Faculty Bibliography

PURPOSE/OBJECTIVE:To examine the characteristics and outcomes of open globe injuries sustained by the urban population compared to the rural population. METHODS:This is a retrospective chart review of 429 patients presenting to University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital with traumatic open globes from July 2005 to July 2013. RESULTS:Rural patients had a longer time which elapsed from injury to presentation (P = 0.023, average 12.04 hours vs 7.53 hours). There was a higher incidence of patient transfer prior to arrival to UPMC Presbyterian Hospital (P = 0.018), patient follow-up elsewhere (P = 0.049), and patients sustaining intraocular foreign bodies (IOFBs) (P = 0.009). CONCLUSIONS:Health care access is a well-known problem in rural areas and using rural-urban commuting area (RUCA) codes can help identify a population for risk factors or potential disparities in care. Rural patients sustained a higher rate of IOFBs; this should heighten the clinicians' suspicion during the evaluation of an open globe in other rural populations.

Chronic cerebrospinal venous insufficiency (CCSVI) has been implicated as a contributing factor to multiple sclerosis (MS). This theory is strongly debated within the neurology and radiology communities. This report presents the case of a 45-year-old man with known MS and suspected CCSVI who had undergone previous internal jugular angioplasty and stenting. The patient reported dramatic improvement of symptoms after intervention. The stent thrombosed despite antithrombotic medication, and several endovascular interventions failed to restore long-term patency. Open venous reconstruction of the internal jugular vein was performed with a spiral graft from the saphenous vein. The patient's symptoms improved for several weeks until the venous reconstruction occluded. This case is the first reported open venous reconstruction for suspected CCSVI.

BACKGROUND:Costal cartilage excision is an effective treatment of slipping rib syndrome (SRS), although the diagnosis of SRS may be elusive. We review our experience with SRS in the pediatric patient. METHODS:This is a retrospective review from 2000 to 2011 of patients presenting with symptoms of SRS before 18 years of age. RESULTS:Seven patients were identified who were diagnosed with SRS and underwent costal cartilage excision. All patients presented with unilateral chest pain that was exacerbated by activity. Five patients reported a popping or clicking sensation with activity that was associated with pain. On physical examination, all patients had reproducible pain with palpation over the affected cartilage. Four patients had a mobile or popping rib with palpation, and 4 also had chest wall asymmetry. Five patients underwent imaging, and 4 patients were referred to specialists. It was a median of 2 years (0-5 years) from onset of symptoms to resection. At resection, all cartilages were grossly abnormal. There were no postoperative complications. Follow-up was complete for all patients over a median 0.9 years (0.2-2.0 years). One patient had recurrence of pain in a different location; another had persistent pain, which was less severe. CONCLUSIONS:Slipping rib syndrome presents with costal cartilage pain that is reproducible on physical examination and commonly associated with a mobile rib. Excision of the affected cartilage(s) is an effective treatment and should be considered early to avoid unnecessary diagnostic tests and evaluation, which delay definitive therapy.

Homolog pairing is indispensable for the proper segregation of chromosomes in meiosis but the mechanism by which homologs uniquely pair with each other is poorly understood. In Drosophila, somatic chromosomes also undergo full homolog pairing by an unknown mechanism. It has been recently demonstrated that both insulator function and somatic long-distance interactions between Polycomb response elements (PREs) are stabilized by the RNAi machinery in Drosophila. This suggests the possibility that long-distance pairing interactions between homologs, either during meiosis or in the soma, may be stabilized by a similar mechanism. To test this hypothesis, we have characterized meiotic and early somatic chromosome pairing of homologous chromosomes in flies that are mutant for various components of the RNAi machinery. Despite the identification of a novel role for the piRNA machinery in meiotic progression and synaptonemal complex (SC) assembly, we have found that the components of the RNAi machinery that mediate long-distance chromosomal interactions are dispensable for homologous chromosome pairing. Thus, there appears to be at least two mechanisms that bring homologous sequences together within the nucleus: those that act between dispersed homologous sequences and those that act to align and pair homologous chromosomes.