CHORIORETINITIS SCLOPETARIA AND ORBITAL EMPHYSEMA CAUSED BY A HIGH-VELOCITY LIQUID MISSILE

PURPOSE

To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer.

METHODS

This is a retrospective case report.

RESULTS

A 19-year-old man presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Left eye visual acuity was 20/40. Dilated fundus examination showed inferior vitreous hemorrhage, retinal whitening, and preretinal, intraretinal, and subretinal hemorrhages, consistent with chorioretinitis sclopetaria. Optical coherence tomography revealed a full-thickness macular hole. Computed tomography scan of the orbits showed subcutaneous and postseptal orbital emphysema. Two months after injury, vitreous and retinal hemorrhages and macular hole resolved. Five months after injury, visual acuity improved to 20/20.

CONCLUSION

Chorioretinitis sclopetaria is defined as a full-thickness chorioretinal disruption resulting from a high-velocity projectile passing adjacent to or into the orbit without penetrating the globe. Chorioretinal deformation and ocular comorbidities are influenced by the velocity of the missile and its spatial relationship to the orbit. Although this pattern of injury is typically associated with indirect trauma to the globe by a BB or a bullet, this is the first report of chorioretinitis sclopetaria precipitated by a high-velocity liquid missile.

Outcomes of Patients With Thyroid Eye Disease Partially Treated With Teprotumumab

PURPOSE

In response to the coronavirus (COVID-19) pandemic, teprotumumab production was temporarily halted with resources diverted toward vaccine production. Many patients who initiated treatment with teprotumumab for thyroid eye disease were forced to deviate from the standard protocol. This study investigates the response of teprotumumab when patients receive fewer than the standard 8-dose regimen.

METHODS

This observational cross-sectional cohort study included patients from 15 institutions with active or minimal to no clinical activity thyroid eye disease treated with the standard teprotumumab infusion protocol. Patients were included if they had completed at least 1 teprotumumab infusion and had not yet completed all 8 planned infusions. Data were collected before teprotumumab initiation, within 3 weeks of last dose before interruption, and at the visit before teprotumumab reinitiation. The primary outcome measure was reduction in proptosis more than 2 mm. Secondary outcome measures included change in clinical activity score (CAS), extraocular motility restriction, margin reflex distance-1 (MRD1), and reported adverse events.

RESULTS

The study included 74 patients. Mean age was 57.8 years, and 77% were female. There were 62 active and 12 minimal to no clinical activity patients. Patients completed an average of 4.2 teprotumumab infusions before interruption. A significant mean reduction in proptosis (-2.9 mm in active and -2.8 mm in minimal to no clinical activity patients, P < 0.01) was noted and maintained during interruption. For active patients, a 3.4-point reduction in CAS ( P < 0.01) and reduction in ocular motility restriction ( P < 0.01) were maintained during interruption.

CONCLUSIONS

Patients partially treated with teprotumumab achieve significant reduction in proptosis, CAS, and extraocular muscle restriction and maintain these improvements through the period of interruption.

A Case of the Blues-Colored Pencil Orbitopathy in an 18-Month-Old Boy

Orbital penetrating injuries from pencils are rare. This report describes a case of penetrating orbital injury in a young child with a retained blue-colored pencil core foreign body, which led to rapid onset of orbital abscess requiring surgical drainage. Intraoperatively, orbital tissues were stained a bright-blue color. Histopathological study of specimen also highlighted bright blue aggregates of foreign material infiltrating the orbital tissues. Cultures grew Streptococcus mitis and Exophiala jeanselmei , which are rare causes of orbital abscess. Unique properties of retained colored pencil core as compared to graphite pencil core are herein discussed. Due to differences in composition, colored pencil core foreign bodies may require more timely surgical intervention compared to noncolored graphite pencil core.

Predictive Modeling of New-Onset Postoperative Diplopia Following Orbital Decompression for Thyroid Eye Disease

PURPOSE

To identify risk factors for the development of new-onset, postoperative diplopia following orbital decompression surgery based on patient demographics, clinical exam characteristics, radiographic parameters, and surgical techniques.

