Isolated Central Epiretinal Membrane: A Rare Complication of Fovea-Sparing Internal Limiting Membrane Peeling Technique

Purpose. To report a rare complication presenting as an isolated central epiretinal membrane (ERM) related to fovea-sparing internal limiting membrane (ILM) peeling technique. Methods. Five patients who received fovea-sparing ILM peeling were enrolled. Postoperatively, an isolated central ERM developed. Optical coherence tomography (OCT) was used to evaluate the serial anatomic change. Results. Among the five included patients, one patient had high myopia with foveoschisis, two patients had vitreomacular traction, and two patients had proliferative diabetic retinopathy with tractional retinal detachment and a fovea cyst. With an average of 5.80 months, OCT showed the gradual development of the isolated central ERM with severe fovea distortion. Four patients received secondary revision surgery, with improvement of the fovea contour and visual acuity. Conclusion. The fovea-sparing ILM peeling technique may cause a rare but serious complication as the isolated central ERM, which would cause significant fovea distortion as well as visual deterioration. Timely detection and intervention is recommended to prevent further visual loss. This trial is registered with NCT04445142.

Prompt gamma imaging for the identification of regional proton range deviations due to anatomic change in a heterogeneous region

Objectives: Prompt gamma (PG) imaging has previously been demonstrated for use in proton range verification of a brain treatment with a homogeneous target region. In this study, the feasibility of PG imaging to detect anatomic change within a heterogeneous region is presented. Methods: A prompt gamma camera recorded several fractions of a patient treatment to the base of skull. An evaluation CT revealed a decrease in sinus cavity filling during the treatment course. Comparison of PG profiles between measurement and simulation was performed to investigate range variations between planned and measured pencil beam spot positions. Results: For one field, an average over range of 3 mm due to the anatomic change could be detected for a subset of spots traversing the sinus cavity region. The two other fields appeared less impacted by the change but predicted range variations could not be detected. These results were partially consistent with the simulations of the evaluation CT. Conclusion: We report the first clinical application of PG imaging that detected some of the expected small regional proton range deviations due to anatomic change in a heterogeneous region. However, several limitations exist with the technology that may limit its sensitivity to detect range deviations in heterogeneous regions. Advances in knowledge: We report on the first detection of range variations due to anatomic change in a heterogeneous region using PGI. The results confirm the feasibility of using PG-based range verification in highly heterogeneous target regions to identify deviations from the treatment plan.

Could sudden cardiac death in epilepsy be related to the occurrence of thalamic dysfunction or anatomic change?

Sudden unexpected death in epilepsy (SUDEP) is the most important direct epilepsy-related cause of death in people with chronic epilepsy. Its physiopathology is still unknown; however, the most commonly suggested potential mechanisms involve cardiac or respiratory abnormalities. As the anatomical substrate of epileptic activity in the central nervous system (CNS) shows a direct relationship with cardiovascular alterations, this may suggests that patients with epilepsy associated with focal CNS lesions may be at particular risk of SUDEP. Currently, experimental and clinical data support an important role for thalamic nuclei in the behavioural manifestations, initiation and propagation of seizures. In view of the above findings, we purpose that SUDEP, at least in some cases, could be related to the occurrence of thalamic dysfunction or anatomic change.

Regional expression of hepatocyte growth factor/c-met in experimental renal hypertrophy and hyperplasia

Hepatocyte growth factor (HGF) and its high-affinity receptor, c-met, have been found to increase in the whole kidney of the rat following several types of renal injury or renal hypertrophy. In an attempt to determine whether the upregulation of this growth factor and its receptor is selective for the regions of greatest anatomic change, and therefore likely to be important in regulating renal tubular hyperplasia and/or hypertrophy, we examined their expression in liver, whole kidney, and subsections of the kidney following either sham operation, transient ischemia of one kidney, or unilateral nephrectomy. The message for HGF was increased in both liver and kidney by all surgical procedures tested, including sham operation, and was seen predominantly in the outer cortex, the site of least morphological change. However, c-met was not upregulated by sham operation or in the liver, but rather was selectively upregulated only in the kidney in both the hypertrophy and hyperplasia (ischemia/reflow) models. Renal subsections revealed that this increase was confined to the renal medulla, with the greatest change in the outer medulla. Thus induction of the message for HGF can occur nonselectively and at sites distant to the injurious stimulus, whereas the target for HGF, c-met, is upregulated selectively at the site of greatest tubular injury or hypertrophy. These results support a role for HGF/c-met in regulation of these renal tubular events.

Acute reversal by saralasin of multiple intrarenal effects of angiotensin II

Glomerular hemodynamics were measured by micropuncture technique in the plasma volume-expanded Munich-Wistar rat in 1) a control group, 2) during a pressor infusion of angiotensin II (AII), and 3) during simultaneous infusions of AII and saralasin, which returned arterial pressure to normal. Respective values obtained in the three groups studied were: nephron filtration rate: 60 +/- 2 vs. 40 +/- 2 vs. 42 +/- 2 nl.min-1.g kidney wt-1; nepphron plasma flow: 263 +/- 13 vs. 106 +/- 5 vs. 165 +/- 13 nl. min-1.g kidney wt-1; LpA, the glomerular permeability coefficient: 0.090 +/- 0.009 vs. 0.033 +/- 0.005 vs. 0.103 +/- 0.020 nl.s-1.g kidney wt-1. mmHg-1; afferent arteriolar resistance: 10.2 +/- 0.7 vs. 25.1 +/- 1.3 vs. 19.7 +/- 3.3 10(9) dyn.s.cm-5; efferent arteriolar resistance: 7.8 +/- 0.5 vs. 22.0 +/- 0.9 vs. 10.8 +/- 1.7 10(9) dyn.s.cm-5. Saralasin acutely reversed the effect of AII on both efferent resistance and LpA, suggesting that AII does not decrease LpA by inducing a fixed anatomic change. For unclear reasons, saralasin did not reverse the increase in afferent resistance associated with infusion of AII. Saralasin infusion in high AII states may acutely affect glomerular hemodynamics by decreasing efferent resistance and increasing the glomerular permeability coefficient.

THE CARDIAC SILHOUETTE IN NEWBORN INFANTS: A CINEMATOGRAPHIC STUDY OF THE NORMAL RANGE

The mediastinum and heart of the newborn baby was studied by a cinematographic method and compared with the roentgenogram. In cinematographs of the resting baby the transverse diameter of the heart shadow varied only slightly with respiration and cardiac cycle. The deduction that the roentgenogram of the quiet baby would give a reliable estimate of the size of the shadow was borne out by reasonable agreement in the measurement of transverse diameter by the two methods. The heart of the crying baby was broadest during the inspiration before a cry. Even so, transverse diameter was rarely greater than when the baby was at rest. The roentgenographic changes on crying were studied in relation to respiratory mechanics. They could be well explained by effects, on venous return to the heart, of conditions which resembled the Mueller and Valsalva maneuvers. Two varieties of appearance were mentioned where the phase of the respiratory cycle could be wrongly inferred in the roentgenogram from the state of lung aeration and level of diaphragm. An interpretation based on them, of changes in size of the silhouette in relation to deep breathing in the newborn infant, would be misleading. Explanation of big differences in terms of anatomic change alone without reference to the large contrasting effects of the Mueller and Valsalva may have helped discredit the roentgenogram of the heart in the newborn infant. Evidence for the prevailing opinion that variations in the thymus interfere to an important degree with the conventional measurement of transverse diameter of the heart is open to question. Reasons are given for the opposite view.