Elusive Neck Carcinoma Simulating Idiopathic Intracranial Hypertension Due to Jugular Venous Outflow Obstruction - Case Report.

Few cases have been reported of extra-cranial tumours in the neck causing intracranial hypertension due to jugular vein compression and consequent outflow obstruction. We present a case of a patient presenting with transient vision loss due to intracranial hypertension of unidentifiable cause on initial imaging workup. Upon further evaluation, the patient was found to have a neck tumour compressing the right jugular vein with stenosis of the ipsilateral transverse sinus - both contributing to his intracranial hypertension. Atypical patients presenting with symptoms concerning for intracranial hypertension may benefit from imaging below the level of the head to evaluate for extra-cranial causes.

Implementation effectiveness of psychosocial and environmental care practices in assisted living.

Psychosocial and environmental care practices are recommended to address behavioral expressions in persons with dementia, but their use has been limited partly because guidance is lacking regarding implementation. In response, we developed a simple "how-to" guide of evidence-based protocols for aromatherapy, natural light, familiar music, and robotic pets; trained staff in four assisted living (AL) communities to use the practices; provided materials; met with them regularly; and evaluated fidelity, facilitators and barriers to implementation, and staff knowledge, attitudes, and self-efficacy. After two months, staff reported more familiarity, confidence, and use; barriers such as difficulty locating supplies and task-focused staff with limited time; and staff "champion" facilitators. Notable differences were identified across communities, suggesting that just as care to individuals must be person-centered, practices embraced by communities must fit that community. Through strategic adoption, successful implementation is possible. The "how-to" guide is appropriate for AL, nursing homes, and persons' own homes.

Rare transitional cell carcinoma of the lacrimal sac.

PURPOSE: Transitional cell carcinomas of the lacrimal sac are rare with less than 55 cases reported in the literature. These tumors typically present with a medial canthal mass and epiphora. OBSERVATIONS: Here we describe a 63-year-old male who presented originally with complaints of dry eye and chronic epiphora. Over the next six months the patient noted the onset of a right medial canthal mass with tenderness and purulent lacrimal reflux. The patient was scheduled for surgery, and a lacrimal sac mass was identified. After excisional biopsy, the mass was diagnosed as transitional cell carcinoma and the patient subsequently underwent right lacrimal sac excision and medial maxillectomy. He was treated post-operatively with chemotherapy and radiation and has undergone subsequent reconstruction for lid malposition and lacrimal obstruction. There has been no recurrence of the cancer over a five-year period, with no evidence of distant metastasis. CONCLUSIONS AND IMPORTANCE: Transitional cell carcinomas of the lacrimal sac can be aggressive and in general carry a poor prognosis. Physicians should have a high index of suspicion in patients presenting with medial canthal mass to avoid delayed diagnosis.

The mirror-based eyes of scallops demonstrate a light-evoked pupillary response.

Light levels in terrestrial and shallow-water environments can vary by ten orders of magnitude between clear days and overcast nights. Light-evoked pupillary responses help the eyes of animals perform optimally under these variable light conditions by balancing trade-offs between sensitivity and resolution [1]. Here, we document that the mirror-based eyes of the bay scallop Argopecten irradians and the sea scallop Placopecten magellanicus have pupils that constrict to ∼60% of their fully dilated areas within several minutes of light exposure. The eyes of scallops contain two separate retinas and our ray-tracing model indicates that, compared to eyes with fully constricted pupils, eyes from A. irradians with fully dilated pupils provide approximately three times the sensitivity and half the spatial resolution at the distal retina and five times the sensitivity and one third the spatial resolution at the proximal retina. We also identify radial and circular actin fibers associated with the corneas of A. irradians that may represent muscles whose contractions dilate and constrict the pupil, respectively.

Expression of G Proteins in the Eyes and Parietovisceral Ganglion of the Bay Scallop Argopecten irradians.

A multitude of image-forming eyes are spread across the bodies of certain invertebrates. Recent efforts have characterized how these eyes function, but less progress has been made toward describing the neural structures associated with them. Scallops, for example, have a distributed visual system that includes dozens of eyes whose optic nerves project to the lateral lobes of the parietovisceral ganglion (PVG). To identify sensory receptors and chemical synapses associated with the scallop visual system, we studied the expression of four G protein α subunits (Gαi, Gαo, Gαq, and Gαs) in the eyes and PVG of the bay scallop Argopecten irradians (Lamarck, 1819). In the eyes of A. irradians, we noted expression of Gαo by the ciliary photoreceptors of the distal retina, expression of Gαq by the rhabdomeric photoreceptors of the proximal retina, and the expression of Gαo and Gαq by the cells of the cornea; we did not, however, detect expression of Gαi or Gαs in the eyes. In the PVG of A. irradians, we noted widespread expression of Gαi, Gαo, and Gαq. The expression of Gαs was limited to fine neurites in the lateral and ventral central lobes, as well as large unipolar neurons in the dorsal central lobes. Our findings suggest that light detection by the eyes of A. irradians is conferred primarily by photoreceptors that express Gαo or Gαq, that the corneal cells of scallops may contain sensory receptors and/or receive neural input, and that G protein labeling is useful for visualizing substructures and identifying specific populations of cells within the nervous systems of invertebrates.