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Purpose Androgens given for gender affirmation have been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH) in transgender patients. 10 cases of transgender adults with IIH have been published but this association has not been described in younger patients. Herein we describe the first case of IIH in an adolescent transgender patient. Observations A 17-year-old non-obese female-to-male transgender patient on subcutaneous testosterone since age 13 presented with a two-month history of transient visual obscuration and frontal headaches. Ophthalmological examination revealed Frisen grade 2 papilledema with preserved visual function. Lumbar puncture confirmed elevated opening pressure. Papilledema resolved with oral acetazolamide and reduction of testosterone therapy. Conclusions and Importance The use of cross-sex hormone therapy (CSH) for gender affirmation may increase the risk of IIH. Awareness of this association is important as the number of younger transgender patients seeking CSH is increasing significantly.

This experiment explores the utility of visual obscuration as a method for creating non-lethal munitions that can delay an adversary’s removal of anti-vehicle mines. Visual obscuration was achieved using controlled levels of artificial fog. Twenty-four subjects searched for mines under laboratory conditions of baseline no fog, low-lying fog, and immersive fog. A .52 or greater obscuration was associated with an 85% suppression mine detection. Under fog, subjects detected most mines by accidental kicking and found them in an average of 5 min compared with under 3 s with no fog. The fog created a condition of heightened stress, as reflected by evidence of increased sympathetic activity indexed by increased heart rate and increased electrodermal activity. Immersive fog showed greater sympathetic activation in subjects as indexed by more frequent electrodermal responses and twice the number of instances of giving up compared with the low-lying fog.

Introduction. Leptomeningeal carcinomatosis (LC) is a serious complication occuring in solid cancer patients with rather poor prognosis. Case report. We presented a 47-yearold woman with the 6-month history of diffuse headache, nausea and visual obscuration. Initially, clinical status and brain magnetic resonance imaging (MRI) indicated syndrome of idiopathic intracranial hypertension. Due to clinical progression and high papillary stasis, cerebrospinal fluid (CSF) examination was performed only after ventriculoperitoneal shunt was implanted. This led to a significant although transient clinical improvement. Futher investigations led to the diagnosis of invasive lobular breast carcinoma and repeated CSF analysis revealed malignant breast carcinoma cells. In this case LC was an initial presentation of a malignant disease. Conclusion. In the presence of a high clinical suspicion of LC, in spite of initially negative findings, a clinician should persist in repeating relevant tests, such are MRI with larger amounts of gadolinium and high-volume cytological CSF analyses in order to make the diagnosis. [Projekat Ministarstva nauke Republike Srbije, br. 175022]

Upper eyelid blepharoplasty is a common procedure for aesthetic and functional treatment of excess eyelid skin, or dermatochalasis. A patient with this condition frequently has a combination of cosmetic and functional complaints. The initial evaluation should include the details of the patient’s particular concerns. A handheld mirror is useful to help patients point out eyelid features that are bothersome to them. A complete medical and ophthalmic history, including the use of topical and systemic medications and drug sensitivities, is documented. Specifically ask the patient about aspirin and anticoagulant use. Additional historical questions should focus on dry eye symptoms, eyelid irritation or edema, and visual obscuration.

A simple safety framework for laser eye dazzle, based on a complex model developed from human subject experiments, is proposed to address the urgent need for guidance within international laser safety standards. Maximum Dazzle Exposure (MDE) safety limits are derived that set the laser irradiance at the eye above which an object cannot be visually detected. A newly defined concept of dazzle level accounts for the extent of visual obscuration, and different ambient light levels are accommodated by determining safety limits for night, dusk/dawn, and day conditions. The resulting table of MDE values allows dazzle effects to be quantified in simple safety calculations across a wide range of scenarios. This safety framework is intended to empower the laser safety community to understand and quantify the impacts of laser eye dazzle, specify protection measures for those at risk, and assure the safety and effectiveness of laser dazzle devices.A simple safety framework for laser eye dazzle, based on a complex model developed from human subject experiments, is proposed to address the urgent need for guidance within international laser safety standards. Maximum Dazzle Exposure (MDE) safety limits are derived that set the laser irradiance at the eye above which an object cannot be visually detected. A newly defined concept of dazzle level accounts for the extent of visual obscuration, and different ambient light levels are accommodated by determining safety limits for night, dusk/dawn, and day conditions. The resulting table of MDE values allows dazzle effects to be quantified in simple safety calculations across a wide range of scenarios. This safety framework is intended to empower the laser safety community to understand and quantify the impacts of laser eye dazzle, specify protection measures for those at risk, and assure the safety and effectiv...

