Iris and anterior chamber involvement in acute lymphoblastic leukemia

The authors describe a 6-year-old child, with a history of acute lymphoblastic leukemia, who presented with leukemic infiltration of the anterior segment of one eye mimicking anterior uveitis. After tissue diagnosis, administration of radiation therapy to the affected eye resulted in dramatic improvement of the condition. Involvement of the iris and anterior chamber is a recognized but unusual manifestation of leukemia. In the absence of systemic relapse, local radiation therapy without chemotherapy is highly effective, although the prognosis in these patients may be guarded.     

Critical appraisal of transesophageal echocardiography in cardioversion of atrial fibrillation

Atrial fibrillation is the most common sustained cardiac arrhythmia and an important health concern in the United States because of the increasing aging population. Cardioversion of atrial fibrillation to sinus rhythm to relieve symptoms and to reduce the incidence of thromboembolism is now common practice. Recently, transesophageal echocardiography (TEE)-facilitated cardioversion emerged as an acceptable therapeutic alternative owing to the assumption that early cardioversion can obviate many of the concerns and disadvantages associated with the conventional approach. We review the current standing of TEE-facilitated early cardioversion vis-à-vis the salient cardioversion issues and its potential future role amid evolving cardioversion paradigms.     

Biochemical and ultrastructural evidences for toxicity of lead through free radicals in rat brain

Studies suggest that some lead-induced toxic effects may occur through free radical production and oxidative stress. This study examined the relationship between brain histopathological alterations and oxidative stress in subchronic lead exposure. Male Albino rats received lead acetate at 0.01%, 0.05% and 0.1% w/v in their drinking water for 30 days. Animals given sodium acetate (0.1% w/v) served as control in the same period. At the end of exposure, blood-lead levels, blood catalase (CAT) and superoxide dismutase (SOD) activities and malondialdehyde (MDA) content (in blood and brain) were measured. The brain tissue samples were prepared and analysed by light and scanning electron microscopy. The results show that, the blood-lead levels in treated animals were higher in comparison with control. CAT and SOD activities in animals treated with 0.01% and 0.05% w/v did not increase in comparison with control (P > 0.05) but these values were higher in animals treated with 0.1% w/v lead acetate (P < 0.01). MDA content in blood and brain of animals treated with lead acetate 0.1% w/v, increased significantly (P <0.01), but these values were not significantly increased in other treated animals. No major histopathological alterations were detected in the brains of animals treated with lead acetate at 0.01% and 0.05% w/v. In animals treated with lead acetate 0.1% w/v, demyelinization and collagenous scar formation with neuronal atrophy in hippocampus region was observed. It is concluded that lead acetate induce oxidative stress which has an important role in brain damage in rats.     

Are Kuwaitis getting fatter?

The purpose of the study is to compare temporal changes in BMI, overweight (BMI > 25 Kg/m2) and obesity (BMI > 30 Kg/m2) of two independent cross-sectional samples of Kuwaitis studied in 1980-81 and 1993-94. The earlier sample of 2067 (896 men and 1171 women) and the latter sample of 3435 (1730 men and 1705 women) adult Kuwaitis (aged > or = 18 years), were drawn from primary health care (PHC) clinics and studied for nutritional assessment and for prevalence of obesity in 1980-81 and 1993-94, respectively. Weight was measured in kilograms and height in meters to obtain the body mass index (BMI), which is the weight in kilograms divided by the height in meters squared (Kg/m2). BMI > 25 and > 30 Kg/m2 were classified as overweight and obesity, respectively. The results of the study show that mean BMI (Kg/m2) increased significantly (p < 0.001) by 10.0 and 6.2% (2.5 and 1.7 Kg/m2) among men and women, respectively. Prevalence of overweight and obesity (BMI > 25 and > 30 Kg/m2) increased by 20.6 and 15.4% and by 13.7 and 8.4% among men and women, respectively. After controlling for sociodemographic differences between the two study periods, mean BMI was 2.0 and 1.6 Kg/m2 higher in 1993-94 than in 1980-81 among men and women, respectively. Prevalence of overweight and obesity (BMI > 25 and > 30 Kg/m2) also increased among both genders between the two periods (OR = 2.1 , 95% CI 1.7-2.7 and OR = 1.9, 95% CI 1.5-2.4, for men and OR = 2.2, 95% CI 1.6-3.0 and OR = 1.4, 95% CI 2.2 CI 1.0-1.9, for women). It can be concluded that the BMI, prevalence of overweight and obesity increased among Kuwaitis between 1980-81 and 1993-94, probably due to the effects of modernization, affluence, increased food consumption and the concomitant changes to sedentary lifestyles. The rate of temporal changes in BMI and obesity were higher, by comparison, in Kuwait than in selected other countries.     

