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Acquired cataract and cognitive impairment are both common age-related problems, and ophthalmologists are increasingly likely to encounter patients who have both. Patients with dementia types who display early visuoperceptual impairment may present first to ophthalmology services. When these patients have coexisting cataract, it may be difficult to distinguish visual complaints due to cataract from those due to dementia. The interaction between visual impairment due to cataract and neurodegenerative disorders affecting the central visual pathways, is not fully understood. Visual impairment due to cataract may stress impaired attentional mechanisms and cataract extraction may improve cognitive performance in some patients with early cognitive impairment; however, the benefits of cataract surgery in established dementia are less clear. In this study, the literature on this subject was reviewed and the implications for practice were considered. [ABSTRACT FROM AUTHOR]

Aim: To report the authors' experience with the use of opaque intraocular lenses (IOL) in diplopia unresponsive to traditional management strategies, and to assess patients' satisfaction and the visual function of patients following insertion of opaque IOL using the Visual Function Index (VF-14). Settings: Royal Victoria Infirmary, Newcastle upon Tyne, UK. Method: Data were obtained on all patients who underwent insertion of an opaque IOL at our institution between 2002 and 2006. Patients were interviewed by telephone. Any visual function impairment was assessed using the VF-14 questionnaire. Patients were also asked to score subjectively their overall satisfaction with the visual outcome after opaque IOL insertion. Results: The authors studied 12 patients In = 12) who had insertion of opaque IOL. All patients had constant and persistent diplopia unresponsive to other treatments acceptable to the patient. The median duration of diplopia was 5.5 years (interquartile range was 2.4-17.3 years). The postoperative VF-14 ranged from 75 to 100, and the mean VF-14 was 91(95% CI 83-991. Three patients reported a maximum score of 100. Patient satisfaction ranged from 2 to 4, and the average was 3.4 out of 4. Conclusions: Opaque IOL insertion is a valuable option in the management of intractable diplopia. The VF-14 revealed very little or no impairment in visual function following the procedure. All patients reported improvement in their visual function and were pleased with the final outcome. [ABSTRACT FROM AUTHOR]

Aims: To establish the range of normal distance stereoacuity in young children using the Frisby Davis distance stereotest (FD2). Methods: Children passing preschool vision screening assessments underwent measurement of distance stereoacuity with the FD2 using a standard testing protocol. Results: 59 visually normal children aged between 36 months and 68 months were recruited to this study. All 59 were able to understand the test requirements and were examined with the FD2 stereotest. Four (6.8%) had no measurable stereoacuity; 13 (24%) had stereoacuity measurable only at a 3 metre testing distance (mean 92.3 seconds of arc; SD 52.6). These children were significantly younger than the remaining 42 (76%) who demonstrated a stereoacuity response at a 6 metre testing distance (mean 29.6 seconds of arc; SD 13.1, p=0.008). Conclusion: The FD2 stereotest enables the measurement of distance stereoacuity in young children. There appears to be a maturational effect with distance stereoacuity improving between 36 months and 68 months. The data on age related normal values will provide a baseline from which to compare outcomes in clinical populations. [ABSTRACT FROM AUTHOR]

Aims: To assess cognitive function in school age children with congenital pituitary hormone deficiency (PHD). Methods: Ten children with PHD (aged 6.0-15.6 years, mean 11.5 years) and sibling controls (aged 8.7-14.9 years, mean 12.1 years) were assessed using the Wechsler Intelligence Scale for Children (WISC-III UK). Results: The patients' full scale IQ scores were all below average (mean 75, 95% CI 70-80), but were not significantly different to those of sibling controls (mean 82, 95% CI 75-89). There was no difference in verbal IQ between patients and siblings, but performance IQ was significantly reduced (mean 75, 95% CI 68-82 in patients; mean 88, 95% CI 80-96 in sibling controls). The reduced performance IQ reflected a poorer performance in tasks assessing perceptual organisational skills. Conclusions: Data suggest that children with PHD have an IQ that is below average when compared to the population norm and a reduced performance IQ when compared to sibling controls. This may reflect abnormal brain development or could be linked to the impact of hypoglycaemia or low thyroxine concentrations in early life. This information is of value when counselling parents and planning a child's care and education, although further, more extensive studies of patients and siblings are required. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity. Design: Randomised controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after one year of follow up. Setting: Eight UK eye departments. Participants: 177 children aged 3-5 years with mild to moderate unilateral impairment of acuity (6/9 to 6/36) detected by screening. Results: Children in the full and glasses treatment groups had incrementally better visual acuity at follow up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050 to 0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36 to 6/18 at recruitment) and no significant effect in the mild acuity group (6/9 to 6/12 at recruitment) (P=0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, six months after the end of the trial, there was no significant difference in acuity between the groups. Conclusions: Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness. [ABSTRACT FROM AUTHOR]

