Subclinical endophthalmitis following a rooster attack

Ocular injury resulting from rooster attacks is rarely reported in the literature. Sadly, the target of these attacks is most often children younger than 3 years old, whose naiveté of the aggressive, territorial behavior of birds can place them at risk. Acute sequelae of these attacks can result in a lifetime of visual impairment. The possibility of a subacute or occult infection is an unusual occurrence that must always be considered. In an effort to prevent future attacks and ocular casualties, we present a case of a 12-month-old boy who suffered an open globe following a rooster attack. The open globe was emergently repaired. One week later, a white cataract was noticed on examination in the absence of systemic or ocular signs of inflammation. Traumatic endophthalmitis and lenticular abscess were suspected during examination under anesthesia. Vitrectomy, lensectomy, and injection of intravitreal antibiotics were performed. Culture of lenticular and vitreous aspirates grew alpha-streptococcus. Alpha-streptococcal endophthalmitis can result from ocular injuries caused by rooster pecking. The infection may present insidiously and without typical ocular or systemic symptoms or signs. Management is challenging and may require surgery.     

Response to bortezomib (velcade) in a case of advanced bronchiolo-alveolar carcinoma (BAC). A case report

A 65-year-old male with 40-pack year smoking history presented with exertional dyspnea and was subsequently diagnosed with bronchiolo-alveolar carcinoma (BAC). He did not respond to first line therapy with geftinib, but he achieved disease stabilization with gemcitabine and carboplatin for 4 months before developing symptomatic worsening requiring oxygen supplementation. He responded dramatically to bortezomib with rapid symptom improvement. The follow-up computerized tomography revealed partial response that was maintained for 11 months. Based on observations like this and those seen in phase I studies with bortezomib, this agent is being studied now in patients with bronchio-alevolar cancer.     

Delayed suprachoroidal hemorrhage and factor VIII deficiency

PURPOSE: To describe the clinical course of a 52-year-old white man with previously undiagnosed hemophilia who suffered blunt trauma to the right eye with consequent delayed, spontaneous suprachoroidal hemorrhage. DESIGN: Observational case report. METHODS: The patient's clinical course from the time of trauma to postenucleation is discussed and correlated with B-scan ultrasonography and histopathology. RESULTS: The patient developed recurrent hyphemas, delayed choroidal hemorrhage with detachment and eventually loss of the eye. Hematologic evaluation established a diagnosis of mild factor VIII deficiency. CONCLUSION: Despite mild hemophilia, this patient had not experienced any clinically important morbidity until his eye injury. Ophthalmologists should be aware that bleeding disorders such as hemophilia predispose patients to spontaneous intraocular hemorrhage.     

Utility of 3D magnetic resonance imaging in preoperative evaluation of hepatobiliary diseases

Three-dimensional (3D) imaging is playing an increasingly important role in modern diagnostic radiology. The recent improvements in magnetic resonance (MR) hardware, scanning protocols and 3D volumetric reconstruction software have facilitated great expansion of the role of 3D imaging for use in hepatobiliary surgery. In this review, we address the various 3D reconstruction techniques used in MRI and demonstrate the value of 3D imaging in preoperative evaluation of hepatobiliary diseases.     

Signal quality of single dose gadobenate dimeglumine pulmonary MRA examinations exceeds quality of MRA performed with double dose gadopentetate dimeglumine

During a recent multi-center trial assessing gadolinium (Gd)-enhanced magnetic resonance angiography (MRA) for diagnosis of acute pulmonary embolism (PE), the Food and Drug Administration announced a risk of nephrogenic sclerosing fibrosis in patients with renal insufficiency who had received intravenous Gd-based MR contrast agents. Although no patients in this trial had renal insufficiency, in cautious response to this announcement, the trial protocol was changed from an intravenous administration of 0.2?mmol/Kg of a conventional Gd-based MR contrast agent to 0.1?mmol/Kg of gadobenate dimeglumine. The study described herein compares the signal quality of pulmonary MRA performed with double dose conventional agent to single dose gadobenate dimeglumine. This study is a retrospective analysis of data from a prospective, multicenter study in men and women ??18?years with documented presence or absence of PE. The study was approved by the Institutional Review Board at all participating centers, and all patients provided written indication of informed consent. We performed both objective and subjective analysis of pulmonary artery image quality. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the main pulmonary artery were assessed in single and double dose protocols and compared. SNR and CNR of the main PA were correlated with subjective quality assessment of main/lobar, segmental and subsegmental pulmonary arteries. Although there were individual outliers, both SNR (P?=?0.01) and CNR (P?=?0.008) were higher in all quartiles for examinations using gadobenate dimeglumine than with gadopentetate dimeglumine. Subjective quality of vascular signal intensity at each vessel order was significantly better for gadobenate dimeglumine (P?<?0.0001), and correlated well with SNR and CNR at each order (<0.001). Because of agent high relaxivity, a single dose of gadobenate dimeglumine provides better pulmonary MRA signal quality than double dose of a conventional Gd-based MR contrast agent.