Head Edema Research Articles

Screening for cystoid macular oedema in children with uveitis using the retinal thickness analyser

This study aimed to investigate the retinal thickness analyser (RTA) as a means to identify the presence of cystoid macular oedema (CMO) in children with uveitis, whether the course of CMO can be monitored using this method, and whether there is a trend towards a correlation between macular oedema and visual acuity (VA) in children. This prospective, cross-sectional study with observer-blinded analysis included 25 eyes. Standardized testing for best corrected distance VA (d-VA), near (reading) VA (n-VA) and slit-lamp examination were conducted. Using the RTA, a 3 x 3-mm scan of the macula was obtained, which was then used to discern CMO and calculate mean foveal thickness (MFT). Macular scanning was possible in all children. Cystoid macular oedema was discerned in 10 eyes (40%) and ruled out in 15. In CMO eyes, d-VA was 0.5 Snellen and n-VA was 2 Jaeger; neither result differed significantly from those in eyes without CMO. Mean foveal thickness correlated with n-VA (r = 0.511, p = 0.015), but not with d-VA (r = 0.271, p = 0.191). After 3 months of tailored therapy, CMO was still detectable in six eyes. Changes in d-VA in the CMO and non-CMO groups were 3 +/- 2.1 and 0.8 +/- 1.8 Snellen, respectively; changes in n-VA were 1 +/- 1.4 and 0.1 +/- 0.3 Jaeger, respectively. Changes in MFT were - 244.8 +/- 137.4 microm and - 0.8 +/- 18.1 microm, respectively. A statistically significant correlation was found between the changes in MFT and n-VA (r = 0.629), but not with that in d-VA (r = 0.292). We used the RTA to establish the presence or absence of CMO according to measurements of the macular region. Our findings show that CMO is a common complication in children with uveitis and can be present even in cases with good d-VA. Mean foveal thickness as measured with the RTA correlates indirectly with n-VA.

Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy With Intravitreal Bevacizumab

