Treatment of pigment epithelial detachments due to age-related macular degeneration with intra-ocular C3F8 injection*

Purpose: To flatten pigment epithelial detachments (PED) cue to age-related macular degeneration in an attempt to visualize the underlying choroidal neovascularization by fluorescein angiography (FA) and reveal a treatment target. Methods: Nine patients with PED received intravitreal gas injections via the pars plana and postured face down. Fluorescein angiograms were obtained before and after gas injection. In two patients, retinal scotopic sensitivity was also measured. Results: Eight patients demonstrated change in the shape and size of the PED following gas injection. Four patients showed a better delineation of underlying structures on FA. Three patients had focal laser treatment to the newly visible choroidal neovascular complex, but this was successful in only one patient with flattening of the PED. Conclusion: Pigment epithelial detachments can be modified by intravitreal gas injection in some patients, but this treatment did not have a major impact on overall outcome or management.     

Community support services and functioning of the seriously mentally ill

A cohort of 729 chronically mentally ill patients receiving community support services (CSS) were followed over a nine-month period. Receiving needed community support services was shown to predict change in client functioning as measured by the Global Assessment Scale (GAS) even after the initial values on the GAS, as well as demographic, psychiatric, residential and medication maintenance variables were considered. Adequacy of social support from family, friends and others also contributed to predicting change in global functioning of the CSS patients.Johns Hopkins UniversityPresented at the American Psychological Association Annual Meeting, Washington, D.C., August 16, 1992.     

Abnormalities of somatosensory evoked potentials in the quinolinic acid model of Huntington's disease: evidence that basal ganglia modulate sensory cortical input.

Intrastriatal injection of quinolinic acid (QA) in rats provides an animal model that mimics some of the neuropathological and neurochemical alterations observed in the striatum of patients with Huntington's disease (HD). One of the very early neurophysiological signs in HD is a diminution of amplitude of early somatosensory evoked potentials (SEPs) recorded over the parietal cortex. The present study investigated whether the QA model exhibits similar neurophysiological abnormalities. Two weeks after unilateral intrastriatal injection of QA (240 nmol) or of the solvent, early SEPs were recorded with chronically implanted electrodes from the somatosensory cortex or from the ventrobasal nucleus of the thalamus of lightly pentobarbital-anesthetized rats, in response to single-shock electrical stimulation of the contralateral forepaw. Whereas intrastriatal injection of solvent did not influence SEPs, the striatal QA lesion significantly reduced the amplitude of early cortical SEPs by about 40% without affecting the latency. SEPs recorded from the ventrobasal nucleus were unchanged after QA lesion. Histological examination and glial fibrillary acid protein staining after intrastriatal injection of QA revealed no evidence for damage in the somatosensory system. It is concluded that (1) the QA animal model of HD mimics some of the SEP abnormalities of patients, and (2) a striatal lesion modulates somatosensory transmission to the cortex in rats.     

Segmental Uterine Horn Replacement in the Rat Using a Biodegradable Microporous Synthetic Tube

To investigate the possible use of a biodegradable microporous synthetic tube for fallopian tube replacement, polyetherurethane/poly-L-lactide (PU/PLLA) grafts in the uterine horn of the rat were studied and their patency and healing characteristics compared with those of nonbiodegradable polytetrafluoroethylene (PTFE; Teflon) grafts as well as with those of reanastomosed uterine horns. Regarding the healing characteristics, the PU/PLLA grafts were superior to the PTFE graft, as was indicated by the regeneration of endometrium and the extensive perigraft tissue ingrowth. However, the graft/uterine anastomoses of the PU/PLLA and PTFE grafts became obstructed by a plug of mucosal folds, all reanastomosed, uterine horns in the control experiments remaining open. In conclusion, although biodegradable microporous PU/PLLA uterine horn grafts have better healing characteristics than PTFE grafts, they easily obstruct at the graft/uterine junction. Mucosal suturing and/or the use of splints may contribute to the feasibility of biodegradable microporous artificial fallopian tubes in tubal surgery.     

Reversible reorganisation of the motor cortical representation of the hand in cervical dystonia.

Previous work has suggested that there may be a widespread disturbance of motor control mechanisms in patients with cervical dystonia. In the present study, we used transcranial magnetic stimulation to investigate the topography of the corticomotor projection to the abductor pollicis brevis (APB) muscle in 10 subjects with idiopathic torticollis. Threshold-adjusted stimuli were delivered at multiple scalp sites during a low-level voluntary contraction of the APB, and maps were generated of motor evoked potential amplitude versus scalp site. The cortical maps for the APB on the side opposite to the direction of head rotation were displaced laterally or posteriorly in all subjects and reverted to a more normal position after botulinum toxin injection of the cervical muscles in 5 subjects. The findings point to a reversible reorganisation of the corticomotor representation of the hand on the same side as the sternocleidomastoid (SCM) muscle that is involved in producing the dystonia. These results provide further evidence for the involvement of cortical centres and for a more widespread abnormality of motor control mechanisms in focal dystonia. The findings also support the notion that head turning is chiefly mediated by the hemisphere ipsilateral to the direction of the head rotation by means of a corticomotor projection to the contralateral SCM.