1
|
Cox I, Xu ZY, Grzywacz R, Ong WJ, Rasco BC, Kitamura N, Hoskins D, Neupane S, Ruland TJ, Allmond JM, King TT, Lubna RS, Rykaczewski KP, Schatz H, Sherrill BM, Tarasov OB, Ayangeakaa AD, Berg HC, Bleuel DL, Cerizza G, Christie J, Chester A, Davis J, Dembski C, Doetsch AA, Duarte JG, Estrade A, Fijałkowska A, Gray TJ, Good EC, Haak K, Hanai S, Harke JT, Harris C, Hermansen K, Hoff DEM, Jain R, Karny M, Kolos K, Laminack A, Liddick SN, Longfellow B, Lyons S, Madurga M, Mogannam MJ, Nowicki A, Ogunbeku TH, Owens-Fryar G, Rajabali MM, Richard AL, Ronning EK, Rose GE, Siegl K, Singh M, Spyrou A, Sweet A, Tsantiri A, Walters WB, Yokoyama R. Proton Shell Gaps in N=28 Nuclei from the First Complete Spectroscopy Study with FRIB Decay Station Initiator. Phys Rev Lett 2024; 132:152503. [PMID: 38682970 DOI: 10.1103/physrevlett.132.152503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/12/2023] [Accepted: 03/08/2024] [Indexed: 05/01/2024]
Abstract
The first complete measurement of the β-decay strength distribution of _{17}^{45}Cl_{28} was performed at the Facility for Rare Isotope Beams (FRIB) with the FRIB Decay Station Initiator during the second FRIB experiment. The measurement involved the detection of neutrons and γ rays in two focal planes of the FRIB Decay Station Initiator in a single experiment for the first time. This enabled an analytical consistency in extracting the β-decay strength distribution over the large range of excitation energies, including neutron unbound states. We observe a rapid increase in the β-decay strength distribution above the neutron separation energy in _{18}^{45}Ar_{27}. This was interpreted to be caused by the transitioning of neutrons into protons excited across the Z=20 shell gap. The SDPF-MU interaction with reduced shell gap best reproduced the data. The measurement demonstrates a new approach that is sensitive to the proton shell gap in neutron rich nuclei according to SDPF-MU calculations.
Collapse
Affiliation(s)
- I Cox
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - Z Y Xu
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - R Grzywacz
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - W-J Ong
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - B C Rasco
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - N Kitamura
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - D Hoskins
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Neupane
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - T J Ruland
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, Louisiana 70803, USA
| | - J M Allmond
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - T T King
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - R S Lubna
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
| | - K P Rykaczewski
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - H Schatz
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - B M Sherrill
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - O B Tarasov
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
| | - A D Ayangeakaa
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Duke University, Durham, North Carolina 27708, USA
| | - H C Berg
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - D L Bleuel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G Cerizza
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Christie
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - A Chester
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Davis
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - C Dembski
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A A Doetsch
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - J G Duarte
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Estrade
- Department of Physics, Central Michigan University, Mount Pleasant, Michigan 48859, USA
| | - A Fijałkowska
- Faculty of Physics, University of Warsaw, PL 02-093 Warsaw, Poland
| | - T J Gray
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - E C Good
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
| | - K Haak
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - S Hanai
- Center for Nuclear Study, University of Tokyo, Wako, Saitama 351-0198, Japan
| | - J T Harke
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Harris
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - K Hermansen
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - D E M Hoff
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R Jain
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - M Karny
- Faculty of Physics, University of Warsaw, PL 02-093 Warsaw, Poland
| | - K Kolos
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Laminack
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S N Liddick
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - B Longfellow
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Lyons
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - M Madurga
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M J Mogannam
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Nowicki
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - T H Ogunbeku
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G Owens-Fryar
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - M M Rajabali
- Physics Department, Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - A L Richard
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E K Ronning
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Chemistry, Michigan State University, East Lansing, Michigan 48824, USA
| | - G E Rose
- University of California, Berkeley, Berkeley, California 94704, USA
| | - K Siegl
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Singh
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Spyrou
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Sweet
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Tsantiri
- Facility for Rare Isotope Beams, Michigan State University, East Lansing, Michigan 48824, USA
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - W B Walters
- Department of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, USA
| | - R Yokoyama
- Center for Nuclear Study, University of Tokyo, Wako, Saitama 351-0198, Japan
| |
Collapse
|
2
|
Bower WF, Rose GE, Whishaw DM, Ervin CF, Wang AC, Moore KH. The association between nocturia, hormonal symptoms and bladder parameters in women: an observational study. BJOG 2022; 129:812-819. [PMID: 34028168 DOI: 10.1111/1471-0528.16752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postmenopausal nocturia is poorly understood. This study aimed to identify hormonal and lifestyle factors associated with nocturia and to understand the relative contribution of altered urine production and bladder storage dysfunction in women. DESIGN, SETTING, POPULATION AND METHODS Women ≥40 years presenting to public continence services were enrolled in a cross-sectional study. A total of 153 participants completed a hormone status questionnaire, a validated nocturia causality screening tool and a 3-day bladder diary. Descriptive statistics and logistic regression models for nocturia severity and bladder diary parameters were computed. RESULTS Overall, 91.5% reported nocturia, 55% ≥2 /night. There was a difference of 167.5 ml (P < 0.001) in nocturnal urine volume between women with nocturia ≥2 (median 736 ml) versus less often (517 ml). Significant predictors of self-reported disruptive nocturia were age (odds ratio [OR] 1.04, 95% CI 1.002-1.073) and vitamin D supplementation (OR 2.33, 95% CI 1.11-4.91). Nocturnal polyuria was significantly more common with nocturia ≥2 compared with less frequent nocturia (P < 0.002). Exercise for 150 minutes a week was protective for nocturnal polyuria (OR 0.22, P = 0.001). Nocturia index >1.3 was significantly predicted by age (OR 1.07, P < 0.001), regular exercise (OR 0.41, P = 0.036), day flushes (OR 4.00, P = 0.013) and use of vitamin D (OR 2.34, P = 0.043). Maximum voided volumes were significantly lower with nocturia ≥2 versus less often (night: 268 ml versus 350 ml; day: 200 ml versus 290 ml). CONCLUSIONS Bothersome nocturia in postmenopausal women is associated with changes to both nocturnal diuresis and bladder storage. Regular physical activity, prolapse reduction and oestrogen replacement may be adjunctive in managing bothersome nocturia in women.