Background: Previous studies comparing different models of neonatal intensive care have generally not been population based. The objective of this study was to compare the perinatal services of two total populations. Methods: Observational study based on two geographically defined populations: the whole of Denmark (some centralisation of neonatal intensive care but most delivered locally by small perinatal centres-48 in total) and the Trent Health Region of the UK (no formal centralisation however deliveries almost all focussed on 16 major hospitals with > 90% of the intensive care provided by 13 hospitals). Information was recorded about the course of every liveborn infant < 28 weeks gestation and or < l000g birth weight and &ges; 21 weeks gestation in 1994 and 1995. Results: Despite having a smaller population the number of liveborn children meeting the study criteria was significantly higher in Trent (Demark 461 (3.3 per 1000 births, 95% confidence interval (CI) 3.0 to 3.6); Trent 572 (4.9 per 1000 births, 95% Cl 4.5 to 5.3)). In Denmark 91.1% of these infants were admitted for intensive care and 85.5% in Trent. Despite significantly more Trent infants being exposed to antenatal steroids their outcome was worse (median Clinical Risk Index for Babies (CRIB) score 7 v 4; proportion receiving ventilation 87.6% v 40.0% ; survival to discharge (uncorrected for disease severity) 42.3% v 35.0%). Conclusion: The population characteristics of Trent seemed to produce a higher prematurity rate compared to Denmark. These infants as a group appeared sicker and, despite more intensive care delivered by a more specialised service, outcomes were worse. [ABSTRACT FROM AUTHOR]

Objectives: To assess the quality of care and timing of possible asphyxial events for infants with neonatal encephalopathy; to compare the quality of care findings with those relating to the deaths from the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI); and to assess whether the confidential enquiry method is a useful clinical governance tool for investigating morbidity. Design: Independent, anonymised, multidisciplinary case reviews. Selling: Trent Health Region, UK. Patients: All cases of grade II and III neonatal encephalopathy born in 1 997, excluding those due to congenital malformation, inborn error of metabolism, or infection. All CESDI deaths thought to have resulted from intrapartum asphyxia in 1996 and 1997. Main measures: Quality of care provided, timing of possible asphyxia1 episodes, and the source and timing of episodes of suboptimal care. Results: Significant or major episodes of suboptimal care were identified for 64% of the encephalopathy cases and 75% of the deaths. An average of 2.8 and 2.5 episodes of suboptimal care were identified for the deaths and encephalopathy cases respectively. Over 90% of episodes involved the care provided by health professionals. Results were fed directly back to the units concerned on request and changes in practice have been reported. Conclusions: The findings were very similar for the encephalopathy cases and the deaths. We have demonstrated that with minor adaptations the CESDI process can be applied to serious cases of morbidity. However, explicit quality standards, control data, and a more formal mechanism for the implementation of findings would strengthen the confidential enquiry process as part of clinical governance. [ABSTRACT FROM AUTHOR]

Determines the association of leatherwork with male infertility in Leicestershire, England. Development of oligozoospermia; Investigation on the effects on sperm motility and deformity; Risk factors for teratozoospermia.

