Laser in situ keratomileusis for treated myopic anisometropic amblyopia in children

To evaluate the effects of laser in situ keratomileusis [LASIK] in decreasing myopic anisometropia in children with spectacles or contact lens intolerance and its validity in facilitating treatment of resultant myopic anisometropic amblyopia. LASIK was performed in 18 eyes of 18 children having myopic anisometropic amblyopia not successfully treated with the standard amblyopia treatment for 6 months. Children were followed up at 1 week, 1, 2, 6, 12, 18 and 24 months. Postoperative amblyopia therapy was continued with occlusion of the dominant eye for 6 h daily for the first 3 months and then for 4 h per day as long as possible. The mean spherical equivalent refraction in the operated eye had reduced significantly from -9.08 +/- 1.86D preoperatively to -0.97 +/- 1.16D at 2 years postoperatively. The mean spherical equivalent in the non-operated fellow eye was -1.0 +/- 1.15D preoperatively and -2.50 +/- 1.15D at 2 years. The mean spherical equivalent myopic anisometropia was -7.75 +/- 2.25D preoperatively and -0.50 +/- 0.3ID at 2 years, representing a 93.5% reduction in myopic anisometropia. The mean regression value was -2.28 +/- 1.62D, however, 18 eyes [72%] were within 3.OD of the fellow eye. The mean BCVA was significantly improved from 0.72 +/- 0.13 preoperatively to 0.47 +/- 0.17 by 2 years after LASIK with amblyopia treatment. LASIK is a safe and effective alternative method for correcting myopic anisometropic amblyopia, especially in children with spectacles or contact lens intolerance, with more better visual acuity and binocular vision

Determinants of in-hospital cardiac catheterization in acute coronary syndrome patients in Kuwait

Clinical trials and practice guidelines have established the efficacy of early invasive strategy for high risk acute coronary syndrome [ACS] patients. This analysis was undertaken to detect the predictors of in-hospital cardiac catheterization [prior to hospital discharge] in patients with ACS in Kuwait and to assess if this use of early catheterization was according to published guidelines. We analyzed data from a prospective registry of 2054 consecutive patients admitted to all 7 general hospitals in Kuwait with the diagnosis of ACS over a period of 6 months in 2004. Citizens were more likely to receive in-hospital catheterization than expatriates [52.1% vs 38.6%; odds ratio 1.7; 95% confidence interval [CI], 1.4 to 2.2; p<0.001]. Patients with recurrent ischemia were more likely to undergo in-hospital catheterization than patients without recurrent ischemia [55.9% vs 12.2%; odds ratio 11.2; 95% CI, 8.6 to 14.5; p<0.001]. two coronary artery disease risk factors [hyperlipidemia and positive history] were associated with high rate of in-hospital cardiac catheterization [respectively, odds ratio 1.3; 95% CI, 1.2 to 2; p<0.001 and odds ratio 1.5; 95% CI, 1.3 to 2.3; p<0.001]. Although high risk patients benefit the most from an early invasive strategy after ACS, this strategy was persrvered for those with recurrent ischemia and citizens. Other risk factors were not determinants of in-hospital cardiac catheterization. Thus, there is substantial opportunity to improve the use of this effective therapy in high risk patients

Effect alpha globlin gene deletion and gamma globin gene -158 [C/T] polymorphism in beta-thalassemic patients

The beta-thalassemias [beta- thalassemias] are among the most common autosomal recessive disorders. They have a remarkably high frequency in the Mediterranean region and represent one of the most common genetic diseases in Egypt. In this study, the spectrum of beta-thalassemia mutations and genotype-to-phenotype correlations were defined in 32 beta- thalassemic patients [beta- thlassemias major and intermedia] with varying disease severity in two cities of the Suez Canal region. Ten different mutations were identified and the most frequent ones were: IVSI-6 [T-C] [37.5%], IVSI-110 [G-A] [34.4%] and both IVSI-1 [G-A], IVSII-745 [C-G] and -102 [C-G] [12.5% each]. There was a wide spectrum of phenotypic severity in all patients. We studied the Xmnl polymorphism [C/T] in gamma- globin gene position -158 of beta- thalassemia as a modulating factor of the disease severity. Presence of the polymorphism was found in two patients and this was not sufficient to explain the diversity of the phenotype encountered. Co-inheritance of alpha thalassaemia as a modulating factor was not evident in our patients. In conclusion, we have been unable to find a molecular basis for the benign clinical course in all our patients. Other genetic or acquired factors must be hypothesized which ameliorate the clinical condition

