Interchangeability of retinal perfusion indices in different-sized angiocubes: An optical coherence tomography angiography study in diabetic retinopathy

Purpose: To evaluate the differences in vascular indices in different scan sizes of optical coherence tomography angiography (OCTA) images in normal persons versus persons with diabetic retinopathy. Methods: OCTA scans of diabetic patients and age-matched controls were performed by a single operator. Automated quantification of vascular indices of the superficial plexus was analyzed in two angiocubes of 3 × 3 mm and 6 × 6 mm, respectively. The agreement was analyzed with the intraclass correlation coefficient (ICC) and Bland–Altman plots. Results: Forty-eight eyes with DR, 36 eyes with no diabetic retinopathy (No DR), and 26 eyes of age-matched normals were scanned. The foveal avascular zone (FAZ) area and perimeter were highly reliable and interchangeable in both angiocubes of the healthy eyes (ICC 0.94, 0.75), No DR (ICC 0.92, 0.85), and DR eyes (ICC 0.97, 0.89). The vessel density (VD) and perfusion density (PD) showed excellent agreement in normal (ICC 0.89, 0.80) and No DR eyes (ICC 0.92, 0.81). But, only fair ICC was observed in DR eyes (0.56, 0.42). Conclusion: The FAZ area and perimeter showed excellent reproducibility. The macular perfusion parameters are not interchangeable despite automated estimation. The variability is more with changes in the vascular network like DR. This variability should be considered while comparing different scans.

Histopathological study of the hepatic and renal toxicity associated with the co-administration of Imatinib and Acetaminophen in a preclinical mouse model

Imatinib, a selective tyrosine kinase inhibitor, is the fi rst line treatment against chronic myelogenous leukaemia (CML) and gastrointestinal stromal tumors (GIST). Several fatal cases have been associated with imatinib hepatotoxicity. Acetaminophen, an over-the-counter analgesic, anti-pyretic drug, which can cause hepatotoxicity, is commonly used in cancer pain management. We assessed renal and hepatic toxicity after imatinib and acetaminophen co-administration in a preclinical model. Four groups of male ICR mice (30-35 g) were fasted overnight and administered either saline solution orally (baseline control), imatinib 100 mg/kg orally (control), acetaminophen 700 mg/kg intraperitoneally (positive control) or co-administered imatinib 100 mg/kg orally and acetaminophen 700 mg/kg intraperitoneally (study group), and sacrifi ced at 15 min, 30 min, 1 h, 2 h, 4 h and 6 h post-administration (n=4 per time point). The liver and kidneys were harvested for histopathology assessment. The liver showed reversible cell damage like feathery degeneration, microvesicular fatty change, sinusoidal congestion and pyknosis, when imatinib or acetaminophen were administered separately. The damage increased gradually with time, peaked at 2 h but resolved by 4 h. When both drugs were administered concurrently, the liver showed irreversible damage (cytolysis, karyolysis and karyorrhexis) which did not resolve by 6 h. Very minor renal changes were observed. Acetaminophen and imatinib co-administration increased hepatoxicity which become irreversible, probably due to shared P450 biotransformation pathways and transporters in the liver.

Evaluation of subjective and objective cyclodeviation following oblique muscle weakening procedures.

PURPOSE: To evaluate the subjective and objective cyclodeviational changes following different weakening procedures on superior and inferior oblique muscles. DESIGN: Comparative case series. MATERIALS AND METHODS: In a prospective institution based study, 16 cases of A pattern horizontal strabismus having superior oblique overaction were randomized to superior oblique weakening procedures: either silicon expander or translational-recession. Similarly, 20 cases of V pattern horizontal strabismus with inferior oblique overaction were randomized for inferior oblique weakening procedures: either 10 mm Fink's recession or modified Elliot and Nankin's anteropositioning. Cyclodeviation was assessed subjectively with the synoptophore and objectively using the fundus photograph before surgery and 3 months postoperatively. Change in cyclodeviation was measured by subjective and objective methods. The index of surgical effect (ISE) was defined as the net torsional change postoperatively. RESULTS: The difference between the extorsional change induced by the two superior oblique procedures, silicone expander (-6 degrees ) and translational recession (-11.3 degrees), was statistically significant (P=0.001). Translational recession caused more extorsional change (ISE=296%) than silicone expander surgery (ISE=107%). The two inferior oblique weakening procedures, Fink's recession (+2.5 degrees) and modified Elliot and Nankin's anteropositioning (+4.7 degrees) produced equitable amount of intorsional shift with no statistical difference (P=0.93). Objective measurements were significantly more than the subjective measurements. CONCLUSIONS: Different weakening procedures on oblique muscles produce different changes in cyclodeviation, which persists even up to 3 months. Subjective cyclodeviation is less than the objective measurements indicating partial compensation by sensorial adaptations.