A baby girl with some of the stigmata of Down's syndrome was found to be a mosaic with three different cell lines: 45,XX,-13,-21,+t(13q21q)/(46,XX/46,XX, -21,+t(21q21q). The chromosome rearrangements detected in this patient appear to have arisen de novo. In the normal cell line the terminal end of the p arm of one chromosome 21 is thought to have been damaged. It seems probable that this is related to the other chromosomal anomalies found. [ABSTRACT FROM PUBLISHER]

An analysis of congenital malformations, other than neural tube defects, which have contributed to perinatal mortality in Leicestershire is presented for the years 1976 to 1982 inclusive. Chromosomal, single gene, or polygenic inheritance accounted for 67% of cases. [ABSTRACT FROM PUBLISHER]

Five probable cases of Meckel's syndrome have been ascertained retrospectively through the Leicestershire Perinatal Mortality Survey for the years 1976 to 1982. All of these babies were born to Hindu parents originating from the Gujarat State in India, suggesting that Meckel's syndrome is particularly common among this ethnic group, with a gene frequency of approximately 0.028. [ABSTRACT FROM PUBLISHER]

To provide an objective rapid means of excluding extrahepatic biliary atresia (atresia), a hepatic index was devised from the ratio of the net hepatic to cardiac distribution of 99mTc diisopropyl iminodiacetic acid or methylbrom iminodiacetic acid between 2.5 and 10 minutes after injection. The hepatic index was compared with subjective assessment of abdominal scintigraphy performed repeatedly over 24 hours. In 22 infants with hepatitis the hepatic index ranged from 5.03 to 14.9, one having no excretion on scintiscan. In 26 infants with atresia the index ranged from 0.49 to 4.26 and in two with paucity of intralobular bile ducts it was 1.85 and 3.69. None of these infants had excretion apparent on scintiscans. Similarly, low hepatic indices occurred in four infants with liver dysfunction but pigmented stools, three of whom had no excretion apparent on scintiscans. These preliminary studies suggest that a hepatic index of greater than 5 is much more rapid and as specific in excluding atresia as repeated abdominal scintigraphy. [ABSTRACT FROM AUTHOR]

Reports issues related to medicine. Assessment on the disappointment and distress experienced by parents in stillbirth; Analysis on the allergic reactions to soya flour; Evaluation on the responsibilities of medical consultants on health service.

Examines the course of patients discharged early after myocardial infarction. Survival of the patients after discharge; Influence of short inpatient care on mortality; Advantage of a discharge policy for patients with myocardial infarction.

AIMS: To investigate the incidence of acute and cicatricial retinopathy of prematurity (ROP) in a cohort of premature neonates entered into a randomised, multicentre trial of prophylactic exogenous surfactant for respiratory distress syndrome (RDS) compared with controls receiving surfactant only if severe RDS developed. METHODS: The incidence of acute and cicatricial ROP was assessed in 304 neonates born at less than 30 weeks' gestation in a geographically defined population of approximately three million. RESULTS: There was a trend towards improved survival in the group receiving prophylactic surfactant with 102/151 (67.5%) surviving compared with 82/141 controls (58.2%, p = 0.12). The prophylactic surfactant group would be expected to have an increased risk of ROP due to improved survival, particularly of the most premature infants. However, there was no statistically significant difference in the incidence of acute ROP between the two groups and the incidence of cicatricial ROP was lower in the group receiving prophylactic surfactant (4/100 survivors, 4.0%) compared with neonates receiving rescue surfactant as required (6/81, 7.4%). This difference did not reach statistical significance (p = 0.35). CONCLUSION: The trend for a lower incidence of cicatricial ROP in those neonates treated with prophylactic surfactant compared with the rescue surfactant group, despite improved survival, suggests that the use of prophylactic surfactant also had a beneficial effect on the development of cicatricial ROP. [ABSTRACT FROM PUBLISHER]

Results of a survey of elderly people living at home suggest that 8% suffer from important degrees of urinary dysfunction and are accessible to community based services. Supply of NHS incontinence aids was inadequate, and improvements in provision are recommended. Attendance at a continence clinic established for the survey period suggests a need for additional specialist services to be made available close to home. Correspondence between actual and predicted cystometric diagnosis provides encouragement to develop simple, valid assessment procedures as an aid to patient management. For the average District Health Authority serving a population of 250 000, two continence nurse advisers and 50 continence clinic sessions per annum are recommended for people aged 75 and over. [ABSTRACT FROM PUBLISHER]

