Exudative macular degeneration and intravitreal triamcinolone: 18 month follow up

Purpose: To evaluate the safety and efficacy of intravitreal triamcinolone after 18 months of follow up in patients with age-related macular degeneration and subfoveal or juxtafoveal choroidal neovascularization considered unsuitable for laser photocoagulation. Methods: Thirty eyes of 28 patients, referred from general eye clinics as well as the private clinic of one of the authors to a hospital-based retinal out-patient clinic, were treated with an intravitreal injection of triamcinolone (4mg). The primary outcome measure was the proportion of eyes with loss of six or more lines on a Bailey-Lovie Chart. The incidence of adverse events associated with treatment was also observed. Results: Of the 20 eyes with initial visual acuity (VA) of 6/60 or better, the vision was maintained (± 1 Bailey-Lovie lines) in 11 eyes (55%), while six eyes (30%) suffered severe visual loss (six or more lines). The VA improved by five to six lines in three of 10 eyes with initial vision of 3/60 or worse. Three of four eyes receiving a second injection suffered either progressive cataract or elevated intra-ocular pressure (IOP) requiring cataract surgery and/or filtering surgery. One of 26 eyes (3%) receiving a single injection showed progression of cataract and elevation of IOP within 6 weeks of treatment and required anti-glaucoma medication for 6 weeks. Progression of nuclear sclerosis 8–12 months after treatment was observed in six of 26 eyes (23%) receiving a single injection. Conclusions: The results of the present study suggest that a single intravitreal injection of 4 mg triamcinolone is reasonably well tolerated by the human eye. The rate of development of severe visual loss was less than reported for historical controls. Because the results are preliminary and uncontrolled, the treatment should not be used routinely until its benefit to patients is established by a prospective, randomized controlled study.     

Evaluation of the clinical efficacy and safety of halofantrine in falciparum malaria in Ibadan, Nigeria

Fifty subjects with acute symptomatic uncomplicated falciparum malaria were treated orally with halofantrine hydrochloride 500 mg 6 hourly for 3 doses if their body weight was 40 kg and above, or 8 mg/kg body weight 6 hourly for 3 doses if their weight was below 40 kg. Parasitaemia cleared in all subjects within 72 h. There was recurrence of parasitaemia in 9 subjects after day 14, and retreatment with halofantrine resulted in prompt clearance of parasitaemia in all but one of these patients. The mean clearance times of parasitaemia, fever and other symptoms were 33.6 +/- 13.0 h, 20.7 +/- 15.3 h, and 35.0 +/- 10.7 h respectively. Minor gastrointestinal side effects occurred in 2 subjects and pruritus in 7 subjects. The pruritus was mild in all but one subject. Haematological and biochemical indices were not adversely affected by treatment except in one subject in whom liver enzymes were elevated before treatment and more than doubled following treatment.     

Medical Law and Ethics.

Medical law as a discrete autonomous discipline—independentof tort, criminal law, and family law, from which it derivessustenance—has excited a lot of interest in the last 20yr. Selecting articles for an anthology is therefore a dauntingbut not insurmountable task. Professor Sheila McLean chose thearticles for inclusion in the anthology in an admirable andeclectic manner, even though one would have wished that somestriking omissions were included. The anthology—Medical Law and Ethics—is dividedinto four parts: (i) negligence/consent; (ii) reproduction;(iii) human experimentation and research; and (iv) death anddying. One golden thread runs through the four parts: the rightof autonomy, which is variously described as the right of self-determination,the right to privacy, liberty right, and the right to be letalone. The right of     

Effects of the diuretics, triamterene and mersalyl on active sodium transport mechanisms in isolated frog skin

1. Triamterene reduces the rate coefficients for sodium movement into the transporting system of the isolated frog skin. The isotopically measured ;active sodium transport pool' is also reduced.2. Mersalyl reduces the rate coefficient for sodium and the calculated sodium flux from the transporting system to the inner bathing solution. The ;active sodium transport pool' is increased by this diuretic.3. The action of triamterene closely resembles that of amiloride and both reduce the entry of sodium into the system. In contrast, mersalyl limits the exit of sodium ions from the skin.     

Giant renal oncocytoma masquerading as infiltrating renal cell carcinoma: case report and literature review

Renal oncocytomas (RO) are tumours containing a population of cells with highly differentiated eosinophilic granular cytoplasm, extremely rich in mitochondria. It is estimated they account for about 3 to 7% of all solid renocortical tumours that were previously regarded as renal cell carcinoma. Based on their clinical behaviour and distinct pathologic features they are now regarded as benign renal tumours, often less than 5cm in diameter. We present a case of giant renal oncocytoma in a patient with synchronous bladder tumour, with pre-operative clinical, urographic and ultrasound features of locally advanced renal cell carcinoma (RCC). Findings at surgery included huge right renal tumour with infiltration to the duodenum; hepatic colic flexure; gall bladder; liver capsule and the greater omentum with small indurations at the base of the bladder. There was no tumour extension to the renal vein, no peritoneal seedling, no nodal metastasis and no ascites. Radical nephrectomy was carried out with good prognosis and without recurrence 52months post nephrectomy. This presentation, besides highlighting the possible giant nature of RO, also illustrates the malignant potential of RO to infiltrate contiguous structures and mimics infiltrating RCC. In view of the difficulties at establishing pre-operative diagnosis in this disease and because nephron-sparing surgery is curative, especially for the well-circumscribed tumours, RO should be considered in the management of patients with features of infiltrating RCC. A review of literature is also presented.     

T1N0M0 bronchogenic carcinoma: assessment by CT

We reviewed medical records and conventional chest radiographs that showed a solitary T1N0M0 nodule in 23 patients who had non-oat-cell bronchogenic carcinoma. No patient had evidence of metastases, either on the chest radiograph or clinically. All patients underwent computed tomography (CT) examination of the thorax, including the adrenal glands. Only one patient (4%) had mediastinal lymph nodes greater than 1 cm in diameter accessible to mediastinotomy; anterior mediastinotomy confirmed metastatic spread in this patient, which precluded curative resection. Three patients each had a mildly enlarged (2 cm or less) adrenal gland; however, follow-up study suggested that metastasis was not the cause of adrenal enlargement in these patients. This study reinforces concern over whether CT is warranted in the preoperative assessment of T1N0M0 bronchogenic carcinoma.     

Chronic pancreatitis: ultrasonic features

A retrospective analysis of 84 ultrasound examinations (in 77 patients) was performed to assess the frequency of sonographic findings in chronic pancreatitis. The findings included: inhomogeneously increased echogenicity in 53% of these examinations, focal or diffuse enlargement in 41%, focal dense echoes in 40%, pseudocyst formation in 21%, and a hypoechoic head mass in 7%. Thirteen per cent of our patients had a normal sonogram. Several presentations of chronic pancreatitis not previously described in the sonographic literature included: pancreatic or common bile duct enlargement or pseudocyst formation with otherwise normal-appearing glands. There was no direct relationship between the presence of focal high-intensity echoes within the pancreatic parenchyma and the presence of radiographic calcification. There was no difference in the frequency of ultrasonic abnormalities between patients with and without clinical evidence of pancreatic insufficiency. These results indicate that the sonographic findings in chronic pancreatitis are significantly more varied than previous reports would indicate.