Non-arteritic Anterior Ischaemic Optic Neuropathy after Uneventful Cataract Extraction

We present the case of a 74-year-old Caucasian female who suffered sudden visual loss after routine phacoemulsification cataract surgery. The patient was subsequently diagnosed with non-arteritic anterior ischaemic optic neuropathy. The case is described in detail, and a concise review of the literature is presented together with the authors’ view on the subject outlined. This is a very rare complication after cataract surgery even in high-risk patients with associated systemic co-morbidities. We suspect that the previous history of obesity, coronary artery disease, and arteriosclerosis contributed to the development of this serious ocular complication. We suggest appropriate measures to reduce the risk of its occurrence.     

Complete hepatic venous isolation and extracorporeal chemofiltration as treatment for human hepatocellular carcinoma: A phase I study

Background: We performed a phase I study of a novel system of complete hepatic venous isolation and extracorporeal chemofiltration in patients with unresectable hepatocellular carcinoma (HCC) to determine (a) whether systemic exposure to doxorubicin could be limited after high-dose hepatic arterial infusion (HAI), and (b) the hepatic maximum tolerated dose (MTD) of doxorubicin. Methods: Ten patients with biopsy-proven HCC were treated with 20-min HAI of doxorubicin (17 total treatments). Two patients were treated with doxorubicin 60 mg/m², three patients were treated at 90 mg/m², and five patients received 120 mg/m². A newly developed dual-balloon vena cava catheter was advanced from the femoral vein, and the balloons were inflated to isolate and capture total hepatic venous outflow. The hepatic venous blood was pumped through extracorporeal carbon chemofilters before return of the blood to the systemic circulation. Results: Peak systemic doxorubicin levels were an average 85.6% lower than were peak prefilter levels (p<0.01). Because all catheters were placed percutaneously and because the chemofiltration markedly limited systemic chemotherapy exposure, patients were discharged 1 day after 16 of the 17 treatments. The hepatic and systemic MTD of doxorubicin in this treatment protocol was 120 mg/m². Conclusions: This novel system of complete hepatic venous isolation and chemofiltration limits systemic chemotherapy toxicity and will allow use of higher doses of chemotherapeutic agents to treat HCC. The results of this study were presented at the 46th Annual Cancer Symposium of The Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Cadmium uptake and depuration in different organs ofLymnaea stagnalis L. and the effect of cadmium on the natural zinc level

The uptake of cadmium (0.1 mg/L) into various organs of the pond snailLymnaea stagnalis L., the depuration of accumulated Cd, and the change in the natural Zn level under the influence of Cd treatment were investigated during a 2 month period. The snails were fed with lettuce (Latuca sativa). The concentrations of Cd were measured in the whole soft body, various organs (liver, viscera, foot), the shell and the lettuce; and zinc concentrations were measured in various organs and the lettuce. As its Cd concentration remained at 10 g/g, which was much lower than the initial value for the soft body (69.4±5.71 g/g), the shell, according to our results, is incapable of accumulating Cd. The uptake pattern of the soft body showed a correlation with the initial Cd levels depending on differences in the Cd concentration of the lettuce. At the higher initial value (69.4±5.71 g/g) the linear Cd uptake began later then it did at the lower initial value; afterwards the snail was saturated with Cd. In the case of the lower, 9.02±1.3 g/g initial concentration, a rapid linear Cd uptake occurred till the 7th day, then the intensity of the uptake decreased. Saturation occurred at 200 g/g Cd concentration, regardless of the initial value. At the lower initial tissue level, the foot and the viscera showed a linear uptake pattern, while the liver, which has the greatest accumulation ability, displayed a logarithmic uptake pattern. The initial and the final Cd concentrations in the foot, viscera, and liver of theL. stagnalis were as follows: 10.3±2.15–60.1±7.13, 5.15±1.04–156±27.2, 14.1±3.09–430±23.3 g/g respectively. The bioconcentration factors (CF) were in the 10² (foot) and 10³ (viscera, liver, soft body) orders of magnitude. Forty to 45% of the accumulated Cd was depurated in Cd-free tap water; during the first three days of the uptake period, a negative linear correlation was found between Cd and Zn levels in the snail organs.     

Effective dose of cone beam CT (CBCT) of the facial skeleton: a systematic review

Objective:

To estimate effective dose of cone beam CT (CBCT) of the facial skeleton with focus on measurement methods and scanning protocols.

Methods:

A systematic review, which adhered to the preferred reporting items for systematic reviews (PRISMA) Statement, of the literature up to April 2014 was conducted. Data sources included MEDLINE®, The Cochrane Library and Web of Science. A model was developed to underpin data extraction from 38 included studies.

Results:

Technical specifications of the CBCT units were insufficiently described. Heterogeneity in measurement methods and scanning protocols between studies made comparisons of effective doses of different CBCT units and scanning protocols difficult. Few studies related doses to image quality. Reported effective dose varied across studies, ranging between 9.7 and 197.0 μSv for field of views (FOVs) with height ≤5 cm, between 3.9 and 674.0 μSv for FOVs of heights 5.1–10.0 cm and between 8.8 and 1073.0 μSv for FOVs >10 cm. There was an inconsistency regarding reported effective dose of studies of the same CBCT unit with the same FOV dimensions.

