Repetitive transcranial magnetic stimulation for posttraumatic stress disorder.
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Adult↗
Biomedical subjects
C M Morgan
Publications and source records attributed to C M Morgan.
Effects of the 5-HT3 antagonist, ondansetron, on the behavioral and physiological effects of pentagastrin in patients with panic disorder and social phobia.
Pentagastrin, a cholecystokinin (CCK) agonist, produces anxiety and panic in patients with panic disorder and social phobia. Preclinical data suggests that pentagastrin-induced anxiogenesis may be mediated via 5-HT3 receptors. In the present study, 14 patients with panic disorder or social phobia underwent pharmacological challenge in three conditions: (1) pretreatment with saline followed by pentagastrin infusion; (2) pretreatment with ondansetron followed by pentagastrin infusion; and (3) pretreatment with saline followed by saline infusion. As expected, pentagastrin administration led to increased anxiety, physical symptoms of panic attacks, pulse, plasma adrenocorticotropic hormone (ACTH), and cortisol. Pentagastrin's behavioral effects were not blocked by ondansetron, and in fact, tended to be exaggerated. Ondansetron pretreatment did not alter the pentagastrin-induced cortisol increase but significantly prolonged the pentagastrin-induced increase in ACTH. These findings suggest that pentagastrin's behavioral effects are not mediated by 5HT3 receptors. Mechanisms by which peripherally administered CCK agonists lead to anxiety remain to be elucidated.
Adult↗
Aboriginal philosophy and its impact on health care outcomes.
Philosophical perspective is an important factor influencing the health and health care outcomes of Aboriginal Australians. To date, the nature of the Aboriginal perspective and its differences from mainstream European thinking have been poorly understood. The negative impact that this has on the health and health care of Aboriginal people has been seriously neglected. We outline some of the important features of the philosophical perspective of Aboriginal Australians. We suggest ways in which the recognition of these views can inform changes in treatment settings and methods that can contribute to improvements in the health care outcomes of Aboriginal Australians.
Attitude to Health↗
Linkage of autosomal dominant radial drusen (malattia leventinese) to chromosome 2p16-21.
OBJECTIVE: To identify the chromosomal location of the gene involved in the pathogenesis of autosomal dominant radial drusen (malattia leventinese). PATIENTS: Eighty-six members of four families affected with radial drusen; one family of American origin and three families of Swiss origin. METHODS: Family members were clinically examined for the presence of radial drusen. Affected patients and potentially informative spouses were genotyped with short tandem repeat polymorphisms distributed across the autosomal genome. The clinical and genotypic data were subjected to linkage analysis. RESULTS: Fifty-six patients were found to be clinically affected. Significant linkage was observed between the disease phenotype and markers known to lie on the short arm of chromosome 2. The maximum two-point lod score (Zmax) observed for all four families combined was 10.5 and was obtained with marker D2S378. Multipoint analysis yielded a Zmax of 12, centered on marker D2S378. The lod-1 confidence interval was 8 cM, while the disease interval defined by observed recombinants was 14 cM. CONCLUSIONS: The gene responsible for autosomal dominant radial drusen has been mapped to the short arm of chromosome 2. This is an important step toward actually isolating the disease-causing gene. In addition, this information can be used to evaluate other familial drusen phenotypes such as Doyne's macular dystrophy for a possible allelic relationship.
Adolescent↗
Pharmacotherapy for cocaine-abusing methadone-maintained patients using amantadine or desipramine.
In a double-blind, placebo-controlled 12-week randomized clinical trial, we compared amantadine hydrochloride (300 mg/d; n = 33), desipramine hydrochloride (150 mg/d; n = 30), and placebo (n = 31) in the treatment of cocaine-abusing methadone-maintained patients. Treatment retention and medication compliance were excellent, with more than 75% of the patients completing the full 12-week trial. Although reported cocaine abuse was significantly lower in the medicated groups compared with the placebo group at week 4, this difference became nonsignificant at week 8, and no difference was found in cocaine-free urine samples. Future studies of amantadine and desipramine treatment in these patients should consider alternatives to methadone hydrochloride, such as buprenorphine hydrochloride, and the selection of more homogeneous patient subgroups, such as depressed cocaine abusers.
Adult↗
Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling.
The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.
Cataract Extraction↗
Subretinal neovascularization in systemic lupus erythematosus.
Choroidal involvement in systemic lupus erythematosus (SLE) occurs infrequently. We describe a patient with unusual manifestations of lupus oculopathy: prominent choroidal vasculopathy associated with multiple chorioretinal scars and subretinal neovascularization in the macular area. Choroidal disease was the primary feature of ocular involvement. SLE should be considered in the differential diagnosis in patients with inflammatory choroidal lesions.
Aged↗
Comparison of acellular and whole-cell pertussis-component DTP vaccines. A multicenter double-blind study in 4- to 6-year-old children.
An acellular pertussis-component combined diphtheria and tetanus toxoids, and pertussis (APDT) vaccine adsorbed was compared with a licensed whole-cell pertussis-component combined diphtheria and tetanus toxoids, and pertussis (DTP) vaccine adsorbed for reactogenicity and immunogenicity when given as the fifth DTP immunization to eighty-two 4- to 6-year-old children. The reaction rates with both vaccines were low; APDT vaccine recipients had significantly less pain and warmth at the injection site than did DTP vaccine recipients. Antibody responses to pertussis antigens (lymphocytosis-promoting factor, filamentous hemagglutinin, and agglutinogens) and to diphtheria and tetanus toxoids were all brisk. The APDT vaccine recipients had a more marked response in antibodies to filamentous hemagglutinin and a less marked response in agglutinins than whole-cell vaccine recipients. On the day after immunization, both APDT and DTP vaccine recipients had an increase in mean leukocyte and neutrophil counts. This APDT vaccine is immunogenic and less reactogenic than a DTP vaccine with a whole-cell pertussis component when administered as a booster to 4- to 6-year-old children.
