Pigmented villonodular synovitis of the knee: A retrospective analysis of 214 cases at a UK tertiary referral centre.

AIMS: Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive and potentially recurrent synovial disease. We present the largest single-centre experience of knee PVNS. Our aim was to evaluate our tertiary hospital's experience in the management of knee PVNS. PATIENTS AND METHODS: Retrospective data collection of consecutive cases of knee PVNS from 2002 to 2015. RESULTS: In total, 214 cases of knee PVNS were identified which represented 53.4% of all PVNS (12.1% were recurrent at presentation). 100 were localised PVNS (LPVNS), 114 diffuse PVNS (DPVNS) and two malignant PVNS. Knee PVNS was more likely to occur in females with a mean age of 39. Following surgery, 47.6% had recurrence with DPVNS as opposed to 8.6% with LPVNS. In LPVNS, there was no significant difference in recurrence between open and arthroscopic synovectomy (8.7% vs 9.1%, P>0.05). However, in DPVNS, there was a significantly higher risk of recurrence with arthroscopic compared to open synovectomy (83.3% vs 44.8%, RR=1.86 95% CI 1.32-2.62, P=0.0004). CONCLUSION: PVNS can be difficult to treat. We found no difference in local recurrence rates between open and arthroscopic treatment of LPVNS but significantly increased rates of recurrence for DPVNS following arthroscopic treatment. We would therefore recommend open synovectomy for DPVNS.

Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment.

PURPOSE: To evaluate the outcomes and complications of 25-gauge (G) pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachment (TRD). METHODS: Retrospective review of consecutive, single-surgeon 25-G PPV cases between July 2007 and July 2014. Seventy eyes from 55 patients were operated on for diabetic TRD; all eyes were tamponaded with sulfur hexafluoride, octofluoropropane, silicone oil, or balanced salt solution. Mean age at surgery was 47.7 years (range 23-76 years), and mean length of follow-up was 713 days (range 90-2368 days; median 671 days). Primary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anatomic success, redetachment, and endophthalmitis. RESULTS: Preoperatively, 49 eyes (70%) had a concurrent rhegmatogenous component (8 of which also had proliferative vitreoretinopathy (PVR)). Mean BCVA improved from logarithm of the minimal angle of resolution 1.59 (20/800, SD 0.88) to 0.68 postoperatively (20/100, 0.77), P-value<0.001. Mean IOP increased from 15.9 to 20 mm Hg 1 day after surgery. Elevated postoperative IOP (≥ 22 mm Hg) occurred in 25 eyes, and low IOP (≤ 5 mm Hg) occurred in 2 eyes. Primary reattachment was achieved in 63 eyes (90%), and final anatomical success occurred in 69 eyes (99%). There were no cases of endophthalmitis. CONCLUSIONS: Twenty-five-G PPV repair was safe and effective in the repair of diabetic TRD, including eyes with a combined rhegmatogenous detachment or PVR. Gas, silicone oil, and balanced salt solution tamponading agents all proved to be efficacious in this surgical population.

Juvenile xanthogranuloma--a rare cause of unilateral orbital swelling in an elderly patient.

OBJECTIVE: To report the clinical and pathologic features of an elderly patient with a unilateral orbital swelling and proptosis caused by Juvenile Xanthogranuloma diagnosed and confirmed by orbital biopsy. DESIGN: Interventional case report. PARTICIPANTS: One patient. INTERVENTION: Steroids (Medrol dose pack) and radiation. MAIN OUTCOME MEASURES: Unusual clinical presentation and pathological features of Juvenile Xanthogranuloma in the orbit. CONCLUSIONS: Juvenile Xanthogranuloma affecting one orbit is very rare with unilateral involvement in an elderly patient. Steroids and radiation therapy were very effective in treatment and provided impressive results.

Are Gujarati Asian Indians 'older' for their 'vascular age' as compared to their 'Chronological age'?

BACKGROUND: South Asians are known to carry higher burden of cardiovascular diseases when compared with their Caucasian counterparts. AIM: This study was designed to evaluate whether vascular age is advanced for Gujarati Asian Indians as matched to their chronological age in apparently healthy, asymptomatic population. We have also assessed the contributing risk factors for premature vascular ageing. DESIGN: It was cross-sectional study of 2483 individuals of Gujarat state in Western India having no past or present history of major illness including cardiovascular diseases. METHOD: The vascular age of the population was calculated using Framingham vascular age calculator. A relationship between risk factor prevalence and vascular ageing was evaluated using univariate analysis of variance. RESULTS: The mean chronological age of the study population was 46.8 (±10.35) years whereas mean vascular age was 53.34 (±16.05) years, and the difference (6.54±9.5) between both was statistically significant (P < 0.0001). Contributory risk factors for advanced vascular age apart from chronological age (75.4%) and male gender (66.2%) were the presence of dyslipidemia (60.4%) hypertension (57.34%) and increased waist circumference (WC) (male 39.7%, female 29%). Results of regression analysis showed that vascular age progression was highly associated with blood pressure (19.9, 95% CI: 14.34-27.63), followed by smoking (15.23, 95% CI: 8.4-27.59), and blood sugar (12.97, 95% CI: 3.48-48.25). CONCLUSION: The Gujarati Asian Indians are subjected to premature vascular ageing and henceforth routine screening for vascular age and risk factors prevalence is strongly advocated in this ethnic group.

