Biomedical subjects
Publications and source records attributed to S P Dhir.
In a prospective analysis of ocular fireworks injuries over three consecutive years (1997 to 1999) during the Indian festival of Diwali, 42 patients presented with various types of fireworks-related ocular injuries. Twenty two (52%) patients had to be admitted for the management of their ocular injuries.
A 15 year old boy presented with diminution in vision of both eyes, diabetes insipidus and hypopituitarism. MRI was suggestive of a large suprasellar and retrosellar craniopharyngioma with stretching of the optic chiasma. Histopathological findings on the first surgical specimen were interpreted as a craniopharyngioma. He was reoperated on account of clinical deterioration and increase in tumour size. Histological examination this time revealed derivatives of all three germ cell lineages along with areas of embryonal carcinoma, and yolk sac tumour besides squamous cysts, establishing the diagnosis of malignant mixed germ cell tumour. Serum and CSF were strongly positive for alpha foetoproteins.
A rare case of a choroidal vascular aneurysm arising from the short posterior ciliary artery is reported in a 40-year-old woman. The aneurysm was detected by fluorescein angiography. It caused recurrent choroidal hemorrhage with blindness as the outcome. The diagnosis of aneurysm would have been missed without fluorescein angiography. A search should be made for choroidal vascular aneurysm in cases of spontaneous choroidal and vitreous hemorrhage both clinically (using fluorescein angiography) and histopathologically (in the event of enucleation of the eyeball).
Three cases of damage to the optic nerves and chiasma following pituitary irradiation with Co60 teletherapy are described. All of them presented with progressive visual impairment months following irradiation and simulated recurrence of the tumour. CT scan was also not helpful in differentiating radionecrosis from tumour recurrence. On exploration the optic nerves and chiasma appeared discoloured and scarred. One case, who also had diffuse radionecrosis of brain parenchyma, died. No satisfactory therapy is currently available for this grave complication but proper safeguards can prevent it.
The case of a horn-like hyperplasia of the caruncle of the left eye in a 3-month-old child is reported. An atavistic origin of this growth as a vestigial upper incisor is suggested from the anatomical location of the horn.
Two patients, a brother and sister, presenting with reduced visual acuity, nystagmus, hypopigmentation of the maculae, head nodding, dysarthria and other neuromuscular incoordinations are reported. They were found to be suffering from histidinaemia by aminoacid analysis of urine.
Intralesional injection of triamcinolone acetonide 5 mg/mL suspension was used in the treatment of 110 cases of chalazion; 92.3% of the cases resolved completely with one to three injections, irrespective of the duration and consistency of the chalazion. Recurrence and yellow deposits were seen at the site of injection in a minority of patients.
A young man had an occlusion of the cilioretinal artery. Recirculation in the vessel was established within 48 hours. The retinal damage has been permanent with no improvement in visual acuity. Fluorescein angiography during the stages of occlusion and established recirculation have been described. Vascular spasm of a short posterior ciliary artery due to smoking is the likely causal factor. The site of obstruction and the hemodynamic factors have been discussed.
In a study of 33 patients of heterochromic cyclitis, some unusual clinical features were observed. In many cases the iris was feltlike, month eaten, and associated with gelatinous nodules at the pupillary border or over the surface of iris stroma. An association of pseudoexfoliation of the lens capsule with bilateral heterochromic cyclitis was noted. Twenty-one eyes were subjected to cataract surgery. Hyphema (23.6%) and phacoanaphylactic uveitis (9.5%) were the main postoperative complications.
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A case of radiation retinopathy in a diabetic individual who received a total dose of 45 Gy for lymphoblastic lymphoma of the orbit is reported. The relationship between radiation retinopathy and diabetes mellitus is discussed.
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