Ophthalmologic wax models as an educational tool for 18th-century vision scientists

The Medical Faculties of the University of Padua (Italy) and the University of Vienna (Austria) preserved two series of wax models, made by the Austrian Johann Nepomuk Hoffmayr at the beginning of the 19th century. These models were created in a period of evolution of both medical specialties and organ pathology, which brought morbid organs at the centre of medical investigation. Ceroplastic was considered a useful tool for didactic and research, as it provided a three-dimensional realistically coloured reproduction of organic lesions. The models represent the typical eye diseases of the period, in particular those affecting external parts, which could be investigated without the need for specific instruments devised for the observation of the inner and posterior anatomy of the eye, at that time not yet available. Even if the nosological categories then employed by Hoffmayr were different from those currently used, it has been possible to find a correspondence thanks to the ophthalmological literature of his period. Ceroplastic started to decline at the end of 19th century, substituted by the much less expensive method of preservation of morbid organs in formalin and by new techniques of investigation of the inner body, such as X-ray

Trattato italiano di Vestibologia clinica

La Vestibologia negli ultimi anni ha cambiato volto e si è notevolmente evoluta nelle sue capacità diagnostiche, grazie a nuove metodiche di esplorazione del sistema vestibolare, quali i potenziali evocati miogenici (Vemps) o il Video Head Impulse Test. Tale evoluzione richiede un costante aggiornamento delle tematiche correlate. Il Trattato italiano di Vestibologia clinica con i suoi 65 capitoli e 864 pagine di testo offre una panoramica di tutti gli aspetti della moderna Vestibologia, dalle più recenti acquisizioni di anatomofisiologia dell’apparato vestibolare sino alle complesse tematiche riguardanti la ‘Persistent Perceptual Postural Dizziness’ o il ‘Mal de debarquement’ senza tralasciare gli aspetti terapeutici, medici e chirurgici, e riabilitativi delle sindromi vertiginose. Aspetti innovativi sono inoltre le trattazioni riguardanti i rapporti tra vestibolo e attività sportive e le recenti acquisizioni sui rapporti tra vestibolo e aspetti cognitivi. Il trattato è corredato da numerosissime illustrazioni a colori ed è corredato da un completo indice analitico di oltre 2000 voci

Ocular nonsuicidal self-injury in a teenager

A 14-year-old male teen presented with unilateral episcleritis, unresponsive to topical and systemic corticosteroid therapy, without a history of ocular trauma or evidence for systemic diseases. The presence of foreign bodies in the conjunctival mucus of the hyperemic fornix has been noticed during one of the follow-up examinations. The toxicological analysis of conjunctival mucus revealed the presence of ethylene glycolmonomethyl ether and triethilene glicolebuthyl ether, used as solvents in nail polish removers and all-purpose cleaners. An unexpected etiology of chemical self-inflicted episcleritis was determined. The teen was admitted to a psychological assessment, after which a psychotherapeutic treatment was recommended. Episcleritis is characterized by the acute onset of ocular pain and redness, with a frequent recurrent and stressful course. Since it can be associated with life-threatening systemic vasculitides, a prompt, aggressive immunosuppressive therapy may be considered, both for the ocular inflammation and for the underlying systemic condition. Rarely episcleritis does not improve despite topical and systemic therapy, administered in a stepladder way. The reported teenager case needed a complex multidisciplinary approach to achieve the correct diagnosis and to avoid unnecessary treatments. In the case of recognized “nonsuicidal self-injury,” a psychological evaluation is strongly recommended, to identify and address underlying neuropsychiatric problems

Comparison between Fundus Automated Perimetry and Humphrey Field Analyzer: performance and usability of the Fundus Automated Perimetry and Humphrey Field Analyzer in healthy, ocular hypertensive, and glaucomatous patients

