Neurochemical characterization of neuronal populations expressing protein kinase C gamma isoform in the spinal cord and gracile nucleus of the rat.

Protein kinase C gamma (PKCgamma) is widely distributed throughout the CNS and is thought to play a role in long term hyper-excitability in nociceptive neurones. Here, we provide the first report of PKCgamma cells in the dorsal column nuclei of the adult rat. Retrograde labeling of PKCgamma cells from the thalamus with choleragenoid revealed that 25% of the PKCgamma positive gracile cells projected to the thalamus. Further, we have characterized the distribution of PKCgamma within gracile nucleus in terms of colocalization with various neurotransmitter receptors or enzymes and calcium binding proteins, and compared this with PKCgamma colocalization in cells of laminae I-III of the spinal cord. We show that approximately 90% of the PKCgamma cells in the gracile nucleus and 60% in the dorsal horn were immuno-positive for the AMPA receptor subunit glutamate 2/3 (GluR2/3). Little coexpression was seen with neurokinin 1 receptor, nitric oxide synthase (NOS) and the AMPA receptor subunit GluR1, markers of distinct neuronal subpopulations. In the spinal cord, a quarter of PKCgamma cells expressed calbindin, but very few cells did so in the gracile nucleus. Electrical stimulation at c-fiber strength of the normal or injured sciatic nerve was used to induce c-fos as a marker of postsynaptic activation in the spinal cord and gracile nucleus. Quantitative analysis of the number of PKCgamma positive gracile cells that expressed also c-fos increased from none to 24% after injury, indicating an alteration in the sensory activation pattern in these neurones after injury. C-fos was not induced in inner lamina II following c-fiber electrical stimulation of the intact or axotomized sciatic nerve, indicating no such plasticity at the spinal cord level. As dorsal column nuclei cells may contribute to allodynia after peripheral nerve injury, pharmacological modulation of PKCgamma activity may therefore be a possible way to ameliorate neuropathic pain after peripheral nerve injury.

Prolonged profound abciximab associated immune thrombocytopenia complicated by transient multispecific platelet antibodies.

Patients receiving abciximab occasionally develop transient severe thrombocytopenia within a few hours of receiving the drug. Thrombocytopenia has been reported to resolve within 10 days of abciximab administration, but in this case profound thrombocytopenia lasted 21 days before a slow spontaneous recovery. Management was complicated by the presence of HLA antibodies and the transient production of antibodies directed at major platelet glycoproteins IIb/IIIa, Ib/IX, and Ia/IIa. The patient remained refractory to platelet transfusion and two courses of intravenous gammaglobulin for the duration of her admission.

Planning and conducting medical support to joint operations.

Operations are core business for all of us and the PJHQ medical cell is at the heart of this process. With the likelihood of a continuing UK presence in the Balkans for some time to come, the challenge of meeting this and any other new operational commitments will continue to demand a flexible and innovative approach from all concerned. These challenges together with the Joint and multinational aspects of the job make the PJHQ medical cell a demanding but rewarding place to work and provide a valuable Joint staff training opportunity for the RNMS.

Sun protection and younger children: lessons from the Living with Sunshine program.

Results are reported from a formative evaluation of Living With Sunshine, a teaching resource to help teachers encourage positive sun-related conduct by children ages six-eight. Results indicate children who used the materials were knowledgeable about the sun's effects and aware of various ways to protect themselves. On a set of four tasks designed to test knowledge, children who used the materials performed as well as or better than similar children who had not used the materials. Both teachers and students responded to the teaching resource with enthusiasm, and teachers were able to use it without special training. The evaluation also raised two general concerns about cancer education for young children. First, should teaching/learning activities avoid direct mention of cancer or should the activities be related directly to the threat of cancer? Second, should the locus of responsibility for sun protection habits rest primarily with children or with the adults and institutions responsible for the children?

High altitude headache: treatment with ibuprofen.

Up to half of those who ascend rapidly to altitudes of over 3,000 m may experience symptoms of acute mountain sickness (AMS) and of these some 95% may suffer from high altitude headache. We report the first controlled trial specifically to assess an oral drug therapy for this common symptom. Subjects were 21 members of mountaineering expeditions to similar altitudes in the Bolivian Andes and the Himalayas in Nepal. The study was of a randomized, placebo-controlled, double-blind, within-patient crossover design. Ibuprofen was significantly superior to placebo both in reducing headache severity and in speed of relief (a mean difference of 94 min in time to no/minimal headache). Only 14% of subjects who initially took ibuprofen felt the need for further medication compared to 83% of those who took placebo first (p = 0.02). Of the 11 subjects completing both phases of the crossover, 8 (73%) favored ibuprofen while the remainder had no preference (p = 0.004). No attributable adverse effects occurred. The results suggest that ibuprofen is a safe and effective treatment for high altitude headache.

Human retroviral infections in The Gambia: prevalence and clinical features.

