This analysis reveals decreased concentrations of homovanillic acid (HVA), 5-hydroxyindolacetic acid (HIAA), and elevated levels of 7,8-dihydrobiopterin, a compound produced in the synthesis of neurotransmitters. Sepiapterin is not detected by the regularly used methods applied in the investigation of biogenic monoamine metabolites in the cerebrospinal fluid. It must be determined by specialized methods that work by indicating a marked and abnormal increase of sepiapterin in cerebrospinal fluid. Confirmation of the diagnosis occurs by demonstrating high levels of CSF sepiapterin and a marked decrease of SR activity of the fibroblasts along with SPR gene molecular analysis. Treatment
Levodopa and Carbidopa
SR deficiency is currently being treated using a combination therapy of levodopa and carbidopa. These treatments are also used for individuals suffering from Parkinsons. The treatment is noninvasive and only requires the patient to take oral tablets 3 or 4 times a day, where the dosage of levodopa and carbidopa is determined by the severity of the symptoms. Levodopa is in a class of medications called central nervous system agents where its main function is to become dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors and it works by preventing levodopa from being broken down before it reaches the brain. This treatment is effective in mitigating motor symptoms, but it does not totally eradicate them and it is not as effective on cognitive problems. Patients who have been diagnosed with SR deficiency and have undergone this treatment have shown improvements with most motor impairments including oculogyric crises, dystonia, balance, and coordination.
In the 19th century, Doyen abdominal retractors were invented by French surgeon Eugène-Louis Doyen. The doyen retractors are auto-static, self-retaining retractors that are used primarily in abdominal OB/GYN procedures. It facilitates the completion of difficult surgeries by providing improved exposure. In the late 19th century, Nicholas Senn, an early adopter of Listerism, felt that having a smooth surface on a surgical instrument was important to help to prevent infection. Thus, he developed what is now called the Senn retractor, a double-ended retractor with an end of three bent prongs that may be dull or sharp, and it was often used in plastic or vascular surgery procedures. The Weitlaner retractor, invented by Franz Weitlaner in 1905, is a self-retaining, finger ring retractor with a cam ratchet lock used for holding back tissue and exposing a surgical site that allows the surgeon to activate using a single hand. His invention inspired the invention of more retractors, such as Adson-Beckman retractors for general surgery and Chung retractors for orthopedic surgery. Forceps
Back in the 6th century BC, laboring caused a high mortality rate for both mothers and newborns due to the hours or days of the lasting delivery process. This problem led to the establishment of forceps-assisted delivery in the 16th century by the Chamberlen family. Forceps were later developed over several centuries by leading obstetricians of the time including James Simpson, Neville Barnes, and Christian Kielland. Michael Ellis DeBakey invented one of the most common and well-known DeBkey biceps.