Direct Damage to a Vertebral Artery Better Predicts a Vertebral Artery Injury than Elongation in Cervical Spine Dislocation

Cervical spine dislocation and fracture of a transverse process are isolated risk factors for vertebral artery injuries (VAIs), which can cause a life-threatening ischemic stroke. Since in vivo experiments are not possible, it has not been unclear whether damage to or extension of vertebral arteries is more predictive of a VAI. To identify the imaging characteristics associated with VAI, we analyzed 36 vertebral arteries from 22 cervical spine dislocation patients who underwent computed tomography angiography (Aug. 2008-Dec. 2014). We evaluated (1) the posttraumatic elongation of the vertebral artery and (2) the presence of fracture involving the transverse foramen. VAI was found in 20 (56%) of the 36 vertebral arteries. The rate of residual shift (vertebral artery elongation) was not markedly different between the VAI and no-VAI groups. However, the rate of >1 mm displacement into the foramen and that of fracture with gross displacement (≥2 mm) differed significantly between the groups. We found that greater displacement of fractured transverse processes with cervical spine dislocation was a risk factor for VAI. These results suggest that direct damage to the vertebral arteries by transverse process fragments is more likely to predict a VAI compared to elongation, even in cervical spine dislocation

A case of iridoschisis associated with lens displacement into the vitreous cavity

We report the case of a 67-year-old woman with a lens that was displaced into the vitreous cavity in one eye and ipsilateral iridoschisis. She was free from a history of ocular trauma or of heritable ocular disease. Her best-corrected visual acuity was 1.2 bilaterally and right eye showed signs of iridoschisis. The corneal endothelial cell density decreased to 1,263 cells/mm2 in the right eye preoperatively. We speculated that iris tissue flowing in the anterior chamber might have intermittently touched the corneal endothelium. 25-gauge pars plana vitrectomy and lens removal were performed immediately. Free-floating iris tissue was cut during surgery with care not to injure the corneal endothelial cells. The postoperative progress was satisfactory and scleral fixation of an intraocular lens is planned. Iridoschisis is an uncommon cause of lens displacement into the vitreous cavity

Scleral fixation of foldable acrylic intraocular lenses in aphakic post-vitrectomy eyes

Tetsuya Mutoh, Yukihiro Matsumoto, Makoto ChikudaDepartment of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, JapanPurpose: To evaluate the outcome for scleral fixation of a foldable acrylic intraocular lens (IOL) in aphakic post-pars plana vitrectomy eyes for vitreoretinal disease.Methods: The medical records of 15 patients were reviewed. We evaluated such factors as the underlying vitreoretinal disease, preoperative expected refraction and postoperative actual refraction, best corrected visual acuity (BCVA), corneal endothelial cell density, and intraoperative and postoperative complications.Results: The most common cause of underlying vitreoretinal disease was retinal detachment, which was found in 8 cases. The mean refractive error was -0.10 diopters (D). The mean minimum angle of resolution (logMAR) values of BCVA were 0.27 preoperatively and 0.14 postoperatively. The mean corneal endothelial cell density was 2400 cells/mm2 preoperatively and 2187 cells/mm2 postoperatively. No significant differences were observed in either the logMAR values of BCVA or the corneal endothelial cell density before and after surgery. No intraoperative complications occurred in any of the patients. Postoperative complications occurred in a total of 7 eyes, and the most severe complications comprised 4 cases of transient ocular hypertension.Conclusion: The results for the scleral fixation of foldable acrylic IOLs were good in aphakic post-vitrectomy eyes.Keywords: scleral fixation, intraocular lens, aphakic post-pars plana vitrectomy eyes, severe vitreoretinal diseas

Relationship between Pentosidine and Pyridinoline Levels in Human Diabetic Cataract Lenses

The relationship between the levels of two different crosslink compounds, pentosidine and pyridinoline, in human diabetic cataract lenses was investigated to elucidate the pathogenic mechanism of diabetic cataract. Subjects were classified into diabetes mellitus (DM) group and non-DM group according to the presence or absence of DM. The levels of the crosslink compounds were determined using high-performance liquid chromatography and spectrofluorometry after acid hydrolysis. In the non-DM group the pentosidine level was significantly and positively correlated with the pyridinoline level and age. In the DM group the pentosidine level was not significantly correlated with either pyridinoline level or age. Pyridinoline levels and age were not significantly correlated in either group. The increase in crosslink compounds due to glycation and the relationship between the compounds are changed in DM lenses

A computational model based on corticospinal functional MRI revealed asymmetrically organized motor corticospinal networks in humans

