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.

Precipitation chemistry and occurrence of acid rain over Dhanbad, coal city of India

The present study investigated the chemical composition of wet atmospheric precipitation over Dhanbad, coal city of India. The precipitation samples were collected on event basis for three years (July 2003 to October 2005) at Central Mining Research Institute. The precipitation samples were analyzed for pH, conductivity, major anions (F, Cl, NO(3), SO(4)) and cations (Ca, Mg, Na, K, NH(4)). The pH value varied from 4.01 to 6.92 (avg. 5.37) indicating acidic to alkaline nature of rainwater. The pH of the rainwater was found well above the reference pH (5.6), showing alkalinity during the non-monsoon and early phase of monsoon, but during the late phase of monsoon, pH tendency was towards acidity (<5.6 pH) indicating the non-availability of proper neutralizer for acidic ions. The observed acidic events at this site were 91, (n = 162) accounting 56% for the entire monitoring months. The (NO(3) + Cl)/SO(4) ratio in majority of samples was found below 1.0, indicating that the acidity is greatly influenced by SO(4). The calculated ratio of (Ca + NH(4))/(NO(3) + SO(4)) ranges between 0.42-5.13 (average 1.14), however in most of the samples, the ratio is greater than unity (>1.0) indicating that Ca and NH(4) play an important role in neutralization of acidic ions in rainwater. Ca and SO(4) dominate the bulk ionic deposition and these two ions along with NH(4) accounts 63% of the annual ionic deposition.

Investigation and management of adult periorbital and orbital cellulitis

Background: Orbital cellulitis has important complications. Despite this, there are few studies in the literature of large groups of cases of this condition.

Methods: We performed a retrospective case analysis of all patients admitted with periorbital and orbital cellulitis between 2002 and 2004.

Results: A total of 27 cases were included in the study. Of these, 25 had undergone a computed tomography scan, 19 of which had revealed significant sinus disease; 10 had had a microbiology result, with the most common organism being Streptococcus milleri; 20 had had a white cell count taken, with raised results in only 10; 12 had undergone surgery; and 25 had made a good recovery. One case had been found to be squamous cell carcinoma of the nasal cavity.

Conclusions: In this study, sinus disease was the commonest cause of orbital cellulitis, with the commonest organism being Streptococcus milleri. Only 50 per cent of cases with proven disease had had a raised white cell count; this is therefore not a very sensitive test.

Myringoplasty: a comparison of bismuth iodoform paraffin paste gauze pack and tri-adcortyl ointment ear dressing

OBJECTIVES

To assess the myringoplasty graft take rate, comparing two methods of post-operative ear packing: bismuth iodoform paraffin paste (BIPP) gauze versus tri-adcortyl ointment (TAO).

METHODS

A retrospective study of patients who had undergone myringoplasty at our department within a three-year period was undertaken. Data, including age, site and size of perforation, grade of surgeon, surgical approach, use of post-operative ear dressings, complications, and audiometric outcome, were collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at six months) was noted.

RESULTS

One hundred and seventy myringoplasties were performed over the study period, but data were complete on 154 patients and these constituted the study population. Age ranged from nine to 71 years (mean age 34 years) and the mean follow-up period was seven months. Consultants performed 62 per cent of the operations, with an 85 per cent success rate, whereas trainees performed the remaining 38 per cent, with a success rate of 73 per cent (p=0.059). The overall success rate was 80 per cent; 79 per cent for BIPP and 83 per cent for TAO (p=0.55), and 87 per cent for small perforations and 75 per cent for subtotal perforations (p=0.22). There was audiometric improvement in 74 per cent of cases.

CONCLUSION

We found no significant difference in outcome between patients packed with TAO and BIPP. Packing with TAO is therefore a suitable alternative to BIPP gauze ear dressing following myringoplasty.

Nontraumatic Spinal Epidural Hematoma Associated with Clopidogrel

A 73-year-old female treated with clopidogrel for vascular disease presented with sudden onset of back pain, urinary retention and paraplegia. MRI scans demonstrated a thoracolumbar epidural hematoma and the patient underwent emergency laminectomy for evacuation of the hematoma. A possible causal link between clopidogrel and occurrence of the hemorrhage is discussed and the literature on spontaneous spinal hematomas is reviewed.

Synthesis, spectroscopic, thermal and antifungal studies on lanthanum(III) and praseodymium(III) derivatives of 1,1-diacetylferrocenyl hydrazones

A series of new coordination complexes of La(III) and Pr(III) with hydrazones, derived from 1,1-diacetylferrocene and different aromatic acid hydrazides have been synthesized and characterized by elemental analyses, electrical conductance, magnetic moment, IR, (1)H NMR, UV-vis spectra and molar conductance. The thermal behaviour of the complexes under non-isothermal condition was investigated by TG and DTG techniques. The antifungal activity of hydrazones and their corresponding complexes were also investigated.

An unfavourable outcome after periprosthetic fracture following metal-on-metal surface hip arthroplasty

We report a case of a varus malunited periprosthetic femoral neck fracture following metal-on-metal hip resurfacing operation. Failure to closely observe and poor compliance in the young and active group of patients may contribute to such an unfavourable outcome.