Conclusion:

The review reveals a need for studies on radiation dosages related to image quality. Reporting quality of future studies has to be improved to facilitate comparison of effective doses obtained from examinations with different CBCT units and scanning protocols. A model with minimum data set on important parameters based on this observation is proposed.

Advances in knowledge:

Data important when estimating effective dose were insufficiently reported in most studies. A model with minimum data based on this observation is proposed. Few studies related effective dose to image quality.Since introduction in the late 1990s, cone beam CT (CBCT) has become a common modality to image the facial skeleton. There is currently a large variety of CBCT units on the market,^1,2 and technical improvements are made continuously, such as the development of the field of view (FOV) from one fixed size to several sizes as well as stitched FOVs in the more recent models.The use of CBCT has increased dramatically, but published evidence supporting informed clinical decision-making is weak.¹ As is the case with emerging healthcare technologies, it will take some time to produce evidence on the cost-effectiveness of CBCT for different diagnostic tasks including “costs” in terms of radiation dosages. Meanwhile, the use of CBCT and choice of scanning protocol has to rely on good practice related to the image quality needed for the actual diagnostic task and the amount of radiation exposure to the patient. The literature on dose levels of CBCT is, however, difficult to grasp and interpret owing to the diversity of CBCT units and different approaches taken in radiation dosimetry.The aim of this systematic review was to estimate the effective dose of CBCT of the facial skeleton with focus on measurement methods and scanning protocols used. Such a review can be beneficial when aiming to perform CBCT examinations with a radiation exposure as low as diagnostically acceptable (ALADA).³ A review may also highlight both strengths and weaknesses in study design to date and can thereby support sound study design in future research.     

Chronic HIV-2 infection protects against total CD4+ cell depletion and rapid disease progression induced by SHIV89.6p challenge

OBJECTIVE: To better understand HIV-1 sexual transmission risk, we have studied the susceptibility of HIV-2-exposed, uninfected (EU) female pig-tailed macaques to intravaginal (IVAG) re-challenge with the homologous HIV-2 strain, followed by heterologous SHIV89.6p. METHODS: Nine female macaques, previously protected by a post-exposure prophylaxis (PEP) regimen, along with one mock-treated EU animal, were re-exposed to HIV-2 by the IVAG route approximately 1.5 years later. A single follow-up challenge was performed approximately 1 year later with SHIV89.6p to assess susceptibility of chronic HIV-2-infected animals to further re-infection and pathogenic effects with a heterologous virus, somewhat mimicking HIV-1. RESULTS: Eight of ten macaques (80%) became infected systemically with HIV-2, and plasma or cervicovaginal vRNA levels did not appreciably differ from prior historic non-PEP control macaques. Interestingly, all eight HIV-2-infected females were susceptible to SHIV89.6p infection by either intravenous (n = 4) or IVAG exposure (n = 4) after one inoculation. Plasma vRNA levels in these groups were controlled by week 8 and there were no decrease in CD4+ T cells > 50%. The remaining two HIV-2 EU macaques, inoculated intrarectally with SHIV89.6p, were unable to control virus replication and succumbed to disease by week 25 or week 61. CONCLUSIONS: Our findings demonstrate that successful PEP regimens to prevent an initial infection do not have any lasting protective effects. The observed lack of cross-protection against SHIV89.6p transmission among chronic HIV-2-infected macaques provides modeling support for limited epidemiologic data indicating that human HIV-2 infection does not protect against HIV-1 infection, but may serve to alter overt clinical outcome.     

Age-specific prevalence,transmission and phylogeny of TT virus in the Czech Republic

Background  

TT virus is prevalent worldwide, but its prevalence and genotype distribution in Central and East-Europe has not been determined. The high prevalence of TTV in multiply-transfused patients points to the importance of a parenteral mode of transmission, but since more than half of the general population is infected other possible routes of transmission must be considered.     

The effect of military clothing on gunshot wounding patterns in gelatine

With no two gunshot wounds (GSW) being the same, novel research into wound ballistics is challenging. It is evident that the majority of previous wound ballistic research has been conducted without the presence of clothing. Whilst the effect of clothing on wound contamination has been explored, there is a paucity of literature examining the effect of clothing on GSW patterns. The aim of this study was to test the effect of Multi-Terrain Pattern (MTP) UK military clothing on GSW patterns within calibrated blocks of 10% by mass gelatine, using two types of ammunition commonly used in recent conflicts—7.62 × 39 mm and 5.45 × 39 mm. In total, 36 blocks were shot, 18 by each projectile type, further divided into 6 with no clothing layers (C_nil), 6 with a single clothing layer (C_min) and 6 with maximum clothing layers (C_max) worn on active duty. Blocks were analysed with high-speed video and dissection to capture measurements of damage, and results compared using analysis of variance (ANOVA). Results showed significantly different damage measurements within blocks with C_max for both ammunition types compared to the other clothing states. This may result in GSWs that require more extensive surgical management, inviting further study.