bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angiomyofibrosarcoma: a rare ischiorectal fossa swelling
Authors: Satheshkumar T , Saklani AP , Banerjee D , Jones DRB 
Published: May 2014

A33-year-old woman presented with a painful lump in the right gluteal region, 7 months after normal vaginal delivery of her child. There was no history of altered bowel habits, bleeding per rectum, dyspareunia or difficult labour. On examination she was afebrile. Local examination revealed asymmetry with a tender lump in the right gluteal region and some redness of the overlying skin. Rectal examination revealed a tender right lateral rectal wall. Magnetic resonance imaging (Figure 1) revealed a 12×8×8 cm complex ‘cyst’ in the right ischiorectal fossa displacing the levator ani upward and the rectum medially, with an apparent pseudo capsule. In the T1-weighted sequences, it had higher signal intensity than the bladder. On T2-weighted sequences, the lesion was of very high intensity. Also in the surrounding fat were multiple linear foci of high intensity, representing oedema or increased vascularity. In view of the location, it was suggested that this could be an abscess. Examination under anaesthesia revealed a boggy swelling in the ischiorectal fossa. An incision to drain this abscess revealed no pus, however, a soft fatty lump protruded from the incision. The incision was extended and a soft tissue mass 12 cm in diameter was enucleated. The cavity was packed and skin incision closed after 3 days. Histopathology revealed an angiomyxoid tumour, extending to the resection margins. Subsequently she was sent to a specialist centre. Computed tomography of the chest was normal. After discussion with the patient about the possibility of incontinence and stoma, re-excision was performed. Histology suggested low grade, sarcomatous changes in a pre-existing myofibroblastic lesion, either angiomyxoma or angiomyofibroblastoma. Immunostaining was positive for desmin and weakly positive for actin and calponin. Staining for caldesmin and myogenin were negative. CD34 was present in few scattered spindle cells. No adjuvant therapy was given. She had one admission since then with a wound collection, which was drained.
Cerebellar arteriovenous malformation presenting with bilateral proptosis mimicking caroticocavernous fistula
Authors: Bhidayasiri Roongroj , Hathout Gasser M , Heyming Theodore W , Ovbiagele Bruce 
Published: May 2014

A 21-year-old man presented with a 3-year history of bulging and redness of his right eye associated with double vision. He had a history of facial trauma 5 years previously. These symptoms, which had progressed over the year preceding the presentation, were accompanied by a bilateral pounding headache and gait unsteadiness with veering to the right. On examination, he had bilateral pulsating exophthalmos that was more marked on the right with a loudly audible orbital bruit. Mild soft tissue swelling of the right eyelid along with dilated veins in the right conjunctival fornices was observed. His visual acuity was 20/20 and there was no papilloedema. Eye movement examination showed restricted up-gaze, in conjunction with skew deviation, the right eye being hypertropic. Although impaired convergence was observed, there was no convergence retraction nystagmus. Right lateral rectus palsy and right sensorineural hearing loss were noted. Coordination testing revealed right finger to nose and heel to shin ataxia associated with a slightly wide based gait. The magnetic resonance images showed several findings of interest. There was a massive right cerebellar arteriovenous malformation, with a large tangle of vessels extending into the quadrigeminal plate and perimesencephalic cistern with mass effect on the right aspect of the midbrain (Figure 1). There was bilateral proptosis, significantly more pronounced on the right, with enlargement of the left lateral rectus muscle and bulging of the right cavernous sinus. Surprisingly, no significant enlargement of the right superior ophthalmic vein was noted (Figure 2). Cerebral angiography showed a massive right cerebellar arteriovenous malformation, fed by the bilateral posterior inferior cerebellar arteries, anterior inferior cerebellar arteries and superior cerebellar arteries, as well as direct branches from the basilar artery and right posterior cerebral artery. Superficial venous drainage was observed directly to the right transverse and sigmoid sinuses, as well as to the deep venous system, with an enlarged straight sinus, vein of Galen and internal cerebral veins. There was also retrograde forward-directed venous flow filling the right cavernous sinus and the inferior petrosal sinus. Emanating from the right cavernous sinus (Figure 3), there were two anterior directed veins: a smaller superior one, representing a cortical vein and a larger inferior vein, representing the right superior ophthalmic vein, which was only mildly dilated. The inferior ophthalmic vein was not visualized. No fistulous communication between the carotid artery and cavernous sinus was seen.
Pulmonary hypertension: a rare but serious complication of ventriculoatrial shunts
Authors: Sharma R , Mcleod AA 
Published: May 2014