Vascular endothelial growth factor (VEGF) results in a rapid and reversible increase in vascular permeability (1). Inhibition of VEGF signaling therefore provides an avenue for reducing vasogenic edema after nonarteritic ischemic optic neuropathy (NAION) and preserving viable but threatened optic nerve tissue. We report the first use of intravitreal bevacizumab (Genentech, South San Francisco, CA) for the treatment of NAION demonstrating a rapid and substantial reduction in optic nerve head edema and an unanticipated level of visual recovery. An 84-year-old woman with a history of NAION in the right eye presented with a 3-week history of visual loss in the left eye. Visual loss was acute, painless, and nonprogressive. She denied any accompanying neurologic or ophthalmologic complaints including headaches, temporal artery tenderness, jaw claudication, or polymyalgia. The initial ophthalmologic examination revealed optic disc swelling in the left eye with associated nerve fiber layer (NFL) hemorrhages. Sedimentation rate and C-reactive protein level were normal. Visual acuity was 20/400 in the right eye and count fingers (CF) at 1 foot in the left eye. Confrontation visual fields demonstrated temporal islands in both eyes. Automated perimetry was not reliably performed. The pupils measured 4 mm and reacted sluggishly to light; there was a right afferent pupillary defect. The ocular ductions were full. Ophthalmoscopic examination revealed a diffusely pale, cupless right optic nerve. The left optic nerve had marked edema and peripapillary NFL hemorrhages (Fig. 1A). The neurologic examination was normal.FIG. 1: Fundus photographs of the left eye at presentation (A) and 9 days after intravitreal injection of bevacizumab (B) show a rapid reduction in the degree of nerve fiber layer edema.Optical coherence tomography (OCT) documented marked swelling of the left optic nerve (Fig. 2). Fluorescein angiography (FA) showed capillary microangiopathy and dye leakage in the mid-phase and late-phase (Fig. 3A-B). An intravitreal injection of 1.25 mg/0.05 mL bevacizumab was administered to the left eye. Nine days later, there was marked reduction in the swelling of the left optic nerve (Figs. 1B, 2) with significant resolution of the dye leakage and microangiopathy (Figs. 3C-D). The patient noticed concurrent improvement in visual acuity to 20/1002 in the left eye.FIG. 2: Ocular coherence tomography (OCT) of the left optic nerve at presentation, 9 days after injection and 2 months after injection. The plane of imaging is through the horizontal nasotemporal axis. On initial presentation, the level of edema exceeded the available scale provided by the OCT software.FIG. 3: Fluorescein angiogram (FA) of the left fundus. A. Mid-phase FA at presentation. B. Late-phase FA at presentation. C. Mid-phase FA at 9 days after intravitreal injection. D. Late-phase FA 9 days after intravitreal injection.Ten days later, visual acuity had improved to 20/70 in the left eye, and the visual field had improved (Fig. 4). Two months after injection, there remained modest inferior and superior optic disc swelling (Fig. 2). Vision has remained stable for more than 24 weeks postinjection.FIG. 4: Automated threshold perimetry (Humphrey SITA 30-2) of the left eye 2 weeks after intravitreal injection of bevacizumab.After intravitreal bevacizumab, we observed a rapid and significant resolution of NAION-induced optic disc edema. Although visual recovery after NAION is not uncommon (2), the resolution of disc edema and visual recovery typically occur over 8 weeks (3). The rapid resolution of disc swelling and prompt improvement in visual acuity after bevacizumab administration suggest that VEGF-induced vascular permeability may play a role in tissue injury in NAION. Interestingly, cabergoline, a dopamine receptor agonist, inhibits VEGF-mediated vascular permeability (4). This feature may explain the potential benefit observed with carbidopa-levodopa therapy in recent-onset NAION (5). Although local VEGF expression after NAION may promote long-term beneficial angiogenesis, acute expression may result in deleterious edema and secondary injury. Indeed, inhibition of VEGF signaling reduces cerebral edema and tissue injury in a murine stroke model (6). Therefore, VEGF inhibition may offer a novel therapeutic approach to limit injury in NAION. A clinical trial of intravitreal bevacizumab in NAION is warranted. Jeffrey L. Bennett, MD, PhD Departments of Neurology and Ophthalmology Rocky Mountain Lions Eye Institute University of Colorado at Denver and Health Sciences Center Denver, Colorado Scott Thomas, MD Jeffrey L. Olson, MD Naresh Mandava, MD Department of Ophthalmology Rocky Mountain Lions Eye Institute University of Colorado at Denver and Health Sciences Center Denver, Colorado [email protected]

A 9 Year-Old Girl with Herpes Simplex Virus Type 2 Acute Retinal Necrosis Treated with Intravitreal Foscarnet

A 9-year-old girl presented with a 2-week history of redness in the left eye. Examination revealed vitritis, retinal whitening, vasculitis, and optic nerve head edema. Polymerase chain reaction testing of the aqueous fluid revealed herpes simplex virus type 2. The retinitis was controlled with intravenous acyclovir and intravitreal foscarnet. The clinical course was complicated by retinal neovascularization and vitreous hemorrhage, which was treated by pars plana vitrectomy and endolaser. While there are few case reports of herpes simplex virus type 2 retinitis in children, this one is unique for the following reasons: it is the first reported case of herpes simplex virus type 2 retinitis in a child less than 10 years old without a previous history of neonatal infection or central nervous system involvement; no other children have been reported to have been treated with intravitreal foscarnet; and retinal neovascularization complicated the recovery.

Peaked waves after head injury

The patient was a 21-year-old woman thrown off her bycicle by a car. The injuries were confined to the head, with massive and early cerebral edema, shallow subdural and extradular hematomas, and small scattered intracerebral hemorrhages. A basal skull fracture involved the pituitary fossa. Her Glasgow Coma Score remained 3 throughout, and she was deemed inoperable.

Computergestütztes System zur Verlaufskontrolle intraokularer Entzündungen

Until now, there has been no consistent rating system for changes of intraocular inflammation. We present such a computer-based system. This program is based on a FileMaker database. It is made of anterior and posterior uveitis scores on the basis of published evaluation guidelines of the International Ocular Inflammation Society (IOIS). An anterior uveitis score consisting of anterior chamber cells, flare, and perilimbal injection on the one hand and a posterior uveitis score consisting of vitreous haze, macula, and optic nerve head edema on the other hand are calculated. After adding visual acuity, intraocular pressure, and systemic dose of corticosteroids, all parameters can be visualized by a radar graph. This system of documentation is easy to handle and presents a simplified version of the disease course. The abstract visualization enables the patient to better understand the therapeutic management. The program presented here offers good opportunities for standardized monitoring of the disease course.

