Volume 92, Issue 10

Over the past 3 years, there has been great interest in transplantation therapy in the treatment of Parkinson's disease. Following the impressive results reported by Madrazo in the spring of 1987, more than 350 cases of adrenal medullary implantation have been performed worldwide. There has been a significant reduction in "off" time and an increase in "on" time without chorea in 40% of patients having this procedure. The duration of effect is 1 year in half of these cases, with the other half (20% of all patients) still demonstrating significant improvement 3 years after the procedure. The mechanism of the bilateral beneficial improvement is unknown. The survival of adrenal medullary tissue has not been demonstrated at autopsy. It is thought that the mechanism of improvement involves either regenerative sprouting of the remaining dopamine producing neurons as a consequence of the release of neurotrophic factors or an interruption of the striatal pallidal output inhibitory influence of the basal ganglia on the thalamus (or both). Fetal mesencephalic implantation has also been attempted in more than 100 cases worldwide. The improvements when seen are not any more dramatic than those following the best results of adrenal medullary implantation. Graft survival has not been proved; it remains a possibility that interruption of the putaminosubthalamic pallidal pathway or a trophic influence of the tissue provides an alleviation in parkinsonism. The ethical controversy, need for long-term immunosuppression, and difficulty with obtaining tissue of the appropriate age and delivering the appropriate quantity to the putamen have made this technique less than adequate. Newer techniques employing genetic engineering, cultures of adrenal medullary tissue, and encapsulated xenografts are being investigated.

Excellent diagnostic images of the liver can now be obtained with magnetic resonance imaging (MRI) because of new imaging techniques. The flow void phenomenon allows excellent anatomic detail of the liver. Morphologic features, comparson of tumor signal to normal parenchymal signal, and tumor behavior in various pulse sequences help to define liver tumors. The MRI characteristics of primary hepatomas, cavernous hemangiomas, hepatic cysts, liver adenomas, and focal nodular hyperplasia are among the hepatic lesions described. In most instances, MRI helps in differential considerations and in some cases will provide a specific diagnosis.

This monthly series was developed from the AOA Task Force on AIDS Writers' Workshop, held August 16 to 18, 1991, in New York. The workshop was sponsored by an education grant from Burroughs Wellcome. It will provide brief clinical updates and perspectives on the human immunodeficiency virus (HIV). Readers may request tear sheets from the AOA editorial offices.

The need to attract students to-and keep them in-osteopathic internship and residency programs is great. Recognizing this fact, the osteopathic hospitals, through the American Osteopathic Hospital Association, have placed a renewed focus on liaisons with osteopathic medical education. Voices From the Future represents one such effort. This report reveals how osteopathic medical students, interns, and residents perceive the current state of osteopathic graduate medical education programs as well as the changes that they would like to see incorporated.

The case of Guillain-Barre syndrome (acute inflammatory polyradiculoneuritis) in pregnancy reported here brings the total reported number to 35. The patient had plasmapheresis with no maternal or fetal complications. She did not require mechanical ventilation. This is only the fifth reported case of Guillain-Barre syndrome in the gravid patient involving plasmapheresis. There have been no controlled studies assessing the safety of plasmapheresis in the pregnant patient with the disorder. The possible'risks ofthe procedure need to be weighed against the high maternal mortality rate in such a patient.