Endoscopic optic nerve decompression is a minimally invasive, safe and efficient treatment for traumatic optic neuropathy. Used in combination with steroids, it provides effective rescue for some patients suffering visual loss. It should be undertaken as soon as possible.
Prolonged retention of intrauterine bone is a recognised cause of secondary infertility. Between 1989 and 1995, eleven West African women had retained intrauterine bone as the cause of their infertility. All the women had had termination of pregnancies in their countries of origin. Transvaginal ultrasound scan detected bright intrauterine echoes suggestive of bone which was confirmed and removed at hysteroscopy. Subsequently eight women conceived spontaneously 12 pregnancies. Doctors treating West African women with infertility should be aware of this condition and include transvaginal ultrasound scan in their investigations. IntroductionProlonged retention of intrauterine bone has been recognised as a cause of secondary infertility with over 70 cases reported. Previous authors have ascribed the presence of the intrauterine bone to a number of causes. These include metaplasia, heteroplasia, dystrophic calcification and retained fetal bone following abortion, either spontaneous or induced. Associated gynaecological complaints are; secondary infertility, menorrhagia, irregular bleeding, pelvic pain, offensive vaginal discharge and passage of bony fragments vaginally. The diagnosis in many cases had been made following curettage and recently by ultrasound scan and hysteroscopy. Previous reports have not identified any particular group of women as being at risk. We have seen this condition only in West African women and report here 11 such cases. MethodsKing's College Hospital Assisted Conception Unit receives referrals for the initial investigation of infertility and for in virro fertilisation from the local community and further afield. All women have a transvaginal ultrasound scan performed. This examination includes a detailed assessment of the endometrium to identify structures which might interfere with conception. Women who had bright echoes suggestive of bone within the uterine cavity (Fig. 1) hysteroscopy to confirm the presence of bone which is then removed at dilatation and curettage.
OBJECTIVE Primary spinal cord H3 K27M-mutant diffuse midline glioma (DMG) is a rare and devastating pathological entity. However, little attention has been paid to this disease. As a result, its clinicoradiological characteristics have yet to be described. The aim of this study was to describe the clinicoradiological characteristics of primary intramedullary H3 K27M-mutant DMG and to compare this tumor with the H3 K27 wild-type to explore potential features that could differentiate the two. METHODS A total of 59 patients with pathologically confirmed intramedullary astrocytoma were included in this study. The cohort was divided into an H3 K27M-mutant group and H3 K27 wild-type group based on the status of H3 K27M according to an immunohistochemistry method. Demographic data, MRI features, and molecular information were collected. Multivariate logistic regression was conducted to investigate variables that might have a role in differentiating an H3 K27M DMG from an H3 K27 wild-type tumor. RESULTS Only symptom duration showed an independent association with the H3 K27M mutation (OR 0.82, 95% CI 0.68–0.94, p = 0.016). Patients with spinal cord H3 K27M-mutant DMG had a shorter symptom duration than patients with H3 K27 wild-type glioma. No significant difference was found in terms of MRI features between the H3 K27M-mutant and H3 K27 wild-type groups. Additionally, H3 K27M-mutant DMG frequently demonstrated overexpression of p53. Survival outcome did not show a statistical difference between the H3 K27-mutant subgroup and H3 K27 wild-type subgroup in histologically high-grade astrocytoma. CONCLUSIONS Symptom duration was associated with an H3 K27M mutation in intramedullary astrocytoma. MRI features were heterogeneous, and no imaging feature was able to predict the H3 K27M mutation. The H3 K27M mutation did not impact survival outcome in spinal histologically high-grade astrocytoma.
Although the augmentation index (AIx) is widely used to evaluate arterial stiffness in clinics and research, some conflicting data exist in regard to its validity. We therefore performed a series of studies to test the validity of AIx. The first study in 196 peritoneal dialysis patients showed that AIx in diabetics was lower than that in non-diabetic patients (p<0.05), which was in contradiction with the previous studies. Further analysis showed that AIx was just weakly correlated with pulse pressure (PP)-a known index of arterial stiffness. We also found that the increase of augmentation pressure (AP) was usually accompanied with increased central PP (C-PP). As AP and C-PP are used as the numerator and denominator in the AIx formula, an increase in the numerator (AP) would not necessarily result in an increase of the quotient (AIx) unless the denominator (C-PP) was stable. We then conducted a second study trying to test the validity of AIx through mathematical ratiocination. The increases in the central second peak (P2) and AP were assumed to represent increased arterial stiffness. Different values of AIx were obtained by varying the central initial systolic peak (P1) and diastolic pressure (DP). Mathematical ratiocination showed that AIx was dependent on multiple factors, F=(DeltaSP-DeltaDP)x(P1-P2)+(DeltaP2-DeltaP1)x(SP-DP), which suggested that a change of AIx would not always be attributable to changes in P2 and AP. This speculation was further proved by clinical data in our third study. In conclusion, through a series of studies and ratiocination, we showed that the augmentation index (AIx or AIx@75bpm) might not be a sensitive surrogate for a change in central pressure waveforms, which is a manifestation of change in large artery function. The limitation of AIx as an index of arterial stiffness is rooted in its formula, which has a clear mathematical flaw.
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