Intraorbital air simulating an intraocular foreign body.

PURPOSE: To present an ultrasonographic finding that simulated an intraocular foreign body after repair of a ruptured globe. METHOD: Case report. An ultrasonogram of a post-trauma eye was correlated with a computed tomographic scan. RESULTS: B-scan ultrasonography was performed on an eye after repair of a corneoscleral laceration. The ultrasonogram showed a highly reflective echo source suggestive of a foreign body; however, an orbital computed tomographic scan demonstrated that the lesion was intraorbital air. CONCLUSION: Although a highly reflective echo source in the presence of a ruptured globe may suggest a foreign body, the presence of orbital air should also be considered when interpreting ultrasonograms used in the preoperative and postoperative management of globe trauma.

Central nervous system malignant B-cell lymphoma identified with standardized echography of the optic nerve.

Ocular-central nervous system malignant B-cell lymphoma initially caused diplopia and morning headaches in a 10-year-old boy. After initial diagnosis of pseudotumor cerebri was made, based on normal findings from magnetic resonance imaging and magnetic resonance angiography elsewhere, he was treated with acetazolamide. Standardized echography demonstrated a combination of solid infiltration and fluid within the optic nerve sheaths. Lumbar puncture showed elevated opening pressure and cerebrospinal diagnostic of central nervous system (CNS) B-cell lymphoma, which was confirmed by gene rearrangement. Results of peripheral blood study were negative. Aggressive treatment with chemotherapy and external-beam radiation produced complete resolution of solid optic nerve sheath infiltration in both eyes. This report discusses the clinical and ultrasonographic characteristics of CNS malignant B-cell lymphoma with ocular involvement and its differentiation from pseudotumor cerebri.

Empowerment praxis in community coalitions.

Community coalitions address a wide variety of community problems, espousing a community development processes that promotes individual and collective self-determination. They offer a promising venue for the study of empowerment of individuals and organizations. This study utilizes data from members of 35 community coalitions organized for the prevention of alcohol and other drug problems to address the following questions: What individual characteristics are related to the psychological empowerment of coalition members? What organizational characteristics are related to the collective empowering of members? What organization characteristics are related to a coalition being organizationally empowered to succeed in achieving its objectives? At the individual level, psychological empowerment was most strongly related to individuals' participation levels, sense of community, and perceptions of a positive organizational climate. At the group level, the strongest predictors of collective empowering (our operationalization of the empowering organization) were net benefits of participation, commitment, and positive organization climate. Psychological empowerment and positive organizational climate were the two predictors of organizational effectivenes (the empowered organization). Implications and limitations of these findings are discussed.

Comparison of standardized echography with magnetic resonance imaging to measure extraocular muscle size.

Using both standardized echography and high-resolution, surface coil magnetic resonance imaging, we measured the transverse diameter of recti extraocular muscles to evaluate comparative accuracy. Maximum transverse diameter of each rectus muscle in primary gaze was measured in 39 orbits of 20 subjects by using standardized A-scan echography. In the same orbits, we obtained multiple coronal magnetic resonance imaging planes by using a surface coil to span the anteroposterior extent of each orbit. Digital image analysis with the National Institutes of Health Image program was used to measure transverse muscle diameter. Average size for each rectus muscle was similar for the echographic and magnetic resonance imaging techniques. However, linear regressions of individual ultrasound against magnetic resonance imaging measurements showed coefficients of determination (R2) moderate (0.29) for inferior recti muscles and low (< or = 0.11) for other recti muscles. For most recti muscles, significant variability in echographic estimates of muscle width results from factors other than true muscle size. Results indicate that ultrasound measurements of muscle size in individual patients should be interpreted cautiously.

Tophaceous gout of the foot: an unusual presentation of severe chronic gout in an undiagnosed patient.

Tophaceous deposits are frequently noted within articular cartilage, synovium, tendons, tendon sheaths, pinnae and the soft tissue on the extensor surface of the forearms, feet, and bursae in patients with a history of chronic gout. The authors describe an unusual case of severe chronic tophaceous gout without prior diagnostic history or presence of acute attacks. They describe the procedure for the excision of these masses as well as the radiographic and pathological findings.

Ultrasonographic measurement of uveal melanoma thickness: interobserver variability.

We retrospectively reviewed ultrasonographic data on 32 uveal melanomas that had been studied both at a referral institution and at our centre within a six-week period. Generally there were good correlations between ultrasonographic measurements of tumour thickness. The mean absolute difference in ultrasound measurements of tumour thickness was 0.64 mm (range 0-2.2 mm); the mean tumour thickness was 5.2 mm (range 3.5-10.2 mm). Tumour diameter, location, the relative ultrasonographic experience with uveal melanoma, type of equipment, and tumour thickness all affected the interobserver variation of measurement.

