To provide information for the formulation of treatment guidelines, we review recently published articles and abstracts on advances in the treatment of Chlamydia trachomatis genital infection. We ask specific questions about new treatments that are answered on the basis of the results of clinical trials and efficacy studies. New, potentially effective treatments for C. trachomatis genital infection include azithromycin and ofloxacin. Clinical studies indicate that the efficacy of these agents is equivalent to that of the current recommended agent doxycycline. Both azithromycin and ofloxacin are substantially more expensive than doxycycline. Azithromycin has the advantage of being given as a single dose, while doxycycline and ofloxacin are administered for 1 week. Issues of compliance, cost, and toxicity for specific patients should be considered when deciding whether to treat C. trachomatis genital infections with these agents.
A combined transganglionic transport and immunocytochemical technique was used to study the synaptic morphology of central carotid sinus afferents and substance P-immunoreactive neurons in the commissural subnucleus of the nucleus of the tractus solitarius in rats. A large population of substance P-immunoreactive neurons (88.32%) were seen in close association with central carotid sinus afferents by light microscopy. However, many labelled central carotid sinus afferents appeared not associated with substance P-immunoreactive neurons in the nucleus of the tractus solitarius. Substance P-immunoreactive neurons were spindle, pear, or oval-shaped with a short axis ranging from 5 to 11 microns. Their long axis was oriented predominantly in a lateral-medial direction along the path of the central carotid sinus afferents from the solitary tract to the midline. Synaptic contacts between central carotid sinus afferents and substance P-structures, including dendritic profiles of different calibers and somas, were readily found by electron microscopy. Many central carotid sinus afferents were also found in synaptic contact with non-immunoreactive dendrites and somas. Appositions between central carotid sinus afferents and unlabelled axon terminals were common, but only in a few cases were morphological manifestations of synapses revealed. In the latter, the substance P-immunoreactive terminals appeared mostly presynaptic but postsynaptic ones were also encountered. Our data provide the evidence that some of the substance P-immunoreactive cells in the nucleus of the tractus solitarius are 2nd order neurons of the carotid sinus afferent pathway. The possibility that some of the substance P-immunoreactive neurons in the nucleus of the tractus solitarius may be interneurons and mediate carotid sinus afferent inputs to catecholaminergic neurons in the nucleus of the tractus solitarius is considered. Our findings also provide an anatomical substrate for a possible presynaptic modulatory role of central carotid sinus afferents on the inputs from other brain centers to the substance P-neurons in the nucleus of the tractus solitarius.
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