Use of refractive direct ophthalmoscopy for estimation of refractive error.

The purpose of this study was to find if direct ophthalmoscopy, a simple technique, could be used to give an approximate value of the refractive correction for a patient. This would shorten the time and lessen the effort to be expended during the following retinoscopic examination done for finding the patient's refractive correction. The use of direct ophthalmoscopy for this specific purpose is especially desirable where retinoscopic examination is quite tedious, e.g. uncooperative patients like children, bed-ridden patients and mentally retarded subjects, in patients with a large central corneal opacity and in patients having a large refractive error. The study was divided into two phases. In phase I, refractive direct ophthalmoscopy followed by classical retinoscopy was done for 92 subjects (184 eyes) in the age group of 11-35 years. The method of regression analysis was used to find a regression equation relating the readings to refractive error determined by the two above techniques. In phase II of study, the refractive correction needed for 50 other subjects in the similar age group was estimated using this regression equation by inserting their respective direct ophthalmoscopy readings. Then, these estimated values and classical retinoscopic examination values were compared. The refractive error determined after retinoscopy and that derived from regression equation (incorporating direct ophthalmoscopy readings) was statistically comparable (t = 0.52, p = 0.60). The correlation coefficient (r value) between the two methods was 0.37. Direct ophthalmoscopic lens reading can be used to give a fairly accurate estimate of refractive error in a patient's eye by using a linear regression equation, which relates these two examination techniques. The magnitude of astigmatic error, however, cannot be obtained.

Efficacy and safety of brimonidine, dorzolamide and latanoprost as adjunctive therapy in primary open angle glaucoma.

A double-blind, randomised, controlled trial was carried out to evaluate the efficacy and safety of brimonidine, dorzolamide and latanoprost as an adjunctive therapy in patients with primary open angle glaucoma (POAG). A total of 200 males and 72 females with POAG uncontrolled with previous glaucoma therapy were randomly allocated to receive topical brimonidine 0.2% b.d. (n = 90), topical dorzolamide 2% b.d. (n=91) or topical latanoprost 0.005% o.d. (n = 91). One year post treatment, the mean percentage reduction in intraocular pressure (IOP) between the three groups was statistically significant (p < 0.0001). In an intergroup comparison of efficacy, there was a statistically significant difference between the brimonidine and dorzolamide groups (p = 0.018) and between the dorzolamide and latanoprost groups (p = 0.76) but the efficacy of brimonidine was not significantly higher than latanoprost in the brimonidine and latanoprost groups (p = 0.002). Patients experiencing mild to severe side-effects were statistically similar in the three groups. On an inter-drug comparison of side-effects, we found no statistically significant difference in the brimonidine and latanoprost groups (p = 0.25); and the brimonidine and dorzolamide groups (p = 0.067), while the number of side-effects with latanoprost was significantly higher in the dorzolamide and latanoprost groups (p<0.003). All three drugs caused a significant reduction in the mean IOP from pretreatment values. The brimonidine group had a higher number of patients experiencing severe side-effects necessitating alteration of therapy.

Pattern of bacterial flora in local genital skin and surgical wounds in children undergoing hypospadias repair: a preliminary study.

To evaluate the pattern of bacterial flora in children undergoing hypospadias repair, the following swabs were sent for 60 consecutive subjects: perimeatal swabs at admission and immediately before surgical scrub, and intraoperative and postoperative wound swabs (after the first change of operative dressing). A pure or predominant growth of organism that was not part of the local flora was labelled 'infection'. The peak incidence of infection (53%) was detected in swabs taken at admission. This decreased to 30% in immediately preoperative skin swabs, following local preparations. Coliforms and Staphylococcus aureus were the most commonly grown pathogens and were sensitive to cephalosporin and aminoglycoside. Proximity to the anus, poor personal hygiene in our study subjects (who were of low socioeconomic status) and the high temperature and humidity in our geographic region probably led to the high incidence of infection. The authors feel that the results of preoperative perimeatal swabs could help dictate antibiotic therapy in patients awaiting hypospadias repair.

Chronic sialadenitis with pleomorphic adenoma of the parotid: coincidental or causal?

