Correction of fetal umbilical vein flow imbalance following laser surgery for twin-twin transfusion syndrome.

OBJECTIVES: Twin-twin transfusion syndrome (TTTS) is characterized by unequal hemodynamics between the twins. We aimed to assess preoperatively the difference in umbilical vein flow (UVF) between the recipient and donor monochorionic diamniotic twins and evaluate the change in UVF following laser surgery in both twins. METHODS: This was a retrospective cohort study of differences in UVF that occurred following laser surgical treatment of TTTS. Sonographic assessment of the umbilical vein before and 24 h after fetoscopic laser surgery for TTTS was performed. Umbilical vein diameter and time-averaged maximum velocity were measured, and UVF per kg (UVF/kg) was converted into a Z-score by a calculator created using gestational age as an independent variable. Z-score values were converted into centiles, which were evaluated statistically. Median differences in UVF/kg centile values were adjusted for TTTS stage and presence of arterioarterial anastomoses. RESULTS: The study population consisted of 363 TTTS patients. The adjusted preoperative median difference in UVF/kg centile between the recipient vs donor twin was 17.9% (-17.1% to 57.6%), P < 0.0001. The adjusted median difference in UVF/kg centile between the postoperative vs preoperative period among recipients was 2.2% (-10.8% to 13.8%), P < 0.0001, while the adjusted median difference among donors was 27.3% (8.2%-34.6%), P < 0.0001. CONCLUSION: The preoperative difference in UVF between the recipient and donor twins confirms the pathophysiology of TTTS. Postoperatively, the substantial increase in UVF of the donor twin and the relatively small increase in UVF of the recipient twin confirm that ablation of the vascular communications resulted in rapid improvement in perfusion of the donor twin. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Expression profiles for genes in the turkey major histocompatibility complex B-locus.

The major histocompatibility complex (MHC) is a highly polymorphic region of the genome essential to immune responses and animal health. In galliforms, the MHC is divided into 2 genetically unlinked regions (MHC-B and MHC-Y). Many MHC-B genes are involved in adaptive or innate immunity, yet others have nonimmune or unknown functions. The sequenced MHC-B region of the turkey (Meleagris gallopavo) contains 40 genes, the majority of which are predicted transcripts based on comparison with the chicken or quail, without direct evidence for expression. This study was designed to test for the presence of MHC-B gene transcripts in a panel of immune and nonimmune system tissues from domestic turkeys. This analysis provides the first locus-wide examination of MHC-B gene expression in any avian species. Most MHC-B genes were broadly expressed across tissues. Expression of all predicted genes was verified by reverse-transcription PCR, including B-butyrophilin 2 (BTN2), a predicted gene with no previous evidence for expression in any species. Previously undescribed splice variants were also detected and sequenced from 3 genes. Characterization of MHC-B expression patterns helps elucidate unknown gene functions and potential gene coregulation. Determining turkey MHC-B expression profiles increases our overall understanding of the avian MHC and provides a necessary resource for future research on the immunological response of these genes.

Psychiatric crises and emergency admissions.

Emphasize safe practice to avoid legal liability when evaluating individuals in psychiatric crisis. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com.

Should you hire that nurse?

Negligent hiring, retention, and supervision practices expose you to liability. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com.

Helping women select primary breast cancer treatment.

Making a decision about breast cancer treatment is complex for women. Patients and caregivers are given a lot of information, then asked to make choices that affect their lives in many ways. Many are facing their mortality for the first time as well. Nurses are key players in providing information and support, and guiding patients in making treatment choices. However, the ultimate decision is up to the patient.

Pseudocysts of the mandibular condyle.

The panoramic radiographs of 507 consecutive patients receiving comprehensive dental treatment were evaluated for the presence of radiolucencies in the mandibular condyles. Nine patients met the study criteria. Five patients had bilateral and four patients had unilateral circumscribed radiolucencies in the anterior aspect of the condyle. Computerized tomography confirmed that these radiolucencies were age-related anatomic variants that were accentuated and distorted during panoramic radiography.

Concurrent benign teratoid medulloepithelioma and pineoblastoma.

Teratoid medulloepithelioma of the ciliary body is a rare tumor usually occurring in young children. Primary tumors of the pineal gland are also quite rare and have a similar age distribution. We report the case of a 2-year-old girl who had a leukocoria of the right eye. Cataract surgery was performed; however, the patient developed a total retinal detachment refractory to treatment. She eventually developed early changes of phthisis bulbi and underwent an evisceration. Histopathologic examination revealed a benign teratoid medulloepithelioma containing islands of hyaline cartilage and rhabdomyoblasts. During the course of her evaluation, a pineoblastoma was discovered and surgically excised. While the association of pineal tumors with retinoblastomas has been well established, no such association has been reported for medulloepitheliomas. To our knowledge, this is the first recorded case of a benign teratoid medulloepithelioma occurring concurrently with a pineoblastoma.

Toxic anterior segment inflammation following cataract surgery.

Cataract extraction with posterior chamber intraocular lens implantation is rarely complicated by an acute, sterile, anterior segment inflammation. We report three unrelated cases of acute intraocular inflammation following uncomplicated cataract extraction and posterior chamber intraocular lens placement. A constellation of clinical features were found in these cases. The hallmark of this entity was an acute toxic inflammatory reaction occurring in the anterior segment on the first postoperative day. Typically, widespread corneal edema with diffuse corneal endothelial damage occurred, accompanied by a fixed, dilated pupil with significant iris atrophy and sometimes a severe secondary glaucoma. Since all cultures were negative, the resulting inflammatory processes were not a result of endophthalmitis. We believe that a toxic insult introduced into the anterior chamber at the time of surgery precipitated the acute inflammatory processes seen in these cases.

