Prevalence of primary angle-closure disease in retinitis pigmentosa

To determine the prevalence of primary angle?closure disease (PACD) in patients with retinitis pigmentosa (RP). Methods: This was a retrospective review of the electronic medical records of all RP patients over the age of 10 years attending the Genetics Eye Clinic of a tertiary?care hospital during a 7?year period. Information regarding age, gender, vision, refraction, lens, intraocular pressure (IOP), type of RP, and inheritance pattern using pedigree charts for all patients were obtained. Patients with a shallow anterior chamber, high IOP, or glaucomatous optic discs were referred to the glaucoma department where they underwent additional IOP measurements, a gonioscopy, and disc evaluation by a glaucoma specialist. The prevalence of PACD was determined. Results: A total of 618 RP patients were examined during the study period, of which 95.1% had typical RP. The prevalence of primary angle?closure suspects was 2.9%, primary angle closure was 0.65%, and primary angle?closure glaucoma (PACG) was 2.27%. In contrast, the prevalence of primary open?angle glaucoma was 1.29%. The prevalence of PACG in those older than 40 years was 3.8% (95% confidence interval: 1.6–6.0). Conclusion: The prevalence of PACG in RP patients over 40 years was higher than that found in the general population of a similar age (3.8% vs. 0.8%). In our cohort of RP patients, 5.9% had PACD. Hence, gonioscopy is warranted in all RP patients to identify this condition and treat it appropriately.

Ultrasound screening of at risk infants optimizes conservative management and can reduce the rate of surgery in developmental dyspalsia of Hip

To determine the usefulness of ultrasound screening of only at risk infants in the management of developmental dysplasia of hip [D.D.H.]. All live births, [9310], were examined by a neonatologist within 24 hours of birth. The infants with unstable hips on clinical examination, clicking hips, family history, breech presentation [vaginal delivery and caesarean sections] and those with concurrent congenital deformity were then seen in the D.D.H. clinic, within 3 weeks of birth .The infants were classified according to the ultrasound appearance of their hips. Graf's typing was used and formed the basis for conservative and surgical management. There were 218 Grade I, normal babies. There were 89 dysplastic hips in 83 patients. 51 Grade II, 23 Grade III and 15 Grade IV dysplasias. During the study of 23 months of study only 3 hips, all with an initial type 1V ultrasound appearance were unresponsive to conservative measures and required open surgery. Ultrasound screening of babies at risk and those with unstable hips on clinical examination optimizes conservative management and can reduce the rate of open surgical intervention in D.D.H

Endoscopic ultrasound guided biopsy of a mediastinal mass

Endoscopic ultrasound [EUS] now has an established role in the diagnosis, staging and management of cancers of the oesophagus, stomach, pancreato-biliary system and rectum. Recently, a role for EUS in the staging of lung cancers has been proposed. Linear EUS allows fine needle aspiration [FNA], core biopsies and therapeutic manoeuvres such as coeliac plexus block to be performed. We present here the first reported EUS-guided biopsy from Pakistan. A patient with probable bronchogenic carcinoma was referred for assessment of operability. A thoracic CT scan showed subcarinal and aorto-pulmonary recess lymphadenopathy. An EUS-guided FNA was performed, confirming metastatic non-small cell lung cancer and rendering the patient inoperable