Optical coherence tomography of the effects of stromal hydration on clear corneal incision architecture.

Purpose: To evaluate the effects of stromal hydration on clear corneal incision (CCI) architecture immediately after surgery using anterior segment optical coherence tomography (AS-OCT).

Setting: Department of Ophthalmology, Royal Berkshire Hospital, Reading, United Kingdom.

Methods: Clear corneal incisions in adult eyes were examined using a Visante AS-OCT imaging system within 1 hour of surgery.

Glucosamine and chondroitin for osteoarthritis.

Osteoarthritis (OA) is a common, chronic disease that most frequently affects the knees and is a major cause of disability in the elderly. It is characterized by progressive cartilage loss, accompanied by secondary changes such as osteophyte formation and calcium deposition. Inflammatory processes are also involved, leading to stiffness and pain, for which patients seek treatment.

Concomitant primary breast carcinoma and primary choroidal melanoma: a case report.

Introduction: Choroidal melanoma and choroidal metastasis are distinct pathological entities with very different treatments and prognoses. They may be difficult to distinguish to the untrained observer.

Case Presentation: A case of concomitant choroidal melanoma in a woman with primary breast carcinoma is described.

Management of Exacerbation of COPD.

COPD is a progressive debilitating lung condition the clinical course of which is punctuated by acute severe increases in symptoms (exacerbations). These can be life threatening and are a considerable cause of morbidity and mortality as well as frequently requiring hospital admission. The aims of treatment are to prevent attacks through vaccination, smoking cessation, appropriate medication, the provision of pulmonary rehabilitation and also patient education.

Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography.

Purpose: To investigate clear corneal incision (CCI) architecture in the immediate postoperative period using optical coherence tomography (OCT).

Setting: Prince Charles Eye Unit, King Edward VII Hospital, Windsor, United Kingdom.

Methods: Thirty-four CCIs in 34 adult eyes were examined prospectively using the Carl Zeiss Visante anterior segment OCT imaging system within 1 hour of uneventful phacoemulsification cataract surgery.

The role of vitamins and minerals in energy metabolism and well-being.

Physicians are frequently confronted with patients complaining of fatigue, tiredness and low energy levels. In the absence of underlying disease, these symptoms could be caused by a lack of vitamins and minerals. Certain risk groups like the elderly and pregnant women are well-recognized.

The influence of micronutrients on cognitive function and performance.

There has been much media speculation (often sensationalist and conflicting) regarding the potential influence of micronutrients on cognitive function and performance. Our aim was to identify the micronutrients specifically implicated in cognitive function and to review the literature to identify original sources underlying the media coverage. Literature searches were carried out to identify recent clinical trials, reviews, editorials and meetings describing the biochemical and physiological role of individual micronutrients.

Feasibility of day-case vitreoretinal surgery.

Purpose: The indications for vitreoretinal (VR) surgery are increasing as equipment and techniques available improve. In order to decrease demand on limited health resources, day-case surgery would be beneficial in many cases. This study combines a retrospective and prospective arm to examine the feasibility and safety of routine day-case VR surgery.

The management of retinal vein occlusion: is interventional ophthalmology the way forward?

Retinal vein occlusions (RVO) are the second commonest sight threatening vascular disorder. Despite its frequency treatments for RVO are unsatisfactory and include several that have not been tested by large, well designed, prospective, randomised controlled trials. There is also the lack of long term follow up in many of the available small uncontrolled studies, and the timings of interventions are haphazard.

Cutaneous sarcoidal granulomas developing after Artecoll facial cosmetic filler in a patient with newly diagnosed systemic sarcoidosis.

Artecoll is a recently developed permanent synthetic cosmetic filler substance, composed of 80% bovine collagen and 20% polymethylacrylate (PMMA) microspheres of 32-40 mum in diameter. It is used for the augmentation of deep wrinkles and is to be injected subdermally. We report the development of granulomas at the site of Artecoll injections in the face in a 48-year-old woman who had pulmonary sarcoidosis.

Intracameral phenylephrine to prevent floppy iris syndrome during cataract surgery in patients on tamsulosin.

Purpose: To describe the use of intracameral phenylephrine to prevent the floppy iris syndrome seen in patients who are on the drug tamsulosin for benign prostatic hypertrophy, during cataract surgery.