METHODS

We conducted a multi-center retrospective chart review of patients who underwent orbital decompression for thyroid eye disease (TED). Patient demographics, including age, gender, smoking history, preoperative exophthalmometry, clinical activity score (CAS), use of peribulbar and/or systemic steroids, and type of orbital decompression were reviewed. Postoperative diplopia was determined at a minimum of 3 months postoperatively and before any further surgeries. Cross-sectional area ratios of each extraocular muscle to orbit and total fat to orbit were calculated from coronal imaging in a standard fashion. All measurements were carried out using PACS imaging software. Multivariable logistic regression modeling was performed using Stata 14.2 (StataCorp, College Station, TX).

RESULTS

A total of 331 patients without preoperative diplopia were identified. At 3 months postoperatively, 249 patients had no diplopia whereas 82 patients developed diplopia. The average postoperative follow-up was 22 months (range 3-156) months. Significant preoperative clinical risk factors for postoperative diplopia included older age at surgery, proptosis, use of peribulbar or systemic steroids, elevated clinical activity score, and presence of preoperative compressive optic neuropathy. Imaging findings of enlarged cross-sectional areas of each rectus muscle to the overall orbital area also conferred a significant risk of postoperative diplopia. Regarding surgical factors, postoperative diplopia was more common among those undergoing medial wall decompression, bilateral orbital surgery, and balanced decompression, whereas endoscopic medial wall decompression was found to be relatively protective.

CONCLUSIONS

This study identifies risk factors associated with the development of diplopia following orbital decompression using multivariable data. This study demonstrates that several characteristics including age, clinical activity score, the cross-sectional muscle to orbit ratios, in addition to the type of orbital decompression surgery, are predictive factors for the development of new-onset postoperative diplopia.

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Immunoglobulin G4 Involvement in Lacrimal Sac Squamous Cell Carcinoma

Lacrimal sac squamous cell carcinoma is a rare but life-threatening disease that is often a delayed diagnosis secondary to difficulty in differentiating from other causes of dacrocystitis and acquired nasolacrimal duct obstruction. Chronic inflammation, including that of an underlying autoimmune disease, prior instrumentation, and poor wound healing, may be risk factors in the development to lacrimal sac squamous cell carcinoma. The authors present the first case of lacrimal sac squamous cell carcinoma associated with antineutrophil cytoplasmic antibody-associated vasculitis and immunoglobulin G4 positivity. Rather than an overlap syndrome between antineutrophil cytoplasmic antibody-associated vasculitis and immunoglobulin G4-related disease, high immunoglobulin G4 positivity may be considered an inflammatory marker of disease severity in the setting of antineutrophil cytoplasmic antibody-associated vasculitis and underlying malignancy. Inflammation-mediated tumorangiogenesis should be considered in the development of malignancy and red flags of chronic uncontrolled inflammation should warrant a lower threshold for further workup.

Development of Herpes Zoster Ophthalmicus in an Immunocompetent Pediatric Patient Following Facial Trauma

Herpes zoster ophthalmicus (HZO) is a neuro-oculo-dermic infection caused by reactivation of latent varicella zoster virus in the dorsal root ganglia of the ophthalmic division of the trigeminal nerve. Although a rare diagnosis in an otherwise healthy, vaccinated pediatric patient, this entity may occur with increasing frequency among those with preceding trauma, particularly in the month prior to presentation. Herein, we highlight a case of HZO in a vaccinated, immunocompetent adolescent in the setting of recent facial trauma.

Isolation and identification of nontuberculous mycobacteria from specimens of lower respiratory tract of transplanted patients based on the evaluation of 16SrRNA gene

BACKGROUND

Nontuberculous mycobacteria are pervasive microorganisms and are often present as saprophytes in humans, animals, and the environment. Today, these bacteria are known as the most important environmental opportunists and, in the last decades, infections by nontuberculous mycobacteria have multiplied, due to increased immunodeficiency (cancer, transplant recipients, HIV).

STUDY DESIGN

This study aimed to investigate the infections by nontuberculous mycobacteria in transplanted patients.

