Syed Wajahat Ali Rizvi

Atypical multifocal hydatid disease of cranial vault: simultaneous orbital and extradural meningeal involvement.

Hydatid disease is endemic in regions where livestock is raised. Liver and lungs are the most commonly affected organs by the disease. Cranial vault and orbital hydatid disease is extremely rare. Signs and symptoms along with serological investigation are often inconclusive in cranial hydatid, making radiological diagnosis extremely important. Surgical removal of the cyst is the mainstay of treatment. Postoperative medical therapy, along with regular follow-up, is the key to detect any recurrence. We report an unusual case of cranial hydatid which showed diffuse scalp infiltration along with oribital and extradural extension.

Managment of Superficial Infantile Capillary Hemangiomas with Topical Timolol Maleate Solution

Abstract Capillary hemangioma is the most common benign tumor of eyelids and orbit in children. Recently, a topical beta blocker has been reported as an effective treatment for superficial capillary hemangiomas. We present a case report of two children having large capillary hemangiomas who responded well to topical treatment by 0.5% timolol maleate solution. After 12 months of treatment, the lesion has significantly reduced in size, thickness, and color in both cases. Thus, we conclude that long-term use of topical 0.5% timolol maleate solution is safe and effective in treating superficial capillary hemangiomas.

Bilateral Persistent Hyperplastic Primary Vitreous: A Close Mimic of Retinoblastoma

Bilateral persistent hyperplastic primary vitreous (PHPV) is a rare disorder of eye. It is one of the most important differential diagnoses of retinoblastoma, hence early and accurate diagnosis is important. We here report a case of an 11-month-old child which was referred to ocular OPD with complaints of bilateral leukocoria. Examination revealed greyish-white masses posterior to both lenses, raising the clinical suspicion of retinoblastoma. Ultrasonography demonstrated echogenic masses extending from the posterior surface of the lens to the optic disc with reduced axial lengths. These masses demonstrated flow on color Doppler evaluation. CT scan revealed hyperdense masses behind the lens without any evidence of intralesional calcification. Clinical features and imaging findings point towards the diagnosis of bilateral PHPV. PHPV is a developmental disorder of the globe in which the hyaloid vasculature fails to regress normally. While unilateral PHPV is common, bilateral PHPV is a rare entity. It is one of the most important conditions mimicking retinoblastoma; hence early and accurate diagnosis is required. Ophthalmological examination is still the best way to confirm the diagnosis. However, if the diagnosis remain unclear, further evaluation using ultrasonography, Color Doppler, and CT scan is useful.

Isolated tubercular scaphoid osteomyelitis: a case report

Bone is the third most frequent site of tuberculosis after lung and lymph node, accounting for 10%–20% of all cases of extrapulmonary disease. The spine and hip are the most commonly involved sites. Involvement of the small bones of the hand has been described exceedingly rarely, and is usually secondary to pulmonary disease. Because a primary focus is not always found, it can be difficult to make a diagnosis of skeletal tuberculosis. Moreover, because clinical and radiographic features are nonspecific, an early diagnosis will only be made where there is a high degree of suspicion. Isolated osteomyelitis of the scaphoid is uncommon, having previously been reported in association with animal bites and interventions such as radial artery cannulation. We describe here the unusual occurrence of tubercular osteomyelitis of the scaphoid, a condition which has rarely been reported.

Role of Whole-Spine Screening Magnetic Resonance Imaging Using Short Tau Inversion Recovery or Fat-Suppressed T2 Fast Spin Echo Sequences for Detecting Noncontiguous Multiple-Level Spinal Tuberculosis

Study Design Retrospective review. Purpose The purpose of the present study was to evaluate the role of whole-spine screening using short tau inversion recovery (STIR) or fat-suppressed T2W fast spin echo (FSE) sequences in patients with spinal tuberculosis (TB). Overview of Literature The identification of noncontiguous multiple-level spinal tuberculosis (NMLST), symptomatic or not, is important because of its management implications. Most centers do not perform routine whole-spine magnetic resonance imaging (MRI), and the reported incidence of NMLST varies from 1.1% to 74.1%. Methods We completed a retrospective review of clinical and radiographic data of 365 patients with spinal TB who presented at Jawaharlal Nehru Medical College, Aligarh over 5 years. The final analysis included 187 patients who full filled the inclusion criteria, consisting of availability of whole-spine MRI and confirmation of vertebral TB. Diagnosis of NMLST was considered when other vertebral lesions were identified in addition to the primary vertebral disease, with the lesions separated by at least one normal spinal segment. The primary site was defined as the site for which the patient had been referred for MRI. Results NMLST was identified in 47 of 187 patients investigated using whole-spine MRI. The incidence was 25.1%, which was higher than that in earlier reports where whole-spine MRI was not routinely performed. The lumbar spine was involved in 37 patients, thoracic spine in 25, cervical spine in 16, and sacrum in five patients. Combined lumbar spine and thoracic spine involvement was observed in 19 patients. Thirteen patients had lumbar and cervical spine involvement, nine had thoracic and cervical spine involvement, four had combined lumbar and sacral spine involvement, and the remaining two had thoracic and sacral spine involvement. Conclusions Tubercular spondylitis may affect the spine at multiple noncontiguous sites with the majority of additional affected sites remaining asymptomatic. Routine whole-spine MRI using all recommended sequences is not cost-effective and hence not feasible. Therefore, we recommend whole-spine screening using STIR or fat-suppressed T2W FSE sequences in all patients with suspected spinal TB. This screening is cost-effective compared with full-protocol MRI and detects additional cases of NMLST over conventional practice.