The physical status of all people aged 75 and over living in and around Melton Mowbray was assessed by the responses to a series of questions on the activities of daily living that the respondents could perform. Three methods of producing an index of disability from these separate questions are investigated: principal component analysis, Guttman scaling, and a variation of Guttman scaling known as severity grading. All the methods produced very similar rankings of persons, confirming the suggestion of Bebbington that the choice of scaling method is of little consequence. Two scales emerged: one measuring physical ability and the other the level of urinary and faecal incontinence. [ABSTRACT FROM PUBLISHER]

A census in which 4514 people aged 65 and over had been enumerated in all types of institutional care both within and outside the National Health Service in Leicestershire was taken as a starting point for the present investigation. This entire population was followed up for one year to determine its mortality experience. Mortality was described by three measures: (a) the proportion surviving for one year from the date of the census, (b) the standardised mortality ratio (using the population of Leicestershire in 1977 as a standard), and (c) using a life-table analysis, the percentage survival to specified time periods after admission to institutional care. We discuss the relationship of these indices to functional capacity, indicated by the ability to undertake basic activities of daily living (ADL), and to type of institution. [ABSTRACT FROM PUBLISHER]

Comments on several issues related to medical care in Great Britain. Risk of Down's syndrome and amniocentesis rate; Information on urinary incontinence in women; Discussion on Marfan's syndrome.

The hands of 10 patients with rheumatoid arthritis were investigated with diphosphonate scanning and radiology. Increased uptake of isotope can be associated with some erosions but not all and also reflects other processes more linked to acute inflammatory areas unassociated with the development of erosions. If the latter are the hallmark of active rheumatoid arthritis then bone scans are not. [ABSTRACT FROM PUBLISHER]

Presents several correspondence on health in Great Britain. Issues on coronary care unit; Criticisms on the utilization of oestrogen treatment for endometrial carcinoma; Emphasis on the subject of chronic bronchitis.

AIMS: To determine lipid profiles and associations with other metabolic disease in a representative British elderly population. METHODS: Part of a prevalence survey of dementia in all 75+ year olds conducted from the large general practice serving the town and surrounding area of Melton Mowbray, Leicestershire (the M-old study). Patients (n = 224) aged from 75 to 98 years, and representative of the overall population, also provided pre-prandial blood samples on which various age and nutrition related analytes were determined. These included documented medical history, thyroid stimulating hormone (TSH), glucose, immunoglobulins, and lipid profile in plasma. RESULTS: Cholesterol and lipid variables showed wide scatter, with some negative trends but no significant associations with age for total cholesterol, high density lipoprotein (HDL) cholesterol, the ratio of total to HDL cholesterol or triglycerides. Women had significantly higher concentrations of total and HDL cholesterol at all ages. Serum TSH was above 6.0 mU/1 in 10/205 patients, random glucose was above 11.2 mmol/l in nine of 207 patients, borderline dysglobulinaemia was present in four of 210 patients, all without correlation with cholesterol concentrations. CONCLUSION: This British data is consistent with an inverse correlation between survival and cholesterol, but wide scatter restricts reliance on single result lipid data in individual patient management. Random lipid screening is also unhelpful, inefficient and without added value in revealing other age related and unrecognised occult metabolic disease. [ABSTRACT FROM PUBLISHER]

Background: Obstructive sleep apnoea, and possibly snoring, are associated with a poorly understood increase in cardiovascular mortality which may be explained by their effects on systemic blood pressure during sleep. This study compares changes in mean blood pressure during obstructive sleep apnoea and snoring without apnoeas with those in matched control subjects during non-REM sleep.Methods: Eighteen men with obstructive sleep apnoea, 16 men who snored without apnoeas, and 34 control subjects matched for age, sex, obesity, smoking, and alcohol intake were studied. During polysomnography non-invasive mean blood pressure (Finapres) was recorded from each cardiac cycle during non-REM sleep and averaged over a 10 minute period. This was compared with the blood pressure during 10 minutes before sleep onset. The changes in the patients' sleeping blood pressure were compared with those in their individually matched control subjects.Results: Compared with the control subjects the change in mean (SD) arterial blood pressure between being awake and asleep was higher during obstructive sleep apnoea (+6.5 (9) mm Hg v-2 (6.5), difference 8.5 (11)), and the rise from wakefulness to sleep in the obstructive sleep apnoea group was itself significant. The average mean arterial pressure was not raised in those who snored without apnoeas compared with either the control subjects or during wakefulness.Conclusions: Average mean arterial pressure is higher during obstructive sleep apnoea than it is during wakefulness, while normal subjects show a fall in blood pressure at sleep onset. This sleep related rise in blood pressure may contribute to the excess cardiovascular morbidity and mortality experienced by patients with this condition. [ABSTRACT FROM AUTHOR]

