Adolescents and young adults with Down syndrome (DS) sometimes experience new-onset mood disorder and decline in adaptive skills. The clinical phenomenon is poorly characterized and its pathogenesis is not understood. The possible contribution of obstructive sleep apnea syndrome (OSAS) to this phenomenon has not been studied. Subjects were ascertained as a convenience sample through our clinic for persons with DS and medical or mental health concerns between 2004 and 2009. When mood symptoms were present an axis I diagnosis was made using DSM-IV-R criteria. Subjects without an axis I diagnosis served as controls. The Reiss scales for children's dual diagnosis and the aberrant behavior checklist (ABC) were completed by caretakers. Twenty-eight cases meeting criteria for major depressive episode (MDE) and nine controls without psychopathology were referred for overnight polysomnography (PSG). Functional decline was reported in 19 (68%) of cases with MDE, but none of the controls. Twenty-four (86%) cases had OSAS compared with only 4 (44%) of controls. Moderate-severe OSAS was present in 15 (54%) of cases compared to only 1 (11%) of controls. Intermittent sleep-associated hypoxia and REM sleep deficits were also more frequent in cases. Across all subjects, prior tonsillectomy was not related to the presence or absence of OSAS. Our findings suggest that OSAS may be a common co-morbidity in adolescents and younger adults with DS and depression. Recognition of this association maybe critical to understanding the pathogenesis and management of mood-related disorders, and functional decline in affected individuals.

The prevalence of autoantibodies to ribonucleoprotein antigens in cases of congenital heart block was established using immunofluorescence, counterimmunoelectrophoresis, double immunodiffusion and Western blots. All of 35 mothers of babies with congenital heart block, none of five mothers of babies with other types of heart block, 10 of 29 women with connective tissue disease but no babies with heart block, four of 445 normal pregnant women and two of 109 healthy nonpregnant women had either Ro (SS-A) or La (SS-B) antibodies. Of 15 babies with congenital heart block, 10 of 10 who were less than 3 months old possessed antibody. Antibody titres in affected but not in normal infants were lower compared with their mothers' titres, suggesting deposition of antibodies in the baby's tissues. The findings indicate that placental transfer of anti-Ro (SS-A) or anti-La (SS-B) is essential for development of congenital complete heart block.

Ametop and EMLA topical anaesthetic agents produce effective skin analgesia for venous cannulation. The use of topical analgesia can reduce perceived anxiety about future cannulation procedures. This has application in the management of anxious patients undergoing intravenous sedation, suggesting that topical analgesia prior to venous cannulation may significantly aid anxiolysis.

This study investigated the effect of acute systemic hypotension, induced by pericardial tamponade, on intestinal hemodynamics and oxygenation in 3- and 35-d-old swine. To delineate intrinsic versus systemic responses, the effects of tamponade were compared with those noted after isolated pressure reduction to an innervated in vivo gut loop, achieved by local arterial constriction. Younger subjects demonstrated 16 and 58% increases in vascular resistance during constriction and tamponade, respectively, whereas older subjects exhibited an increase in resistance (27%) only during tamponade. Intestinal oxygen uptake decreased approximately 30% during both constriction and tamponade in the younger group, despite the greater effect of tamponade on gut perfusion. Older subjects exhibited no change in gut oxygenation during either perturbation. In a separate series of experiments, vasopressin, phenylephrine, and angiotensin II, each an element of the systemic pressor response, were infused into in vitro gut loops from 3- and 35-d-old swine. Vasopressin caused sustained vasoconstriction in both age groups; however, phenylephrine and angiotensin II caused greater sustained increases in intestinal vascular resistance in 3- than in 35-d-old intestine. We conclude that systemic hypotension compromises intestinal perfusion to a greater extent in younger subjects, although this effect is not associated with overwhelming tissue hypoxia. The pronounced rise in gut vascular resistance in 3-d-old intestine may reflect the additive effects of intrinsic and systemic vasoactive forces engaged during acute systemic hypotension.

This pilot study evaluated a primary prevention programme delivered to mothers who were considered to be vulnerable to the development of psychological dif®culties (N 11). Bene®cial effects were noted in terms of mood and coping, as well as a reduction in the mothers' attendance at their general practitioners surgery.