Medical and Surgical Management of Keratomycosis.

BACKGROUND: Fungal keratitis is a diagnostic and therapeutic challenge to the ophthalmologist. If not treated energetically it results in marked ocular morbidity and permanent visual loss. METHODS: Twenty five patients of fungal keratitis were studied for their response to management and final visual outcome. RESULT: Males outnumbered females. Medical treatment was successful in 72% cases, while 28% required surgical intervention. Keratoplasty was done in five patients out of which graft was clear in four after one year of follow up. Three of these underwent optical keratoplasty since therapeutic grafts became opaque. CONCLUSION: Early recognition of the disease and institution of prompt therapy is the key to successful management in fungal keratitis. Occasionally surgical management is required to preserve anatomical integrity of the globe and to salvage useful vision.

Prevalence of vitreomacular interface abnormalities on spectral domain optical coherence tomography of patients undergoing macular photocoagulation for centre involving diabetic macular oedema.

AIM: Macular traction may influence the formation and response to treatment of diabetic macular oedema (DME). The aim of this study was to determine the prevalence and associations of spectral domain optical coherence tomography (SD-OCT) evident epiretinal membrane (ERM) and/or partial vitreomacular separation (pVMS) in consecutive patients undergoing macular photocoagulation for centre involving DME. METHODS: A single-centre retrospective cross-sectional observational study. RESULTS: 198 eyes of 198 patients were included. Twelve per cent of eyes demonstrated pVMS and 14% ERM. All cases of pVMS had vitreoretinal adhesion located in the Early Treatment Diabetic Retinopathy Study grid central 1 mm subfield. In 2/3 of ERM cases, ERM was either found in the central subfield or the thickening associated with ERM was contiguous with the thickening in the central subfield. Patients with signs of ERM or pVMS were significantly older and had significantly worse acuity than those without (mean age 67.2 vs 62.8 years (p=0.02); 0.49 vs 0.31 logMAR, p=0.0006). Macular thickness was similar in both groups. The prevalence of pVMS and/or ERM were 31% in Caucasian, 5% in Asian and 24% in Afro-Caribbean subjects (p=0.11). CONCLUSIONS: ERM or pVMS was found on SD-OCT scanning in 25% of patients undergoing laser for centre involving DME. In 20% of all patients, these potentially tractional elements were either present in the central subfield scan or the traction was contiguous with the central macular thickening, suggesting a possible role for surgical or enzymatic relief of traction in their management. This requires targeted investigation.

The difficulties of diagnosing myositis ossificans circumscripta in the paraspinal muscles of a human immunodeficiency virus-positive man: magnetic resonance imaging and temporal computed tomographic findings.

Myositis ossificans circumscripta (MOC) is an uncommon disease that has been reported to develop after trauma, burns, and infections, as well as in cases in which the pathogenesis is unknown. Although most cases of MOC develop below the clavicles, it has been reported in the head and neck area, where it primarily involves the muscles of mastication. To our knowledge, there have been only 4 previous reports of MOC affecting the paraspinal muscles. We report the fifth such case, which developed in a human immunodeficiency virus-positive patient, and describe the longitudinal imaging changes of MOC.

Imaging of the osseous, membranous, and perilymphatic labyrinths.

The inner ear is located within the petrous portion of the temporal bone and consists of the membranous, perilymphatic, and the outer osseous labyrinths. Together, these structures form the end organs for mediating hearing and balance. This article provides a detailed review of the neonatal anatomy and development of these structures, knowledge of which derives in great part from advances in CT and sophisticated MR imaging. Current research should soon enable clinicians to identify a wide variety of subtle lesions of the inner ear that heretofore have been inaccessible to imaging diagnosis.

Imaging of postnatal maturation of the skull base.

The skull begins to form when mesenchyme thickens and condenses around the developing brain. At the skull base, most of this mesenchyme derives from neural crest, and some arises from general head mesenchyme. This article reviews the patterns for maturation of the ossification, sutures, and synchondroses in the occipital, the sphenoid, and the orbitoseptal regions, and reports additional data derived from specific study of CT scans of the skull base in children and young adults.

