Marfan Syndrome: Clinical Presentation with Congenital Glaucoma? / Síndrome de Marfan: ¿presentación clínica con glaucoma congénito?

ABSTRACT Congenital glaucoma (CG), diagnosed in the first year of life, can fall into three main groups: primary CG, glaucoma associated with congenital anomalies, and secondary glaucoma of infants. The associated congenital anomaly of CG includes the autosomal dominant: Marfan Syndrome (MS), the phenotypic features of which would rarely be evident in the first year of life. Multiple other associated autosomal dominant, autosomal recessive, X-linked and chromosomal conditions that can present with CG need to be excluded. Hence, this is a retrospective diagnosis and is the first known documented case report in an Afro-Caribbean with MS presenting with CG at six weeks of age. The Marfanoid features became apparent in late childhood and adolescence.

RESUMEN El glaucoma congénito (GC), diagnosticado en el primer año de vida, puede clasificarse en tres grupos principales: GC primario, glaucoma asociado con anomalías congénitas, y glaucoma secundario de lactantes. La anomalía congénita asociada con el GC incluye el trastorno autosómico dominante conocido como síndrome de Marfan (SM), cuyas características fenotípicas serían raramente evidentes en el primer año de vida. Otras múltiples condiciones asociadas - autosómicas dominantes, autosómicas recesivas, ligadas al cromosoma X, y cromosómicas - que pueden presentarse con el GC, necesitan ser excluidas. Por lo tanto, éste es un diagnóstico retrospectivo, a la par que el primer reporte de caso documentado de que se tenga noticia en relación un bebé afrocaribeño con SM, que presentaba GC a las seis semanas de la edad. Las características marfanoides se hicieron evidentes en la última etapa de la niñez y en la adolescencia.

Ilial anterior rotation hypermobility in a female collegiate tennis player.

BACKGROUND AND PURPOSE: This case report describes the examination, evaluation, and intervention by a physical therapist for a female collegiate tennis player with a right ilial anterior rotation hypermobility. CASE DESCRIPTION: The patient was a 21-year-old, female collegiate tennis player who developed a right anterior ilial rotation hypermobility as a result of her tennis stroke. Functional limitations were related to sitting, squatting, gait, and playing tennis. Treatment interventions consisted of massage, joint manipulation, stretching, stabilization exercises, sport-specific exercises and modification of tennis stroke, proprioceptive taping, and the use of a sacroiliac belt. OUTCOMES: After 26 weeks (33 treatments), tissue tenderness of the sacroiliac joint region was normalized, pelvic/trunk and lower-extremity mobility and flexibility were restored, sacroiliac symmetry and stability were regained, and the patient achieved her goal of returning to competitive tennis at the collegiate level. DISCUSSION: The patient's right ilial anterior rotation hypermobility was directly related to the mechanics of her tennis stroke. Her outcomes suggest that rehabilitation should focus on the entire abdomino-sacro-pelvic-hip complex, addressing articular, neural, and muscular inhibitions and deficiencies.

Does requiring continuing education units for professional licensing renewal assure quality patient care?

Although most states in the United States require health care professionals to complete continuing education units (CEUs) for licensure renewal, little evidence to date has established a relationship between completing CEUs and clinical competency. Considering the high cost of health care delivery and services, it would be prudent for both managers and consumers of health care to review the costs and benefits of requiring CEUs for professional licensing renewal. This study features an extensive review of the literature to analyze the supportive as well as the opposing views of mandatory CEUs for professional license renewal. Most of the studies reviewed reported almost no relationship between participation in traditional continuing education courses and improved patient outcomes. Several recommendations evolved out of this study for improving patient outcomes following the attendance of continuing education courses.

Radiographic analysis of intervertebral separation with a 0 degrees and 30 degrees rope angle using the Saunders cervical traction device.

STUDY DESIGN: Radiographic analysis of cervical intervertebral separation, (IVS) while using the Saunders Cervical Traction Device (SCTD) (Chattanooga Corp., Chattanooga, TN) on a healthy population. OBJECTIVE: To determine whether a rope angle of 0 degrees or 30 degrees achieves higher posterior and anterior IVS when using the SCTD. SUMMARY OF BACKGROUND DATA: To our knowledge, research using a 0 degrees rope angle and the SCTD has not been documented. METHODS: A convenience sample of 15 females and 5 males, with no history of cervical dysfunction, trauma, or pain, participated in the study. Static mechanical cervical traction, using the SCTD at a 0 degrees rope angle, was applied for 2 minutes using 11.34 kg (25 lb) of force. A cross-table lateral cervical spine radiograph was obtained before traction and again at 2 minutes of traction. Two weeks later, the subjects underwent the same procedure with the rope angle set at 30 degrees . RESULTS: A 0 degrees rope angle produced a significant mean difference in anterior IVS at all cervical segments as compared to a 30 degrees rope angle. Traction measurements comparing posterior IVS at 0 degrees and 30 degrees were not statistically significant. However, the posterior IVS increased significantly at a 0 degrees rope angle, with the exception of C2-C3. CONCLUSIONS: The research findings may have treatment implications when applying cervical traction with the SCTD. Further research using subjects with cervical nerve root compression will need to be conducted to substantiate clinical outcomes.

An electrophysiologic indication of defective information storage in childhood autism.

We used a combined behavioral and electrophysiological technique to test the hypothesis that storage of information is impaired in childhood autism. Endogenous event-related potentials associated with the random deletion of stimuli within a regular train of auditory or visual stimuli were examined in three autistic and three normal children. We found that all subjects were able to detect the stimulus deletions, but cortical potentials associated with stimulus omissions were smaller or absent in the autistic subjects. These results are consistent with dysfunction within the system that includes posterior parietal cortex and its connections with the mesolimbic temporal cortex and hippocampus.

