Pain, while salient, is highly subjective. A sensation perceived as painful by one person may be perceived as uncomfortable, not painful or even pleasant to others. Within the same person, pain may also be modulated according to its threat value and the context in which it is presented. Imaging techniques, such as functional magnetic resonance imaging and positron emission tomography, have identified a distributed network in the brain, the pain-relevant brain regions, that encode the sensory-discriminative aspect of pain, as well as its cognitive and affective/emotional factors. Current knowledge also implicates the prefrontal cortex as the modulatory area for pain, with its subdivisions forming the cortico-cortical pathway, an alternative pain modulatory pathway distinct from the descending modulatory pathway of pain. These findings from neuroimaging in human subjects have paved the way for the molecular mechanisms of pain modulation to be explored in animal studies.

To report a rare case of acute onset of proptosis secondary to subcutaneous panniculitis-like T cell lymphoma (SPTCL). METHODS: A case report. RESULTS: A 27-year-old Malay man presented with history of acute onset of proptosis in the left eye for 2 weeks. It was associated with history of prolonged high fever. He also developed multiple erythematous swelling on his body and both thighs during this period. On examination, visual acuity in both eyes was 6/6. The left eye was proptosed and chemotic.The extraocular move-ment was limited in all directions.The cornea and the anterior segment were normal. Fundoscopy showed normal optic disc and retina.The examination of the right eye was unremarkable.His body temperature was 40.0℃.There was presence of multiple erythematous subcu-taneous lesions over the body mainly in the left axillary, right hypochondriac, both thighs and the suprapubic area.The inguinal lympnodes were also palpable.MRI of orbit and brain revealed generalized soft tissue swelling in the left extraconal and retro-orbital space suggesting of inflammatory reaction.The cavernous sinus and brain were normal.Skin biopsy from the erythematous lesion revealed as SPTCL.He was referred to the haematologist and was started on chemotherapy-CHOP regime. The patient responded well to the chemotherapy and the proptosis reduced. CONCLUSION: Proptosis secondary to SPTCL is very rare. This is a variant of a peripheral T cell lymphoma characterised by multiple subcutaneous nodules presented with proptosis and fever.

Purpose: Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. Methods: The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. Results: The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = –0.41, p = 0.019), the nasal outer macula (r = –0.41, p = 0.019), and the inferior outer macula (r = –0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. Conclusions The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.