MANAGEMENT OF CONCURRENT GLAUCOMA AND CATARACT BY PHACOTRABECULECTOMY TECHNIQUE: AN EFFECTIVE ALTERNATIVE APPROACH

30 cases of open angle glaucoma with cataract who underwent phacoemulsification, PMMA phaco profile IOL implantation and trabeculectomy through same incision were critically evaluated. The mean controlled, preoperative intra ocular pressure was 20 mm of Hg (range 18 to 35 mm of Hg) by aplanation method. Mean post operative pressure after 12 months was 13 mm of Hg (range 11 to 22 mm of Hg) intra operative hyphaema, post operative uveitis were noted problems. Periodic, post operative optic disc and field evaluation remained static in 66% cases. Visual acuity of 6/12 or better was achieved in 60% cases. Failure to restore glaucoma control without medication was seen in 13.3% cases after 9–12 months. The combined phacotrabeculectomy is an effective single step technique of managing concurrent glaucoma with cataract.Key words: Single incision, Phacotrabeculectomy     

Good morning creativity: task reactivation during sleep enhances beneficial effect of sleep on creative performance

Both scientists and artists have suggested that sleep facilitates creativity, and this idea has received substantial empirical support. In the current study, we investigate whether one can actively enhance the beneficial effect of sleep on creativity by covertly reactivating the creativity task during sleep. Individuals’ creative performance was compared after three different conditions: sleep‐with‐conditioned‐odor; sleep‐with‐control‐odor; or sleep‐with‐no‐odor. In the evening prior to sleep, all participants were presented with a problem that required a creative solution. In the two odor conditions, a hidden scent‐diffuser spread an odor while the problem was presented. In the sleep‐with‐conditioned‐odor condition, task reactivation during sleep was induced by means of the odor that was also presented while participants were informed about the problem. In the sleep‐with‐control‐odor condition, participants were exposed to a different odor during sleep than the one diffused during problem presentation. In the no odor condition, no odor was presented. After a night of sleep with the conditioned odor, participants were found to be: (i) more creative; and (ii) better able to select their most creative idea than participants who had been exposed to a control odor or no odor while sleeping. These findings suggest that we do not have to passively wait until we are hit by our creative muse while sleeping. Task reactivation during sleep can actively trigger creativity‐related processes during sleep and thereby boost the beneficial effect of sleep on creativity.     

Mid-term results after operative treatment of rockwood grade III-V Acromioclavicular joint dislocations with an AC-hook-plate

Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72 %) of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale) was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%). Constant score showed an average of 92.4 of 100 possible points with 89 % excellent and good results and 11 % satisfying results. All patients had some degree of pain or discomfort with the hook-plate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6 %. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function.     

Cutaneous manifestations of HIV—a detailed study of morphological variants,markers of advanced disease,and the changing spectrum

Background

Cutaneous manifestations are early and easily identifiable markers of human immunodeficiency virus (HIV) infection. They can help in predicting severity and progress of the disease and can be correlated well with CD4 counts. This study was undertaken to study the cutaneous manifestations of HIV infection and to correlate them with CD4 counts. It also aimed to study the changing spectrum of these manifestations and describe cutaneous manifestations seen in advanced disease.

Method

A total of 234 HIV-positive patients not on anti-retroviral therapy, who attended the outpatient department or were admitted as inpatients at Military Hospital, Shillong during the period between May 2008 and October 2009 were included. Cutaneous, mucosal, and genitourinary manifestations in these patients were studied in detail and were correlated with CD4 counts.

Results

Infections were the most common group of mucocutaneous manifestations, while onychomycosis was the commonly observed individual manifestation. A different set of cutaneous markers for advanced HIV disease was observed and new parameters for therapy were also arrived at.

Conclusion

Specific morphological variants of cutaneous markers may provide a better clue to early diagnosis of HIV and can help in diagnosing advanced stages of the disease. Fresh cutaneous markers are required for indicating cut-off levels of CD4 count at 350/μL for starting therapy.Key Words: AIDS, CD4 count, cutaneous manifestations, HIV     

Linkage and physical mapping of X-linked lissencephaly/SBH (XLIS): a gene causing neuronal migration defects in human brain

While disorders of neuronal migration are associated with as much as 25% of recurrent childhood seizures, few of the genes required to establish neuronal position in cerebral cortex are known. Subcortical band heterotopia (SBH) and lissencephaly (LIS), two distinct neuronal migration disorders producing epilepsy and variable cognitive impairment, can be inherited alone or together in a single pedigree. Here we report a new genetic locus, XLIS, mapped by linkage analysis of five families and physical mapping of a balanced X;2 translocation in a girl with LIS. Linkage places the critical region in Xq21-q24, containing the breakpoint that maps to Xq22.3-q23 by high-resolution chromosome analysis. Markers used for somatic cell hybrid and fluorescence in situ hybridization analyses place the XLIS region within a 1 cM interval. These data suggest that SBH and X-linked lissencephaly are caused by mutation of a single gene, XLIS, that the milder SBH phenotype in females results from random X-inactivation (Lyonization), and that cloning of genes from the breakpoint region on X will yield XLIS.