Purtscher's retinopathy

Purtscher's retinopathy presents to the clinician as loss of vision in a patient with a history of a possible precipitating event such as recent major trauma, pancreatitis, childbirth or renal failure. The ophthalmological picture is one of ischaemia at the posterior pole with white patches of oedema and haemorrhages concentrated around the optic disc. The most probable pathological cause is embolisation of the peripapillary terminal arterioles supplying the superficial peripapillary capillary net. The nature of the embolic particles remains uncertain. Complement-mediated aggregates, fat, air, fibrin clots and platelet clumps may all be involved in what is most likely to be a multifactorial process. There is at present no recognised treatment for the condition.

Ultrastructure study of the intramolluscan stages of Meiogymnophallus minutus (digenea: gymnophallidae) in Scrobicularia plana (bivalvia) from Portugal

The ultrastructure of the tegument of the sporocyst and contained cercariae of Meiogymnophallus minutus found in Scrobicularia plana collected in Ria de Aveiro estuary (Portugal) were studied by scanning (SEM) and transmission electron microscopy (TEM). TEM revealed microvilli extending from the surface of the sporocyst tegument that contributed to the lacetrimmed surface morphology observed by SEM. The cercarial surface was papilliform and covered densely with single-pointed tegumental spines. On TEM, besides the spines and several mitochondria, translucid and electrondense spherical secretory vesicles were evident in the matrix of the tegument but were not seen on the sporocyst tegument. Uniciliate sensory receptors found in the cercaria of M. minutus were examined under SEM and TEM. Structural differences between the oral and the ventral sucker were observed. On the lip of the ventral sucker, large and strong spines were arranged in concentric rows, and two groups of six sensory papillae were placed concentrically and equidistantly. The oral sucker, surrounded by a crown of dense and long microvilli, exhibited a ring of uniciliate sensory papillae and some tegumental spines along the lip. The surface morphology of the M. minutus cercaria is compared with that of other Gymnophallidae cercariae.

Cappuccino, a Drosophila maternal effect gene required for polarity of the egg and embryo, is related to the vertebrate limb deformity locus

We report the molecular isolation of cappuccino (capu), a gene required for localization of molecular determinants within the developing Drosophila oocyte. The carboxy-terminal half of the capu protein is closely related to that of the vertebrate limb deformity locus, which is known to function in polarity determination in the developing vertebrate limb. In addition, capu shares both a proline-rich region and a 70-amino-acid domain with a number of other genes, two of which also function in pattern formation, the Saccharomyes cerevisiae BNI1 gene and the Aspergillus FigA gene. We also show that capu mutant oocytes have abnormal microtubule distributions and premature microtubule-based cytoplasmic streaming within the oocyte, but that neither the speed nor the timing of the cytoplasmic streaming correlates with the strength of the mutant allele. This suggests that the premature cytoplasmic streaming in capu mutant oocytes does not suffice to explain the patterning defects. By inducing cytoplasmic streaming in wild-type oocytes during mid-oogenesis, we show that premature cytoplasmic streaming can displace staufen protein from the posterior pole, but not gurken mRNA from around the oocyte nucleus.

Multiple vortex vein varices masquerading as choroidal secondaries

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Evaluation of the safety and efficacy of topical nitroglycerin ointment to facilitate venous cannulation

The purpose of this study was to determine the safety and efficacy of 2% nitroglycerin ointment to facilitate venous cannulation. In a double-blind experimental design, 80 adult subjects were randomly assigned to receive a 2% nitroglycerin ointment or a placebo ointment prior to cannulation. Variables measured before and after ointment application included heart rate, electrocardiogram, vein size, and presence of headache. No statistically significant differences were found in vein size or adverse effects following nitroglycerin ointment application.

Tourette's syndrome in New Zealand. A postal survey

It has become increasingly evident that Tourette's syndrome (TS) is not as rare as was once thought and substantial cohorts from various parts of the world have been reported. The clinical characteristics seem independent of culture as they appear to occur with some degree of uniformity irrespective of the country of origin. We investigated the point prevalence and report the clinical characteristics of TS in New Zealand. Forty probable cases were identified and the symptoms were similar to those described in cohorts from other parts of the world.

The role of electrode size on the incidence of spreading depression and on cortical cerebral blood flow as measured by H2 clearance

Cerebral blood flow was measured by the H2 clearance method 30 and 60 min after the implantation of 300, 250, 125, or 50 microns diameter platinum-iridium electrodes 2 mm deep into the right parietal cortex of normothermic, normocarbic halothane-anesthetized rats. Another group of animals had 50 microns electrodes inserted 1 mm. In all animals, the presence or absence of a wave of spreading depression (SD) was noted at the time of implantation, with recordings made with glass micropipettes. H2 flow values were compared with those measured in gray matter from the same anatomical region (but from different rats), using [3H]nicotine. The incidence of SD ranged from 60% following insertion of 300 microns electrodes to 0% with 50 microns electrodes. H2 clearance flows also varied with electrode size, from 77 +/- 21 ml 100 g-1 min-1 (mean +/- standard deviation) with 300 microns electrodes to 110 +/- 31 and 111 +/- 16 ml 100 g-1 min-1 with 125 and 50 microns electrodes, respectively (insertion depth of 2 mm). A CBF value of 155 +/- 60 ml 100 g-1 min-1 was obtained with 50 micron electrodes inserted only 1 mm. Cortical gray matter blood flow measured with [3H]nicotine was 154 +/- 35 ml 100 g-1 min-1. When the role of SD in subsequent flow measurements was examined, there was a gradual increase in CBF between 30 and 60 min after electrode insertion in those animals with SD, while no such change was seen in rats without SD.(ABSTRACT TRUNCATED AT 250 WORDS)

Training--have your cake and eat it

Training programmes which take staff away from the workplace for long periods are unpopular with managers. In this special report we look at developments in on-the-job training: how open learning has become the main growth area in staff development; why national vocational qualifications aren't yet living up to the ideal; how Cornwall providers have replaced 'sitting beside Nellie' with more effective IT training.

Continuous quality improvement applied to medical care: experiences at LDS hospital

At LDS Hospital the authors are implementing continuous quality improvement (CQI), a systems-analytic approach to quality management in industry, as an approach to quality management in medical domains. Their approach consists of 1) choosing a process to be improved, 2) assembling a team of expert clinicians that understands the process and the outcomes, 3) determining key steps in the process and expected outcomes, 4) collecting data that measure the key process steps and outcomes, and 5) feeding back the data to the practitioners. CQI theory states that the practitioners will use the information and their own best intentions to improve the manner in which they provide care. The authors have developed statistical tools that display the data and distinguish between random and assignable variation.