Agglutinins↗
The complication of pneumatic retinopexy.
There have been 26 published series with a total of 1274 detachments operated with pneumatic retinopexy. Eighty percent were reattached with a single procedure and 98% with reoperations. New breaks occurred in 13% and PVR in 4%. The complications published in 101 papers on pneumatic retinopexy in the last 5 years are analyzed as to frequency, prevention, management, and results.
Cryosurgery↗
Growth rate of subretinal neovascularization in age-related macular degeneration.
To determine the growth rate of subretinal neovascularization (SRNV) in age-related macular degeneration (ARMD), 35 pairs of serial fluorescein angiograms from 30 consecutive patients with SRNV who had not been treated with laser photocoagulation were analyzed. The daily growth rate of SRNV measured on consecutive fluorescein angiograms less than 120 days apart ranged from 0 to 74 microns (mean, 18 microns daily). The daily estimated growth rate of SRNV in any one direction ranged from 0 to 37 microns (mean, 9 microns daily). Documented initial slow growth of SRNV in one eye did not preclude a greater subsequent growth rate in the fellow eye. It was not possible to predict reliably the growth rate of SRNV. This reinforces the necessity of prompt evaluation of all subretinal neovascular membranes initially for the purpose of possible laser treatment.
Aged↗
Atrophic creep of the retinal pigment epithelium after focal macular photocoagulation.
To determine if enlargement of laser scars occurs in nonmyopic individuals, the authors retrospectively reviewed 126 consecutive patients with age-related macular degeneration who had been successfully treated with focal macular laser photocoagulation for subretinal neovascularization. Of the 174 laser scars in the study, 122 (70%) increased in size from 50 to 1016 microns (mean, 290 microns) as determined photographically on serial examination ranging from 2 to 81 months. There was no statistically significant difference in the number of scars which increased in size among the three laser wavelengths used. Four (3%) patients lost vision as a result of the scar extending into the fovea. Enlargement of retinal pigment epithelial (RPE) atrophy after focal macular laser photocoagulation may cause significant, delayed visual loss after successful treatment of subretinal neovascularization.
Aged↗
Retinal and choroidal vascular occlusion secondary to corticosteroid embolisation.
We report a case of visual loss following intranasal injection of triamcinolone acetonide and phenylephrine hydrochloride in a 22-year-old female with chronic sinusitis. Clinical examination and fluorescein angiography revealed vascular occlusions which involved multiple small branches of both the choroidal and retinal circulations. The mechanism of such a complication probably involves inadvertent intra-arterial injection into the anterior or the posterior ethmoidal artery, with retrograde flow into the opthalmic arterial system. Precautions can be taken to avoid such complications.
Adult↗
Vitrectomy surgery in proliferative sickle retinopathy-- correction.
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Anemia, Sickle Cell↗
Ocular complications associated with retrobulbar injections.
The authors describe six complications, of retrobulbar injections documented by fundus photography and fluorescein angiography. These include (1) injection of corticosteroid into the posterior ciliary arterial circulation resulting in emboli in the vasculature of the choroid and the optic nerve head; (2) injection of corticosteroid into the ophthalmic artery resulting in emboli in both the choroidal and retinal circulations; (3) presumed injection of lidocaine and air into the optic nerve sheath adjacent to the globe with extension anteriorly into the subretinal space and the space between the posterior vitreous and the internal limiting membrane; (4) occlusion of the central retinal artery without an associated retrobulbar hemorrhage; (5) trauma to and partial injection of lidocaine in the central retinal artery with embolization into the retinal circulation; and (6) presumed injection of lidocaine into the optic nerve sheath producing a combined central retinal vein and artery occlusion. Alternative techniques that might decrease the incidence of complications associated with retrobulbar injections are discussed.
Adult↗
New posteriorly located retinal breaks after pneumatic retinopexy.
Pneumatic retinopexy is a new procedure that is effective in treating many uncomplicated cases of rhegmatogenous retinal detachment (RD). It may be done in the office using a cryoprobe or laser and an expanding gas bubble and for this reason has become popular among RD surgeons. Reports of associated complications are limited. Three patients who had remarkably posterior retinal breaks after pneumatic retinopexy are presented with evidence that these breaks are a direct complication of this procedure. A possible explanation as to the pathogenesis of pneumatic retinopexy-associated posteriorly located retinal tears, as well as suggestions regarding prophylactic measures that may be taken to avoid this complication, are also presented.
Adult↗
Neisseria mucosa endophthalmitis.
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Adrenal Cortex Hormones↗
Vitrectomy surgery in proliferative sickle retinopathy.
Visual loss secondary to vitreous hemorrhage or retinal detachment can occur in proliferative sickle retinopathy. Severe complications including a high incidence of anterior segment necrosis have been reported in both vitrectomy and scleral buckling operations in patients with this disease. We examined four patients with longstanding vitreous hemorrhages or retinal detachments that were treated successfully with standard vitrectomy surgery techniques or scleral buckling procedures without serious complications.
Adult↗