[Delayed diagnosis of ophthalmic artery obstruction due to atrial myxoma]

CASE REPORT

A 56 year old woman with atrial myxoma presented with a visual acuity of no light perception after acute ophthalmic artery obstruction (OAO) associated with stroke. She developed late retinal pigmentary changes due choroidal infarction, typical of the OAO.

DISCUSSION

Simultaneous obstruction of the retinal and choroidal circulation was observed in the OAO. Atrial myxoma should be suspected in patients who suffer from OAO associated with stroke. Systemic studies should be performed to find the origin of OAO.

Comparison of different wound closure techniques in translabyrinthine acoustic neuroma surgery

In a series of 277 patients with translabyrinthine acoustic neuroma, three techniques of wound closure were used to prevent cerebrospinal fluid (CSF) leakage. In the first group, we used a piece of fascia to cover the dural defect and then placed several pieces of fat on the fascia. The incidence of CSF leak was 28.2%; 7.7% required reoperation. In the second group, in addition to the fasia-fat complex, we made a large musculoperiosteal flap to compress the fat. The incidence of CSF leak and revision were not reduced, however. In recent cases, we placed several pieces of fat directly into the operative cavity without fascia graft; then it was covered with a musculoperiosteal flap. With this technique, CSF leak was significantly reduced to 7.4%, and reoperation was rare (3.7%). The direct application of fat into the translabyrinthine operation cavity appears to be effective to prevent CSF leaks.

Brain Abscesses of Ear, Nose, and Throat Origin: Comparison between Otogenic and Sinogenic Etiologies

This retrospective study analyzed 29 cerebral abscesses of ear, nose, and throat (ENT) origin. The mean follow-up of patients was 37 months. ENT etiologies included 45% otitis media (n = 13), 48% sinusitis (n = 14), and 7% ethmoidal sinus tumors (n = 2). Thirty-eight percent (n = 5) of otogenic abscesses occurred within 15 days after a mastoidectomy. Sinogenic abscesses were never due to surgery but were associated in 31% of cases (n = 5) with anterior skull base defects. The main locations of otogenic abscesses were the temporal lobe (54%; n = 7) and the cerebellum (23%; n = 3), whereas sinogenic abscesses were located in the frontal lobe in 75% of cases (n = 12). Because of this location, sinogenic abscesses were less symptomatic than otogenic ones and had greater size and encapsulation at the time of diagnosis. Thus, they required longer antibiotic treatment (p = 0.05) and more numerous surgical drainages (p = 0.02). Bacteriologic abscesses samples were positive in 90% of cases. Bacteria found in brain abscesses were different from the ones found in ENT samples in 62% of cases. Thus, the results of ENT bacteriologic samples were not helpful for choosing adequate antibiotic agents in case of negative brain abscess samples. Although mortality was not significantly higher in otogenic abscesses (31%; n = 4) than in sinogenic ones (6%; n = 1, p = 0.08), otogenic abscesses appeared more threatening. Indeed, they represented 80% (n = 4) of lethal cases and encompassed more clinical or radiological prognosis pejorative factors than sinogenic ones (p = 0.006). In conclusion, higher danger of otogenic abscesses mainly resulted both from their temporal or cerebellous locations and from the bacteria that were more frequently resistant to antibiotics.

Loggerhead sea turtle bycatch data in artisanal fisheries within a marine protected area: fishermen surveys versus scientific observations

Loggerhead sea turtles can be incidentally captured by artisanal gears but information about the impact of this fishing is inconsistent and scarce. Recent studies have observed that the bycatch, or incidental catch rate, in fishermen surveys is irregular. The aim of this study was to compare direct data (onboard observers) concerning the incidental catch of loggerhead sea turtles by the artisanal vessels versus data from fishermen surveys. The study area was the Cabo de Gata-Níjar marine protected area, situated in the western Mediterranean (southeast of the Iberian peninsula). We observed two loggerhead turtles that were incidentally caught in a total of 165 fishing operations. According to fishermen surveys, a total of nine loggerheads were incidentally caught in 861 fishing operations. The differences between the loggerhead sea turtle bycatch reported by fishermen surveys and scientific observations versus random distribution (x2 = 0.3146, P = 0.575, df = 1) were not significant. We conclude that the surveys are useful but that findings should be interpreted with caution.

Soil [N] modulates soil C cycling in CO2-fumigated tree stands: a meta-analysis

Under elevated atmospheric CO(2) concentrations, soil carbon (C) inputs are typically enhanced, suggesting larger soil C sequestration potential. However, soil C losses also increase and progressive nitrogen (N) limitation to plant growth may reduce the CO(2) effect on soil C inputs with time. We compiled a data set from 131 manipulation experiments, and used meta-analysis to test the hypotheses that: (1) elevated atmospheric CO(2) stimulates soil C inputs more than C losses, resulting in increasing soil C stocks; and (2) that these responses are modulated by N. Our results confirm that elevated CO(2) induces a C allocation shift towards below-ground biomass compartments. However, the increased soil C inputs were offset by increased heterotrophic respiration (Rh), such that soil C content was not affected by elevated CO(2). Soil N concentration strongly interacted with CO(2) fumigation: the effect of elevated CO(2) on fine root biomass and -production and on microbial activity increased with increasing soil N concentration, while the effect on soil C content decreased with increasing soil N concentration. These results suggest that both plant growth and microbial activity responses to elevated CO(2) are modulated by N availability, and that it is essential to account for soil N concentration in C cycling analyses.

[Vitrectomy surgery for the treatment of the vitreo-retinal complications of the pars planitis]

OBJECTIVE

To evaluate the effect of pars plana vitrectomy in the management of patients with pars planitis.