A 12-year-old boy with a pleomorphic adenoma of the parotid is reported. The excised gland specimen also showed evidence of chronic sialadenitis. The co-existence of these two entities has not been previously reported in the literature surveyed by us. The authors feel that the two conditions may have a common underlying etiology.

Lung agenesis in a neonate presenting with contralateral mediastinal shift.

A neonate with right lung agenesis presenting with respiratory distress is described. The unusual radiological features were contralateral mediastinal shift (in contrast to expected ipsilateral shift) and diaphragmatic eventration on the affected side. Mediastinal shift to the opposite side was due to intrathoracic hepatic herniation under a high placed eventrated diaphragm. Both these features have not been reported in association with lung agenesis to date. The authors have discussed other causes of respiratory distress in newborns that can cause mediastinal shift and have urged a high degree of clinical suspicion to pick up the cases with lung agenesis. The newer diagnostic modalities and the causes of mortality in neonates with this anomaly have also been highlighted.

Posttraumatic pseudocyst of the greater omentum: report of a case.

Posttraumatic intra-abdominal cysts generally develop in relation to solid abdominal organs and most originate as a result of the organization of fluid or blood collection after trauma. They lack true endothelial lining and are hence called "pseudocysts." We report herein the rare case of a traumatic pseudocyst of the greater omentum in a 6-year-old child who was successfully treated by laparotomy and excision of the cyst.

Mercurochrome as an adjunct to local preoperative preparation in children undergoing hypospadias repair.

OBJECTIVE: To determine whether the local application of mercurochrome over genital skin before surgery, in addition to soap/water scrubs, can help to decrease the incidence of infection patients undergoing hypospadias repair, and thereby the incidence of fistula formation. PATIENTS AND METHODS: The study comprised 44 consecutive boys undergoing primary or repeat surgery for hypospadias between October 1999 and April 2000. They were arbitrarily divided into two groups; group 1 received a conventional local scrub with soap/water 48 h before surgery and group 2, a conventional local scrub with soap/water was followed by a local application of 2% mercurochrome for 48 h before surgery. Both groups were comparable in age, location of the meatus and stage of repair. All patients were exposed to similar conditions during and after surgery. Urine, skin and wound swabs taken before during and after surgery were assessed microbiologically, using standard precautions. The incidence of infection and complications was then compared. RESULTS: Mercurochrome significantly decreased local infection, especially before surgery, but its effect in decreasing fistula formation, although appreciable, was not statistically significant. CONCLUSION: The local application of mercurochrome after a soap/water scrub for at least 48 h before surgery is a simple, economic and effective means to decrease postoperative wound infection. Future studies are needed, keeping other determinants of fistula formation constant, to evaluate its role in decreasing fistula formation in patients undergoing hypospadias repair.

Association among duration of unconsciousness, Glasgow Coma Scale, and cranial computed tomography abnormalities in head-injured children.

The impact of head trauma leads to generation of forces that cause both the intracranial injuries and loss of consciousness. Glasgow Coma Score (GCS) and cranial CT scan are widely used to gauge the severity of head injury. Milder cranial impacts insufficient to cause intracranial injuries generally cause no or minimal loss of consciousness. Nevertheless, cases with contradictory findings are also seen. This study was undertaken to find out the association among the three above-stated variables. A knowledge of such an association can enable the attending clinician in prognosticating a cranial injury and selecting out those patients with mild head injuries who deserve closer observation. While a significant positive association was found between duration of unconsciousness and GCS, no signifficant association of either of these variables with CT scan findings was noted.

Lesser evaluated determinants of fistula formation in children with hypospadias.

Determinants of fistula formation, some of them not previously evaluated, were studied in 30 consecutive children admitted for hypospadias repair to our centre. All children were screened for any urinary or local infections. Vicryl and catgut were used alternately for reconstruction of the neo-urethra. Per urethral drainage was employed in all patients. The presence of unfavourable local anatomical factors, the surgeon's satisfaction at the end of the procedure and duration of surgery were noted. The patients were followed up for any urethrocutaneous fistula. Unsatisfactory surgery (chi-square = 6.53, p = 0.01), unfavourable anatomical factors (chi-square = 10.80, p = 0.001) and local infection (chi-square = 5.66, p = 0.017) had a strong association with fistula formation, whereas urine leakage and a history of previous surgery had only a marginal association. On application of stepwise binary logistic regression, unfavourable local anatomical factors (OR [95% CI]: 13.19 [1.20-143.50]) and urine leakage (OR [95% CI]: 14.35 [1.20-171.45]) emerge as strong risk factors for urethrocutaneous fistula, and local infection (OR [95% CI]: 8.70 (0.93-81.01]) as a moderate risk factor.