Glutaric Aciduria Type II: A Case Report

We report a case of a newborn with Glutaric aciduria type II. Pregnancy was complicated by polyhidramnios and fetal bradycardia. Cardiomegaly was detected by fetal echocardiography. The baby was admitted to the Neonatal Intensive Care Unit of Chieti with respiratory distress syndrome immediately after delivery. He showed head and neck edema, micrognathia, paucity of movement, pronounced hypotonia, bilateral cryptorchidism, micropenis, small hands, skin hyperelasticity and joint hypermobility. Serum and urine analysis showed a fatty acid beta-oxidation disorder. He died at 7 days of age for cardiac arrest and autopsy showed marked hepatic and cardiac vacuolisation, lipid storage myopathy and glial cells vacuolisation. Based upon these findings, we speculate that this infant may be suffering from inborn metabolic disease.

Right Shoulder Injury-Basketball

HISTORY A 20-year old right hand dominant female collegiate basketball player sustained an injury to her right shoulder while reaching forward for the ball during a conference game. Although she is not certain, she believes that she may have had some minor contact with another player at that time. She reported that it felt as if her shoulder was dislocated and she was unable to move it through any considerable range of motion. The trainer at the game placed her arm in external rotation and apparently reduced the shoulder. PHYSICAL EXAMINATION She was evaluated for the complaint of apprehension and inability to return to basketball three days after the injury. The right shoulder examination was significant for abnormal scapulothoracic rhythm with scapular hiking present but nearly full active abduction. Active internal rotation was limited to approximately 20 degrees and active external rotation to approximately 30 degrees. Passively slightly more motion was present but produced significant pain. Strength was graded as 4–5/5 within the available motions, but again produced discomfort. Although apprehension signs were negative, Hawkin's, Neer's, O'Brien's and anterior glide tests were all positive. DIFFERENTIAL DIAGNOSIS Labral tear (Bankart lesion) Supraspinatus impingement vs. strain or tear Infraspinatus impingement vs. strain or tear Biceps strain Hill Sachs lesion Subscapularis impingement vs. strain or tear TEST AND RESULTS Shoulder MRI with and without contrast Disruption of the subscapularis tendon with changes involving the periosteum of the scapula Remaining rotator cuff muscles intact Bankart's and ALPSA lesion with disruption of the anterior-inferior labrum with bone and soft tissue defect Intact humeral head without evidence of bone avulsion or humeral head edema FINAL WORKING DIAGNOSIS: Right subscapularis tear with disruption the scapular periosteum, Bankart's and ALPSA lesions. TREATMENT AND OUTCOMES Acute treatment consisted of ice, NSAIDs and activity modification-choose not to play for the remainder of the season. Initial therapeutic exercise consisted of active and active assisted shoulder range of motion exercises in all planes. Gradually advanced to a progressive rotator cuff strengthening program as full pain-free motion returned. A scapular stabilization exercise program was initiated. Sport specific conditioning, initiated 4 months post injury, consisted of over-head activities in preparation for volleyball season. Outcome: Began playing collegiate volleyball approximately 5 months post injury and will hopefully return to basketball this coming season.

