Anatomical Deterioration Research Articles

Idiopathic epiretinal membrane and when to operate

Idiopathic epiretinal membrane is a product of pathological processes during the progression of posterior vitreous detachment. Its incidence increases over time and reaches up to 34% of the population over 60 years of age, a rate that significantly increased after the introduction of spectral‐domain optical coherence tomography (SD‐OCT) in daily clinical practice.Traditionally, the decision to intervene was mostly based on the balance between subjective patient complaints and the risks related to vitrectomy surgery itself and less on OCT imaging, especially since advanced epiretinal membranes as seen on OCT are often accompanied by remarkably good visual acuity. Additionally, unilateral incidence, could mask symptoms, depending on eye dominance. However, more recently, technological advances in posterior segment surgery, have significantly reduced the rate of post vitrectomy complications, leading to earlier surgical intervention practices.There is great literature debate concerning the determination of the right intervention timing for idiopathic epiretinal membrane. The most important predictive factors include preoperative visual acuity, the presence of metamorphopsia and impact on the quality of life.According to existing literature, natural progression of the disease leads to anatomical deterioration in a rate ranging from 17 to 39%. Factors related to faster deterioration include metamorphopsia and the presence of cystic formations in the inner layers of the retina on SD‐OCT.

Clinical Phenotypes of Patients with Neovascular Age-Related Macular Degeneration and Poor Response to Aflibercept Treatment

The purpose: to identify and describe the clinical phenotypes of patients depending on their response to treatment with Aflibercept.Material and methods. The study had a prospective cohort design, including 92 eyes (n = 84) with a newly diagnosed diagnosis of nAMD and signs of disease activity. According to the OCT, the activity and type of macular neovascularization (MNV) were verified. Disease activity was monitored by central retinal thickness (CRT), the presence of subretinal and intraretinal fluid (SRF, IRF), and pigment epithelial detachment (PED). Eyes showing fresh hemorrhage ophthalmoscopically, OCT signs of SRF, IRC or sub-RPE, and dye leakage on the FAG were classified as having active nVMD. Treated with intravitreal injections (IVI) of Aflibercept 40 mg/ml in the “treat and extend” mode. The group with an unsatisfactory response to treatment was divided into 5 subgroups: true non-responders (without changes in activity throughout the course of treatment); partial nonrespondents (minimal regression of SRF and/or IRF) during treatment; dependent on anti-VEGF (complete regression on the background of injections, relapse after 4 weeks (increase in SRF/IRF, sub-RPE fluid, PED size); progression of anatomical changes, with exudation or hemorrhage, despite treatment; decreased response to treatment over time. Studied differences in baseline characteristics between the eyes among respondents and non-respondents and in five subgroups of incomplete respondents.Results. In the OCT characteristic, 45.5 % of eyes with tachyphylaxis showed normal CRT, lack of SRF (90.9 %) and IRF (90.9 %), high prevalence of fibrovascular PED (90.9 %); 90.0 % of the eyes showed type 1 MNV. In the subgroup of non-respondents with anatomical deterioration, type 2 and 3 of MNV were more often present (p = 0.00001) and fibrovascular-hemorrhagic PED was present in every sixth eye. Half (51.2 %) of the VEGF-dependent eyes (p = 0.0139) had the phenotype SRF+ and IRF- (91.3 % vs. 57.9 %, p = 0.0123), dominated by the OCT phenotype: SRF+/IRF-, as well as type 1 and 2 of MNV (91.3 % and 8.7 %, respectively). The eyes are partially non-respondent in 32 % had normal CRT, in 40 % of the eyes SRF+, in 24 % of IRF+, different types of PED, 1 and 3 types of MNV were present.Conclusion. The presented descriptions of clinical phenotypes of eyes with nVMD depending on their response to treatment with Aflibercept may be useful in predicting the response to treatment.

Long-Term Consequences of COVID-19 Lockdown in Neovascular AMD Patients in Spain: Structural and Functional Outcomes after 1 Year of Standard Follow-Up and Treatment.

