Idiopathic intracranial hypertension in a child after hemodialysis

Idiopathic intracranial hypertension remains a disease of unknown etiology. Epidemiology, associations, features, and prognosis in children have changed over the years. The main clinical complaint of pediatric idiopathic intracranial hypertension is headache with visual disturbance. We report on a patient with childhood idiopathic intracranial hypertension, who presented without headache after hemodialysis for acute renal failure. Idiopathic intracranial hypertension without headache is believed to have a poor prognosis. However, this child demonstrated a favorable outcome with medical therapy. The child was followed with serial optical coherence tomography of retinal nerve fiber layer thickness around the optic nerve head. In the absence of a reliable procedure to evaluate the therapeutic efficacy in the follow-up of patients with idiopathic intracranial hypertension, the importance of optical coherence tomography, a noninvasive, objective, and reproducible procedure, is highlighted as a useful adjunct in the management of idiopathic intracranial hypertension.     

The testicular position and descent in developing human

AimThe present study aimed at reevaluating and providing a more comprehensive knowledge of position and descent of the testis.Materials and methodsThe position and descent of testis was studied on 104 male formalin fixed human fetuses in the Department of Anatomy, RIMS, Imphal. The fetuses were dissected and the location of the testes and the extent of the gubernaculum were noted. Special staining was done using Weigert's iron hematoxylin and Van Gieson's stain.ResultsThe testes were located, in the earliest specimen of the present series, retroperitoneally in the lower abdomen at L3–4 level. Left testis was usually at a lower level than the right. Testicular descent was observed earliest at 24 weeks of intra-uterine life (IUL) and 100% successful complete bilateral descent by 36 weeks IUL. Descent through the inguinal canal was rapid and no case of undescended testis was encountered. The testicular descent was symmetrical in majority of the cases except in 7 where the descent was asymmetrical with the left descending earlier. Structural changes in gubernaculum but not its contraction played a role in testicular descent.ConclusionThus, a comprehensive and thorough knowledge of the testicular descent will assist in management of cases related with testis, especially the undescended and ectopic testis.     

A cross-sectional study on aqueous humour lactate dehydrogenase level in retinoblastoma

Lactate dehydrogenase enzyme is a non-specific marker found raised in different body fluids in various pathological conditions. This cross-sectional study was done in a medical college of Kolkata, India to find out lactate dehydrogenase level of aqueous humour in retinoblastoma cases. Aqueous humour lactate dehydrogenase level from 21 histology proved retinoblastoma cases and 21 controls was estimated and compared. Range of lactate dehydrogenase levels in retinoblastoma cases were 863-4819 IU/l; mean being 3396.9 IU/l; and in controls range was 48-146 IU/l; mean being 90.6 IU/l; 76.19% of retinoblastoma cases had value over 3000 IU/l. None of the controls had value above 150 IU/l. The difference between lactate dehydrogenase values of cases and controls was significant (p<0.001).     

Development and Morphogenesis of Testis in Human Fetuses

Development and maturation of prenatal testis was studied on 104 human male fetuses. At 9 weeks, the testes were seen as elongated yellowish tissue superolateral to the developing urinary bladder and medial to mesonephros. The testis assumed ellipsoidal shape at 13 weeks. At about 16 weeks, the testes developed convexity on its anterior aspect. Epididymis and testis were at the same level until 20 weeks thereafter the upper testicular pole was encroached upon by the epididymis, with complete encroachment till its anterior aspect at 24 week. The sinus was also distinctly present between the two. The testis assumed miniature adult testis at term, but its size was approximately 1/15th of the adult. Cytoarchitecture of the testis at 9 weeks revealed radially disposed sex cords. At 13 weeks, tunica albuginea,tubular organization in the parenchyma and the Leydig cells were identifiable. At 17 weeks, tunica vasculosa and incomplete lobules were apparent. At 24 weeks, testis was marked by more but solid seminiferous tubules lined by 4–5 germ layers. Leydig cells were also identifiable till 24 weeks. Spermatogenic cells, both pale and dark type were distinguishable although pale spermatogonia were more numerous than dark cells. 28 weeks onwards tunica vaginalis and complete septa in the testicular parenchyma were evident. Moreover, the seminiferous tubules developed central vacuolation. By 30 weeks, seminiferous tubules became more complex as evident by their increase in number and coiled and tortuousity. At term, the fetal testis had not yet attained the cytoarchitecture of the adult testis suggesting that testicular maturation continues postnatally.     

