Brachytherapy of intra ocular tumors using ‘BARC I-125 Ocu-Prosta seeds’: An Indian experience.

Aim: To report our experience of brachytherapy using ‘BARC I‑125 Ocu‑Prosta seeds’ for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011. Materials and Methods: We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty‑one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult‑onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15‑ or 20‑mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor. Results: For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow‑up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow‑up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage. Conclusion: The results of this retrospective study confirms that the use of ‘BARC I‑125 Ocu‑Prosta seeds’ in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.

A comparison of intravenous ketoprofen versus pethidine on peri-operative analgesia and post-operative nausea and vomiting in paediatric vitreoretinal surgery.

AIM: To compare the efficacy of ketoprofen and pethidine for peri-operative analgesia and post-operative nausea and vomiting in children undergoing vitreoretinal surgery and surgery for retinal detachment. MATERIAL AND METHODS: Children aged 7 to 16 years and ASA I status, undergoing vitreo-retinal surgery were randomly allocated to receive either ketoprofen 2mg/kg or pethidine 1mg/kg intravenously for peri-operative analgesia. In all patients, general anaesthesia was induced with thiopentone and intubation was facilitated with vecuronium bromide and maintained with 33% oxygen in nitrous oxide and isoflurane. Intra-operative and post-operative monitoring was done by an observer blinded to the technique. Intra-operative rescue analgesia was used if heart rate and/or blood pressure increased by 25% from pre-incision values. Post-operative pain and episodes of nausea and vomiting were evaluated at recovery (0 hour), 2, 6 and 24 hours intervals. Standard rescue analgesia and anti-emetic agents were administered if required. RESULTS: Eighty-six children were enrolled in the study. Forty-four received ketoprofen while 42 received pethidine. Intra-operative analgesia was comparable in both the groups and no significant difference was found in the requirement of intra-operative rescue analgesia, as well. Postoperatively 6/44 (13.6%) children in ketoprofen group had pain at recovery compared to 17/42 (40.4%) in pethidine group. Pain at 2, 6 and 24 hours, and postoperative analgesic requirement were not significantly different among the two groups. Post-operative nausea, vomiting, and antiemetic requirement were significantly less in the ketoprofen group at all time intervals. CONCLUSION: Ketoprofen is a satisfactory alternative analgesic to pethidine for vitreoretinal surgery and results in a lower incidence of postoperative nausea and vomiting.

Laparoscopy assisted hemi-colectomy for ileo-caecal tuberculosis.

Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.

Blade and balloon atrial septostomy for creation of an adequate interatrial communication.

During a 7 year period from 1984 to 1991, 100 infants underwent either balloon atrial septostomy (BAS) (n = 92) or blade septostomy (BLS) (n = 8). The indication was complete transposition of the great arteries in all the patients. The mean age in the BAS group was 1.8 +/- 1.5 months while that in the infants requiring BLS due to a thick septum was 3.03 +/- 2.29 months. The degree of improvement in arterial oxygen saturation in both groups was satisfactory -27.16 +/- 14.06% in the BAS group vs 23.5 +/- 12.18% in the BLS group. There were no procedure related deaths in the BLS group, through only monoplane fluoroscopy was used in 6/8 patients. Three patients however died following balloon septostomy. We conclude that BLS is a safe and effective alternative to surgical septostomy when performed with due care. Two dimensional echocardiography during BAS enhances the speed and safety of the procedure and helps to identify patients who may require BLS due to a thick interatrial septum.

Congenital epulis.

A tumor was found to be arising from the right maxillary alveolar margin of a newborn baby. No other congenital abnormality was detected. Following excision and histopathological examination, diagnosis of benign congenital granular cell epulis was made. The post-operative course was uneventful.

Pattern of rheumatic diseases in south India. IV. Clinical profile of juvenile rheumatoid arthritis.

An analysis of 100 consecutive cases of juvenile rheumatoid arthritis from South India revealed a male preponderance (62%), a lower incidence of the systemic onset variety (10%) and equal incidence of systemic features when compared with the West. Knees and ankles were the joints commonly involved. The incidence of elevated erythrocyte sedimentation rate and C reactive protein, with haemoglobin levels below 10 g/dl was highest in the systemic onset variety. The polyarticular and systemic onset group responded well to aspirin, while the pauciarticular group responded well to indomethacin.