Consequences of the COVID-19 pandemic on medical care have been extensively analyzed. Specifically, in ophthalmology practice, patients suffering age-related macular degeneration (AMD) represent one of the most affected subgroups. After reporting the acute consequences of treatment suspension in neovascular AMD, we have now evaluated these same 242 patients (270 eyes) to assess if prior functional and anatomical situations can be restored after twelve months of regular follow-up and treatment. We compared data from visits before COVID-19 outbreak and the first visit after lockdown with data obtained in subsequent visits, until one year of follow-up was achieved. For each patient, rate of visual loss per year before COVID-19 pandemic, considered “natural history of treated AMD”, was calculated. This rate of visual loss significantly increased during the lockdown period and now, after twelve months of regular follow-up, is still higher than before COVID outbreak (3.1 vs. 1.6 ETDRS letters/year, p < 0.01). Percentage of OCT images showing active disease is now lower than before the lockdown period (51% vs. 65.3%, p = 0.0017). Although anatomic deterioration, regarding signs of active disease, can be apparently fully restored, our results suggest that functional consequences of temporary anti-VEGF treatment suspension are not entirely reversible after 12 months of treatment, as BCVA remains lower and visual loss rate is still higher than before the COVID-19 pandemic.

Surgical interventions for lamellar macular holes.

Lamellar macular holes (LMHs) are small, partial-thickness defects of the macula defined by characteristic features on optical coherence tomography (OCT), including a newly recognised type of epiretinal membrane termed 'epiretinal proliferation'. There may be a rationale to recommend surgery for individuals with LMHs, particularly those with functional or anatomical deterioration, or poor baseline vision causing significant disability, to stabilise the LMH and prevent further visual deterioration; however, there is currently no evidence-based consensus. To assess the effect of surgical interventions on post-operative visual and anatomical outcomes in people with a confirmed LMH. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, Scopus SciVerse, ISRCTN registry, US National Institutes of Health Ongoing Trials Register, ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We also searched reference lists of included trials to identify other eligible trials which our search strategy may have missed. The date of the search was 20 July 2021. We included randomised controlled trials (RCTs) involving participants with a confirmed LMH diagnosis which reported one or more surgical intervention(s), alone or in combination, in at least one arm of the RCT. We used standard methods as expected by Cochrane. Two study authors independently extracted data and assessed the risk of bias for included trials. Trial authors were contacted for further information and clarification. A single RCT was eligible for inclusion. Thirty-six participants were randomised in a 2:1 ratio; 24 were allocated to undergo surgery (pars plana vitrectomy, peeling of the epiretial proliferation followed by fovea-sparing removal of the internal limiting membrane) and 12 (10 following two participant dropouts) to observation. Overall, the certainty of the evidence was low for all outcomes due to selection and detection bias, and the low number of participants enrolled in the study which may affect the accuracy of results and reliability of conclusions. At six-month follow-up, change in vision was better in the surgery group (-0.27 logMAR improvement) than observation (0.02 worsening) (mean difference (MD): -0.29 logMAR, 95% confidence intervals (CI): -0.33 to -0.25). Central retinal thickness increased in the surgery group over 6 months 126 μm increase) compared with observation group (decrease by 11μm) (MD: 137 μm, 95% CI: 125.87 μm to 148.13 μm). Finally, at six-month follow-up, retinal sensitivity was better in the surgery group (3.03 dB increase) compared with the observation group (0.06 dB decrease) (MD: 3.09 dB, 95% CI: 2.07 to 4.11 dB). Vision-related quality of life and metamorphopsia were not reported. No adverse outcomes or complications were reported in the study, however, authors could not provide information on whether any individuals developed deterioration in vision of 0.2 logMAR or worse. The included single trial demonstrated improvements in visual and anatomical outcome measures for participants with a LMH who underwent surgery compared with observation only. Therefore, we can conclude that participants who undergo surgery may achieve superior post-operative best corrected visual acuity and anatomical outcomes compared with observation only. However, the results of a single and small RCT provides limited evidence to support or refute surgery as an effective management option for LMHs. Future RCTs with a larger number of participants and with fewer methodological limitations and biases are necessary to inform future clinical practice.

Isolated reversal of flow in the vertebral artery - A missed entity.

