Outer Retinal Tubulation in Subretinal Neovascularization Associated with Macular Telangiectasia Type 2

Purpose: To describe characteristics of outer retinal tubulation (ORT) in eyes with subretinal neovascular membrane (SRNVM) associated with Macular Telangiectasia type 2 (MacTel type 2). Methods: A retrospective analysis of longitudinal spectral domain optical coherence tomography (SD-OCT) scans of 46 eyes of 30 patients with SRNVM associated with MacTel type 2 was performed. To identify ORTs, each B-scan image of the macular cube (512 X 128) scan on the Cirrus® SD-OCT was reviewed. Changes in ORT characteristics, including location, size, reflectivity of the borders, and internal reflectivity, were noted during an average follow-up period of 18 months. Results: Ten ORTs were detected in 7 of 46 eyes (15.2%); SRNVM showed no activity in six of these seven eyes. ORT was seen as round or ovoid hyporeflective spaces with hyperreflective borders, and measured 56 to 206 μm in height and 120 to 357 μm in width. An average of 1 bevacizumab injection (range: 0–2) was administered before at least one ORT was diagnosed. The mean interval between the last injection and detection of ORT was 10.2 months (range: 1–48 months). Over the 18-month follow-up period, ORTs were unchanged in four eyes, while in the remaining three eyes ORTs underwent structural changes. Five ORTs disappeared, four new ORTs appeared, and one ORT disappeared and reappeared. The size and the shape of ORT did not change, except in one case. Conclusion: Outer retinal tubulation can develop in eyes with MacTel type 2 associated SRNVM, with similar characteristics to ORT found in other degenerative diseases. ORTs may undergo dynamic structural modifications over time, with or without ongoing bevacizumab treatment.     

Is proliferative colonic disease presentation changing?

AIM: To compare the site, age and gender of cases of colorectal cancer (CRC) and polyps in a single referral center in Rome, Italy, during two periods.METHODS: CRC data were collected from surgery/pathology registers, and polyp data from colonoscopy reports. Patients who met the criteria for familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study. Overlap of patients between the two groups (cancers and polyps) was carefully avoided. The χ² statistical test and a regression analysis were performed.RESULTS: Data from a total of 768 patients (352 and 416 patients, respectively, in periods A and B) who underwent surgery for cancer were collected. During the same time periods, a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies (428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B). A proximal shift in cancer occurred during the latter years for both sexes, but particularly in males. Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio (OR) 3.31, 95%CI: 2.00-5.47; P < 0.0001). A similar proximal shift was observed for polyps, particularly in males (OR 1.87, 95%CI: 1.23-2.87; P < 0.0038), but also in females (OR 1.62, 95%CI: 0.96-2.73; P < 0.07).CONCLUSION: The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade, particularly in males.     

Teaching advanced operation of an iPod-based speech-generating device to two students with autism spectrum disorders

We evaluated a program for teaching two adolescents with autism spectrum disorders (ASD) to perform more advanced operations on an iPod-based speech-generating device (SGD). The effects of the teaching program were evaluated in a multiprobe multiple baseline across participants design that included two intervention phases. The first intervention focused on teaching the students to navigate between two screen pages and complete a multi-step response sequence to request preferred stimuli. The second intervention aimed to teach the students to turn on and unlock the device prior to navigating to the correct screen pages. Teaching procedures included response prompting, prompt fading, and differential reinforcement. Results showed that both interventions were effective in teaching the respective operations. Learning advanced operation of the iPod-based SGD could be seen as one way to promote greater independence in using such devices for multi-step communication.     

A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism

Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a mindfulness-based procedure, Meditation on the Soles of the Feet, in helping three adolescents to manage their physical aggression. This procedure required the adolescents to rapidly shift the focus of their attention from the aggression-triggering event to a neutral place on their body, the soles of their feet. Incidents of aggression across the three adolescents ranged from a mean of 14–20 per week during baseline, 4–6 per week during mindfulness training, including zero rates during the last 4 weeks of intervention. Aggression occurred a rate of about 1 per year during a 3-year follow-up. Our results suggest adolescents with autism can learn, and effectively use, a mindfulness-based procedure to self-manage their physical aggression over several years.     

Techniques of biliary drainage for acute cholecystitis: Tokyo Guidelines

The principal management of acute cholecystitis is early cholecystectomy. However, percutaneous transhepatic gallbladder drainage (PTGBD) may be preferable for patients with moderate (grade II) or severe (grade III) acute cholecystitis. For patients with moderate (grade II) disease, PTGBD should be applied only when they do not respond to conservative treatment. For patients with severe (grade III) disease, PTGBD is recommended with intensive care. Percutaneous transhepatic gallbladder aspiration (PTGBA) is a simple alternative drainage method with fewer complications; however, its clinical usefulness has been shown only by case-series studies. To clarify the clinical value of these drainage methods, proper randomized trials should be done. This article describes techniques of drainage for acute cholecystitis.