Melatonin treatment of non-epileptic myoclonus in children

Oral melatonin (MLT) has been used by our Vancouver research group in the treatment of paediatric sleep disorders since 1991; slightly over 200 children, mainly with multiple disabilities, who frequently had seizures, have been treated. Three children with markedly delayed sleep onset due to recurring myoclonus were also referred for MLT treatment: two had non-epileptic, and one had epileptic and non-epileptic myoclonus. Low doses of oral MLT (3 to 5 mg) unexpectedly abolished their myoclonus and allowed them to sleep. There were no adverse effects. It appears that certain types of myoclonus, which might be resistant to conventional anticonvulsant medications, may respond to MLT but the mechanism of action is unclear. Further research on this novel treatment is urgently needed.     

Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy

Background: Haemophilus aphrophilus is a rare cause of ocular infection. It has been reported once as a cause of late-onset endophthalmitis in a patient with an inadvertent bleb after cataract surgery. We present a case of Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy.
Methods: A 56-year-old woman presented with a bleb infection 10 weeks after a mitomycin C augmented trabeculectomy at a University tertiary referral practice of one of the authors (GET). The causative organism was Haemophilus aphrophilus , identified by the Toronto Public Health Laboratory, Ontario, Canada.
Results: The bleb infection resolved following topical, subconjunctival and intravenous antibiotic therapy. A formal bleb revision was required to repair a persistent bleb leak.
Conclusion: Patients who have had trabeculectomies augmented with mitomycin C may be predisposed to bleb infection with unusual organisms. Prompt diagnosis and treatment is necessary to control the infection. Increased awareness and communication with laboratory personnel may increase the isolation of this fastidious organism.     

Crohn's disease of the stomach a case report and review of the literature

Conclusions Crohn's disease of the stomach is a rare but well-established clinical and pathologic entity. It is not justifiable to assume that isolated granulomatous gastritis is Crohn's disease, although this has been reported as its first manifestation (6, 9). In the stomach the antrum is most commonly involved, and narrowing, rigidity, alteration of mucosal pattern, ulceration, and striking hypomotility are the usual radiologic features. Duodenal involvement is a frequent concomitant. When combined with the typical ileal or colonic lesion, a presumptive clinical diagnosis on the basis of radiologic findings can be made with confidence. Occasionally, as in our patient, the diagnosis can be confirmed histologically by endoscopic biopsy. On the basis of short-term followup, gastric involvement does not appear to portend an unusually bad prognosis. Surgical intervention is recommended only for complications such as perforation or gastric outlet obstruction.     

Tuberculosis in Canadian Eskimos

The tuberculosis rates among Canadian Eskimos are among the highest in the world, in the period 1967 to 1969, the average annual incidence was 131 cases per 10,000 while the corresponding rate for all Canadians was just over 2 per 10,000. The rates are highest in eastern Arctic where the peak incidence occurs in young women and reaches almost 4% per annum. The risk of developing tuberculosis is very high in all epidemiological groups such as inactive cases, positive tuberculin reactors with normal chest x-ray film, and even BCG-vaccinated individuals.     

Who is a visually impaired child?

Until the late 1700s, the eyes were thought to be the organs of sight while the visual function of the brain remained unclear. Just over a century ago a German professor of physiology, Hermann Munk, argued against scientific community scepticism that because blindness could be caused by damage to the occipital lobes, these anatomical areas must have an important function in vision¹. During the Russo–Japanese war of 1904–5, Tatsuji Inouye, a Japanese physician and pioneer vision researcher, began to correlate the visual difficulties of soldiers with their head wounds, thereby increasing our understanding of the role of the brain in vision.     

Prediction of left ventricular pressure from the vectorcardiogram in transposition of the great arteries

Eighty-two cardiac catheterizations were performed in 72 children with complete transposition of the great arteries; vectorcardiograms (Frank lead) and orthogonal electrocardiograms were obtained in all cases within 24 hours. Fifty-six of these studies were performed in children with an additional ventricular septal defect, and 26 in children with an intact ventricular septum. There was a significant correlation between the ratio of the right and left maximal spatial vectors and the S/R ratio in lead X of the orthogonal lead electrocardiogram. A clockwise loop in the horizontal vector or an S/R ratio of more than 2:1 suggested decreased left ventricular pressure, whereas a counterclockwise or figure-of-8 loop in the horizontal plane or an S/R ratio of less than 2:1 in lead X of the orthogonal electrocardiogram suggested increased left ventricular pressure. Nineteen additional patients with transposition of the great arteries were studied in the same way. With use of the direction of rotation of the horizontal loop and the S/R ratio in lead X, left ventricular pressure was correctly predicted in 84 percent of cases.

After cardiac catheterization has established the diagnosis of transposition of great arteries, repeat vectorcardiograms should be obtained to determine left ventricular pressure. In a patient with initially decreased left ventricular pressure, change to a figure-of-8 or counterclockwise loop or the presence of an S/R ratio in lead X of less than 2.0 suggests the development of a systemic level of left ventricular pressure. This finding is an indication for repeat catheterization.