No-patch 23-gauge vitrectomy under topical anesthesia: a pilot study

A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.     

Effect of chewing a mixture of areca nut and tobacco on periodontal tissues and oral hygiene status

The present study was conducted to clarify the effects of chewing a quid containing areca nut and tobacco on periodontal tissue and oral hygiene status. A total of 365 subjects (168 chewers and 197 non-chewers with a mean age of 32.5 +/- 0.7 and 30.4 +/- 0.8 years, respectively) were enrolled. Clinical data on periodontal tissues, oral hygiene status, as well as information on bleeding from gums, ulcers in the oral cavity, or a burning sensation in the soft tissues, were collected as indicators of the possible presence and extent of periodontal lesions. The results indicated that a significantly higher number of quid-chewers suffered bleeding from the gums, halitosis, difficulty in opening the mouth and swallowing solid food, a burning sensation in the soft tissues, and ulcers in the oral cavity than non-chewers. There was no significant difference between quid-chewers and non-chewers with respect to oral hygiene measures adopted. However, clinical examination using the oral hygiene index score indicated that the oral hygiene status of quid-chewers was significantly deteriorated. The effect of quid-chewing on the periodontium, i.e. the occurrence of periodontal pockets, gingival lesions and gum recession, were significantly higher in quid-chewers than in non-chewers. Age, sex and smoking adjusted odds ratios for quid-chewers against non-chewers using logistic regression analysis indicated that, in general, chewers were at significantly higher risk for various oral complaints and periodontium status. The present data indicate that chewing quid comprising areca nut and tobacco has adverse effects on periodontal tissues, oral hygiene and incidence of oral lesions.     

Non-familial multiple keratoacanthomas in a 70 year-old long-term non-progressor HIV-seropositive man

We describe here multiple keratoacanthomas in an Human Immunodeficiency Virus (HIV)-seropositive 70 year-old man. The patient had multiple epithelial tumors of the skin showing rapid growth, histopathological features of a keratoacanthoma and a conspicuous tendency toward spontaneous remission. A diagnosis of nonfamilial multiple keratoacanthoma was established. The patient had a CD4 count of 633 cells/microL. The HIV disease in our patient was of a nonprogressive nature with CCR5-positive T cells.     

Congenital cytomegalovirus infection in a highly seropositive semi-urban population in India

To determine the incidence and natural history of congenital cytomegalovirus (CMV) infection in a population of women with near universal serologic reactivity for CMV, a prospective study of 423 women attending the antenatal clinic of the Comprehensive Rural Health Center in northern India was conducted. All 9 (2.1%) CMV positive infants were born to mothers who were CMV seropositive at the first antenatal visit. One child had hepatosplenomegaly at birth and another child had mild unilateral hearing loss at 4 months of age.     

Immediate respiratory management of the preterm infant

Infants born prematurely have underdeveloped lungs characterised by both morphological and biochemical abnormalities. Respiratory distress syndrome (RDS) is the leading cause of morbidity and mortality in this population. Both surfactant replacement therapy with mechanical ventilation and continuous positive airway pressure (CPAP) have been shown to be of benefit. However, considerable controversy exists about how best to use these therapies. This paper will review the pathophysiology of RDS and the evidence supporting each of these treatments.