The lungs in tuberous sclerosis complex: a case report / Los pulmones en el complejo de esclerosis tuberosa: reporte de un caso

Tuberous sclerosis complex manifests predominantly as a neurocutaneous disorder Lung involvement was considered rare. Lymphangioleiomyomatosis which occurs mainly in women of childbearing age is the major pulmonary disorder seen in tuberous sclerosis. Multifocal micronodular pneumocyte hyperplasia has also been described in tuberous sclerosis. The case of a 51-year old female diagnosed with tuberous sclerosis is described after she presented with progressive shortness of breath and was found to have interstitial lung disease. Tuberous sclerosis should be considered as a differential in patients with interstitial lung disease especially in association with cutaneous lesions.

El complejo de esclerosis tuberosa se manifiesta predominantemente como un desorden neurocutáneo. El compromiso pulmonar era considerado raro. La linfangioleiomiomatosis que se presenta principalmente en mujeres en estado de gestación, es el principal trastorno observado en la esclerosis tuberosa. La hiperplasia micronodular pneumocítica ha sido también descrita en la esclerosis tuberosa. Se describe el caso de una mujer de 51 años a quien se le diagnosticó esclerosis tuberosa, luego de que se presentara con disnea y se hallara que padecía la enfermedad intersticial del pulmón. La esclerosis tuberosa deber ser considerada como un diagnóstico diferencial en pacientes con la enfermedad intersticial del pulmón, especialmente cuando se encuentra asociada con lesiones cutáneas.

Differentiating amoebic ulcero-haemorrhagic recto-colitis from idiopathic inflammatory bowel disease: still a diagnostic dilemma / Diferenciar la Rectocolitis Úlcero-hemorrágica Amebiana de la Enfermedad Inflamatoria Idiopática del Intestino: un Dilema Diagnóstico sin Resolver

The colon responds monomorphically to a variety of insults thus making it difficult to differentiate invasive amoebic colitis and inflammatory bowel disease (IBD). The authors present a case with chronic dysentery, haematochezia, anaemia and hypoproteinaemia. The endoscopic findings were suggestive of IBD. The stool examination was negative for trophozoites or cysts of parasites. The recto-colonic biopsy specimens showed mucosal inflammation with exudates containing amoebic trophozoites. The patient was successfully treated with metronidazole and iodoquinol. He recovered within two weeks and repeat colonoscopy four weeks after the treatment showed a normal rectum and colon. Clinicians should have a high level of suspicion for amoebic colitis in cases of colitis especially in regions where amoebiasis is still present. Efforts should be made to find the amoebic trophozoites in multiple stool and colonic biopsy specimens

El colon responde de manera monomórfica a una variedad de insultos, lo cual hace difícil distinguir entre la colitis amebiana invasiva y la enfermedad intestinal inflamatoria (EII). Los autores presentan un caso con disentería crónica, hematoquexia, anemia e hipoproteinemia. Los resultados endoscópicos apuntaban a una EII. El análisis de las heces fecales arrojó resultados negativos en cuanto a presencia de trofozoitos o quistes de parásitos. Esto condujo a un diagnóstico erróneo y el paciente fue tratado por una EII. Sin embargo, los especímenes de la biopsia rectocolónica mostraron una inflamación mucosal con exudados en los que se hallaban presentes trofozoitos amebianos. El paciente tuvo un tratamiento exitoso con metronidazol y iodoquinol. Se recuperó en dos semanas, y se le repitió la colonoscopia cuatro semanas después de que el tratamiento mostró un recto y colon normales. Los clínicos debían mostrar un alto nivel de sospecha ante la colitis amebiana, especialmente en aquellas regiones donde la amebiasis todavía está presente. Deben hacerse esfuerzos por encontrar trofozoitos amebianos en múltiples especímenes de heces fecales y biopsia colónica.

