Color vision: a study of essential tremor cases versus normal controls.

BACKGROUND AND PURPOSE: Patients with essential tremor (ET) and Parkinson's disease (PD) may exhibit overlapping clinical features. Also, a growing number of non-motor features are being documented in ET. Color vision abnormalities, although well known to occur in PD, have not been studied extensively in ET. We assessed color vision in ET cases and controls. We furthermore assessed subgroups of ET cases with clinical features that might link them to PD (i.e., ET cases with a family history of PD, and ET cases with rest tremor) to determine whether these cases had greater color vision abnormalities than ET cases without those features. METHODS: Participants were enrolled in a case-control study at Columbia University Medical Center. Color discrimination testing was performed using the Farnsworth-Munsell 100 Hue test. The total error score (TES) for the hue test was determined. RESULTS: The TES was similar in 55 ET cases and 55 controls (144.6 ± 91.8 vs. 145.6 ± 96.6, P = 0.96). ET cases with rest tremor (n = 8) were similar to ET cases without rest tremor (n = 47) with respect to the TES (117.0 ± 73.4 vs. 149.3 ± 94.4, P = 0.36), as were ET cases with a family history of PD (n = 9) versus without (n = 46) (144.4 ± 57.0 vs. 144.6 ± 97.6, P = 0.996). CONCLUSIONS: Although a number of links exist between ET and PD, and non-motor features have been described in both, a color vision abnormality does not seem to be a feature of ET.

Depressive traits in essential tremor: impact on disability, quality of life, and medication adherence.

BACKGROUND: There is growing study of the psychiatric features of essential tremor. Depressive symptoms occur in a considerable number of patients. Yet their impact, as a primary factor, has received almost no attention. We assessed whether, independent of tremor severity, patients with more depressive symptoms have more perceived tremor-related disability, lower tremor-related quality of life, and poorer compliance with tremor medication. METHODS: On the basis of their Center for Epidemiological Studies Depression Scale score, we stratified 70 essential tremor patients into three groups: 41 with minimal depressive symptoms, 24 with moderate depressive symptoms, and five with severe depressive symptoms. Importantly, the three groups had similar tremor severity on neurological examination. We assessed self-reported tremor-related disability, tremor-related quality of life (Quality of Life in Essential Tremor) (QUEST) score, and medication compliance. RESULTS: Cases with minimal depressive symptoms had the lowest QUEST scores (i.e., highest quality of life), cases with moderate depressive symptoms had intermediate scores, and those with severe depressive symptoms had the highest QUEST scores (i.e., lowest quality of life) (P < 0.001). Depressive symptoms were a stronger predictor of tremor-related quality of life than was the main motor feature of essential tremor (ET) itself (tremor). Self-reported medication compliance was lowest in cases with severe depressive symptoms and highest in cases with minimal depressive symptoms. CONCLUSIONS: The physical disability caused by the tremor of ET has traditionally been regarded as the most important feature of the disease that causes distress, and it has received the most attention in the management of patients with this disease. Our data indicate that this may not be the case.

Evidence for a common binding cavity for three general anesthetics within the GABAA receptor.

The GABA(A) receptor is an important target for a variety of general anesthetics (Franks and Lieb, 1994) and for benzodiazepines such as diazepam. Specific point mutations in the GABA(A) receptor selectively abolish regulation by benzodiazepines (Rudolph et al., 1999; McKernan et al., 2000) and by anesthetic ethers (Mihic et al., 1997; Krasowski et al., 1998; Koltchine et al., 1999), suggesting the existence of discrete binding sites on the GABA(A) receptor for these drugs. Using anesthetics of different molecular size (isoflurane > halothane > chloroform) together with complementary mutagenesis of specific amino acid side chains, we estimate the volume of a proposed anesthetic binding site as between 250 and 370 A(3). The results of the "cutoff" analysis suggest a common site of action for the anesthetics isoflurane, halothane, and chloroform on the GABA(A) receptor. Moreover, the data support a crucial role for Leu232, Ser270, and Ala291 in the alpha subunit in defining the boundaries of an amphipathic cavity, which can accommodate a variety of small general anesthetic molecules.

Posteroanterior stiffness in the lumbosacral spine. The correlation between adjacent vertebral levels.

