Tuberculous choroidal granuloma in an HIV-positive patient.

We report a case of a 34-year-old HIV-positive patient undergoing treatment for pulmonary and lymph node Mycobacterium tuberculosis infection, who developed loss of vision secondary to a tuberculous choroidal granuloma.

Predicting local control of choroidal melanomas following ¹°6Ru plaque brachytherapy.

BACKGROUND: We evaluated the control rate of choroidal melanomas treated with ¹°6Ru plaque brachytherapy to identify the risk factors associated with local recurrence and lack of response. METHODS: A retrospective review of ¹°6Ru plaque brachytherapy for patients with choroidal melanoma treated at St Bartholomew's Hospital, London. Survival analysis was used to assess associations between evaluated age, sex, location, foveal proximity, tumour base and height, presence of lipofuscin and subretinal fluid, apex dose, radiation rate and type of plaque with time to local recurrence. Logistic regression analysis was used to assess to evaluate the association between the same set of variables and lack of tumour response. RESULTS: From January 2002 to December 2006 189 patients were treated. The follow-up ranged from 12 to 78 (median 33) months. None of the patients received adjuvant diode laser thermotherapy. The control rate was 85.7% (14 recurred while 13 did not respond). Of the patients who had local recurrence, univariate survival analysis demonstrated an association with younger patients, foveal proximity, preoperative subfoveal fluid and tumour base >11 mm. Age and foveal proximity remained significant in a Cox multiple variable model (p=0.03). Of the patients who did not respond, logistic regression analysis showed that lack of response was associated with a tumour height >5 mm, confirmed through multiple variable analysis (p=0.027). CONCLUSIONS: Tumours that are close to the fovea in young patients appear more likely to show local recurrence. Tumour height >5 mm was the only prognostic factor that determined lack of response. These results may be used to select which tumours require adjuvant therapy.

Light sensitivity and pain sensation during cataract surgery. A comparative study of two modes of anaesthesia.

The objective of this study was to compare the light sensitivity and pain experienced by patients undergoing cataract surgery under subtenon and topical with intracameral anaesthesia. Fifty-four patients were randomly assigned to receive either two drops of proxymethacaine 0.5% as topical anaesthesia with 0.5 ml preservative-free 1% intracameral lidocaine or 4 ml 2% lignocaine as subtenon anaesthesia. Light sensitivity and overall pain perception were recorded at the end of surgery. The mean pain score in the subtenon group (0.11; range 0-1) was lower than in the topical group (1.07; range: 0-3, P < 0.001). The mean light-sensitivity score was lower in the subtenon group (0.26; range: 0-4) than in the topical group (1.29; range: 0-4, P = 0.001). Subtenon anaesthesia was more effective in suppressing light sensitivity and pain during cataract surgery than topical with intracameral anaesthesia. This suggests that use of subtenon anaesthesia may lead to a more comfortable operative experience.

The effect of dietary oregano essential oil on microbial growth of rabbit carcasses during refrigerated storage.

The effect of dietary supplementation with oregano essential oil on microbial growth of rabbit carcasses during refrigerated storage was investigated. A total of 45 weaned rabbits were separated into three equal groups with three subgroups each. One group was given the basal diet and served as control and the other two groups were administered diets supplemented with oregano essential oil at levels of 100 and 200mg/kg diet, respectively (OR100 and OR200 groups). Total viable counts, Pseudomonas spp., lactic acid bacteria, Brochothrix thermosphacta, Enterobacteriaceae and yeast and mould counts, as well as off-odours and appearance of slime were all assessed on rabbit carcasses stored at 3±1°C for 12 days. The results showed that performance parameters were not affected (p>0.05) whereas the dietary supplementation with oregano essential oil resulted in lower (p<0.05) average microbial counts on the carcasses, compared to controls, throughout storage. Dietary supplementation with oregano essential oil at 200mg/kg was more effective in inhibiting microbial growth compared with 100mg/kg. Sensory evaluation scores indicated that the carcasses obtained from OR100 and OR200 groups gave a noticeable putrid odour after days 8 and 10, respectively, whereas the control carcasses developed off-odours after the 6th day of storage. Slime formation in the controls was observed after day 6, while the OR100 and OR200 groups were just beginning to show slime after days 8 and 10, respectively.

A survey of investigations used for the management of glaucoma in hospital service in the United Kingdom.