Left diaphragmatic eventration with a suprapubic spleen: report of a case.

Diaphragmatic defects such as eventration and hernia are known to be associated with a high-sited, sometimes intrathoracic spleen. We report here a unique case of an 8-year-old boy found to have a left congenital diaphragmatic eventration and a suprapubic wandering spleen after presenting with symptoms of an "acute abdomen" due to torsion of the splenic pedicle. To our knowledge only one other case of a similar paradoxical association of these anomalies has been reported before; interestingly, in this patient splenic infarction had also resulted secondary to splenic torsion. We recommend careful evaluation of the location and vascular status of the spleen in all patients with congenital diaphragmatic defects due to the common occurrence of splenic vascular insult.

Laryngotracheo-esophageal cleft in a neonate with esophageal atresia and tracheo-esophageal fistula: report of a case.

Laryngotracheo-esophageal cleft (LTEC) is a congenital anomaly, rarely found in neonates with esophageal atresia (EA) and tracheo-esophageal fistula (TEF), that poses diagnostic and treatment dilemmas for the attending surgeon. In most cases previously reported, the diagnosis of this association was made either at surgery or at autopsy. We present herein the case of a neonate with EA and distal pouch (type C) TEF who was also found to have a LTEC (Evans type III) at the time of surgery. The salient clinical and radiological features of this association are highlighted to increase awareness of the possibility of this rare association and to help promote its early detection.

Cystic duplication of the cecum with segmental dilatation of the ileum: report of a case.

Duplication cyst and segmental dilatation are rare congenital anomalies of the gastrointestinal tract, both of which are known to result in intestinal obstruction. We describe herein a case of intestinal obstruction in a neonate, caused by a duplication cyst in the cecum. A small dilated segment of ileum was also present at the site where Meckel's diverticulum would be expected, which was not causing obstruction to the luminal contents. Although it is well known that either of these conditions may coexist with a number of congenital malformations, their concurrent occurrence has never been reported before.

Acute idiopathic mesenteroaxial gastric volvulus in a child.

Gastric volvulus is a rare abdominal emergency in children and occurs secondary to associated predisposing congenital defects. The less frequent idiopathic variety of gastric volvulus is mostly chronic in its clinical course. Acute idiopathic mesenteroaxial gastric volvulus is a rare subtype and two out of the four reported cases of this entity among children in the past 12 years have been from the Indian subcontinent. We report another case of acute idiopathic mesenteroaxial gastric volvulus in a 7 year old Indian girl. Possibly there is an increased propensity of Asians to this is potentially fatal disease.

Lipoblastoma of the neck.

Lipoblastoma and lipoblastomatosis are benign tumours arising from embryonal fat cells. These rare tumours essentially occur in infancy and early childhood. The males are affected more than females often in the ratio of 3:1. These tumours usually arise in extremities. The involvement of neck is rare with only 10 cases reported so far in English literature. We herein report lipoblastoma of the neck in a 3 year old girl.

Predictors of posttraumatic convulsions in head-injured children.

The purpose of this study was to determine predictors of posttraumatic convulsions in children. Study subjects included children under 12 years of age, who were admitted to the Safdarjang Hospital, New Delhi, during the year 1997 (January to December) after suffering head trauma. The occurrence of first convulsion after head injury was taken as the outcome variable in the study. Medical records were reviewed for data about clinical, radiological and epidemiological features of such children. The study revealed that children younger than 2 years of age (odds ratio, OR 2.96; 95% confidence interval, CI 1.42-6.21), those suffering severe head injuries, i.e. with low Glasgow Coma Score (OR 3.07; 95% CI 1.40-6.77), and those with longer period of unconsciousness after head trauma, especially longer than 12 h (OR 1.71; 95% CI 0.69-4.19) have higher likelihood of suffering convulsions after head injury. However, none of the radiological findings were found to be significantly associated with posttraumatic convulsions.