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Purpose: Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms., Methods: In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features., Results: The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally., Conclusion: Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)

Background: Elevated free fatty acid (FFA) levels are known to impair aortic elastic function. In obesity, FFA levels are elevated and aortic distensibility (AD) reduced in a pattern that predominantly affects the distal aorta. Despite this, the role of FFAs in obesity-related aortic stiffness remains unclear., Methods and Results: Using vascular MRI, we aimed to determine if (1) FFA level correlated with AD in obesity; and (2) whether elevating FFA acutely and subacutely in normal-weight subjects reproduced the distal pattern of AD change in obesity. To do this, regional AD was recorded in 35 normal-weight and 70 obese subjects and then correlated with FFA levels. When compared with normal weight, obesity was associated with reduced AD in a pattern predominantly affecting the distal aorta (ascending aorta by -22%, proximal descending aorta by -25%, and abdominal aorta by -35%; P<0.001). After controlling for age, blood pressure, and body mass index, FFA levels remained negatively correlated with abdominal AD (r=-0.43, P<0.01). In 2 further normal-weight groups, AD was recorded before and after elevation of FFA levels with intralipid infusion (by +535%, n=9) and a 5-day high-fat, low-carbohydrate diet (by +48%, n=14)., Conclusions: Both intralipid infusion and a low-carbohydrate diet resulted in reduced abdominal AD (infusion -22%, diet -28%; both P<0.05), reproducing the distal pattern AD reduction seen in obesity. These findings suggest that elevated FFA impair AD in obesity and provide a potential therapeutic target to improve aortic elastic function in obesity.

We have observed an association between the use of tourniquets for limb surgery and a progressive increase in body temperature in pediatric patients. Consequently, we evaluated the effect of leg tourniquet(s) on intraoperative nasopharyngeal temperature in pediatric patients. We measured central temperature in three groups of children anesthetized with halothane and nitrous oxide: those with unilateral tourniquets (n = 15), those with bilateral tourniquets (n = 8), and a control group not requiring tourniquets (n = 24). Intraoperative ambient temperatures were maintained near 23 degrees C, respiratory gases were actively heated and humidified, and skin was warmed using a circulating water blanket set at 38 degrees C. The control patients remained normothermic during anesthesia and surgery. In contrast, central temperature increased 1.0 +/- 0.6 degrees C in 90 min in those with one tourniquet and 1.7 +/- 0.6 degrees C in those with bilateral tourniquets. The tourniquet-induced hyperthermia appeared to result from decreased effective heat loss from distal skin and from constraint of metabolic heat to the central thermal compartment. These data suggest that pediatric patients requiring intraoperative tourniquets should not be aggressively warmed during surgery.

Serum immunoglobulin levels (IgM, IgG, IgA), complement levels (C3 and C4), and the response of peripheral blood lymphocytes to mitogens [phytohemagglutinin (PHA), concanavalin A (Con-A), and pokeweed mitogen (PWM)] were investigated in healthy patients clinically diagnosed as keloid formers and in nonkeloid volunteers in good health. Serum IgM and serum C3 were significantly higher in keloid patients than in nonkeloid patients both at P less than 0.001, while serum IgA and serum C4 levels were higher in nonkeloid patients than in keloid patients at P less than 0.01 and P less than 0.001, respectively. Serum IgG levels were essentially unchanged in the keloid and the control groups in this study. Mitogenic stimulation was significantly lower in the keloid population in this investigation at P less than 0.001 for both PHA and Con-A. However, major differences were not observed with PWM stimulation in both keloid and control groups.

Progesterone concentrations in amniotic fluid and maternal plasma were determined in 11 midtrimester pregnant patients following the intraamniotic administration of prostaglandin F2alpha. Samples were obtained at 3-hour intervals until abortion or spontaneous rupture of membranes occurred or fetal heart tones disappeared. In amniotic fluid, the mean progesterone concentrations increased throughout the sampling period. The plasma progesterone levels declined by about one-third of basal values in the first 3 hours after prostaglandin administration. The paradoxic increase in amniotic fluid progesterone is probably secondary to alterations in uterine blood flow and intrauterine pressure.

We have presented a classification scheme to help in evaluating the diagnosis of stridor in the pediatric patient. The correct diagnosis can usually be arrived at on the basis of a careful and complete history, physical examination, appropriate radiographic studies and bronchoscopy. The anesthesiologist should be aware of the problems associated with all these conditions. In every instance prompt establishment of an adequate airway is imperative.