Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: Case report

We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73 × 74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.

Validation of the DRAGON Score in 12 Stroke Centers in Anterior and Posterior Circulation.

BACKGROUND AND PURPOSE: The DRAGON score predicts functional outcome in the hyperacute phase of intravenous thrombolysis treatment of ischemic stroke patients. We aimed to validate the score in a large multicenter cohort in anterior and posterior circulation. METHODS: Prospectively collected data of consecutive ischemic stroke patients who received intravenous thrombolysis in 12 stroke centers were merged (n=5471). We excluded patients lacking data necessary to calculate the score and patients with missing 3-month modified Rankin scale scores. The final cohort comprised 4519 eligible patients. We assessed the performance of the DRAGON score with area under the receiver operating characteristic curve in the whole cohort for both good (modified Rankin scale score, 0-2) and miserable (modified Rankin scale score, 5-6) outcomes. RESULTS: Area under the receiver operating characteristic curve was 0.84 (0.82-0.85) for miserable outcome and 0.82 (0.80-0.83) for good outcome. Proportions of patients with good outcome were 96%, 93%, 78%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 2%, 4%, 89%, and 97% for 0 to 1, 2, 3, 8, and 9 to 10 points, respectively. When tested separately for anterior and posterior circulation, there was no difference in performance (P=0.55); areas under the receiver operating characteristic curve were 0.84 (0.83-0.86) and 0.82 (0.78-0.87), respectively. No sex-related difference in performance was observed (P=0.25). CONCLUSIONS: The DRAGON score showed very good performance in the large merged cohort in both anterior and posterior circulation strokes. The DRAGON score provides rapid estimation of patient prognosis and supports clinical decision-making in the hyperacute phase of stroke care (eg, when invasive add-on strategies are considered).

Bilateral Sequential NAION: A Comparison of Visual Outcomes in Fellow Eyes Using Quantitative Analysis of Goldmann Visual Fields

Purpose: Previous studies of the visual outcome in bilateral non-arteritic anterior ischemic optic neuropathy (NAION) have yielded conflicting results, specifically regarding congruity between fellow eyes. Prior studies have used measures of acuity and computerized perimetry but none has compared Goldmann visual field outcomes between fellow eyes. In order to better define the concordance of visual loss in this condition, we reviewed our cases of bilateral sequential NAION, including measures of visual acuity, pupillary function and both pattern and severity of visual field loss.Methods: We performed a retrospective chart review of 102 patients with a diagnosis of bilateral sequential NAION. Of the 102 patients, 86 were included in the study for analysis of final visual outcome between the affected eyes. Visual function was assessed using visual acuity, Goldmann visual fields, color vision and RAPD. A quantitative total visual field score and score per quadrant was analyzed for each eye using the numerical Goldmann visual field scoring method previously described by Esterman and colleagues. Based upon these scores, we calculated the total deviation and pattern deviation between fellow eyes and between eyes of different patients. Statistical significance was determined using nonparametric tests.Results: A statistically significant correlation was found between fellow eyes for multiple parameters, including logMAR visual acuity (P = 0.0101), global visual field (P = 0.0001), superior visual field (P = 0.0001), and inferior visual field (P = 0.0001). In addition, the mean deviation of both total (P = 0.0000000007) and pattern (P = 0.000000004) deviation analyses was significantly less between fellow eyes ("intra"-eyes) than between eyes of different patients ("inter"-eyes).Conclusions: Visual function between fellow eyes showed a fair to moderate correlation that was statistically significant. The pattern of vision loss was also more similar in fellow eyes than between eyes of different patients. These results may help allow better prediction of visual outcome for the second eye in patients with NAION. These findings may also be useful for evaluating efficacy of therapeutic interventions.

Evaluation of the new photosensitizer Stakel (WST-11) for photodynamic choroidal vessel occlusion in rabbit and rat eyes.