Right Shoulder Injury-Basketball

HISTORY A 20-year old right hand dominant female collegiate basketball player sustained an injury to her right shoulder while reaching forward for the ball during a conference game. Although she is not certain, she believes that she may have had some minor contact with another player at that time. She reported that it felt as if her shoulder was dislocated and she was unable to move it through any considerable range of motion. The trainer at the game placed her arm in external rotation and apparently reduced the shoulder. PHYSICAL EXAMINATION She was evaluated for the complaint of apprehension and inability to return to basketball three days after the injury. The right shoulder examination was significant for abnormal scapulothoracic rhythm with scapular hiking present but nearly full active abduction. Active internal rotation was limited to approximately 20 degrees and active external rotation to approximately 30 degrees. Passively slightly more motion was present but produced significant pain. Strength was graded as 4–5/5 within the available motions, but again produced discomfort. Although apprehension signs were negative, Hawkin's, Neer's, O'Brien's and anterior glide tests were all positive. DIFFERENTIAL DIAGNOSIS Labral tear (Bankart lesion) Supraspinatus impingement vs. strain or tear Infraspinatus impingement vs. strain or tear Biceps strain Hill Sachs lesion Subscapularis impingement vs. strain or tear TEST AND RESULTS Shoulder MRI with and without contrast Disruption of the subscapularis tendon with changes involving the periosteum of the scapula Remaining rotator cuff muscles intact Bankart's and ALPSA lesion with disruption of the anterior-inferior labrum with bone and soft tissue defect Intact humeral head without evidence of bone avulsion or humeral head edema FINAL WORKING DIAGNOSIS: Right subscapularis tear with disruption the scapular periosteum, Bankart's and ALPSA lesions. TREATMENT AND OUTCOMES Acute treatment consisted of ice, NSAIDs and activity modification-choose not to play for the remainder of the season. Initial therapeutic exercise consisted of active and active assisted shoulder range of motion exercises in all planes. Gradually advanced to a progressive rotator cuff strengthening program as full pain-free motion returned. A scapular stabilization exercise program was initiated. Sport specific conditioning, initiated 4 months post injury, consisted of over-head activities in preparation for volleyball season. Outcome: Began playing collegiate volleyball approximately 5 months post injury and will hopefully return to basketball this coming season.

Kompressionssyndrome

Superior vena cava syndrome is a medical condition determined by the mechanisms of extrinsic compression, invasion or thrombosis of the superior vena cava. The most common underlying cause is a malignant process, especially lung cancer and lymphoma. Typical symptoms include progressive dyspnea, head and upper body edema and cyanosis. Most patients can be treated with appropriately directed chemotherapy or radiotherapy. Accurate diagnosis of the underlying etiology needs to be established before treatment. Only under extreme emergency conditions such as laryngeal or cerebral edema irradiation should be initiated without a histological diagnosis. With the refinement of endovascular stents, percutaneous stenting is being increasingly used as primary treatment modality. Metastatic spinal cord compression is one of the most dreadful complications of cancer. In most patients the initial symptom is progressive back pain with an axial or radicular distribution. MRI should be preferred in the diagnostic work-up, corticosteroids be administered promptly after biopsy. Radiation therapy or surgical treatment should be started as soon as possible.

Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation.

The purpose of this study was to examine preoperative shoulder magnetic resonance imaging (MRI) and intraoperative arthroscopic findings in throwing athletes with a clinical diagnosis of internal impingement. Retrospective review. A retrospective review of the surgical indications for 769 shoulder arthroscopic procedures performed from 1997 to 2000 revealed 9 throwing athletes with a diagnosis of severe internal impingement. Each had failed treatment that included a minimum of 3 months of rehabilitation. Preoperative MRIs in all 9 were read by a fellowship-trained musculoskeletal radiologist blinded to the operative findings. Findings at arthroscopy were culled from the operative reports. On both MRI and at arthroscopy, all 9 athletes had posterosuperior labral lesions, 1 had a humeral head articular cartilage lesion, and 1 had a SLAP lesion. Additional findings on MRI included humeral head edema, subchondral cystic changes, posterosuperior glenoid sclerosis, and rotator cuff tendonopathy predominantly in the infraspinatus. At arthroscopy, there were additional findings of articular-sided partial rotator cuff tears not shown on MRI. Both MRI and arthroscopic findings described labral and humeral head articular cartilage lesions. These findings may be indicative of internal impingement in throwing athletes. Level III, diagnostic.

