[A model of primary open-angle glaucoma: manifestations and outcomes]

OBJECTIVE

To determine the expected duration of the disease and the age of the patients with different stages ofprimary open-angle glaucoma complicated by pseudoexfoliation syndrome (PES) and/or patients with pseudoexfoliation glaucoma (PEG).

METHODS

The study protocol included data from 120 patients (50 males (41.7%), 70 females (58.3%)); 189 eyes; 102 right eyes; 87 left eyes). The first study group (28 patients, 44 eyes) comprised patients with suspected glaucoma. The second group (53 patients, 84 eyes) consisted ofpatients with early glaucoma. The third group (21 patient, 33 eyes) included patients with advanced glaucoma, the forth group (18 patients, 28 eyes) comprised patients with terminal glaucoma. Mean age of the patients at diagnosis was 61.6 (58.4; 66.9) years and 66.9 (63.4; 72.8) years at the endpoint visit in 2013. In all cases, diagnosis was made in accordance with the differential diagnostics system and confirmed by special diagnostic techniques. The database included data from 3 qualified examinations taking account of the results of tonometry and static automated perimetry.

RESULTS

The mean expected age of the patients age at the onset of blindness was 75.1 years. The occurrence of the event was limited to a period of 6.1 years. Mean age at the time of possible glaucoma development was 59.58 (56.14; 64.36) years. The disease itself could develop within 3.24 (-5.38; -1.2) years prior to diagnosis.

CONCLUSION

Studies for glaucoma diagnosis should be focused on the age group of 55-60 years. The degree of IOP reduction in patients with advanced glaucoma does not agree with the Russian glaucoma society recommendations which accounts for progression of the disease.

High average-power ultrafast CPA Yb:KYW laser system with dual-slab amplifier

A diode-pumped, ultrafast Yb:KYW laser system utilizing chirped-pulse amplification in a dual-slab regenerative amplifier with spectral shaping of seeding pulse from a master oscillator has been developed. A train of compressed pulses with pulse length of 181 fs, repetition rate up to 200 kHz, and average power exceeding 8 W after compression and pulse picker was achieved.

[Methods of statistical analysis in differential diagnostics of the degree of brain glioma anaplasia during preoperative stage]

The authors proposed a possible preoperative diagnostics of the degree of supratentorial brain gliom anaplasia using statistical analysis methods. It relies on a complex examination of 934 patients with I-IV degree anaplasias, which had been treated in the Institute of Neurosurgery from 1990 to 2004. The use of statistical analysis methods for differential diagnostics of the degree of brain gliom anaplasia may optimize a diagnostic algorithm, increase reliability of obtained data and in some cases avoid carrying out irrational operative intrusions. Clinically important signs for the use of statistical analysis methods directed to preoperative diagnostics of brain gliom anaplasia have been defined

[Study of the mitochondria movement using videomicroscopy]

A stable cell line CV-1 was obtained for vital observation of the transport of mitochondria in animals cells, which express a fragment of the resident protein of mitochondria marked by yellow fluorescent protein. The parameters and conditions of movement of the mitochondria in living cells were established using fluorescence videomicroscopy. Under the normal conditions, only a small part of mitochondria (ca. 7%) was transported over significant distances, while others were in the state of relative rest. The effective transport of mitochondria strictly depended on the dynamic properties of microtubules. Incubation of cell in a serum-free medium suppressed active transport of mitochondria, thus suggesting its dependence on certain, not yet determined environmental factors.

Noradrenergic effects in tardive dyskinesia, akathisia and pseudoparkinsonism via the limbic system and basal ganglia

1. This paper proposes that the neuropsychiatric symptoms of tardive dyskinesia, akathisia and pseudoparkinsonian tremor are modulated by a noradrenergic pathway that projects from the locus coeruleus to the limbic system. 2. The proposed pathway is found to the consistent with neuroanatomical and neurochemical data in the literature. 3. The proposed pathway is found to be clinically consistent with observations by ourselves and others on the efficacy of clonidine and beta-adrenoreceptor blockers like propranolol for treating akathisia and pseudoparkinsonian tremor. It is also consistent with reports by ourselves and others that some patients with tardive dyskinesia benefit from treatment with propranolol or clonidine. 4. Noradrenergic modulation of the limbic system by way of the locus coeruleus accounts for a number of clinical observations, such as the worsening of tardive dyskinesia by stress, the greater risk for tardive dyskinesia in patients with affective disorder, the time-of-onset of tardive dyskinesia, and the coexistence of tardive dyskinesia and pseudoparkinsonism. 5. The functional significance of beta-adrenoreceptors in the basal ganglia is considered from an evolutionary perspective. 6. The model proposed in this article appears to have considerable heuristic value because it may further our understanding of Gilles de la Tourette syndrome and attention deficit disorder (hyperkinesis).

Abstinence syndrome from therapeutic doses of oxazepam

A patient developed severe anxiety, moodswing, depression, and thinking disorder 24 hours after abruptly stopping oxazepam, of which he had taken 30 mg 3 times a day for two months, for anxiety and panic attacks. Oxazepam was restarted and tapered off gradually; nevertheless, a relatively severe abstinence syndrome occurred. Muscular fasciculations and moodswing were very marked. The patient also experienced significant anxiety, depression, moodswing, and muscular fasciculations for two months after detoxication from oxazepam. Subsequently, the patient's panic attacks were treated successfully with propranolol hydrochloride. This report concludes with a brief review of the literature on benzodiazepine withdrawal.

Case report of propranolol (Inderal) pharmacotherapy for neuroleptic-induced akathisia and tremor

This case report describes a schizophrenic patient who developed akathisia and tremor following neuroleptic pharmacotherapy with fluphenazine decanoate. The patient also suffered from familial (benign essential) tremor. The patient's neuroleptic-induced extrapyramidal side effects were not relieved by anticholinergic antiparkinson drugs or by phenobarbital. The patient was started on propranolol 10 mg b.i.d. She was also started on diazepam 5 mg t.i.d. for anxiety. The diazepam dose was held constant and propranolol was gradually increased to 40 mg q.i.d. The patient's extrapyramidal symptomatology gradually resolved over the course of one month, during which time the propranolol dose was being steadily increased. Propranolol also effectively controlled her familial tremor. After nine months as an outpatient, during which time the patient was neuroleptic-free, she developed psychotic decompensation for which she was treated with thiothixene. Akathisia or tremor did not develop, possibly because the patient was taking propranolol simultaneously. Propranolol may be useful for treating neuroleptic-induced akathisia. This requires systematic investigation with open and controlled trials.

Delirium and stereotypy from anticholinergic antiparkinson drugs

1. This report describes two cases of psychotic syndrome from benztropine (Cogentin), which was used to treat haloperidol-induced extrapyramidal side effects. The patients' symptomatology meets DSM III criteria for delirium. Both patients displayed repetitive motor automatisms (stereotypy). 2. Symptomatology appeared one-to-two days after the start of benztropine 2 mg b.i.d. and subsided one-to-several days after benztropine was stopped. Treatment consisted of administration of sedative hypnotic drugs. 3. The literature on anticholinergic-induced psychotic syndromes is surveyed. Particular attention is drawn to the occurrence of stereotypy. 4. It is proposed, on the basis of a review of animal and clinical data, that stereotypies in delirious patients are related to muscarinic blockade in the central nervous system. This model is used to explain repetitive motor automatisms which are seen in Alzheimer's disease. 5. The paper concludes with brief guidelines for the management of anticholinergic delirium.