The anterior chamber angle width in adults in a tertiary eye hospital in Nigeria

Objective: The objective was to determine the anterior chamber angle width in adult Nigerian patients seen at the Guinness Eye Center Onitsha Nigeria.Materials and Methods: Consecutive new adult patients (aged ≥21 years) seen between March and July 2006 were the subjects of this study. Exclusion criteria included refusal to consent to the test, previous intraocular surgery that could distort the angle integrity and anterior segment pathology precluding the visualization of the angle. Each patient had visual acuity assessment, visual field analysis, ophthalmoscopy, intraocular pressure measurement, refraction, and gonioscopy. The angle grading was by the Shaffer method.Results: Of the 328 patients (648 eyes), aged 21–85 years (median age 59 years), 195 (59.5%) were females and patients older than 50 years constituted 64.9%. Gonioscopy showed that 245 eyes (37.8%) had wide open angles (grades III and IV); 227 (35.0%) had grade II angles; 176 (27.2%) had narrow angles (grade I or slit), 9 of which were deemed occludable. Of the 80 patients with chronic simple glaucoma, 20 (25%) had at least grade III angle; 34 (42.5%) had grade II angle; and 26 (32.5%) had grade I angle. Peripheral anterior synechiae were observed in three eyes. Compared with nonglaucomatous eyes, the angles of the glaucomatous eyes were significantly narrower (P <0.01). Similarly patients older than 50 years were more likely to have narrower angles (P < 0.001). However there was no significant difference between the angle width of male compared to female patients (P >0.05).Conclusions: A little more than a third of adult patients seen in our hospital have wide open angles; a third of the glaucoma patients usually taken as open angle cases actually have very narrow angles some of which are occludable. A population-based study is therefore recommended to clearly define the epidemiologic characteristics of glaucoma including the anterior chamber width in different parts of Nigeria

Bi‑lobed Perirectal Epidermoid Cyst: An Unusual Cause of Hematochezia in a Middle‑aged Woman

Perirectal epidermoid cysts are congenital cysts originating from the ectodermal germ cell layer of the hind gut. Their presenting symptoms are most often nonspecific and distinguishing them from other presacral developmental cysts often present a diagnostic and therapeutic dilemma. We present a 58‑year‑old woman who presented with chronic dyschezia and hematochezia of a few days duration and no prior colonoscopies. Initial blood work and tumor markers were unremarkable. Pelvic magnetic resonance imaging (MRI) showed a 7.5 cm × 5 cm × 6 cm homogenous bi‑lobed cystic mass in the pelvis adherent to the left lateral wall of the rectum and posteriorly to the sacrum with a displacement of the rectum anteriorly and to the right. There was no pelvic sidewall adenopathy or free fluid in the pelvis. Preoperative colonoscopy showed rectal compression with no rectal involvement of the mass. The cyst was successfully resected posteriorly via the trans‑sacrococcygeal approach. An intraoperative proctosigmoidoscopy confirmed an intact rectum. The patient remains recurrence‑free 1 year postsurgical resection.Keywords: Perirectal, Epidermoid cyst, Bi‑lobed, Posterior approac

Previously clinically “silent” adrenal phaeochromocytoma presenting as hypovolemic shock with paradoxical hypertension

No Abstract Keywords: Phaeochromocytoma; Acute abdomen; Rupture; Hypovolemic shoc

Intraocular pressure, retrobulbar anaesthesia and digital ocular massage

No Abstract

Proapoptotic genes BAX and CD40L are predictors of survival in transitional cell carcinoma of the bladder

The purpose of the study was to investigate the effects of expression of a range of genes involved in apoptosis on outcome in bladder cancer. Immunohistochemistry was used to examine expression of BCL2, BAX, P53, CD40 and CD40L in archival tissues of patients included in various treatment trials for transitional cell carcinoma (TCC) of the bladder. Data were collected on 94 patients who first presented with either invasive or superficial bladder cancer. Median follow-up for alive patients was 83 months (m) (range 12-195 m). Median survival was 80 m (95% CI=56-128 m). Median survivals for the various markers were as follows: BAX-positive patients 110 m vs BAX-negative patients 18 m (P=0.0002); CD40L-positive patients 95 m vs CD40L-negative patients 45 m (P=0.04); BCL2-positive patients 44 m and BCL2-negative patients 74 m, (P=0.64); CD40-positive patients 110 m and CD40 negative patients 45 m (P=0.12); and P53 positive patients 80 m and P53 negative patients 45 m (P=0.58). In conclusion, it was seen that overexpressions of BAX and CD40L are prognostic of better survival in TCC of the bladder. Our results also raise the possibility of the future development of CD40- and CD40 ligand-based immunotherapy for bladder cancer. This study links proapoptotic and antiapoptotic markers to overall survival

Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: A pragmatic, randomised clinical trial

Introduction: Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life. Methods and analysis This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided p<0.05. Ethics and dissemination Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences, scientific publications, internet-based educational materials and mass media. Trial registration number NCT02241655; Pre-results

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio