Diagnosis of intravascular lymphoma by a novel biopsy site.

PURPOSE: To report the first known case of intravascular lymphoma (IVL), a rare disease, diagnosed via lacrimal gland biopsy. DESIGN: Interventional case report. PARTICIPANTS: Single patient case report. INTERVENTION: Bedside lacrimal gland biopsy. MAIN OUTCOME MEASURES: Clinicopathologic diagnosis of IVL, a neoplasm with only a few prior reports of ophthalmic manifestations, via a novel biopsy site. RESULTS: A 70-year-old Chinese man with 6 months of progressive paraplegia complained of blurred vision in both eyes. He had unremarkable cerebrospinal fluid studies and magnetic resonance imaging that showed abnormal thoracic cord signal and periventricular brain white matter changes with a normal pituitary gland and stalk. Dilated fundus examination showed multifocal areas of intra- and subretinal hemorrhage with serous retinal detachment. The workup included serologies and 2 normal bone marrow biopsies but did not reveal the underlying etiology. Because of the continued high suspicion for a malignant process, we performed bedside transconjunctival biopsy of the lacrimal gland. This demonstrated large, atypical CD20-positive B cells confined to the vessel lumina, consistent with IVL, an unusual form of large B-cell lymphoma. CONCLUSIONS: This case represents the first time that IVL has been detected via lacrimal gland biopsy, which may be a useful way to investigate cryptogenic neurologic processes. Furthermore, it is one of the only reported cases of ophthalmic IVL diagnosed before autopsy. IVL is a rare disease but has protean manifestations involving the central nervous system, skin, bone marrow, liver, and spleen. The eye should also be considered an end organ for involvement.

Thyroid eye disease: pathogenesis and treatment.

Thyroid eye disease is common, yet poorly understood. Clarification of the pathogenesis of thyroid eye disease should provide a rational therapeutic approach. This article provides a review of current pathogenic theories for the condition and of the medical management based on those theories.

Advanced glycation end products and receptors in Fuchs' dystrophy corneas undergoing Descemet's stripping with endothelial keratoplasty.

PURPOSE: To describe the histopathologic features of Descemet's membrane (DM) obtained from Fuchs' endothelial corneal dystrophy (FECD) corneas undergoing Descemet's stripping with endothelial keratoplasty (DSEK) and to assess the presence of advanced glycation end products (AGEs) and their receptors in FECD endothelium and DM. DESIGN: Prospective observational case series. PARTICIPANTS: Five eyes of 5 patients undergoing DSEK for FECD and 4 normal control eyebank corneas. METHODS: Descemet's membrane and corneal endothelium from FECD patients undergoing DSEK were assessed with hematoxylin-eosin staining and immunohistochemistry for AGEs, receptor of AGEs (RAGE), and galectin 3 (AGE-R3). MAIN OUTCOME MEASURES: Histopathologic abnormalities and presence of AGEs, RAGE, and AGE-R3 in DSEK specimens. RESULTS: Histopathologic assessment of DSEK specimens from FECD patients disclosed thickening and nodularity of DM and loss of endothelial cells. Immunohistochemical staining of FECD DM for AGE, RAGE, and AGE-R3 showed an abundance of AGEs in the anterior portion of DM, mild positivity for RAGE, and moderate positivity for AGE-R3. CONCLUSIONS: Tissue quality after DSEK is sufficient to allow detailed histopathologic analysis. The presence of AGEs, RAGE, and AGE-R3 in DM and corneal endothelium of FECD patients supports a link between accumulation of AGEs, oxidative stress, and corneal endothelial cell apoptosis in the pathogenesis of FECD.

Evaluation of deep lamellar endothelial keratoplasty surgery using scatterometry and wavefront analyses.

OBJECTIVE: To determine if postsurgical corneal interface abnormalities after deep lamellar endothelial keratoplasty (DLEK) cause increased light scattering or wavefront aberrations that may help to explain decreased best-corrected visual acuity in DLEK patients compared with penetrating keratoplasty (PK) patients. DESIGN: Prospective comparative case series. PARTICIPANTS: Clinically clear corneas of 4 eyes that had undergone DLEK surgery and 4 eyes that had PK were studied. Normal control data for light scattering was collected from 12 right eyes and 11 left eyes with normal corneas. METHODS: Corneal light scattering was measured with a scatterometer designed at the Johns Hopkins Applied Physics Laboratory, and wavefront analysis was performed using standard methods with a Hartmann-Shack wavefront sensor. MAIN OUTCOME MEASURES: Corneal scattering measurements were normalized by taking the ratio of the subject's corneal light scattering to a reference material. A scattering index was calculated as the ratio of the normalized scattering for a given patient's cornea to the average scattering of normal corneas. Astigmatism and higher-order aberrations were analyzed using standard data output from wavefront analysis and Zernike polynomial decomposition. RESULTS: The mean scattering index was significantly higher after DLEK (1.78+/-0.29, mean+/-standard deviation [SD]) than after PK (1.03+/-0.27; P = 0.043). The higher-order root mean square (RMS) wavefront error was significantly higher after PK (0.71+/-0.11 microm, mean+/-SD) than after DLEK (0.44+/-0.12 microm; P = 0.029). Zernike polynomial decomposition of the wavefront aberrations revealed that regular corneal astigmatism was the most important aberration component for both PK and DLEK, but the PK patients had significantly more regular astigmatism (1.7+/-0.45 diopters [D], mean+/-SD) than did the DLEK patients (0.84+/-0.27 D; P = 0.029). CONCLUSIONS: Our data quantitatively support subclinical corneal haze as an explanation for the limited visual acuity after DLEK as compared with PK. Intraoperative or postoperative modifications to reduce stromal haze after DLEK may result in better visual acuity outcomes.