Setting: Prince Charles Eye Unit, King Edward VII Hospital, Windsor, Berkshire, UK.

Method: Seven patients who were on systemic tamsulosin for benign prostatic hypertrophy received intracameral phenylephrine before capsulorexhis during their cataract surgery.

Data from a study of effectiveness suggested potential prognostic factors related to the patterns of shoulder pain.

Objective: Shoulder pain is a common complaint in primary care, and the factors associated with persisting shoulder pain are varied. We therefore explored prognostic factors associated with shoulder pain problems.

Study Design And Setting: Patients (n=109) were randomly allocated to 6 weeks of treatment with either corticosteroid injections (53 patients) or physiotherapy (56 patients).

Biopsy-confirmed spontaneous resolution of orbital langerhans cell histiocytosis.

A 17-year-old boy presented with a left upper lid swelling, headaches and diplopia. An orbital computerized tomography (CT) scan showed a mass in the left lacrimal fossa eroding bone and extending into the temporalis fossa and intracranially. An urgent biopsy without curettage was carried out and showed Langerhans cell histiocytosis.

Oxygen therapy for older people.

Oxygen therapy requires careful assessment before treatment is commenced and ongoing monitoring. Teresa Smith reviews the use of oxygen with older people and considers the nurse's role.

Pre-operative and post-operative effect of a pain management programme prior to total hip replacement: a randomized controlled trial.

Patients may wait some time for total hip replacement with conservative management of pain and disability, but no attempts to rehabilitate them. This study randomised 40 patients accepted for and awaiting total hip replacement to a brief rehabilitative psychologically based pain management programme (PMP) or to a control group with no intervention. Patients were assessed before randomisation, 3 months after the PMP or equivalent waiting time, and again one year later after total hip replacement.

The new NICE guidelines on COPD.

The National Institute of Clinical Excellence guidelines on chronic obstructive pulmonary disease, published in March this year, provide a new way of thinking about the management of the disease. This article highlights the key areas and recommendations made by the guidelines.

Metastatic mesothelioma presenting with proptosis.

Purpose: To describe the clinical presentation and histologic findings in a patient with metastatic mesothelioma presenting to the ophthalmologist with nonaxial proptosis.

Design: Case report.

Methods: A 55-year-old man presented with a short history of progressive ocular discomfort and vertical diplopia.

Hyaluronidase allergy after peribulbar anesthesia with orbital inflammation.

A 70-year-old woman previously exposed to hyaluronidase during ophthalmic surgery had excision of hypertrophic bulbar conjunctival tissue in the right eye. Hyaluronidase was added to the peribulbar anesthetic agent. Five days postoperatively, the patient presented with proptosis in the right eye, extraocular muscle restriction, and decreased visual acuity.

Total abdominal hysterectomy: development of a patient-centred care pathway.

This article describes how one organisation developed an integrated care pathway for women undergoing the procedure total abdominal hysterectomy. The efficacy of care pathways to provide patient-centred care is also discussed.

A pilot study of the effect of the Queen's Square external bladder stimulator on urinary retention after knee replacement surgery.

Postoperative urinary retention remains an important problem after major orthopaedic surgery and can increase morbidity. External vibration applied to the suprapubic region has improved bladder emptying and urinary symptoms in patients with neurogenic bladders. Forty-three patients undergoing elective major knee surgery were randomly assigned to receive either a Queen's Square bladder stimulator or placebo device for 24 h postoperatively.

Charnley low-friction arthroplasty: a worldwide retrospective review at 15 to 20 years.

This is a retrospective survivorship analysis review of 5089 Charnley low-friction arthroplasties performed as a primary procedure at 8 hospitals around the world before December 31, 1980. Data collected were simple with a well-defined endpoint: death or revision. There was no clinical or radiographic evaluation.

An evaluation of baseline risk factors predicting severity in juvenile idiopathic arthritis associated uveitis and other chronic anterior uveitis in early childhood.

Background/aims: The clinical course for childhood chronic anterior uveitis can vary from mild, self limiting disease to bilateral blindness. The purpose of this study was to identify those risk factors at onset that predict disease severity.

Methods: A retrospective case note review of all patients with painless anterior uveitis diagnosed from 1982 to 1998.