PURPOSE: To evaluate the photodynamic potential of a new hydrosoluble photosensitizer (WST-11, Stakel; Steba Biotech, Toussus-Le-Noble, France), for use in occlusion of normal choroidal vessels in the rabbit eye and CNV (choroidal neovascularization) in the rat eye. METHODS: Occlusive and nonocclusive parameters of Stakel and verteporfin photodynamic therapy (PDT) were investigated in pigmented rabbits. Eyes were followed by fluorescein angiography (FA) and histology at various intervals after PDT. RESULTS: When occlusive parameters (fluence of 50 J/cm(2), 5 mg/kg drug dose and DLI [distance to light illumination] of 1 minute) were used, Stakel PDT was efficient immediately after treatment without associated structural damage of the RPE and retina overlying the treated choroid in the rabbit eye. Two days later, total occlusion of the choriocapillaries was seen in 100% of the treated eyes, along with accompanying histologic structural changes in the overlying retina. When the occlusive parameters (fluence, 100 J/cm2; drug dose, 12 mg/m2; and DLI, 5 minutes) of verteporfin PDT were used, occlusion of the choriocapillaries was observed in 89% of the treated eyes. Histology performed immediately after treatment demonstrated structural damage of the overlying retina and RPE layer. Weaker, nonocclusive Stakel PDT parameters (25 J/cm2, 5 mg/kg, and DLI of 10 minutes) did not induce choriocapillary occlusion or retinal lesions on FA or histology. Weaker, nonocclusive verteporfin PDT parameters (10 J/cm2, 0.2 mg/kg, and DLI of 5 minutes) did not induce choriocapillary occlusion. However, histology of these eyes showed the presence of damage in the retinal and choroidal tissues. Moreover, preliminary results indicate that selective CNV occlusion can be achieved with Stakel PDT in the rat eye. CONCLUSIONS: Unlike verteporfin PDT, Stakel PDT does not cause direct damage to the RPE cell layer or retina. These observations indicate that Stakel PDT may have a high potential for beneficial therapeutic outcomes in treatment of AMD.

Tema y narración en Eyes Wide Shut

A partir de la complejidad argumental y temática de la película Eyes Wide Shut, dirigida por Stanley Kubrick, se presenta una propuesta interpretativa que analiza la relación entre el tema de la película, la trama narrativa y la novela en que se basa, Traumnovelle (Relato soñado), de Arthur Schnitzler. La estructura argumental se sostiene en un elemento temático específico, los impulsos sexuales de una pareja –y los sueños y las fantasías vinculados–, en una trama en la que se suceden episodios que representan estos impulsos. Las escenas proyectan las tendencias del inconsciente de los personajes (en sueños, en fantasías y también en situaciones dudosamente reales) de forma cada vez más intensa, hasta llegar al anticlímax de cotidianidad con que concluye la película.

Test-retest repeatability of the pupil light response to blue and red light stimuli in normal human eyes using a novel pupillometer.

In this study, we evaluated the repeatability of pupil responses to colored light stimuli in healthy subjects using a prototype chromatic pupillometer. One eye of 10 healthy subjects was tested twice in the same day using monochromatic light exposure at two selected wavelengths (660 and 470 nm, intensity 300 cd/m(2)) presented continuously for 20 s. Pupil responses were recorded in real-time before, during, and after light exposure. Maximal contraction amplitude and sustained contraction amplitude were calculated. In addition, we quantified the summed pupil response during continuous light stimulation as the total area between a reference line representing baseline pupil size and the line representing actual pupil size over 20 s (area under the curve). There was no significant difference in the repeated measure compared to the first test for any of the pupil response parameters. In conclusion, we have developed a novel prototype of color pupillometer which demonstrates good repeatability in evoking and recording the pupillary response to a bright blue and red light stimulus.

Influência de substratos e fungos micorrízicos arbusculares no desenvolvimento vegetativo do porta-enxerto flying dragon. (Poncirus trifoliata, var. montruosa Swing.)