Minimally invasive plate osteosynthesis for comminuted femoral fractures

This prospective study presented 27 male patients with unilateral closed comminuted femoral fractures treated by the minimally invasive plate osteosynthesis technique. They were 6 subtrochanteric, 3 diaphyseal and 18 distal fractures. Indirect reduction was done without exposure of the comminuted fragments. Two separate incisions were used for sub-muscular insertion of the plate. DHS was used in 7 cases, broad DCP in 2 cases and condylar buttress plate in the 18 distal fractures. The mean follow-up interval was 18 months [range 9-28 months]. All fractures united [100%] without bone grafting alter a mean interval of 4.3 months [range 3-5 months]. No cases of nonunion or infection were reported. According to Neer's scale, the results were excellent and satisfactory in 24 cases [88.9%] and unsatisfactory in 3 patients [11.1%] with no failures. Few complications occurred in the form of 1 cm shortening in two cases and 10 degrees valgus in two cases. The minimally invasive plate osteosynthesis technique proved to be useful for treatment of comminuted femoral fractures, especially those in which the interlocking nail can not be used. It is technically not difficult, has a high rate of success and low incidence of complications

Two staged reconstruction of flexor tendons of the fingers using ipsilateral pedicled flexor digitorum superficialis tendon graft

Twenty-three patients with flexor tendon injuries were operated upon for flexor tendon reconstruction using a staged technique of Hunter rode replacement, followed by pedicled flexor digitorum superficialis graft. The indication for this technique was excessive scarring of the tendon bed. There were 16 men and 7 women ranging in age from 16 to 48 years. Four patients had 4 fingers involved, 2 patients had 3 and 6 patients had 2 fingers involved, while the rest 11 patients had one finger involved. The number of involved fingers were 45 fingers. The postoperative follow up period ranged from 1 to 3 years. The measurements of active range of motion of the involved finger were taken in the closed fist position. Twenty seven fingers in this series were rated as excellent, 15 as good, 3 as fair and no finger as poor. Two stage flexor tendon reconstruction using this technique proved to be a safe and effective technique with minimal complications

Intracapsular femoral neck fracture in young adults, the unsolved fracture: results of fixation by cannulated cancellous screws

Sixteen young adult patients [13 males and 3 females; their ages ranged between 20 and 52 years with an average of 36.1 years] with unilateral intracapsular femoral neck fractures were treated and followed-up after cannulated cancellous screw fixation. The preoperative Garden stage was 4 in 10 cases, 3 in 5 and 2 in one case. Fixation was performed within 48 hours after injury in 12 patients and was delayed more than 48 hours in the remaining 4 cases. After an average follow-up interval of 3.7 years [range between 1 and 10 years], 14 cases [87.5%] united in a good position. According to D'Aubigne and Postel scale, the hip score was excellent in 4 patients [25%], good in 7 [43.75%], fair in one [6.25%] and poor in 4 cases [25%]. Two cases [12.5%] of avascular necrosis of the femoral head [AVNFH] were treated by hemiarthroplasty and 2 cases [12.5%] of nonunion were treated by valgus osteotomy and healed within 8 months after osteotomy. Intracapsular hip fracture in young age is still considered the unsolved fracture due to the debilitating complications of AVNFH and nonunion in such young active individuals. However, early fixation by cannulated cancellous screws was found to be an effective and technically simple method with comparatively fewer complications

Thyrotoxic hypokalaemic paralysis in a pregnant Afro-Caribbean woman. A case report and review of the literature

