Simultaneously measured pupillary light reflex and heart rate variability in healthy children

We investigated the potential inter-relationship between two measures of autonomic nervous system: pupillary light reflex (PLR) and heart rate variability (HRV), in healthy children of 8-16 years old. PLR was measured at both dark- and light-adapted conditions with various stimulation intensities. Simultaneously measured HRV was obtained in five different PLR testing phases: before PLR test, light-adapted PLR test, dark adaptation, dark-adapted PLR test and after PLR test. The frequency domain HRV parameters measured during the PLR test were significantly different from those measured during rest. Both the regression analysis and factor analysis indicated that PLR and HRV parameters were not correlated, which suggests that they may provide complementary assessment of different aspects of the overall autonomic nervous system.     

Ultrasound assessment of extraocular movements and pupillary light reflex in ocular trauma

We present the case of a 26-year-old man with significant periorbital trauma after blunt head trauma. Ultrasound techniques for evaluation of extraocular movements and pupillary light reflex are described as a proposed adjunct to physical examination and manual retraction of the eyelids.     

Morphine-induced mydriasis and inhibition of pupillary light reflex and fluctuations in the cat

Morphine has species-characteristic effects on pupillary size The effects of morphine on pupillary size, fluctuations and the light reflex were tested with an infrared video pupillometer in the gallamine-paralyzed cat. Compared with saline or base-line responses, i.v. morphine (0.06-1.5 mg/kg) caused a dose-related decrease in the light reflex and fluctuations but increased pupil size. Naloxone (1-100 micrograms/kg i.v.), injected 1 h after morphine, reversed all pupillary effects. Levorphanol (0.5 mg/kg i.v.) had pupillary actions like those of morphine, but dextrophan (0.5 mg/kg i.v.) was inactive. Sympathectomy did not alter the morphine response. It was concluded that morphine disrupts parasympathetic innervation of the iris through interactions with opiate receptors, some of which are in the brain. The morphine-induced changes on the light reflex and fluctuations in the cat are opposite those reported in the rat and rabbit. These results enlarge on the familiar species-dependent effects of opiates on pupillary size.     

Reproducibility of the pupillary light reflex over short intervals in psychiatric patients and community volunteers

The pupillary light reflex (PLR) is a method for measuring dynamic responses within the autonomic nervous system, and would have potential value as a point-of-care test in a psychiatry clinic if reproducible results could be obtained in a short period of time. We collected PLR from adult community volunteers and depressed outpatients with the purpose of demonstrating (1) that valid data could be obtained >90% of the time from both the community volunteers and the patients, and (2) that reproducible results could be obtained with repeated measurement over short periods of time. Valid data were captured for 90.3% of 76 participants, allowing for two attempts of the PLR per participant. Success rates were similar for depressed patients and community volunteers. Eighteen of these 76 participants provided repeated paired measurements after 5 and 10 min of dark adaptation, producing high correlations for maximum constriction velocity (MCV) between assay 1 and 2 (Pearson's r = 0.71, p < 0.001), but there was a significant 8% increase in velocity for MCV between assay 1 and 2 (∆ = 0.34 ± 0.59 mm/s, p < 0.05). In contrast, PLR measurements were stable when tested in a separate cohort of 21 additional participants at 10 and 15 min of dark adaptation with an MCV Pearson's correlation of r = 0.84, p < 0.001, with a nonsignificant 1% difference between the two time points. These findings indicate an acceptable rate of collecting valid and reproducible PLR data when contrasting two measurements of PLR after 10 or 15 min of dark adaptation in depressed and suicidal patients.     

Aldose reductase inhibition ameliorates pupillary light reflex and F-wave latency in patients with mild diabetic neuropathy

OBJECTIVE--The present study was conducted to investigate the effect of an aldose reductase inhibitor, epalrestat, on autonomic and somatic neuropathy at an early stage in type 2 diabetic patients by assessing the pupillary light reflex and minimum latency of the F-wave. RESEARCH DESIGN AND METHODS--A total of 30 diabetic patients with subclinical or mild diabetic neuropathy were randomly allocated to a control group (n = 15) and epalrestat (150 mg/day) group (n = 15). After 24 weeks, the pupillary light reflex test, cardiovascular autonomic function tests, and nerve conduction study were performed. RESULTS--The beneficial effect of epalrestat on the pupillary light reflex was observed in the minimum diameter after light stimuli (P = 0.044), constriction ratio (P = 0.014), and maximum velocity of constriction (P = 0.008). Among cardiovascular autonomic nerve functions, the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing was significantly improved by epalrestat (P = 0.037). Minimum latencies of F-wave of median and tibial motor nerves were significantly shortened by epalrestat (P = 0.002 and P = 0.001, respectively); however, no significant effects were observed in motor or sensory nerve conduction velocity. CONCLUSIONS--These observations suggest that epalrestat may have therapeutic value at the early stage of diabetic neuropathy and that the pupillary light reflex and minimum latency of F-wave may be useful indicators of diabetic neuropathy.     