Percutaneous transluminal coronary angioplasty by right transradial approach in a patient with arteria lusoria.

Though the radial artery is an ideal site of access for coronary interventions, at times anatomical variations make this procedure complicated. We describe one such arterial aberrancy, the retroesophageal right subclavian artery or arteria lusoria, in which the right subclavian artery arises distal to the left subclavian artery. Therefore, approaching through the right radial artery, the catheter has to take a zigzag course through the right subclavian to the descending aorta, and then to the ascending aorta. This often makes it difficult to perform diagnostic angiography. Performing angioplasty by the right transradial approach also becomes a more difficult task and requires greater perseverance and skill. In the case described here, the patient with arteria lusoria had tandem 90% stenosis involving the proximal and mid left anterior descending artery. Percutaneous transluminal coronary angioplasty with stenting of the proximal and mid left anterior descending artery by the right transradial approach was performed, negotiating the loop with two paclitaxel-eluting stents.

Comparison of target concentration intervention strategy with conventional dosing of digoxin.

Digoxin is a widely used drug in patients with congestive heart failure. The present study compared the quality of life of congestive heart failure patients on one year follow-up period with two different dosing of digoxin (5/7 therapy and 7/7 therapy in whom the target serum digoxin concentration is maintained). Quality of life significantly improved in intervention group thus emphasizing the need for continuous dosing of digoxin based on target concentration.

Locally aggressive orbital fibrous histiocytoma.

We report a rare presentation of a massive, locally aggressive, fibrous histiocytoma of the orbit. The importance of histopathological grading and appropriate management are highlighted.

Incidence and risk factors of asymptomatic first-dose hypotension with angiotensin-converting enzyme inhibitors in chronic heart failure due to systolic dysfunction.

BACKGROUND: In practice, chronic heart failure is often not treated with angiotensin-converting enzyme inhibitors. One reason is the fear of first-dose hypotension. In the majority of patients, this condition is asymptomatic and the consequences are unexpected. Presently, little is known of its epidemiology. METHODS AND RESULTS: This was a prospective, 48-hour observational study of 160 patients with chronic heart failure due to systolic dysfunction, previously untreated with angiotensin-converting enzyme inhibitors, randomly drawn from the clinical practice of selected cardiologists across India. The primary outcome was a change in the mean arterial pressure during the first 24-hours after the first dose of an angiotensin-converting enzyme inhibitor. In 131/160 patients (81.9%) with no hypotensive symptoms, the incidence of first-dose hypotension (maximum 24-hour fall in mean arterial pressure greater than 10% from baseline) was 56/131 (42.7%). Pre-treatment diastolic pressure had a negative, independent association with 24-hour change in mean arterial pressure, accounting for 29% (R2=0.29, p<0.01) of its variability, and its predictive value was greater with pro-drug angiotensin-converting enzyme inhibitors. The incidence of first-dose hypotension increased from 1 patient (4.8%) at a pre-treatment diastolic pressure of 50-70 mmHg to 35 patients (42.7%) at 71-90 mmHg, p<0.01. CONCLUSIONS: The incidence of first-dose hypotension with angiotensin-converting enzyme inhibitors in outpatients with chronic heart failure due to systolic dysfunction is high. Pre-treatment diastolic pressure is an independent risk factor, and its predictive value increases with pro-drug angiotensin-converting enzyme inhibitors. This could help physicians to anticipate asymptomatic first-dose hypotension and increase the utilization of these agents in heart failure.

Catheter intervention in valvular obstruction and long-term results.

Percutaneous balloon mitral valvuloplasty has been established as an effective alternative to surgery for the treatment of mitral stenosis. The authors describe their experience in percutaneous mitral commissurotomy with a detailed discussion of the procedures and a brief review of literature.