A 34-year-old woman presented with a 6-month history of progressive dyspnoea. Past history included cerebral palsy and epilepsy. At the age of 14 years she had a ventriculoatrial (VA) shunt for hydrocephalus secondary to congenital aqueduct stenosis. There was no past history of deep vein thrombosis, liver disease, appetite suppressant use, intravenous drug abuse or other systemic disease. On examination she was unwell with central cyanosis, tachypnoea (respiratory rate 36 breaths per minute), sinus tachycardia (heart rate 120 beats per minute), and blood pressure 100/60 mmHg. There was ankle oedema, raised jugular venous pressure, accentuated pulmonary second sound and a right ventricular gallop. Chest X-ray showed cardiomegaly with prominent pulmonary arteries (Figure 1). Electrocardiogram demonstrated right axis deviation, dominant R wave in V1 and ST depression across the precordial leads (Figure 2). On room air her arterial partial pressures of oxygen and carbon dioxide were 7.1 KPa and 3.2 KPa respectively. Transthoracic echocardiography showed dilated right ventricle and right atrium with severe tricuspid regurgitation and moderate pulmonary regurgitation. Estimated pulmonary artery pressure was 100 mmHg. There was no evidence of intracardiac thrombus and left ventricular systolic function normal. A ventilation perfusion scan showed multiple sub-segmental perfusion defects. Cardiac catheterization confirmed severe pulmonary hypertension (pulmonary vascular resistance 1048 dynes/sec/cm2) with normal left heart pressures and no intracardiac shunt. Calculated cardiac index was low (1.5 litre/min/kg) with high right atrial pressure (20 mmHg) and low mixed venous oxygen saturation (50%). Pulmonary angiography and chest computed tomogram with contrast showed thrombus in the main pulmonary trunk extending into the proximal right and left pulmonary arteries. Duplex ultrasonography of both legs suggested no evidence of deep vein thrombosis. A thrombophilia, vasculitis and infection screen was negative. The patient was commenced on nasal continuous positive airways pressure, high flow oxygen, intravenous heparin and intravenous colloid with haemodynamic stability maintained for the first 4 days. After this she became more hypoxic and hypotensive so fluids were stopped and a frusemide, dopamine and prostacyclin infusion commenced to reduce right ventricular distension with some improvement. Because of her deteriorating haemodynamic state, pulmonary thromboendarterectomy was performed with removal of extensive thrombus from the proximal pulmonary tree. The patient died in the immediate postoperative period. Postmortem showed a distended and hypertrophied right heart with extensive chronic thromboembolic changes in the distal pulmonary tree. The tip of the VA catheter in the right atrium had no signs of infection and at this time was free of thrombus. The coroner concluded cause of death was pulmonary hypertension secondary to longstanding thromboembolic disease.
Aggressive angiomyxoma of the vulva
Authors: Baruah S , Latthe P , Bhatti NR , Ghataura SS 
Published: May 2014

A 33-year-old nulliparous women presented with a 4-week history of a painful vaginal swelling. There had been no relevant medical or gynaecological history of note and she was using the combined oral contraceptive pill (Cilest, Janssen-Cilag, High Wycombe, Bucks) for contraception. On pelvic examination, she had a tender right labial swelling 3×3×2 cm in size. The surrounding area showed no evidence of inflammation. Systemic examination was unremarkable. The clinical diagnosis made was of a right Bartholin cyst. At examination under anaesthesia and excisional biopsy, the lesion appeared to be a cystic, fleshy-looking lesion located on the right labia majora, but was also seen to be extending towards the right ischiorectal fossa. The area was excised and multiple grey fragments (the largest being 110×45×20 mm) were submitted for pathological examination. The lesion was well sampled and consisted of a mass of rather featureless spindled and stellate cells set in a myxoid and fibrillary background. It was highly vascular with considerable areas of red cell spillage into the stroma and some of the larger vessels showed medial hypertrophy. There was evidence of infiltration into adjacent muscle. The other main differential diagnosis considered was angiomyofibroblastoma, but the perivascular condensation and zonality was not seen, nor was the plasma cell or epithelioid component. The tumour was positive for desmin (marker for intermediate cytoskeletal filaments), but negative for smooth muscle actin, S100 and epithelial membrane antigen. The appearance was in keeping with an aggressive angiomyxoma. On confirmation of histology, the patient was sent to the gynaecological oncology team for further follow up, and magnetic resonance imaging was planned for identification of any invasion by tumour in case of recurrence.
Ogilvie's syndrome: a rare complication of inguinal hernia repair
Authors: Hamilton SW , Jabbar AA 
Published: May 2014

