Bilateral Diffuse Uveal Melanocytic Proliferation: Molecular Genetic Analysis of a Case and Review of the Literature

PURPOSE OF THE STUDY

To describe the clinicopathological features, mutational and chromosomal copy number analysis, and 8-year follow-up of a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with clear-cell carcinoma of the endometrium.

METHODS

Histological evaluation, multiplex ligation-dependent probe amplification (MLPA) analysis and GNAQ/11 mutational analysis were performed in a 67-year-old female patient with the diagnosis of BDUMP.

RESULTS

Histological evaluation revealed proliferation of bland spindle cells, diffusely replacing the uveal tract, which showed a proliferation index of less than 1%. There was absence of mutations involving the codon 209 and 183 of GNAQ, and of GNA11. MLPA analysis showed disomy 3 with polysomy 8q for both eyes. The patient died 8 years later of an unrelated condition.

CONCLUSIONS

Although BDUMP is considered to be a benign proliferative disease, copy number alterations of unknown significance may occur in these lesions.

Combined endothelial keratoplasty and clear lens extraction for corneal decompensation in irido-corneal endothelial syndrome

A 38-year-old woman presented with corneal decompensation in left eye secondary to irido-corneal endothelial (ICE) syndrome. She underwent simultaneous Descemet's stripping endothelial keratoplasty (DSEK) and clear lens extraction with posterior chamber intraocular lens implantation. The surgery was accomplished comfortably without rupture of peripheral anterior synechiae (PAS). 5 weeks postoperatively, the graft was attached, the cornea was clear and best-corrected visual acuity improved from 20/400 to 20/30. DSEK combined with clear lens extraction appears to be an effective measure to treat corneal decompensation in patients with ICE syndrome. Associated lens extraction in such cases increases the working space in anterior chamber for DSEK, which minimizes the intra-operative graft manipulation. This also avoids a future difficult cataract surgery in the presence of PAS and an endothelial graft, which may increase the chances of graft survival.

Challenges in pediatric endothelial keratoplasty

We performed endothelial keratoplasty (EK) in three eyes of two siblings (2.5 years, male and 3.5 years, female) with congenital hereditary endothelial dystrophy (CHED) and report the intraoperative and postoperative difficulties. Repeated iris prolapse, apprehension of crystalline lens touch due to positive vitreous pressure, and need for frequent air injections to attach the graft were intraoperative challenges in all three eyes. These were addressed by use of Sheet's glide instead of Busin's glide during graft insertion and suturing of main and side ports before air injection. One eye had graft dislocation on second postoperative day due to eye rubbing by the child. Graft was repositioned with air and a venting incision was created. Postoperative examination required repeated general anesthesia. Corneal edema resolved completely in all three eyes. Present case series highlights the possible intraoperative and postoperative challenges and their solutions in pediatric EK for CHED.

Retinochoroidal toxoplasmosis in a patient with cerebral post-transplant lymphoproliferative disease of Hodgkin's type: a diagnostic challenge

Toxoplasmosis is a relatively rare complication in renal transplant patients and can pose diagnostic challenges, especially when it manifests as an ocular inflammation. Authors hereby report an unusual case of a 57-year-old male who developed retinochoroidal toxoplasmosis after 15 years of renal transplant, the diagnoses of which were challenging as the patient was also a known case of cerebral post-transplant lymphoproliferative disease (PTLD) of Hodgkin’s type, which misled the ophthalmologists towards a clinical diagnosis of ocular PTLD. Histopathology examination of the enucleated eye revealed numerous toxoplasmosis cysts within the retina and choroid. No ocular PTLD was observed.

Effect of caudal fin flexibility on the propulsive efficiency of a fish-like swimmer

A computational model is used to examine the effect of caudal fin flexibility on the propulsive efficiency of a self-propelled swimmer. The computational model couples a penalization method based Navier-Stokes solver with a simple model of flow induced deformation and self-propelled motion at an intermediate Reynolds number of about 1000. The results indicate that a significant increase in efficiency is possible by careful choice of caudal fin rigidity. The flow-physics underlying this observation is explained through the use of a simple hydrodynamic force model and guidelines for bioinspired designs of flexible fin propulsors are proposed.

