Disordered respiration in dystrophia myotonica

The purpose of this investigation is to endeavour to find an explanation for the high morbidity and mortality that occurs in patients suffering from dystrophia myotonica, in relation to anaesthesia, and to ascertain whether there exists a specific hyper- sensitivity to thiopentone.The natural history of the disease is reviewed in some detail, surveying many of its features, including the muscular wasting and myotonia, which might well affect the muscles of respiration.10 cases of the disease and a series of controls are investigated.Some tests of lung function are performed, and the effects of thiopentone on respiration are studied under various conditions. The earlier experiments make use of a simple recording spirometer for studying the possible respiratory depressant effects of the drug on ventilation; but later, with the aid of a Jerkin plethysmograph, it is also possible to inspect the pattern of respiration.Five of the 10 cases of dystrophia myotonica display profound and prolonged respiratory depression, after injection of 50 - 100 mg. thiopentone, and irregular respiration is induced or accentuated in three of these cases. The drug has little effect on the remaining patients and controls.The maximum expiratory pressure in all cases is reduced to a level that is significantly lower than the controls, while other tests such as the maximum breathing capacity is within the normal range in 90% of the patients. It is concluded that there exists in dystrophia myotonica, respiratory dysfunction which varies with the severity of the disease, and which may not be evident until a respiratory depressant drug is given.The prolonged and profound respiratory depressant effect of thiopentone depends on the presence of pre-existing respiratory insufficiency, which appears to be due to muscular wasting and not myotonia.The reduction in maximum expiratory pressure implies a decreased ability to cough, which in the presence of pharyngeal and laryngeal weakness may lead to the inhalation of secretions into the bronchial tree.The response to thiopentone is not specific, but can be produced by other respiratory depressant drugs. It is impossible to predict the effect on respiration by the use of simple tests of lung function.The morbidity and mortality appears to be related not specifically to anaesthesia but to sedation of these patients, which accentuates any respiratory depression already present. With the reduced ability to cough, these features represent a condition similar to that of bulbo-spinal poliomyelitis, with its attendant disabilities

Note and Comment

Judicial Reform in Michigan - The legislature which has been in regular session this year has enacted a measure enlarging the scope of judicial action in a way likely to add very greatly to the iusefulness of the courts. This law authorizes courts of record to make binding declarations of the rights of parties prior to the commission of a wrongful ac

Oscillatory activity in the infant brain and the representation of small numbers

Gamma-band oscillatory activity (GBA) is an established neural signature of sustained occluded object representation in infants and adults. However, it is not yet known whether the magnitude of GBA in the infant brain reflects the quantity of occluded items held in memory. To examine this, we compared GBA of 6–8 month-old infants during occlusion periods after the representation of two objects vs. that of one object. We found that maintaining a representation of two objects during occlusion resulted in significantly greater GBA relative to maintaining a single object. Further, this enhancement was located in the right occipital region, which is consistent with previous object representation research in adults and infants. We conclude that enhanced GBA reflects neural processes underlying infants’ representation of small numbers

The pharmacological management of psychiatric comorbidities in patients with epilepsy.

Psychiatric disorders represent a frequent comorbidity in patients with epilepsy affecting quality of life, morbidity and mortality. Evidence-based data on the management of these conditions are limited but a number of recommendations are now available to guide clinical practice. The present paper reviews the pharmacological treatment of psychiatric problems in epilepsy with special attention to data coming from randomised controlled trials (RCTs), pharmacological interactions with AEDs and the issue of seizure worsening during treatment with psychotropic drugs. Epidemiologically or clinically relevant psychiatric conditions are discussed namely mood and anxiety disorders, psychoses and attention deficit hyperactivity disorder

Measuring changes in Schlemm’s canal and trabecular meshwork in different accommodation states in myopia children: an observational study

Abstract Purpose: Studies were designed to evaluate changes in the size of the Schlemm's Canal (SC) and trabecular meshwork(TM) during accommodation stimuli and cycloplegia states in myopic children. Methods: 34 children were enrolled. A -6D accommodation stimulus was achieved by looking at an optotype through a mirror. Cycloplegia state was induced with 1% tropicamide. Two states were confirmed by measuring the central lens thickness（CLT）, the anterior chamber depth and the pupil diameter. The size of the Schlemm's Canal (SC) and Trabecular Meshwork(TM) was measured using swept-source optical coherence tomography. And the associations between the change of the SC and the CLT were analyzed. Results: When compared with the relaxation state, under -6D accommodation stimuli, the size of SC increased significantly: the SC area (SCA) amplified from 6371±2517μm2 to 7824±2727 μm2; the SC length (SCL) from 249±10 μm to 295±12 μm, and SC width (SCW) from 27±9 μm to 31±8 μm. Under cycloplegia state, the SCA reduced to 5009±2028 μm2; the SCL to 212±μm and the SCW to 22±5 μm. In addition, the changed areas of SCA (r=0. 35; P=0.0007), SCL (r=0. 251; P=0.0172), and SCW (r=0. 253; P=0.016) were significantly correlated with the change in CLT. However, the size of TM did not change substantially when compared with the relaxation state. Only the TM length (TML) increased from 562±45μm to 587±47μm after -6D accommodation stimulus. Conclusion: SC size enlarges after -6D accommodation stimuli and shrinks under cycloplegia. However, for TM, only the TM length increase under accommodation stimulus state. KEYWORDS: Schlemm’s Canal, Trabecular Meshwork, accommodatio

Explaining gender differences in non-fatal suicidal behaviour among adolescents: a population-based study

<p>Abstract</p> <p>Background</p> <p>While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents.</p> <p>Methods</p> <p>A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female.</p> <p>Results</p> <p>Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R² of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained.</p> <p>Conclusions</p> <p>The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age.</p