AMBLYOPIA IN THE FOUR TO NINE YEAR AGE GROUP. A FOUR-YEAR SURVEY

A guide to the ophthalmologist in the choice of the older child with amblyopia most likely to respond to active intensive visual stimulation in short bursts is presented. A series of 99 children treated on a CAM vision-stimulator is described. Visual improvement of at least two rows of letters on the Snellen chart was maintained for at least three years after treatment in 62% of these patients aged between five and nine years with visual fixation within 3^° of the fovea. Amblyopia following minor trauma or minor pathology also responded well. Children maintaining the visual improvement were those with esophoria up to 13^°. those with hypermetropia up to 11.0 D and those with astigmatism of 1.5 D. Also responding well were children with anisometropia with up to 3.0 D of either hypermetropia or astigmatism     

RETINOBLASTOMA IN THE ANTERIOR CHAMBER OF THE EYE

An uncommon presentation of retinoblastoma in an eleven-year-old boy is discussed. There was no family history of retinoblastoma and the child had never complained of a sore eye. He was not aware that he could not see out of his right eye.     

The Effect of Biphasic Waveform Tilt in Transvenous Atrial Defibrillation

Atrial defibrillation can be accomplished using low energy shocks and transvenous catheters. The biphasic waveform tilt required to achieve optimal atrial defibrillation thresholds (ADFTs) is, however, not known. The effect of single capacitor biphasic waveform tilt modification on ADFT was assessed in 20 patients. Following AF induction the defibrillation pulses were delivered between the catheters positioned in the coronary sinus and the right atrium.
The single capacitor biphasic waveform shocks, delivered over the same pathways, consisted of 65% tilt (65/65 biphasic waveform) to produce an overall tilt of 88%, or 50% tilt (50/50 biphasic waveform) to produce an overall tilt of 75%. Although 65/65 biphasic waveform delivers more energy, the shorter duration 50/50 biphasic waveform reduced stored energy ADFT 21%, from 1.34 ± 0.82 J with 65/65 biphasic to 2.06 ± 0.81 J. These differences were not statistically significant. Nine patients had lower ADFT with 50/50 biphasic waveform while five patients had lower ADFT with 65/65 biphasic waveform. Equivalent reduction in ADFT was seen in the remaining six patients. The ADFT was 0.83 ± 0.65 J when both tilts were considered. In conclusion, biphasic waveform tilt modification may affect the ADFT in an individual patient. The optimal biphasic waveform for ADFT is not known.     

The Action of 1,2,3,5,6,11b-Hexahydro-[1]benzothieno [3,2-g]indolizine Hydrochloride (ADT 16) on Peripheral and Central Responses Mediated by 5-Hydroxytryptaminergic and Adrenergic Systems of the Rat

Abstract— Some acute pharmacological effects have been examined of racemic ADT 16 (1,2,3,5,6,11b-hexahydro[1]benzothieno[3,2-g]indolizine hydrochloride), on peripheral and central responses mediated by 5-HT and adrenergic systems in the rat. In-vitro, ADT 16(10–1000 Nm ), similarly to mianserin, antagonized the inhibitory responses to B-HT 920 of the electrically-stimulated rat isolated prostatic vas deferens. High concentrations of ADT 16 (10 μm ), also resembled those of mianserin by potentiating twitch responses to electrical stimulation of the tissue. Contractile responses to phenylephrine of rat isolated epididymal vas deferens were antagonized by ADT 16 (0·3–1 μm ). In the rat stomach fundus strip, ADT 16 (1–3 μm ) antagonized contractions due to 5-HT. ADT 16 (0·1–1 μm ) had no effect on responses to acetylcholine of the guinea-pig isolated ileum. In-vivo, in spinalized, decerebrated rats, fenfluramine- or clonidine-induced facilitation of flexor reflex activity of the anterior tibialis muscle was attenuated by ADT 16 (3 and 10 mg kg^?1, i.v., and 3 mg kg^?1, i.v. respectively). In the anaesthetized rat, l -3,4-dihydroxyphenylalanine (l -dopa)- or l -5-hydroxytryptophan (l -5-HTP)-induced increases in the frequency of spontaneous twitches of the anterior digastricus muscle were attenuated by ADT 16 (1 and 3 mg kg^?1, i.v.; n = 4). It is concluded that ADT 16, similarly to mianserin, is a novel peripherally and centrally active antagonist of 5-HT and adrenergic responses in the rat.     

Long-acting injectable bromocriptine does not reduce relapse in alcoholics

Abstract Dopamine is one of several neurotransmitters that may mediate alcohol intake and dependence. A randomized, double-blind, placebo-controlled international, multicentre study was conducted to assess the effects of a long-acting injectable preparation of bromocriptine, a dopamine agonist, (Parlodel-LAR ) in reducing relapse in 366 moderately/severely dependent alcoholics (DSM-III-R), drinking approximately 200 g alcohol (14.5 standard drinks) per day. After detoxification they were randomized to receive six monthly injections of bromocriptine 25 mg ( n= 120), bromocriptine 50 mg ( n= 124), or placebo ( n= 122). Brief psychosocial treatment was allowed. At 6 months there were no significant differences between treatment groups in rates of relapse to any drinking or to drinking 5 days per month and 3 drinks per day. Pre-treatment alcohol intake did not determine response. Efficacy ratings by subjects and investigators and adverse events, reported by 51% of subjects, did not differ between treatments. The results of this large study, in which compliance was enhanced by Parlodel-LAR , do not indicate that bromocriptine is efficacious in the maintenance of abstinence or reduced drinking. Possible reasons for the discrepancy between these conclusions and those of some previous clinical trials, in which bromocriptine was reported to reduce symptoms of alcohol withdrawal and dependence, are discussed.     

OCULAR LEUKAEMIA IN ACUTE LYMPHOBLASTIC LEUKAEMIA OF CHILDHOOD

Abstract Modern cytotoxic drugs increase the survival rate of children with Acute Lymphoblastic Leukaemia (ALL): But the eye is a pharmacological sanctuary and after clinical “cure” of the haematological disease the child may be blinded by leukaemic ocular infiltration. Should this prophylactic irradiation of the posterior segment of the eye and optic nerve be repeated on diagnosis of CNS leukaemia and at specified intervals thereafter with recurrence of CNS leukaemia? This is the history of a child who had had no recurrence of haematological leukaemia for four and a half years but following remission developed central nervous system (CNS) leukaemia followed by leukaemic iridocyclitis in the right eye after 20 months and in the left eye after three years three months from the initial diagnosis of ALL Prophylactic cranial irradiation is performed on initial haematological diagnosis of ALL This includes prophylactic irradiation of the posterior segment of the eye and optic nerve.