Isolated reversal of flow in the vertebral artery is a rare phenomenon occurring in the general population and is due to intrinsic anatomical defects. The most common cause is subclavian stenosis; however, reversal of flow in the vertebral artery can occur regardless of any detection of anatomic deterioration. In this series, we report three asymptomatic cases where the extracranial Doppler scan preceding off-pump coronary arterial bypass grafting showed isolated reversal of flow in the vertebral artery. No signs of subclavian stenosis or steal syndrome were elicited. However, all patients subsequently suffered from a posterior circulation stroke following off-pump coronary arterial bypass grafting but recovered fully with medical management. We conclude that a detailed pre-operative neurological investigation can mitigate this risk and improve neurological outcomes following off-pump coronary arterial bypass grafting.

Outcome of Off-Label AREDS 2 Supplementation for the Treatment of Macular Degeneration in Non-Proliferative Idiopathic Type 2 Macular Telangiectasia.

PurposeTo evaluate if off-label Age-Related Eye Disease Study 2 (AREDS2) supplementation prevents visual and anatomical deterioration in non-proliferative Idiopathic Macular Telangiectasia Type 2 (IMT2).Patients and MethodsThis is a single-center retrospective, comparative study of 82 IMT2 eyes treated with AREDS2 from January 1st, 2013 to January 1st, 2018. The study analysis consisted of a non-comparative arm, which included all AREDS2 eyes, and a comparative arm (27 AREDS2 and 42 untreated eyes) that only included eyes with complete follow-up data. Eyes were evaluated at baseline, 12 and 24 months. Better/worse eye sub-analysis was performed in the comparative study arm. Primary outcomes were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) anatomical characteristics including largest cavitation diameter, central macular thickness (CMT), and length of ellipsoid zone (EZ) loss at 24 months.ResultsIn the non-comparative arm, AREDS2 eyes showed stable BCVA (0.28 ± 0.18 logMAR at baseline vs 0.26 ± 0.19 logMAR at 24 months; p = 0.35) and OCT anatomical features after 24 months of supplementation. In the comparative arm, BCVA mean difference was greater for untreated eyes at 24 months (−0.09 ± 0.15 vs 0.03 ± 0.11 logMAR; p = <0.001). AREDS2 eyes had decreased cavitary diameter and EZ loss compared to untreated eyes at the study endpoint (p = 0.01 and p = 0.02, respectively). CMT remained stable for both cohorts throughout the study. For better/worse eye analysis, untreated eyes had worse BCVA at 24 months in both better and worse eyes (both p = 0.01). For anatomical outcomes, increases in both EZ loss (p = 0.04) and cavitary diameter (p = 0.001) among untreated eyes were only significant for eyes with worse baseline BCVA.ConclusionOur results suggest that off-label AREDS2 supplementation in non-proliferative IMT2 may prevent anatomical and visual deterioration in a subset of eyes.

Exacerbations and Pseudomonas aeruginosa colonization are associated with altered lung structure and function in primary ciliary dyskinesia

BackgroundRecurrent bacterial infections of the respiratory tract are one of the major clinical features of the primary ciliary dyskinesia (PCD), a rare genetic disease due to malfunctioning of motile cilia. Chronic infections and persistent inflammation of the respiratory system result in progressive lung disease.Aim of the study was to highlight the main factors associated with clinical, functional and anatomical deterioration in PCD patients.MethodsWe retrospectively analyzed data from 58 patients with PCD, 37 adults and 21 children. The demographic and clinical data, forced expiratory volume at 1 s (FEV1) and forced vital capacity (FVC), sputum microbiology and imaging results (chest CT scores-modified Bhalla) were recorded. Patients were stratified according to the number of exacerbations (< 2/year vs ≥ 2/year) and chronic Pseudomonas aeruginosa (PA) colonization. The possible correlations between lung function and chest CT scores were assessed; we also evaluated the correlation between these parameters and the severity scores for bronchiectasis (BSI, FACED and e-FACED).ResultsChest CT scores showed a significant correlation with FEV1 (p = 0.0002), age (p < 0.0001), BMI (p = 0.0002) and number of lung lobes involved (p < 0.0001). PA colonization had an overall prevalence of 32.6%: no significant difference in FEV1 between PA colonized and non-colonized patients was found (p = 0.70), while chest CT score was significantly worse in chronic PA colonized patients (p = 0.009). Patients with a high number of exacerbation (≥ 2/year) were older (p = 0.01), had lower FEV1 (p = 0.03), greater number of lobes involved (p < 0.001) and worse CT score than patients with low number of exacerbations (p = 0.001); they also had higher prevalence of PA chronic bronchial infection (33.3% versus 13.6%, p = 0.10). Multivariable linear regression analyses adjusted for gender, age and BMI showed positive associations between PA colonization and number of exacerbations with severity of disease (number of lobes involved, CT score, BSI, FACED, and e-FACED).ConclusionsIn our PCD population the number of exacerbations (≥ 2/year) and PA colonization were the two most relevant factors associated with severity of disease.

Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography.

Prospective, cross-sectional observational study. We aimed to investigate the effects of chronic cervical radiculopathy (CR) on the cross-sectional area (CSA) values of the cervical nerve roots (CNRs), median, ulnar, and radial nerves with high-resolution ultrasonography. Symptomatic nerve roots are wider than asymptomatic nerve roots due to the presence of edema. Peripheral nerves have also been shown to develop edema, fibrosis, and changes distal to the affected nerve as a result of mechanical compression. In addition according to "double-crush syndrome" hypothesis, the peripheral nerves are more sensitive to pressure, and a proximal nerve lesion makes the distal segment of the nerve more susceptible to anatomic deterioration by causing interruption in the axoplasmic conduction due to compression. Forty patients with chronic CR were included to the study. Both affected CNRs and the contralateral nerve roots (control group) were evaluated with high-resolution ultrasonography. Ulnar and median nerve CSA measurements were performed at four measurement points and radial nerve measurements at a single measurement point. CSA measurements were statistically significantly higher at the CNR of the affected side compared to the unaffected side. There was no statistically significant difference when affected and unaffected sides were compared in terms of measurements performed from median, ulnar, and radial nerves at all measurement points. The results of the present study indicate that the changes in the CNR caused by CR do not have any effect on the peripheral nerves. We did not find any affection in peripheral nerve CSA that might have been suggestive of double-crush syndrome in CR. 2.

Electroacupuncture ameliorates post-stroke learning and memory through minimizing ultrastructural brain damage and inhibiting the expression of MMP-2 and MMP-9 in cerebral ischemia-reperfusion injured rats.

The aim of the present study was to investigate the potential neuroprotective effects of electroacupuncture (EA) in the treatment of cerebral ischemia/reperfusion (I/R) injury, and to elucidate the association between this neuroprotective effect and brain ultrastructure and expression of matrix metalloproteinase (MMP)-2 and 9. Rats underwent focal cerebral I/R injury by arterial ligation and received in vivo therapeutic EA at the Baihui (DU20) and Shenting (DU24) acupoints. The therapeutic efficacy was then evaluated following the surgery. The results of the current study demonstrated that EA treatment significantly ameliorated neurological deficits and reduced cerebral infarct volume compared with I/R injured rats. Furthermore, EA improved the learning and memory ability of rats following I/R injury, inhibited blood brain barrier breakdown and reduced neuronal damage in the ischemic penumbra. Furthermore, EA attenuated ultrastructural changes in the brain tissue following ischemia and inhibited MMP-2/MMP-9 expression in cerebral I/R injured rats. The results suggest that EA ameliorates anatomical deterioration, and learning and memory deficits in rats with cerebral I/R injury.

