Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy.

PURPOSE: To evaluate the evolution of morphologic features of autoimmune pancreatitis (AIP) at computed tomography (CT) and to identify imaging features that can predict AIP response to corticosteroid therapy (CST). MATERIALS AND METHODS: This HIPAA-compliant retrospective study had institutional review board approval. From among a cohort of 63 patients with AIP, 15 patients (12 men, three women; mean age, 64.7 years; age range, 30-84 years) who underwent sequential CT examinations before treatment were included to assess the evolution of disease by reviewing pancreatic, peripancreatic, and ductal changes. Of these patients, 13 received CST and underwent posttreatment CT; these CT studies were evaluated to determine if there were imaging features that could predict response to CST. RESULTS: The disease evolved from changes of diffuse (14 of 15 patients) or focal (one of 15 patients) parenchymal swelling, peripancreatic stranding (10 of 15 patients), "halo" (nine of 15 patients), pancreatic duct changes (15 of 15 patients), and distal common bile duct narrowing (12 of 15 patients) to either resolution or development of ductal strictures and/or focal masslike swelling. In 13 patients treated with CST, favorable response to treatment was seen in those with diffuse pancreatic and peripancreatic changes. Suboptimal response was seen in patients with ductal stricture formation (two of 13 patients) and in those in whom focal masslike swellings persisted after resolution of diffuse changes (seven of 13 patients). CONCLUSION: CT features like diffuse swelling and halo respond favorably to CST and likely reflect an early inflammatory phase, whereas features like ductal strictures and focal masslike swelling are predictive of a suboptimal response and symbolize a late stage with predominance of fibrosis.

Genitourinary imaging with noncontrast computerized tomography--are we missing duplex ureters?

PURPOSE: Noncontrast computerized tomography has replaced excretory urography as the first line diagnostic tool for evaluating nephrolithiasis at many centers. We evaluated the ability of noncontrast computerized tomography to detect ureteral duplication to determine how frequently these anomalies are under diagnosed. MATERIALS AND METHODS: Computerized tomography images of 14 patients with known ureteral duplication who had previously undergone noncontrast and contrast enhanced computerized tomography and 5 control patients with normal ureteral anatomy were interpreted by 2 blinded radiologists who specialize in genitourinary imaging. RESULTS: The sensitivity of axial computerized tomography with contrast material, axial computerized tomography without contrast material and coronal computerized tomography without contrast material was 96%, 59% and 65%, respectively. The negative predictive value of axial computerized tomography with contrast material, axial computerized tomography without contrast material and coronal computerized tomography without contrast material was 95%, 65% and 67%, respectively. The accuracy of axial computerized tomography with contrast medium was significantly higher than that of noncontrast axial or noncontrast coronal computerized tomography (each p <0.01). CONCLUSIONS: Duplicated ureters, which represent a challenge to the endourologist, are under diagnosed on noncontrast computerized tomography. Urologists and radiologists should be aware of this limitation and contrast studies should be done when anatomical anomalies are suspected.

Body Dysmorphic Disorder: gender differences and prevalence in a Pakistani medical student population.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by a preoccupation with an imagined or slight defect which causes significant distress or impairment in functioning. Few studies have assessed gender differences in BDD in a non clinical population. Also no study assessed BDD in medical students. This study was designed to determine the point prevalence of BDD in Pakistani medical students and the gender differences in prevalence of BDD, body foci of concern and symptoms of BDD. METHODS: The medical students enrolled in a medical university in Karachi, Pakistan filled out a self-report questionnaire which assessed clinical features of BDD. BDD was diagnosed according to the DSM-IV criteria. RESULTS: Out of the 156 students, 57.1% were female. A total of 78.8% of the students reported dissatisfaction with some aspect of their appearance and 5.8% met the DSM-IV criteria for BDD. The male to female ratio for BDD was 1.7. Regarding gender differences in body foci of concern, the top three reported foci of concern in male students were head hair (34.3%), being fat (32.8%), skin (14.9%) and nose(14.9%), whereas in females they were being fat (40.4%), skin (24.7%) and teeth (18%). Females were significantly more concerned about being fat (p = 0.005). Male students were significantly more concerned about being thin (p = 0.01) and about head hair (p = 0.012). CONCLUSION: BDD is fairly common in our medical student population, with a higher prevalence in males. Important gender differences in BDD symptomatology and reported body foci of concern were identified which reflected the influence of media on body image perception. The impact of cultural factors on the prevalence as well as gender differences in BDD symptomatology was also established.

Self-medication amongst university students of Karachi: prevalence, knowledge and attitudes.

