The acute and chronic effects of intravitreal anti-vascular endothelial growth factor injections on intraocular pressure: A review

The acute and chronic effects of repeated intravitreal antivascular endothelial growth factor (VEGF) injections on intraocular pressure have not been fully characterized, and the development of sustained ocular hypertension could adversely affect patients who are at risk of glaucomatous optic neuropathy. As expected, volume-driven, acute ocular hypertension immediately follows intravitreal injection, but this pressure elevation is generally transient and well tolerated. Several medications have been investigated to limit acute ocular hypertension following anti-VEGF therapy, but the benefits of pretreatment are not conclusive. Chronic, sustained ocular hypertension, distinct from the short-term acute ocular hypertension after each injection, has also been associated with repeated intravitreal anti-VEGF injections. Risk factors for chronic ocular hypertension include the total number of injections, a greater frequency of injection, and preexisting glaucoma. Proposed mechanisms for chronic ocular hypertension include microparticle obstruction, toxic or inflammatory effects on trabecular meshwork, as well as alterations in outflow facility by anti-VEGF agents. Although limiting anti-VEGF therapy could minimize the risk of both acute and chronic ocular hypertension, foregoing anti-VEGF therapy risks progression of various macular diseases with resulting permanent central vision loss. While definitive evidence of damage to the retinal nerve fiber layer is lacking, patients receiving repeated injections should be monitored for ocular hypertension and patients in whom sustained ocular hypertension subsequently developed should be periodically monitored for glaucomatous changes with optic nerve optical coherence tomography and static visual fields.     

Atrial septal defect: A report of two cases in which there was recurrent laryngeal nerve paralysis

Two cases of atrial septal defect with the unusual complication of recurrent laryngeal nerve paralysis are presented. The necessity of exact diagnosis of congenital heart disease is stressed because both patients were erroneously suspected of having diseases which are amenable to surgical treatment, namely, patency of the ductus arteriousus in one instance, and substernal goiter in the other.     

Asymmetry of neuroleptic-induced rigidity: Development of quantitative methods and clinical correlates

Twenty-six medicated schizophrenic patients and 14 normal controls underwent laboratory assessment for the presence and asymmetry of neuroleptic- induced rigidity to evaluate the sensitivity, reliability, and validity of a quantitative procedure. Measures of muscle stiffness were made in the upper extremeties. Results indicated that 65% of the patients exhibited pathological rigidity. Moreover, 76% of these patients exhibited asymmetric rigidity, while the remaining 24% exhibited bilateral symptoms. Newly treated patients exhibited a greater laterality of rigidity toward the right side compared with patients who were on stable treatment regimens for at least 3 months. Since parkinsonism reflects dopamine receptor blockade by neuroleptic medication, probably in the striatum, we suggest that the lowered susceptibility of the right striatum to drug-induced parkinsonism supports the hypothesis that striatal dopaminergic activity may be asymmetric and more marked in the right striatum among recently treated patients.     

Second-trimester markers of fetal size in schizophrenia: a study of monozygotic twins.

OBJECTIVE: Since the second prenatal trimester is the critical period of massive neural cell migration to the cortex, and fingertip dermal cells migrate to form ridges during this same period, the authors sought to determine whether there are differences in fingertip ridge count in pairs of monozygotic twins discordant for schizophrenia, possibly indicating that a prenatal anatomical insult affected the twins differently. METHOD: The fingertip dermal ridges of 30 pairs of monozygotic twins (23 pairs in which the twins were discordant for schizophrenia and seven pairs in which both twins were normal) were counted by two persons trained in anthropometric research. Intrapair differences in the counts were then measured, and the differences among the pairs of normal twins were compared with the differences among the pairs discordant for schizophrenia. RESULTS: The twins discordant for schizophrenia had significantly greater absolute intrapair differences in total finger ridge count and significantly greater percent intrapair differences than the normal twins; i.e., their fingerprints were significantly less "twin-like." CONCLUSIONS: The study suggests that various second-trimester prenatal disturbances in the epigenesis of one twin in a pair discordant for schizophrenia may be related to the fact that only one of the twins expresses his or her genetic predisposition toward schizophrenia. This is consistent with a "two-strike" etiology of schizophrenia: a genetic diathesis plus a second-trimester environmental stressor.     