This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis

Post-hepatectomy glucose tolerance curve in a rat model

Background: The liver is the main site where most of glucose metabolic processes take place. It is suspected that partial hepatectomy will alter the glucose homeostasis, so it is mandatory to study the effect of partial hepatectomy on the glucose metabolism. Introduction: the liver exerts multiple complex metabolic functions. Partial hepatectomy, reduces the functioning liver cell mass. The body responds to surgery both locally and generally. The general one includes endocrinal and metabolic response

Aim of the Work: To determine the effect of partial hepatectomy on the glucose metabolism, by performing Glucose tolerance curve

Materials and Methods: 32 rats were included in this work, divided into 4 groups, 8 rats per each [5 were subjected to actual resection and 3 were subjected to sham operation]. First group: glucose tolerance curve [GTC] was done 24 hours after hepatectomy, 2[nd] group the GTC was done 48 hours after hepatectomy, 3[rd] group the GTC was done 72 hours after hepatectomy, and 4[th] group the GTC was done 96 hours after hepatectomy. Two blood samples were taken, pre-operative and post-operative, for determination of blood sugar and liver enzymes. For determination of the GTC, blood glucose was determined 4 times: at [0] time fasting sample, then [1/2 an hour] after an oral glucose meal then at [1 1/2 hours] and at [2 1/2 hours]

Results: There was weight loss in the post-operative period in various groups, that was minimal [8 grams] in the 1[st] group, and maximal [13 grams] in the 4[th] group. The resected segments varied from 30% to 60% of the whole liver mass. The mean liver weight was 3.67% of the whole body weight. In the P.O. period there was elevation of the ALT and AST, which was greater in the 1[st] group and least in the 4[th] group. There was low grade hyperglycemia, and the blood glucose level failed to return to baseline, 2 1/2 hours after the oral meal, in all groups. There were slight changes in the level of the B. sugar between various groups and between the individuals of each group, but not to the significant level

Conclusion: There was postoperative glucose intolerance manifested by low grade hyperglycemia in the early postoperative period with mild diabetic curve despite the reduced functional liver cell mass

Pre-operative endosonographic assessment of pancreatic lesions

Background: Pancreas is a deeply seated organ and difficult to investigate. Many studies have appeared comparing Endoscopic Ultrasonography [EUS] with various other pancreatic imaging techniques, and proved that [EUS] has emerged as the most accurate single test for imaging pancreatic disease

Introduction: Many investigators proved that EUS was superior to other investigation modalities, and could be used both as conventional and interventional modality. EUS is capable of evaluating and integrating: mucosal, vascular, ductal and parenchymal abnormalities caused by disease. To obtain information about these 4 types of abnormalities; 4 separate tests are often required: endoscopy for mucosa, venogram or arteriogram for veins and arteries. ERCP for ducts: and CT scan or standard US for parenchyma and lymph nodes

Aim of the Work: To evaluate the value of EUS in pre-operative assessment of pancreatic lesions

Patients and Methods: Thirty patients were included in this study, all of them were diagnostically problematic. All had symptoms related to pancreato-biliary disease, but had either no diagnosis after conventional studies, or probable malignancy with uncertain tumor stage or resection status. All of them were subjected to EUS examination in addition to full clinical examination, laboratory investigations and other imaging modalities [U/S, spiral CT and ERCP]. The imaging findings were compared with both operative and histopathological findings for tumor status and vascular involvement

Results: male to female ratio was 3:2, with high frequency in the age group of 65- years. In diagnosis of pancreatic cancer EUS was able to detect mass that coincide with operative findings and histopathology in 80% of the cases, as compared with US [28 %] and CT [48 %]. In pancreatic cysts, EUS was as sensitive as both US and CT., while in chronic pancreatitis, EUS was more sensitive [100%] than both CT [66%] and US [0%]. EUS was superior to spiral CT in diagnosis of vascular invasion [8 versus 4 respectively], while CT was superior in detecting lymph node involvement [4 versus 8 respectively]