Incidental central tear in Descemet membrane endothelial complex during Descemet membrane endothelial keratoplasty

Descemet membrane endothelial keratoplasty (DMEK) was performed in a 70-year-old man diagnosed with pseudophakic bullous keratopathy. During Descemet endothelial complex (DEC) preparation, a central tear was noticed in the DMEK graft. However, the surgery was continued. On sixth postoperative day, a small fluid pocket was observed between the DEC and the posterior host stroma in inferior third of the graft area. It was, however, decided to observe it for spontaneous attachment. At 2 weeks, the inferior DEC detachment had increased with overlying corneal oedema. Descemetopexy with 100% air was performed the same day which reattached the DEC. Subsequently, DEC remained attached and at the last follow-up of 2 months, DEC was well opposed with a clear overlying cornea. The final best-corrected Snellen's visual acuity was 20/60. A small tear in the DEC does not necessitate tissue replacement and a good anatomical and visual outcome can be achieved in such cases.

Dermolipoma of the lower eyelid

PURPOSE

To report a rare case of isolated dermolipoma of the lower eyelid.

DESIGN

Case report.

RESULTS

A young otherwise healthy girl presenting with a slowly progressive, painless lesion of the left lower eyelid of about 3 years' duration had undergone conservative management elsewhere for symptoms of intermittent, mild irritation associated with the mass without any significant benefit. Increase in the size of the lesion in the recent past had been noted. Mass excision with histopathology showed it to be consistent with a dermolipoma.

CONCLUSIONS

An eyelid dermolipoma is distinctly uncommon in occurrence. Nonetheless, it should be considered in the differential diagnosis of benign mass lesions of the eyelid.

Mail versus telephone administration of the Oxford Knee and Hip Scores

Telephone and postal methods of administration of the Oxford Knee Score (OKS) and the Oxford Hip Score (OHS) were compared on 85 and 61 patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA), respectively. The test for equivalence was significant for both the knee (P<0.001) and hip participants (P<0.001) indicating that the modes of administration yielded similar results. The ICCs of the OKS and OHS were 0.79 (95% Confidence Interval (CI) 0.70, 0.86) and 0.87 (0.79, 0.92) respectively. The 95% limits of agreement were wide for both scores (OKS LOA, -8.6, 8.2; OHS LOA, -7.7, 5.3). The two modes of administration of the OKS and OHS produce equivalent survey responses at a group level but the same method of administration should be constant for individual monitoring in a clinical setting.

Drug utilisation study in a tertiary care center: recommendations for improving hospital drug dispensing policies

Drug therapy accounts for a major portion of health expenditure. A useful strategy for achieving cost efficient healthcare is drug utilisation research as it forms the basis for making amendments in drug policies and helps in rational drug use. The present observational study was conducted to generate data on drug utilization in inpatients of our tertiary care hospital to identify potential targets for improving drug prescribing patterns. Data was collected retrospectively from randomly selected 231 medical records of patients admitted in various wards of the hospital. WHO Anatomical Therapeutic Chemical/Defined Daily Dose methodology was used to assess drug utilisation data and drug prescriptions were analysed by WHO core drug indicators. Antibiotics were prescribed most frequently and also accounted for majority of drug costs. The prescribed daily dose for most of the antibiotics corresponded to defined daily dose reflecting adherence to international recommendations. Brand name prescribing and polypharmacy was very common.78% of the total drugs prescribed were from the National List of Essential Medicines 2003. Restricting the use of newer and costlier antibiotics, branded drugs and number of drugs per prescription could be considered as targets to cut down the cost of drug therapysignificantly.

Tufted angioma (Angioblastoma) of eyelid in adults-report of two cases

Abstract

Tufted angioma, first recognized in Japanese literature as “Angioblastoma of Nagakawa”, is a rare benign vascular tumour with a variable clinical presentation. It commonly manifests as a macule, papule or nodule in infancy or childhood in the region of the upper trunk and neck. Here in we report two cases of this rare progressive angioma as lesions of the eyelid in adults. Tufted angioma has a classical “cannon ball” like appearance of vascular tufts on histopathology. Immunohistochemical staining with actin highlights the spindly stromal cells surrounding the capillaries. Complete physical examination and haematological work up is recommended in patients with tufted angioma to exclude rare association of port wine stain and Kasabach-Merritt syndrome with this rare entity. To the best of our knowledge, our cases illustrate the first case report of tufted angioma presenting as an eyelid lesion.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1230909536950947.