Uric acid as a cardiorenal risk factor - ready for prime-time?

Patients with cardiac morbidity are known to have increased risk of developing renal disease, and vice versa. Cardiorenal syndrome is a general term describing concomitant cardiac and renal dysfunction, and recently there has been renewed interest in the role of uric acid (UA) in its pathophysiology and management. There is evidence to suggest that UA-lowering drugs, such as the xanthine oxidase (XO) inhibitors allopurinol and Febuxostat, may not only retard deteriorating renal function in the context of chronic kidney disease (CKD) but also confer protective cardiovascular effects. As these diseases represent considerable health burdens, this evidence merits evaluation to determine whether or not hyperuricaemia is a cardiorenal risk factor that necessitates intervention and if existing pharmacological agents are sufficiently efficacious.

Rapid response of retinal pigment epithelial detachments to intravitreal aflibercept in neovascular age-related macular degeneration refractory to bevacizumab and ranibizumab.

PURPOSE: The aim of this study is to report the short-term efficacy of aflibercept in the treatment of neovascular age-related macular degeneration (AMD) with associated retinal pigment epithelial detachment (PED) which is refractory or develops tachyphylaxis to bevacizumab and ranibizumab. METHODS: The method comprised a retrospective review of the medical records of patients with neovascular AMD and associated PEDs recently treated with aflibercept and previously treated with bevacizumab and ranibizumab. RESULTS: Three eyes of three female patients of ages 49, 55, and 65 years old with large serous PEDs and subretinal fluid (SRF) associated with occult choroidal neovascularization and neovascular AMD were treated with aflibercept after intravitreal bevacizumab and/or ranibizumab failed to resolve the lesions. All had complete resolution of SRF and complete or near-complete resolution of the PEDs after aflibercept injections over a 3-month period. Visual acuity improved in all three eyes. CONCLUSION: Intravitreal aflibercept may be an effective treatment option for serous PED in neovascular AMD patients after bevacizumab and ranibizumab have previously failed. Larger studies with longer follow-up are required to determine the role of aflibercept in treatment of PED in neovascular AMD.

Efficacy and safety of beta-arteether and alpha/beta-arteether for treatment of acute Plasmodium falciparum malaria.

One hundred thirty-eight adult patients with acute Plasmodium falciparum malaria were randomized to receive either beta-arteether or alpha/beta-arteether. The drugs were administered in the dose of 150 mg once a day intramuscularly for three consecutive days in hospitalized patients. After one week of hospitalization, patients were followed-up for three weeks after release from the hospital. There was no statistically significant difference between cure rates, mean fever clearance time (FCT), mean parasite clearance time (PCT), and occurrence of side effects in either group. The cure rate was 97.14% for beta-arteether and 97.01 for alpha/beta-arteether (P = 0.9660). The mean PCT was 38.49 hours for beta-arteether and 36.90 hours for alpha/beta-arteether (P = 0.6054), and the mean FCT was 37.27 hours for beta-arteether and 37.9 hours for alpha/beta-arteether (P = 0.8718). Both arteether formulations were safe and efficacious in reducing the clinical symptoms of acute falciparum malaria. There was also rapid clearance of parasitemia with both formulations. Thus, either beta-arteether or alpha/beta-arteether can be used in the treatment of acute falciparum malaria.

Metallothionein cDNA, promoter, and genomic sequences of the tropical green mussel, Perna viridis.

The primary structure of the cDNA and metallothionein (MT) genomic sequences of the tropical green mussel (Perna viridis) was determined. The complete cDNA sequences were obtained using degenerate primers designed from known metallothionein consensus amino acid sequences from the temperate species Mytilus edulis. The amino acid sequences of P. viridis metallothionein deduced from the coding region consisted of 72 amino acids with 21 cysteine residues and 9 Cys-X-Cys motifs corresponding to Type I MT class of other species. Two different genomic sequences coding for the same mRNA were obtained. Each putative gene contained a unique 5'UTR and two unique introns located at the same splice sites. The promoters for both genes were different in length and both contained metal responsive elements and active protein-binding sites. The structures of the genomic clones were compared with those of other species. J. Exp. Zool. 284:445-453, 1999.

Comparison of blood viscosity in red-eared sliders (Trachemys scripta) adapted to cold and room temperature.