Iridoschisis and bilateral lens subluxation associated with periocular eczema.

We present a 53-year-old man with bilateral lens subluxation, unilateral iridoschisis, and a long-standing history of periocular eczema. Although a case of unilateral lens subluxation and ipsilateral iridoschisis has been described recently, the pathogenesis of this simultaneous occurrence remains unclear. Our case raises questions about the relationship among these clinical observations and suggests that these findings may exist as part of an unrecognized oculodermal syndrome.

Inadvertent trypan blue posterior capsule staining during cataract surgery.

PURPOSE: To report 5 cases of inadvertent posterior capsule staining with trypan blue during phacoemulsification. DESIGN: Retrospective, observational case series. METHODS: Five cases of posterior capsule staining with trypan blue were identified from cataract surgeries performed at an academic institution. All 5 eyes underwent phacoemulsification with use of iris retractors. The surgical videos from each case were reviewed to better understand the mechanisms and risk factors for posterior capsule staining with trypan blue and techniques to avoid this complication. RESULTS: No eyes had clinical evidence of zonular pathology during their preoperative examination. Only 1 patient reported a possible childhood history of trauma to both eyes. One eye had uveitis, requiring posterior synechialysis. All 5 cases involved the use of iris retractors. No other intraoperative complications occurred, and the intraocular lens was successfully placed in the capsular bag in all cases. All eyes had resolution of posterior capsule staining by postoperative day 8. CONCLUSIONS: Inadvertent posterior capsule staining with trypan blue can occur in eyes that appear structurally normal. The use of iris retractors may facilitate posterior capsule staining by allowing the posterior flow of trypan blue under the iris and through the zonules to the posterior capsule. Surgeons should consider techniques to minimize the risk of posterior capsule staining, particularly in cases involving the use of iris retractors.

Adolescent physical activity participation and motivational determinants across gender, age, and race.

BACKGROUND: Physical activity (PA) declines as adolescents get older, and the motivational determinants of PA warrant further investigation. The purposes of this study were to investigate the amount of physical and sedentary activity that adolescents participated in across age, gender, and race, and to investigate adolescents' attraction to PA and their perceived barriers and benefits across age, gender, and race. METHODS: High school students (N = 1163) aged between 13 and 16 years completed questionnaires on minutes and intensity of physical and sedentary activity, interests in physical activity, and perceived benefits and barriers to participating in PA. RESULTS: A series of multivariate analyses of variance were conducted and followed up with discriminant function analysis. PA participation decreased in older females. In addition, fun of physical exertion was a primary attraction to PA for males more than females. Body image as an expected outcome of participating in PA contributed most to gender differences. CONCLUSION: There is a need to determine why PA drops-off as females get older. Findings underscore the importance of structuring activities differently to sustain interest in male and female adolescents, and highlights motives of having a healthy body image, and making PA fun to enhance participation.

Goal setting in sport and exercise: research and practical applications / Estabelecendo metas no esporte e exercício físico: pesquisa e aplicações práticas

The purpose of this paper was to briefly review the major theoretical and empirical research in goal setting related to sport and develop applications for best practice. Different types of goals were discussed and Locke's theory of goal setting provided the foundation for future research. After briefly reviewing the goal setting literature in sport and organizational settings, principles for how to apply goal setting to enhance performance were developed. The development and implementations of a goal setting system was presented including planning, meeting, and evaluation stages. Finlly, effective goal setting practices based on empirical literature were discussed.

Este trabalho focalizou a efetividade do estabelecimento metas no esporte e em ambientes de exercícios físicos. A teoria de Locke de estabelecimento de meta, que indica que metas específicas, difíceis, desafiadoras conduzem a níveis mais altos de desempenho de tarefa do que metas fáceis, nenhuma meta, ou a meta do tipo "faça o seu melhor", foi apresentada. Pesquisas mais recentesinvestigando a relação meta-desempenho em esporte e exercícios físicos também encontraram apoio para a efetividade de metas embora os resultados não sejam tão robustos quanto os da literatura industrial. Foram apresentados os princípios básicos de estabelecimento de metas, incluindo estabelecimento de metas específicas, de metas realísticas e desafiadoras, de metas em curto e longo prazo, estabelecimento de metas de desempenho, anotação de metas, provimento de apoio para as metas e incentivo à avaliação de metas. Um processo para estabelecimento de metas com equipes foi esboçado junto com um processo de sete-passos para estabelecer metas efetivamente. É importante lembrar que a efetividade de qualquer programa de estabelecimento de metas em grande parte dependeda interação entre o treinador, do coordenador de exercícios físicos, do psicólogo desportivo e da motivação dos participantes. Em essência, ao estabelecer metas sempre se deve levar em contao ambiente e as diferenças individuais.