Differences in the Surgical Outcomes of Glaucoma Surgery in Patients of African Caribbean Descent.

PURPOSE: People of African Caribbean Descent (ACD) have a higher prevalence of glaucoma compared to people of European Descent (ED) and there is uncertainty if treatment outcomes are equivalent between the two groups. To assess surgical failure rates comparing ACD with ED focusing on trabeculectomy, aqueous shunt implantation, non-penetrating filtering surgery (NPFS), and minimally invasive glaucoma surgery (MIGS) by performing a systematic review in accordance with the PRISMA guidelines and to determine whether there is any evidence in to show a difference in success rates based on race. METHODS: A systematic review of articles using the CENTRAL, Ovid MEDLINE, PubMed, EMBASE, and ClinicalTrials.gov databases was completed. Additional studies were identified by contacting clinical experts and searching bibliographies. All retrospective and prospective studies on trabeculectomy, aqueous shunt implantation, NPFS, and MIGS that included at least 20% ACD were included. Two review authors independently screened search results for eligibility and inclusion and extracted the data using pre-determined fields. RESULTS: A total of 76 studies were identified for inclusion in the review. Glaucoma surgical outcomes in ACD appear to be poorer compared to ED overall, particularly for trabeculectomy. Data on NPFS are limited, but the studies completed thus far demonstrate surprisingly good results for ACD, particularly when compared to ED, who have significantly lower pre-operative IOPs. Evidence from studies investigating aqueous shunts does not suggest that ACD have poorer outcomes than ED. There is not enough data on MIGS to provide a significant conclusion. CONCLUSION: In a population where trabeculectomy may no longer be the gold standard, sufficiently powered studies assessing surgical outcomes in aqueous shunts, NPFS, and MIGS are needed to guide clinicians.

Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review.

Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.

Ileal obstruction: a rare complication due to appendicular band.

Acute intestinal obstruction as a result of inflammed appendix resulting in band formation in a 50-year-old male is being reported due to its rarity. The purpose of this paper is to draw attention to this rare complication of appendicitis as a cause for presenting as intestinal obstruction-delayed diagnosis of which results in intestinal strangulation and subsequent gangrene of the bowel loop. In this case, after diagnosis of intestinal obstruction, the patient was selected for exploratory laparotomy. The constricting band, incidentally the inflamed appendix along with the strangulated portion of the ileum was dissected out. The patient was discharged after 8 days without having any complications.

Paradoxical cerebral arterial gas embolism: Computed tomography findings.

Computed tomography scan findings are described in cerebral arterial gas embolism in two patients with right to left intracardiac shunts by accidental injection of air during intravenous therapy. Although imaging may not be necessary to diagnose the condition, the patient may be referred to CT scan as a case of stroke. Cerebral arterial gas embolism should be considered in the differential diagnosis of stroke, particularly in case of right-to-left shunts. CT findings described are classical and diagnostic of the condition.

Blood-fluid levels in the brain.

17 cases reviewed prospectively over a period of 4 months highlight the varied appearance of blood-fluid levels in intracranial cystic lesions of different aetiologies; a finding which has not featured significantly in the medical literature. Four types of intracranial cysts demonstrating blood-fluid levels have been categorised according to the nature of the pathology, i.e. primary neoplasms of the brain, metastatic deposits to the brain in cases of extraneural malignancies, lesions of vascular aetiology and intraparenchymal bleeds secondary to trauma. The group of four primary intracranial neoplasms lists an oligodendroglioma, a recurrent tumour in a case of Von Hippel-Lindau syndrome, a Grade 3 astrocytoma and an acoustic schwannoma. Four cases of metastatic deposits to the brain were each secondary to primary malignant neoplasms of the breast, liver, ovary and lung. Of seven cases of a vascular aetiology, three resulted from arterial infarction, two from hypertension and one each from venous infarction and following anticoagulant therapy. Intracranial cysts within tumours have been postulated to occur secondary to a breakdown of the blood-brain barrier (BBB) rather than as a result of tumoural degeneration, as was thought probable earlier.

Giant renal capsular leiomyoma: study of two cases.

Leiomyomas of the renal parenchyma and of the capsule are rare. These tumours are normally small asymptomatic and often detected incidentally. Large renal leiomyomas can present with pain or as an abdominal mass, but they are rare. The imaging features of these tumours have been poorly described in the literature. A radiological distinction from other renal neoplasms is often difficult to make owing to the similarity of imaging findings. We report two patients with renal leiomyomas who presented with pain and an abdominal mass. Both patients underwent nephrectomy and histological evaluation confirmed the diagnosis of leiomyoma.

Echinococcosis of the rib with epidural extension: a rare cause of paraplegia.

Skeletal echinococcosis is a relatively rare entity and that of the rib is exceptional. Less than 50 cases of costal echinococcosis have been reported in the literature so far. Accurate pre-operative diagnosis aids in appropriate management and helps to eradicate the disease. This also prevents the dissemination of parasite and further complications. We report a case of echinococcosis of the rib with epidural extension in a young adult who presented with paraparesis and back pain. His laboratory investigations were within normal limits. Plain radiographs of the dorsal spine, CT scan of thorax and MRI of dorsal spine were performed. The imaging features were suggestive of echinococcosis involving the rib with epidural extension. The cyst was completely resected. Histopathology of the resected specimen confirmed the diagnosis of echinococcosis.

Mast cell reactivity in lymphoma: a preliminary communication.

Fifty nodes of Hodgkin's disease, 50 of non-Hodgkin's lymphoma and 20 of reactive hyperplasia revealed varying degree of mast cell reactivity. It was maximum in reactive lymph nodes, sinuses and interfollicular areas being infiltrated more than zones. The number of mast cells was more in nodular sclerosis variety of Hodgkin's disease than other Rye-subtypes, and more in Hodgkin's group than non-Hodgkin's, out of the latter, the diffuse histiocytic lymphoma revealed higher number. Analysis of a larger series and follow-up of these patients are indicated to establish the possible reactionary nature of mast cell reactivity in lymphomas, and the prognostic bearing, if any.

Fertility status of men following vaso-vasostomy.

PIP: In 1977, 114 vas reanastomoses were performed at the S.V.B.P. Hospital in Meerut, India. Follow-up of 74 of the cases indicated that 81.08% of the procedures were technically successful in that an adequate sperm count was reestablished; however, clinical success, as measured by the wife's subsequent pregnancy, was achieved in only 20.27% of the cases. Wives who did not conceive were gynecologically examined and no abnormalities were observed. In order to identify factors which contributed toward fertility restoration failure the investigators assessed the relationship between clinical and technical success and 1) the age of the patient; 2) the length of the interval between the vasectomy and the reversal procedure; and 3) the presence of sperm agglutinating and sperm immobilizing antibodies in the blood serum of the patients. The age of the patient was not related to either clinical or technical success. The length of the interval between vasectomy and reversal did not affect technical success; however, as the interval increased, clinical success declined. Serum samples were obtained from 86 of the 114 patients and from a control group of 24 fertile men and examined for the presence of sperm agglutinating and sperm immobilizing antibodies. The antibodies were absent in the sera of all but 1 of the controls; however, both types of antibodies were present in the sera of 32 of the patients and sperm agglutinating antibodies only were present in the sera of another 26 patients. The presence of the antibodies was not related to technical success but the presence of the antibodies did appear to have an adverse effect on clinical success. This relationship also appeared to be influenced by the length of the interval between vasectomy and vas reanastomosis. Major findings were presented in tabular form.^ieng