Forms of cadmium in sandy soils after amendment with soils of higher fixing capacity.

Most of the Cd applied through phosphatic fertilizers in sandy soils tends to stay in mobile forms (soluble or exchangeable) and hence the risk of it leaching to underground water or its uptake by plants is higher. A sequential extraction procedure was used to assess the efficacy of amending materials (soils containing inorganic or organic adsorption components) on the re-distribution of forms of Cd in a sandy soil. Amendment of the sandy soil with each of the three soils (yellow earth, lateritic podzolic and peaty sand) was generally effective in altering the more mobile or available forms of Cd to immobile or unavailable forms. The extent of alteration varied with the type of component present in the amendment soil, pH and the rate of Cd addition. The yellow earth was more effective at pH 7, whereas the peaty sand was equally effective at both pH 4 and 7 in altering the mobile to immobile forms. The lateritic podzolic soil was the least effective of the soils used at any of the pH values.

Assessment of olfactory status in allergic and non-allergic rhinitis patients.

A study undertaken to assess the olfactory acuity in allergic (group I) and non-allergic rhinitis (group II) patients in comparison with age and sex matched controls (group III). Patients presenting with atleast three of the five cardinal symptoms of rhinitis i.e. rhinorrhoea, sneezing, itching, headache and nasal obstruction were grouped as non-infective rhinitis and further divided into allergic rhinitis (group I, n = 20) and non-allergic rhinitis (group II, n = 20) based on nasal smear cytology positivity or negativity for eosinophils respectively. Detailed Ear, Nose and Throat examination was carried out in both the groups and peripheral blood samples were analysed for total, differential leukocyte and absolute eosinophil counts using standard techniques. In all the three groups the olfactory thresholds for 5 odorants i.e. musk (M), formalin (F), camphor (C), asafoetida (A, 10% aqueous solution) and oil of peppermint (P, 20%) were evaluated for testing musky, pungent, camphorous, putrid and minty odours respectively by the method described by Elsberg and Levy for quantitative olfactometry. The results indicated elevation of olfactory thresholds (delta %, calculated taking control values as 100%) for 4 or 5 odorants in group I and group II patients respectively as compared with controls (group I: delta % for P--89.6%; M--116.4%; A--55.8%; P < 0.001; C--73.1%; P < 0.02; F--26.6% N.S.; group II: P--96.9%; M--99.3%, P < 0.01 for both; A--66.8%; C--102.7%, P < 0.001; F--42%, P < 0.05). In the non allergic rhinitis group the magnitude of the olfactory loss was more severe except for the odorant musk. Further interpretations as per gender based specificities revealed more severe olfactory loss in males of both the groups for the odorants peppermint and musk and moderately severe olfactory loss for formalin and camphor as compared to females. However, for the odorant asafoetida females showed greater olfactory loss than males in both the groups (delta % 73.38% versus 52% in group I and 81.29% versus 69.7% in group II).

Role of laser therapy in post herpetic neuralgia.

The efficacy of combi laser therpay was evaluated in fifty cases of post neuralgia (PHN) of different age groups (31 to 81 years) and with varying duration of illness from 2 months to 4 and a half years in the present study. The affected areas were irradiated from a distance of 5 cms. using the probe of 12x70 watts at a frequency of 1000 Hz. each area being exposed for a time period of 5 minutes and 6 seconds. In each case the combi laser therapy was given for 15 consecutive days and therapeutic effect of the therapy was evaluated after 5th, 10th and 15th laser application during the treatment with the help of visual analouge scale (VAS). Patients started responding to the therapy after an average of 3.28 laser applications and VAS steadily decreased as the therapy progressed. After completion of therapy, 43 (86%) out of 50 cases showed excellent relief (76-100%) and remaining 7 (14%) cases showed partial relief, 4(8%) cases with good relief (51-75%), 2 (4%) cases with fair relief (26-50%) and 1(2%) case with poor relief (1-25%). Partial relief in our 7 cases could be due to multiple factors like prolonged duration of illness, involvement of ophthalmic division of trigeminal nerve and formation of scarring and keloids. No side effects were observed during the treatment as well as duing the follow up period of 8 weeks.