Background: Respiratory sleep studies are frequently performed to identify sleep disruption resulting from upper airway obstruction. Traditional polysomnographic studies may not detect brief recurrent sleep disruption and thus fail to recognise a significant problem when apnoea, hypopnoea, or arterial desaturation are not present. Arousal from sleep causes a transient blood pressure rise, and each inspiration causes a transient blood pressure fall. This study assesses whether these blood pressure changes are a useful indirect marker of disturbed sleep, obstructed sleep apnoea, and snoring related sleep disturbance.Methods: Computer algorithms were developed to identify blood pressure falls caused by inspiration and rises related to arousal from 286 sleeping blood pressure samples of a consistent respiratory state drawn from 51 polysomnographic studies. From these samples, normal ranges for the number of arousal related systolic rises and the average size of the inspiratory falls were established. These were then applied prospectively to all night unedited blood pressure recordings from a further 20 subjects.Results: The size of the inspiratory falls in blood pressure progressively increased from normal sleep, through snoring, to frank obstructive sleep apnoea. The 95th centile of normal was 12.5 mm Hg. The number of arousal related blood pressure rises also increased during obstructive sleep apnoea and periods of snoring with associated arousals, compared with normal undisturbed sleep, and all these periods of disturbed sleep included more than 30 such rises per hour. When these blood pressure features were examined in the 20 subjects studied prospectively, the six with a sleep related breathing disorder could all have been identified from their systolic blood pressure profile alone.Conclusions: The systolic blood pressure profile may be helpful in identifying patients with obstructive sleep apnoea, snoring with arousals, or other sleep disruption syndromes. [ABSTRACT FROM AUTHOR]

Gastric emptying was measured using a gamma camera in 22 patients with anorexia nervosa, in 10 patients of normal or high weight with bulimia nervosa and in 10 controls. Patients with anorexia nervosa were tested (1) while underweight and selecting their own diet (10 patients); (2) underweight, but receiving an adequate diet on an inpatient unit (refeeding diet) (12 patients); and (3) under refeeding diet conditions after weight gain (eight patients). Three meals, each labelled with technetium 99m-sulphur colloid, 3.7 MBq were used: (1) a mixed solid meal containing labelled poached egg; (2) 200 ml d-glucose solution, 0.5 kcal/ml, and (3) 200 ml physiological saline. Only gastric emptying rates of the solid meal and glucose solution were significantly delayed. Gastric emptying of saline was normal. The gastric disturbance was confined to patients with anorexia nervosa selecting their own diet. Patients receiving adequate nutrition on the ward had normal gastric emptying and weight gain in this group had no significant effect on emptying. Slow emptying was observed in patients who maintained a low weight solely by food restriction as well as in patients whose anorexia nervosa was complicated by episodes of bulimia. Thus, slow gastric emptying occurred when the quantity of food reaching the duodenum was sufficiently reduced to result in severe weight loss. Moreover, abnormal gastric emptying was seen only after the two meals that contained calories and were hypertonic to plasma, either of which properties could mediate the disturbance. Gastric emptying in bulimia nervosa was normal. Slow gastric emptying could exacerbate undereating in starving patients with anorexia nervosa by enhancing satiety. [ABSTRACT FROM PUBLISHER]

Sixty-four patients with transient ischaemic attacks were investigated for the presence of an associated cardiac arrhythmia. 24-hour ambulatory monitoring showed arrhythmia in 41% of patients where the standard ECG had shown arrhythmia in only 25%. Significant arrhythmias were found in 21% of patients with focal transient ischaemic attacks on prolonged monitoring as compared to 7% in a control group. Where arrhythmias were specifically treated there was abolition or improvement of neurological symptoms. [ABSTRACT FROM AUTHOR]

