Medical and Health Care

Objective The objective of this retrospective study was to study the outcome in patients with basal ganglia, thalamus and brainstem (central/deep) arteriovenous malformations (AVMs) treated with gamma knife radiosurgery (GKS) and to compare the results with that for AVMs at other intracranial locations. Methods and results The results of 53 patients with central AVMs and 255 patients with AVMs at other locations treated with GKS at our center between April 1997 and March 2005 with minimum follow-up of 1 year were analyzed. Central AVMs Forty of these 53 AVMs were Spetzler-Martin grade III, 11 were grade IV, and 2 were grade V. The mean AVM volume was 4.3 cm3 (range 0.1–36.6 cm3). The mean marginal dose given was 23.3 Gy (range 16–25 Gy). The mean follow-up was 28 months (range 12–96 months). Check angiograms were advised at 2 years after GKS and yearly thereafter in the presence of residual AVM till 4 years. Presence of a residual AVM on an angiogram at 4 years after radiosurgery was considered as radiosurgical failure. Complete obliteration of the AVM was documented in 14 (74%) of the 19 patients with complete angiographic follow-up. Significantly lower obliteration rates (37% vs. 100%) were seen in larger AVMs (>3 cm3) and AVMs of higher (IV and V) Spetzler-Martin grades (28% vs. 100%). The 3- and 4-year actuarial rates of nidus obliteration were 68% and 74%, respectively. Eight patients (15%) developed radiation edema with a statistically significantly higher incidence in patients with AVM volume >3 cm3 and in patients with Spetzler-Martin grade IV and V AVMs. Five patients (9.4%) had hemorrhage in the period of latency. Comparison of results with AVMs at other locations Patients with central AVMs presented at a younger age (mean age 22.7 years vs. 29 years), with a very high proportion (81% vs. 63%) presenting with hemorrhage. Significantly higher incidence of radiation edema (15% vs. 5%) and lower obliteration rates (74% vs. 93%) were seen in patients with central AVMs. Conclusions GKS is an effective modality of treatment for central AVMs, though relatively lower obliteration rates and higher complication rates are seen compared to AVMs at other locations.

Introduction: Ocular manifestations of human immunodeficiency virus (HIV) infection are common. The aim of this study was to assess the prevalence of the ophthalmic manifestations observed in AIDS patients. Materials and Methods: 169 patients who were confirmed to be living with HIV were included into the study. Ophthalmic diagnoses were made based upon LogMAR and slit lamp biomicroscopic examination of the anterior segment (eyelids, conjunctiva, cornea, anterior chamber), and dilated indirect ophthalmoscopy to provide views of the central and peripheral retina. Results: Heterosexual mode of transmission was the most common with 91.1%. Most of them had the infection for less than 5 years and 106 of them were on ART. Ocular manifestations was seen in 96 (56.8%) of the patients. Cytomegaloviral retinitis was the most common cause of the ocular manifestation with 29 of the patients being affected. 16 of the patient s ha dcottony conjunctival growth, 11 had uveitis and 10 had a cutaneou...

Introduction: Pseudo-exfoliation is a complex age related disorder of production and accumulation of fibrillar material in the anterior segment of eye.It is more common as the age advances. It is also associated with serious ocular problems such as cataract and glaucoma. Aims: To find out the prevalence and pattern of clinical presentation in pseudo-exfoliative syndrome in patients visiting ophthalmology outpatient department in a rural area. Materials and Methods: This was a prospective study carried out over a period of one year in the department of Ophthalmology, Mamata Medical College and associated General Hospital, Khammam. In this study 2000 individuals, (1111 male and 889 female) above the age of 40 years, were selected randomly and complete ocular examination was done in these subjects. Results: Ninety (4.5%) out of 2000 individuals screened showed varying degree of pseudo-exfoliation syndrome in one or both eyes. The prevalence rate increased with advancing age. It was 4.5...