Recent Publications by CFE Educators

This study addressed the possible coexistence of products of the proenkephalin and prodynorphin opioid peptide precursors in single neurons of the central nervous system of the rat. Antisera directed against met-enkephalin-arg-gly-leu and against Dyn B were used in immunohistochemical preparations of sections through the rat medulla. Examination of serial three micron frozen sections stained alternately with the two different antisera revealed that the majority of labelled neurons stain with only one of the two antisera. In specific area, however, immunoreactive m-enk and Dyn B could be detected in the same neuron. This was particularly true of the caudal ventrolateral nucleus of the solitary tract, where the two peptides were colocalized in most neurons. Other areas where the two peptides coexist include the midline raphe and the nucleus reticularis paragigantocellularis. These data provide the first evidence for colocalization of different opioid peptide families in single CNS neurons.

Using personality style preferences as the basis for faculty development workshops, physician educators in several departments of obstetrics and gynecology learned how to use these differences to enhance clinical teaching. Data from five workshops are analyzed to determine the predominant personality styles of 184 department chairmen, faculty, and residents in obstetrics and gynecology. Chairmen had a stronger preference for taking charge than faculty or residents. As a whole, all preferred use of logic and action in pursuit of excellence. These findings are discussed in relation to student ratings of faculty clinical teaching and to faculty development.

Affinity-purified goat anti-rabbit immunoglobulin G (GAR) was conjugated with (3H)-propionyl succinimidate and used to localize substance P (SP), enkephalin (ENK), and serotonin immunoreactive sites in the spinal dorsal horn and medulla of the rat and cat. Autoradiographic localization was demonstrated on paraffin, frozen, Vibratome, and 2 micron plastic sections. The latter were obtained from radiolabeled Vibratome sections that were embedded in epoxy resin. The distribution of SP, ENK, and serotonin demonstrated by radioimmunocytochemistry was comparable to that observed on semiadjacent sections using peroxidase-antiperoxidase (PAP) immunocytochemistry. The autoradiograms, however, were generated using primary antibody concentrations up to five times more dilute than concentrations used for the PAP procedure. Indirect radioimmunocytochemistry using a (3H) anti-immunoglobulin G second antibody can be used to localize a variety of monoclonal and polyclonal antisera. It is quantifiable at the light microscopic level and can be potentially used with peroxidase histochemistry to double label immunoreactive structures at the ultrastructural level.

Doctors are encouraged to look upon each patient as a learning experience ( Wyngaarden , 1979). Case-oriented learning begins in the clinical years of medical school and continues throughout the professional career of the doctor. Clinical cases, or anecdotes, have the potential of producing accurate, relevant and meaningful learning for the clinician even though they are uncontrolled in a scientific sense. However, unusual or atypical cases can also result in erroneous learning which can negatively affect patient care. The purpose of this article is to identify difficulties in this form of subjective learning which can lead to suboptimal doctor practice patterns. Six actual clinical cases are briefly described to illustrate how inaccurate learning distorted subsequent clinical problem-solving by doctors. Suggestions are then made for ameliorating this difficulty.

Through combined ultrastructural localization of ENK immunoreactivity and [3H]5-HT uptake sites, it was found that 5-HT radiolabeled axons contact ENK immunoreactive cell bodies and small dendrites in the cat superficial dorsal horn. While some contacts displayed both pre- and postsynaptic specializations, the majority lacked a definitive synaptic cleft and postsynaptic density. These results suggest that 5-HT-containing axons, presumably derived from the medullary nucleus raphe magnus, directly influence spinal opiod antinociceptive activity.

A patient with Waldenström's macroglobulinemia who presented with pleuropulmonary manifestations is described. The course was complicated by recurrent Streptococcus pneumoniae infections despite pneumococcal immunization.

Although the midbrain periaqueductal gray (PAG) is thought to have a major role in an endorphin-mediated analgesia system, little is known about its neuroanatomical organization. To determine the microcircuitry within the PAG through which exogenous and endogenous opiates may act, we analyzed the synaptic organization of normal and immunoreactive enkephalin (ENK)-labeled profiles in the caudal PAG, a region of particular interest because of its effectiveness in generating analgesia. Examination of the normal fine structure of this region demonstrated that there is no characteristic synaptic morphology that distinguishes individual regions of the caudal PAG (ventromedial, ventrolateral and dorsolateral) from one another. In all 3 regions of the caudal PAG, axodendritic synapses are the predominant form of synaptic interaction making up 93-97% of all synapses counted. Axosomatic synapses are much less common, as are presumed axoaxonic and dendrodendritic synapses. In the caudal ventral PAG, the largest population of ENK-labeled axonal boutons are found presynaptic to unlabeled, centrally placed dendrites. Much less frequently, immunoreactive ENK-containing boutons are found presynaptic to neuronal perikarya or vesicle-containing profiles. Thus, these results suggest that the dendrites of neurons intrinsic to the PAG are the most probable site of opiate action in the caudal ventral PAG.

Eighteen patients with lupus erythematosus (LE) and pleural effusions were evaluated. Fourteen patients had lupus pleuritis and four had pleural effusions of other etiologies. All patients were symptomatic, and the presenting signs and symptoms did not help distinguish between lupus pleuritis and pleural effusions of other causes. The presence of LE cells confirmed the diagnosis of lupus pleuritis in seven of eight patients. In 11 of 13 patients with lupus pleuritis, the pleural fluid antinuclear antibody (ANA) titer was greater than or equal to 1:160, and in nine of 13 patients with lupus pleuritis, the pleural fluid to serum (PF/S) ANA ratio was greater than or equal to 1. In the four patients with LE and a pleural effusion of another etiology, the pleural fluid ANA titer was negative in two and low titer in two (1:40, 1:80); the pleural fluid to serum ANA titer was always less than one. Of 67 patients with pleural effusions of other etiologies, the pleural fluid ANA was negative. The signs and symptoms of lupus pleuritis are nonspecific, however; the findings of LE cells in pleural fluid confirms the diagnosis and a high pleural fluid ANA titer (greater than or equal to 1:160) and a PF/S ANA ratio of greater than or equal to 1 strongly supports the diagnosis.

The component parts and development of a comprehensive system to evaluate and improve teaching in a school of medicine are described by the author in this paper. This system integrates quantitative measures of teaching (student/resident ratings of classroom and clinical teaching), descriptive documentation (faculty teaching load, innovations, and research on teaching), and qualitative judgments (peer review) on the full spectrum of instruction in medicine. Medical school policies have standardized evaluation criteria, instrumentation, and procedures while granting departments flexibility in conducting peer review. The results of two studies indicate that the evaluation system described here has had a positive impact both on the improvement of teaching and on academic promotions.