Regional Differences of Choroidal Structure Determined by Wide-Field Optical Coherence Tomography.

Purpose: To compare the submacular to the perimacular choroidal structure in images obtained by wide-field optical coherence tomography (OCT). Methods: Thirty eyes of 30 healthy volunteers (15 men) were studied. Twelve wide-field radial circumferential scans were recorded with enhanced depth imaging OCT from the macular and perimacular zones. The sizes of the luminal and stromal areas of the choroid were determined. The two zones were subdivided into the superior, inferior, nasal, and temporal sectors. The total choroidal area, the luminal and stromal areas, and the luminal ratio of each sector were compared. Results: All of the choroidal structural parameters analyzed in the present study were largest in the superior sector followed by the temporal, inferior, and nasal sectors. The coefficients of variation were larger in the perimacular zone than in the macular zone: The luminal ratio in the macular zone varied by 1.2%, and that in perimacular zone varied by 4.2%. Conclusions: The variations in the ratios of the luminal areas of the choroid in the wide-field OCT images are slight in the macular zone but considerable in the perimacular zone.

Influence of Pneumococcal Conjugate Vaccine on Acute Otitis Media with Severe Middle Ear Inflammation: A Retrospective Multicenter Study.

The Japanese guidelines for acute otitis media in children recommend classifying acute otitis media by age, manifestations and local findings, and also recommend myringotomy for moderate-grade cases with severe local findings, severe-grade cases, and treatment-resistant cases. The heptavalent pneumococcal conjugate vaccine was released in Japan in February 2010. In Hiroshima City, public funding allowing free inoculation with this vaccine was initiated from January 2011, and the number of vaccinated individuals has since increased dramatically. This study investigated changes in the number of myringotomies performed to treat acute otitis media during the 5-year period from January 2008 to December 2012 at two hospitals and five clinics in the Asa Area of Hiroshima City, Japan. A total of 3,165 myringotomies for acute otitis media were performed. The rate of procedures per child-year performed in <5-year-old children decreased by 29.1% in 2011 and by 25.2% in 2012 compared to the mean rate performed in the 3 years prior to the introduction of public funding. A total of 895 myringotomies were performed for 1-year-old infants. The rate of myringotomies per child-year performed for acute otitis media in 1-year-old infants decreased significantly in the 2 years after the introduction of public funding for heptavalent pneumococcal conjugate vaccine compared to all years before introduction (p<0.000001). Our results suggest a benefit of heptavalent pneumococcal conjugate vaccine for acute otitis media in reducing the financial burden of myringotomy. In addition, this vaccine may help prevent acute otitis media with severe middle ear inflammation in 1-year-old infants.

A case of an acute cervicomediastinal hematoma secondary to the spontaneous rupture of a parathyroid adenoma.

We herein report the case of a patient with an acute cervicomediastinal hematoma secondary to the spontaneous rupture of a parathyroid adenoma. A 47-year-old female presented with swelling and pain in the neck. She had no history of trauma or of having undergone any medical or odontological procedures. An ultrasound examination revealed the presence of an obscure mass located behind the right lobe of the thyroid gland. A computed tomography scan showed the presence of a low-density lesion extending from the retropharynx to the mediastinum, a high-density lesion located behind the right lobe of the thyroid gland and a right pleural effusion. Because the patient's neck swelling and anemia gradually worsened, she underwent emergency surgery. The neck was found to be swollen due to a hematoma; however, no abscesses were detected in the operative field.Thoracoscopy of the right chest showed no active bleeding. The fragmented mass was histopathologically diagnosed as a parathyroid adenoma with acute hemorrhage, which is quite rare. Our experience suggests that, in patients with severe cervicomediastinal hematomas without any trauma or trigger, a diagnosis of spontaneous rupture of a parathyroid gland lesion should be considered.