Collapse
Affiliation(s)
- W F Bower
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Sub-Acute Care Services, The Royal Melbourne Hospital, Parkville, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - G E Rose
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - D M Whishaw
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - C F Ervin
- Department of Sub-Acute Care Services, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - A C Wang
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - K H Moore
- Department of Urogynaecology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
3
|
Abstract
Objective: The objective of this study is to identify variables that describe nocturia-related bother in a sample of community-dwelling individuals. Materials and methods: Community-dwelling individuals age 40 years and older who woke to pass urine at night completed an online questionnaire. Participants were asked (i) their top three concerns in relation to nocturia, (ii) to agree or disagree with a list of statements related to bother, and (iii) to complete the Nocturia Impact Diary items. Fisher exact test and the Mann–Whitney U test were used to assess whether differences in nocturia-related bother existed when comparing participants stratified by nocturia severity. Results: Moderate to extreme nocturia-related bother was described by 56% of the 202 respondents and by 68% of individuals with nocturia two or more times per night. Effects of nocturia, specifically sleep disruption and impact on daytime function, were the most cited concerns. Low nocturia-related health literacy was evident. The sample was younger (83% age <70 years), predominantly female (74%) and nocturia treatment naïve (95%). Conclusion: The study highlights the potential to evaluate patient care based on change in sleep and daytime function rather than solely on nocturia frequency. A suite of patient-reported outcome measures adjunctive to clinical data may have utility in quantifying meaningful change to patients after treatment for nocturia. Level of evidence: Not applicable for this multicentre audit.
Collapse
Affiliation(s)
- GE Rose
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Australia
| | - C Ervin
- Sub-Acute Care Services, Department of Medicine & Aged Care, The Royal Melbourne Hospital, Australia
| | - WF Bower
- Department of Medicine & Aged Care, The Royal Melbourne Hospital, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Australia
| |
Collapse
|
4
|
Hamed-Azzam S, Verity DH, Rose GE. Lateral canthotomy orbitotomy: a rapid approach to the orbit. Eye (Lond) 2017; 32:333-337. [PMID: 28862259 DOI: 10.1038/eye.2017.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 07/02/2017] [Indexed: 11/10/2022] Open
Abstract
PurposeThe lateral compartment of the orbit can readily be accessed through a horizontal lateral canthotomy without the need to swing the lid or remove bone. In this paper the technique, accessible orbital territory, and duration of surgery are presented.Patients and methodsRetrospective, non-interventional descriptive case series for patients who underwent a lateral canthotomy to access pathology within the lateral orbit.ResultsA series of 18 patients are included, all presenting with pathology lateral to, or within, the optic nerve. Pathologies included amyloidosis (1), lymphoma (4), metastatic adenocarcinoma within the optic nerve (1), idiopathic lateral rectus muscle mysositis (4), meningothelial meningioma of the optic nerve (1), intraconal orbital meningioma (1), reactive lymphoid hyperplasia (1), optic nerve glioma (3), optic nerve meningioma (1), and cavernous haemangioma (1). The median surgical time was 36 min (range 23-75 min). No patient required detachment of the lower lid, the technique leaving both upper and lower 'arms' of the lateral canthal tendon attached to Whitnall's tubercle.ConclusionsThe lateral canthotomy approach orbitotomy is a rapid, safe, and minimally disruptive approach for accessing pathology in the lateral orbit and optic nerve. The lateral canthal tendon is split along the horizontal raphe without detachment of either limb from Whitnall's tubercle, no bone is removed, and the post-operative recovery is rapid with minimal associated inflammation or chemosis. This approach is also flexible, permitting the clinician to increase exposure to the orbit peroperatively by swinging the lower lid if required.
Collapse
Affiliation(s)
- S Hamed-Azzam
- Orbital Service, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - D H Verity
- Orbital Service, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - G E Rose
- Orbital Service, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Mellington FE, Dayan CM, Dickinson AJ, Hickey JL, MacEwen CJ, McLaren J, Perros P, Rose GE, Uddin J, Vaidya B, Foley P, Lazarus JH, Mitchell A, Ezra DG. Management of thyroid eye disease in the United Kingdom: A multi-centre thyroid eye disease audit. Orbit 2017; 36:159-169. [PMID: 28296512 DOI: 10.1080/01676830.2017.1280057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article aims to provide baseline data and highlight any major deficiencies in the current level of care provided for adult patients with thyroid eye disease (TED). We undertook a prospective, nonrandomized cross-sectional multicenter observational study. During a 3-month period June-August 2014, consecutive adult patients with TED who presented to nominated specialist eye clinics in the United Kingdom, completed a standardized questionnaire. Main outcome measures were: demographics, time from diagnosis to referral to tertiary centre, time from referral to review in specialist eye clinic, management of thyroid dysfunction, radioiodine and provision of steroid prophylaxis, smoking, and TED classification. 91 patients (mean age 47.88 years) were included. Female-to-male ratio was 6:1. Mean time since first symptoms of TED = 27.92 (73.71) months; from first visit to any doctor with symptoms to diagnosis = 9.37 (26.03) months; from hyperthyroidism diagnosis to euthyroidism 12.45 (16.81) months. First, 13% had received radioiodine. All those with active TED received prophylactic steroids. Seven patients who received radioiodine and did not have TED at the time went on to develop it. Then, 60% patients were current or ex-smokers. 63% current smokers had been offered smoking cessation advice. 65% patients had active TED; 4% had sight-threatening TED. A large proportion of patients (54%) were unaware of their thyroid status. Not enough patients are being provided with smoking cessation advice and information on the impact of smoking on TED and control of thyroid function.
Collapse
Affiliation(s)
| | - C M Dayan
- b Institute of Molecular and Experimental Medicine , Cardiff University School of Medicine , Cardiff , United Kingdom
| | - A J Dickinson
- c Newcastle Eye Centre , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , United Kingdom
| | - J L Hickey
- d British Thyroid Foundation , Harrogate , United Kingdom
| | - C J MacEwen
- e Department of Ophthalmology , Ninewells Hospital , Dundee , United Kingdom
| | - J McLaren
- f Thyroid Eye Disease Charitable Trust , Bristol , United Kingdom
| | - P Perros
- c Newcastle Eye Centre , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , United Kingdom
| | - G E Rose
- a Moorfields Eye Hospital , London , United Kingdom.,g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom
| | - J Uddin
- a Moorfields Eye Hospital , London , United Kingdom.,g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom
| | - B Vaidya
- h Department of Endocrinology , Royal Devon and Exeter Hospital and University of Exeter Medical School , Exeter , United Kingdom
| | - P Foley
- i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association
| | - J H Lazarus
- i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association
| | - A Mitchell
- i Members of TEAMeD and organisations represented: A. J. Dickinson, J. L. Hickey, G. E. Rose and P. Foley - British Thyroid Foundation, J. McLaren and C. M. Dayan - Thyroid Eye Disease Charitable Trust, D. G. Ezra - Royal College of Ophthalmologists, J. Uddin - British Oculoplastic Surgery Society, C. J. MacEwen - Scottish Ophthalmologists Club, J. H. Lazarus - Royal College of Physicians, P. Perros - Society for Endocrinology and B. Vaidya - British Thyroid Association
| | - D G Ezra
- a Moorfields Eye Hospital , London , United Kingdom.,g UCL Institute of Ophthalmology Biomedical Research Centre for Ophthalmology , London , United Kingdom
| | | |
Collapse
|
6
|
Wickwar S, McBain HB, Ezra DG, Hirani SP, Rose GE, Newman SP. Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery? Eye (Lond) 2015; 29:951-7. [PMID: 25998940 DOI: 10.1038/eye.2015.76] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/28/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Graves' orbitopathy (GO) is associated with changes in the appearance of the eyes and visual dysfunction. Patients report feeling socially isolated and unable to continue with day-to-day activities. This study aimed at investigating the demographic, clinical, and psychosocial factors associated with quality of life in patients presenting for orbital decompression surgery. METHODS One-hundred and twenty-three adults with GO due for orbital decompression at Moorfields Eye Hospital London were recruited prospectively. Clinical measures including treatment history, exophthalmos, optic neuropathy, and diplopia were taken by an ophthalmologist. Participants completed psychosocial questionnaires, including the Graves' Ophthalmopathy Quality of Life Scale (GO-QOL), the Hospital Anxiety and Depression Scale, and the Derriford Appearance Scale. Hierarchical multiple regression analyses were used to identify predictors of quality of life. RESULTS Higher levels of potential cases of clinical anxiety (37%) and depression (26%) were found in this study sample than in patients with other chronic diseases or facial disfigurements. A total of 55% of the variance in GO-QOL visual function scores was explained by the regression model; age, asymmetrical GO and depressed mood were significant unique contributors. In all, 75% of the variance in GO-QOL appearance scores was explained by the regression model; gender, appearance-related cognitions and depressed mood were significant unique contributors. CONCLUSION Appearance-related quality of life and mood were particularly affected in this sample. Predominantly psychosocial characteristics were associated with quality of life. It is important when planning surgery for patients that clinicians be aware of factors that could potentially influence outcomes.