Twenty-seven migraine headache patients were divided into three equal groups which received thermal biofeedback, frontalis EMG biofeedback, or relaxation training. Training was given under "massed" practice conditions (nine sessions per week) and consisted of 18 training sessions and six test-generalisation sessions. While improvements in headaches were observed in all groups, the best improvements took place in the thermal biofeedback group, which had almost complete elimination of migraine attacks by the end of training, and maintained that performance as long as six months after training. Examination of the patterns of skin temperature and EMG changes in the three groups over the course of training also points to a relationship between skin temperature control and reduction in migraine headache symptomatology, and suggests that this relationship is worthy of further investigation. [ABSTRACT FROM AUTHOR]

Estimates of the population prevalence of peptic and duodenal ulceration in men aged between 25 and 64 years were made in the London borough of Lambeth. The sampling frame for these estimates was a 20% private census. The lifetime prevalence rate of proved peptic ulcer (haematemesis, gastric and duodenal ulcers as validated by operation or barium meal), adjusted for age and social class, was estimated to be 6-7%, while the similarly adjusted lifetime prevalence for duodenal ulcer was 4-4%. The lifetime prevalences increased with age but not significantly so. A social class gradient was demonstrated with the highest prevalence in social class I and II. Previously described associations with blood group, secretor status, and serum pepsinogen were confirmed. Reported use of medical services increased with increasing severity of symptoms. A large number of respondents, however, who reported symptoms reported no medical care. It seemed unlikely that those men who reported symptoms and no medical care had demonstrable peptic ulcers. [ABSTRACT FROM PUBLISHER]

Comments on issues related to medicine in Great Britain. Overall prevalence of diabetes and the prevalence of classical insulin dependent diabetes in Asians; Treatment of severe falciparum malaria; Possibility of outbreaks of falciparum malaria.

Presents letters related to medicine. Treatment of sleep problems in children; Value of maternal alpha-fetoprotein screening programmes; Benefits of venesection.

Two influenza epidemics in Britain in 1968-9 and 1969-70, were due to the Hong Kong/68 variant of influenza A2 virus. The first epidemic was prolonged with low morbidity and mortality rates; the second was sharp with high rates. The difference between total morbidity and mortality in the two epidemics, however, was less than it appeared to be—the estimated excess morbidity and mortality due to all causes in 1969-70 was only about 50% greater than in 1968-9. Antibody studies showed that about one-quarter of two groups of adults investigated were infected in the first epidemic and about one-third in the second. After the two epidemics about one-third still had no antibody to the A2/Hong Kong/68 virus. [ABSTRACT FROM PUBLISHER]

Background: Studies of distance stereoacuity in intermittent exotropia suggest that normal stereoacuity corresponds to good control of the deviation and that reduced or negative stereoacuity signifies poorer control. Aim : To evaluate distance stereoacuity in intermittent exotropia using the Frisby Davis Distance stereo test (FD2). Methods: Children with intermittent exotropia where the near angle was less than or equal to distance were eligible for recruitment. Standardised prospective data collection included FD2 distance stereoacuity. This was a longitudinal study in which outcomes are reported for baseline, last follow-up (‰6 months before any surgery) or preoperative and last postoperative visits for those undergoing surgery. Results: 110 children with intermittent exotropia had FD2 stereoacuity tested at baseline: 70 comprehended the test. Mean (standard deviation (SD)) age was 4.6(1.7) years (range 2-10 years). 41/70 (59%) showed positive responses: mean (SD) stereoacuity 30 (12) s of arc. The mean follow-up period before any surgery was 13 months (range 6-27 months). At follow-up, mean (SD) stereoacuity was 24 (11) s of arc. Preoperative and postoperative stereoacuity were not significantly different from those not undergoing surgery. Conclusion: This study was the first to report distance stereoacuity in intermittent exotropia using the FD2 stereo test: patients with intermittent exotropia can achieve normal levels of distance stereoacuity, but a considerable proportion, despite comprehending, showed a negative response. This suggests that using the FD2, distance stereoacuity in intermittent exotropia is either absent or normal rather than reduced. Possible reasons for this and its implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Unilateral visual impairment (UVI) as a result of amblyopia or refractive error is common in childhood, but its functional significance remains largely unexplored. Aim: To investigate the influence of visual acuity and stereoacuity on the performance of preschool children on tasks requiring visuomotor skills and visuospatial ability. Methods: Children with normal (6/6) visual acuity (VA) in both eyes and children with UVI ranging from 6/9 to 6/60, with no strabismus and normal vision in the fellow eye, were assessed on a neurodevelopmental test battery of visually guided tasks. Results: 50 children (mean age (SD): 52.4 (5.7) months; median (range) VA: 6/9 (6/6 to 6/60); median (range) stereoacuity: 70 seconds arc (40-absent)) completed the test battery. UVI and stereoacuity correlated moderately (Pearson's r=0.537, p<0.001) but seven of 28 children with impaired VA had normal stereoacuity (<70 seconds arc) while five of 22 with normal VA had abnormal stereoacuity. Stereoacuity correlated with performance on a task requiring fine hand-eye coordination and a task measuring visuomotor integration. UVI did not correlate with performance on any test battery items. Conclusions: UVI itself does not appear to relate to visuomotor actions, except when associated with reduced stereoacuity. Stereoacuity appears to have an influential role in fine visuomotor actions and spatial representation in preschool children. [ABSTRACT FROM AUTHOR]