FRI-04 GENITOURINARY TUBERCULOSIS: FROM MUMMIES TO MODERN DAY

You have accessJournal of UrologyHistory of Urology: History Forum I1 Apr 2016FRI-04 GENITOURINARY TUBERCULOSIS: FROM MUMMIES TO MODERN DAY Jonathan Pavlinec, Rishi Modh, and Thomas Stringer Jonathan PavlinecJonathan Pavlinec More articles by this author , Rishi ModhRishi Modh More articles by this author , and Thomas StringerThomas Stringer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.089AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tuberculosis (TB) affects one-third of the world population, with genitourinary manifestations occurring in an estimated 4-20 percent of individuals with a pulmonary infection. Involvement of the genitourinary tract accounts for 40 percent of extra-pulmonary TB cases, second only to lymph node involvement. Given the ancient history of tuberculosis dating as far back as 9,000 BC, genitourinary manifestations of TB have invariably been present for thousands of years prior to G. L. Bayle first classic description in 1810. METHODS Literature review was performed to understand the historical significance of genitourinary tuberculosis and the role of mycobacteria within urology, including review of textbook chapters and peer-reviewed articles on pubmed. RESULTS Researches in Portugal recently identified the oldest suspected case of renal tuberculosis in an Egyptian mummy from approximately 900 BC. Several other cases of genitourinary findings consistent with tubercular disease have been described in the literature, spanning many of the major, ancient civilizations. Predating the classic description of genitourinary tuberculosis by nearly three millennia, tuberculosis has exerted an enduring and mystifying effect on the history of mankind. Several contributions from the study of Mycobacteria continue to play a role in practice today, including Dr. Robert Koch’s urine studies of genitourinary tuberculosis that shaped “Koch’s postulates,” the early foundation for the field of microbiology. Dr. Selman Waksman first coined the term “antibiotic” in describing the effects of streptomycin on mycobacteria. In addition, vaccine work against Mycobacteria by Calmette and Guerin was discovered to induce immunologic reactivity and tumor inhibition, the foundation for our regimens of therapy for superficial bladder cancers. Several other impactful discoveries and correlations may be attributed to the public health impact and historical perception of tuberculosis and it’s genitourinary manifestations. These range from the widespread use of TB sanitariums, to the thought that vampires were associated with TB, to the identified transmission of genitourinary tuberculosis to Jewish males during circumcision rituals from the infected sputum of Rabbis. CONCLUSIONS Tuberculosis is one of the oldest human diseases and has spanned across millennia, affecting major ancient civilizations and still persisting as a leading public health concern in 2015. It has likely been the major cause of anatomic deterioration of the urinary tract for thousands of years, but was not readily apparent clinically due to the long latency period and the markedly shorter life expectancy prior to the 19th and 20th centuries. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e527 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jonathan Pavlinec More articles by this author Rishi Modh More articles by this author Thomas Stringer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Aging of the Human Vestibular System.

Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.

The natural history of rotator cuff tears: a systematic review.

To analyse the current scientific evidence regarding the natural history of the clinical and anatomical progression of rotator cuff tears. A broad systematic review of the literature (PubMed database through January 2014) which was guided, conducted and reported according to PRISMA criteria. This article focuses on the rotator cuff tears. Articles had to meet an inclusion criteria. The methodological quality of each study was individually assessed using a recently developed general assessment tool AMQPP (assessing the methodological quality of published papers). Seven articles dealing with rotator cuff tears were included, one of them was a high-quality study. Three papers assessed the natural history and the natural course of rotator cuff rupture directly. The other studies indirectly assessed the natural history with reports on non-operative and operative therapy trends. All of these articles had been published in four different top medical journals according to 2013 ranking. We found no articles which clearly referred to the role of regression to the mean of rotator cuff tears. The development of symptoms and anatomical deterioration are often directly correlated. Spontaneous recovery to normal levels of function has been successfully achieved, and standardised non-operative treatment programmes are an effective alternative to surgery for many patients. Follow-up is necessary to avoid irreparable stage. However, surgery is still favoured by young active people and highly professional persons who need to get fit in a short period of time. Further research is still necessary. The AMQPP score system is simple and reliable. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily.

Is long-term follow-up of adequately coil-occluded ruptured cerebral aneurysms always necessary? A single-center study of recurrences after endovascular treatment

PurposeAneurysm recurrence following coil occlusion is well recognized. However, there is controversy as to how long these patients should be followed up after coiling to detect reopening. We aimed to...

