Treadmill training stimulates brain-derived neurotrophic factor mRNA expression in motor neurons of the lumbar spinal cord in spinally transected rats.

Brain-derived neurotrophic factor (BDNF) induces plasticity within the lumbar spinal circuits thereby improving locomotor recovery in spinal cord-injured animals. We examined whether lumbar spinal cord motor neurons and other ventral horn cells of spinally transected (ST) rats were stimulated to produce BDNF mRNA in response to treadmill training. Rats received complete spinal cord transections as neonates (n=20) and one month later, received four weeks of either a low (100 steps/training session; n=10) or high (1000 steps/training session; n=10) amount of robotic-assisted treadmill training. Using combined non-radioactive in situ hybridization and immunohistochemical techniques, we found BDNF mRNA expression in heat shock protein 27-labeled motor neurons and in non-motor neuron cells was greater after 1000 steps/training session compared to the 100 steps/training session and was similar to BDNF mRNA labeling in untrained Intact rats. In addition, there were significantly more motor neurons that contained BDNF mRNA labeling within processes in the ST rats that received the higher amount of treadmill training. These findings suggested that motor neurons and other ventral horn cells in ST rats synthesized BDNF in response to treadmill training. The findings support a mechanism by which postsynaptic release of BDNF from motor neurons contributed to synaptic plasticity.

Perinatal medical negligence closed claims from the St. Paul Company, 1980-1982.

One hundred fifty-three closed claims involving perinatal injury or death filed from 1980 through 1982 with the St. Paul Fire and Marine Insurance Company were studied. The claims included were those in which an indemnity was paid or $1,000 or more was expended on the legal defense. Five obstetricians reviewed these cases to identify obstetric and neonatal risk factors. In addition, cases were classified as to the presence or absence of medical negligence. Most of the complications leading to claims arose during labor and delivery. Many claims resulted from the failure to evaluate or treat in a manner consistent with accepted standards of care. Many lacked documentation of the physician's recognition of the risk factors involved. Low Apgar scores at both one and five minutes were the newborn risk factors seen most commonly. In the opinion of the reviewers, medical negligence occurred in 47% of the cases. Indemnity payment occurred with most of the claims judged to be associated with medical negligence. Payment to the claimant was made in a number of cases in which the reviewer thought no malpractice occurred. These results suggest that improvements may be needed in prenatal and perinatal health care as well as in the legal system used to address the problem of perinatal medical negligence.

Von Recklinghausen's disease associated with diffuse lepromatous leprosy--a case report.

Both leprosy and Recklinghausen's disease (Neurofibromatosis) are diseases affecting the Schwann cells of the peripheral nerves, though both are quite different entities. Lesions of Neurofibromatosis may be mistaken for nodules of lepromatous leprosy and vice versa, but when they occur simultaneously in the same patient, this may pose difficulty in the diagnosis of leprosy. Their coexistence is only a casual one. One such case of Multiple Neurofibromatosis (VRHD) associated with Diffuse LL is reported here.

Investigation of obstetric malpractice closed claims: profile of event.

The files of 220 obstetric closed-claim cases were reviewed by five obstetricians to determine whether information could be collected an analyzed to identify common predisposing factors to claims and to suggest preventative measures. The data suggests these cases contain common easily identified obstetric risk factors, most of which occurred in labor and delivery (66%). Fifty-four percent of the risks were recognized, 32% correctly managed, and a high percentage of risks were considered by the reviewers to be directly related to the obstetric outcome leading to the claim (66%). The authors feel obstetric closed claims can be studied and suggestions made to aid obstetricians in providing care. Identification of common obstetric risks and correct management of these risks is poor in these cases. Recognition and management guidelines are imperative in ensuring good obstetric outcome. These two physician-controlled factors played important parts in the majority of cases reviewed. It would appear from this study that obstetric malpractice closed claims are amenable to study; physicians and their patients would benefit from better data collection systems to identify risks in individual pregnancies; physicians need readily available resources to aid their management of patients; only through modification of physician behavior can suits be avoided.

Magnesium sulfate and beta-mimetic dual-agent tocolysis in preterm labor after single-agent failure.

Twenty-three patients in preterm labor failed to respond to single-agent tocolytic therapy or could not tolerate the dosage necessary to inhibit contractions. A combination of magnesium sulfate and ritodrine or terbutaline was used to inhibit labor in these patients. Fourteen patients (60.9%) responded to dual-agent tocolysis by delaying delivery for 48 hours or more. Six patients had delivery delayed for more than one week. Five patients had multiple gestations; three of them had delivery delayed more than 48 hours. Five patients developed pulmonary edema under treatment with dual-agent tocolysis; all responded to diuretic and/or oxygen therapy after the termination of tocolysis. Dual-agent tocolysis may significantly prolong some pregnancies complicated by preterm labor, but only at some risk to maternal well-being.

Plasma L-tryptophan/neutral amino acid ratio and dexamethasone suppression in depression.

We examined the ratio of plasma L-tryptophan (L-TRP) to other neutral amino acids (NAA) in normal controls and depressed patients undergoing a dexamethsone suppression test (DST). The L-TRP/NAA ratio discriminated controls from patients; however, there was no difference in the mean L-TRP/NAA ratio between DST suppressors and nonsuppressors. The cortisol level measured at 1600h postdexamethasone and the L-TRP/NAA ratio were positively correlated. The 1600h postdexamethasone cortisol levels accounted for 24% of the variance of Hamilton Depression Rating Scale ( HDRS ) scores. The inclusion of L-TRP/NAA ratios with 1600h postdexamethasone cortisol levels in a multiple regression equation resulted in an increase in this value and accounted for 65% of the variance in HDRS scores. The finding supports the use of multivariate biological models in depression.

Failure of naloxone to reverse apomorphine effects in humans.

Twelve male volunteers given apomorphine (20 micrograms/kg/hr) for 40 min by i.v. infusion had significant changes in growth hormone, prolactin, vasopressin, pulse rate, sedation and nausea. Naloxone, (20 mg i.v.) or placebo given in a double-blind manner 10 min before the end of the apomorphine infusion as a concealed bolus did not alter the effects of apomorphine. Vasopressin rise correlated significantly with nausea intensity. We conclude that acute opiate receptor blockade does not reverse most apomorphine effects.