METHODS

The study was performed on 57 samples from respiratory secretions of transplant recipients taken by standard methods. Nontuberculous mycobacteria were identified by culture method and molecular identities of clinical isolates were investigated by PCR amplification using 16SrRNA gene and sequence analysis and Blast of the sequences. Demographic data were evaluated by Spss software.

RESULTS

The prevalence of nontuberculous mycobacteria in transplant patients was 22.8%, the age of patients was between 23 and 52 years. The most common involvement of nontuberculous mycobacteria in our transplanted individuals were 6 strains of M avium-intracellulare Complex (42.87%), followed by 2 strains of M marinum (14.29%) and 1 strain each (7.14%) of M xenopi, M chelonae, M intracellulare, M kansasii, M simiae. At the conclusion of the tests, one final strain was identified as M tuberculosis (7.14%).

CONCLUSION

The prevalence of nontuberculous mycobacteria indicates their importance in the fate of these patients. The identification of nontuberculous mycobacteria is a neglected part of microbiology laboratories, due to the lack of sufficient facilities and the risk associated with their culture. Therefore developing routine methods for the identification of these infections appears to be critical, especially in hospitals with the transplantation ward.

In Vivo Assessment of Retinal Biomarkers by Hyperspectral Imaging: Early Detection of Alzheimer's Disease

A noninvasive and cost-effective means to detect preclinical Alzheimer's disease (AD) and monitor disease progression would be invaluable. The retina is a developmental extension of the brain and has been viewed as a window to evaluate AD-related pathology. Cross-sectional studies have shown structural changes in the retina of AD patients that include thinning of the retinal nerve-fiber layer and changes in retinal vasculature. However, such changes do not manifest in early stages of the disease nor are they specific biomarkers for AD. Described herein is the utilization of our retinal hyperspectral imaging (rHSI) technique as a biomarker for identification of AD-related early pathological changes in the retina. Specifically, this account concerns the translation of our rHSI technique from animal models to human AD subjects. The underlying principle is Rayleigh light scattering, which is expected from low-order Aβ aggregates present in early pathology. Recruitment was restricted to AD subjects (N = 19) and age-matched controls, with no family history of AD (N = 16). To limit the influence of skin pigmentation, subjects were restricted to those with skin pigmentation values of 2-3 on the Fitzpatrick scale. The largest spectral deviation from control subjects, rHSI signature, was obtained at the MCI stage with MMSE scores ⩾22, suggesting higher sensitivity of this technique in early disease stages. The rHSI signature observed is unaffected by eye pathologies such as glaucoma and cataract. Age of the subjects minimally influenced the spectral signatures. The rHSI technique shows promise for detection of preclinical AD; it is conducted in a truly noninvasive manner, without application of an exogenous label, and is thus potentially suitable for population screening.

Thyroid eye disease presenting with superior rectus/levator complex enlargement

Purpose: To describe the demographic and clinical characteristics of patients with thyroid eye disease (TED) who present with predominate superior rectus/levator complex involvement.Methods: A multi-institutional retrospective review was performed to identify patients with TED who presented with superior isolated or predominate rectus/levator involvement. Baseline and subsequent visits were reviewed to characterize the clinical course.Results: Nineteen patients were identified. All patients had imaging demonstrating an enlarged levator/superior rectus complex. At presentation, the mean clinical activity score (CAS) was 2.1 (range: 0-5). Nineteen (100%) patients had proptosis on the affected side. Lid abnormalities, including upper/lower eyelid retraction and ptosis were higher on affected side compared to the unaffected side. Eleven (58%) patients had vertical misalignment. Mean thyroid stimulating immunoglobulin (TSI) was 3.7 (range: 1-7.1). Mean follow-up time was 18 months (range: 0-60 months). At last follow-up, the mean CAS was 1.3 (range 0-5). Ten (53%) patients had proptosis. Eleven (58%) patients had vertical misalignment. Repeat imaging in eight patients showed interval enlargement of other extraocular muscles.Conclusions: The presentation of TED with superior rectus/levator complex enlargement may be under-appreciated. Orbital imaging, as well as laboratory evaluation, may help support a diagnosis of TED. In the setting of abnormal TSI and/or thyrotropin receptor antibody, presence of upper eyelid retraction, and an otherwise unremarkable laboratory and systemic evaluation, a presumptive diagnosis of TED may be made, and the patient can be followed closely, as he/she is likely to develop involvement of other extraocular muscles, consistent with a more typical presentation of TED.