Independent component analysis of subdurally recorded occipital seizures

OBJECTIVE: To study the components of occipital seizures using independent component analysis (ICA) of subdurally recorded electroencephalogram (EEG) data. METHODS: Twenty-seven subdurally recorded occipital seizures from eight patients were studied. ICA was performed, and the resulting independent components (ICs) were compared with respect to their power, frequency, degree of spread within the epileptogenic zone, and propagation patterns. The ictal ICs were further subdivided into propagating and non-propagating types. RESULTS: ICA provided information over and above that supplied by standard visual EEG analysis, confirming that all the seizures originated in the occipital lobe, and affording additional knowledge regarding the nature of the seizure onset zone. Each seizure was composed of multiple ICs, some of which propagated while others remained within the epileptogenic zone. There was no statistical difference between the propagating and non-propagating ICs with respect to power or frequency. However, propagating ICs involved a significantly greater number of recording electrodes at their onset when compared to the non-propagating ICs. CONCLUSIONS: The propagation likelihood of ICs in occipital seizures is independent of their power or frequency, but it is dependent on the volume of brain giving rise to that signal; ICs that are generated by a greater volume of brain within the epileptogenic zone are more likely to propagate. SIGNIFICANCE: This study shows that ICA has the potential to be used to redefine the epileptogenic zone and guide the extent of cortisectomy for the treatment of patients with medically intractable occipital epilepsy.     

Analgésie autocontrôlée chez les enfants atteints d’anémie falciforme: l’expérience d’un centre canadien

Résumé  Afin d’évaluer’ la prise en charge de la douleur chez des enfants atteints d’anémie falciforme, nous avons revu rétrospectivement les dossiers médicaux de 26 enfants hospitalisés pendant une période de 28 mois, pour crises vaso-occlusives (CVO) et qui ont bénéficié de l’analgésie contr?lée par le patient (ACP) à 54 occasions. Tous ces patients ont eu une ACP à la morphine à l’exception d’un seul qui a re?u de la mépéridine. La dose des bolus, de la perfusion de base et la dose totale de médicament ont beaucoup varié pendant les trois premiers jours du traitement. L’utilisation de morphine chez les enfants qui se sont servis du bolus plus perfusion de base a été significativement plus importante que chez ceux qui n’ont re?u que les bolus. Toutefois, les scores de douleur n’ont pas été significativement différents. Un tiers des enfants a re?u des adjuvants en plus des antalgiques. La nausée (n=6), les vomissements (n=6) et le prurit (n=6) sont survenus chez 11% des patients. II n’y a pas eu d’épisode de sédation excessive ou de dépression respiratoire. Six patients avaient un syndrome thoracique aigu à l’admission, et deux d’entre eux ont d? être admis pour une nuit aux soins intensifs. A deux occasions, les parents ont décidé d’arrêter l’ACP du fait d’une mauvaise analgésie. En nous appuyant sur notre expérience, nous proposons quelques recommandations pour l’amélioration de la qualité de l’ACP dans la prise en charge de la douleur des CVO chez les enfants et les adolescents.

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Summary  To Examine our experience of pain management in children with sickle cell disease (SCD), we retrospectively reviewed the medical charts of 26 patients hospitalized over a 28 month period, for vaso-occlusive crisis (VOC) who used patient controlled analgesia (PCA) on 54 different occasions. All of the patients used morphine PCA, except one who used meperidine. The bolus dose, use of basal infusion and total amount of drug received daily varied greatly, over the first three days of therapy. Morphine use in those admissions which used bolus plus basal PCA was significantly higher than those which used bolus only. However, pain scores were not significantly different. One-third of the admissions used adjuvant pain medication. Nausea (n=6), vomiting (n=6) and pruritus (n=6) each occured in 11% admissions. There were no episodes of excessive sedation or respiratory depression. Six patients had documented acute chest syndrome on admission, two of which necessitated overnight stays in ICU. On two occasions, parents decided to stop their child’s PCA due to dissatisfaction with pain relief. Recommendations for continuous quality improvement of PCA use in the management of VOC pain in children and teens with SCD are proposed based on this centre’s experience.