This paper describes an evaluation of the performance of a fast response residential sprinkler system in a simulated apartment in the event of a fire caused by a burning television set. The evaluation was conducted in an 8m × 4m × 2.4m high gypsum plasterboard lined compartment. A 1.2 m2 lobby was used to represent an adjoining room and a standard hollow core door connected the two spaces. The compartment was fitted with two pendent mounted fast response residential sprinkler heads, and the television sets were located in one corner of the compartment. A series of 21 tests was conducted using a tea light candle against the outside of the television casing as the ignition source. Gas analysis for CO, CO2, O2 was carried out along with measurements of visual obscuration, compartment temperature and mass loss of the fuel. Tenability conditions within the compartment were determined using Fractional Effective Dose calculations. The results showed that the sprinkler system did not respond well to the television fires. Conditions within the compartment approached or exceeded tenable limits on a number of occasions. In some instances the television set burned out completely without activating the sprinkler system. Language: ja

Object Concern regarding the ability to accomplish adequate hemostasis during intracranial neuroendoscopy is often cited as a potential obstacle for primary endoscopic tumor management. In this study, the rate of clinically significant hemorrhage encountered as a result of endoscopic surgery for an intraventricular brain tumor is examined. Methods A total of 86 patients underwent an endoscopic biopsy procedure or resection of an intraventricular tumor. Recognized hemorrhagic sequelae occurred at a rate of 3.5% per patient. Visual obscuration due to the presence of intraventricular bleeding necessitated aborting the procedure before completion of the objective in two cases. There was a hemorrhagic event resulting in relevant morbidity in one patient, who suffered a bilateral diencephalic stroke after attempted tumor biopsy sampling. Conclusions The low hemorrhagic complication rate described in this series counters the misconception surrounding ineffective hemostasis during intracranial endoscopy for tumors and provides further evidence that this minimally invasive approach is a safe alternative to some conventional intracranial approaches.

Fires in multi-compartment buildings often occur in enclosed spaces or in enclosures opening into other rooms or corridors. Where such fires occur in relatively small enclosures, with limited external venting, the growth of the fire itself remains restricted. If large vents are present opening into large enclosed spaces or to the outside, flashover may occur. In either case these fires are likely to become oxygen vitiated, producing large amounts of smoke and toxic products. Fire-retarded (FR) and non-FR materials behave differently in these situations from the well-ventilated conditions in most standard tests, with smaller differences in toxic product yields. The main hazard to building occupants is the rapid contamination of building spaces by toxic smoke. Visual obscuration and irritancy of smoke impedes escape efficiency, affecting escape behaviour and slowing travel speeds. This may be followed by incapacitation, primarily due to exposure to asphyxiant gases (mainly CO and HCN), and death. A series of full-scale fire tests conducted in enclosed test rigs and buildings is reported, in which detailed measurements of smoke, heat, toxic gases and time to detection were made, enabling assessment of time to incapacitation using Fractional Effective Dose methodology. Also described are hazard analyses for fires in which an active suppression was used. These include fires in two-storey maisonettes with and without domestic sprinklers. Results are presented on the relationship between plume oxygen and CO concentrations, and between CO and HCN yields. The effects of interactions between fuel type and load, ventilation and building enclosures are discussed and their implications for choice of design fires appropriate to different fire scenarios.

When aircraft cabin occupants are exposed to fire effluent, the first hazard encountered is usually smoke, containing particulates and toxic gases, which cause immediate visual obscuration and painful irritation of the eyes and respiratory tract. This may be followed by incapacitation due to pain or asphyxia, if exposure continues. In smouldering or small, confined, in-flight fires, where the yields of organic irritants and acid gases are likely to be high and exposure times long, then the distressing effects of irritants, lung inflammation, and asphyxia induced by carbon monoxide (CO) are likely to be the main hazards. For post-crash fires, which tend to develop rapidly to flashover, the time available for escape is often limited to a few minutes before conditions become lethal due to the effects of toxic smoke and heat, so that survival depends upon a rapid egress. Visual obscuration and smoke irritancy are important during the early stages in that they may reduce the speed and efficiency of escape. People have been shown to be reluctant to enter smoke-logged areas if these are between them and an exit, and movement speeds are greatly reduced at optical densities above OD/m 0.5, and even more when the smoke is irritant. Once cabin lining and seating materials become heavily involved in the area opposite a cabin breach, then the concentrations of toxic gases, especially CO and hydrogen cyanide, can increase rapidly further down the cabin causing rapid incapacitation of any remaining cabin occupants. This is followed or accompanied by extreme heat, so that deaths result from asphyxia and/or heat shock. For in-flight fires, it is recommended that consideration should be given to reducing the hazard from irritants. For post-crash fires, measures aimed at delaying the involvement of cabin contents (such as spray mist systems) should be considered.

