Spontaneous Dural Carotid-Cavernous Fistula Treated with Microcoil Insertion

This report includes a case of a 65-year-old woman presenting with a spontaneous dural carotid-cavernous fistula. Biomicroscopic examination of the anterior segment showed significant conjunctival chemosis, dilatation of the episcleral vessels, narrow anterior chamber, and a proptosis of the right eye, whereas the fellow eye was unremarkable. Retinal examination revealed an impaired arteriovenous ratio (A/V) from 1-4 to 1-2 and two extensive cotton exudates. An ultrasound scan (US) demonstrated congestion of the upper ophthalmic vein. Selective brain angiography through right femoral catheterization revealed a dural fistula of the wall of the cavernous right sinus. The patient underwent surgery on the superior ophthalmic vein and insertion of a micro-catheter in the cavernous sinus under CT guidance. Furthermore, a trans-femoral catheter was placed in the carotid artery on the same side as the fistula to allow arteriographic controls after micro coil positioning and embolization. Angiographic follow-up immediately after positioning the coils showed the occluded fistula and a regular flow circulation between the internal and the external carotid arteries. After treatment, the patient presented a complete resolution of symptoms. Conservative management is effective and safe in treating patients with carotid-cavernous fistula and mild clinical features because of a good chance of spontaneous or secondary thrombosis after arteriographic occlusion

Efficacy with Autologous Conjunctival Implant Associated with Phototherapeutic Keratectomy (PTK) in the Treatment of the Pterygium

Purpose: To evaluate the efficacy of new formula of the PTK calculated with the head-limbus-distance (=height) and limbal base length of the pterygium and ablation thickness on the anterior corneal curvature and visual acuity, associated with autologous conjuntival implant in patients with primary (Group A)and secondary(Group B) pterygium. Setting: This study was developed in the Department of Ophthalmology, Maggiore Hospital of Bologna. Design: Prospective non randomized study was conducted in 18 eyes of 18 subjects (9 eyes primary and 9 eyes with recurrent pterygium) operated with a dedicated PTK program. Methods: All patients signed informed consent before the start of the research. BCVA (Best Corrected Visual Acuity), mean refractive error (ME) and topographic astigmatism and recurrence of pterygium was followed. Mean follow up was 18.67 ± 6.13 months Min: 12 Max: 24 months. Results: Mean post-operative BCVA increased at 3-24 months compared with pre-op BCVA (p= 0.003). Mean post-op BCVA improved independent of the optical zone involvement in the pre-op (p= 0.845). Mean Pre-op astigmatism (Group A): was: 0,97 ± 2,7 (MIN: -2,8 Max: +5). Mean pre-op Astigmatism (Group B) :-0,33 ± 1,98 (MIN: -3 Max:+4). Astigmatism reduction in the group A: 0 D; Group B: -0,1D ± 0,74D MIN: -1 Max: +1. No statistically difference at 24 months from two groups in BCVA (p=0,59), Sf ( P=0,7), ME(p=0,7), astigmatism ( p=0,96) ANOVA. Recurrence of pterygium was: 0%. Conclusions: The dedicated programme of PTK was shown to be safe and effective for the treatment of the pterygium. BCVA can be improved by providing a smooth corneal surface in cases of optical zone involvement

Ultrastructural observations on the microvasculature in advanced gastric carcinomas

The ultrastructural features associated with vascular permeability in 9 cases of advanced gastric carcinomas were studied, and compared with that of control non-neoplastic mucosa. Tumour rnicrovasculature showed features in common with those of control mucosa, including complete basa1 lamina, welldeveloped interendothelial junctions, fenestrations and caveolae. Some tumour blood vessels showed endothelial cell swelling accompained by luminal narrowing and perivascular fibrosis. In 2 out of 9 cases, there were endothelial attenuation with numerous fenestrations and vesiculo-vacuolar organelles. The vesiculo-vacuolar organelle is a recently described cytoplasmic structure found in the endothelial cells lining turnour microvessels and normal venules and which provides an important pathway for extravasation of circulating macromolecules. Our ultrastructural data suggest that advanced gastric carcinomas share with experimental tumour models in vivo only some morphologic features associated with hyperpermeability including fenestration, endothelial attenuation and vesiculo-vacuolar organelles. The implications of perivascular fibrosis on the delivery of immune cells to gastric carcinomas are discussed

Ultrastructural observations on the microvasculature in advanced gastric carcinomas

The ultrastructural features associated with vascular permeability in 9 cases of advanced gastric carcinomas were studied, and compared with that of control non-neoplastic mucosa. Tumour microvasculature showed features in common with those of control mucosa, including complete basa1 lamina, welldeveloped interendothelial junctions, fenestrations and caveolae. Some tumour blood vessels showed endothelial cell swelling accompained by luminal narrowing and perivascular fibrosis. In 2 out of 9 cases, there were endothelial attenuation with numerous fenestrations and vesiculo-vacuolar organelles. The vesiculo-vacuolar organelle is a recently described cytoplasmic structure found in the endothelial cells lining turnour microvessels and normal venules and which provides an important pathway for extravasation of circulating macromolecules. Our ultrastructural data suggest that advanced gastric carcinomas share with experimental tumour models in vivo only some morphologic features associated with hyperpermeability including fenestration, endothelial attenuation and vesiculo-vacuolar organelles. The implications of perivascular fibrosis on the delivery of immune cells to gastric carcinomas are discussed