AIMS: This study surveys the current use of investigations for the management of glaucoma in hospital practice by UK ophthalmologists. METHODS: A total of 1007 questionnaires were posted to all active NHS consultant ophthalmologists. They were asked to indicate the type of hospital (whether university (UTH) or general (DGH) hospital), glaucoma specialist status, and availability and use of automated perimetry, disc photography, HRT, GDx, OCT, and pachymetry. RESULTS: A total of 493 completed questionnaires were received and 469 were analysed: 284 (60.6%) DGH, 185 (39.4%) UTH, 144 (30.7%) glaucoma specialists. There was good availability of automated perimetry (467, 99.6%), disc photography (420, 89.6%), pachymetry (374, 79.7%), OCT (212, 45.2%), HRT (206, 43.9%), and GDx (59, 12.6%). A total of 308 (65.7%) consultants had at least one digital imaging instrument available. The majority of consultants used SAP (347, 74.0%) and SITA-fast (282, 60.1%) for glaucoma suspects, and for monitoring glaucoma (283, 60.3% and 197, 42.0%, respectively). Some used Esterman (155, 33.0%) and Goldmann fields (90, 19.2%) in addition to SAP and SITA-fast for glaucoma suspects. Few consultants used short-wavelength automated perimetry and frequency-doubled perimetry. Of the three imaging tests, HRT was the most commonly used investigation for disc asymmetry, early glaucoma, glaucomatous progression, ocular hypertension, normal tension glaucoma, and unreliable visual fields (P<0.0001). Where pachymeters were available, 333 (89.0%) consultants and 117 (98.3%) glaucoma specialists used pachymetry in glaucoma management. CONCLUSIONS: There was some variation in the use of investigations for the diagnosis and management of glaucoma, reflecting the range of techniques available. SAP, SITA-fast, and pachymetry were the most commonly utilised investigations followed by HRT. Glaucoma specialist status, type of hospital, and presence of research influenced the availability and use of all investigations, except visual fields.

A case report of Merkel cell carcinoma on chronic lymphocytic leukemia: differential diagnosis of coexisting lymphadenopathy and indications for early aggressive treatment.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is a monoclonal disorder, characterized by a progressive proliferation of functionally incompetent B lymphocytes. There is increased evidence of association between CLL and skin cancers, including the uncommon Merkel cell carcinoma (MCC). CASE PRESENTATION: A case report of an 84-year old male, who presented with an aggressively recurrent form of MCC on the lower lip, on the background of an 8-year history of untreated CLL. During the recurrences of MCC, coexisting regional lymphadenopathy, posed a problem in the differential diagnosis and treatment of lymph node involvement. Histopathology and immunoistochemistry showed that submandibular lymphadenopathy coexisting with the second recurrence of MCC, was due to B-cell small lymphocytic lymphoma. The subsequent and more aggressive recurrence of the skin tumor had involved the superficial and deep cervical lymph nodes. Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies. CONCLUSION: MCC has a high incidence of regional lymphadenopathy at presentation (12-45%) and even when it arises on the background of chronic leukemia, lymphadenopathy at presentation should be managed agressively with elective lymph node dissection. We overview the postulated correlation between Merkel tumor and CCL, the differential diagnosis of regional lymphadenopathy during the recurrences of the skin tumor and the strategies of treatment.

Corrected QT interval in relation to the severity of diabetic autonomic neuropathy.

The aim of this study was to investigate to what extent the existence of objective signs of diabetic autonomic neuropathy affects the corrected QT interval (QTc) in diabetic subjects. A total of 105 diabetic subjects (type 1, n = 53; type 2, n = 52) as well as 40 matched (by age and sex) control subjects were studied. All subjects underwent the battery of five Ewing tests. Autonomic neuropathy was diagnosed if two of the five tests were abnormal. In addition, the result of each test was considered as normal (grade = 0), borderline (grade = 1) or abnormal (grade = 2), and on the basis of the sum of the scores we calculated a total score for autonomic neuropathy. The QTc interval was measured at rest, and a value > 440 ms was considered abnormal. The QTc interval was significantly more prolonged in diabetic persons with autonomic neuropathy than in those without neutopathy and in control subjects: 408.4 +/- 24.2 ms vs. 394.6 +/- 27.9 ms and 393.6 +/- 25.5 ms respectively (P = 0.001). Furthermore, multivariate analysis controlling for age, sex, systolic and diastolic blood pressure, body mass index (BMI), waist-hip ratio (WHR), smoking, type and duration of diabetes, type of treatment, HBA1c and total score of autonomic neuropathy eliminated the role of all these factors as potential confounders except for the total score of autonomic neuropathy, which was found to affect QTc interval independently and significantly (P = 0.012). In summary, the present study confirmed the well-known relation between autonomic neuropathy and QTc interval; in addition, it showed that QTc prolongation is associated with major degrees of autonomic neuropathy.

A study of apoptosis in brain tumors by in situ end-labeling method.

Recognition of apoptotic cells has recently been facilitated by in situ end-labeling (ISEL) techniques which identify DNA strand breaks. The ISEL assay has been applied in 26 brain tumors, meningiomas, and gliomas of different grade of malignancy in order to determine the apoptotic index (AI). Apoptotic cells were readily found in all the examined tumors; in most cases the AI values were below 1%. Any significant relationship between AI and grade of malignancy could not be determined. However, the AI mean value of the meningiomas was higher than that of gliomas WHO II and III, respectively. Furthermore, it seemed that in the examined gliomas, with the exception of the glioblastoma group, low grade malignancy was related with higher AI values. The latter decreased gradually in the WHO II and III group of tumors, respectively. Our preliminary results indicate that an apoptotic process may play a significant role in brain tumor kinetics and will probably contribute to our understanding of the biologic behavior of those tumors.