Erfahrungen mit Personal-Weiterbildung in Altersheimen

Zusammenfassung Die vorliegende Arbeit will dazu anregen, sich eines Teilgebietes der Sozialpsychiatrie anzunehmen, das zunehmend wichtiger wird: Der Personal-Weiterbildung. Eine 1980 durchgeführte Umfrage in den Alters- und Pflegeheimen der Psychiatrieregion Zürich Oberland ergab, dass von den 1507 Pensionären fast die Hälfte pflegebedürftig ist, rund ein Viertel an psychischen Störungen leidet. Da nur 12% der Angestellten eine abgeschlossene Ausbildung in Krankenpflege haben, häufen sich Überforderungsanzeichen und Personalwechsel. Dem zu begegnen, entwickelten wir 2 ausführlich dargestellte Weiterbildungsmodelle für das Personal: A. Patientenzentrierte Gruppengespräche und B. Weiterbildungsblock. Beide bezwecken, die berfliche Kompetenz der in den Heimen Tätigen zu verbessern, ihnen mehr Sicherheit und Gewandtheit im Umgang mit schwierigen Patienten zu vermitteln, so dass die Zufriedenheit bei der Arbeit wächst.Aus einer bei 77 Kursteilnehmerinnen durchgeführten Evaluation resultierte, dass sich ca. 2/3 diesen Zielen nähern oder sie bereits erreicht haben. Grossen Anklang fand das für alle Beteiligte weniger anspruchsvolle Modell B. Auch nicht so erfahrene Kursleiter erzielen damit gute Erfolge und können sich dosiert in die Supervision einarbeiten. Die Evaluation liess ferner einen Trend in Richtung eines Rückgangs an notwendigen psychiatrischen Hospitalisierungen von Pensionären und eine Minderung der Personalfluktuation erkennen.

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Experiences with personnel improvement training in old age and nursing homes

This paper concerns a proposal in an area of increasing importance to social psychiatry: improving personnel training. A survey in 1980 of old age and nursing homes in the psychiatric region of the Zurich Oberland showed that a quarter of the residents suffer from psychiatric disturbances. As only 12% of the personnel have completed any nursing training, the signs of overwork and the changes in personnel are many. Therefore we have developed 2 successful methods for personnel improvement: A) Patient-centered, ongoing training sessions, and B) Periodic intensive seminars. The goal of both is to increase the professional competence of those working in these homes; to give them skills and confidence to deal with sometimes difficult patients, and to increase the likelihood of their job loyalty. The evaluation shows a trend that such an approach helps to achieve these goals, to avoid unnecessary psychiatric hospitalizations as well as reduces the turnover of personnel.

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Experiences avec des cours de formation pour le personnel des maisons de repos

Résumé Ce travail veut inviter à s'occuper d'une section de la psychiatrie sociale devenue de plus en plus importante: les cours de formation complémentaire du personnel. Une enquête faite en 1980 parmis les faisons de repos au Zurich Oberland montrait que 1/4 des pensionnaires souffrait des troubles psychiatriques. Etant donné que seulement 12% du personnel a terminé une formation d'infirmier beaucoup entre eux sont débordés de travail et changent souvent leurs places d'emploi. Pour remédier à ce développement nous avons mis au point 2 modèles de formation du personnel présentés dans ce travail. Les 2 types de séminaires, l'un plus intensif que l'autre, ont comme but d'améliorer la compétence professionelle du personnel soignant. En leur procurant plus de sécurité et d'habilité dans leurs relations avec les malades difficiles augmente également la satisfaction avec le travail. Une évaluation parmis 77 participants montre que ces buts sont atteints et que les séminaires mènent à une diminution des hospitalisations psychiatriques et une diminution du mouvement du personnel.

     

The effects of anterior infarction complicated by bundle branch block upon the form of the QRS complex of the canine electrocardiogram

In dogs, myocardial infarcts induced by ligating the anterior descending coronary artery in its middle third do not usually modify the QRS complexes of the standard limb leads in a characteristic manner when bundle branch block is present.When such infarcts are complicated by right bundle branch block, the QRS complexes of unipolar leads from the right side of the precordium display a large, initial Q deflection, followed by an R wave which attains its summit late in the long QRS interval. The first component is due to potential variations transmitted from the epicardial surface of the infarcted region, and the second to potential variations transmitted from the epicardial surface of the free wall of the right ventricle. Leads from that part of the precordium overlying the infarct present large, broad QS deflections, often conspicuously slurred or notched.When left branch block is present, infarction of the kind in question does not give rise to characteristic changes in the QRS complexes of the precordial leads because the potential of the left ventricular cavity and, therefore, of the epicardial surface of the infarcted region is positive during the earliest part of the QRS interval. In direct leads from the epicardial surface of the infarct the QRS complex consists of an initial R deflection of variable size, followed by an S component of like or greater voltage. In the case of very large lesions, QRS complexes of this kind probably occur in leads from precordial points overlying the part of the left ventricular wall which is affected, but cannot be considered reliable evidence of infarction.