Pattern of ocular tumors in the eastern region of Nepal

BACKGROUND

ocular tumors are commonly encountered in ophthalmic practice.

OBJECTIVE

to study the clinical pattern of ocular tumors in the eastern region of Nepal.

MATERIALS AND METHODS

the hospital records of patients with ocular tumors treated at B P Koirala Institute of Health Sciences in the eastern region of Nepal over a period of 5 years (April 2003 - March 2008) were studied retrospectively.

RESULTS

of 115 consecutive patients with ocular tumors, 40 (34.75%) were below the age of 21 years, 41 (35.65%) were in the age group of 21-50 years and 34 (29.56%) of age above 50 years. There were 48 (41.73%) and 67 (58.26%) patients with benign and malignant tumors respectively. The common benign tumors were conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma. Among the malignant tumors, basal cell carcinoma was the commonest (22.38%). Retinoblastoma was the most common ocular malignant tumor in the pediatric age group (88.8%). Basal cell carcinoma was the commonest eyelid malignancy (53.57%).

CONCLUSION

conjunctival papilloma, dermoid cysts, nevus, cystic lesions and hemangioma are common benign ocular tumors, whereas basal cell carcinoma and retinoblastoma are the commonest ocular malignancies in adults and children respectively.

An ICMR task force study of Prevention of Parent to Child Transmission (PPTCT) service delivery in India

A retrospective survey was conducted during August to December 2007 in 19 medical colleges of India to examine the functioning of the PPTCT service delivery. Data was extracted from records of the PPTCT centers for the year 2005-2006. HIV prevalence was higher than 2005 NACO figures in 11 out of 19 (57.8%) centers. There was wide variation in the proportion of women counseled & tested for HIV in different centers. Antenatal prophylaxis was practiced in 7 out of 19 (36.8%) centers. Overall intra-natal ART was provided to 52.8% of HIV positive women. Early newborn testing was available at 3 out of 19 (15.7%) centers. Improved counseling services are required for better case detection.

Asymmetric breast uptake of radioiodine in a patient with thyroid malignancy: metastases or not?

Various physiological processes can cause potentially misleading appearances in radioiodine whole body scans; proper understanding of the causes of these can therefore obviate diagnostic errors. Whole-body radioiodine scintigraphy with I131 or I123 is an accurate form of imaging used for management of differentiated thyroid carcinoma. Following thyroidectomy, any residual thyroid tissue or metastatic disease is ablated with high dose I131 and diagnostic images are acquired, demonstrating residual thyroid tissue and metastatic disease. However, atypical physiological uptake of I131 can simulate metastases.

Imaging appearance of parasitic infestations of the breast: a report of two cases and review of the literature

Parasitic infestations of the breast are uncommon. They may occur as a part of generalized disease, or present as primary breast infestations, making diagnosis difficult. Clinically, they are difficult to differentiate from the more common breast pathologies. However, imaging plays an important role, and different modalities often help distinguish and diagnose these rare conditions.

Clinical examination, MRI and arthroscopy in meniscal and ligamentous knee Injuries - a prospective study

Data from 565 knee arthroscopies performed by two experienced knee surgeons between 2002 and 2005 for degenerative joint disorders, ligament injuries, loose body removals, lateral release of the patellar retinaculum, plica division, and adhesiolysis was prospectively collected. A subset of 109 patients from the above group who sequentially had clinical examination, MRI and arthroscopy for suspected meniscal and ligament injuries were considered for the present study and the data was reviewed. Patients with previous menisectomies, knee ligament repairs or reconstructions and knee arthroscopies were excluded from the study. Patients were categorised into three groups on objective clinical assessment: those who were positive for either meniscal or cruciate ligament injury [group 1]; both meniscal and cruciate ligament injury [group 2] and those with highly suggestive symptoms and with negative clinical signs [group 3]. MRI was requested for confirmation of diagnosis and for additional information in all these patients. Two experienced radiologists reported MRI films. Clinical and MRI findings were compared with Arthroscopy as the gold standard. A thorough clinical examination performed by a skilled examiner more accurately correlated at Arthroscopy. MRI added no information in group 1 patients, valuable information in group 2 and was equivocal in group 3 patients. A negative MRI did not prevent an arthroscopy. In this study, specificity, positive and negative predictive values were more favourable for clinical examination though MRI was more sensitive for meniscal injuries. The use of MRI as a supplemental tool in the management of meniscal and ligament injuries should be highly individualised by an experienced surgeon.

Polymer assisted hydroxyapatite microspheres suitable for biomedical application

Hollow Microspheres of hydroxyapatite-polymer composite can be used as carriers in drug delivery and fillers in tissue engineering. Based on the concept of soft chemistry, a battery of technique is available in the literature to synthesize hollow microspheres, however, an economically viable synthesis route, having good control over the microarchitect and easy to be scaled up, is yet to be developed. Polymer matrix mediated synthesis of inorganic nanoparticles is known to synthesize nanoparticles with controlled morphology and dimensions. It is termed as biomimetic synthesis. Integrating the biomimetic synthesis of nano-particles and spray drying techniques, a novel process of producing hydroxyapatite-polymer composite hollow microspheres is briefly discussed here.

