Glycine-containing terminals in the rat dorsal vagal complex

The present study examined the distribution of glycine and glycine-receptors in the dorsal vagal complex using pre-embedding immunocytochemistry. Glycine-immunoreactive terminals were present in moderate densities in the medial, intermediate, interstitial, commissural and ventrolateral subnuclei of the nucleus tractus solitarii. The dorsolateral nucleus tractus solitarii and the dorsal vagal motor nucleus contained only very few, scattered glycine-containing terminals. Glycine terminals appeared to be concentrated in regions of the dorsal vagal complex receiving primary vagal afferents, though previous studies have suggested that glycine is not present in these afferents. A conspicuously high concentration of glycine terminals was observed in the medial nucleus tractus solitarii where a population of cholinergic neurons has been identified previously. Ultrastructurally glycine immunoreactivity was principally associated with terminals containing flattened, pleomorphic vesicles and forming symmetrical synaptic contacts, mostly with dendrites. Glycine receptor immunoreactivity was present throughout the dorsal vagal complex with little evidence of subnuclear localization. With electron-microscopic examination, glycine receptor immunoreactivity was associated with dendritic membranes and was associated presynaptically with terminals containing flattened pleomorphic vesicles. Overall, the present data provide evidence consistent with a neurotransmitter role for glycine in the dorsal vagal complex. The presence of glycine in regions of the dorsal vagal complex receiving vagal afferents suggests a prominent role for this neurotransmitter in autonomic regulation.

Diagnosing sinusitis by X-ray: is a single Waters view adequate?

OBJECTIVE

To determine whether a single Waters view (occipito-mental) radiograph could be substituted for a four-view sinus series to diagnose sinusitis, and to determine the inter- and intraobserver variabilities for sinus radiography.

DESIGN

Radiographs were interpreted by radiologists blinded to the clinical history, and results were recorded on a standardized form.

SETTING

Veterans Affairs Medical Center.

PARTICIPANTS

Staff attending radiologists, an attending radiologist with special training in skull radiology, and a senior radiology resident.

MEASUREMENTS AND MAIN RESULTS

The agreement between the Waters view and the four-view sinus series was moderate to substantial (simple agreement = 75-84%, kappa = 0.5-0.68). However, agreement varied by sinus and, after correction for chance agreement, was substantial only for the maxillary sinuses (kappa = 0.72-0.87). Intraobserver agreement (kappa = 0.72-0.84) was superior to interobserver agreement (kappa = 0.49-0.59) for the four-view sinus series.

CONCLUSIONS

Substituting a single Waters view for a four-view sinus series may be an acceptable strategy for diagnosing maxillary sinusitis.

Making the burned hand functional

The goal of treatment of the burned hand is to make the hand functional at the conclusion of treatment. Function should ideally include both fine pinch and power grip but will ultimately be determined by the individual patient's needs. At no time, however, can the care of the burned hand be performed in a vacuum, losing sight of the patient as a whole. It must also be remembered that the hand functions as part of the upper extremity. Full hand motion is useless if significant contractures of the elbow or axilla prevent the patient from positioning the hand so that this motion can be utilized. Rehabilitation must render the entire extremity functional. Thus, it becomes obvious that a team effort is mandatory. This usually will include the following individuals: physician, nurse, occupational therapist, physical therapist, vocational rehabilitation counselor, and social worker. A functional upper extremity means that the goal must be to return patients to their preburn vocations and avocations. A clear understanding of job requirements and work habits will allow realistic goals to be established. However, when the goal of optimal function cannot be reached, early retraining will help to obtain optimal rehabilitation.

Workplace smoking restrictions, occupational status, and reduced cigarette consumption

Reductions in workday cigarette consumption among indoor workers subject to different levels of smoking restriction were examined using representative population data for both blue-collar and white-collar workers. Regardless of whether workplace smoking bans were total or applied only to the usual work station, reported workday cigarette consumption was reduced by approximately five cigarettes per day compared with leisure-day consumption. This was in contrast to there being no difference between workday and leisure-day consumption among those who had no ban on smoking at their usual work station. This pattern of findings applied to all occupational-status groups, after controlling for sex and number of cigarettes smoked on a leisure day. These results are discussed with reference to potential public-health benefits and to implications for reduced retail sales of cigarettes.

Characteristics of heavy smokers

BACKGROUND

Heavy smokers (those who smoke greater than or equal to 25 or more cigarettes a day) are a subgroup who place themselves and others at risk for harmful health consequences and also are those least likely to achieve cessation. Despite this, heavy smokers are not well described as a segment of the smoking population.

METHODS

We used representative population data on 1,048 smokers to examine differences between heavy and lighter smokers (less than or equal to 24 cigarettes per day).

RESULTS

Heavy smokers constituted 26.7% of all cigarette smokers. Compared with lighter smokers, heavy smokers were significantly more likely to be male, to be age 30 years or older, to smoke their first cigarette of the day within 30 min of waking, to perceive quitting as very difficult, to have little confidence in their ability to quit, to be less likely to report variation in their rate of smoking between work and leisure days, and to be less likely to be employed.

CONCLUSIONS

Public health strategies which may particularly assist heavy smokers include stronger restrictions on smoking in public places, nicotine replacement therapies, and the use of segmentation research to more carefully target campaign messages to influence quit attempts and confidence.

Renal acidosis, thyroiditis, hemolytic anemia: an autoimmune link?

Distal renal tubular acidosis (DRTA) is characterized by a urine of inappropriately high pH in the presence of a metabolic acidosis. Female patients with DRTA may have associated autoimmune disorders. We have described a patient with DRTA, followed by acute thyroiditis and autoimmune hemolytic anemia within 2 years. This combination of autoimmune diseases has not been described previously. These conditions are likely linked by an autoimmune pathogenesis. Clinicians are advised that some patients with DRTA may subsequently have features of any autoimmune disorder as the natural history of the disease.