Periocular Asymmetry in Infants with Deformational Posterior Plagiocephaly

PURPOSE

To analyze the clinical significance of the periorbital features associated with the facial asymmetry that is common in deformational posterior plagiocephaly (DPP).

PATIENTS AND METHODS

We identified 32 patients with DPP, photographed their faces and tops of their head, and performed a complete eye examination. Four examiners analyzed the patient's periorbital features on the photographs.

RESULTS

Median age was 6.5 months (range 3-12 months). Pseudoptosis was identified in 30 patients and pseudo-brow ptosis in 19. Pseudoptosis was marked in 17 patients. Five patients were misdiagnosed with congenital blepharoptosis and received regular follow-ups for amblyopia checks until the diagnosis of pseudoptosis was established. All patients had normal levator function and symmetric eyelid crease. One patient with pseudoptosis and physiologic anisocoria was diagnosed with pseudo-Horner syndrome after a negative 10% cocaine test. None of the patients developed meridional or occlusion amblyopia.

CONCLUSION

DPP is the most frequent form of skull deformation in infants. Its main features are occipital flatness and facial asymmetry. Infants with DPP may present with pseudoptosis and pseudo-brow ptosis on the contralateral side of the occipital flatness. The pseudoptosis in DPP is non-amblyogenic, therefore, ophthalmologic intervention and regular follow-ups are not necessary unless other abnormalities co-exist.

Effects of Repeated Eyelid Injections with Botulinum Toxin A on Innervation of Treated Muscles in Patients with Blepharospasm

PURPOSE

To assess changes in innervation and muscle morphology after repeated botulinum toxin A injections in subjects with benign essential blepharospasm.

METHODS

Surgical waste specimens were processed for histologic examination of nerve fibers, neuromuscular junctions, fiber size, and central nucleation and compared to age matched controls and to two subjects with blepharospasm that had not received botulinum toxin A injections.

RESULTS

There was a significant increase in amount of nerve fibers and numbers of neuromuscular junctions in the orbicularis oculi muscles from subjects with blepharospasm treated repetitively with botulinum toxin A. In addition there was a significant decrease in mean muscle fiber cross-sectional area and an increase in central nucleation. The specimens from the subjects with only blepharospasm had the same density of nerves but had intermediate levels of neuromuscular junctions.

CONCLUSIONS

These data suggest that repeated injections of botulinum toxin A has an effect on nerve and neuromuscular junction numbers, which are partly mirrored in orbicularis oculi muscle from subjects with blepharospasm only. These studies suggest the potential for modulating these changes in order to extend the duration of effectiveness of botulinum toxin.

Periorbital Necrobiotic Xanthogranuloma Successfully Treated with Intravenous Immunoglobulin

Background

Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans histiocytosis with cutaneous manifestations, most commonly of the periorbital skin, and is often associated with hematologic disorders such as monoclonal gammopathy. Treatment of NXG is notoriously difficult, and fraught with recurrence and progression.

Case Presentation

The authors describe a case of NXG with periorbital involvement in a patient with a complex autoimmune and hematologic medical history. The biopsy of this rare lesion prompted subsequent evaluation for an underlying disorder, which led to the diagnosis of multiple myeloma. Her NXG lesions demonstrated remarkable clinical improvement after treatment with intravenous immunoglobulin (IVIG).

Conclusions

This case demonstrates the ophthalmologist's critical role in the diagnosis and management of NXG, as early detection cannot only prevent ophthalmic consequences such as ocular perforation and blindness, but also prompt further investigation that may reveal an underlying disorder or systemic involvement, including hematologic malignancy as in this case. NXG has been effectively treated with IVIG in a handful of reported cases. To the author's knowledge, this is the third case of periorbital NXG successfully treated with IVIG, and the first in the ophthalmic literature.