Collapse
Affiliation(s)
- S Wickwar
- 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Adnexal Department, Moorfields Eye Hospital, London, UK
| | - H B McBain
- 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Community Health Newham, East London Foundation Trust, London, UK
| | - D G Ezra
- 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK
| | - S P Hirani
- Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK
| | - G E Rose
- 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK
| | - S P Newman
- Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK
| |
Collapse
|
7
|
Verity DH, Rose GE. Response to Drs Litwin and Malhotra. Eye (Lond) 2014; 28:632-3. [PMID: 24603427 DOI: 10.1038/eye.2013.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- D H Verity
- Adnexal Department, Orbital Unit, Moorfields Eye Hospital, London, UK
| | - G E Rose
- Adnexal Department, Orbital Unit, Moorfields Eye Hospital, London, UK
| |
Collapse
|
8
|
Abstract
BACKGROUND Necrotising fasciitis (NF) is a devastating disease with considerable mortality and morbidity, and early aggressive surgical debridement of devitalised necrotic tissues has traditionally been advocated. METHODS We describe three patients who were referred from other units several weeks after developing periocular necrotising fasciitis; in all the three, the disease had been managed medically without surgical debridement, with apparent 'stalling' of the inflammatory process despite persistent necrotic periocular tissue. RESULTS Following 'elective debridement' of the devitalised tissues and reconstruction with local flaps, all achieved a satisfactory aesthetic result. DISCUSSION The role of host genetic determinants, polarised cytokine responses, and early, effective medical treatment in patients with atypical 'disease phenotypes' in NF are discussed.
Collapse
Affiliation(s)
- A Mutamba
- Orbital Unit, Moorfields Eye Hospital, London, UK
| | | | | |
Collapse
|
9
|
Abstract
Vascular events in the orbit can present with an acute onset of symptoms, and, if untreated, raised orbital pressure and reduced arterial perfusion can lead to loss of orbital functions. Such events are commonly due to haemorrhage, but can also be due to arterio-venous shunts and very rarely arise from intraorbital vascular occlusion. The likely diagnosis is often evident on taking a thorough history and examination and in most cases, after appropriate imaging, the process can be monitored for progression. Visual failure is usually due to high pressure at the orbital apex, resulting in ischaemic optic neuropathy, and any evidence of a persistent significant visual impairment should prompt intervention.
Collapse
Affiliation(s)
- G E Rose
- Orbital Clinic, Moorfields Eye Hospital, London, UK.
| | | |
Collapse
|
10
|
Abstract
PURPOSE Untreated periocular discoid lupus erythematosus (DLE), though very rare, may lead to significant morbidity with lid deformities, trichiasis, and symblepharon formation. We present the largest reported cohort of patients with biopsy-proven DLE solely affecting the periorbital region. METHODS Observational case series of patients managed over a 7-year period (2004-10). RESULTS Seven patients (one male) presented to the Adnexal Service at Moorfields Eye Hospital at a median age of 47 years (range 23-71 years); median interval from symptom onset to biopsy-proven diagnosis was 38 months (range 6-86 months). Changes in peripheral skin were present in 1 patient (occurring after the initial eyelid presentation) and the presenting periocular features were dissimilar across the group, these included: chronic blepharo-conjunctivitis, madarosis, atypical chalazia, depigmentation of the eyelid margin, or marked, persistent periocular oedema with dacryoadenitis.Two cases settled spontaneously, but five required systemic hydroxychloroquine or intralesional corticosteroid injections. CONCLUSION Periorbital DLE is rare and very varied in its presentation, the protean manifestations often resulting in significant diagnostic delay. All patients with unusual periocular skin disease and those with a refractory inflammatory dermopathy, should undergo biopsy of involved tissue(s), thus leading to earlier diagnosis and prevention of permanent cicatricial periocular changes.
Collapse
Affiliation(s)
- T Gupta
- Adnexal Department, Moorfields Eye Hospital, London, UK
| | | | | | | |
Collapse
|
11
|
Babar-Craig H, Kayhanian H, De Silva DJ, Rose GE, Lund VJ. Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients. Rhinology 2011; 49:315-7. [PMID: 21858262 DOI: 10.4193/rhino10.103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. METHODS A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. RESULTS Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. DISCUSSION SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.
Collapse
Affiliation(s)
- H Babar-Craig
- Royal National Throat Nose and Ear Hospital, London, UK.
| | | | | | | | | |
Collapse
|
12
|
Maino AP, Dawson EL, Adams GGW, Rose GE, Lee JP. The Management of Patients with Thyroid Eye Disease After Bilateral Orbital 3 Wall Decompression. Strabismus 2011; 19:35-7. [DOI: 10.3109/09273972.2011.575432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Rose GE, Lightbody KA, Ferguson RG, Walsh JC, Robb JE. Natural history of flexed knee gait in diplegic cerebral palsy evaluated by gait analysis in children who have not had surgery. Gait Posture 2010; 31:351-4. [PMID: 20116253 DOI: 10.1016/j.gaitpost.2009.12.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 12/20/2009] [Accepted: 12/22/2009] [Indexed: 02/02/2023]
Abstract
Eighteen children with diplegic cerebral palsy and no history of orthopaedic surgery had two gait analyses a mean of 6.3 years apart to analyse the effects of time on their gait. The mean age of the children at first analysis was 7.7 years (range 4.4-13.3 years). The data was analysed as a whole group (18 children) and as two sub-groups of nine children: those with a shorter follow-up (mean 5.0 years) and those with a longer follow-up (mean 7.5 years) between analyses. The following significant bilateral changes were seen in the whole group and longer follow-up sub-group: deterioration in the range of knee flexion, mid-stance knee flexion, peak knee extension in stance and hamstring length and an improvement in mean and maximum hip rotation. Temporal data showed no significant changes once normalised. There were no bilateral significant changes in data from children evaluated at a mean of 5 years follow-up. GMFCS scores generally improved over time despite the significant increase in flexed knee gait. There was no significant change in gait deviation index in any group over time. There was an increase in body mass index in 16 children but there was no correlation between this and the degree of mid-stance knee flexion. These findings may have implications for longer term follow-up of children with cerebral palsy into adulthood.