STUDY DESIGN: A descriptive design of posteroanterior stiffness in the lumbosacral spine. OBJECTIVES: To measure posteroanterior stiffness between L1 and S1 to establish the pattern of stiffness in individuals with no history of low back pain. SUMMARY OF BACKGROUND DATA: In clinical examination for low back pain, manual assessment of abnormal stiffness is used to determine the site of the pain-producing lesion. However, there is little objective evidence of the variation in stiffness between levels in normal spines or of the factors that determine posteroanterior stiffness. METHOD: Posteroanterior stiffness was measured with a specially developed measuring device at each of the six vertebral levels between L1 and S1. Force-displacement relations were computed for each vertebral level. The gradient of the linear part of the force-displacement relation was used as a coefficient of stiffness, and the amount of displacement between 5 N and 30 N of applied force (D5-30) was used as a measure of the length of the toe region. RESULTS: Overall there was a significant linear trend of increasing stiffness from L1 to S1. Ninety percent of the difference scores for adjacent level comparisons were less than 3.6 N/mm. There was considerable variation in the patterns of stiffness found in different individuals. The stiffness coefficient and D5-30 correlated significantly with skinfold thickness measurements and body mass index. CONCLUSION: A linear trend of increasing stiffness was found between L1 and S1, but this pattern was influenced by variables related to body type (adiposity).

Direction of manual force applied during assessment of stiffness in the lumbosacral spine.

OBJECTIVE: To measure the angle of applied manual force during assessment of posteroanterior stiffness in the lumbosacral spine. DESIGN: Ten physiotherapists with bachelor's degrees in physiotherapy and postgraduate qualifications in manipulative physiotherapy assessed stiffness at 6 lumbosacral vertebral levels in a controlled order. Two pain free subjects acted as patients. SETTING: A university biomechanics laboratory. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Applied force vector angles in the sagittal plane. RESULTS: The physiotherapists all varied the direction of the force they applied so that it was directed slightly toward the feet at the lower vertebral levels and more toward the head as they moved up the spine. There was a significant difference between the direction of the applied force vector angles at each vertebral level (p < .0001). The direction of force used was also significantly different for the two patients (p = .0067). The forces used by the physiotherapists were applied in directions more vertical than if forces had been applied in directions perpendicular to the surface curves of the two patients. CONCLUSION: The direction of the force applied by the physiotherapists in this study when assessing posteroanterior stiffness varied significantly between vertebral levels and seemed to take into account the individual shape of the lumbosacral curve of each patient.

[Sodium cromoglycate in spray treatment (author's transl)]. / Le cromoglycate de sodium en nébulisation.

1) Intal nebuliser solution can be effectively administered to young asthmatic children. 2) The treatment is well accepted and efficacious with no reported side effects. 3) Nebulisation provides a practical alternative for patients unable to inhale Intal powder via a spinhaler.

A guide to comprehensive tendering for sterile dressing packs.

Local circumstances dictated that the supply of sterile dressing packs for the District be the subject of competitive tendering in August, 1984. This article shares the experience of conducting this task which involved developing a methodology in advance of detailed DHSS or Regional guidelines on this service.

Retrospective survey of 1271 patients diagnosed as perennial rhinitis.

Data from 1271 patients with perennial rhinitis has been assessed. This condition predominantly affects children and young adults; 31-5% stated that symptoms first appeared before the age of 10 years, less than 10% were aged 50 years or more suggesting that the disease process may well disappear in later life. The total sample size was equally divided between the sexes and the mean age for the sexes was similar. In terms of age distribution a sex difference was found in that the peak incidence for males occurred in the age group 10-19 years whereas for females it was in the third decade (P less than 0-001). The duration of the disease was, in most cases, between 2 and 9 years but it can extend to over 15 years and thus become subacute or chronic. The major symptom is blocking which could be due to either histological changes in the mucosa or immunological reactions. Skin tests showed that 64% had a positive reaction to common allergens; however, nasal challenge tests were of little value in determining whether a patient could be classified as allergic. Eosinophils were noted in 66%. The value of skin tests and nasal smears is discussed.

A double blind trial of a 2% solution of sodium cromoglycate in perennial rhinitis.

Nineteen patients with perennial rhinitis were studied in a double blind crossover trial of 8 weeks duration using a 2% solution of sodium cromoglycate and placebo. Nasal smears, blood counts and serum IgE levels were carried out to determine whether any changes occurred with either the active or placebo formulations. Clinically, thirteen patients were greatly improved with the active solution, four showed no change and two became worse. Eosinophils in the nasal secretions were generally reduced during the administration of active solution but remained unchanged with the placebo.