Comparison of biometry formulas and their relationship with axial lengths

The purpose of cataract surgery is mostly to render patient emmetropic. There are many variables involved while achieving this, one of which is correct biometry. Regardless of the procedure involved in biometry, the formulas used also effect the spherical power of the eye post-operatively. Four major biometry formulas [SRK/T, SRK-2, Holladay, and Hoffer-Q] were chosen and were subjected to comparison with each other and their correlation to axial length of the patient's eye noted. Total of 34 patients were chosen, who met the inclusion criteria, and their biometry was done using the respective formula. These patients were followed up for three post-op visits for over a period of 1-1.5 month postoperatively and their spherical errors noted by auto refractometry. This error was later confirmed by subjective refraction. All these patients were operated by a single surgeon with same technique of surgery in all of them i.e. phaco-emulsification. Results showed a statistically significant importance of choice of different formulas [p-value 0.028] while no significant difference in performance of these formulas over same group of axial lengths. Newer generation formulas [Hoffer-Q, SRK/T and Holladay-1] all proved to be equally effective in predicting IOL power in all ranges of axial lengths with no significant difference in their performance

Role of transvaginal ultrasound in identifying endometrial hyperplasia

Transvaginal sonography [TVS] is one of the diagnostic modalities used to evaluate endometrial pathologies in women with abnormal uterine bleeding. It permits use of high frequency ultrasound waves at greater proximity to the uterus. This study aimed at determining the diagnostic accuracy of TVS in identifying endometrial hyperplasia by comparing with histologic findings in perimenopausal women with abnormal uterine bleeding. This cross-sectional study was conducted in Department of Obstetrics and Gynaecology, Unit II, Fauji Foundation Hospital, from Sep 2011 to Mar 2012. A total of 263 perimenopausal women aged 40-50 years with abnormal uterine bleeding in the form of menorrhagia, metrorrhagia and polymenorrhagia were enrolled. Thickness of the endometrium was first measured by ultrasound and then was later confirmed by sampling of endometrium. The outcome was measured in terms of accurately diagnosing endometrial hyperplasia by TVS and then using histologic findings as gold standard to confirm. The mean age of selected patients was 45.3 +/- 3.2 years. Out of total 263 cases, 129 [49.0%] presented with menorrhagia, 120 [45.6%] presented as metrorrhagia while 14 [5.3%] had polymenorrhagia. The sensitivity and specificity of TVS was 100.0% and 63.7% respectively. Similarly positive predictive value [PPV] and negative predictive value [NPV] were 56.3% and 100.0% respectively. Diagnostic accuracy of TVS in identifying endometrial hyperplasia using histopathology as gold standard was found to be 75.6%. TVS has a moderate diagnostic accuracy in detecting endometrial hyperplasia. Due to the fact that transvaginal ultrasound is safe, acceptable and easily available in most secondary and tertiary care settings and is non-invasive in nature, in our opinion TVS is to be used as a 1st line diagnostic tool in patients who present with abnormal uterine bleeding

Adult woman with intra-oral epidermoid cyst

Epidermoid cyst is a rare, slow growing lesion of head and neck region. Its rarest site of presentation is intra-oral. It presents later in life, while taking its time to grow to a significant size, causing other complaints as dyspnoea and dysphagia. We present here a case report of epidermoid cyst at a very rare and unexpected site of presentation. Patient presented in ENT OPD with complaints of large intra-oral midline swelling and associated complaints of dyspnoea and dysphagia. Patient was admitted and operated upon with intra-oral approach, producing good results. It should be kept in mind as one of the differential diagnoses when dealing with long standing intra-oral swellings