Multimodal imaging in Susac syndrome: A case report and literature review

7noSusac syndrome (SS) is a rare microangiopathy that involves arterioles of the brain, retina, and cochlea. Diagnosis is extremely difficult because of the rarity of the disease and because the signs and symptoms often occur at different times. Multidisciplinary approaches and multimodal images are mandatory for diagnosis and prompt therapy. In this report, we describe a case of SS and the application of multimodal retinal imaging to evaluate the ophthalmologic changes and to confirm diagnosis. Early diagnosis and therapy based on the associations of steroids and immunosuppressants are necessary to limit the sequelae of the disease.openopenBagaglia S.A.; Passani F.; Oliverio G.W.; Inferrera L.; Menna F.; Meduri A.; Mazzotta C.Bagaglia, S. A.; Passani, F.; Oliverio, G. W.; Inferrera, L.; Menna, F.; Meduri, A.; Mazzotta, C

Supplementary Material for: Phacoemulsification wound burn and its management

Introduction: the production of ultrasonic energy during phacoemulsification is associated with heat generation that could damage ocular tissues, particularly at the corneoscleral wound site. Case presentation: an 89-year-old patient with senile hypermature cataract and Fuchs endothelial dystrophy developing severe thermal corneoscleral injury during phacoemulsification. At presentation visual acuity was finger count at 40 cm and there was a 1x2-mm area of corneal melting at the corneal tunnel with diffuse corneal oedema. After 1 month a temporal circular corneal patch graft was applied to the corneal burn. A penetrating keratoplasty was performed 16 months after the first surgery. Conclusion: Corneal surgery, including lamellar patch grafts and full-thickness penetrating grafts, could be used, when necessary, to restore the cornea’s integrity. These procedures could eliminate corneal scarring, decrease astigmatism, and improve vision in patients with phacoemulsification burns

Non-erosive reflux disease - what we know so far

Non-erosive reflux disease (NERD) is the most common phenotypic presentation of gastro-oesophageal reflux disease (GORD) with physiological, pathophysiological, anatomical and histological characteristics that are unique to this subgroup of GORD. Moreover, NERD accounts for the majority of reflux patients who fail proton-pump inhibitor (PPI) treatment. For these reasons, NERD has represented one of the most attractive areas for research and novel developments in the last decade. Current investigations in NERD are focussed primarily on understanding its pathophysiology, natural history and the various stimuli able to provoke symptoms in patients. The diagnosis of the complex NERD population remains a difficult task, but the recent introduction of oesophageal impedance-pH monitoring has contributed to a clearer and objectively reliable diagnosis. In particular, this test has allowed the objective identification of real NERD from functional heartburn patients, who do not belong to the realm of GORD. Therapeutic modalities still focus on acid suppression, but there is growing interest in finding and developing other therapeutic strategies in NERD

Gastro-esophageal reflux and idiopathic pulmonary fibrosis-new evidences of a causal relationship

Idiopathic pulmonary fibrosis (IPF) is a relentless and progressive lung disease of unknown etiology with no effective cure available. Recent data support the concept that chronic silent microaspiration (ie, aspiration of gastric acid, food, bile salts, and trypsin in forms of small droplets) could be involved in the pathogenesis, development, and progression of IPF. However, limited data are present on this direction and the precise relationship between chronic microaspiration and IPF remains poorly understood. It has been demonstrated that gastroesophageal reflux (GER) plays an important role in causing extra-esophageal symptoms, including chronic bronchitis, bronchiectasis, diffuse panbronchiolitis, recurrent pneumonia, chronic cough, hoarseness, and asthma. Moreover, it is considered a presumed risk factor for microaspiration. Recent studies evidenced that it is strongly associated with IPF with an estimated prevalence of up to 90%. This review aims to explore the relationship between GER and pulmonary fibrosis by highlighting the pathophysiologic mechanisms, the role of diagnostic testing, as well as the therapeutic options for this important group of patients. Furthermore, the gaps in our current understanding of the diagnosis and treatment of chronic microaspiration in patients with IPF will be highlighted. Clarifying the role of chronic microaspiration in IPF is essential because it could potentially have a widespread clinical impact on the progression of this fatal disease

The ocular microbiome and microbiota and their effects on ocular surface pathophysiology and disorders

The ocular surface flora perform an important role in the defense mechanisms of the ocular surface system. Its regulation of the immunological activity and the barrier effect against pathogen invasion are remarkable. Composition of the flora differs according to the methods of investigation, because the microbiome, composed of the genetic material of bacteria, fungi, viruses, protozoa, and eukaryotes on the ocular surface, differs from the microbiota, which are the community of microorganisms that colonize the ocular surface. The observed composition of the ocular surface flora depends on harvesting and examining methods, whether with traditional culture or with more refined genetic analysis based on rRNA and DNA sequencing. Environment, diet, sex, and age influence the microbial flora composition, thus complicating the analysis of the baseline status. Moreover, potentially pathogenic organisms can affect its composition, as do various disorders, including chronic inflammation, and therapies applied to the ocular surface. A better understanding of the composition and function of microbial communities at the ocular surface could bring new insights and clarify the epidemiology and pathology of ocular surface dynamics in health and disease. The purpose of this review is to provide an up-to-date overview of knowledge about this topic