NEUROVISUAL ADAPTATIONS TO SUBNORMAL VISION IN CHILDREN

Neurovisual adaptations to subnormal vision in children are of practical importance and need to be remembered in the management of children with low vision The physiological adaptations discussed include shortening the focal distance, abnormal head positions, compensatory head movements, and ocular motor search strategies In addition the concept of neural plasticity, particularly in respect to the ability of the extrageniculate striaete system to assume primary visual function in cortically damaged children is discussed.     

Identification of predictors of post-ictal delirium after electroconvulsive therapy

Aim:  Although electroconvulsive therapy (ECT) often causes post-ictal delirium (PID), to date, the specific risk factors of PID have not been described. The purpose of the present study was therefore to elucidate the predictors of PID via identification of the characteristics of patients with PID.
Methods:  ECT was conducted in 50 patients and all patients underwent more than four sessions. A sine wave or a brief-pulse square wave ECT instrument was used. After convulsions the patients' PID was monitored for 30 min. The patients were allocated into four groups based on PID severity (none, mild, moderate or severe PID). Variables, including age, gender, duration of illness, diagnosis, clinical features (psychotic or catatonic features) and stimulus waveform (sine or brief pulse square waveform), were analyzed.
Results:  Moderate to severe PID developed during the ECT sessions in 18 patients (36%). Most patients with severe delirium were successfully treated with i.v. bolus of propofol (1–2 mg/kg). Although the incidence of PID was 24% in patients without catatonic features, the incidence in patients with catatonic features was extremely high (88%; P  < 0.001). Multiple regression analyses showed that the severity of PID correlated significantly with the presence of catatonic features (β = 0.428, P  < 0.01).
Conclusion:  The presence of catatonic features before ECT is a predictor of PID. Propofol is useful for the treatment of PID.     

Positron emission tomography/computed tomography introduction in the clinical management of patients with suspected recurrence of ovarian cancer: a cost-effectiveness analysis

Aim of this study was to evaluate the economic impact of the introduction of positron emission tomography/computed tomography (PET/CT) in the early detection of recurrent ovarian cancer through a cost-effectiveness analysis of different diagnostic strategies. Thirty-two consecutive patients with suspected ovarian cancer recurrence, studied by both contrast enhanced abdominal CT and PET/CT, were retrospectively included in the study. Three different diagnostic strategies were evaluated and compared: (1) CT only or baseline strategy; (2) PET/CT for negative CT or strategy A; (3) PET/CT for All or strategy B. For each one, expected costs, avoided surgery and incremental cost-effectiveness ratio (ICER) were calculated to identify the most cost-effective strategy. The number of positive patients increased from baseline strategy (20/32) to strategy A and B (30/32 and 29/32 respectively). Positron emission tomography/computed tomography reoriented physician choice in 31% and 62% of patients (strategies A and B respectively). Strategy A is dominated by strategy B, which is more expensive (2909€ vs. 2958€), but also more effective (3 cases of surgery avoided) and presents an ICER of 226.77€ per surgery avoided (range: 49.50–433.00€). Positron emission tomography/computed tomography introduction in this population is cost-effective and allowed to redirect the clinical management of patients towards more appropriate therapeutic choices.