Immunohistological and electron microscopic studies of microfilariae in skin and lymph nodes from onchocerciasis patients after ivermectin treatment.

Microfilariae were studied in skin and lymph node biopsies from Liberian patients with generalised onchocerciasis 12-78 hours after administration of a single dose of 150 micrograms/kg body weight using histology, transmission electron microscopy and immunocytological staining with antibodies against an immunodominant antigen of Onchocerca volvulus. Most microfilariae in the skin appeared morphologically intact and beginning signs of degeneration were seen only on the ultrastructural level. The densities of microfilariae in the lymph nodes were about thousandfold higher in ivermectin treated patients. More than 90% of the microfilariae in the lymph nodes showed distinct signs of degeneration. Early changes were seen in the muscle cells. The disintegrating microfilariae in the lymph nodes were always encircled by eosinophils or macrophages or both cells. Immunohistological staining with antifilarial antibodies increased the detection of small and disintegrating pieces of microfilariae considerably.

Intraocular lens explantation and exchange. A review of lens styles, clinical indications, clinical results, and visual outcome.

We conducted a retrospective review of 102 patients who had intraocular lens (IOL) explantation or exchange over a 7.5 year period. Seventy-one patients had IOL exchange while 31 had lens removal without exchange. Anterior chamber IOLs comprised 66.7% of the lenses removed. The most frequent indication for anterior chamber IOL explantation was pseudophakic bullous keratopathy (PBK), followed by the uveitis-glaucoma-hyphema syndrome and cystoid macular edema. Of the IOLs removed, 17.6% were iris-supported, with PBK being the most common indication for removal. Posterior chamber IOLs comprised 15.7% of the explanted lenses in this series. Lens dislocation/decentration was the leading indication for IOL removal in the posterior chamber IOL group. Among the 71 patients who had IOL exchange, 71.8% received an anterior chamber lens and 28.2% received a posterior chamber lens. Visual outcome following IOL exchange or removal showed that 40 patients (39%) improved, 47 patients (46%) had the same vision, and 15 patients (15%) had worse vision postoperatively. The most common reason for a worsening of vision postoperatively was corneal decompensation, followed by glaucoma and cystoid macular edema. Analysis of the clinical results revealed that 86.3% of the patients who had an exchange with an anterior chamber IOL had a successful outcome with either improvement or stabilization of the ocular condition. Ninety percent of the patients who received a posterior chamber IOL had a successful clinical outcome.

Protective effects of Healon and Occucoat against air bubble endothelial damage during ultrasonic agitation of the anterior chamber.

An important aspect of any new viscoelastic substance is the corneal endothelial protection. We compared the protective effects of sodium hyaluronate (Healon) and hydroxypropylmethylcellulose (Occucoat) by introducing a controlled volume of air bubbles into the anterior chamber of human eye bank eyes during ultrasonic agitation of the anterior chamber. Eight eyes received Healon and 11 eyes received Occucoat. Damage to endothelial cells in the central cornea was quantified by vital staining. Endothelial damage averaged 4.5% in eyes in which no viscoelastic was used (positive control); damage was 0.4% in eyes in which a viscoelastic was injected but no air bubbles were introduced (negative control). We found that endothelial damage averaged 4.25% in specimens that received air plus Healon and 1.4% in specimens that received air plus Occucoat. Occucoat appeared to have somewhat better protective effects than Healon against air bubble damage to the corneal endothelium during ultrasonic agitation of the anterior chamber.

Influence of lens cortex on postoperative inflammation and cellular deposits on surface of intraocular lenses in rabbit eye.

An animal model was used to evaluate the influence of residual lens cortex on postoperative inflammation and cellular deposits on intraocular lenses (IOLs). Eighteen New Zealand white rabbits underwent bilateral endocapsular phacoemulsification with placement of a one-piece polymethylmethacrylate (PMMA) IOL in the capsular bag. A predetermined amount (15 mg, 30 mg or 60 mg) of homogenized lens cortex was injected into the anterior chamber of one of the eyes of each rabbit after bilateral IOL implantation. The contralateral eye served as the control. The animals underwent slit-lamp examination postoperatively, and the anterior segment of each eye was examined by gross and light microscopy. On slit-lamp examination, the eyes which had received a 60-mg injection of cortex showed a significantly higher amount of posterior synechiae than their contralateral, control eyes. After 2 weeks of observation, the rabbits were sacrificed, the eyes were enucleated, and the IOLs were removed and examined by light microscopy and scanning electron microscopy (SEM). The number of cellular deposits on the IOLs removed from the eyes receiving a 30-mg injection of cortex was significantly larger than that found in their contralateral, control eyes (P less than 0.05), but the eyes in the 60-mg and 15-mg injection groups showed no significant difference between control eyes and IOL eyes in the number of cellular deposits on explanted IOLs. Observation by SEM determined that the filopodia on the epithelioid cells found on the IOLs removed from the eyes in the 60-mg injection group showed an increased number and length compared to their controls. The epithelioid cells on the IOLs of the 30-mg injection group showed an increased number of filopodia compared to their controls.