Plummer-Vinson syndrome:

Guys, this is really important viva question as well as theory question.

Frequently asked for end posting!!!

link : Plummer-Vinson syndrome: MedlinePlus Medical Encyclopedia

Plummer-Vinson syndrome is a condition that sometimes occur in people with long-term (chronic) iron deficiency anemia. People with this condition have difficulty swallowing due to small, thin growths of tissue that partially block the upper food pipe, or esophagus.

Causes

The cause of Plummer-Vinson syndrome is unknown. Genetic factors and a lack of certain nutrients (nutritional deficiencies) may play a role. It is a rare disorder that can be linked to cancers of the esophagus and throat. It is more common in women.

Symptoms

• Difficulty swallowing
• Weakness

Exams and Tests

Some patients develop skin and nail abnormalities that the doctor can see during an examination.

Upper GI series or upper endoscopy may show the web. Tests to diagnose anemia or iron deficiency may be useful.

Treatment

Patients with Plummer-Vinson syndrome should receive iron supplements. This may improve the swallowing difficulty.

If supplements do not help, the web can be widened during upper endoscopy to allow normal swallowing and passage of food.

Outlook (Prognosis)

Patients generally respond to treatment.

Possible Complications

Devices used to stretch the esophagus (dilators) may cause a tear, which leads to bleeding.

Plummer-Vinson syndrome has been linked to esophageal cancer.

When to Contact a Medical Professional

Call your health care provider if food gets stuck after you swallow it or if you have severe fatigue and weakness.

Prevention

Good nutrition with enough iron may prevent this disorder.

Alternative Names

Paterson-Kelly syndrome; Sideropenic dysphagia; Esophageal web

link :

Snake Baby

Have you ever heard or watched about the snake baby in Saudi Arabia?

The baby is not alone.

It is a genetic-related disease called Harlequin icthiyosis.

One of the baby that survived spoke in here.

Want to help?

Got to this http://youtu.be/SM88sZZz2iY

Optho: Glaucoma

Good study and presentation material

~http://video.about.com/vision/Glaucoma.htm

Eye Examination

Ehem!

~That day i wanted to see pupillary shadow. I hadno idea how the shadow will look like. Finally, i've seen it. 

  The shadow falls on the lens when the light is shined obliquely from the temporal site and seen through the pupil.

~General tests to be done.

1. Visual acuity 
2. Rosenbalm test
3. vision test - by using Snellen`s chart and repeat Rosenbalm test
4. Eye movement test - look up,down.left and right
5. Confrontation test : The examiner closes his left eye while the patient closes his right eye. Move the finger in all four quadrant and repeat the test in the other eye.
6. The H test - Move the finger from center outwards in H pattern.Repeat for other eye.
7. Convergence test- From the nose, ask the patient to look far object .The pupil should constrict.
8. Squint and Strabismus test : Shine torch on nose and see the light reflection on the pupil which is slightly deviated to nasal site. Assymetry indicates strabismus.
9. Pupill reaction test- Shine from temporal site.See the pupillary constriction. See the other eye for consensual reflex.
10. Accommodation test- Make the finger on nose. Ask patient to see far object . Pupil should constrict.

Optho : Operation Theatre Day

Friday is an OT day.

But,i didn't bring my OT slippers.

Its okay, they didn't bother at all. Hoyeah!

It was an awesome OT because the case is related to our theory class we just had that morning.

It was wonderful because i still have the Wow! moment in there. I need it badly. 

It is awesome how the eyes are numbed,cut,poked and rolled on the surgery table,while the patient still conscious and he/she could actually see the whole procedure!!! 

These are the highlights during OT.
Might be viva question too.

The screen. Thanks to it, i can see what is going on under the microscope.

~Do you know what is biometry? Biometry is for intraocular lense power calculation. 
  Answer : P=A-2.5L - 0.9K.
  Where P is the power of IOL,A is a constant for lens type, L is the axial length of eyeball in mm determined by A-scan ultrasonography, K is average corneal curvature determined by keratometry.


~Traumatic induced cataract in a teenage girl following needle break in sewing lesson. The needle penetrated the cornea all the way through the vitreous and posterior capsule. Removal of the lense or lensectomy with anterior and posterior capsule removal  is done. Vitrectomy is completed using cutting ,irrigation and aspiration mechanism and implantation of IOL of 22D slightly higher than normal lense. He said even with loss of vitreous there will be no associated diminished vision or  post operative complications. Although, the damaged done is irreversible,they tried to save what they can since the patient is still young and they do not want to disfigure her.