Collapse
Affiliation(s)
- G E Rose
- Anderson Gait Analysis Laboratory, Edinburgh, United Kingdom
| | | | | | | | | |
Collapse
|
14
|
Abstract
AIM To review a group of patients with sphenoid wing meningioma and visual impairment. The technique and results for endoscopic transnasal decompression of the orbital apex is presented. PATIENTS AND METHODS Patients presenting between 1993 and 2004 with visual impairment due to sphenoid wing meningioma were identified. All patients had full ophthalmic assessment, automated visual field testing, and appropriate orbital imaging. Patients with clinical evidence of significant progression in visual impairment (loss of acuity, reduced colour discrimination, or field deterioration) underwent endoscopic transnasal orbital decompression. OUTCOME MEASURES Assessment of visual function (Snellen acuity, Ishihara colour perception, and visual field testing), together with other measures of orbital structure and function (ocular balance, ductions, and exophthalmometry). RESULTS Twelve patients (all women) presented to the Orbital Clinic between the ages of 38 and 71 years (mean 42.6; median 48.5 years) and with symptoms for an average of 32 months (3-102 months; median 22). The most common symptom was swelling and proptosis, in 11 (91%) patients, and subjective deterioration of vision had been noted in six cases (50%). Eight right orbits (67%) were affected and the preoperative acuity varied between Snellen 6/5 and counting fingers, with visual field impairment in all cases. There was an average of 5.0 mm of axial proptosis (range 5-9 mm; median 5). Endoscopic decompression was without complication in all cases. With a follow-up interval of 33.9 months (range 5-80; median 26 months), there was a subjective and objective improvement in visual functions-with Snellen acuity improving between 1 and 4 lines in seven patients, reduction in relative afferent pupillary defect in 10/12 patients, and improved visual field testing. There was a 2.3 mm reduction in proptosis (1-4 mm; median 3 mm) with less lid swelling, improved ocular balance and motility in four patients, and slightly worse diplopia in one patient. Three patients required further procedures: one had ipsilateral middle meatal antrostomy for retained secretions at 18 months and two had strabismus surgery. Three patients underwent fractionated radiotherapy for large tumours, or for late tumour growth and recurrent visual impairment. CONCLUSION Orbital decompression by transnasal endoscopic ethmoidectomy appears to alleviate optic nerve compression due to sphenoid wing meningioma, with a reasonable relief of the condition for some years. Some patients will require later radiotherapy for progressive tumour growth or visual failure.
Collapse
Affiliation(s)
- V J Lund
- Institute of Laryngology and Otology, London, UK
| | | |
Collapse
|
15
|
Anderson OA, Lee V, Singh R, Ford RL, Rose GE, Thuau H. Orbital fractures: ophthalmic or maxillofacial? Br J Oral Maxillofac Surg 2007; 45:90-1. [PMID: 16298460 DOI: 10.1016/j.bjoms.2005.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2005] [Accepted: 10/05/2005] [Indexed: 11/28/2022]
|
16
|
Abstract
AIM This investigation newly describes the characteristics and treatment for a group of patients with inactive thyroid eye disease who presented with recurrent transient visual obscuration, generally related to sudden changes in posture. STUDY DESIGN A retrospective case-note review of an unmatched case series. PATIENTS AND METHODS Clinical records were reviewed for patients with thyroid eye disease, presenting to the Orbital Clinic at Moorfields Eye Hospital with recurrent transient visual obscuration. All patients underwent orbital decompression and the response to this, and other, treatment was reviewed. RESULTS Six patients (five female) presented to the Orbital Clinic, between the ages of 43 and 66 years (mean 54.7; median 52 years), with recurrent visual obscurations related to postural changes. Transient obscurations had been noted for between 3 weeks and 2 months, the patients having had symptoms of underlying thyroid eye disease for between 6 and 18 months. Five patients had diabetes for between 2 and 45 years, four being controlled with insulin and one with metformin. All patients had increased orbital tension on clinical assessment, intraocular pressures were raised in 5/6, and the optic disc in affected eyes was markedly swollen (with bilateral choroidal folds in two patients). Hertel exophthalmometry ranged from 22 to 27 mm, and there was a global reduction in ocular ductions in all. Bilateral orbital decompression was performed in all patients, although sequentially in one patient: 4/6 patients had three-wall decompression with an average proptosis reduction of 5.8 mm (range 2-8 mm; eight orbits) and 2/6 had decompression of the medial wall and floor alone (mean reduction 6.8 mm, range 5-8 mm; four orbits). In all patients, there was an almost immediate cessation of obscurations, together with a subjective and objective improvement in various visual functions. Optic disc swelling resolved over a few weeks after surgery. CONCLUSION The 'hydraulic' variant of thyroid eye disease-characterised by high orbital apex pressures, with secondarily raised episcleral venous and intraocular pressures-may be linked with certain orbital shapes, such as that of Asians. This variant can present with recurrent visual obscuration associated with transient postural hypotension, especially in diabetics-this possibly being due to a microvasculopathy of the orbital or optic nerve circulation.
Collapse
Affiliation(s)
- G E Rose
- Orbital Service, Moorfields Eye Hospital, London EC1 V 2PD, UK.
| |
Collapse
|
17
|
Abstract
AIM Although the clinical characteristics of childhood periocular capillary haemangiomas are well known, serial measurements of blood velocity and lesion size are unknown. This investigation was designed to measure the changes in maximum blood velocity and estimated size of lesion in children with capillary haemangioma not requiring active intervention. STUDY DESIGN Retrospective case-note review for a cohort of children with capillary haemangioma involving the eyelid and orbit. PATIENTS AND METHODS Children with periocular capillary haemangioma, under the care of the Orbital unit at Moorfields Eye Hospital between 1996 and 2005, were monitored clinically and with repeated ultrasonographic examination. Volume estimates were calculated as an ovoid based on the three maximum orthogonal measurements for the haemangioma, and blood velocity was assessed by Colour Flow Mapping, Colour Doppler Energy Imaging, and Spectral Doppler techniques using a Sequoia 512 Acuson scanner. RESULTS Twenty-four children (12 boys) had initial assessment by 18 months of age, and the haemangioma increased in size in 14/24 (58%), the increase being between 4 and 931% of initial volume estimate. The largest measured size for an individual haemangioma appears inversely related to the child's age at measurement, this mirroring a similar trend in measurements for the maximum blood velocity. Blood velocity measurements also tend to decrease with time, the peak velocity being before 1 year of age in the majority (15/24; 62%). In many children, both volume estimates and blood velocities show a cyclic variation-this occurring with increasing intervals between the maxima, before a final decay in both parameters. Although, for the whole group, there was no correlation (correlation coefficient=0.29) between estimated size and measured blood velocity, some individual children showed a significant correlation between the two parameters. The age at maximum blood velocity appeared to precede the age at maximum volume in most children, and in many there was an orbital anomaly detectable on ultrasonographic examination, even with complete clinical resolution of the haemangioma. CONCLUSIONS Ultrasonographic examination of periocular capillary haemangiomas show that these lesions have a very high blood velocity in feeding vessels-about 2-3 orders of magnitude greater than normal capillary beds-and that the velocity and volume of such lesions undergo a cyclic variation during their natural history. Evidence suggests that both velocity and volume decrease with time, although often not returning to zero on ultrasonography (unlike the clinical resolution of the lesions). In most children, blood velocity peaks before volume estimates and this might suggest that decreasing perfusion leads to later tissue atrophy and involution of the haemangioma.