Correlation of macular thickness and posterior hyaloid change following bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged patients

To compare changes in posterior vitreous detachment (PVD) following intravitreal injection of bevacizumab and triamcinolone in diffuse diabetic macular edema in middle-aged type 2 diabetes patients and to correlate this change with change in central macular thickness (CMT). Design: cross sectional study. Fifteen consecutive patients treated by intravitreal bevacizumab (group A) and ten patients treated by intravitreal triamcinolone (group B). Institutional study carried out by retrospective analysis of patient registers including serial optical coherence tomography (OCT) images at baseline, and after 1 and 4 months. A central macular thickness (CMT) and vitreomacular relationship was noted on OCT. PVD was graded on a linear scale (0–4). Change in grade of PVD was correlated with change in CMT at each follow-up. At month 4, the decrease in mean CMT from baseline was 51.2 μ (P = 0.000) and 45 μ (P = 0.022) in group A and group B, respectively, with no significant difference between the two groups (P = 0.874). A change in grades of PVD from baseline to month 4 was significant in both group A (P = 0.001) and group B (P = 0.004) with no significant difference between the two groups (P = 0.906). A significant correlation between change in PVD and reduction of CMT was observed in group A (P = 0.011) but not in group B (P = 0.315). Both bevacizumab and triamcinolone caused a significant reduction in macular thickness and a significant change in grade of PVD. Change in PVD played an influential role in the reduction of macular thickness following bevacizumab.     

Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery

Purpose: To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non‐foldable polymethyl methacrylate (PMMA) lens implantation. Methods: Prospective study was carried out with one eye each of 224 patients with senile cataract randomized into two groups, phacoemulsification and MSICS, by simple 1:1 randomization. Following surgery by either of the two methods, macular thickness was measured by optical coherence tomography (OCT) on the 1st, 7th, 42nd and 180th postoperative day. Main outcome measure was postoperative macular thickness. Results: On the first postoperative day, central subfield mean thickness (CSMT) in MSICS group was 192.8 ± 17.9 μm and that in phacoemulsification group was 192.1 ± 27.4 μm, with no significant difference (p = 0.12). On the 7th day, CSMT in MSICS group (198.9 ± 21.4 μm) was significantly (p = 0.04) more than that in phacoemulsification group (193.1 ± 19.3 μm). On the 42nd day, CSMT in MSICS group was 207.8 ± 26.3 μm and that in phacoemulsification group was 198.3 ± 23 μm, the difference being significant (p = 0.007). Clinically macular oedema was not diagnosed in any of the patients at any visit. The increase in macular thickness was sub‐clinical and did not affect final visual outcome in any patient. Conclusion: In spite of the greater theoretical risk of increased postoperative inflammation following MSICS, there was no evidence of cystoid macular oedema, either clinically or on OCT. However, chance of sub‐clinical increase in CSMT was more following MSICS compared to phacoemulsification.     

First report of an alphasatellite associated with Okra enation leaf curl virus

An alphasatellite DNA associated with Okra enation leaf curl virus (OELCuV) which causes enation and leaf curling in okra (Abelmoschus esculentus) plants was characterized. The full-length DNA comprises 1,350 nucleotides and shows typical genome organization of an alphasatellite. It shows the highest nucleotide sequence identity (79.7 %) to Hollyhock yellow vein virus-associated symptomless alphasatellite (HoYVSLA). This is the first report of the association of an alphasatellite with OELCuV from India.     

Diagnostic accuracy in retinoblastoma

This study was done to ascertain the accuracy of diagnosis and possible risk of misdiagnosis in suspected retinoblastoma cases by different pre-operative diagnostic procedures like fundoscopy, ultrasonography, computerised tomography, and aqueous cytology study. Twenty-four eyes excised with diagnosis of suspected retinoblastoma were included in the study. Final diagnosis was reached by histopathological examination of excised eyes and compared with pre-operative diagnosis by different diagnostic procedures and accuracy of each procedure was calculated. Twenty-two cases were finally diagnosed as retinoblastoma and 2 cases (8.33%) as other than retinoblastoma. Computerised tomography and aqueous humour cytology were two most specific (100%) tests. Computerised tomography was the most sensitive (95.4%) test. Aqueous cytology was poorly sensitive (9.09%). Both ultrasonography and fundoscopy demonstrated sensitivity over 90% but with low specificity (50%). When test results of fundoscopy and ultrasonography were combined, specificity of this combination was 100% and sensitivity was 95.4%, which match exactly the values of computerised tomography. Combination of fundoscopy and ultrasonography has accuracy as high as that of computerised tomography. In patients with clear media this combination can be used as an effective alternative to computerised tomography to reach a diagnosis with comparable accuracy.