Exhaled Nitric Oxide is Highly Increased in a Case of Hodgkin's Disease

Hodgkin’s lymphoma is characterized by an increase in circulation cytokines, which are known to be able to induce nitric oxide (NO) production. Exhaled nitric oxide (FENO) has been proposed as an inflammatory marker of the airways, and it has also been shown to be increased in lung cancer (1). So far no reports have used exhaled NO to follow the progress of cancer during treatment. The authors followed-up a patient with Hodgkin’s disease with extended NO analysis of the exhaled breath. The patient’s alveolar NO fraction was 9 ppb NO before diagnosis, which decreased to 7 ppb NO after four treatment periods, and after eight periods the fraction was 3 ppb NO. We conclude that extended NO analysis is a simple noninvasive tool to follow-up an inflammatory process in the human body, as well as following treatment during disease. Case report. A 27-year-old female with epilepsy and atopic dermatitis complained of coughing and shortness of breath. She had no history of airway atopy or asthma-like symptoms. She was referred to the lung clinic where the diagnosis of asthma was excluded. However, the exhaled NO levels were extremely high. Exhaled NO was measured with a chemiluminescence analyser (Sievers NOA 280, Sievers, Boulder, CO, USA) and a flow sensor, (D-lite TM , Datex-Ohmeda, Helsinki, Finland) was used to measure NO at different expiratory flow rates. Following the ATS guideline for NO measurement (2), it was seen that patient had more then tenfold increase in exhaled NO. Using an extended NO analysis (3) revealed high alveolar fraction (FANO), as well as an increase in airway wall fraction (FwNO) and airway wall diffusion rate of NO (DwNO), see Table 1. During a four-month period she developed fever, night sweats, and weight loss (BMI 24). Her symptoms became aggravated and she developed a vena cava superior compression with an oedema of upper thorax, head and neck. She had lymph node enlargement in the neck and axillae. Chest x-ray showed a large mediastinal mass. Laboratory analysis revealed elevated LDH, C-reactive protein and peripheral Blymphocytes. Fine-needle aspiration and lymph node biopsy showed a Hodgkin’s disease of mixed cellularity. The disease was classified as stage II by staging with CT-scan and bone marrow biopsy. She received treatment with eight courses of baseline BEACOPP, i.e. Bleomycin 10 mg/m 2 day 8, Etoposide 100 mg/m 2 day 1 � /3, Doxorubicin 25 mg/m 2 day 1, Cyclophosphamide 650 mg/ m 2 day 1, Vincristine 1.4 mg/m 2 (max 2 mg) day 8, Procarbazine 100 mg/m 2 day 1 � /7 and Prednisone 40 mg/m 2 day 1 � /14 (4). When she had finished four out of eight treatment periods the exhaled NO, CRP and B-lymphocytes had decreased. The CT scan showed shrinkage of the lymphoma mass. The patient developed severe haematological toxicity after every

Ocular toxoplasmosis presenting as neuroretinitis: report of two cases

Background: Neuroretinitis is a clinical entity usually seen in young healthy adults, that is characterized by rapid profound unilateral loss of vision and includes optic nerve head edema, splinter hemorrhages, macular exudate in a stellate pattern, and variable vitreous inflammation. There are numerous entities that can cause a picture of neuroretinitis ranging from vascular to infectious to autoimmune. Patient and methods: We report two patients with neuroretinitis, who presented with unilateral blurred vision and had serologic evidence of Toxoplasma gondii infection. Results: Both patients responded well to treatment with systemic antibiotics and corticosteroids. Visual acuity returned to 20/60 in one patient and 20/20 in the other. Conclusion: Although the etiology is usually idiopathic, infectious causes of neuroretinitis, including toxoplasmosis, should be kept in mind in order to maintain visual acuity by early diagnosis and appropriate therapy.

Atypical anterior optic neuropathy caused by toxoplasmosis

PURPOSE: To report atypical anterior optic neuropathy due to toxoplasmosis. METHODS: Interventional case report. A 33-year-old male presented with sudden painless loss of vision and floaters in the right eye. Examination demonstrated a best-corrected visual acuity of 20/200, optic nerve head edema, retinal hemorrhages, and vitreous opacities. RESULTS: Nine days later, a granuloma at the optic nerve head was apparent, and the patient was treated with pyrimethamine, sulfadiazine, folinic acid, and prednisone. Six weeks after initiating therapy, best-corrected visual acuity had improved to 20/25. CONCLUSION: Optic nerve involvement in toxoplasmosis is uncommon and, when it occurs, usually presents with a white inflammatory mass on the optic disk. The current case demonstrates the importance of including toxoplasmosis in the differential diagnosis of unilateral anterior optic neuropathy, even if a focal inflammatory mass is not apparent.