Purpose: We compared the performance and usability of the Fundus Automated Perimetry (FAP) and Humphrey Field Analyzer (HFA) in patients with glaucoma, ocular hypertension, and healthy subjects. Materials and methods: A total of 60 participants, divided in three groups of 20, glaucoma (POAG), ocular hypertension (OHT), and controls group, underwent a HFA test 24-2 SITA standard and a FAP test 24-2 ZEST sequence, in randomized order. The mean differences between perimeters of mean deviation (MD), pattern standard deviation (PSD) were correlated using the t-test and the Bland-Altman plot while execution time, Glaucoma Staging System 2 (GSS2), Hodapp-Parrish-Anderson staging system, localization of the defect, false positives (FP), and false negatives (FN) were compared with t-test analysis. Usability was measured through answers of a dedicated questionnaire. Results: MD's difference was higher for FAP than HFA: OHT -2.20 \ub1 1.33 dB (p < 0.001), POAG -2.00 \ub1 1.66 dB (p < 0.001), and controls -1.08 \ub1 1.43 dB (p < 0.001). PSD's difference was higher for FAP than HFA: OHT 0.85 \ub1 1.16 dB (p < 0.001), POAG 0.78 \ub1 2.32 dB (p = 0.043), and controls 0.49 \ub1 1.15 dB (p < 0.001). GSS2's difference showed that FAP found more severe defects than HFA. Exams duration was longer for FAP versus HFA: in OHT 363 s versus 301 s, in POAG 494 s versus 362 s, and in controls 360 s versus 277 s. For FN and FP, there were no statistically significant differences. The 77% of all subjects preferred FAP to HFA test. Conclusion: Considering MD and GSS2 classification, FAP finds more severe defects. Moreover, although FAP duration is longer, this method is preferred by most of the patients

Thymic Carcinoma With Thyroid Transcription Factor-1 Expression: An Insidious Pitfall

The expression of thyroid transcription factor-1 (TTF-1), commonly used as a marker of pulmonary and thyroid tumor, has been recently described in association with thymomas. Herein we report the clinicopathologic features of the first case of thymic carcinoma with nuclear expression of TTF-1, initially misdiagnosed as a lung tumor

Accelerated corneal crosslinking to treat Acanthamoeba and Fusarium coinfection of the cornea

A 44-year-old man presented with Acanthamoeba and Fusarium coinfection keratitis. Fifteen years before, he had hyperopic laser in situ keratomileusis, and the coinfection was under the flap. The keratitis was nonresponsive to topical and systemic therapy; therefore, accelerated corneal crosslinking (CXL) with photoactivated riboflavin (photoactivated chromophore for keratitis) was performed to prevent a corneal perforation. After the treatment, there was unexpected rapid corneal melting with subsequent perforation. A reconstructive penetrating keratoplasty was promptly performed and was effective in resolving the coinfection. The current protocol for the application of photoactivated riboflavin CXL should be improved, and clinical criteria for applying this technique are required. Photoactivated riboflavin CXL might be an effective alternative to conventional agents in some cases of fungal and/or amoeba keratitis. However, in cases of deep stromal infections on previous surgically treated anterior stroma, it should not be considered a viable option. \ua9 2018 ASCRS and ESCR

Intrathymic Localization of Melanoma: A Brief Report of Two Cases and a Review of the Literature

Intrathymic localizations of melanoma represent a very rare entity, with fewer than ten cases of intrathymic melanoma described in the literature. Herein, we describe two cases of patients who underwent surgical removal of a thymic mass at our thoracic surgery department between 2015 and 2022. The final pathological examination revealed a malignant melanoma in both cases; we therefore carried out a literature review to identify such rare and similar cases. In the first case, the intrathymic localization of melanoma was the first manifestation of the disease, posing a dilemma regarding the metastatic and primitive nature of the neoplasm. The second case described a thymic metastasis from a known previous cutaneous melanoma, for which the patient had successfully been treated six years earlier. After carefully reviewing the literature, we identified only six cases of verified primary intrathymic melanomas and one case of intrathymic metastasis resulting from melanoma previously described. Pathologists should be aware of the occurrence of this rare entity and mindful of the differential diagnoses. Several tools, including immunostaining of melanocytic markers and molecular investigations, are mandatory for final pathological diagnosis