Collapse
Affiliation(s)
- D H Verity
- Orbital Clinic, Moorfields Eye Hospital, London, UK
| | | | | |
Collapse
|
18
|
Abstract
AIM To examine the results of open lacrimal drainage surgery in patients with rare nasal diseases. METHOD A retrospective review of a group of patients with rare nasal disease who underwent open lacrimal surgery over a 15-year period at Moorfields Eye Hospital. Three main groups of disease were identified: (I) patients with treated mid-face tumours; (II) patients with prior major midfacial injury or surgery; and (III) patients with congenital nasal anomalies, including nasal aplasia. The more common systemic conditions of Wegener's granulomatosis and sarcoidosis were specifically excluded. RESULTS Eighty-six patients (43 men; 50%) were identified with an age range between 1 and 82 years at the time of surgery. A total of 100 primary procedures were performed in 85 patients and symptomatic relief was achieved in 83/100 (83%) eyes, with 18/100 eyes (18%) requiring two or more lacrimal procedures. Lacrimal reconstructive surgery was considered impractical in two further patients. There were no intraoperative and few postoperative complications. CONCLUSION With adequate experience, open lacrimal surgery appears to be a safe and effective procedure in the majority of patients with rare nasal diseases or major nasofacial anomalies.
Collapse
Affiliation(s)
- R Jain
- Lacrimal Service, Moorfields Eye Hospital, London, UK
| | | |
Collapse
|
19
|
Abstract
AIM The prevalence of thyroid orbitopathy, compared with an estimate for the United Kingdom population, is examined in a large cohort of patients treated for periocular lymphoma. PATIENTS AND METHODS Clinical details were reviewed for patients presenting to the Orbital Clinic at Moorfields Eye Hospital with biopsy-proven periocular lymphoma. Recorded evidence of prior thyroid gland abnormality or thyroid eye disease was sought and treatment details recorded, together with that of the subsequent periocular lymphoma. The calculated prevalence of thyroid orbitopathy in our patients with periocular lymphoma was compared with an estimate based upon published figures for a United Kingdom population. RESULTS Of 369 patients with periocular lymphoma, 20 (5%) had a history of thyroid disease and adequate notes were available in 10 cases: All had autoimmune thyrotoxicosis between 11 and 27 years (median 17.5) before diagnosis of periocular lymphoma and 6/10 had thyroid orbitopathy-none receiving orbital radiotherapy for treatment of their thyroid eye disease. Using a calculated estimate for the UK prevalence of thyroid orbitopathy, the probability of even these six cases of ophthalmopathy among 369 patients with periocular lymphoma is very low (P=0.007). CONCLUSION Compared with a population estimate, patients with periocular lymphoma had a significantly greater prevalence of preceding thyroid orbitopathy, with a median latency of 17 years. Thyroid orbitopathy possibly predisposes to later local lymphoma in a manner similar to the late emergence of lymphoma with other chronic inflammatory diseases-such as Sjögren's syndrome, Hashimoto's thyroiditis, coeliac disease, or Helicobactergastritis.
Collapse
|
20
|
Manzouri B, Bates A, Rose GE, Adams GGW. Late presentation of severe thyroid eye disease. Eye (Lond) 2004; 18:1021-3. [PMID: 15094732 DOI: 10.1038/sj.eye.6701396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
21
|
|
22
|
Islam N, Mireskandari K, Rose GE. Orbital varices and orbital wall defects. Br J Ophthalmol 2004; 88:1092-3. [PMID: 15258032 PMCID: PMC1772267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
|
23
|
|
24
|
Burton BJL, Islam N, Plant GT, Rose GE. Double jeopardy; brain abscess and subdural empyema presenting with painful enlargement of orbital varices in a patient with known encephalocele. Eye (Lond) 2004; 18:79-81. [PMID: 14707974 DOI: 10.1038/sj.eye.6700494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
25
|
Jenkins C, Rose GE, Bunce C, Cree I, Norton A, Plowman PN, Moseley I, Wright JE. Clinical features associated with survival of patients with lymphoma of the ocular adnexa. Eye (Lond) 2003; 17:809-20. [PMID: 14528242 DOI: 10.1038/sj.eye.6700379] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although systemic or eyelid involvement by ocular adnexal lymphoma carries a worse prognosis, there have been few reports of the outcome in relation to clinical presentation. The outcome of malignant ocular adnexal lymphoma was, therefore, related to presenting clinical symptoms and signs. DESIGN AND METHODS A retrospective, noncomparative case-note review of 326 patients treated in the Orbital Clinic at Moorfields Eye Hospital. The associations between presenting symptoms or signs and three outcome measures (v.i.) were assessed by univariate and multiple variable regression together with Kaplan-Meier analysis. MAIN OUTCOME MEASURES (i) Presence of extra-orbital disease at the time of presentation; (ii) development of systemic lymphoma after new presentation with solely ocular adnexal disease; and (iii) death attributable to widespread lymphoma. RESULTS Presentation with disseminated disease was rarer with over 1 year's ophthalmic symptoms (odds ratio (OR) 0.7; 95% CI 0.5-0.9) and much more frequent with bilateral adnexal disease (OR 5.8; 95% CI 3.0-11.2). With solely adnexal disease at presentation, subsequent extra-orbital lymphoma was more frequent and earlier with lacrimal gland disease (as compared to those without; hazard ratio (HR) 1.9; 95% CI 1.2-4.5) or with eyelid disease (compared to those without; HR 2.4; 95% CI 1.2-4.5), or with bilateral disease (compared to unilateral disease; HR 2.6; 95% CI 1.4-5.2). Prior or concurrent systemic disease was the most significant predictive factor for lymphoma-related death (HR 6.8; 95% CI 4.3-10.9), but tumour-related death was also commoner and earlier with bilateral disease (HR 2.4; 95% CI 1.4-4.0) or where a relative afferent papillary defect was present (HR 2.8; 95% CI 1.6-4.9). Similarly, the rate of tumour-related death was slightly less where symptoms had been present for more than a year (HR 0.8; 95% CI 0.7-1.0) and slightly greater in the elderly (HR 1.03; 95% CI 1.01-1.05). Conjunctival lymphoma had the lowest rate of extra-orbital spread and lymphoma-related death, the rate of these two events being sequentially greater for patients with predominantly deep orbital lymphoma, lacrimal gland lymphoma, or eyelid lymphoma. CONCLUSION These data suggest that presenting symptoms and signs of patients with ocular adnexal lymphoma are significantly associated with the risk of systemic disease at orbital presentation, the rate of subsequent spread, and the rate of lymphoma-related death.
