BackgroundWe sought to update our prior report of findings on sentinel lymph node biopsy (SLNB) and predictors of a positive SLN in patients with conjunctival or eyelid melanoma. MethodsWe reviewed the records of all patients with ocular adnexal melanoma who underwent SLNB at one institution during 2000-2015. We determined rates of positive and false-negative findings on SLNB, primary tumour features correlated with positive findings and rate of nodal recurrence (false-negative event) after negative findings. ResultsThe study included 51 patients, 31 with conjunctival and 20 with eyelid melanoma. These patients include 30 patients who underwent SLNB during 2000-2008, described in our previous report, and 21 additional patients who underwent SLNB during 2008-2015. There were 30 women and 21 men with median age at SLNB of 62years (range, 24-83). The nodal basins most commonly sampled were intraparotid (27 patients) and level II (14 patients). Ten patients had positive SLNB findings. Compared to tumours with negativefindings, tumours with positive findings had greater median thickness (3.5mmversus2.2mm, p=3D0.04), greater median number of mitotic figures (6 versus 2, p=3D0.03) and greater incidence of ulceration (80% versus 26%, p=3D0.003). Perineural and vascular invasion were not significantly associated with positive findings. There were three false-negative events. Three patients (6%) had temporary marginal mandibular weakness which resolved spontaneously. ConclusionSLNB in patients with ocular adnexal melanoma is safe and identifies nodal micrometastasis in approximately 20% of cases. Histologic features associated with a positive SLN included greater tumour thickness, greater number of mitotic figures and ulceration.

BackgroundWhile Leber hereditary optic neuropathy typically causes bilateral visual loss in the second through fourth decades, we highlight visual loss from Leber hereditary optic neuropathy in older patients to characterize the clinical features of this cohort. DesignRetrospective case series. ParticipantsPatients seen between January 2003 and July 2012 at Baylor College of Medicine and between April 2010 and July 2012 at The Methodist Hospital in Houston, Texas. MethodsPatients with visual loss from genetically confirmed Leber hereditary optic neuropathy were identified via retrospective chart review. Main Outcome MeasuresClinical courses of patients. ResultsFive patients with visual loss from genetically confirmed Leber hereditary optic neuropathy were greater than 60years of age at the time of visual loss (range 62-70years, mean 66.43.0). ConclusionThis series reinforces the importance of including Leber hereditary optic neuropathy in the differential diagnosis of patients of any age with optic neuropathy.

Objectives: The etiologies, clinical presentations and diagnosis of acute pathogen-specific dysentery in children and adults in industrialized and developing regions is described to help develop recommendations for therapy. Methods: We conducted a systematic review of literature published between January 2000 and June 2011 to determine the frequency of occurrence of pathogen-specific dysentery. Results: Shigella, Salmonella, and Campylobacter remain the most frequent bacterial causes of dysentery worldwide. Shiga toxin-producing Escherichia coli (STEC) is potentially important in industrialized countries. Entamoeba histolytica must be considered in the developing world, particularly in rural or periurban areas. Clinicians should use epidemiological clues and knowledge of endemicity to suspect Vibrio spp., Aeromonas spp., Plesiomonas spp., Yersinia enterocolitica, Clostridium difficile, Cytomegalovirus or Schistosoma mansoni in cases presenting with dysentery. A single fecal sample studied for etiologic agents is the customary way to make an etiologic diagnosis. Conclusions: While a majority of dysenteric cases will not have an identifiable agent causing the illness, when an etiologic organism is identified, other than STEC, each has a specific recommended form of therapy, which is provided in this review. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Erdheim-Chester disease (ECD) is a rare xanthogranulomatous disease in which orbital involvement can have devastating outcomes. Through a case report and review of the ophthalmic literature, we explore orbital findings, disease progression, and treatment options. Cases of orbital involvement in Erdheim-Chester disease were identified in the ophthalmic literature with a PubMed query and review of cited references. A total of 14 publications reporting 19 separate cases that included ophthalmic examination data were identified. Patient ages ranged from 26-77 years with a mean age of 50 years. Seventy-four percent (14/19) were men. Vision progression to no light perception was found in 32% (6/19) of the patients. Reviewed cases reported a variety of medical and surgical treatment approaches, however, only 53% reported cases (10/19) demonstrated disease improvement or stabilization. Erdheim-Chester disease with orbital involvement is a devastating disease with a poor prognosis. Awareness of this entity by the ophthalmologist is important as orbital signs and symptoms may manifest early, and orbital biopsy is often crucial to the definitive diagnosis.

Questo saggio si occupa del significato dell’amore passionale nel romanzo di Margaret Mazzantini Non ti muovere (2001). Narratore e protagonista della storia è Timoteo, chirurgo di successo, sposato con Elsa, la cui figlia adolescente, Angela, si trova in ospedale tra la vita e la morte. Ad Angela, che non può ascoltarlo, Timo racconta la storia della relazione extraconiugale che ebbe nel periodo della nascita della ragazza e che cambiò il suo modo di guardare all’umanità. Quella storia iniziò con uno stupro. Nel romanzo, l’amore è rappresentato come forza rivoluzionaria che diventa strumento critico di conoscenza dell’altro e agisce spingendo il protagonista fuori dalla sua vita altoborghese, costringendolo a ripensare la sua umanità. Timoteo si apre così a una comprensione del genere umano più profonda, laddove norme e pratiche sociali della sua classe d’appartenenza avevano invece fallito. Eppure, a dispetto del potere che esercita sull’individuo, l’amore lascia inalterate le strutture sociali che sfida e si propone di cambiare. In questa prospettiva, lo stupro resta un elemento non poco problematico della lettura critica del testo.