The Natural History of Asymptomatic Rotator Cuff Tears

Little is known about the clinical and anatomic progression of asymptomatic rotator cuff tears. The purpose of our study was to assess if deterioration in rotator cuff tear anatomy would be correlated to the development of symptoms. Fifty patients with initially asymptomatic full-thickness rotator cuff tears were followed clinically, sonographically, and by magnetic resonance imaging over three years. Changes of tear size, muscle atrophy, fatty degeneration, and condition of the long head of the biceps tendon were compared between tears that developed symptoms and those that did not. Eighteen of fifty tears developed symptoms during follow-up. There was a significantly larger increase (p = 0.02) in the mean tear size in the newly symptomatic group (10.6 mm) when compared with the still-asymptomatic group (3.3 mm). The rate of progressing to advanced muscle atrophy was higher (p = 0.08) in the newly symptomatic group (35% [six of seventeen subjects]) when compared with the still-asymptomatic group (12% [three of twenty-five subjects]). The rate of fatty degeneration was significantly higher (p = 0.02) in the newly symptomatic group (35% [six of seventeen subjects]) when compared with the still-asymptomatic group (4% [one of twenty-five subjects]). The rate of pathology of the long head of the biceps tendon was significantly higher (p = 0.02) in the newly symptomatic group (33% [six of eighteen subjects]) when compared with the still-asymptomatic group (6% [two of thirty-two subjects]). During a relatively short-term follow-up, a substantial percentage of asymptomatic rotator cuff tears became symptomatic and underwent anatomic deterioration. Increase in tear size and decrease of muscle quality were correlated to the development of symptoms. Subjects diagnosed with an asymptomatic rotator cuff tear should be informed about the natural history of the condition and follow-up with repeated imaging may be indicated to monitor tear progression.

Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy: complications and management.

We report the management of a young woman with preeclampsia of pregnancy who developed bilateral Purtscher-like retinopathy and serous retinal detachment subsequently complicated by macular hole and tractional retinal detachment. The best-corrected visual acuity was 20/1000 bilaterally. Fundus examination showed a picture of Purtscher-like retinopathy bilaterally and a macular hole in the right eye. Fluorescein angiography showed areas of capillary dropout and Elschnig spots bilaterally. Optical coherence tomography confirmed the macular hole in the right eye and a shallow serous retinal detachment bilaterally. Systemic and laboratory workup was unremarkable. Triamcinolone acetonide (4 mg/0.1 mL) was injected intravitreally in the left eye; vitrectomy was advised for the right eye. However, when the patient returned after 4 months, the right eye had developed a macular tractional retinal detachment. Vitrectomy, membrane peeling, and gas tamponade were performed. When the patient returned 4 months after the intravitreal injection in the left eye, best-corrected visual acuity had improved to 20/40 with complete resolution of serous retinal detachment in that eye. Best-corrected visual acuity in the right eye remained at 20/1000 but with anatomic deterioration. One month after vitrectomy for the macular hole and tractional retinal detachment in the right eye, best-corrected visual acuity improved to 20/240 with normalizing foveal contours. Status quo was observed in both eyes for the next 8 months. Final best-corrected visual acuity was 20/200 in the right eye and 20/40 in the left eye. An unusual combination of Purtscher-like retinopathy with serous retinal detachment in preeclampsia of pregnancy and its complication-macular hole with tractional retinal detachment-were managed by surgery and pharmacotherapy.

Secondary pigmented macular pucker on optical coherence tomography

To describe the clinical features, retinal architecture and tomographic configuration of a pigmented epiretinal membrane on optical coherence tomography (OCT). A 52-year-old man presented during a routine examination with an asymptomatic, darkly pigmented, pre-retinal epiretinal membrane in his right eye. His best corrected visual acuity (BCVA) on Snellen charts was 20/25 in the right eye and 20/20 in the left. The patient complained of no visual symptoms or metamorphopsia. In the fundus periphery there was a small, old, well pigmented retinal hole with pigmentation in its immediate vicinity, without signs of vitreal traction, which required no treatment. The foveal indentation was not apparent on OCT and a well demarcated hyperreflective band defined the pigmented epiretinal membranes (ERMs). Sequential fundus examination over a 2-year period demonstrated no functional or anatomical deterioration attributable to the disease. Pigmented ERM may have different cellular origins depending on the underlying pathology. Patients with pigmented ERM and full VA should be followed by sequential OCT.

