Intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to pseudotumor cerebri.

BACKGROUND: In pseudotumor cerebri (PTC), elevated intracranial pressure (ICP) results in papilledema and, rarely, choroidal neovascularization (CNV). Pseudotumor cerebri-induced CNV often regresses following medical or surgical ICP reduction, but additional treatments, such as photocoagulation, photodynamic therapy, peri-ocular steroid injections and/or subretinal surgery, may be necessary. Anti-angiogenic intravitreal injections have been shown to cause regression of both CNV and optic nerve edema. CASE REPORT: We describe a patient with PTC and CNV whose CNV regressed and vision normalized after a single intravitreal injection of bevacizumab (Avastin; Genentech, San Francisco, CA).

Chordoma of the anterior cranial fossa and ethmoids with orbital involvement.

PURPOSE: To report a case of orbital chordoma, emphasizing the clinical, operative, and histopathologic findings, and to review similar English-language reports. METHODS: This is a single case report with histopathologic correlation. Search of the English-language literature and review of referenced citations was performed. RESULTS: After treatment with resection and proton beam radiation, our patient is alive, without recurrence at 3-year follow-up. Biopsy of the recurrent tumor was consistent with chordoma. The original biopsy had S100 and pancytokeratin-positive tumor cells, with abundant clear to eosinophilic cytoplasm. Focal EMA positivity was present. Literature review identified 14 additional cases. CONCLUSION: Orbital chordoma is rare. Extraocular motility disturbances occur solely with intracranial lesions as well as those extending into the orbit, but globe displacement is the most common sign of orbital involvement. This tumor often recurs in the path of previous resection. Diagnosis is confirmed by distinctive histopathologic features and positive staining for S100, pancytokeratin, and EMA. Treatment and outcome analysis of orbital chordoma is difficult due to its rarity and lack of reported follow-up and may need to be extrapolated from reported skull base cases.

A UNIQUE CASE OF ACUTE MACULAR NEURORETINOPATHY ASSOCIATED WITH COTTON WOOL SPOTS AND INTRARETINAL FLUID.

PURPOSE: To discuss the clinical findings in a unique case of acute macular neuroretinopathy with a focus on the pathophysiology of this rare entity. METHODS: The patient's clinical course was documented with color fundus photography and spectral domain ocular coherence tomography registered to infrared reflectance imaging. The visual field was assessed using the Amsler grid testing and Humphrey visual field 24-2. RESULTS: Initial fundus photography showed cotton wool spots and slight darkening of the central macula in each eye. Optical coherence tomography showed initial hyperreflective plaques at the level of the outer plexiform layer/outer nuclear layer junction with subsequent thinning of the outer nuclear layer and corresponding disruption of the ellipsoid and outer segment/retinal pigment epithelium. Infrared reflectance imaging revealed perifoveal hyporeflective lesions in each eye with corresponding visual field defects on the Amsler grid and visual field testing. The hyporeflective infrared lesions became more discreet during the ensuing weeks and remained stable beyond 11 weeks. CONCLUSION: The authors present the case of a 15-year-old girl diagnosed with acute macular neuroretinopathy. This case is notable in that she presented with cotton wool spots and intraretinal fluid, both of which are unusual for acute macular neuroretinopathy. The authors suggest that the presence of cotton wool spots and several small foci of intraretinal fluid seen in their patient may lend support to the ischemic hypothesis described by Sarraf et al. The optical coherence tomography images obtained in this case have the typical wedge-shaped or petaloid configuration, and the authors suggest that the shape of the lesions themselves also lends support to a vascular mechanism.

Chlorination of model drinking water biofilm: implications for growth and organic carbon removal.