A Case of Orbital Solitary Fibrous Tumor

Background: Solitary fibrous tumor is a spindle cell neoplasm that most commonly arises in the pleura and very rarely involves the orbit. Case: A 38-year-old woman presented with slowly progressive proptosis of 3 months duration and optic nerve head edema in her right eye. Magnetic resonance imaging revealed a well-circumscribed, round mass lesion, which showed isointensity to the gray matter in a T1-weighted image, and variegated intensity in a T2-weighted image and contact with the optic nerve in her right orbit. The tumor was successfully removed by anterior orbitotomy. Observations: The tumor showed a “patternless pattern” of tumor cell arrangement, alternating hypercellular and hypocellular areas, a hemangiopericytoma-like pattern, and thickened strands of collagen. Immunohistochemically, the tumor cells were positive for CD34 and vimentin, and all were negative for other markers of epithelial, neural, muscular, histiocytic, and vascular endothelial cell elements. The tumor was diagnosed as a solitary fibrous tumor, and the patient was doing well with no evidence of recurrence 15 months after surgery. Conclusions: This case was the 19th reported case of solitary fibrous tumor in the orbital region. CD34 is a highly sensitive marker for solitary fibrous tumor.

Effect of the thigh-cuffs on the carotid artery diameter jugular vein section and facial skin edema: HDT study.

Objective: To evaluate the distal arterial, venous and skin changes in a group using thigh cuffs during daytime and in a control group. Method: Cardiac, arterial, venous parameters were measured by echography and Doppler. Skin thickness was measured by high frequency echography. Results & discussion: Head down position induced plasma volume reduction, increased cerebral resistance, reduced lower limb resistance. The jugular vein increased whereas the femoral and popliteal veins decreased. All these changes were already observed in previous HDT. Common carotid diameter decreased, Front head skin thickness increased and Tibial skin thickness decreased. Eight hours with thigh cuffs increased the cardiac and carotid sizes which is in agreement with the plasma volume increase. Conversely they reduced the cerebral vascular resistance, jugular section and front head edema which may explain the sensation of comfort reported by the subjects. At the lower limb level the thigh cuffs restored the skin thickness to pre-HDT level but enlarged markedly the femoral and popliteal veins. HR, BP, CO, TPR did not change.

Practice parameter: the role of corticosteroids in the management of acute monosymptomatic optic neuritis. Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Optic neuritis (ON) is an inflammatory disorder of the optic nerve. Most cases are idiopathic or associated with MS. ON can be associated with a variety of systemic or ocular disorders and is the most common acute optic neuropathy in adults younger than 46 years. Among high-risk populations for MS, the incidence of ON is about 3 per 100,000 population per year, whereas in other areas the incidence is about 1 per 100,000 population per year.1-13 Acute ON often presents as an isolated clinical event without contributory systemic abnormalities (monosymptomatic ON). Clinical features include periocular pain, abnormal visual acuity and fields, reduced color vision, a relative afferent pupillary defect, and abnormal visual evoked potentials. The fundus may appear normal or demonstrate edema of the optic nerve head (papillitis).12-18 MRI white matter abnormalities identical to those seen in MS are found in 50 to 70% of monosymptomatic ON cases.19-22 The visual deficit of ON may worsen over 1 to 2 weeks and usually begins improving over the next month. Lack of improvement in visual function by 30 days is unusual.23 However, most patients have some residual visual function deficit, even if visual acuity improves to 20/20.1-18 Differential diagnosis includes compressive, ischemic, hereditary, toxic, or other inflammatory optic neuropathies (e.g., sarcoid). These conditions usually do not exhibit the same clinical pattern (table 1) or rate of recovery as monosymptomatic ON.1-13 View this table: Table 1. Features of acute demyelinating monosymptomatic optic neuritis Treatment of monosymptomatic ON has included oral, retrobulbar, and IV steroids, immunoglobulin, and acupuncture.23-77 Monosymptomatic acute ON is not rare and because the usefulness of oral prednisone in this disorder has recently been questioned,23,78-82 this practice parameter was developed to provide …

Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis.