The prevalence of infection with human immunodeficiency virus type 1 (HIV 1) is lower in west Africa than in other parts of Africa. Human immunodeficiency virus type 2 (HIV 2) has been isolated from west African patients and may be transmitted by heterosexual contact. The prevalence of antibodies to HIV 1 and HIV 2 was studied by enzyme linked immunosorbent assay (ELISA) among various groups of subjects in The Gambia, west Africa--namely, prostitutes, blood donors, patients with suspected infection with HIV, patients attending clinics for sexually transmitted diseases, and patients with tuberculosis. Four cases of the acquired immune deficiency syndrome (AIDS) due to infection with HIV 1 were detected, of which three had been acquired abroad. No other subject was found to be positive for antibodies to HIV 1. The prevalence of antibodies to HIV 2 among the patients attending clinics for sexually transmitted diseases was found to have increased from 0/117 in 1984 to 10/185 (5%) in the last six months of 1986. One out of 278 blood donors was positive for antibodies to HIV 2 as were 10 out of 80 patients with suspected AIDS. HIV 2 seems to be transmitted sexually, and, although it has been present for only a short time, it seems to be endemic in The Gambia and is pathogenic.

PIP: The prevalence of infection with human immunodeficiency virus type 1 (HIV 1) is lower in West Africa than in other parts of Africa. Human immunodeficiency virus type 2 (HIV 2) has been isolated from West African patients and may be transmitted by heterosexual contact. The prevalence of antibodies to HIV 1 and HIV 2 was studied by enzyme linked immunosorbent assay (ELISA) among various groups of subjects in The Gambia, West Africa. These subjects included prostitutes, blood donors, patients with suspected infection with HIV, patients attending clinics for sexually transmitted diseases, and patients with tuberculosis. 4 cases of the acquired immune deficiency syndrome (AIDS) due to infection with HIV 1 were detected, of which 3 had been acquired abroad. No other subject was found to be positive for antibodies to HIV 1. The prevalence of antibodies to HIV 2 among the patients attending clinics for sexually transmitted diseases was found to have increased from 0/117 in 1984 to 10/185 (5%) in the last 6 months of 1986. 1/278 blood donors was positive for antibodies to HIV 2 as were 10/80 patients with suspected AIDS. HIV 2 seems to be transmitted sexually, and, although it has been present for only a short time, it seems to be endemic in The Gambia and is pathogenic.

Leucocyte depleted blood.

Non-haemolytic febrile transfusion reactions (NHFTR) are commonly associated with the production of leucocyte antibodies, especially in multitransfused patients. These reactions can be prevented or ameliorated by the transfusion of leucocyte depleted red cells. Manual centrifugation techniques are least effective and risk the loss of excessive red cells. Saline washing can be effective, but is either tedious (manual techniques) or results in slight excess red cell losses (machine techniques). Sedimentation with high molecular weight polymers such as dextran produce excellent leucocyte depletion and small red cell losses. Filtration is both relatively straightforward and relatively cheap, and results in very effective red cell depletion with acceptable red cell losses. Microaggregate filtration is an alternative low cost bedside technique whose effectiveness does not depend entirely on maximum total leucocyte depletion. Freezing and thawing of red cells is very effective but is costly. Whatever technique is chosen, leucocyte depletion of at least 80% should be aimed for. The final choice however will depend on factors such as available facilities, experience and expense, and additional clinical factors such as the requirements for platelet depletion and plasma removal.

Leukocyte-depleted blood. A comparison of filtration techniques.

Febrile transfusion reactions due to leukoagglutinins are commonly seen in multitransfused patients. It has been suggested that reduction of the number of leukocytes per transfusion to 0.5 x 10(9) or less would prevent nonhemolytic febrile transfusion reactions in the majority of patients. Therefore, we have compared the ability of several filters to reduce the leukocyte content of stored whole blood drawn into citrate-phosphate-dextrose. The leukocyte absorption filters, Imugard IG500 and Erypur, produced 98.3 +/- 2.4 and 98.3 +/- 1.7 percent leukocyte depletion, respectively. The leukocyte adherence filter, Leuko-Pak, produced a depletion of 54.6 +/- 14.7 percent. The microaggregate filters, Biotest MF10B Microfiltration set, Ultipor Blood Transfusion Filter SQ40S, and Travenol 20 micron High Capacity Transfusion Filter, produced 37.5 +/- 10.8, 13.3 +/- 11.2, and 44.5 +/- 11.3 percent leukocyte depletion, respectively. It would appear that of the filters tested, the Imugard IG500 and the Erypur are the only filters which can invariably reduce the absolute number of leukocytes in a unit of stored whole blood to below 0.5 x 10(9).

Platelet activation during exercise-induced myocardial ischaemia.

Twenty-six normal subjects (aged 18-52) and eighteen patients with ischaemic heart disease (aged 36-67) underwent maximal 12 lead ECG treadmill exercise testing. Coronary angiography was performed on sixteen of the patients. In-vivo platelet activation was assessed by measuring plasma levels of the platelet specific protein beta-thromboglobulin (beta-tg). The mean beta-tg levels pre- and post-exercise in the normal subjects were 47 (SD: 42- 26-85) ng/ml and 48 (29-78) ng/ml respectively, and in the patient group 68 (43-107) ng/ml and 70 (45-109) ng/ml. There was a significant difference between the two groups at rest (p less than 0.05), but there was no change in either following exercise. Post exercise beta-tg levels showed no correlation with the degree of induced ischaemia as judged by ST segment depression and the number of leads involved. Resting beta-tg levels, however, were positively correlated with the presence and extent of angiographically demonstrable coronary disease (r = 0.53, p less than 0.05). We conclude that in vivo platelet activation is present at rest in patients with coronary artery disease, and whilst related to the presence and extent of such disease is unrelated to induced ischaemia.