A 49-year-old man had an open, tension-free, mesh (Lichtenstein) repair performed under general anaesthetic for a left-sided direct inguinal hernia. His immediate postoperative recovery was uneventful and he was discharged the following day. He was readmitted as an emergency 2 days later with intermittent abdominal pain, nausea and complete constipation. On examination his abdomen was slightly distended, but was not tender. X-ray (Figure 1) showed dilated loops of small bowel with gas in the colon and rectum. He was managed conservatively. However, over the next 24 hours his symptoms became worse with increasing abdominal pain and vomiting. He was still passing no flatus. His abdomen became more distended and generally tender to light palpation. Repeat X-ray (Figure 2) revealed markedly distended small bowel and a grossly distended caecum. He proceeded to theatre as the caecal distension was increasing and he had developed signs of peritoneal irritation. At laparotomy his bowel was free from the left hernia repair and no mechanical cause for the obstruction was found. The colon was distended to the rectum and the caecum was 10 cm in diameter with tearing almost imminent. It was therefore decompressed with an aspiration needle and on-table sigmoidoscopy. Appendicectomy was performed and the stump used to place a caecostomy. Recovery was slow but he was discharged home 2 weeks after readmission.
The reality of international ophthalmic peri-operative training
Authors: Machin Heather 
Published: May 2014

For developed nations and developed regions, competency training and assessment in nursing has been the gold standard for the standardization of nursing practice. As national and international nursing communities continue to increase their interest and dependence on competencies, which ultimately offer patients a standardized and expected level of care, nurses are able to contribute to their career advancement and professional development through the simple task of completing a competency training and assessment programme at their place of work. While competency development is going into full throttle in developed nations of the world, the same competency standardization has not reached nurses in lesser developed nations with equal zeal, and nurses within these systems continue to fall behind their international counterparts. This paper follows the development initiative of ORBIS International to provide developing and emerging economy peri-operative ophthalmic nurses with the opportunity to access standardized and sustainable competency training, education and assessment resources.
Developing and evaluating patient information for patients with dry eye
Authors: Hardman Elizabeth Jane 
Published: May 2014

Background Verbal interactions between healthcare professionals and patients form the basis of most hospital outpatient consultations helping to determine diagnoses and treatments and to provide patient information. The use of the patient information leafet (PIL) to complement and reinforce the verbal message is well reported. In disease management where self care plays an important role, providing patient information is particularly crucial. Dry eye is a multifactorial and complex disease and it is recognized that patients who have a better understanding of dry eye tend to have better treatment outcomes and better control of their symptoms. Aims The purpose of this project was to design an evidence-based PIL for the chronic, ocular condition ‘dry eye’, which would meet the information needs of patients. Primary objectives To demonstrate the efficacy of the revised PIL as an effective educational tool for patients suffering with dry eye and identify (i) themes of information dry eye patients would like to see incorporated into a new PIL and (ii) demographic characteristics of those patients. Design A needs analysis on an existing leaflet (PIL1) via a patient satisfaction survey was performed to determine the content of a newer, revised leaflet (PIL2). PIL2 was evaluated by patients via a repeat questionnaire. Data analysis involved statistical comparison of fixed-response data and thematic description of open-response data. Participants Patients attending ophthalmology outpatient clinics at Gloucestershire Royal and Cheltenham General Hospitals with a diagnosis of dry eye either as primary pathology or as an incidental finding to other ocular pathology, plus representatives of the multidisciplinary team in ophthalmology. Results 66 participants were recruited and 53 completed questionnaires were returned yielding a response rate of 82%. Data analysis demonstrated statistically significant improvements in patients' understanding of dry eye and symptom management, and satisfaction with information on treatments after reading PIL2, but little improvement in confidence in self management of symptoms. Conclusions This work produced a PIL whose content refects current evidence and opinion, and which has been received favourably by patients and clinicians alike.
Nursing management during intra-aterial therapy in children with retinoblastoma
Authors: Bergeron Marie-Paule , Binaghi Stefano , Beck-Popovic Maja , Munier Francis L. , Ruchat Gillian 
Published: May 2014