Cervical cancer in Seychelles

Cervical carcinoma is a most common cancer of women in Seychelles. Since 1983; Papanicolaou smear diagnosis of cytological specimens of cervix has been carried out. The recent observation is that the incidence of cervical carcinoma is decreasing. With the data on all the cases of cervical carcinoma diagnosed by histopathological examination from 1986 to 1995 in the Republic of Seychelles and demographic data in the same period; a simple epidemiological study of cervical carcinoma was made. Mean age of occurrence for cervico intra-ephithelial neoplasia (CIN) III; microinvasive carcinoma; invasive squamous cell carcinoma and adenocarcinoma were respectively 39.8; 40.9; 56.2; 52 years; the annual incidences were 64.3; 17.4; 39.8 and 9.2 per 100;000 women aged 20 years above. It appears that the incidence of cervical cancer has declined over the last decade

Rupture of dissecting aneurysm: autopsy study of 3 cases

Dissecting aneurysm (DA); more appropriately termed dissecting haematoma; is the separation of layers of the vascular wall by a column of blood from the lumen. Dissecting aneurysms of the aorta differ from atherosclerotic and syphilitic aneurysms in that they are not usually associated with marked dilatation of the aorta. DA of the aorta; irrespective of the etiology; if untreated; are associated with a rapidly fatal outcome in 75 per cent to 90 per cent of the patients. Death from DA most often results from rupture. Rupture sites frequently associated with a fatal outcome include the pericardial sac leading to acute haemopericardium; the mediastinum; the left pleural cavity and the retroperitoneum. Autopsy study on three cases of sudden death revealed haemopericardium as a result of rupture of DA of the ascending aorta. One case was seen in a young individual with Marfan's syndrome and two were present in elderly individuals with hypertension. The etiopathogenesis; presentation; outcome and management of this fatal complication is discussed

Trend of cervical cancer in Seychelles

A 10-year study of all cervical biopsies and hysterectomy specimens received in the Department of Pathology; Victoria Hospital was carried out. Representative punch biopsies of cervix; either colposcope guided; or taken from non-staining areas of cervix following application of Schiller's iodine paint; and fixed in 10 per cent formal saline in the theatre were received in the pathology department. During the ten year period (1983-1992); 175 cases of cervical cancer were detected. Of these; 66 cases were at the CIN 3 stage; 28 were CIN 3 with microinvasion; 69 cases showed frank infiltrating squamos cell carcinoma; 11 exhibited adenocarcinoma and 1 had adenosquamous features

Clinicopathology study of oral and oropharyngeal carcinoma in Seychelles

Oral and oropharyngeal carcinoma happens to be one of the commonest cancerous lesions in Seychelles. According to cancer registry statistics; of 621 cases of cancer from 1983 to 1991; oral and oropharyngeal carcinoma account for 9.98 per cent of all cases. An attempt has been made to analyse the age and sex of patients; the location and morphology of the carcinomas; and the prognosis; so as to present the clinicopathological features of oral and oropharyngeal carcinoma in Seychelles; with possible etiological factors

Pseudosarcoma in marfan's syndrome : a case study

Pseudosarcomatous fasciitis was reported by Knowaler et al in 1955. It is a benign and quasi-neoplastic proliferation of fibroblasts; which is often mistaken for a sarcoma because of its rapid growth; rich cellularity and mitotic activity. It is one of the more common soft tissue lesions and exceeds in frequency other tumor or tumor-like lesions of fibrous tissue. This attested to by the more than 1000 cases that were reviewed at the American Armed Forces Institute of Pathology (AFIP) in a 20 year period. The case of pseudosarcoma occuring in a patient with marfan's syndrome in Seychelles is reported

Non-cancerous breast lesions in Seychelles : an appraisal

In recent years there has been an increase in the number of both cancerous and non-cancerous lesions of the breast seen by doctors in Seychelles. The cancer registry held by the department of pathology reveals that 3 cases of breast cancer were reported in 1989; 4 in 1990; 6 in 1991 and 11 in 1992. Department of pathology records also reveal that 36 cases of non-cancerous breast lesions were reported in 1989; 30 in 1990; 48 in 1991 and 49 in 1992. These increases call for the development of a protocol for the management of all the palpable; nodular swellings of the breast; irrespective of marital status; age; parity and use of oral contraceptives