Conclusion: EUS is a good partially invasive modality, more sensitive than other imaging modalities in diagnosis of pancreatic lesions particularly those less than 3 cm in diameter. It can detect chronic pancreatitis in patients where other tests have not shown diagnostic findings. It can predict the unresectable cases and then preclude unnecessary exploration, and so prevent the morbidity and the cost of an unnecessary surgical procedure

ilioinguinal approach for surgical treatment of acetabular fractures

Between 1998 and 2002, 20 patients [16 males and 4 females, with an average age at time of surgery 44.1 years] with unilateral displaced acetabular fractures were treated surgically through the ilioinguinal approach and followed-up for an average time of 27.3 months [range 13-38 months]. The fracture types were ten anterior column, six associated both columns and two anterior fracture with posterior lip fracture. According to D'Aubigne and Postel scale, excellent and good clinical results were obtained in 13 patients, fair in 5 and poor in 2. The reduction was anatomical in 6 cases, satisfactory in 10 and unsatisfactory in 4 cases. The final radiographic results were considered excellent and good in 13 patients, fair in 6 and poor in 2 according to Matta's grading system. Complications were few, only two cases of superficial wound infection and one patient with permanent lateral cutaneous nerve of thigh injury. There were no reported cases of ectopic ossification in this series

Arthroscopic release of the diabetic persistent frozen shoulder

Sixteen diabetic patients who developed frozen shoulder which failed to respond to conservative treatment were subjected to arthroscopic shoulder release between January 2000 and March 2001. They had persistent pain, stiffness and limited function. They were followed up for an average period of 22 months, ranging between 19 and 24 months and evaluated according to the modified score of UCLAwith an average improvement of 16.25 points; 3 patients scored excellent [18.75%], 12 good [75%] and 1 fair [6.25%] result. In addition, the patients were assessed preoperatively and postoperatively for forward flexion, external rotation, abduction and internal rotation. The study revealed a good measurable increase in the range of motion in all planes. The study also considered arthroscopic release of the diabetic persistent frozen shoulder to be an effective method of treatment

Management of stage 3 Kienbock's disease by scapho-trapezio-trapezoid fusion [STT Fusion]

In this study, 34 patients having unilateral stage 3 Kienbock's disease were followed up after scapho-trapezio arthrodesis [STT fusion] between 1997 and 2002 [24 females and 10 males with an average age at the time of surgery of 23.2 years]. The follow up ranged between 12 and 52 months with an average of 38.7 months. In conclusion, in spite of the decreased postoperative range of motion, STT fusion is effective in reducing the pain and improving the grip strength in cases of Kienbock's disease. STT fusion improves and prevents the collapse of the carpus in stage 3 Kienbock's disease. The decreased postoperative range of motion [ROM] could be improved by adding radial styloidectomy to STT fusion to decrease radioscaphoid impingement. The adjustment of scaphoid orientation intra-operatively is a technical defect which should be taken in consideration to have a better outcome from STT fusion

Simple effective regional technique for eye surgery

The study included 50 elderly cooperative unpremedicated patients undergoing peribulbar block for elective cataract extraction and intraocular lens implantation [ASA physical status I, II or 111]. The patients were assigned to one of the two groups according to the technique of peribulbar block used [n=25 per group] by random selection. Group I received local anesthetic mixture through a single transconjunctival infrotemporal approach. Group II received the block through a single transconjunctival medial approach. The injected anesthetic mixture was composed of equal volumes [5 ml each] of plain lignocaine 2% and plain bupivacaine 0.75% supplemented by 15 U/m1 hyaluronidase and 0.05 ml of 8.4% sodium bicarbonate that makes pH of the mixture around 6.5. Up to 10 ml of this solution was injected initially. This study assessed the injective volume [initial, supplementary and total volume used]. Motor block scoring system was done after initial and supplementary injections. Eye tension was reported after initial and supplementary injections and the overall quality assessment of the block by the surgeon, as well as patient satisfaction, together with any complication were reported. On conclusion, the ideal local anesthetic mixture for peribulbar block is that made from equal volumes of lignocaine and bupivacaine supplemented with 15 U/ml hyaluronidase and 0 05 ml of 8.4% sodium bicarbonate. The medial transconjunctival approach is easy to be performing by non-ophthalmologist, more comfortable to the patient and with minor complications