Aims: Retinoblastoma is a rare childhood cancer that can be life and vision threatening. This recently developed therapy, which injects melphalan into the ophthalmic artery, is only available in a few European centres. Our aim is to explain the procedure and some important nursing strategies for patient care. Method: Twelve children received superselective ophthalmic artery chemotherapy in our angiography unit under general anaesthesia. With careful planning between all practitioners a course of three sessions, one every 3 weeks, was organized with the parents. To assess the chemotherapy response and evaluate any adverse side effects the children were examined under general anaesthesia prior to each injection. Results: Each child has had their eye preserved with the highest visual potential at the time of reporting. Complications were encountered, fortunately without any serious consequences, and all children are doing well. Conclusions: Nursing strategies and intervention help prevent complications as a result of the procedure by maintaining a safe and secure environment. We also gain expertise by sharing skills in a multidisciplinary team.
Introducing the WHO's Safe Surgery Saves Lives initiative to ophthalmic nurses involved in ORBIS' training programmes
Authors: Machin Heather 
Published: May 2014

Aim: To monitor and improve patient safety systems within partner peri-operative nursing settings within developing regions of the world through the implementation the WHO's Safe Surgery Saves Lives initiative. Method: Prior to implementation of the Safe Surgery Saves Lives initiative ORBIS observed and assessed existing safety systems and the use of patient indicators within partner hospitals in 2010. Thereafter ORBIS provided training and conducted preliminary assessment of new skills within each hospital. Results: ORBIS' programmes had a significant impact on introducing, informing and instructing nurses within ORBIS' partner hospitals around the world of the importance of safe surgery checking within the peri-operative ophthalmic department. Conclusion: This initiative demonstrates the need for training and the implementation of safe site surgery checking systems within peri-operative ophthalmic departments within developing region partner hospitals around the world, and it highlights the ongoing need to continue such training.
A comparative study of the tonometers: Goldmann applanation, Perkins, Tono-Pen XL and Reichert 7CR
Authors: Eriksson E , Davidsson L , Brautaset R 
Published: May 2014

Aim: The aim of this study was to compare and analyze the correlation between intraocular pressure (IOP) measured with Goldmann applanation tonometry (GAT), Perkins, Tono-Pen XL and the Reichert 7CR in healthy eyes. Methods: 36 healthy voluntary subjects participated in the study, age raging from 21 to 59 years (mean age 33.2 years). In total 32 eyes were selected for analysis. Two optometrist using GAT, Perkins, Reichert 7CR and Tono-Pen XL measured four successive IOP readings in a cyclic permutation. The Reichert 7CR gives two values for IOP: a Goldmann correlated intraocular pressure (IOPg) and a corneal compensated intraocular pressure (IOPcc). Lidocaine hydrochloride 4% + fluorescein sodium 0.25% was instilled before measuring the IOP. Results: Mean values: GAT 14.00 ± 2.00 mmHg (min=10 mmHg, max=18 mmHg); Perkins 13.50 ± 1.565 mmHg (min=11.00 mmHg, max=18.00 mmHg); Reichert 7CR (IOPg) 13.65 ± 2.581 mmHg (min=8.10 mmHg, max=17.90 mmHg); Reichert 7CR (IOPcc) 13.10 ± 2.22 mmHg (min=9.20 mmHg, max=18.40 mmHg) and Tono-Pen XL 14.50 ± 2.471 mmHg (min=9.00 mmHg, max=19.00 mmHg). Coefficient of determination as a function of GAT was calculated to: Perkins R2=0.63, IOPg R2=0.33, IOPcc R2=0.33 and Tono-Pen XL R2=0.35. Statistical analysis was performed with a repeated measure ANOVA test. The limits of agreement was set to 95%. A statistically signifcant difference in IOP readings was found between GAT vs IOPcc and Tono-Pen XL vs IOPcc (p<0.05). Conclusions: All devices show reliable measurements of IOP in normal healthy eyes. Perkins, IOPg and Tono-Pen XL show agreement with GAT, but are not interchangeable. Perkins shows the highest correlation to GAT. IOPcc differs significantly from GAT and Tono-Pen XL, but within normal pressure limits this has no clinical relevance.
Ophthalmologists can predict the stage of diabetic nephropathy
Authors: Aljindan MY , Alghadyan AA 
Published: May 2014