Evaluation of the anaplasmosis rapid card agglutination test for detecting experimentally-infected elk.

Anaplasma marginale was experimentally transmitted from cattle to elk to cattle. Six intact adult elk (Cervus canadensis canadensis) inoculated with freshly collected heparinized blood from cattle chronically infected with A. marginale became asymptomatic carriers. Although the elk did not develop clinical or hematologic evidence of infection, they became seropositive by the serum(SRCA) and plasma rapid card agglutination (PRCA) tests. Blood from the experimentally-infected elk produced disease in splenectomized bovine calves and the carrier state persisted for at least one year. Infection did not occur when two elk were inoculated with 0.5 ml of frozen blood from known bovine carriers. The blood had been frozen for four weeks in liquid nitrogen with 6% dimethyl-sulfoxide. The bovine SRCA and PRCA tests were adapted for use with elk serum. To obtain accurate test results, serum collected from clotted elk blood had to be held for at least 72 h at 21-27 C before performance of the SRCA test. Comparative serologic and infectivity studies indicated that the carrier (reactor) status of elk was accurately identified with the serologic tests in 61 of 68 samples evaluated. Incorrect serologic results with the SRCA and PRCA tests were false-negative readings. In no case were uninfected elk identified as seropositive.

The immobilization of wapiti with etorphine hydrochloride.

Data and observations on the use of Etorphine hydrochloride (M99) (in combination with Acepromazine) and its antagonist M50-50 for immobilization of captive elk (Cervus elaphus canadensis) are presented. The study period covers 3 years during which 8 adult elk were immobilized 52 times with M99. The average dose of M99 administered for each immobilization was 2.2 mg per 100 kg body weight. Reversal with M50-50 was effected by an average dose of 4.4 mg per 100 body weight. Induction averaged 5.9 minutes while reversal took an average of 4.6 minutes.

The scalp topography of potentials in auditory and visual discrimination tasks.

Averaged event-related cortical potentials (ERPs) were obtained from an array of scalp electrodes overlying the left hemicranium in response to regularly presented visual or auditory stimuli (non-signals)and to infrequent random replacements by different stimuli (signals) in the same modality. A motor response was required to the signals. Non-signal ERPs were subtracted from signal ERPs and the topographic distributions of the negative (N2 delta) and positive (P3 delta) components were plotted as isopotential maps. N2 delta distributions differed for the auditory and visual modalities, whereas P3delta was modality unspecific. These topographic data were compared to those from the previous study of missing stimulus potentials (Simson et al. 1976) using maps representing the contributions from unilateral cerebral sources. The N2 delta and negative missing stimulus potential distributions ascribed to cortical activity within the secondary auditory and visual regions, whereas the late positive component (positive missing stimulus potential or P3 delta) were considered to derive principally from inferior parietal association cortex.

Evaluation of free-roaming mule deer as carriers of anaplasmosis in an area of Idaho where bovine anaplasmosis is enzootic.

Samples of blood from 87 Rocky Mountain mule deer (Odocoileus hemionus hemionus) were inoculated into 3 susceptible splenectomized calves to determine the anaplasmosis carrier status of the deer. The deer were trapped along the Idaho-Utah state boundary, near Stone, Id. Acute anaplasmosis was induced in 2 of the 3 inoculated calves, and blood from the 3 calves caused anaplasmosis when inoculated into adult non-splenectomized cattle. Serum rapid card agglutination testing revealed 13 (14.9%) positive reactions among the 87 mule deer. When these seropositive samples were evaluated with the complement-fixation test, positive reactions were not found and only 3 (3.5%) serums gave suspect reactions. A serologic survey for anaplasmosis in 1,852 cattle that cohabit spring and summer rangeland areas with mule deer revealed 14.5% reactors by the serum rapid card agglutination test. The study area consisted of an ecosystem that supports cattle, free-roaming mule deer, and Dermacentor andersoni, and thus contained the elements necessary to effect interspecies transmission of Anaplasma marginale. The significance of wildlife reservoirs and their bearing on anaplasmosis control and eradication programs needs further investigation.

Survey of anaplasmosis in elk of the Clearwater National Forest (Idaho).

Samples of blood from 27 free-roaming elk (Cervus canadensis canadensis) from the Clearwater National Forest in north central Idaho were tested by the rapid card agglutination test and complement-fixation test for the presence of antibodies against Anaplasma marginale. The serum card test and complement-fixation test gave incomplete and false-positive reactions; the plasma card test did not give any reactions. Anaplasma bodies or other blood parasites were not observed in stained smears of elk blood. Blood from 11 elk, including 2 that were serum card test-positive, did not produce clinical, hematologic, or serologic evidence of infection in 3 anaplasmosis-susceptible bovine calves.

Effect of five daily intravenous treatments with oxytetracycline hydrochloride on the carrier status of bovine anaplasmosis.

Intravenous administration of oxytetracycline hydrochloride at the rate of 22 mg/kg daily for 5 days was effective in rendering parasite-free 11 adult cattle that were naturally infected Anaplasma marginale carriers. The treatment did not cause any noticeable distress or side effect. Through 12 posttreatment months, the efficacy of the treatment procedure was evaluated by serologic tests and subinoculation of blood into susceptible splenectomized calves. Results of the rapid card agglutination test were positive for 5 cattle at 2 months after treatment, but negative for all cattle at 4 through 12 months. Complement-fixation titers were variable and transient in posttreatment serologic studies. After subinoculation of blood into splenectomized calves (at 4 and 12 months after chemotherapy), serologic, hematologic, or clinical evidence of infection with A marginale was not seen during a 60-day observation period.