[Orbital decompression : Indications, technique, results]. / Orbitadekompression : Indikationen, Operationstechnik, Ergebnisse.

Orbital decompression is an effective surgical procedure to reduce intraorbital pressure. Causes may diseases leading to rapid pressure increases, e. g., bleedings, and those causing slower, progressive pressure increases, e. g., tumors or Graves' orbitopathy. During fat tissue decompression, peri- and retrobulbar adipose tissue is removed; in bony decompression, one or more bony orbital walls are removed (one-, two-, or three-wall decompression). In many cases the procedures are combined. Recent developments are the transconjunctival approaches for removing parts of bony orbital walls. Complications include double vision, which occurs in up to 30% of cases depending on the approach, hemorrhage, infections, development of chronic sinusitis, and iatrogenic skull base lesions with consecutive meningitis. In the hands of an experienced rhino- and head and neck surgeon, the intervention has low complication rates.

Potential contributions of mature prairie and turfgrass to phosphorus in urban runoff.

Urban vegetative plantings are considered desirable to mitigate and filter stormwater runoff and nonpoint-source pollution. Phosphorus fertilization of turfgrass may enhance P in urban runoff; however, the amount of P from nonfertilized, native vegetation that could potentially replace some turf is not known. This study was conducted to measure the relative contributions of nonfertilized, native prairie vegetation and fertilized turfgrass to runoff water and P loads. Six replicates of side-by-side mature urban prairie and turfgrass were monitored for mean annual runoff volumes and P loads, biomass production, vegetative nutrient composition, and changes in soil moisture. Vegetation type did not significantly affect seasonal or annual runoff volumes or P loads. The mean annual total P loads of 0.46 kg ha for prairie and 0.28 kg ha for turfgrass were significant and comparable to those reported by other researchers when studied separately. Total P concentrations in runoff water from prairie and turf vegetation were above USEPA limits, averaging 1.86 and 1.63 mg L, respectively, over 2 yr. Averaged across 2 yr, 78% of runoff P was collected when the soil was frozen. Biomass P reductions over the period of November to April were strongly related to quantities of runoff total P from frozen soil ( = 0.874). Phosphorus losses from urban areas appeared to be primarily correlated with runoff depth, not vegetation type, because correlation coefficients revealed 86 and 45% of the Year 1 and Year 2 total P loads were directly accounted for by runoff volumes.

Prospective randomised trial of endobronchial ultrasound-guide sheath versus computed tomography-guided percutaneous core biopsies for peripheral lung lesions.

AIM: To determine diagnostic rate, complications and patient tolerability of endobronchial ultrasound-guide sheath (EBUS-GS) and computed tomography (CT)-guided percutaneous core biopsy for peripheral lung lesions. METHODS: Lesions >1 cm diameter on CT were randomised to either EBUS-GS or CT-guided biopsy. Excluded were patients with severe chronic obstructive airway disease, lesions touching visceral pleura or hilum, and patients with symptoms needing bronchoscopic evaluation. Patients completed preprocedure and postprocedure questionnaires on tolerability. RESULTS: Of 64 participants (mean lesion size 29 ± 16 mm), 57 completed the study. Diagnostic sensitivity was 67% for EBUS-GS and 78% for CT-guided biopsy (P = not significant). In those with negative results, in the EBUS group, nine had a CT-guided biopsy as a cross-over, seven of which were positive. In the CT group, four had cross-over EBUS-GS of which three were diagnostic. Sensitivity for malignancy was 17/23 for EBUS-GS (74%) and 23/26 (88%, P = not significant). For lesions <2 cm, CT-guided biopsy had a significantly better diagnostic yield (80% vs 50%, P = 0.05). In EBUS-GS cases, for lesions with an air bronchogram, sensitivity was 89%. Pneumothorax and intercostal catheter insertion occurred in three and two cases, respectively, for EBUS, and 10 and 3 cases for CT-guided biopsy (P = 0.02 for pneumothorax). Nine unexpected admissions occurred after CT-guided biopsy compared with three after EBUS-GS. Overall, tolerability was high for both groups; however three patients had moderate-to-severe pain after CT-guided biopsy. CONCLUSIONS: In lesions <2 cm, CT-guided biopsy had higher yields; however, EBUS-GS had better tolerability and fewer complications.

Effects of long-term feeding of genetically modified corn (event MON810) on the performance of lactating dairy cows.