Localisations réno-aortiques de la maladie de Takayasu

From 1972 to 2003, we surgically treated 25 patients (17 females) for aortic and renal complications of Takayasu's disease. Their mean age was 18.5 +/- 11.2 years. Despite heavy medical treatment, all had severe uncontrollable hypertension. Nineteen patients had associated lesions of the aorta and renal arteries, 6 had isolated lesions of a renal artery, and 10 had lesions of the mesenteric arteries. Percutaneous transluminal angioplasty of the renal artery or arteries was attempted in four cases and was always unsuccessful. Thirteen patients with bilateral lesions underwent nephrectomy (three cases) and renal artery repair (35 cases). Aortic bypass was performed in 7 patients and revascularization of other visceral arteries in 4 patients. Follow-up ranges from 1 to 20 years (mean 5 years). There were no deaths. Three thromboses occurred post-operatively, two in a renal artery and one in the superior mesenteric artery. Immediately after the operation blood pressure normalized in 18 patients (72%), was improved in 4 (16%) and remained unchanged in 3 (12%). The disease progressed in 11 patients (44%), with four recurrent stenoses of renal arteries, 3 aggravations of aortic lesions (requiring an aortic bypass in one patient at three years), 3 aggravations of supraaortic artery involvement, and one case of coronary insufficiency requiring bypass at 8.5 years. Long term blood pressure normalized in 14 patients (56%), was improved in 5 patients (20%) and remained unchanged in 6 patients (24%), owing mainly to secondary or late anatomical deterioration.

The aging olfactory epithelium: Neurogenesis, response to damage, and odorant-induced activity

Olfactory epithelium retains the capacity to recover anatomically after damage well into adult life and perhaps throughout its duration. None the less, olfactory dysfunctions have been reported widely for elderly humans. The present study investigates the effects of aging on the neurophysiological and anatomical status of the olfactory epithelium in barrier-raised Fischer 344X Brown Norway F 1 hybrid rats at 7, 10, 25 and 32/35 months old. The posterior part of the olfactory epithelium in 32/35-month-old rats is well preserved. Globose basal cells are dividing, and new neurons are being born even at this advanced age. None the less, the numbers of proliferating basal cells and immature, GAP-43 (+) neurons are significantly decreased. Neurophysiological status was evaluated using voltage-sensitive dye techniques to assess inherent patterns of odorant-induced activity in the epithelium lining the septum and the medial surface of the turbinates. In middle and posterior zones of the epithelium, there were neither age-related changes in overall responsivity of this part of the olfactory epithelium to any of five odorants, nor shifts in the location of the odorant-induced hotspots. The inherent activity patterns elicited by the different odorants do become more distinct as a function of age, which probably reflects the decline in immature neurons and a slight, but not statistically significant, increase in mature neurons as a function of age. In contrast with the excellent preservation of posterior epithelium, the epithelium lining the anterodorsal septum and the corresponding face of the turbinates is damaged in the 32/35-month-old animals: in this part, horizontal basal cells are reactive, more basal cells and sustentacular cells are proliferating than in younger animals or in posterior epithelium of the same animals, and the neuronal population is less mature on average. Our findings indicate that degeneration of the olfactory epithelium is not an inevitable or pre-programmed consequence of the aging process, since the posterior zone of the epithelium is very well preserved in these barrier-protected animals. However, the deterioration in the anterior epithelium suggests that environmental insults can accumulate or become more severe with age and overwhelm the regenerative capacity of the epithelium. Alternatively, the regenerative capacity of the epithelium may wane somewhat with age. Either of these mechanisms or some combination of them can account for the functional and anatomical deterioration of the sense of smell associated with senescence in humans.

DEATH OF STEPPE CRYPTOGAMS UNDER THE ASH FROM MOUNT ST. HELENS

Terrestrial mosses and lichens in the steppe of Washington were buried under volcanic ash from the 18 May 1980 eruption of Mount St. Helens. Unlike adult vascular plants in these communities, these cryptogams died following the deposition of silt‐size ash. Death within as little as four months was demonstrated by anatomical deterioration and these organisms' inability to fix CO2, to fluoresce in IR radiation, and to absorb vital stains. Although cryptogams in the steppe have probably been destroyed repeatedly by ash falls during the Holocene, this recent destruction is the first since the arrival of alien plants in the nineteenth century. Death of cryptogams may allow the initiation of further colonization by alien plants because a cryptogamic crust forms a barrier to seedling establishment.