Medical Cannabis, a Beneficial High in Treatment of Blepharospasm? An Early Observation

The objective of this study was to observe the effect of medical cannabis in benign essential blepharospasm (BEB) as an adjunct to botulinum toxin. A retrospective chart review was performed on patients certified for medical cannabis use for BEB from September 2015 to May 2016. Patient demographics and responses, cannabis history, and severity indices were collected. Ten patients were certified for medical cannabis use. Five met the inclusion criteria, which was any patient with a diagnosis of BEB receiving standard botulinum toxin treatment who had started medical cannabis treatment by a registered distributor within the state, and was contactable by phone. Four patients discontinued use. Three out of four patients (75%) reported symptomatic improvement. Medical cannabis is an accepted therapy for muscle spastic disorders. Its potential as an adjunctive therapy for BEB remains unknown, and further investigations would be of benefit.

Quantitative efficacy of external and internal browpexy performed in conjunction with blepharoplasty

Browpexy surgery is a minimally invasive surgical adjunct to upper blepharoplasty. The traditional internal (IB) approach is well documented, while the newer external (EB) variant has only recently been described. To date, there is little quantitative data to evaluate the efficacy of either procedure, and no data to compare results between the two. We determine the efficacy of, and compare surgical results between, internal and external browpexy surgery in lifting the central and lateral brow. A 3.5-year retrospective review of patients undergoing internal and external browpexy surgery to assess the amount of central and lateral lift to the brow was performed. Patients undergoing blepharoplasty without brow lift were used as a control group. The Massachusetts Eye and Ear Infirmary FACE-gram program was used to quantify surgical outcome. Ninety-eight patients are included for review, with an average follow-up of 4-5 months. The average elevation in lateral/central brow position was 2.29 mm and 1.47 mm in the IB group, and 2.97 mm and 1.90 mm in the EB group. These were not statistically significant (p = 0.164, and p = 0.507, respectively). There was a statistically significant elevation in central and lateral brow height for both browpexy techniques and the control group (p < 0.001). External and internal browpexy surgery afford a similar, and non-statistically different, elevation of the central and lateral brow at 4-5 months. When compared to standalone blepharoplasty (control) the amount of lift for both procedures is statistically significant.

Giant Cell Tumor of the Frontal Bone Presenting as an Orbital Mass

A 10-year-old male was referred for evaluation of a right orbital mass present for 3 weeks with associated tenderness to palpation. Magnetic resonance imaging (MRI) and computed tomography imaging (CT) revealed a solid mass centered in the frontal bone with extension into the orbit. Surgical excision and histologic analysis of the lesion was consistent with a diagnosis of a Giant Cell Tumor (GCT) of the frontal bone. The patient tolerated the procedure without complication and is doing well upon follow-up.

Waiting to deliver a final diagnosis

We report a patient with left eye positional transient visual obscurations, diplopia, a left afferent pupillary defect, and optic disk edema-all occurring during pregnancy. Noncontrast magnetic resonance imaging revealed an orbital mass encasing the optic nerve and extending through the superior orbital fissure into the cavernous sinus. An magnetic resonance imaging with gadolinium after parturition and strongly positive somatostatin receptor scintigraphy suggested the diagnosis of meningioma. Biopsy confirmed the diagnosis, and she was treated with CyberKnife stereotactic radiosurgery. In cases of atypical presentation, somatostatin receptor scintigraphy can help distinguish optic nerve sheath meningioma from alternative orbital masses.

Safety and Long-term Outcomes of Congenital Ptosis Surgery: A Population-Based Study

PURPOSE

To report the long-term outcomes of childhood ptosis surgery in a population-based setting over a 46-year period.

METHODS

In this population-based cohort study, the medical records of all patients who were residents of Olmsted County, Minnesota, diagnosed as having blepharoptosis and having undergone surgical management prior to 19 years of age (between January 1, 1965, and December 31, 2010), were retrospectively reviewed. Age at time of surgery, type of surgery, duration of follow-up, number and nature of revisions, degree of amblyopia, and postoperative lagophthalmos and dry eye were documented.