~Pilocarpine injection into anterior chamber to asses pupillary reflex.


~Peribulbar anesthatic injection. I say you, it is painful and scary to us! Imagine a needle being poked straight  into the eye.!!! Gosh, i had anesthesia before, it was painful and i shed a tear. Well, a bit. But this is so scary and painful, even to those watching from bedside!


~Superior rectus muscle fixation. It is also know as bridle suture is passed to fix the eye in downward gaze manner.Sir said it was the most painful stage of cataract removal surgery.


~Tryphan blue dye to stain anterior capsule. A bubble is introduced between capsule and cornea. The bluish 
   tinged capsule is then teared with help of a knife to expose the pearly white cataractous lense.




~Phacoemulsification. 

• It has three significant stage. Irrigation, aspiration and ultrasound.
• Something about needle. Fact: Nucleus of the cataract is emulsified using a needle that vibrates at ultrasonic speed of 40000 times a second. One of great WOW! moments is OT, i must say.

~What type of cataract could develop after ECCE ? Answer: it is also known as after cataract. It has two types, Soemmering's ring and Elschnig's pearls.

~What is IOL related complications? Answer: CMO, corneal endothelial damage,uveitis and secondary which is frequently seen with anterior chamber IOLs. UGH syndrome refers to occurence of uveitis, glaucoma, and hyphema. 

~Students, where do we put the incision for lens delivery in intracapsular cataract extraction ? Is it from 6 o'clock or 12 o'clock?  With pure curiosity and without further thinking i asked " Sir, which clock sir? Your clock or our clock? " while standing on the bedside with surgeon sitting behind patient head. They burst into laughter. Pfft! What a bummer! I cracked a joke when the patient is STILL lying there.I didn't mean to. But, still it is a fair question! Answer: Indian smith method, fix the eye at 6 o'clock and by using another hand put counter pressure at 12 o'clock to deliver the lens out of the capsule through the pupil and anterior chamber.



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Optho:Methods of Drug administration

Ocular pharmacotherapeutics can be delivered by four methods:

• —topical instillation into the conjunctival sac, 
• —periocular injections, 
• —intraocular injections and 
• —systemic administration

a)Topical instillation 

Eye drops may be in the form of aqueous solutions (drug totally dissolved) or aqueous suspensions (drug is present as small particles kept suspended in the aqueous medium) or oily solutions

Eye ointment increases the bioavailability of the drug by increasing tissue contact time and by preventing dilution and quick absorption.

Ocusert is a system of drug delivery through a membrane. These can be placed in the upper or lower fornix up to a week and allow a drug to be released at a relatively constant rate. Pilocarpine ocuserts have been found very useful in patients with primary open-angle glaucoma; by efficiently controlling intraocular pressure with comparatively fewer side-effects.

——Soft contact lenses are also used to deliver antibiotics and antiviral drugs in patients with corneal ulcers.A pre-soaked soft contact lens in 1 percent pilocarpine has been found as effective as 4 percent pilocarpine eyedrops in patients with acute angle closure glaucoma.

b)Periocular injections

These are not infrequently employed to deliver drugs.

These include :

• —subconjunctival, 
• —sub-Tenon, 
• —retrobulbar and 
• —peribulbar injections.

Subconjunctival injections. These are commonly used to achieve higher concentration of drugs.
Further, the drugs which cannot penetrate the cornea owing to large-sized molecules can easily pass through the sclera. 

Sub-Tenon injections.These are preferred over subconjunctival injection. Anterior sub-Tenon injections are used mainly to administer steroids in the treatment of severe or resistant anterior uveitis.
Posterior sub-Tenon injections are indicated in patients with intermediate and posterior uveitis .

Retrobulbar injection: These are used to deliver drugs for optic neuritis, papillitis, posterior uveitis and also for administering retrobulbar block anaesthesia.

Peribulbar injection: These are now frequently used for injecting anaesthetic agents. Peribulbar anaesthesia has almost replaced retrobulbar and facial block anaesthesia.

c)Intraocular injections

Such injections are made in desperate cases (e.g., endophthalmitis) to deliver the drugs in maximum
concentration at the target tissue.

These include:

• —intracameral injection (into the anterior chamber), 
• — intravitreal injection (into the vitreous cavity)