A Standardized Ultrasound Scoring System for Preoperative Prediction of Difficult Laparoscopic Cholecystectomy

Purpose Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). Our aim was to develop a standardized Ultrasound based scoring system for preoperative prediction of difficult LC. Methods and materials Ultrasound findings of 300 patients who underwent LC were reviewed retrospectively. Four parameters (time taken, biliary leakage, duct or arterial injury, and conversion) were analyzed to classify LC as easy or difficult. The following ultrasound findings were analyzed: GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. Out of seven parameters, four were statistically significant in our study. A score of 2 was assigned for the presence of each significant finding and a score of 1 was assigned for the remaining parameters to a total score of 11. A cut-off value of 5 was taken to predict easy and difficult LC. Results 66 out of 83 cases of difficult LC and 199 out of 217 cases of easy LC were correctly predicted on the basis of scoring system. A score of >5 had sensitivity 80.7% and specificity 91.7% for correctly identifying difficult LC. Prediction came true in 78.8% difficult and 92.6% easy cases. US findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant. Conclusion This indigenous scoring system is effective in predicting conversion risk of LC to OC. Patients having high risk may be informed and scheduled appropriately and decision to convert to OC in case of anticipated difficulty may be taken earlier.

Tear film and ocular surface dysfunction in diabetes mellitus in an Indian population

Purpose: Ophthalmic complications in diabetes such as retinopathy, cataract, and infections have been extensively studied. Recently, attention has been drawn toward ocular surface changes in diabetes mellitus (DM). This study has been carried out to investigate the tear film and ocular surface abnormalities in type II DM patients. Materials and Methods: A total of 83 participants (130 eyes) were enrolled: 53 diabetics (80 eyes) and 30 healthy controls (50 eyes). Of the 53 diabetics, 24 patients (42 eyes) had some diabetic retinopathy. The tear film and ocular surface were evaluated using Schirmer test, tear film break-up time (TBUT), keratoepitheliopathy score (KES), Rose Bengal Staining (RBS) test, and conjunctival impression cytology. Results: When compared with the healthy controls, diabetics showed significantly reduced Schirmer, TBUT measurements and the higher grades of KES and RBS test (P < 0.001). Impression cytology analysis showed goblet cell loss and conjunctival squamous metaplasia in diabetics. Conclusion: Tear film abnormality is a significant feature of diabetic ocular surface diseases. These abnormalities are likely on account of poor quality and function of tears, combined with the subnormal ocular surface. Therefore, all diabetic patients especially those with evidence of retinopathy changes should undergo routine early examination and follow-up of tear function and ocular surface parameters.

Central corneal thickness and severity of visual field loss in primary open-angle glaucoma

Purpose: To determine whether central corneal thickness (CCT) is correlated to severity of visual field (VF) loss among patients of primary open-angle glaucoma (POAG) at initial evaluation. Materials and Methods: One hundred and two eyes with POAG were recruited in this cross-sectional study. Humphrey field analysis, applanation tonometry, and CCT measurement were done in all subjects. Based on severity of VF loss, the sample was split into mild (n = 55), moderate (n = 21), and severe VF loss (n = 26) as per Anderson-Patella criteria. For each of the three groups, calculated mean values were compared using analysis of variance (ANOVA). Results: The sample contained 102 eyes of 102 patients which were divided into groups of mild, moderate, and severe VF loss. The mean (±standard deviation [SD]) CCT for Group I was 543.07 μm (±24.60), for Group II was 539.24 μm (±22.30), and for Group III was 536.11 μm (±22.86). The mean (±SD) mean deviation for Group I was –2.78 dB (±1.65), for Group II was −8.91 dB (±2.18), and for Group III was –21.47 dB (±5.98). When analyzed, the mean differences of CCT in patients with mild, moderate, and severe VF involvement were not statistically significant (ANOVA, P = 0.43). Conclusion: We failed to find any significant association between CCT and severity of VF defect in the eyes with POAG.

Extreme Ophthalmomyiasis externa with simultaneous facial and scalp involvement

BACKGROUND Ophthalmomyiasis is a rare entity seen mainly in immunocompromised host with neglected wounds under poor hygienic conditions. CASE We report a case of extreme ophthalmomyiasis with extensive facial and scalp involvement in an old rural inhabitant following evisceration. CONCLUSION Proper wound care and personal hygiene are of paramount importance for good wound healing.

Delleman Oorthuys syndrome.

Oculocerebrocutaneous or Delleman syndrome is a rare congenital syndrome characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects, intracranial cysts and skin appendages. We here report a case of 1-year-old male child with periocular skin tags, lid colobomas, and dermal hypoplasia. The patient had delayed developmental milestones and history of tonic-clonic seizures. Magnetic resonance imaging of the head revealed a large arachnoid cyst, aplastic cerebellar vermis and polymicrographic pattern of the cerebral cortex. A complex cyst of spleen was also noted on abdominal ultrasonography. Orbital cysts depending on the size can be excised or left alone. Neuroimaging evaluation of patients with congenital orbital cysts and skin appendages is emphasized for early and appropriate management.