Use of ECT to Treat Bipolar Depression in a Mental Retardate with Cerebral Palsy

We report the use of electroconvulsive therapy (ECT) for treatment of a bipolar episode in a mildly retarded young man with cerebral palsy. Difficulties in the diagnosis and treatment of affective disorders in the retarded are discussed.     

New instruments, bone liners, and tray for finger joint arthroplasty

Titanium circumferential grommets have been developed for finger joint arthroplasty that fit on the base of the silicone implant stems to protect the flexible hinge from tearing and fracture. To facilitate grommet insertion, new intramedullary bone rasps have been devised with a reverse cutting tooth pattern, an extended shaft for an improved view of the surgical field, and a redesigned cutting head to allow for grommet insertion. Surgical accessibility and ease of recognition have been facilitated by the development of color-coded sizers. All of the instruments necessary for finger joint surgery are available in a molded tray that has also been redesigned with a transparent lid and clearly labeled compartments for accurate determination of instruments and implant sizers.     

A randomized phase II trial of interferon-α2b versus 5-fluorouracil after trabeculectomy*

Purpose: The aim of the present study was to investigate the safety and potential efficacy of subconjunctival interferon-α2b (IFN-α), either alone or in combination with 5-fluorouracil (5-FU), in reducing the risk of failure of glaucoma surgery. Methods: A prospective, masked randomized phase II study was undertaken in which patients received three subconjunctival injections per week for 3–4 weeks postoperatively. Three treatments were compared: (i) IFN-α (1 × 10 ⁶ IU per dose); (ii) 5-FU (5 mg per dose); and (iii) alternating IFN-α and 5-FU (BOTH). The primary outcome measures were: (i) rate of successful control of intra-ocular pressure without further surgery; and (ii) the incidence of side effects. Results: Fifty-seven patients undergoing glaucoma surgery with an increased risk of failure were evaluated, including 23 patients (40%) undergoing trabeculectomy combined with extracapsular cataract extraction as well as other conventional high-risk groups. With 53 patients (93%) completing 2 years follow up, there was no significant difference in success rates among the three groups. Intra-ocular pressure was controlled without further surgery in 79% of patients (95% confidence interval (CI): 61, 97%) receiving IFN-α, in 89% of patients (76, 100%) receiving 5-FU and in 89% of patients (76, 100%) receiving BOTH. Side effects were similar among the three groups. Conclusions: These results are consistent with a beneficial effect of IFN-α2b given either alone or in combination with 5-FU after glaucoma filtering surgery. However, the lack of a clear and substantial benefit over conventional anti-fibrotic therapy does not support the further clinical evaluation of these treatments.     

Effects of intracameral Na2EDTA and EGTA on aqueous outflow routes in the monkey eye

Intracameral perfusion with 4 to 6 mM Na2EDTA or 4 mM EGTA for 40 to 80 min caused a very large increase in gross outflow facility. This effect was partly reversible when followed by perfusion with mock aqueous humor. Eyes perfused with Na2EDTA were studied morphologically. In the trabecular meshwork the cells separated due to a splitting of the cell junctions. A distention of the cribriform meshwork, a wash-out of extracellular material , and a disintegration of the denuded trabecular cores were also noticed. The inner wall of Schlemm's canal protruded in a "balloonlike" manner into the lumen of the canal and showed frank ruptures, especially after prolonged perfusion times. The conventional outflow pathways beyond Schlemm's canal showed no abnormalities. In the uveoscleral outflow routes the anterior and middle part of the ciliary muscle demonstrated very wide intermuscular clefts and many degenerated muscle fibers. The posterior third of the muscle was normal. So were the ciliary epithelium, the choroid, and the retina. The pupillary sphincter also showed degeneration. The corneal endothelial cells separated, starting at the apical junctional complex.     

Effects of Sex,Handedness, Stimulus and Visual Field on “Mental Rotation”

Shepard's mental rotation paradigm (e.g. Shepard and Metzler, 1971) was modified to allow tachistoscopic presentation of stimuli at varying angles of orientation (0° to 180°) in the right and left visual fields. Thirty male and thirty female subjects divided into three handedness groups (right-handers, non-familial and familial left-handers) judged whether a stimulus was a standard form or its mirror image. In general response times for correct judgements (RT_c) increased monotonically as a function of angle of orientation though the curves tended to be negatively accelerated rather than linear. Right-handers showed a slower rate of increase in RT_c as a function of angle than either left-handed group. Mean RT_c and the rate of increase in RT_c were equivalent for the two sexes and for the two visual fields. Both mean RT_cs and on the rate of increase in RT_c varied as a function of the stimulus.Error rates also increased monotonically as a function of angle of orientation. No sex or handedness differences in error rates were found. However, errors increased significantly less rapidly when stimuli were presented in the left visual field. It is argued that right hemisphere specialization for spatial processing minimizes the rate of increase in errors.The present failure to find sex differences may be of interest and it is argued that rapid presentation of stimuli results in subjects setting maximum and minimun response times. Within this relatively restricted “bandwith” of response times males and females may perform spatial tasks equally efficiently. Some confirmation for this hypothesis vs. an alternative based upon differences in hemispheric organization was found in a second experiment.     

Klinische und molekulargenetische Befunde bei Familien mit Cherubismus über 3 Generationen

Hintergrund  

Cherubismus ist eine seltene genetisch bedingte Erkrankung der Knochen, die fast ausschlie?lich den Ober- und Unterkiefer betrifft.     

Effects of vasoactive intestinal polypeptide (VIP) on intraocular pressure, facility of outflow and formation of aqueous humor in the monkey

Stimulation of the facial nerve causes a non-cholinergic vasodilation in the uvea and a rise in the intraocular pressure in rabbits, cats and monkeys. Vasoactive intestinal polypeptide (VIP) has been suggested as the neurotransmitter mediating these effects. In the present investigation, the effects of VIP on aqueous humor dynamics were studied in cynomolgus monkeys. After intracameral injection of 1 microgram VIP, the outflow facility was higher in the experimental eye than in the control; 0.42 +/- 0.46 compared with 0.33 +/- 0.03 microliter cm H20-1 min-1, difference 0.09 +/- 0.04 microliter cm H2O-1 min-1. Intravenous infusion of VIP, 160 ng min-1, increased aqueous humor flow from 1.12 +/- 0.07 to 1.65 +/- 0.09 microliter min-1. Almost the same effect, a 50% increase in aqueous humor flow, was found after intracameral administration of 90 micrograms VIP. This dose of VIP caused a significant increase in intraocular pressure (IOP) in the experimental eye. The maximal difference in IOP between the experimental eye and the control eye was 7.5 +/- 0.4 cm H2O. A lower dose of VIP, 30 micrograms intracamerally, increased aqueous humor flow by about 20%, but had no consistent effect on IOP. The effect of VIP on aqueous humor flow was not affected by pretreatment with indomethacin. The results suggest that most of the rise in IOP caused by intracameral VIP administration is due to a rise in the pressure in the veins into which the aqueous humor is drained. Enhanced formation of aqueous humor plays a smaller role. The effects of VIP on aqueous humor formation and outflow facility suggest that the facial nerve may be involved in nervous control of aqueous humor dynamics, as VIP is most probably released in the eye by stimulation of the facial nerve.     

BBC TELEVISION SERIES “Let's Go…”: — programmes for teaching the mentally handicapped

A series of 20 programmes designed specifically for the mentally handicapped will be screened by the BBC this Autumn. The following two contributions give an idea of the kind of background work that has taken place.