Collapse
Affiliation(s)
- C Jenkins
- Orbital Clinic Moorfields Eye Hospital City Road, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
PURPOSE To report a series of 15 primary lacrimal sac tumours and present an algorithm in managing this rare condition. DESIGN Noncomparative interventional case series. METHODS A retrospective review of the clinical, radiological, and pathological records of 15 patients with primary lacrimal sac tumours. Main outcome measures Histologic evaluation and clinical follow-up, including tumour clearance and recurrence, were assessed. RESULTS Of the patients, 11 were female and the median age at presentation for the whole group was 59 years (range 22-94 years). The commonest tumour was non-Hodgkins B-cell lymphoma (five cases), followed by two cases each of squamous cell carcinoma and transitional cell carcinoma, one case of benign transitional papilloma, haemangiopericytoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, mixed (squamous/transitional) carcinoma, and a highly malignant undifferentiated tumour. Treatment modalities included surgery, radiotherapy and chemotherapy and, with a median follow-up of 30 months (range 2 months to 17 years), two patients had died from metastatic disease but nine patients remained without evidence of recurrent tumour. CONCLUSIONS Primary lacrimal sac tumours are extremely rare, require long-term follow-up for recurrence and metastasis, and can be fatal.
Collapse
Affiliation(s)
- D N Parmar
- Lacrimal Clinic, Moorfields Eye Hospital, London, UK
| | | |
Collapse
|
27
|
Abou-Rayyah Y, Rose GE, Konrad H, Chawla SJ, Moseley IF. Clinical, radiological and pathological examination of periocular dermoid cysts: evidence of inflammation from an early age. Eye (Lond) 2002; 16:507-12. [PMID: 12194059 DOI: 10.1038/sj.eye.6700045] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2000] [Accepted: 08/13/2001] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Periocular dermoid cysts are common and leakage of the lipid or keratin contents leads to an inflammation-often asymptomatic-around the cyst, which may cause adherence of the dermoid cyst to neighbouring structures. PURPOSE To investigate the frequency of clinical and radiological signs of inflammation with periocular dermoid cysts, to relate this to the histopathological examination of the excised specimens, and to assess whether the degree of inflammation is related to age at presentation. PATIENTS AND METHODS A retrospective non-comparative series of 124 patients with periocular dermoid cysts that had undergone imaging. Case-notes were reviewed for clinical and histopathological details and there was independent review of the radiological imaging. RESULTS Surgery was undertaken at between 1 and 66 years of age, most patients being under 10 years, and the duration of symptoms varied from 4 weeks to 30 years. Symptoms of inflammation-mainly intermittent lid swelling with localised redness and pain-occurred in all age groups, the proportion being greatest in the fourth decade. Clinical signs of inflammation at the time of clinic visit were relatively few, although 8% had some localised erythema and 7% had tenderness at the site of lesion. In more than two-thirds of the excised cysts, pathological examination demonstrated various degrees of chronic inflammation, even in those cysts removed before the age of 5 years. CONCLUSION Even if the patient does not have symptoms or signs of inflammation, most periocular dermoid cysts show histological evidence of inflammation due to leakage of the lipid and keratin contents from the cyst, the incidence being similar at all ages.
Collapse
|
28
|
Redmill B, Sandy C, Rose GE. Reply. Eye (Lond) 2002. [DOI: 10.1038/sj/eye/6700092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
29
|
Abstract
PURPOSE To review two cases of primary orbital melanoma presenting like orbital vascular anomalies. METHODS Retrospective review of clinical presentation, treatment, radiology and pathology for two patients under the care of the Orbital Clinic at Moorfields Eye Hospital. RESULTS Both lesions presented with the appearance and behaviour of vascular anomalies. In one case, a spindle cell melanoma appeared to be a low flow vascular anomaly with a loculated secondary haemorrhage and, in the other case, a melanoma of soft parts was considered to be an arteriovenous malformation and responded partially to embolisation. CONCLUSION Primary malignant melanoma may present as a secondary vascular lesion of the orbit and this very rare tumour should be considered in the differential diagnosis of any vascular anomaly.
Collapse
Affiliation(s)
- V Lee
- Moorfields Eye Hospital, London, UK
| | | | | | | | | | | |
Collapse
|
30
|
Smith JM, Rose GE, Plowman PN. Pulsatile visual phenomenon, ipsilateral to a metastatic orbital carcinoid, occurring during usage of sildenafil (Viagra). Eye (Lond) 2001; 15:809-11. [PMID: 11827018 DOI: 10.1038/eye.2001.265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
31
|
|
32
|
Affiliation(s)
- B Odufuwa
- Orbital Clinic, Moorfields Eye Hospital, London, England
| | | |
Collapse
|
33
|
Abstract
BACKGROUND/AIMS Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity. METHODS A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze. RESULTS 102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%). CONCLUSION Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management.
Collapse
|
34
|
Abstract
The management of failed probing for congenital nasolacrimal duct obstruction is given by a panel of authors. Treatment options examined are repeat probing, inferiorturbinate infracture, closed lacrimal intubation and dacryocystorhinostomy. There is considerable variation as to the timing of these interventional techniques.
Collapse
Affiliation(s)
- B A O'Donnell
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE To determine the outcome of pediatric dacryocystorhinostomy (DCR) for large mucoceles or for primary nasolacrimal duct obstruction unresponsive to multiple probings. DESIGN Retrospective noncomparative case series. PARTICIPANTS One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. METHODS Clinical case notes were reviewed for a series of cases operated on at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 and 1999. MAIN OUTCOME MEASURES Postoperative relief of presenting symptoms and signs and complications. RESULTS Fifty-nine percent of admissions (75 of 127) were day cases, and the other 52 admissions were inpatient. Simultaneous bilateral surgery was performed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubation was performed in 20% of operations, these generally being early in the series. Three children had Down syndrome, five had craniofacial anomalies, and two had systemic disorders. Mild postoperative cellulitis occurred in three cases, all of which settled without complication after systemic antibiotic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpatient groups. Complete cure of symptoms was achieved in 96% and an improvement of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). CONCLUSION For surgeons experienced in pediatric lacrimal surgery, external DCR with sutured mucosal flaps can be accomplished through an 8-mm incision with no surface sutures and minimal scarring. Symptoms are improved in all cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is amenable to day case management, without significant morbidity, and may be performed as a simultaneous bilateral procedure.
Collapse
Affiliation(s)
- E A Barnes
- Moorfields Eye Hospital, London, England, UK
| | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE To report two cases of suspected parosteal osteosarcoma of the orbit, with dedifferentiation into a high-grade liposarcoma occurring in one patient. DESIGN Two retrospective case reports. METHODS The clinical, radiologic, and pathologic records of two patients with suspected orbital parosteal osteosarcoma were retrospectively reviewed. MAIN OUTCOME MEASURES Histologic evaluation and clinical follow-up were measured. RESULTS The first patient was a 47-year-old male presenting with a 5-month history of painless right lower lid swelling; excision biopsy suggested a well-differentiated parosteal osteosarcoma of the orbital floor, which recurred 3 years later. Six months after excision of the recurrence, the mass demonstrated accelerated growth, and a lid-sparing exenteration was performed; histologic examination showed a high-grade liposarcoma. The patient remains disease-free at 4 years. The second patient, a 40-year-old male, presented with an 8-year history of proptosis and a right superotemporal orbital mass. The mass was excised completely at lateral orbitotomy; histologic examination suggested a well-differentiated parosteal osteosarcoma. The patient remains well 9 months postoperatively. CONCLUSIONS Parosteal osteosarcoma is an uncommon tumor, usually affecting long bones, that is extremely rare in the orbit. It is a low-grade sarcoma that tends to recur locally after excision but has a favorable prognosis. Dedifferentiation into a high-grade sarcoma occasionally occurs in parosteal osteosarcoma, but transformation into liposarcoma does not seem to have been previously reported. It is important to recognize dedifferentiated parosteal osteosarcoma, because the prognosis is poor, and radical treatment may be required.
