Indications for penetrating keratoplasty in India

Indications for penetrating keratoplasty (PK) in the developing world from a large series are not well documented. This study was done to evaluate the indications for PK in a major eye care institution in India. The records for a consecutive series of 1,964 PKs were analysed and multiple logistic regression was used to study the effect of age, socioeconomic status and sex on the indications for PK. The indications for PK were corneal scarring in 551 (28.1%) including adherent leukoma in 147 (7.5%), regrafts in 336 (17.1%), active infectious keratitis in 239 (12.2%), aphakic bullous keratopathy in 231 (11.8%), pseudophakic bullous keratopathy in 209 (10.6%), corneal dystrophies in 165 (8.4%) including Fuchs' dystrophy in 23 (1.2%), keratoconus in 118 (6%), and miscellaneous in 115 (5.9%). The odds that the patient belonged to lower socioeconomic status were significantly higher if the PK was done for active infectious keratitis (odds ratio 2.73, p < 0.0001), corneal scarring (odds ratio 1.72, p = 0.0009) or regraft (odds ratio 1.44, p = 0.047). Corneal scarring, including adherent leukoma, and active infectious keratitis are relatively more common indications whereas keratoconus, pseudophakic bullous keratopathy and Fuchs' dystrophy are less common indications for PK in India than reported from the developed world. Indications for PK which carry a poorer prognosis for graft survival are relatively more common in India than in the developed world.

Automated MR imaging protocols for improved patient throughput

The total time spent on each patient during an MR study determines patient throughput and ultimately influences MR scan charges. Actual data acquisition often represents only a small portion of this examination time. Other functions such as patient loading and unloading, positioning, coil placement, scan setup, and image reconstruction time also contribute to the total examination time. We describe a technique for creating automated imaging protocols for standard MR examinations which optimize these functions, thereby decreasing operator interventions and shortening the overall examination time. A prototype sequence for examining the larynx and neck was developed which allowed three sequential multiple slice acquisitions to be obtained in three orthogonal planes with a single operator setup step. All tuning and scan placement after this first step was done under computer control. The new sequence allowed larynx and neck studies to be performed in less than 30 min for spin echo and under 16 min for field echo instead of the 50-60 min required by previous methods. The new technique should be useful for improving patient throughput for a cariety of standardized examinations including the temporal bone, head and neck, joints, and other regions.

Low 1,25-dihydroxyvitamin D, secondary hyperparathyroidism, and normal osteocalcin in elderly subjects

The relationship among serum vitamin D metabolites, PTH, and osteocalcin concentrations was investigated in 20 elderly subjects. All except 2 had subnormal 25-hydroxyvitamin D concentrations. Eighteen (90%) had subnormal serum 1,25-dihydroxyvitamin D [1,25-(OH)2D] concentrations, while 8 subjects (40%) had elevated PTH concentrations. There was a highly significant inverse relationship between PTH and 1,25-(OH)2D concentrations. Serum osteocalcin concentrations were not elevated in any subject, and in fact, the mean osteocalcin concentration was in the lower part of the normal range. These data indicate no compensatory increase in 1,25-(OH)2D in response to secondary hyperparathyroidism and no increase in osteocalcin in response to hypersecretion of PTH in the elderly. These 2 defects may contribute to the bone disease of the elderly.