In vivo detection of Choroidal abnormalities related to NF1: Feasibility and comparison with standard NIH diagnostic criteria in pediatric patients

PURPOSE. To evaluate the feasibility of near-infrared (NIR) imaging acquisition in a large sample of consecutive pediatric patients with neurofibromatosis type 1 (NF1), to evaluate the diagnostic performance of NF1-related choroidal abnormalities as a diagnostic criterion of the disease, and to compare this criterion with other standard National Institutes of Health (NIH) diagnostic criteria. METHODS. A total of 140 consecutive pediatric patients (0\u201316 years old) affected by NF1 (at least two diagnostic criteria), 59 suspected (a single diagnostic criterion), and 42 healthy subjects (no diagnostic criterion) were consecutively included. Each patient underwent genetic, dermatologic, and ophthalmologic examination to evaluate the presence/absence of each NIH diagnostic criterion. The presence of NF1-related choroidal abnormalities was investigated using NIR confocal ophthalmoscopy. Two masked operators assessed Lisch nodules and NF1-related choroidal abnormalities. RESULTS. Neurofibromatosis type 1\u2013related choroidal abnormalities were detected in 72 affected (60.5%) and 1 suspected (2.4%) child. No healthy subject had choroidal abnormalities. Feasibility rate of this sign was 82%. Sensitivity, specificity, and positive and negative predictive values of NF1-related choroidal abnormalities were 0.60, 0.97, 0.98, and 0.46, respectively. Compared with standard NIH criteria, the presence of NF1-related choroidal abnormalities was the third parameter for positive predictive value and the fourth for sensitivity, specificity, and negative predictive value. Compared with Lisch nodules, NF1- related choroidal abnormalities were characterized by higher specificity and positive predictive value. The interoperator agreement for Lisch nodules and NF1-related choroidal abnormalities was 0.67 (substantial) and 0.97 (almost perfect), respectively. The use of this sign moved one patient from the suspected to the affected group (0.5%). CONCLUSIONS. Neurofibromatosis type 1\u2013related choroidal abnormalities represent a new diagnostic sign in NF1 children. The main advantage of this sign seems the theoretical possibility to anticipate NF1 diagnosis, whereas the main obstacle is the cooperation required by very young patients

Molecular Profiling of Tissue Samples with Chronic Rejection from Patients with Chronic Lung Allograft Dysfunction: A Pilot Study in Cystic Fibrosis Patients

Chronic rejection (CR) is the main culprit for reduced survival and quality of life in patients undergoing lung transplantation (Ltx). High-throughput approaches have been used to unveil the molecular pathways of CR, mainly in the blood and/or in bronchoalveolar lavage. We hypothesized that a distinct molecular signature characterizes the biopsies of recipients with clinically confirmed histological signs of CR. Eighteen cystic fibrosis patients were included in the study and RNA sequencing was performed in 35 scheduled transbronchial biopsies (TBBs): 5 with acute cellular rejection, 9 with CR, and 13 without any sign of post-LTx complication at the time of biopsy; 8 donor lung samples were used as controls. Three networks with 33, 26, and 36 differentially expressed genes (DEGs) were found in TBBs with CR. Among these, seven genes were common to the identified pathways and possibly linked to CR and five of them (LCN2, CCL11, CX3CL1, CXCL12, MUC4) were confirmed by real-time PCR. Immunohistochemistry was significant for LCN2 and MUC4. This study identified a typical gene expression pattern in TBBs with histological signs of CR and the LCN2 gene appeared to play a central role. Thus, it could be crucial in CR pathophysiology