A long-term study over 25 months was conducted to evaluate the effects of genetically modified corn on performance of lactating dairy cows. Thirty-six dairy cows were assigned to two feeding groups and fed with diets based on whole-crop silage, kernels and whole-crop cobs from Bt-corn (Bt-MON810) or its isogenic not genetically modified counterpart (CON) as main components. The study included two consecutive lactations. There were no differences in the chemical composition and estimated net energy content of Bt-MON810 and CON corn components and diets. CON feed samples were negative for the presence of Cry1Ab protein, while in Bt-MON810 feed samples the Cry1Ab protein was detected. Cows fed Bt-MON810 corn had a daily Cry1Ab protein intake of 6.0 mg in the first lactation and 6.1 mg in the second lactation of the trial. Dry matter intake (DMI) was 18.8 and 20.7 kg/cow per day in the first and the second lactation of the trial, with no treatment differences. Similarly, milk yield (23.8 and 29.0 kg/cow per day in the first and the second lactation of the trial) was not affected by dietary treatment. There were no consistent effects of feeding MON810 or its isogenic CON on milk composition or body condition. Thus, the present long-term study demonstrated the compositional and nutritional equivalence of Bt-MON810 and its isogenic CON.

Functional analysis of -351 interleukin-9 promoter polymorphism reveals an activator controlled by NF-kappaB.

Genetic studies have shown linkages for asthma to the chromosomal region 5q31-q33 in humans that includes the IL-9 gene. An A-to-G base substitution has been identified at bp -351 in the IL-9 promoter. The role of this polymorphism in IL-9 promoter function was assessed utilizing CD4+ T cells purified from individuals with one or two of the G alleles in comparison to those homozygous for the wild-type A. The presence of an A at -351 (A allele) increased mitogen-stimulated IL-9 transcription twofold in comparison to subjects with one or two G alleles at this position. Binding of nuclear extract proteins from IL-9-producing human cell lines to DNA sequences including this base exchange demonstrated specific binding of the transcription factor NF-kappaB. Binding of NF-kappaB to the IL-9 promoter was confirmed in vivo using the chromatin immunoprecipitation assay. Recombinant NF-kappaB bound to a promoter fragment with the A allele with fivefold higher affinity than it did to a promoter with the G allele. Individuals carrying the A allele of the IL-9 promoter display increased synthesis of IL-9, which may result in strong Th2 immune responses and a modulation of their susceptibility to infectious, neoplastic, parasitic or atopic disease.

Prairie and turf buffer strips for controlling runoff from paved surfaces.

Eutrophication of surface waters due to nonpoint source pollution from urban environments has raised awareness of the need to decrease runoff from roads and other impervious surfaces. These concerns have led to precautionary P application restrictions on turf and requirements for vegetative buffer strips. The impacts of two plant communities and three impervious/pervious surface ratios were assessed on runoff water quality and quantity. A mixed forb/grass prairie and a Kentucky bluegrass (Poa pratensis L.) blend were seeded and runoff was monitored and analyzed for total volume, total P, soluble P, soluble organic P, bioavailable P, total suspended solids, and total organic suspended solids. Mean annual runoff volumes, all types of mean annual P nutrient losses, and sediment loads were not significantly affected by treatments because over 80% of runoff occurred during frozen soil conditions. Total P losses from prairie and turf were similar, averaging 1.96 and 2.12 kg ha(-1) yr(-1), respectively. Vegetation appeared to be a likely contributor of nutrients, particularly from prairie during winter dormancy. When runoff occurred during non-frozen soil conditions turf allowed significantly (P < or = 0.10) lower runoff volumes compared with prairie vegetation and the 1:2 and 1:4 impervious/pervious surface ratios had less runoff than the 1:1 ratio (P < or = 0.05). In climates where the majority of runoff occurs during frozen ground conditions, vegetative buffers strips alone are unlikely to dramatically reduce runoff and nutrient loading into surface waters. Regardless of vegetation type or size, natural nutrient biogeochemical cycling will cause nutrient loss in surface runoff waters, and these values may represent baseline thresholds below which values cannot be obtained.

An analysis of incidental and symptomatic pulmonary embolism (PE) in medical oncology patients.

