Functional role of exercise-induced cortical organization of sensorimotor cortex after spinal transection.

Spinal cord transection silences neuronal activity in the deafferented cortex to cutaneous stimulation of the body and untreated animals show no improvement in functional outcome (weight-supported stepping) with time after lesion. However, adult rats spinalized since neonates that receive exercise therapy exhibit greater functional recovery and exhibit more cortical reorganization. This suggests that the change in the somatotopic organization of the cortex may be functionally relevant. To address this issue, we chronically implanted arrays of microwire electrodes into the infragranular layers of the hindlimb somatosensory cortex of adult rats neonatally transected at T8/T9 that received exercise training (spinalized rats) and of normal adult rats. Multiple, single neuron activity was recorded during passive sensory stimulation, when the animals were anesthetized, and during active sensorimotor stimulation during treadmill-induced locomotion when the animal was awake and free to move. Our results demonstrate that cortical neurons recorded from the spinalized rats that received exercise 1) had higher spontaneous firing rates, 2) were more likely to respond to both sensory and sensorimotor stimulations of the forelimbs, and also 3) responded with more spikes per stimulus than those recorded from normal rats, suggesting expansion of the forelimb map into the hindlimb map. During treadmill locomotion the activity of neurons recorded from neonatally spinalized rats was greater during weight-supported steps on the treadmill compared with the neuronal activity during nonweight supported steps. We hypothesize that this increased activity is related to the ability of the animal to take weight supported steps and that, therefore, these changes in cortical organization after spinal cord injury are relevant for functional recovery.

Persistent corneal oedema following ICCE. Influence of IOL type.

PURPOSE: To examine the frequency of persistent corneal oedema following intracapsular cataract extraction (ICCE). To examine whether the type of intraocular lens has any influence on persistent corneal oedema following ICCE. METHODS: A retrospective study of 1041 consecutive ICCE operations followed for at least eight years. The cumulative incidence of persistent corneal oedema was calculated for the whole group and compared to the incidence in subgroups defined by type of intraocular lens. RESULTS: The cumulative incidence of persistent corneal oedema following ICCE was 2.3% for the whole group. The highest incidence (10.3%) was found in the group of patients, who received a 3-M style 77 anterior chamber lens while the lowest incidence (1.0%) were found among patients receiving a Choyce anterior chamber lens. Compared to this, the patients who received no intraocular lens showed a frequency of persistent corneal oedema of 1.4%. Among the patients who developed persistent corneal oedema the number of re-operations was higher (27.3%) compared to the patients who did not develop persistent corneal oedema (4.4%). The frequency of preoperative dystrophy was the same whether or not the patients developed persistent corneal oedema. There were no difference in gender, age or other pre-operative data between the two groups. CONCLUSION: After ICCE 2.3% developed persistent corneal oedema. There was a significant difference between the frequencies of persistent corneal oedema depending on the type of intraocular lens from 1.0% in eyes receiving a Choyce anterior chamber lens to 10.3% in eyes receiving a semi-flexible 3-M style 77 anterior chamber lens.

Mortality and causes of mortality among cataract-extracted patients. A 10-year follow-up.

PURPOSE: The purpose of this study was to compare the mortality among patients undergoing intracapsular cataract extraction to the mortality in a gender-and age-identical Danish reference population, and to compare the patients' primary causes of death to those in the general population. MATERIALS AND METHODS: We reviewed medical records of patients undergoing ICCE from January 1st 1984 to December 31st 1986 at the Department of Ophthalmology, Aalborg Hospital, Denmark. Information on the deaths of these patients was obtained from the Danish National Population Register. Information on mortality in Denmark was obtained from published statistics. RESULTS: We found an increased mortality among the patients with cataract with an SMR (standard mortality rate) of 1.12 (95% confidence interval 1.02-1.23). The slightly increased mortality was observed for both men and women and for all examined causes of death. CONCLUSION: The slightly increased mortality among patients with cataract may indicate a general deterioration of health for these patients.

Retinal detachment following intracapsular cataract extraction. A 10-year follow-up study.

PURPOSE: To examine the incidence of and risk factors for retinal detachment during a 10-year follow-up on intracapsular cataract extraction (ICCE). METHODS: Retrospective analysis of medical records of 1041 eyes operated on with ICCE in the years 1984-86. A complete follow-up was achieved, and actuarial methods were used in the risk assessment. The risk time averaged 82 months. RESULTS: Twenty-two (2.1%) eyes developed retinal detachment; half of the cases occurred during the first postoperative year, but new cases emerged throughout the period. The cumulative incidence of RD amounted to 2.8%; 95% confidence interval: 1.5-4.2%. Multivariate Cox regression analysis identified younger age at surgery (relative risk for each 10-year increase in age=0.6; 95% confidence interval: 0.39-0.95) and male gender (relative risk=2.5; 95% confidence interval 1.04-6.04) as significant risk factors for RD. Eleven eyes, 50% of eyes with RD and 1% of the total number of eyes, lost useful vision in spite of retinal surgery. CONCLUSION: Even though the risk for both RD and an unfavourable result following retinal surgery may be smaller using contemporary surgical techniques, the present study indicates a substantial morbidity following cataract surgery, when a sufficiently long observation period is considered.

[Cytomegalovirus retinitis. Blindness in a patient with lymphoma]. / Cytomegalovirus-retinitis. Blindhed hos en lymfompatient.

We present a case of a 52 year-old female treated with high dose chemotherapy for a malignant lymphoma. After a six month period on maintenance chemotherapy the patient developed a cytomegalovirus induced retinitis which was first suspected to be a lymphoma relapse. She went blind, despite treatment with ganciclovir.

Flumazenil used for antagonizing the central effects of midazolam and diazepam in outpatients.

In a double-blind, randomized trial, the efficacy and safety of flumazenil, a benzodiazepine antagonist, was evaluated in patients after gastroscopy under midazolam or diazepam sedation. The criteria of efficacy were the degree of sedation and anterograde amnesia. Flumazenil significantly reduced the degree of sedation in both groups without significant intergroup differences. No sign of resedation was found during the observation period of 3 h. The anterograde amnesia was effectively antagonized in both groups. Flumazenil was well tolerated. Flumazenil is a safe and effective benzodiazepine antagonist which makes it possible to reduce the recovery period in outpatients sedated sufficiently with benzodiazepines for gastroscopy.