The influence of chlorine on biofilm in low organic carbon environments typical of drinking water or industrial process water was examined by comparing biomass and kinetic parameters for biofilm growth in a chlorinated reactor to those in a non-chlorinated control. Mixed-population heterotrophic biofilms were developed in rotating annular reactors under low concentration, carbon-limited conditions (< 2 mg/L as carbon) using three substrate groups (amino acids, carbohydrates and humic substances). Reactors were operated in parallel under identical conditions with the exception that chlorine was added to one reactor at a dose sufficient to maintain a free chlorine residual of 0.09-0.15 mg/L in the effluent. The presence of free chlorine resulted in development of less biofilm biomass compared to the control for all substrates investigated. However, specific growth and organic carbon removal rates were on the average five times greater for chlorinated biofilm compared to the control. Observed yield values were less for chlorinated biofilm. Although chlorinated biofilm's specific organic carbon removal rate was high, the low observed yield indicated organic carbon was being utilized for purposes other than creating new cell biomass. The impacts of free chlorine on mixed-population biofilms in low-nutrient environments were different depending upon the available substrate. Biofilms grown using amino acids exhibited the least difference between control and chlorinated kinetic parameters; biofilm grown using carbohydrates had the greatest differences. These findings are particularly relevant to the fundamental kinetic parameters used in models of biofilm growth in piping systems that distribute chlorinated, low-carbon-concentration water.

Evaluation of a new water treatment for point-of-use household applications to remove microorganisms and arsenic from drinking water.

Contamination of drinking water by microorganisms and arsenic represents a major human health hazard in many parts of the world. An estimated 3.4 million deaths a year are attributable to waterborne diseases. Arsenic poisoning from contaminated water sources is causing a major health emergency in some countries such as Bangladesh where 35 to 77 million people are at risk. The World Health Organization (WHO) has recently recognized point-of-use water treatment as an effective means of reducing illness in developing country households. A new point-of-use water treatment system that is based on flocculation, sedimentation and disinfection was evaluated for the removal of bacterial, viral and parasitic pathogens as well as arsenic from drinking water to estimate its potential for use in developing countries. Tests were conducted with United States Environmental Protection Agency (EPA)-model and field- sample waters from developing countries. Samples were seeded with known numbers of organisms, treated with the combined flocculation/disinfection product, and assayed for survivors using standard assay techniques appropriate for the organism. Results indicated that this treatment system reduced the levels from 10(8)/l to undetectable (<1) of 14 types of representative waterborne bacterial pathogens including Salmonella typhi and Vibrio cholerae. No Escherichia coli were detected post-treatment in 320 field water samples collected from five developing countries. In addition, the water treatment system reduced polio and rotavirus titres by greater than 4-log values. Cyrptosporidium parvum and Giardia lamblia inocula were reduced by greater than 3-log values following use of this water treatment system. Arsenic, added to laboratory test waters, was reduced by 99.8%, and naturally occurring arsenic in field samples from highly contaminated Bangladeshi wells was reduced by 99.5% to mean levels of 1.2 microg/l. This water treatment system has demonstrated the potential to provide improved drinking water to households in developing countries by removing microbial and arsenic contaminants.

Bilateral optic nerve sheath enhancement from giant cell arteritis.

An 83-year-old man presented with acute bilateral visual loss to no light perception (NLP) OD and 20/50 OS. His fundus examination showed moderate bilateral pallid disc edema. A sedimentation rate was 60 mm/h. Magnetic resonance imaging of the brain and orbits with gadolinium revealed marked bilateral enhancement of the optic nerve sheaths and adjacent orbital fat. He underwent biopsies of the optic sheath OD and bilateral temporal arteries. Histopathology of the optic nerve sheath area revealed fibroadipose tissue containing numerous arteries with intimal thickening, and mild mural inflammation consisting predominantly of lymphocyte with occasional giant cells. The bilateral temporal artery biopsies revealed focal disruption of the elastic lamina with rare giant cells. His vision had since stabilized on IV methypdnisolone therapy. The biopsies of the nerve sheath suggest that the radiologic finding of optic nerve sheath enhancement in giant cell arteritis is caused by tbe same pathophysiology, and therefore may be a manifestation of this systemic disease.