AIM: To determine the incidence of symptomatic versus incidental pulmonary embolism (PE) in oncology patients, characterize the nature and extent of incidental PE and the factors contributing to diagnosis. METHODS: Specialized web search engine was used to identify oncology patients with positive imaging studies for PE. PE identified at staging CT scans were classified as incidental PEs, whereas PE diagnosed by CTPA/VQ scan were classified as symptomatic PEs. RESULTS: A total of 111 patients with PE were identified over the period of three years. Of these, 67 (60%) patients had symptomatic whereas 44 (40%) patients had incidental PE. Most PEs were segmental and non-occlusive irrespective of the type of PE or stage of the disease. Incidence of PE was equal with/without chemotherapy. Platinum-based chemotherapy was more commonly associated with PE. Most patients received anticoagulation irrespective of type of PE. CONCLUSION: Forty percent of the diagnosed PEs were incidental, more common in the metastatic group. This may be due to the increased frequency of staging scans performed in patients with metastatic disease, as well as the inherent disease biology of metastatic compared with localized disease. Further prospective analysis of survival by PE subtype and optimal length of anticoagulation in incidental PE is warranted.

Extensive migration of injected free liquid silicone for breast augmentation with related major complications.

Free liquid silicone breast injections have been used for off-label breast augmentation since the 1960s. Shortly after the invention of this technique, multiple adverse effects became apparent and the technique became illegal in most countries. The procedure continues to be undertaken owing to its decreased cost compared with silicone prostheses. Complications from free silicone injections lead to complex management issues and health risks. This case demonstrates severe silicone migration, the extent of which has not previously been documented. In addition, the migration caused a serious life-threatening complication with subsequent complex management issues.

Percutaneous pulmonary radiofrequency ablation: difficulty achieving complete ablations in big lung lesions.

The size of both primary and metastatic lung tumours often exceeds 3 cm in diameter at the time of diagnosis. The radiofrequency (RF) electrodes of the three leading companies currently in use are designed for a maximum ablation diameter of 5 cm. Therefore, the tumour to be ablated should not exceed 3 cm in maximum diameter, as a 1 cm safety ablation margin surrounding the tumour should ideally be achieved. A possible solution in treating larger tumours is to create overlapping ablations, a method successfully used in the radiofrequency ablation (RFA) of liver tumours. We report on the percutaneous overlapping ablation of three large lung metastases, 4 cm, 4.5 cm and 5 cm in their longest diameter. The largest of them showed incomplete ablation with residual viable tumour tissue. The overlapping percutaneous RFA of large lung tumours is feasible although the bigger the lesion, the higher the risk of incomplete ablation appears compared with smaller tumours treated by a single ablation.

Fire-eating: hazards of hydrocarbon aspiration.

A 30-year-old male fire eater presented following aspiration of hydrocarbon fuel during a performance. A plain chest radiograph carried out 2 h after aspiration showed left lower lobe consolidation. The patient subsequently developed worsening shortness of breath, haemoptysis, fever and myalgia and a repeat plain chest radiograph showed extensive bilateral pulmonary consolidation with mediastinal and bilateral hilar lymphadenopathy. Computed tomography showed features consistent with necrotizing pneumonia. The clinical course was complicated by the development of large pleural effusions, pneumatocoeles and a spontaneous pneumothorax. Early abnormalities on a plain chest radiograph following suspected hydrocarbon aspiration require close monitoring for the development of further life-threatening complications.

[Diffuse alveolar hemorrhage (DAH): an underestimated pulmonary complication after hematopoietic stem cell transplantation]. / Diffuse alveoläre Hämorrhagie (DAH): Eine unterschätzte pulmonale Komplikation nach hämatopoetischer Stammzelltransplantation.

Diffuse alvedar haemorrhage (DAH): a severe complication post haematopoietic stemcell transplantation (HSCT) with high mortality. Early diagnose and distinction from other pulmonary complications is essential. Radiologic imaging provides first cues to diagnose. Confirmation of diagnose by BAL. Therapeutic approach with high dose steroids

Unusual cross-sectional imaging findings in hepatic peliosis.

Hepatic peliosis is a rare entity that represents focal, multifocal, segmental, or diffuse dilatation of liver sinusoids. Hepatic peliosis is often associated with chronic wasting diseases but also has been reported in association with anabolic, contraceptive, or other hormonal treatment, and even in context with HIV-related bacterial infections. Hepatic peliosis is usually clinically unapparent and mostly found only during autopsy, but occasionally it may lead to diagnostic problems if detected radiologically since the imaging findings in hepatic peliosis are quite variable according to the variety of its possible histologic features as well as the possibility of additional hemorrhage. We present a case of hepatic peliosis associated with bronchial carcinoma that showed moderate centripetal enhancement during the portal-venous phase on CT, pronounced venous pooling on contrast enhanced T1-weighted images acquired during the hepatic-venous phase, and bright signal on T2-weighted images, thus mimicking in some way a capillary hemangioma. We also discuss some not yet described CT and MR features of this rare entity which should be included into the differential diagnosis of atypical liver lesions in patients with the above-mentioned conditions.