A comparative study of the hovering efficiency of flapping and revolving wings

Direct numerical simulations are used to explore the hovering performance and efficiency for hawkmoth-inspired flapping and revolving wings at Reynolds (Re) numbers varying from 50 to 4800. This range covers the gamut from small (fruit fly size) to large (hawkmoth size) flying insects and is also relevant to the design of micro- and nano-aerial vehicles. The flapping wing configuration chosen here corresponds to a hovering hawkmoth and the model is derived from high-speed videogrammetry of this insect. The revolving wing configuration also employs the wings of the hawkmoth but these are arranged in a dual-blade configuration typical of helicopters. Flow for both of these configurations is simulated over the range of Reynolds numbers of interest and the aerodynamic performance of the two compared. The comparison of these two seemingly different configurations raises issues regarding the appropriateness of various performance metrics and even characteristic scales; these are also addressed in the current study. Finally, the difference in the performance between the two is correlated with the flow physics of the two configurations. The study indicates that viscous forces dominate the aerodynamic power expenditure of the revolving wing to a degree not observed for the flapping wing. Consequently, the lift-to-power metric of the revolving wing declines rapidly with decreasing Reynolds numbers resulting in a hovering performance that is at least a factor of 2 lower than the flapping wing at Reynolds numbers less than about 100.

Dual infection by streptococcus and atypical mycobacteria following Ahmed glaucoma valve surgery

PURPOSE

To report a case of late postoperative endophthalmitis caused by Streptococcus pneumoniae and conjunctival necrosis by Streptococcus pneumoniae and Mycobacterium fortuitum following Ahmed glaucoma valve (AGV) surgery in a young patient.

METHODS

Case report of a 13-year-old boy with purulent exudates and extensive conjunctival necrosis two months following amniotic membrane graft and conjunctival closure (for conjunctival retraction post AGV for secondary glaucoma).

RESULTS

The conjunctiva showed extensive necrosis causing exposure of the tube and plate associated with frank exudates in the area adjoining the plate and anterior chamber mandating explantation of the plate along with intravitreal antibiotics. The vitreous aspirate grew Streptococcus pneumoniae while Streptococcus pneumoniae with Mycobacterium fortuitum was isolated from the explanted plate. Despite adequate control of infection following surgery, the final visual outcome was poor owing to disc pallor.

CONCLUSION

Conjunctival necrosis and retraction post-AGV can cause late postoperative co-infections by fulminant and slow-growing organisms. A close follow-up is therefore essential in these cases to prevent sight-threatening complications.

Phonons and colossal thermal expansion behavior of Ag3Co(CN)6 and Ag3Fe(CN)6

Recently colossal volume thermal expansion has been observed in the framework compounds Ag(3)Co(CN)(6) and Ag(3)Fe(CN)(6). We have measured phonon spectra using neutron time-of-flight spectroscopy as a function of temperature and pressure. Ab initio calculations were carried out for the sake of analysis and interpretation. Bonding is found to be very similar in the two compounds. At ambient pressure, modes in the intermediate frequency part of the vibrational spectra in the Co compound are shifted slightly to higher energies as compared to the Fe compound. The temperature dependence of the phonon spectra gives evidence for a large explicit anharmonic contribution to the total anharmonicity for low-energy modes below 5 meV. We have found that modes are mainly affected by the change in size of the unit cell, which in turn changes the bond lengths and vibrational frequencies. Thermal expansion has been calculated via the volume dependence of phonon spectra. Our analysis indicates that Ag phonon modes within the energy range 2-5 meV are strongly anharmonic and major contributors to thermal expansion in both systems. The application of pressure hardens the low-energy part of the phonon spectra involving Ag vibrations and confirms the highly anharmonic nature of these modes.