Relief of severe retro-orbital pain and vision improvement after optic-nerve decompression in polyostotic fibrous dysplasia: case report and review of the literature

INTRODUCTION

We describe a case of a 9-year-old girl who developed progressive severe retro-orbital pain and partial visual loss in association with left optic-nerve compression due to polyostotic fibrous dysplasia of the skull.

MATERIALS AND METHODS

Intradural decompression of the optic nerve resulted in immediate and complete resolution of the pain as well as a vast visual improvement.

CONCLUSION

In cases of fibrous dysplasia of the skull with evidence of optic-nerve compression, relief of retro-orbital pain should be an additional consideration when deciding to proceed with surgical management.

Profile of renal diseases in Nepalese children

AIM AND OBJECTIVES

To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal.

MATERIALS AND METHODS

A retrospective chart review of all the patients admitted at the department of pediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis.

RESULTS

A total number of 10,396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and hemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%).

CONCLUSION

A substantial number of children are hospitalised with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal.

A gestation- and postnatal age-based reference chart for assessing renal function in extremely premature infants

OBJECTIVE

A single value of plasma creatinine cannot be used to define renal dysfunction in premature babies, as levels are influenced by gestation and postnatal age. The aim of this study was to create reference ranges for plasma creatinine in cohort of extremely premature infants.

STUDY DESIGN

Retrospective analysis of plasma creatinine levels in the first 8 weeks of life from 161 consecutively admitted premature infants 28 weeks gestation.

RESULT

Babies were divided into three groups according to gestation. Peak (10th, 90th percentiles) creatinine levels were 132 (106,162) in 22 to 24 weeks gestational infants, 127 (89,151) in those from 25 to 26 weeks and 110 (87,134) in those from 27 to 28 weeks (P<0.001). Creatinine at birth was similar across the groups with levels increasing during the first few days. It decreases thereafter before reaching stable levels by 5 weeks of age.

CONCLUSION

Gestation- and age-based reference charts should be used for interpretation of creatinine values in extremely premature babies.

Intrathyroid metastasis presenting as a solitary thyroid nodule: an unusual case of clinically silent lung cancer

Metastases in the thyroid gland are very rare. Carcinoma lung is one of the tumours, which may metastasize to the thyroid. We report a 60-year-old lady with intrathyroid metastasis presenting as a solitary thyroid nodule. Fine needle aspiration cytology from the nodule showed features of metastatic adenocarcinoma. Further detail evaluation revealed primary lung adenocarcinoma with secondaries to adrenals, retroperitoneal and bilateral axillary nodes. This report emphasizes this unusual clinical presentation of carcinoma lung with wide spread secondaries; and a solitary thyroid nodule can be a presenting complain of a metastatic disease.

Quantitative studies of pyrocarbon-coated materials using synchrotron radiation

Phase-contrast imaging provides enhanced image contrast and is important for non-destructive evaluation of structural materials. In this paper, experimental results on in-line phase-contrast imaging using a synchrotron source (ELETTRA, Italy) for objects required in material science applications are discussed. Experiments have been carried out on two types of samples, pyrocarbon-coated zirconia and pyrocarbon-coated alumina microspheres. These have applications in both reactor and industrial fields. The phase-contrast imaging technique is found to be very useful in visualizing and determining the coating thickness of pyrocarbon on zirconia and alumina microspheres. The experiments were carried out at X-ray energies of 16, 18 and 20 keV and different object-to-detector distances. The results describe the contrast values and signal-to-noise ratio for both samples. A comprehensive study was carried out to determine the thickness of the pyrocarbon coating on zirconia and alumina microspheres of diameter 500 microm. The advantages of phase-contrast images are discussed in terms of contrast and resolution, and a comparison is made with absorption images. The results show considerable improvement in contrast with phase-contrast imaging as compared with absorption radiography.

Low velocity traumatic dissection of the internal carotid artery presenting as a stroke after a slash injury

Low velocity traumatic dissection of the carotid artery is an infrequent but serious complication of blunt cranio-cervical injury. A 25-year-old man was hit by a blunt sickle over his chest and left side of his neck, and sustained open wounds over zone II of the neck. At that time, he had no neurological deficits and the wounds were sutured primarily. On the sixth day, while he was undergoing a change of dressing for the wounds, he suddenly became unconscious, and on recovery hours later, he was aphasic. Computed tomography showed a left posterior fronto-temporal ischaemic infarct in the territory of the middle cerebral artery. Colour Doppler ultrasonography showed an intimal tear and thrombus in the left common carotid artery. We discuss the possible mechanism of neurological deficits and also emphasise that in any patient with blunt injury to the neck, new neurological deficits should prompt us to suspect carotid artery injuries.