Background: Diabetes mellitus affects different parts of the body due to its effect on the microvascular system. Both ophthalmologists and nephrologists participate in the management of these patients. Therefore it will be useful to compare the findings in the kidney and in the eye at different stages of the disease. Methods: Fifty patients were recruited to investigate the correlation between the progression of diabetic retinopathy and diabetic nephropathy. Complete history and ophthalmic examination were performed. Fundus photos and _fluorescein angiography were obtained. Urine samples were obtained over a 24 hour period and random urine samples were collected to determine the microalbuminuria, albumin/creatinine ratio. Results: Albuminuria was present in all tested patients to different levels. Eighty two percent of patients with proliferative diabetic retinopathy had a higher level of microalbuminuria, compared with 52.1% of patients with non-proliferative retinopathy. Albumin/creatinine ratio was found to have a similar pattern. There was a negative correlation between total serum protein and urine protein. Conclusion: There was a progressive increase in protein in the urine as the diabetic retinopathy progressed, suggesting parallel progression.
NHS reforms and eye care services: quality, priority and competition
Authors: Diamond Jeremy P 
Published: May 2014

NHS eye services will increasingly be exposed to competition under the 2012 Health and Social Care Act. The scale of this is widely underestimated, as private sector companies see UK eye care as lucrative. NHS services can be at a disadvantage to private companies in tendering. Provision of medical eye care will increasingly be divided between public and private sector providers, with the NHS retaining complex cases.
Behavioural optometry: learning difficulties and the visual process
Authors: Hurst Caroline M.F. 
Published: May 2014

Across the world, behavioural optometrists are working with patients with conditions including learning difficulties, dyslexia, dyspraxia, dyscalculia, attention deficit hyperactivity disorder (ADHD), autistic spectrum disdorder (ASD), strabismus, amblyopia and acquired brain injury (ABI).This article describes some of the behavioural philosophy behind the development of vision, and the possibilities for improving visual skill and thus improving patient performance.
A review of the management options for periorbital basal cell carcinomas
Authors: Platts Marion , Danial Sheeba Putheen , Cook Anne , Cooper John 
Published: May 2014

Skin cancer is the most common form of cancer and the incidence of basal cell carcinoma (BCC) is increasing each year ( Cancer Research UK, 2013 ). The incidence of BCC is higher among males, white populations and the older age groups ( Zak-Prelich et al, 2004 ). Anatomically, the head and neck are the most commonly affected sites, attributing to 80% of all reported areas of the body ( Wong et al, 2003 ). According to the British Dermatological Association (BAD) current guidelines ( Telfer, 2008 ), such BCCs are categorised as ‘high risk’ due to their locality and their potential for recurrence. The BAD guidelines propose that the majority of high-risk lesions be treated surgically or by radiotherapy. The eyelids represent a particularly susceptible region for eyelid tumours, and approximately 90% of all eyelid cancers are BCCs ( Baxter et al, 2012 ). Presentation may be diverse; however, it is generally accepted that most BCCs are slow growing, locally invasive, and rarely metastasise, but some variants may be more aggressive. As a form of intervention to remove lesions, surgically there are various options available, namely Mohs micrographic surgery, excision under frozen section control, Slow Mohs and excision with delayed reconstruction. The reconstruction method used by the oculoplastic surgeon will depend on the position and extent of the excised area. This article describes the various treatment options for BCC in more detail, and relates treatment choice to appropriate patient-centred care.