Increments in plasma homovanillic acid concentrations after neuroleptic discontinuation are associated with worsening of schizophrenic symptoms.

1. Thirty-two male schizophrenic patients participated in this study. 2. Plasma concentrations of the dopamine metabolite, homovanillic acid (pHVA) were assessed once on neuroleptic medication and twice a week for a maximum of six weeks after its discontinuation. 3. Psychiatric symptomatology was assessed once on neuroleptic medication and once a week for a maximum of six weeks after its discontinuation, using the brief psychiatric rating scale (BPRS). 4. pHVA and total BPRS score increased significantly after discontinuation of neuroleptic as compared to baseline. 5. The magnitude of pHVA and BPRS increments after discontinuation of neuroleptic correlated significantly. 6. Results of this study suggest that worsening of schizophrenic symptoms after discontinuation of neuroleptic treatment is associated with increased pHVA concentrations.

Effects of lithium on the kidney.

We tested kidney function in 268 patients given lithium treatment for an average period of 37.6 months and in 59 manic-depressive patients never given lithium. No patients suffered serious renal damage during the course of our observations. Maximum concentration capacity was lower and serum creatinine concentration higher in the lithium treated patients than in the controls, but the differences did not achieve statistical significance. Females had poorer concentrating ability than males, both among the control subjects and during lithium treatment. Concomitant antipsychotic drug therapy may affect concentrating ability and possibly glomerular function adversely.

Lipoma of the foot: a large and unusual case.

Lipomas are usually found in adipose tissue; however, on rare occasions, they are found in the hands or feet. The authors describe a lipoma in the lateral plantar aspect of the left heel of one of their patients. They describe the procedure used in surgical excision of lipomas and the possible complications.

Indications and uses of prophylactic antibiosis in podiatric surgery.

A literature review of the use of prophylactic antibiosis , and the protocol for its specific usage in conjunction with podiatric surgery is presented. Attention is raised to the many manifestations that require prophylactic antibiosis in foot and ankle surgery. With proper understanding of prophylactic antibiosis in podiatric surgery, the surgeon has an excellent skill to add to his armamentarium.

Partial matricectomy with electrodesiccation for permanent repair of ingrown nail borders.

A large number of chemical and surgical procedures have been described for the management and correction of onychocryptosis (1-15). Many of these procedures share the problem of prolonged postoperative drainage, which may continue from 4 to 6 weeks. This extended time period can cause the patient inconvenience and discomfort, and continuous follow-up care by the physician is necessary. Electrodesiccation combined with surgical excision of the nail matrix to correct an ingrowing nail border permanently is simple, fast, has a low incidence of infection, and will usually have a dry bed of granulation tissue within 10 days after surgery.

Small malignant melanoma of the choroid with extraocular extension.

A disciform macular lesion in the hyperpigmented eye of a patient with melanosis oculi demonstrated slowly progressive increase in size during eight years. Clinical observation and serial fundus photography indicated increase in anteroposterior thickness of the lesion to 2.0 mm and in greatest diameter from 3.5 to 6.0 mm. Subsequent echography revealed an overall anteroposterior dimension of 3.4 mm and an increase to 5.5 mm in 20 months. Enucleation of the affected eye with the intact extraocular tumor mass and a local tenonectomy demonstrated a choroidal malignant melanoma of the epithelioid cell type with extraocular extension, peripapillary scleral infiltration, focal invasion of the juxtalaminar optic nerve, and tumor cells in the subarachnoid space. This experience emphasizes the importance of echography in the periodic evaluation of small choroidal malignant melanomas to detect growth not apparent by ophthalmoscopy.

B-scan ultrasonography of retinal detachments.

Characteristic ultrasonsographic patterns of retinal detachment in a variety of clinical circumstances are demonstrated and discussed. Uncomplicated retinal detachment consists of ultrasonically detected retinal detachment without associated pathology in the vitreous, subretinal space, or choroid. The simultaneous detection of lesions in one or more of these areas may be a source of diagnostic confusion. Acoustic diagnostic criteria for differentiation of associated conditions in complicated retinal detachments are demonstrated and discussed. High resolution A-scan and B-scan ultrasonography provides a method for detection and diagnosis of retinal detachment, associated ocular pathology, and simulating conditions.

Pigmented villonodular tenosynovitis: a case report.

A case of pigmented villonodular tenosynovitis is described. The characteristics and clinical course are discussed and compared as to natural history, histopathology, pathophysiology, etiology, differential diagnosis, and treatment. The etiological factors of this entity are generally uncertain; however, this case may well be associated with a specific incident of trauma, eg., a puncture wound sustained from stepping on a nail.