Complex Regional Pain Syndrome Type 1 Treated with Vitamin C.

Complex regional pain syndrome, formerly reflex sympathetic dystrophy or causalgia, is a chronic progressive disease characterized by severe pain, swelling, and changes in the skin. It often affects an arm or a leg and may spread to another part of the body and is associated with dysregulation of the autonomic nervous system resulting in multiple functional loss, impairment, and disability. It occurs mostly in adolescence. Although treatment is often unsatisfactory, we report a young girl treated satisfactorily with vitamin C.

Limbal stem cell deficiency: concept, aetiology, clinical presentation, diagnosis and management.

Defects in renewal and repair of ocular surface as a result of limbal stem cell deficiency are now known to cause varying ocular surface morbidity including persistent photophobia, repeated and persistent surface breakdown and overt conjunctivalisation of the cornea. Ocular conditions with abnormalities of ocular surface repair include pterygium, limbal tumours, aniridia, severe scarring following burns, cicatricial pemphigoid and Stevens-Johnson Syndrome, sequelae of mustard gas exposure and Herpes simplex epithelial disease, radiation keratopathy, contact lens induced keratopathy, neuroparalytic keratitis and drug toxicity. Restoring ocular health in these eyes has traditionally been frustrating. An understanding of these intricate cell renewal and maintenance processes has spurred the evolution in recent years of new treatment methods for several blinding diseases of the anterior segment; many more exciting modalities are in the offing. However, there is inadequate awareness among ophthalmologists about the current principles of management of ocular surface disorders. The purpose of this article is to help elucidate the important principles and current treatment methods relevant to ocular surface disorders.

Corneal allograft rejection: risk factors, diagnosis, prevention, and treatment.

Recent advances in corneal graft technology, including donor tissue retrieval, storage and surgical techniques, have greatly improved the clinical outcome of corneal grafts. Despite these advances, immune mediated corneal graft rejection remains the single most important cause of corneal graft failure. Several host factors have been identified as conferring a "high risk" status to the host. These include: more than two quadrant vascularisation, with associated lymphatics, which augment the afferent and efferent arc of the immune response; herpes simplex keratitis; uveitis; silicone oil keratopathy; previous failed (rejected) grafts; "hot eyes"; young recipient age; and multiple surgical procedures at the time of grafting. Large grafts, by virtue of being closer to the host limbus, with its complement of vessels and antigen-presenting Langerhans cells, also are more susceptible to rejection. The diagnosis of graft rejection is entirely clinical and in its early stages the clinical signs could be subtle. Graft rejection is largely mediated by the major histocompatibility antigens, minor antigens and perhaps blood group ABO antigens and some cornea-specific antigens. Just as rejection is mediated by active immune mediated events, the lack of rejection (tolerance) is also sustained by active immune regulatory mechanisms. The anterior chamber associated immune deviation (ACAID) and probably, conjunctiva associated lymphoid tissue (CALT) induced mucosal tolerance, besides others, play an important role. Although graft rejection can lead to graft failure, most rejections can be readily controlled if appropriate management is commenced at the proper time. Topical steroids are the mainstay of graft rejection management. In the high-risk situations however, systemic steroids, and other immunosuppressive drugs such as cyclosporin and tacrolimus (FK506) are of proven benefit, both for treatment and prevention of rejection.

Skin involvement in leukemia.

Skin infiltration in leukaemia occurs rarely. We describe here four such cases of acute leukaemia. In two, the skin infiltration was evident at presentation; in the other two, it developed while on treatment. The lesions varied from maculopapular to tumorous stage. Complete remission could be achieved with chemotherapy, however, the long term prognosis was poor.

Vincristine infusion in advanced non Hodgkin's lymphoma.

Prognosis in cases of advanced Non Hodgkin's Lymphoma refractory to primary chemotherapy - continues to be poor. In search of suitable alternative we have recently treated six such patients with continuous, intravenous infusion of vincristine for five days. All patients had a variety of histological types and had received earlier primary combination chemotherapy including Vincristine by Intravenous bolus injection. A total of 21 courses (average 3.5) were given. Three patients (50%) achieved objective-partial response. Duration of response varied from two to nine months (mean 4.5 months). Toxicity was low with minimal myelosuppression and no increased neurotoxicity occurred. Vincristine infusion treatment may provide better palliation in advanced refractory Non Hodgkin's lymphoma and suggests the possibility of its use in combination chemotherapy protocols in untreated patients.