Approach to a sewing needle in the parapharyngeal space: A case report

Objective@#To describe a unique situation of a sewing needle lodged in the parapharyngeal space and elucidate the problems encountered in its successful removal.@*Methods@#Design: Case Report. Setting: Tertiary Private Hospital. Patient: One.@*Result@#A 24-year-old male tailor accidentally swallowed a sewing needle that pierced the oropharyngeal wall and was wedged in the parapharyngeal space. After a thorough physical examination, 70 degree rod endoscopy, radiography and doppler ultrasonography and intraoperative C-arm X-ray for intraoperative localization and as a guide for extraction all yielded less than optimal guidance. Although an intra-oral approach was initially taken, the transcervical approach provided the best access. @*Conclusion@#Removal of a sharp foreign body in the parapharyngeal space should be considered a surgical emergency owing to its close proximity to vital structures and the potential for serious complications. Identifying the exact location may require a variety of imaging modalities, and foreign body extraction may entail multiple surgical approaches.

Manual suture less small incision cataract surgery in patients with uveitic cataract

The purpose of this study is to evaluate the outcome of manual small incision cataract surgery [SICS] in eyes with uveitic cataract. Setting- Medical college hospital of the subcontinent, Retrospective case series. In this retrospective study, patients who underwent SICS with posterior chamber intraocular lens implantation for uveitic cataract from 2006 to 2009 were evaluated. Patients with less than 3 months follow-up were excluded. Post-operative vision and complications were analyzed. A total of 54 patients completed the study. The mean age was 52.3 +/- 9.3 years. The mean follow-up was 11.53 +/- 5.05 months. The mean surgical time was [10.2 +/- 3.8 min]. Etiological diagnosis was possible in 31.41% [17/54] of patients. There was a statistically significant improvement in vision after surgery [P< 0.00l]. When uveitis was well-controlled, pre-operative corticosteroids did not change post-operative inflammation [P= 0.796]. However, pre-operative corticosteroids were statistically significantly associated to final best corrected visual acuity [BCVA] [P = 0.010]. SICS with posterior chamber intraocular lens implantation is safe in most cataracts due to uveitis and improves BCVA at 6 months. Inflammation should be well-controlled pre-operatively for at least 3 months. Posterior capsule opacification, macular edema and persistent uveitis were the main factors affecting visual outcome. SICS requires minimal instrumentation, surgical time is short and can also be performed in rural clinics and eye-camps, where phacoemulsification machines are unavailable. SICS may be a more practical and cost-effective technique for uveitic cataract, in such circumstances

The Correlation of Routine Tear Function Tests and Conjunctival Impression Cytology in Dry Eye Syndrome

PURPOSE: To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard? METHODS: The tear film profile included tear film break up time (TBUT), Schirmer's-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin. RESULTS: The mean Schirmer's value was 11.66 +/- 5.90 in patients and 17.17 +/- 2.97 in controls (p Schirmer's > RBS, and the specificity was Schirmer's > TBUT > RBS in decreasing order when CIC was considered the gold standard.