O presente estudo teve por objetivos avaliar o efeito da composição do substrato e da inoculação de duas espécies de fungos micorrízicos arbusculares (FMA) (Glomus clarum e Acaulospora scrobiculata) sobre o desenvolvimento vegetativo, o conteúdo em substâncias de reserva nos tecidos e a percentagem de colonização radicular por FMA no porta-enxerto Flying dragon (Poncirus trifoliata, var. monstruosa Swing). Os tratamentos consistiram de dois substratos: S1= solo + areia (1:1; v:v) e S2 = solo + areia + resíduo decomposto de casca de acácia-negra (2:2:1; v:v:v), ambos com e sem inoculação isolada de duas espécies de FMA (G. clarum e A. scrobiculata). Constatou-se que a adição de resíduo decomposto de casca de acácia-negra melhorou as características químicas e físicas do substrato, permitindo um maior desenvolvimento vegetativo e acúmulo de substâncias de reserva às plantas de Flying dragon em relação ao substrato solo + areia. A eficiência da simbiose foi variável com o substrato e com a espécie de FMA, onde o efeito positivo dos FMA foi notado apenas no substrato solo + areia, mais pobre nutricionalmente, sendo A. scrobiculata a espécie mais eficiente.

Caracterização de frutos e poliembrionia em sementes de 'flying dragon' e de híbridos de porta-enxerto de citros

A diversificação de porta-enxertos é uma realidade no momento atual da citricultura brasileira, devido aos inúmeros problemas fitossanitários que vêm sendo recorrentes. Neste contexto, algumas alternativas já são implementadas, como a utilização de alguns híbridos produzidos a partir do melhoramento convencional e por variedades já consagradas na citricultura. O presente trabalho foi realizado com o objetivo de caracterizar os frutos e avaliar a germinação e a poliembrionia das sementes de híbridos e alguns porta-enxertos convencionais. Para caracterização, foram colhidas, ao acaso, 12 amostras (frutos) de cada porta-enxerto. Na avaliação do percentual de germinação, índice de velocidade de germinação e poliembrionia, foi utilizado o esquema fatorial 5 (porta-enxertos: híbridos UFLAD-2, UFLAD-3 e UFLAD-4, citrumeleiro 'Swingle' e o Poncirus trifoliata var. monstrosa 'Flying Dragon') x 2 (com e sem a remoção do tegumento da semente), sendo utilizadas quatro repetições. De acordo com os resultados obtidos, concluiu-se que: O tamanho do fruto não influenciou no rendimento de sementes. A remoção do tegumento acelerou o tempo de germinação das sementes em todos os porta-enxertos e proporcionou maior percentual de germinação. A poliembrionia não afetou o processo de germinação das sementes. Os porta-enxertos UFLAD-2, UFLAD-3, UFLAD-4 e citrumeleiro 'Swingle' apresentam potencial para serem utilizados como porta-enxertos na propagação de algumas variedades cítricas.

Caracterização dos frutos e germinação de sementes dos porta-enxertos trifoliata Flying Dragon e citrumelo Swingle

Objetivou-se realizar a caracterização fitotécnica dos frutos e avaliar o efeito da remoção do tegumento da semente e do uso do GA3 e do bioestimulante (Stimulate®) sobre a germinação de sementes dos porta-enxertos de citros Flying Dragon e citrumelo Swingle. A caracterização fitotécnica compreendeu a massa do fruto, o diâmetro transversal e longitudinal e a espessura da "casca" e a contagem de sementes viáveis e inviáveis por fruto. Realizou-se um experimento para cada porta-enxerto, em casa de vegetação sob nebulização intermitente, e as avaliações foram a cada 3 dias, após o início do processo germinativo, verificando-se porcentagem de germinação e índice de velocidade de germinação. A utilização do GA3 e a retirada do tegumento em sementes do porta-enxerto Flying Dragon aumentam a porcentagem de germinação e o índice de velocidade de germinação, e para o porta-enxerto citrumelo Swingle, a retirada do tegumento das sementes aumenta a porcentagem de germinação e o índice de velocidade de germinação.