The purpose of this study was to clarify whether bone marrow edema is detectable on initial MR imaging of steroid-induced osteonecrosis of the femoral head. Forty-eight hips with osteonecrosis were examined consecutively with MR imaging and radiography. In a previously reported screening program, osteonecrosis was diagnosed on MR imaging when subchondral bands of abnormal signals were present. In the screening program, the MR images of 200 hips of 100 patients receiving high-dose steroid therapy were examined prospectively. Subchondral bands were detected in 48 hips at a mean of 14 weeks after the initiation of steroid therapy. On follow-up MR imaging of 47 hips (one hip excluded) bone marrow edema was initially observed in 13 hips after the onset of hip pain. MR imaging of the remaining 34 hips did not reveal bone marrow edema and the patients were all asymptomatic. MR imaging of 31 of the 34 hips continued to show subchondral bands and MR imaging of the other three hips indicated that the subchondral bands had disappeared. When bone marrow edema was detectable, abnormal findings on radiography were slight but 11 (85%) of the 13 hips progressed to advanced osteonecrosis. Bone marrow edema was highly correlated with the subsequent collapse of the femoral head (p<0.0001). Bone marrow edema was not present on initial MR imaging of osteonecrosis. Bone marrow edema should be considered a marker for potential progression to advanced osteonecrosis, and careful examinations for osteonecrosis are necessary when bone marrow edema is seen.

C1 esterase inhibitor deficiency, airway compromise, and anesthesia.

C1 esterase inhibitor deficiency, airway compromise, and anesthesia.

Bilateral Vocal Cord Paralysis After Radical Cystectomy in a Patient with a History of Bulbar Polio

Bilateral Vocal Cord Paralysis After Radical Cystectomy in a Patient with a History of Bulbar Polio

EFFECTS INDUCED BY FEEDING ORGANOCHLORINE CONTAMINATED CARP FROM SAGINAW BAY LAKE HURON TO LAYING WHITE LEGHORN HENS II EMBRYOTOXIC AND TERATOGENIC EFFECTS

Carp from Saginaw Bay, Lake Huron, MI, was fed to White Leghorn chickens for a period of 8 wk. The diets contained 0.3 (control; 0% carp), 0.8 (3.4% carp), and 6.6 (35% carp) mg polychlorinated biphenyls (PCBs)/kg diet, by wet weight (ww). These concentrations corresponded to 3.3, 26, and 59 pg 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) equivalents/g diet ww, respectively. Though the diets were not acutely toxic to the adult laying hens, dose- and time-dependent responses were observed in the embryos and chicks. Toxicity was manifested as a dose-dependent increase in embryo mortality and decreased hatching rates. Furthermore, embryos and chicks displayed various deformities, including (1) head and neck edema and hemorrhage, (2) abdominal edema and hemorrhage, (3) foot and leg deformities, (4) skull and brain deformities, (5) yolk-sac deformities, and (6) miscellaneous deformities. The types of deformities observed were similar to those reported for embryos and chicks of colonial waterbirds in Saginaw Bay, as well as in controlled studies where technical mixtures or individual congeners of polychlorinated diaromatic hydrocarbons (PCDAHs) were fed to chickens. Increasing concentrations of carp also significantly affected the various organ weights in 18-d embryos and hatched chicks. At 18 d of incubation, weights of the embryos' livers were directly proportional to the concentration of PCBs in the diets. The weights of the spleens and bursae were inversely proportional to the dietary PCB concentration. After 3 additional days of incubation, significant effects in body, brain, liver, heart, and bursa weights were observed in hatched chicks. The concentrations of total PCBs, as well as 2,3,7,8-TCDD equivalents (TEQs) in the diets, were in the range of those that have been shown to cause similar adverse effects in other species. This study has shown that fish, the primary food source of colonial waterbirds in Saginaw Bay, are capable of causing adverse reproductive effects in a model avian species, the chicken. However, due to differences in the relative potency to cause effects on different endpoints in different species, the results of this study should not be used to predict the threshold for effects in other species.