Red-eared sliders (Trachemys scripta) in their northern range undergo hibernation at temperatures of about 5 degrees C, which may result in a profound bradycardia and a drop in blood pressure leading to very slow blood flows. Blood viscosity increases with decreasing temperature and at low shear rates associated with slow blood flows. To investigate the effects of temperature on the blood viscosity of these animals, 20 red-eared sliders were randomly assigned to each of two groups, cold environment (5 degrees C) or room-temperature environment (25 degrees C). At the end of 5 months treatment, hematocrit values, plasma protein concentration, and whole-blood viscosity values were determined for each turtle. Blood viscosity measurements were determined at five shear rates (3.75, 15, 30, 75, and 150 s-1) at 5 degrees C and 25 degrees C for all animals. No significant differences were found in hematocrit or plasma protein values between cold-adapted and room temperature-adapted animals. Whole-blood viscosity between groups at any shear rate at a temperature of 5 degrees C was also nonsignificant. The only significant difference in blood viscosity between turtles adapted to cold and room temperature occurred at a shear rate of 3.75 s-1 at 25 degrees C. The whole-blood viscosity of red-eared sliders, whether adapted to cold or to room temperature, tended to be lower as compared to other vertebrates under similar conditions of temperature, shear rate, and hematocrit. This innate lower blood viscosity may compensate for the potential detrimental effects on blood viscosity brought about by the low temperatures and decreased shear rates that occur in these animals during hibernation.

Metipranolol-associated nongranulomatous anterior uveitis.

PURPOSE: To describe the findings in a patient with a nongranulomatous anterior uveitis, presumed to be induced by metipranolol. METHOD: A 69-year-old woman developed bilateral, nongranulomatous, anterior uveitis while undergoing treatment with metipranolol 0.3% for primary open-angle glaucoma. Four months after resolution of the initial episode, the patient was challenged with metipranolol 0.3% in the right eye. RESULT: On reinstituting metipranolol 0.3%, the patient once again developed a unilateral, nongranulomatous, anterior uveitis in the challenged eye. CONCLUSION: Metipranolol 0.3% eyedrops, used to treat primary open-angle glaucoma, appear to cause a nongranulomatous anterior uveitis.

Incidence of acute angle-closure glaucoma after pharmacologic mydriasis.

PURPOSE: To study the incidence of acute angle-closure glaucoma secondary to pupillary dilation and to identify screening methods for detecting angles at risk of occlusion. METHODS: We studied 5,308 respondents to the Baltimore Eye Survey, a cross-sectional, population-based survey conducted in a multiracial urban community. We measured incidence of acute angle-closure glaucoma after pharmacologic mydriasis and the specificity and sensitivity associated with three screening criteria in identifying those with potentially occludable angles. The screening factors were presence of shallow anterior chamber on penlight examination, history of glaucoma, and blindness. RESULTS: Of the 4,870 subjects whose eyes were dilated on screening examination, none developed acute angle-closure glaucoma. However, 38 patients of the 1,770 who were referred for definitive eye examination were judged to have occludable angles on the basis of gonioscopic methods. Of note, subjects aged 70 years and more were three times more likely to have occludable angles than those aged 40 to 69 years (P < .004) In 14 black subjects with occludable angles, six were detected by history of glaucoma and not by shallow anterior chamber configuration; alternatively, in 24 white subjects, 11 (46%) were detected on the basis of shallow anterior chambers (Fisher's exact test, P = .014). When the three screening factors were considered alone and in combination, the most effective combination for predicting a potentially occludable angle was to use shallow anterior chamber on penlight examination and history of glaucoma. These criteria provide 60.5% sensitivity and 93.3% specificity. CONCLUSION: If screening is performed accurately and the results are negative, the risk of dilating a potentially occludable angle was less than one in 333 subjects (negative predictive value, 0.997) in this population.

Halofantrine in the treatment of falciparum malaria.

50 patients (45 males + 5 females) suffering from acute uncomplicated attack of Plasmodium falciparum (Pf) malaria were treated with 1500 mg of halofantrine divided in three doses of 500 mg each given at an interval of 6 h. Results showed there were no primary treatment failures. Average Parasite Clearance Time (av. PCT) was 51.12 h and average Fever Clearance Time (av. FCT) was 31.25 h. Adverse Drug Reactions (ADR) were mild and self limiting. We conclude that halofantrine is a quite safe and effective new antimalarial agent in the treatment of Pf malaria cases.

Bilateral transnasal cauterization of the vidian nerve in vasomotor rhinitis.

A brief report of twenty cases of bilateral cauterization of the Vidian Nerve Canals in intractable non-atopic chronic Vasomotor Rhinitis by a Trans-Nasal approach not previously described is given. The authors find this approach to be a much safer and simpler procedure than either the Trans-Septal or the Trans-Antral routes. The advantages of this approach to the Vidian Nerve Canal over the Trans-Septal and Trans-Antral routes are discussed.