OBJECTIVE: To determine the prevalence, attitude and knowledge of self-medication amongst university students of Karachi, Pakistan. METHODS: This cross-sectional, study was conducted from Jan-Feb 2007. A convenience sample was taken from 2 medical and 2 non-medical universities of the city of Karachi, Pakistan. Data was analyzed using SPSS v 14 and associations were tested using the Chi square test. RESULTS: Of the 572 participants (mean age=21 +/- 1.8 years, Male: Female ratio=1:1.5), 295 were medical and 277 were non-medical students. The prevalence of self-medication was 76%. Forty three percent students stated that they alter the regimen of prescribed medicines while 61.9% stated that they stop taking a prescribed medicine without consulting a doctor. The most common reason for self-medication was previous experience (50.1%) and the most common symptoms were headache (72.4%), flu (65.5%), and fever (55.2%). Commonly used medicines were analgesics (88.3%), antipyretics (65.1%) and antibiotics (35.2%). Eighty seven percent of students thought self-medication could be harmful and 82.5% students thought that it was necessary to consult a doctor before taking a new medicine. There was no significant difference between the self medication practices of medical and non medical students (p=0.8) CONCLUSION: Prevalence of self-medication is high in the educated youth, despite majority being aware of its harmful effects. There is a need to educate the youth to ensure safe practices. Strict policies need to be implemented on the advertising and selling of medications to prevent this problem from escalating.

The Efficacy and Safety Profile of Ocriplasmin in Vitreomacular Interface Disorders.

Vitreomacular adhesion (VMA) describes the adhesion of the posterior hyaloid face to the inner retina in any part of the macula. This can arise after incomplete separation of the posterior vitreous cortex from the macula during vitreous liquefaction. While the VMA may resolve spontaneously, a strong and persistent adhesion can lead to a variety of anatomical changes, including vitreomacular traction (VMT) and macular hole (MH). Both conditions can present with metamorphopsia and decreased vision. In cases of symptomatic VMT and full-thickness macular hole, pars plana vitrectomy has long been the standard of care. However, due to the possible surgical complications and need for postoperative care, many have searched for non-surgical options via pharmacologic vitreolysis. Ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) is a recombinant protease approved in October 2012 for the treatment of symptomatic vitreomacular adhesion (VMA). There have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. This publication reviews the efficacy and safety of ocriplasmin injection for VMA based on previously published data.

Herpes keratitis in a patient undergoing treatment with topical mitomycin C.

PURPOSE: To report a case of herpetic keratitis in a patient undergoing mitomycin C therapy for conjunctival squamous cell carcinoma. METHOD: Case report. RESULTS: A 70-year-old man was referred to the Massachusetts Eye Research and Surgery Institution in consultation for a persistent redness in the right eye. He was diagnosed with conjunctival squamous cell carcinoma and treated with topical mitomycin C (MMC). The patient initially improved on topical MMC therapy. At the end of the second cycle of topical MMC, he complained of intense ocular pain and redness in the eye under treatment. A diagnosis of herpetic epithelial keratitis was made based on the clinical findings, and he was subsequently treated with 1 drop of trifluridine 9 times per day in the affected eye. The patient responded with dramatic improvement and resolution of symptoms. CONCLUSIONS: This case reports a reactivation of latent herpes simplex virus with productive ocular infection, triggered by MMC therapy and highlights the importance of awareness of this possible risk associated with the use of MMC.

Microperimetry findings in patients with birdshot chorioretinopathy.

OBJECTIVE: To assess the role of microperimetry-1 (MP1) as an ancillary tool in patients with birdshot chorioretinopathy (BSCR). DESIGN: Observational cross-sectional study. PARTICIPANTS: Twenty-three eyes of 23 patients. METHODS: A review of medical records was conducted of patients with BSCR seen at our institution, from January 2008 to August 2008, on whom MP1 had been performed. Of the 23 eyes included in the study, 15 eyes were identified as having HLA-A29 positive BSCR; 8 eyes with no known ocular pathology were used in the analysis as the control group. The clinical status was assessed by biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography. RESULTS: When eyes with active disease were compared with eyes with inactive disease there was a statistically significant difference (p = 0.001) between them in the number of points below 16 dB. The difference was also statistically significant (p = 0.04) when it was adjusted for visual acuity, associated disease, and age. When eyes of patients with inactive disease were compared with control eyes, there was a statistically significant difference (p = 0.01) in the number of points below 16 dB, suggesting that not all patients may recover their full retinal sensitivities. When eyes of patients with active disease were compared with controls there was a statistically significant difference (p = 0.01) between them in the number of points below 16 dB after adjusting for age, visual acuity, and associated disease (macular edema and epiretinal membrane). CONCLUSIONS: Microperimetric quantification of macular sensitivity in patients with BSCR may provide an ancillary tool to evaluate activity and may help to assess visual impairment in these patients.