Second cluster of strabismus cases after periocular anesthesia without hyaluronidase.

We describe a second cluster of cases of iatrogenic strabismus that occurred in clinical practices following cataract surgeries that occurred in 2000 when hyaluronidase was once again unavailable for use in periocular anesthetic regimens. Twelve cases of transient or permanent strabismus were referred by 4 anterior segment surgeons who had no previous cases of postcataract strabismus when performing periocular injections with hyaluronidase. The charts of the patients were reviewed retrospectively. Recurrence of an increase in postoperative strabismus when hyaluronidase became unavailable for a second time supports the concept that this enzyme may be more important than previously suspected in preventing damage to the extraocular muscles after periocular anesthetic injections.     

Fishing Down Under: case report and review of management of a fishhook injury of the eyelid

A 21‐year‐old man presented to the emergency department of the Royal Victorian Eye and Ear Hospital with a fishhook embedded in his unprotected left upper eyelid. The fishhook was removed after exploration of the left eye by vertical eyelid incision. Subsequent eyelid reconstruction by lid margin adaptation was performed. Management of these injuries depends on type of hook, the involved ocular structure and location of the hook. This is an update on management options, where triage and surgical approaches are discussed. This case illustrates the risk to the eyes while fishing. Persons with an interest in fishing should be advised to wear eye protection.     

Ovarian vascular pedicle sign in ovarian metastasis arising from gall bladder carcinoma

A case of a large mass in the pelvis confirmed to be a rare ovarian metastasis arising from a primary adenocarcinoma of the gall bladder is presented. The value of the recently described ovarian pedicle sign in confirming the organ of origin of the pelvic mass is emphasized.     

窝洞清洁剂暴露的牙本质中TGF—β超微结构定位

目的：了解不同窝洞清洁剂暴露窗洞内牙本质中TGF－β的能力。方法：采用金标记免疫组化染色，扫描电镜观察。结果：170g/L的EDTA处理组牙本质中有大量TGF－β1暴露，表面玷污层去除彻底；30g/L次的人和100g/L柠檬酸处理组有一定量的TGF－β1暴露，玷污层被部分去除；而PBS且只有少量TGF－β1被暴露。TGF－β2、β3在各组中均未测得。结论：TGF－β1是牙本质中最主要的TGF－β异构体，EDTA是所测试剂中暴露TGF－β最有效的窝清洁剂。     

Skeletal muscle training in chronic heart failure.

Patients with heart failure are limited in their ability to tolerate exercise. Recent research has suggested that this limitation cannot be entirely attributed to cardiac or lung impairment but rather that changes in peripheral muscles may play an important role. There are objective similarities between heart failure and muscular deconditioning. Deficiencies in peripheral blood flow and skeletal muscle function, morphology, metabolism and function are present in both conditions. Moreover, an exaggerated activity of the receptors sensitive to exercise-derived metabolic signals (muscle ergoreceptors and peripheral and central chemoreceptors) leads to early and profound exercise-induced fatigue and dyspnoea. These muscle afferents contribute to the ventilatory, haemodynamic and autonomic responses to exercise both in physiological and pathological conditions, including chronic heart failure. Against this background, a skeletal muscle origin of symptoms in heart failure has been proposed. The protective effects of physical training have been described in many recent studies: training improves ventilatory control, skeletal muscle metabolism and autonomic nervous system activity. The exercise training appears to induce its beneficial effects on skeletal muscle both directly (on muscle function, histological and biochemical features) and indirectly (by reducing the activation of the muscle afferents). The metabolic mediators of these muscle afferents may become a potential target in the future therapy of heart failure symptoms.     

EICOSAPENTAENOIC ACID IN TREATMENT-RESISTANT DEPRESSION ASSOCIATED WITH SYMPTOM REMISSION,STRUCTURAL BRAIN CHANGES AND REDUCED NEURONAL PHOSPHOLIPID TURNOVER

The n-3 essential fatty acid eicosapentaenoic acid (EPA) was added to the conventional antidepressant treatment of a treatment-resistant severely depressed and suicidal male patient with a seven-year history of unremitting depressive symptoms. The niacin skin flush test and cerebral magnetic resonance scanning were carried out at baseline and nine months later. The addition of ethyl-EPA led to a dramatic and sustained clinical improvement in all the symptoms of depression, including a cessation of previously unremitting severe suicidal ideation, within one month. Symptoms of social phobia also improved dramatically. During the nine-month period the volumetric niacin response increased by 30%, the relative concentration of cerebral phosphomonesters increased by 53%, and the ratio of cerebral phosphomonesters to phosphodiesters increased by 79%, indicating reduced neuronal phospholipid turnover. Registered difference images showed that the EPA treatment was accompanied by structural brain changes including, in particular, a reduction in the lateral ventricular volume.