Nitrogen bisphosphonate-induced orbital inflammatory disease: gamma delta T cells--a report and review of 2 cases.

With the increased use of nitrogen bisphosphonate therapy for osteoporosis, multiple myeloma, metastatic prostate carcinoma, and Paget disease, it is now recognized that orbital inflammation is a potential sequelae of treatment. To date, 15 isolated cases of orbital inflammation exist in the literature with additional 2 cases reported herein. While the precise triggering mechanism for orbital inflammation is not definitively understood, it appears that a regulatory response from gamma delta T cells is the most likely causative factor. Nitrogen bisphosphonates are a causative agent of orbital inflammatory disease. These case reports adhered to the principles of Helsinki and the Health Insurance Portability and Accountability Act.

Surgical interventions for idiopathic intracranial hypertension.

PURPOSE OF REVIEW: Idiopathic intracranial hypertension (IIH) can present with severe loss of vision or with ongoing vision loss despite maximal medical therapy; these situations require aggressive management with surgical interventions. To date, optimal surgical management has not been clearly defined. A review of the recent literature is undertaken to clarify the role of surgical interventions in IIH. RECENT FINDINGS: To date, no prospective, randomized study has been performed comparing lumboperitoneal shunt, ventriculoperitoneal shunt and optic nerve sheath fenestration/decompression. Procedure choice appears to be based on local availability and expertise, as well as the prominence of presenting symptoms. Delay in surgical intervention for fulminant and medically refractory cases leads to worse visual outcomes. SUMMARY: Surgical intervention for IIH will likely be based on local expertise until well designed, multicentered clinical trials clarify which intervention best suits a particular patient.

Carotid artery surgery and carotid stenting in prevention of strokes.

PURPOSE OF REVIEW: To summarize the randomized trial data comparing carotid endarterectomy with carotid artery stenting and describe ischemic visual symptoms and their presentation to ophthalmologists. RECENT FINDINGS: Carotid stenosis, symptomatic and asymptomatic, is prevalent and is a significant cause of stroke. Timely evaluation and intervention are important in stroke prevention. SUMMARY: Carotid endarterectomy remains the standard of care for extracranial carotid stenosis except in specific clinical scenarios. Ongoing and future trials will clarify the role of revascularization methods. The role of carotid artery stenting in acute stroke, including its use in the intracranial circulation, is being investigated. Ophthalmologists should be familiar with ischemic risk factor assessment, appropriate and timely referral for imaging and evaluation and initiation of antiplatelet therapy.

Black as night.

A 30-year-old man presented with painless total visual loss in the right eye. Fundus exam and imaging was consistent with total internal carotid artery occlusion and hemispheric stroke. The presentation and management options of retinal vascular occlusive disease in association with asymptomatic stroke are discussed.

Short-term reproducibility of T wave alternans measurement.

INTRODUCTION: Microvolt T wave alternans (TWA) has been proposed as a strong independent predictor of malignant ventricular tachyarrhythmias and sudden cardiac death. TWA reproducibility during bicycle stress test has not been previously investigated. We sought to assess the short-term reproducibility of TWA, as well as heart rate (HR) threshold for TWA, and its spatial distribution and magnitude. METHODS AND RESULTS: The study enrolled 42 patients who were able to complete two bicycle stress tests with HR at peak exercise >110 beats/min within 4 hours of each other and who had technically adequate recordings for TWA analysis during both tests. Concordant results for TWA determination were obtained in 39 (93%) of 42 cases. TWA was present during both tests in 23 patients and was absent during both tests in 16 patients. In the 23 patients with two positive tests, HR at the onset of TWA was not significantly different during the two tests. Further, the number of leads showing TWA and the magnitude of TWA were not significantly different between the two tests. CONCLUSION: TWA is characterized by satisfactory short-term reproducibility and, when present, by high temporal and spatial stability.