Collapse
Affiliation(s)
- D N Parmar
- Orbital Clinic, Moorfields Eye Hospital, London, England
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Abstract
BACKGROUND The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss. METHODS A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery. RESULTS All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. CONCLUSION Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed.
Collapse
Affiliation(s)
- C Rene
- Moorfields Eye Hospital, London EC1V 2PD, UK
| | | | | | | |
Collapse
|
39
|
|
40
|
Jenkins C, Rose GE, Bunce C, Wright JE, Cree IA, Plowman N, Lightman S, Moseley I, Norton A. Histological features of ocular adnexal lymphoma (REAL classification) and their association with patient morbidity and survival. Br J Ophthalmol 2000; 84:907-13. [PMID: 10906102 PMCID: PMC1723589 DOI: 10.1136/bjo.84.8.907] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The histological characteristics of ocular adnexal lymphomas have previously provided only a limited guide to clinical outcome for affected patients. This clinicopathological relation was re-examined using the Revised European American Lymphoma (REAL) system to classify the tumours in a large cohort of patients. METHODS The biopsies and clinical follow up data for 192 patients with ocular adnexal lymphoma were reviewed, the biopsies being regraded in accordance with the REAL classification. For each of five histological groups, logistic regression analysis was used to determine the odds ratios (OR) for the presence of systemic disease at the time of orbital diagnosis and Cox regression analysis was used to assess the hazard ratios (HR) for disseminated disease and lymphoma related death. For 108 patients in whom extraorbital spread occurred, the histological category of lymphoma was compared with the sites of dissemination. RESULTS At presentation, the frequency of previous or concurrent extraorbital disease increased from marginal zone lymphoma (OR 1.0), diffuse lymphoplasmacytic/lymphoplasmacytoid lymphoma (OR 2.3), follicle centre lymphoma (OR 3.8), diffuse large B cell lymphoma (OR 4.0) to other histological lymphoma variants (OR 26.8). For all histological types, the estimated risk of extraorbital disease and lymphoma related death continued for many years and the proportion of patients with at least one extraorbital recurrence after 5 years was 47% for MZL, 48% for LPL, 64% for FCL, 81% for DLCL, and 95% for other lymphoma variants. The corresponding estimated rates for 5 year lymphoma related mortality were 12%, 19%, 22%, 48%, and 53% respectively. CONCLUSIONS Patients with ocular adnexal lymphoma can be classified by REAL into five distinct groups, which show a progressive increase in the risks of extraorbital disease at diagnosis, of disease dissemination with time, and of tumour related death.
Collapse
Affiliation(s)
- C Jenkins
- Orbital Clinic, Moorfields Eye Hospital, London
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Abstract
We retrospectively reviewed 104 dacryocystograms carried out on 72 patients who had previously undergone dacryocystorhinostomy, to assess the diagnostic contribution of the radiological investigation in patients with persistent or recurrent symptoms. In patients whose symptoms were referable to the operated side, dacryocystography was performed as part of further pre-operative assessment. In 42% of these patients it demonstrated an anatomical or physiological abnormality that explained the symptoms. However, no clear reason for the recurrence of symptoms was demonstrated in 58% of cases.
Collapse
Affiliation(s)
- M Amin
- Department of Radiology, Moorfields Eye Hospital, London, UK
| | | | | |
Collapse
|
43
|
Abstract
OBJECTIVE The study compares the use of Jones' retractor plication and the Wies procedure as a primary procedure for the repair of involutional lower lid entropion in the absence of horizontal lid shortening. DESIGN Retrospective case series comparison. PARTICIPANTS One hundred two cases with at least 6 months follow-up after primary surgery for involutional lower lid entropion performed between 1993 and 1996. INTERVENTIONS Two groups were compared: Jones' retractor plication was performed in one group and the Wies procedure in the other; neither group had horizontal shortening of the lower eyelid. MAIN OUTCOME MEASURES The rates of cure, recurrence, and overcorrection of the lower lid entropion. RESULTS Jones' retractor plication was performed in 37 (36%) patients and the Wies procedure in 65 (64%). Two of the 37 (5%) Jones cases had recurrent entropion develop, both at 31 months after surgery, compared with 1 1 of 65 (17%) recurrences after the Wies procedure (P = 0.81); recurrence after Wies procedure was earlier, at a median of 6 months after surgery. There were 20 of 65 (31 %) overcorrections after the Wies procedure and 4 of 37 (11 %) after the Jones procedure (P < 0.02); one quarter of each group required secondary repair of the overcorrection (5 of 20 after failed Wies procedure; 25% after failed Jones procedure). Overall, there were 6 of 37 (16%) unsatisfactory results after the Jones procedure in contrast to 31 of 65 (48%) after the Wies procedure (P < 0.001). CONCLUSIONS These data provide strong evidence (P < 0.001) that, in the absence of horizontal shortening of the lower eyelid, a successful outcome is more likely after Jones retractor plication than after the Wies procedure.
Collapse
Affiliation(s)
- K Boboridis
- Adnexal Service, Moorfields Eye Hospital, London, England
| | | | | |
Collapse
|
44
|
|
45
|
Abstract
OBJECTIVE The purpose of the study was to review the surgical management of postherpetic lacrimal obstruction. DESIGN Retrospective noncomparative case series. PARTICIPANTS One hundred sixty patients (111 female, 49 male) with a mean age at presentation of 31 years. All had a history typical of primary herpes simplex blepharoconjunctivitis. INTERVENTION Open lacrimal surgery was performed on 158 patients (171 eyes), of whom 99 patients (108 eyes) had undergone no surgery before being seen at Moorfields. The most common primary procedure was dacryocystorhinostomy (DCR) with anterograde or retrograde intubation (94 eyes, 54%), and primary placement of a Lester Jones tube (conjunctivo-DCR) was performed in 56 eyes (32%). A secondary procedure was required in 43 eyes (26%), the most common being closed placement of a Lester Jones tube (40 eyes). MAIN OUTCOME MEASURES Persistent symptoms of impaired lacrimal drainage and need for additional surgery. RESULTS Reduction of epiphora was good or complete in 171/173 eyes (98%). CONCLUSIONS This study shows that there is a justification for procedures that use any remaining unaffected portion of canaliculi, such as DCR, with anterograde or retrograde intubation, as well as the more commonly used Lester Jones tube.