RESULTS

Forty-seven children meeting inclusion criteria underwent ptosis surgery. The median age at time of first surgery was 5.6 years (range: 1.5 to 17.7 years). Fifteen of 47 (31.9%) patients required a second procedure. Three of 47 (6.4%) patients underwent three procedures. The median time was 1.1 years (range: 0.03 to 7.8 years) between the first and second surgery and 6.0 years (range: 0.3 to 6.1 years) between the second and third procedure. Seven of 47 (14.9%) patients had amblyopia. Nineteen of 47 (40.4%) patients were noted to have lagophthalmos and 3 of 47 (6.4%) presented for symptomatic dry eye postoperatively.

CONCLUSIONS

In this population-based setting, more than half of the children with ptosis required only a single surgical procedure, although a significant proportion required two procedures. Postoperative lagophthalmos is common, but symptomatic dry eye is rare. [J Pediatr Ophthalmol Strabismus. 2016;53(4):212-217.].

Identification of possible cytotoxicity mechanism of polyethylenimine by proteomics analysis

Polyethylenimine (PEI) is a polycation widely used for successful gene delivery both in vitro and in vivo experiments. However, different studies showed that PEI could be cytotoxic to transfected cells, and the mechanism of toxicity is poorly understood. Identification of PEI-interacting proteins may help in understanding the toxicity pathways. In this study, we investigated proteins that could interact with PEI in human colorectal adenocarcinoma cells (HT29). In order to identify the proteins interacting with PEI, PEI was immobilized to sepharose beads as solid matrix. The HT29 cell lysate were passed through the matrix. PEI-bound proteins were isolated, and further separation was performed by two-dimensional gel electrophoresis. After gel digestion, proteins were identified by matrix-assisted laser desorption/ionization-time-of-flight (TOF)/TOF mass spectrometry. Our data indicated that most of the identified PEI-interacting proteins such as shock proteins, glutathione-S-transferases, and protein disulfide isomerase are involved in apoptosis process in cells. Thus, although this is a preliminary experiment implicating the involvement of some proteins in PEI cytotoxicity, it could partly explain the mechanism of PEI cytotoxicity in cells.

Controversies and advances in the management of congenital ptosis

The management issues associated with pediatric ptosis begin with determining the etiology of the ptosis, and considering how the eyelid position affects the child's visual and psychosocial development. These ultimately determine if and when surgical management should be undertaken. Surgical challenges include the lack of intraoperative feedback regarding the dynamic eyelid height and contour under general anesthesia. When the eyelid elevators do not function or if there is little drive to lift the involved eyelid, obtaining good surgical outcomes can be extremely challenging. A plethora of surgical techniques and materials have been developed, each with their own benefits and drawbacks. Careful preoperative evaluation, planning and counseling can usually result in satisfactory surgical results with happy parents and patients. Families should always be aware that the child will need to be followed long term for visual development, ocular health, and they need to be counseled regarding the possibility of revision surgery.

Recurrent orbital varices after surgical excision with and without prior embolization with n-butyl cyanoacrylate

PURPOSE

To report a series of 4 recurrent orbital varices after resection, 2 of which were embolized with cyanoacrylate glue before surgery.

DESIGN

Retrospective case series.

METHODS

Charts of all patients seen by a single orbital surgeon from January 1986 through June 2013 with presumed or histologically confirmed orbital varix were reviewed retrospectively. Four patients were identified with recurrence of symptoms after resection of the varix, 2 after embolization with n-butyl cyanoacrylate and 2 via a right frontal craniotomy. Each had initial complete resolution of their symptoms followed by recurrence to a lesser degree. Characteristics and common features in each case were reviewed.

RESULTS

After initial resection, these 4 patients had recurrence of their symptoms within 8 months to 12 years. A common feature among them included an active lifestyle involving significant heavy lifting.

CONCLUSIONS

Orbital varices may be recurrent, even after n-butyl cyanoacrylate embolization, with repeated Valsalva-type maneuvers.

The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

OBJECTIVE

To demonstrate that tibial intraneural ganglia in the popliteal fossa are derived from the posterior portion of the superior tibiofibular joint, in a mechanism similar to that of peroneal intraneural ganglia, which have recently been shown to arise from the anterior portion of the same joint.

DESIGN

Retrospective clinical study and prospective anatomic study.

