Green environments and cardiovascular health.

Several large epidemiological studies have found robust associations between greenness and the risk of cardiovascular disease (CVD). These studies report that close residential proximity to greenness is associated with a decrease in cardiovascular mortality as well as major adverse cardiovascular events. Although mechanisms underlying this link are not well understood, the beneficial health effects of greenness have been linked to its ability to relieve stress, decrease air pollution, and encourage physical activity. Greenness in residential neighborhoods could also increase access to healthy goods and services, as well as social interactions. Research into the health effects of greenness could provide new insights into the environmental determinants of CVD risk and could inform the development of actionable greenness-based strategies to prevent CVD and its clinical manifestations.

G1961E mutant allele in the Stargardt disease gene ABCA4 causes bull's eye maculopathy.

The aim of this study was to characterize the pathological and functional consequences of the G1961E mutant allele in the Stargardt disease gene ABCA4. Data from 15 patients were retrospectively reviewed and all the patients had at least one G1961E mutation. Comprehensive ophthalmic examination, full-field and pattern electroretinograms, and fundus autofluorescence (FAF) imaging were performed on all patients. Microperimetry, spectral-domain optical coherence tomography (OCT), and fluorescein angiography were performed in selected cases. Genetic screening was performed using the ABCR400 micro-array that currently detects 496 distinct ABCA4 variants. All patients had normal full-field scotopic and photopic electroretinograms (ERGs) and abnormal pattern electroretinograms (PERGs) performed on both eyes, and all the fundi had bull's eye maculopathy without retinal flecks on FAF. On OCT, 1 patient had disorganization of photoreceptor outer segment, 2 had outer nuclear layer (ONL) thinning likely due to photoreceptor atrophy proximal to the foveal center, and 3 had additional retinal pigment epithelium (RPE) atrophy. On microperimetry, 6 patients had eccentric superior fixation and amongst this group, 5 had an absolute scotoma in the foveal area. DNA analysis revealed that 3 patients were homozygous G1961E/G1961E and the rest were compound heterozygotes for G1961E and other ABCA4 mutations. The G1961E allele in either homozygosity or heterozygosity is associated with anatomical and functional pathologies limited to the parafoveal region and a trend to delayed onset of symptoms, relative to other manifestations of ABCA4 mutations. Our observations support the hypothesis that the G1961E allele contributes to localized macular changes rather than generalized retinal dysfunction, and is a cause of bull's eye maculopathy in either the homozygosity or heterozygosity state. In addition, genetic testing provides precise diagnosis of the underlying maculopathy, and current non-invasive imaging techniques could be used to detect photoreceptor damage at the earliest clinical onset of the disease.

Malrotation with volvulus of the transverse colon and duodenal obstruction secondary to Ladd's bands.

Colonic volvulus is a relatively uncommon cause of large bowel obstruction, accounting for 10% of colonic obstructions. Volvulus of the transverse colon is quite rare, accounting for only 4-11% of all reported cases of colonic volvulus (Kerry RL, Ransom HK. Volvulus of the colon: etiology, diagnosis, and treatment. Arch Surg 1969;99:215-221). We report an unusual case of documented volvulus of the transverse colon in a young man with intestinal malrotation and concomitant duodenal obstruction by Ladd's bands.

Narrowing of the proximal jejunal limbs at their passage through the transverse mesocolon: a potential pitfall of laparoscopic Roux-en-Y gastric bypass.

OBJECTIVE: We reviewed images obtained in patients who had recently undergone laparoscopic Roux-en-Y gastric bypass procedures, noting radiographic appearances and possible complications. CONCLUSION: In five (45%) of 11 patients, we observed a focal area of circumferential narrowing of the proximal jejunal Roux-en-Y loop. This narrowing corresponded to the site of multiple circumferential sutures from the edge of the hiatus created in the transverse mesocolon to the serosa of the traversing jejunal Roux-en-Y loop as the latter courses superiorly to join the gastric pouch. This narrowing should not be confused with localized ischemia or another disease process.

The cisterna chyli: incidence and characteristics on CT.

The objective of this study was primarily to determine the incidence of the cisterna chyli (CC) on computed tomography (CT). Its radiologic characteristics were also evaluated. Retrospective review of 403 randomly chosen CT cases was made. All patients received intravenous contrast. Note was made of incidence, location, size, attenuation values, slice thickness, age, sex, and the presence or absence of malignancy or adenopathy. There were seven cases of demonstrated CC (1.7%). It was variably located at the L2 to T11 levels; average attenuation was 4 H and average size was 7.4 mm AP by 7.0 mm in transverse diameter with rounded to elliptical shape. Average length of CC was 1.5 mm. Malignant primary was present in four of the seven cases, and none of the seven had adenopathy. There were three males and four females; average age of the CC group was 55.5 years. Visualization of the CC on CT is not rare (1.7%); as previously reported, it should be distinguished from retrocrural adenopathy by its low water attenuation, anatomic continuity with the thoracic duct, tubular nature, and lack of intravenous contrast enhancement.

Demonstration of inferior phrenic arteries on spiral CT--case report.

An unusual case is presented in which normal noncollateral left and right inferior phrenic arteries (IPAs) are clearly visualized on two successive CT axial sections for long continuous lengths of their courses, presumably due to their relative horizontal orientation. They are both noted to penetrate the diaphragm (infradiaphragmatic to supradiaphragmatic) as a normal variation. There was no liver pathology, other tumor, or other unusual anatomy.