Peripapillary haemorrhagic retinal pigment epithelium detachment following radial optic neurotomy

Central retinal vein occlusion is a common vascular cause of blidness. In this paper, we first report focal haemorrhagic pigment epithelium detachment and chorioretinal anastomosis in the peripapillary area as an intraoperative complication of radial optic neurotomy (RON). A 65-year-old white man presented with ischaemic central vein occlusion OS. He underwent vitrectomy with RON, panretinal photocoagulation and intravitreal injection of triamcinolone acetonide. A circumscribed subretinal haemorrhage was noted intraoperatively at the nasal site of the RON. The haemorrhage size decreased at the seventh postoperative day when an optical coherence tomography scan disclosed a haemorrhagic pigment epithelium detachment. Fluorescein angiography and fundus photograph revealed a chorioretinal anastomosis formation nasal to the optic nerve confirmed by indocyanine green angiography. Best-correlated visual acuity improved from hand movements to 6/18 at the fourth week and it was stable until last examination. This case illustrates the role of chorioretinal anastomosis formation in the vision improvement following RON.     

Real-time atomic force microscopy of root dentine during demineralization when subjected to chelating agents

AIM: To explore the potential of atomic force microscopy (AFM) for the examination of changes to dentine surfaces during demineralization and evaluate qualitatively the effect of EDTA, EDTAC and citric acid. METHODOLOGY: Nine canine teeth were sectioned transversely at the cemento-enamel junction, and the crowns discarded. Subsequently, each root was embedded in an epoxy cylinder and discs approximately 5 mm thick were cut. A standard metallographic procedure was then used to prepare the surfaces for observation. From the central portion of these samples, two specimens were symmetrically prepared per tooth so that a total number of 18 samples was produced. To allow the use of a liquid cell during AFM, the samples were embedded in silicone rubber and were then randomly divided into three groups, as follows: group 1: 17% EDTA (pH 7.7), group 2: 17% EDTAC (pH 7.7) and group 3: 10% citric acid (pH 1.4). Topographical images were acquired during the demineralization process, allowing real-time observation of the dentine surface. Two operators assigned scores to the AFM images using a double-blind method. anova analysis with random effects (P < 0.05) was used to compare the results. RESULTS: The average scores were 6.13 +/- 0.35 for EDTAC, 7.36 +/- 0.23 for EDTA and 14.55 +/- 1.21 for citric acid. Citric acid was statistically different from EDTA and EDTAC while EDTA and EDTAC were not statistically different. CONCLUSIONS: The most effective demineralizing substance was citric acid. The methodology developed for real-time observation of dentine surfaces is a valuable method to evaluate demineralization.     

Phrenic Nerve Injury After Catheter Ablation: Should We Worry About This Complication?

Introduction: Phrenic nerve injury (PNI) is a complication that can occur with catheter ablation.
Methods: Data from 17 patients with PNI following different catheter ablation techniques were reviewed. PNI was defined as decreased motility (transient) or paralysis (persistent) of the hemi-diaphragm on fluoroscopy or chest X-ray. Patient's recovery was monitored. Normalization of chest images and sniff test would be considered as complete clinical recovery.
Results: Out of the 17 PNI patients (16 right, 1 left), 13 (11 persistent, 2 transient) occurred after pulmonary veins isolation with or without superior vena cava ablation. Three patients had persistent PNI after sinus node modification and one other patient experienced PNI after epicardial ventricular tachycardia ablation. Ablation was performed with different energy source including radiofrequency  (n = 13)  , cryothermal  (n = 1)  , ultrasound  (n = 2)  and laser  (n = 1)  . Patient's symptoms varied broadly from asymptomatic to dyspnea, and even to respiratory insufficiency that required temporary mechanical ventilation support. Two patients with transient PNI resolved immediately after the procedure and the other 15 persistent PNI patients resolved within a mean time of  8.3 ± 6.6 months  .
Conclusions: PNI caused by catheter ablation appears to functionally recover over time regardless of the energy sources used for the procedure.     

A 24-week open-label extension study of olanzapine-fluoxetine combination and olanzapine monotherapy in the treatment of bipolar depression

OBJECTIVE: Olanzapine-fluoxetine combination has shown efficacy in the acute treatment of depressive episodes in patients with bipolar I disorder. The present analyses examined the efficacy and safety of longer term treatment with olanzapine-fluoxetine combination or olanzapine monotherapy in a 6-month open-label extension study. METHOD: 376 patients with DSM-IV bipolar I disorder, depressed, who completed an acute trial entered the open-label study and received 1 week of olanzapine monotherapy (5-20 mg/day). At all subsequent visits, patients could choose between olanzapine monotherapy or olanzapine-fluoxetine combination (6/25, 6/50, or 12/50 mg/day). Three treatment groups were defined retrospectively according to the medication course taken from week 1: olanzapine, olanzapine-fluoxetine combination, or switched. The efficacy measures were the Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impressions-Bipolar Version, and Young Mania Rating Scale. The study was conducted from July 2000 to May 2002. RESULTS: Among patients who started in remission, MADRS total scores did not change significantly from baseline to endpoint in the olanzapine-fluoxetine combination (0.8) or olanzapine (0.3) groups, but increased slightly in the switched (2.3, p = .02) group. For patients who started in nonremission, MADRS total scores decreased significantly in all groups (olanzapine-fluoxetine combination: -5.7, p = .001; olanzapine: -11.6, p = .004; switched: -6.4, p = .015). The majority of patients who entered the study in nonremission achieved remission (MADRS total score < or = 12) during the trial (olanzapine-fluoxetine combination: 66.7%, olanzapine: 64.7%, switched: 62.5%). The overall rate of depressive relapse was 27.4%, and the overall incidence of mania emergence was 5.9%. CONCLUSIONS: The present findings suggest that long-term treatment with olanzapine-fluoxetine combination may be a useful option for the management of depressive symptoms and carries a low risk of mania emergence.     

Nonadenomatous tumors of the pituitary and sella turcica

While pituitary adenomas make up over 90% of all sellar masses, there are a number of less known tumors, both malignant and benign, which may arise within the sella turcica. These include relatively common tumors such as meningiomas and craniopharyngiomas, as well as extremely rare tumors such as pituitary astrocytomas and granular cell tumors. Unfortunately, many of these tumors lack characteristic imaging features, often making it extremely difficult to distinguish them by imaging alone from the more common pituitary adenoma. In this article, we review several nonadenomatous tumors of the sella, with a focus on their clinical features and typical MR imaging characteristics.     

Magnetic resonance imaging findings in substance abuse: alcohol and alcoholism and syndromes associated with alcohol abuse

Alcohol abuse is common among the population and results in significant diseases that shorten life span. Ethanol may result in chronic brain changes such as atrophy but may also result in neurologic disease that may be acute or chronic and sometimes life threatening. Accompanying vitamin deficiencies may lead to Wernicke's encephalopathy and changes in serum osmosis may lead to several acute demyelinating disorders. In addition, pregnant women who consume alcohol place their babies at high risk for the fetal alcohol syndrome. In this article we review these disorders and emphasize their imaging features.