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“Years later, to the philosopher Hippolyte Taine, Flaubert gave his most precise account of grand mal aura. ‘First there is an intermediate anguish, a vague malaise, a painful sensation of waiting, as before poetic inspiration, when one feels that something is going to come (a state comparable only to that of the fornicator feeling his sperm well up before discharge. Do I make myself clear?). Then suddenly, like a thunderclap, the invasion or rather, the instantaneous eruption of memory, for in my case the hallucination is, strictly speaking, nothing but that. It is an illness of memory, of slackening of what holds it in. One feels images escaping like torrents of blood. One feels everything in one’s head is bursting all at once like a thousand pieces of a fireworks display, and one does not have time to look at the internal images furiously rushing past. In certain circumstances, it begins with a single image that grows larger, develops, and in the end covers objective reality, like, for example, an errant spark becoming a conflagration. In the latter case, one can turn one’s mind to other thoughts, and this gets confused with what we call black butterflies, that is little fattened discs that some people see floating in the air when the sky is grayish and their eyes are tired.’ An American neurologist, John M C Burst, has described this phenomenon as something wholly internal and representing an exhibition of the mnemonic process where the very act of remembering as much as the summoning of specific memories.”

Although the pathophysiology of autism has yet to be defined some of the genetic aspects of the disorder are being clarified. Mutations of the gene called MECP2 causes Rett syndrome, a severely physically disabling disorder within the autism spectrum. Investigators from the University of Edinburgh have shown that reactivating MECP2 in mice reversed their neurologic damage. No doubt, many genes are involved in causing the common forms of autism but this development provides promise for future investigations of the genetic aspects of autism. (

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Macular edema occurs in association with a number of ocular and systemic disorders. Effective treatment for it has not yet been developed. Nevertheless, intravitreal dexamethasone has proved effective in the short- term. A multi-centered trial has recently been completed on the use of an intravitreal dexamethasone drug delivery system. In this trial a single dexamethasone treatment provided statistically significant improvement in macular edema for 90 days after treatment and was tolerated for 180 days. Further long-term studies will be necessary in order to document specific ocular complications of this therapy, especially cataract formation, but these preliminary results are promising. (

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The one and half syndrome consists of an unilateral gaze palsy with a contralateral internuclear ophthalmoplegia. Physicians from the University of Iowa have reported the first case of what they refer to as half and half syndrome consisting of a unilateral internuclear ophthalmoplegia and ipsilateral six nerve palsy. They report a case of traumatic injury to the brain stem in which a dorsal pontine hemorrhage occurred and involved the left medial longitudinal fasciculus and the six nerve fasciculus but sparing the six nerve nucleus. They suggest that lesions in this area can present with this unique ocular motility disturbance. (

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Antioxidants seem to be useful in preventing certain aging cellular responses in the laboratory. Their use in clinical medicine is less clear. Alarmingly, a recent review of 68 trials of antioxidant therapy supplementation suggests that antioxidant supplements may actually increase mortality by 5% compared with placebo. The authors suggest this is a conservative estimate since trials reporting harm are more likely not to be published. This has particular importance for ophthalmologists who have accepted the recommendation of advising patients with early, age- related macular degeneration of the wisdom of antioxidant supplementation. Further specific studies addressing this question of increased mortality and their usefulness in ocular disease are urgently needed. (

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The term “epigentics” refers to the study of changes in gene expression that do not involve changes in the genetic code. Epigenetic analysis could be a major component of developing personalized therapy for cancer treatment. By diagnosing the epigenetic characteristics of a tumor, one might be able to develop drugs more efficacious and better tolerated by patients. A recent study found 12 different types of biomarkers in prostate cancer that did not match previous histologic classifications. Ophthalmologists are aware of the ground-breaking and promising work in St. Louis investigating biomarkers in ocular melanoma. (

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It is well accepted that consumption of fish is an important part of every healthy person’s diet. Precisely how much fish should be consumed is a matter of argument however. This is particularly true in the case of pregnant women where fish contaminated with mercury is a potential hazard for the developing fetus. Nevertheless, a study from Bristol suggests that women who are pregnant should eat more than three portions of seafood each week. In this study children of mothers who ate less seafood had poorer verbal IQ’s, less positive social interactions and poorer fine motor communication and social development scores.Further studies assessing the potential benefits and risks of fish consumption are obviously required. (

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Diabetes continues to be an epidemic especially in the richer countries. In 1995, approximately 5% of the adult population of Ontario, Canada had diabetes. Ten years later in 2005, that prevalence had increased to nearly 9% (8.8%). Mortality however fell approximately one quarter during that ten-year follow-up period. Nevertheless, if prevalence rates continue to rise as they have in the last decade one would expect that more than one in ten adults living in Ontario would have diabetes by 2010. (

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Confusion as to the usefulness of stents for the treatment of cardiovascular disease is noteworthy. A recent study suggested that stenting single coronary artery disease was no more effective than aggressive medical therapy. Now a report compares bare metal stents with drug eluting stents. In this study a Swedish group found that after six months the risk of death started to increase for people treated with drug eluting stents as compared to those with bare metal stents. The authors of this article suggest that the use of drug eluting stents should be re-evaluated and their Off-label use should be discouraged. (

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