新規MRI技術で利き手の神経制御メカニズムを解明 --手指運動中の脳・脊髄機能結合パターンの左右差を世界で初めて計測--. 京都大学プレスリリース. 2022-08-08.Evolution of the direct, monosynaptic connection from the primary motor cortex to the spinal cord parallels acquisition of hand dexterity and lateralization of hand preference. In non-human mammals, the indirect, multi-synaptic connections between the bilateral primary motor cortices and the spinal cord also participates in controlling dexterous hand movement. However, it remains unknown how the direct and indirect corticospinal pathways work in concert to control unilateral hand movement with lateralized preference in humans. Here we demonstrated the asymmetric functional organization of the two corticospinal networks, by combining network modelling and simultaneous functional magnetic resonance imaging techniques of the brain and the spinal cord. Moreover, we also found that the degree of the involvement of the two corticospinal networks paralleled lateralization of hand preference. The present results pointed to the functionally lateralized motor nervous system that underlies the behavioral asymmetry of handedness in humans

Photorefractive keratectomy: measuring the matrix metalloproteinase activity and chondroitin sulfate concentration in tear fluid

We herein report the case of a 20-year-old man who underwent a photorefractive keratectomy (PRK). We measured matrix metalloproteinase-9 (MMP-9) activity and chondroitin 4 sulfate and chondroitin 6 sulfate concentrations in tear fluid. Tear fluid was collected pre-operatively via microcapillary tube, and was collected postoperatively on the first and fourth days, and after one week, one month, three months, and six months. Samples were formulated by dilution with 200 μL of saline. MMP-9 activity was analyzed by an enzyme immunocapture activity assay, and the concentrations of chondroitin sulfate were analyzed by enzyme-linked immunosorbent assay. No complications were observed after surgery, except for a minimal subepithelial haze. Although MMP-9 activity changed on the fourth postoperative day, the activity changed only minimally at this time. Chondroitin 4 sulfate concentrations in tear fluid increased dramatically from one week to one month, decreased transiently at three months, and increased by six months. The chondroitin 6 sulfate concentration did not normalize within one week, and decreased from one week to three months compared with the preoperative score, and was close to the preoperative score at six months. We conclude that corneal wound healing was still incomplete six months after PRK, and chondroitin 4 sulfate appears to be critical in this process

Case of bilateral complete posterior dislocation of lens caused by elder abuse

We report a case of bilateral complete dislocation of lenses into the vitreous cavities due to elder abuse in a patient with senile dementia. According to the patient’s son, bilateral complete lens dislocation occurred after he hit his father in the head with socks in order to control his violent behavior. Although the patient was taken to our ophthalmological ward for a planned vitrectomy, restlessness and inability to remain in his room during the night led to his leaving the hospital. The patient has not returned but did receive a vitrectomy at another clinic. While the number of patients with senile dementia has dramatically increased, no specific remedy is currently available. When treating medical concerns of seniors with unknown backgrounds, elder abuse needs to be considered as a potential cause of such injuries

Complications Associated With Spine Surgery in Patients Aged 80 Years or Older: Japan Association of Spine Surgeons with Ambition (JASA) Multicenter Study

Study Design:Retrospective study of registry data.Objectives:Aging of society and recent advances in surgical techniques and general anesthesia have increased the demand for spinal surgery in elderly patients. Many complications have been described in elderly patients, but a multicenter study of perioperative complications in spinal surgery in patients aged 80 years or older has not been reported. Therefore, the goal of the study was to analyze complications associated with spine surgery in patients aged 80 years or older with cervical, thoracic, or lumbar lesions.Methods:A multicenter study was performed in patients aged 80 years or older who underwent 262 spinal surgeries at 35 facilities. The frequency and severity of complications were examined for perioperative complications, including intraoperative and postoperative complications, and for major postoperative complications that were potentially life threatening, required reoperation in the perioperative period, or left a permanent injury.Results:Perioperative complications occurred in 75 of the 262 surgeries (29%) and 33 were major complications (13%). In multivariate logistic regression, age over 85 years (hazard ratio [HR] = 1.007, P = 0.025) and estimated blood loss ≥500 g (HR = 3.076, P = .004) were significantly associated with perioperative complications, and an operative time ≥180 min (HR = 2.78, P = .007) was significantly associated with major complications.Conclusions:Elderly patients aged 80 years or older with comorbidities are at higher risk for complications. Increased surgical invasion, and particularly a long operative time, can cause serious complications that may be life threatening. Therefore, careful decisions are required with regard to the surgical indication and procedure in elderly patients