Aim: To describe the development and application of a novel scoring system for grading the severity of intermittent distance exotropia (IDEX) and its potential application as an intervention criterion for surgical intervention. METHODS: The Newcastle Control Score (NCS) for IDEX was developed by incorporating both subjective (home control) and objective (clinic control) criteria into a scale to grade severity. The score structure described was evaluated for interobserver and test-retest reliability. To determine an optimal score threshold for surgical intervention, 170 cases of IDEX were scored retrospectively. Cure rates for surgical and non-surgical cases were then compared according to preoperative or presenting scores. RESULTS: Interobserver and test-test reliability were good (r = 0.82 and r = 0.89 respectively). Total cure rate with surgery was 54% and without surgery 18% (chi(2) = 23.093, df = 1, p<0.001). Significantly fewer patients with NCS >/=3 achieved cure without surgery than those with NCS 2 (chi(2) = 3.362, df = 1, p<0.047). CONCLUSIONS: The NCS is a reliable method for grading the severity of IDEX and aids decisions regarding intervention. Patients with a score of 3 or more are unlikely to attain a cure without surgery. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about an autosomal dominant syndrome.

Focuses on importance of the information presented when making referrals to an antenatal clinic. Deficiencies of the details of care provided for by midwives and general practitioners; Emphasis on the information needed and the rationale for collecting the information; Importance of the data from all information sources to the completion of a structured questionnaire.

Examines the lethal malformations and perinatal mortality. Percentage of lethally malformed babies; Increase on the incidence of malformations in the Asian population; Contribution of lethal malformations to perinatal mortality.

Traditional superior oblique weakening procedures may be unpredictable and lead to superior oblique underaction. The use of 240 retinal band as a spacer to lengthen the superior oblique tendon has been proposed as a more controlled approach than superior oblique tenotomy and related procedures. The use of this technique is reported in a patient with diplopia following an orbital floor blow out fracture, and in a child with Brown's superior oblique tendon sheath syndrome. [ABSTRACT FROM PUBLISHER]

STUDY OBJECTIVE--The aim was to explore the relationship between dementia, impairment of mobility, and incontinence and the implications for management. DESIGN--The study was a survey of a sample population drawn from a general practice register. SETTING--A large general practice serving the entire population of Melton Mowbray, Leicestershire, UK. PARTICIPANTS--Of 1329 persons aged 75 or over, 1203 (90%) took part in the survey. Of non-responders, refusers accounted for 5%, deaths 4%, and failure to trace 1%. MEASUREMENTS AND MAIN RESULTS--12% of the population complained of incontinence. No more than 24% of these cases were demented. Dementia and isolated locomotor problems were significantly associated with presence of incontinence, but 31% of cases were completely free of either problem. A minimum estimate of 56% of cases of incontinence were considered to be due to local physical disorders of the bladder. CONCLUSIONS--A search for local disorders causing incontinence is important, and more attention should be paid to the management of locomotor problems and possibly depression in the relief of incontinence. [ABSTRACT FROM PUBLISHER]