent of cases having self-dilatation developed strictures compared with 34% having internal urethrotomy. It was concluded that in those patients with a narrow external meatus meatotomy should not be carried out, but self-dilatation following internal urethrotomy greatly reduces the incidence of meatal strictures.

Concentrations of trimethoprim and sulphamethoxazole in the human prostate gland after intramuscular injection.

Following intramuscular injection of co-trimoxazole (trimethoprim/sulphamethoxazole 1 : 5), concentrations of trimethoprim (TMP) and sulphamethoxazole (SMX) were measured in the prostatic tissue and serum of 30 men undergoing endoscopic prostatectomy. Tissue levels for TMP appeared to be higher than serum levels and probably reached the minimum inhibitory concentration (MIC) for most urinary pathogens. Administration of the drug at 4, 8 and 12 h prior to sampling produced no significant difference in tissue levels. It is concluded that TMP is concentrated in prostatic tissue following intramuscular injection. Tissue levels for SMX were apparently lower than serum levels.

Scuba diver's delayed toxic epithelial keratopathy from commercial mask defogging agents.

Two unrelated cases of delayed epithelial keratopathy in amateur scuba divers were attributed to the improper use of commercial chemical defogging agents on the divers' masks. Symptoms of corneal damage emerged one to three hours after exposure to such agents. Damage to the cornea in both cases was limited to a diffuse superficial punctate keratopathy that resolved within 24 hours without scarring or permanent damage.

Preliminary evaluation of mesoionic 6-substituted 1-methylimidazo[2,1-b][1,3]thiazine-5,7-diones as potential novel prodrugs of methimazole.

A series of five 6-alkyl- and 6-aryl-mesoionic 1-methylimidazo[2,1-b][1,3]thiazine-5,7-diones was synthesized and found to produce 1-methyl-3H-imidazole-2-thione (methimazole) upon alkaline hydrolysis or treatment with amine or thiol reagents. The alkaline hydrolysis followed a second-order rate expression, being dependent on both substrate and hydroxide-ion concentrations. The rate constants for the five derivatives fell within 6-15 x 10(-2) liter/mole min at 40 degrees. These compounds were stable in aqueous acidic solutions and in human serum or rat liver homogenate under conditions producing rapid hydrolysis of the methimazole prodrug 1-carbethoxy-2-methylimidazole-2-thione (carbimazole).