Collapse
Affiliation(s)
- C J McLean
- Moorfields Eye Hospital, London, England
| | | |
Collapse
|
46
|
Abstract
BACKGROUND Orbital xanthogranuloma, a diagnosis confirmed histologically, occurs rarely in adults and children. With its characteristic macroscopic appearance the adult form may be associated with a spectrum of biochemical and haematological abnormalities including lymphoproliferative malignancies. METHOD The clinicopathological features and imaging appearances on computed tomography and magnetic resonance imaging of this condition are described in eight adults and a child. RESULTS Radiological evidence of proptosis was present in seven patients. In all nine patients an abnormal infiltrative soft tissue mass was seen, with increased fat in six cases. All patients had associated enlargement of extraocular muscles suggestive of infiltration and five had lacrimal gland involvement. Encasement of the optic nerve, bone destruction, and intracranial extension was present only in the child with juvenile xanthogranuloma. Haematological and/or biochemical abnormalities were detected in seven patients and seven patients had other systemic diseases which were considered to have an immune basis. One patient subsequently developed non-Hodgkin's lymphoma. CONCLUSION The investigation and management of orbital xanthogranulomas requires a multidisciplinary approach even though the diagnosis may be suspected clinically. Imaging delineates the extent of disease and involvement of local structures and may influence the differential diagnosis. The juvenile form may be more locally aggressive, causing bone destruction with consequent intracranial extension.
Collapse
Affiliation(s)
- K A Miszkiel
- Department of Radiology, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK
| | | | | | | | | |
Collapse
|
47
|
Abstract
AIM To examine the results of open lacrimal surgery in patients with Wegener's granulomatosis. METHODS A retrospective review of patients with Wegener's granulomatosis who underwent lacrimal surgery over a 17 year period. RESULTS 11 patients were identified and a total of 14 primary dacryocystorhinostomies (DCR) and one revisional DCR were performed; symptomatic relief was achieved in 13/14 operations and one patient required revisional surgery for persistent symptoms. There were no intraoperative and few postoperative complications. CONCLUSIONS In contrast with some previous reports, open DCR appears to be a safe procedure and it is recommended as a treatment for lacrimal obstruction in patients with Wegener's granulomatosis, but an increase of perioperative immunosuppression is recommended in certain cases.
Collapse
Affiliation(s)
- A S Kwan
- Moorfields Eye Hospital, London EC1V 2PD, UK
| | | |
Collapse
|
48
|
Abstract
OBJECTIVE Soft-tissue cellulitis after open lacrimal surgery, almost exclusively caused by infection, is associated with a reduced surgical success rate, inconvenience for the patient, and may predispose to secondary hemorrhage. Although postoperative oral antibiotics have been shown to significantly reduce the infection rate, this investigation was designed to compare this regimen with two other methods for the prevention of postoperative infection. DESIGN A prospective nonrandomized comparative trial of three methods for prevention of postoperative infection. PARTICIPANTS Patients, recruited over a 16-month period from the Lacrimal Clinic at Moorfields Eye Hospital, who required primary open dacryocystorhinostomy. METHOD Two hundred and sixty-five patients were assigned, on the basis of hospital number, to one of three groups: to receive either an intravenous broad-spectrum antibiotic immediately after induction of anesthesia (group 1), intraoperative lavage of the rhinostomy site just after suture of the anterior mucosal flaps (group 2), or a postoperative course of oral antibiotics (group 3). OUTCOME MEASURES Cellulitis was considered to be present when there was marked tenderness along a swollen and erythematous incision line, evidence of frank pus from the suture line, or late postoperative hemorrhage occurred. Patients were reviewed within a week of surgery. RESULTS Signs of infective cellulitis occurred in 1 of 127 (0.8%) cases in group 1, 7 of 41 (18%) cases in group 2, and 2 of 127 (1.5%) cases in group 3. Whereas the infection rate in group 2 was significantly greater than that in group 1 (P << 0.001) or group 3 (P<0.001), no significant difference was found between that in groups 1 and 3 (0.75>P>0.5; chi-square test with Yates' correction). CONCLUSION Compared with intraoperative saline lavage, intraoperative or postoperative broad-spectrum antibiotics have comparable efficacy in the prevention of postoperative soft-tissue cellulitis after open lacrimal surgery. Intraoperative administration of antibiotics has the advantages of compliance and economics.
Collapse
Affiliation(s)
- S J Vardy
- Moorfields Eye Hospital, London, England
| | | |
Collapse
|
49
|
Abstract
OBJECTIVE Retrograde intubation of canaliculi during dacryocystorhinostomy can restore canalicular patency in cases otherwise managed with bypass tubes. The surgical technique and success for this procedure are discussed. DESIGN A retrospective, noncomparative case series with clinic or telephone interview for long-term follow-up of patients' symptoms. PARTICIPANTS One hundred two patients who had undergone this particular lacrimal drainage surgery at Moorfields Eye Hospital between 1992 and 1997. INTERVENTION All patients underwent a dacryocystorhinostomy and retrograde canaliculostomy while under general anesthetic. MAIN OUTCOME MEASURES Relief or reduction of epiphora and discharge. RESULTS One hundred twenty-three lacrimal systems of 102 patients were included. There were 53 females and 49 males, with ages at surgery ranging from 6 to 83 years (mean, 49 years). The etiology was idiopathic (30%), herpetic canaliculitis (24%), punctal agenesis (18%), and trauma (11%); less-common causes included dacryocystitis, Stevens-Johnson syndrome, eczema, and prior radiation therapy. Both upper and lower canalicular systems were involved in the majority (73%) of patients, and in 13 (11%) systems a dacryocystorhinostomy had previously been performed. The silicone tube was placed for a mean of 2 months (range, 1 week-9 months), and the mean postoperative follow-up was 8 months (range, 2-24 months). Epiphora subjectively improved in 90 (73%) of 123 systems, of which 27 (22%) of 123 were asymptomatic. In 33 systems (27%) in which epiphora persisted, 14 (11%) have undergone closed placement of a Jones canalicular bypass tube with control of symptoms. CONCLUSIONS Retrograde canaliculostomy and intubation can spare a significant number of patients the long-term inconvenience of Jones tubes. Failure of this technique does not, however, compromise or complicate the future placement of a bypass tube.
Collapse
Affiliation(s)
- M J Wearne
- Moorfields Eye Hospital, London, England
| | | | | | | |
Collapse
|
50
|
Abstract
AIMS To analyse bone fragments from rhinostomies of patients undergoing revisional dacryocystorhinostomy, looking for evidence of new bone formation. METHODS 14 consecutive patients undergoing secondary lacrimal surgery were included in this study. In each case the existing rhinostomy was enlarged with bone punches, care being taken to use the punches with the jaws cutting perpendicularly to the edge of the rhinostomy, to allow accurate orientation of the specimens. The fragments were examined histologically for evidence of new bone formation. RESULTS Histological sections showed fragments of bone with variable fibrosis at the edge of the rhinostomy. There was evidence of only very little new bone formation. CONCLUSION This study has clearly shown that, at the edge of a rhinostomy, healing is predominantly by fibrosis and there is only very limited new bone formation.
Collapse
Affiliation(s)
- C J McLean
- Moorfields Eye Hospital, London EC1V 2PD
| | | | | |
Collapse
|