Prospective optical coherence tomographic evaluation of the efficacy of oral and posterior subtenon corticosteroids in patients with intermediate uveitis

Purpose To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT).Methods Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks.Results Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman’s correlation coefficient for visual acuity and foveal thickness was found to be significant.Conclusion OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.     

Gall Bladder Tumour,Choledochal Cyst and an Anomalous Pancreatico-Biliary Junction

This report highlights the association of a tumour in an acalculous gall bladder with an anomalous pancreatico-biliary junction (PBJ) and a type IVa choledochal cyst. Cholecystectomy and Rouxen- Y hepatico-jejunostomy (RHJ) was performed after division of the common bile duct (CBD) and excision of the dilated segment. The details of the case are presented and the role of an abnormal PBJ in gall bladder carcinogenesis is discussed.     

Acute intestinal obstruction caused by lithopaedion

A case report of a 36-year-old unmarried woman who was admitted to the hospital with right-sided colicky abdominal pain accompanied by nausea and vomiting is presented. The woman had undergone a vaginal operation for termination of pregnancy 3 months previously during which the uterine fundus had been accidentally perforated and then repaired. On the present occasion, a straight radiograph of the abdomen showed a small calcified fetus (lithopedion) in the pelvis to the right of the midline. The obstruction was removed during laparotomy. Apparently, at the time of accidental uterine perforation the fetus escaped into the peritoneal cavity where it underwent calcification. Other cases of lithopedion reported in the literature have generally been related to extrauterine rather than intrauterine pregnancies as in this case.     

Persistence of an activating N-RAS oncogene mutation in clonogenic progenitor cells from an acute myeloid leukaemia patient in remission

Summary A patient with acute myeloid leukaemia (AML) with an activating N- RAS oncogene mutation was studied in a haemopoietic clonogenic progenitor cell assay. Individual colonies and clusters were analysed by polymerase chain reaction and oligonucleotide hybridization for the original mutation. The mutation was detected in a majority of leukaemic clusters, but also in almost half of the differentiated colonies. After chemotherapy the patient entered clinical remission. However, the mutation could still be detected in the bone marrow. Only differentiated colonies and no leukaemic clusters were grown from the remission bone marrow, but the original mutation was still detectable in almost half of the colonies.     

Frontoethmoidal mucocele with intraorbital extension: an unusual cause of diplopia

Frontoethmoidal mucoceles are pseudo-cystic lesions which may present with orbital symptoms. A case of frontoethmoidal mucocele in an elderly lady is described who presented with diplopia primarily and was diagnosed with CT scan regarding primary pathology and intraorbital extension. Recovery followed surgical excision and orbital clearance.