Polyangiitis epididymo-orchitis secondary to hepatitis C

This is a case report a of hepatitis C-positive 43-year-old male who presented with small vessel involvement resulting in infarction of the testis, kidney and fingers in addition to multiple and painful aneurysms of arteries. The diagnosis, features and management of the patient are discussed briefly

Isolated post-traumatic rotary sub-luxation of the scaphoid: Management by triscaphoid arthrodesis

Eight patients with unilateral chronic wrist pain were operated upon by triscaphoid arthrodesis [scaphoid fused to both trapezium and trapezoid]. All the patients had a history of trauma and clinically had a positive scaphoid shift test. Radiologically all the patients were proved to have static [type 2] rotary subluxation of the scaphoid. The average postoperative follow up period was three years and two months. Evaluation of the results showed that in spite of postoperative decreased range of motion of the wrist, a significant improvement of pain and function was observed

Retrospective review of dot enzyme immunoassay test for typhoid fever in an endemic area.

Typhoid fever remains a common problem in Malaysia, but for its diagnosis both blood culture and the Widal test have drawbacks. A dot enzyme immunoassay (EIA) has been developed which detects IgM and IgG antibodies to a specific 50 kDa outer membrane protein on Salmonella typhi. This study was performed among outpatients attending the university hospital in Kelantan, a state on the east coast of Peninsular Malaysia where typhoid is endemic. The dot EIA was done on 149 outpatients of all ages in whom typhoid was suspected. Of these, 60 were not analysable due to insufficient data. The other 89 were retrospectively classed as typhoid (total = 21), or not typhoid (total = 68). The criteria for diagnosis of typhoid was either, blood culture was positive, or with blood culture negative, temperature was at least 38 degrees C and Widal O and/or H titer greater than or equal to 1/160. We then compared the diagnosis with the EIA result. For the result where either IgM or IgG was positive, sensitivity was 90%, specificity 91% and negative predictive value 97%. For IgM positive, specificity was 100%. But the specificity of IgG positive alone was reduced by six false positives, which were probably due to persistence of IgG after acute infection. Other cases were found where IgG positive alone appeared in the first week of typhoid fever, probably due to rapid response in a second or subsequent infection. We also found that IgM-producing patients were significantly younger than those showing IgG alone positive.

Thyroid function in patients with chronic renal failure

Ninety-four patients with chronic renal failure were categorized into three groups: twelve conservatively-treated patients, nineteen patients treated by peritoneal dialysis, and sixty-three patients treated by haemodialysis [HD]. Thirty-eight healthy subjects were used as controls. All patient groups studied showed a reduction in serum total thyroxine [T4] and serum total triiodothyronine [T3] with normal serum thyroid stimulating hormone [TSH]. All conservatively-treated patients [group 1] exhibited significant reduction [P<0.01] in serum T4 and T3 values when compared with the control group. Fifty-three% of patients treated by peritoneal dialysis [group II] displayed a significant reduction [P<0.05] in serum T4 in comparison with the control group, an eighty-four% of Them had lower serum T3 values [P<0.01]. Eighty-nine% of patients nested by haemodialysis [group Ill] Showed a reduction in total T4, while sixty% of patients remained with low serum T4 post-dialysis [P<0.05]. Seventy nine% of group Ill demonstrate low serum T3 values predialysis, and fifty-two patient of them had reduced serum T3 after dialysis [P<0.05]. A different of low serum T4 and T3 syndrome in the three groups studied may be suggested. The mean serum TSR value could not be taken as a parameter to depend upon due to individual variations