A CASE OF a pituicytoma is presented that describes the clinical, pathological, and magnetic resonance imaging features of a rare tumor of the neurohypophysis. A 26-year-old woman presented with a 4-month history of dizziness and visual obscuration. A magnetic resonance image revealed a pitu

The Gopher tortoise (Gopherus polyhemus) and the Indiana Bat (Myotis sodalist) are species found on many military installations. The Indiana bat is endangered throughout its range, and the Gopher tortoise is threatened in its westernmost distributions and at risk everywhere else. On installations where troop readiness training is conducted, an important component of realistic troop readiness training is the generation of obscurant material and the conduct of maneuvers under obscurant cover. Fog oil (FO) has long been deployed for visual obscuration training, and the effects of such obscurants on these species are unknown. As a preliminary step prior to instituting toxicological studies, a laboratory simulation was performed on the capability of FO to penetrate the living space of these species: the tortoise burrow and the hollow-tree location of a bat maternity colony. The FO smoke did not enter the simulated tortoise burrow in significant concentrations, but the smoke concentrations in the simulated tree cavity approached ambient levels under some test conditions. This suggests that tortoise burrows do not need to be studied in-situ, and that the tortoise may be considered protected while in the burrow. Bat maternal colony sites, however, should not be considered protected from smoke entry to any significant degree.

The gopher tortoise (Gopherus polyhemus) and the Indiana bat (Myotis sodalist) are species found on many military installations. The Indiana bat is endangered throughout its range, and the gopher tortoise is threatened in its westernmost distribution and at risk everywhere else. On installations where troop readiness training is conducted, an important component of realistic troop readiness training is the generation of obscurant material and the conduct of maneuvers under obscurant cover. Fog oil has long been deployed for visual obscuration training, and the effect of such obscurants on these species is unknown. As a preliminary step prior to instituting toxicological studies, a laboratory simulation was performed of the capability of the fog oil smoke to penetrate the living space of these species, the tortoise burrow and the hollow-tree location of a bat maternity colony. The fog oil smoke did not enter the simulated tortoise burrow in significant concentrations, but smoke concentrations in the simulated tree cavity approached ambient levels. This suggests that tortoise burrows do not need to be studied in situ, and that tortoises may be considered protected while in the burrow. Bat maternal colony sites, however, should not be considered protected from smoke entry to any significant degree.

Merkel cell carcinoma (MCC) is a rare skin neoplasm. Tang and Toker1 first described MCC in 1978 and since then 19 cases in association with chronic lymphocytic leukaemia (CLL) have been reported.2–5 To the best of our knowledge, involvement of the eyelid by MCC has never been reported in the literature in association with CLL. An 84 year old white man was referred with an 8 week history of a painless lump on his right upper eyelid (Fig 1A). He was complaining of visual obscuration secondary to a mechanical ptosis. Ophthalmic history was unremarkable and specifically there were no previous chalazions or trauma. On examination a firm lesion of the right eyelid measuring 2 × 1 cm with overlying telangiectatic vessels and sparing of the eyelashes was noted (Fig 1A). Further ophthalmic examination was unremarkable. General …

PURPOSE: To describe a patient with bilateral retinitis pigmentosa and visually disabling vitreous opacities, who benefited from vitrectomy in both eyes. METHODS: A 37-year-old man with retinitis pigmentosa and severely constricted visual fields developed a large, dense, vitreous floater and visual obscuration in the right eye. Subsequently, diffuse vitreous opacification and visual obscuration developed in the left eye. RESULTS: Bilateral pars plana vitrectomy relieved the patient's visual obscurations. Electron micrographs of the excised vitreous opacity from the left eye showed collagen fibrils and cellular debris. CONCLUSION: Visually significant vitreous opacities may develop as a complication of retinitis pigmentosa. The visual impact of such opacities may be magnified by its superimposition on limited visual fields. Vitrectomy may be of benefit in such cases.

Dr Poujol began the proceedings by considering the diagnosis of vitreous pathology from point-like echoes arising from haemorrhage, inflammation or degeneration of the gel. He emphasized that differentiation between these pathologies is frequently difficult using ultrasonic criteria alone, but inflammatory vitritis tends to produce diffuse low amplitude echoes while echoes from asteroid degeneration usually have a very high amplitude. In discussion, Dr Coleman had calculated that a coagulum of 60 microns (using a 10 MHz probe) is necessary for ultrasonic detection of haemorrhage, while Dr Ossoinig felt that a chain of low amplitude spikes detected with highly sensitive equipment implies considerable opacification and visual obscuration.