METHODS

A retrospective analysis of the clinical course, post-operative complications and recurrent uveal inflammation following pars plana vitrectomy in patients with pars planitis.

RESULTS

The study included 22 eyes of 19 patients. The mean follow-up was 55.7 (± 39.6) months (range 7 - 144 months). The surgical indications were, persistent vitreous opacities in 10 eyes, vitreous haemorrhage in 9 eyes, and epiretinal membrane in 3 eyes. There was an improvement in the clinical course of the uveitis in 19 of the 22 eyes (86.4%), allowing the suspension of the systemic treatment in 16 patients. An improvement of the visual acuity was observed in 20 eyes (90.9%). The most common post-operative complications were, lens opacities in 9 eyes (40.9%), and glaucoma in 4 eyes (18.2%).

CONCLUSIONS

The results of this study suggest that pars plana vitrectomy has a beneficial effect on the course and visual function of patients with vitreo-retinal complications associated with pars planitis.

How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II-III serous borderline tumours of the ovary

BACKGROUND

The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour.

PATIENTS AND METHODS

From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed.

RESULTS

The median follow-up interval was 8.2 years (range 19-286 months). The mode of diagnosis of recurrences was imaging (n = 19), clinical symptoms (n = 8), cancer antigen (CA) 125 elevation (n = 7), secondary surgery (n = 5) and unknown (n = 6). The median time to recurrence was 31 months (range 4-242 month). The type of recurrence was invasive low-grade serous carcinoma in 14 patients. Five patients died of recurrent tumour. Among the 39 patients with a known mode of diagnosis of recurrence, the most frequent diagnostic method for invasive recurrences was blood CA 125 elevation (6 of 13) and the majority of noninvasive recurrences were diagnosed by imaging (16 of 23).

CONCLUSIONS

This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.

[Clinical features of ocular toxoplasmosis in an inmigrant population in the Barcelona area: Study of 22 patients]

PURPOSE

To report the epidemiological, clinical and prognostic features of ocular toxoplasmosis in an immigrant population in the Barcelona area.

METHODS

A retrospective non-comparative observational study was conducted on a case series of 22 immigrant patients diagnosed with ocular toxoplasmosis by ophthalmoscopic and serological findings. Demographic, clinical and laboratory data were analysed under baseline conditions. The minimum follow-up was 6 months.

RESULTS

Bilateral involvement was observed in five of the 22 patients (22.7%), a total of 27 eyes being affected by active lesions and old scars. Atypical presentations, including multiple or large necrotizing lesions, were observed in 5 eyes (25%). In 15 eyes (75%) the retinal lesions were associated with intraocular inflammation. Vitreoretinal complications were observed in eight eyes (29.6%), with 22.7% of them requiring vitreous surgery.

CONCLUSIONS

In immigrant patients from our area in Barcelona, ocular toxoplasmosis has specific clinical and prognostic features, including high rates of atypical presentations, frequent intraocular inflammation, and vitreoretinal complications, requiring surgery in most of the cases.

Impact of adjuvant treatment modalities on the management of patients with stages I-II endometrial stromal sarcoma

PURPOSE

To explore whether adjuvant treatment options may impact on the prognosis in localized endometrial stromal sarcomas (ESSs; stages I and II). The historical options usually discussed in addition to hysterectomy and bilateral salpingoophorectomy (BSO) are active surveillance, pelvic radiotherapy, chemotherapy and hormonal therapy, alone or in combination.

PATIENTS AND METHODS

Among 84 consecutive patients treated for ESS at a single referral center, 54 with localized stage disease were identified. Recurrence-free survival and overall survival were estimated and patterns of recurrences described. Univariate and multivariate analyses were carried out.

RESULTS

With a median follow-up of 58 months, only one patient had died. None of the 23 patients who had received adjuvant therapy relapsed compared with 13 of 31 patients who had not received any adjuvant therapy. Adjuvant treatments were hormonal therapy (n = 10) and brachytherapy with/without pelvic radiotherapy (n = 13). Almost the majority of relapses were local (92%) and extra-pelvic metastasis was observed in nearly half of the patients (46%). In the multivariate analysis, the major determinants of relapse-free survival were adjuvant treatment, myometrial invasion (P = 0.005) and no BSO (P = 0.005).

CONCLUSIONS

In this series, adjuvant treatment of localized ESSs was associated with the absence of recurrence.

Selectivity of hydrogen peroxide decomposition towards hydroxyl radicals in catalytic wet peroxide oxidation (CWPO) over Fe/AC catalysts

Two Fe/AC catalysts prepared with different iron precursors (iron nitrate and iron pentacarbonyl) and the same AC support have been tested in H(2)O(2) decomposition in presence and absence of methanol, a known strong scavenger of hydroxyl radicals, to investigate the selectivity towards .OH formation in this reaction and their behavior in the CWPO of phenol. The catalyst prepared with iron nitrate, with the most oxidized surface and the highest Fe surface content, seems to favor a higher selectivity towards .OH formation in CWPO allowing for complete phenol conversion and a significant TOC removal, with the highest mineralization degree at 50 degrees C and atmospheric pressure. Fe/AC catalysts were more efficient in the CWPO of phenol than in methanol presence due to a better use of the oxidant since adsorbed phenol on catalyst surface minimizes inefficient H(2)O(2) decomposition to H(2)O and O(2)(g). The influence of the initial H(2)O(2) concentration on phenol oxidation with this catalyst was also studied. A theoretical stoichiometric amount of H(2)O(2) for complete oxidation of phenol was chosen as the best starting concentration since auto-scavenging reactions can be minimized and it is sufficient for oxidizing phenol and the aromatic intermediates.