Magnetic resonance imaging characterization of orbital changes with age and associated contributions to lower eyelid prominence.

BACKGROUND: Multiple orbital aging models have been suggested to explain the progressive development of lower eyelid prominence. Objective data to support these theories are limited, however. METHODS: Orbital anatomy was measured with high-resolution orbital magnetic resonance imaging in the quasi-sagittal plane parallel to the long axis of the orbit passing through the globe center. The association between measurements and age was analyzed by stratifying subjects into predetermined age groups and as a continuous variable. RESULTS: Forty subjects (17 men and 23 women) were imaged and are reported by age group: 12 to 29 years, 30 to 54 years, and 55 to 80 years. Inferior periocular soft-tissue area anterior to the anteroposterior globe axis increased with age: 99, 103, and 131 mm (p = 0.008), respectively. The largest contributor to this size increase was fat expansion: 28, 31, and 43 mm (p = 0.009), respectively. Total orbital fat also increased with age: 335, 377, and 398 mm, respectively (p = 0.035). The globe position relative to the inferior orbit in both the anteroposterior and the superoinferior planes remained unchanged. CONCLUSIONS: The authors' measurements suggest that with aging there is a significant increase in anterior inferior periocular soft-tissue volume, and that fat expansion is the main contributor to this volume increase. These observations provide supporting evidence that orbital fat expansion occurs with age and is the primary age-associated contributor to lower eyelid prominence, rather than globe descent or fat repositioning caused by weakening of the orbital septum. We believe these data suggest that fat excision should be a component of treatment for lower eyelid prominence.

Evolution of fine needle aspiration cytology in the accurate diagnosis of pancreatic neoplasms.

In the era of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), a minimally invasive, safe, and accurate cytologic examination of a variety of intra-abdominal neoplasms has become possible. To assess the efficacy of EUS-FNA for diagnosis of primary pancreatic tumors, a 10-year retrospective review of a consecutive series of patients diagnosed between 1996 and 2005 was undertaken. Comparisons were made between early (1996-2000) and late (2001-2005) periods regarding diagnostic modalities used and the concordance of EUS-FNA cytology with macroscopic tissue histology. Although macroscopic biopsy diagnostic yield did not change over time, yield from EUS-FNA increased from 40 per cent to 95 per cent (P = 0.001). Because of improved accuracy of FNA cytology, only six per cent of tumors required additional macroscopic tissue histology in the late period versus 35 per cent in the early period (P = 0.001). There was 100 per cent concordance between the cytologic and histologic diagnoses in the late period versus only 33 per cent in the early period (P = 0.032). We conclude that (1) the frequency of pathologically diagnosed pancreatic tumors doubled over 10 years, (2) utilization of EUS-FNA significantly increased the accuracy of cytologic diagnosis, and (3) as a result, the need for macroscopic tissue biopsy for diagnosis of pancreatic neoplasms has been obviated.