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Purpose

To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).

Methods

We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).

Results

At any time between day 1 and 3, an NPi?≤?2 (n?=?456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p? <?0.001 at day 1 and 2; p ?=?0.06 at day 3). The combination of NPi?≤?2 with bilaterally absent somatosensory evoked potentials (SSEP; n?=?188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].

Conclusions

Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.

     

The borderline personality

These individuals, who are often bright and verbal, present with intriguing physical and emotional symptoms. The pathology of the borderline personality begins at an early age with a failure to integrate a sense of self. Patients with this disorder have little sense of who they are or what they are feeling; anger is the one emotion felt consistently. Such patients may present with psychosomatic symptoms, brief psychotic episodes, depression or suicide attempts. Extended psychotherapy is generally required for enduring benefits.     

The Somogyi phenomenon in insulin-dependent diabetics

Insulin-dependent diabetics at times of changing stress levels require alterations in their insulin dosage. Determination of the required insulin dosage is not a precise science. At these times, the diabetic may experience insulin overdosage with a resulting rebounding hyperglycemia (Somogyi phenomenon). Adequate data collection and a systematic approach to documentation of the data by either the nurse or the patient will provide both the physician and the nurse with the means to recognize the occurrence of the Somogyi phenomenon. The author recommends a tool that can be used to enhance recognition of the occurrence and provide clinical criteria to evaluate its presence.     

The blink reflex in migraine

The blink reflex is an objective and useful method to study the trigeminal system. It was recorded in 43 migraine patients and the findings compared with those of 31 healthy controls. The latencies of the R1 component were in the normal range in both groups. The R2 latencies ranged between 30 and 32 ms in the control group. In contrast, more than half of the patients with migraine had R2 latencies between 32 and 35 ms in the migraine group. Some migraine patients had latencies above 35 ms. The R2 latency was statistically significantly different between controls and migraineurs (p < 0.0001). Our findings indicate that trigeminal afferents and/or polysynaptic pathway in brainstem may be altered in migraine.     

The different clinical variants of scleroderma in diabetics

The course of scleroderma is compared in patients with and without diabetes mellitus. In combined pathology, bullous foci of injury and trophic abnormalities occur more frequently. All the patients were diagnosed to have abnormalities on the part of connective tissue metabolism.     

The functional kidney reserves of diabetics

Ten patients with insulin-dependent diabetes mellitus not associated with any signs of diabetic nephropathy were examined for the reserves of filtration renal function and early morphological alterations in organ tissues. The reserves of filtration were detected under the conditions of acute oral administration of protein (1.5 g/kg) as difference between the initial and stimulated levels of glomerular filtration (GF). Two groups of patients were distinguished: group I included patients with preserved filtration reserves (increment of GF amounted to 35%), group II included patients with no filtration reserves (reduction of GF was 20%). Both the groups differed significantly only in the initial level of GF (120 and 209 ml/min, respectively) and in the degree of morphological changes in the glomeruli: group I manifested minimum structural changes, group II showed the commencing diabetic glomerulosclerosis characterized by pronounced injury to the manubrium of the glomeruli. Therefore, the lack of filtration reserves in diabetes mellitus patients suggests the presence of the commencing diabetic glomerulonephritis even with the lack of the clinical signs of renal injury, which does not require the resorting to organ biopsy. The primary injury to the manubrium of the glomeruli is likely to be related to a high gradient of intraglomerular hydrostatic pressure, resulting in hyperfiltration.     

糖尿病患者疾病知识掌握情况的调查分析

目的:了解糖尿病患者对糖尿病知识的掌握情况,以促进对患者实施糖尿病知识健康教育.方法:对128例糖尿病患者进行问卷调查与分析.结果:糖尿病患者教育后比教育前,有关糖尿病知识的掌握程度有明显提高.结论:对糖尿病患者进行健康教育,是治疗糖尿病的重要措施,应引起高度重视,且深入开展,以提高患者的生存质量,降低医疗费用.