MATERIALS

The clinical records and MRI findings of three patients with tibial intraneural ganglion cysts were analyzed and compared with those of one patient with a tibial extraneural ganglion cyst and one volunteer. Seven cadaveric limbs were dissected to define the articular anatomy of the posterior aspect of the superior tibiofibular joint.

RESULTS

The condition of the three patients with intraneural ganglia recurred because their joint connections were not identified initially. In two patients there was no cyst recurrence when the joint connection was treated at revision surgery; the third patient did not wish to undergo additional surgery. The one patient with an extraneural ganglion had the joint connection identified at initial assessment and had successful surgery addressing the cyst and the joint connection. Retrospective evaluation of the tibial intraneural ganglion cysts revealed stereotypic features, which allowed their accurate diagnosis and distinction from extraneural cases. The intraneural cysts had tubular (rather than globular) appearances. They derived from the postero-inferior portion of the superior tibiofibular joint and followed the expected course of the articular branch on the posterior surface of the popliteus muscle. The cysts then extended intra-epineurially into the parent tibial nerves, where they contained displaced nerve fascicles. The extraneural cyst extrinsically compressed the tibial nerve but did not directly involve it. All cadaveric specimens demonstrated a small single articular branch, which derived from the tibial nerve to the popliteus. The branch coursed obliquely across the posterior surface of the popliteus muscle before innervating the postero-inferior aspect of the superior tibiofibular joint.

CONCLUSIONS

The clinical, MRI and anatomic features of tibial intraneural ganglion cysts are the posterior counterpart of the peroneal intraneural ganglion cysts arising from the anterior portion of the superior tibiofibular joint. These predictable features can be exploited and have implications for the pathogenesis of these intraneural cysts and treatment outcomes. These ganglion cysts are joint-related and provide further evidence to support the unifying articular theory. In each case the joint connection needs to be identified preoperatively, and the articular branches and the superior tibiofibular joint should be addressed operatively to prevent cyst recurrence.

Age-related RNA decline in adult Drosophila melanogaster

We investigated the correlation between age and total RNA levels in long-lived and control lines of Drosophila melanogaster. Total RNA was extracted at 10 ages from 1-63 days posteclosion from 3 inbred lines, with replication. Three different methods of RNA quantitation gave highly correlated estimates. Total RNA declined substantially with age, exhibiting a dramatic drop in the first few days of adult life. We find no evidence for a causal relationship between adult longevity and total RNA levels, since long-lived and control lines exhibited similar patterns of age-related RNA decline. These observations suggest that the dramatic decline in total RNA that occurs early in adult life does not explain the twofold differences in life span between lines. The pattern of age-specific decline coincides with published observations on age-specific metabolic rates, and suggests that 14-day-old flies are functionally senescent.

Utilization of F1 monosomics for genetic analyses involving awn expression, glume color, seed setting, and seed abortion in crosses of tetraploid and hexaploid wheats

F1 plants, monosomic for chromosomes 1A to 7B, from crosses of three lines of Triticum durum var. Khapli with the Chinese series were investigated together with their backcrosses to normal Chinese Spring. The three Khapli lines were designated K1-A, K1-B, and K1-D. Five parameters were analyzed: awn development, glume color, degree of selfing, crossing ability, and seed abortion.Morphological examination of F1 monopentaploid plants revealed that, in the three lines, chromosomes 5A, 1B, 3B, 4B, 5B, and 6B had promotor genes and 2A, 6A, and 2B had inhibitor genes for awn development. Results on glume color suggested the presence of at least three inhibitor genes on 1B, 5B, and 7B, and three promotor genes on 3A, 6A, and 6B chromosomes of Chinese Spring.The first backcross of interspecific hybrids seemed to indicate that some chromosomes (1A, 1B, and 4B) originating from the Khapli lines possessed promotor genes, others (2B and 4A) carried inhibitor genes for seed setting. Similarily, the genetic factor (s) carried by chromosome 5A increased seed abortion whereas those on 2B and 6B reduced it.Self fertility in K1-D hybrids was probably the result of the inhibitor factor (s) on 7A and promotor genes on 3B, 4B, 5B, and 6B chromosomes coming from K1-D.