THE MULBERRY TUMOUR (A Case Report).

A case of tuberous sclerosis with the classical triad of adenoma sebaceum, mental retardation and epilepsy is reported in a 10 year old boy. Fundus examination revealed a typical "mulberry" tumour and CT scan showed multiple "brain - stones". Fundus examination as aid to early diagnosis is emphasized.

STUDY OF TRAUMATIC CATARACT IN OCCUPATIONAL AND ENVIRONMENTAL TRAUMA AND ITS MANAGEMENT.

Sixty cases of traumatic cataract in 5 years due to occupational and environmental hazards were studied to highlight mode of trauma, structural damage; management profile and final visual outcome. Thirty six (60%) cases had mechanical trauma whereas 18 (30%) cases had injuries due to non metalic or organic substances. Industrial accidents were responsible in 25 (41.66%) cases. Forty four cases (73.3%) had associated anterior segment injuries. Reconstruction of anterior segment with Posterior Chamber Intraocular lens (PC IOL) implantation could be done in 42 (70%) cases as primary or secondary procedure. Adherent leucoma, iridal trauma, posterior capsular tear and dislocated lens were noted problems. Forty six (76.67%) cases had attained 6/12 or better corrected visual acuity. Defective visual gain was due to corneal opacities and post operative complications.

Molecular characterization of light chain 3. A microtubule binding subunit of MAP1A and MAP1B.

Light chain 3 (LC3) is a subunit of the neuronal microtubule-associated proteins (MAPs), MAP1A and MAP1B. Recent findings show that the cDNAs for MAP1A and MAP1B encode polyproteins that contain the MAP1A or MAP1B heavy chain and a LC2 or LC1 subunit, respectively. We have sequenced a cDNA encoding rat LC3, and its sequence is not found in the MAP1A/LC2 or MAP1B/LC1 polyprotein cDNAs. The deduced amino acid sequence of LC3 is highly conserved between rat and mouse. Rat LC3 is a 16.4-kDa protein with a predicted pI of 9.2. It is encoded on a 1.7-kilobase mRNA. Our anti-LC3 antiserum shows that LC3 is abundant only in neurons and that the majority of LC3 in brain co-purifies with microtubules. Purified recombinant rat LC3 retains the ability to associate with microtubules assembled in the presence of brain MAPs and with microtubules assembled from purified tubulin. We propose that LC3 functions primarily as a MAP1A and MAP1B subunit and that its expression could regulate the microtubule binding activity of MAP1A and MAP1B.

Gene localization and developmental expression of light chain 3: a common subunit of microtubule-associated protein 1A(MAP1A) and MAP1B.

Microtubule-associated proteins 1A (MAP1A) and MAP1B are abundant neuronal MAPs thought to be involved in neurite formation and stabilization. The relative levels of MAP1A and MAP1B change dramatically during development, with MAP1B expression highest in forming neurons, and MAP1A expression highest in mature neurons. We examined the expression of light chain 3 (LC3), a subunit of both MAP1A and MAP1B, to see if its expression paralleled that of either heavy chain. Anti-LC3 immunohistochemistry reveals that LC3 in rat brain is restricted to neurons that are expressing either the MAP1A or MAP1B heavy chain. Although LC3 is expressed exclusively in cells expressing heavy chains, developmental changes in the total amount of LC3 protein are not proportional to changes in the amount of either the MAP1A or MAP1B heavy chain. LC3 protein expression measured by quantitiative immunoblotting is twice as high in postnatal brain as in embryonic and adult brain. The localization of the LC3 gene to human chromosome 20cen-q13 demonstrates that LC3 is the only MAP1 subunit that is not linked to the heavy chain genes. Because LC3 is a component of both the MAP1A and MAP1B microtubule-binding domains, the heavy-chain independent regulation of LC3 expression might modify MAP1 microtubule-binding activity during development.