COVID-19: Initial experience of an international group of hand surgeons.

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons throughout the world. The survey comprised 47 surgeons working in 34 countries who responded to an online questionnaire. We found that the protocols varied in terms of visitors, health professionals in the operating room, patient waiting areas, wards and emergency rooms. Based on these preliminary findings, an international consensus on hand surgery practices for the current viral pandemic, and future ones, needs to be built rapidly.

Inter-Rater Reliability of the Mealtime Scan+.

BACKGROUND AND OBJECTIVES: The Mealtime Scan (MTS) was developed to assess the dining environment in Long Term Care (LTC). MTS has been reviewed and updated to ensure its standardization and responsiveness to changes in the dining environment. The objectives of this paper are to provide an overview of the changes made in the new MTS+ tool and to describe its inter-rater reliability. RESEARCH DESIGN AND METHODS: The observational and scoring methods used to evaluate the physical, social, and relational-centered dining environments in LTC homes were reviewed and updated into MTS+ and an overall quality of dining rating derived. Two trained assessors were evaluated for the inter-rater reliability. Nine dining rooms in three LTC homes at different meals were observed for a total of 45 observations. Interclass Correlation Coefficient (ICC) was used to assess reliability. RESULTS: MTS+ demonstrated good reliability on the orientation cues, social environment, and relationship-centered activities (orientation cues ICC: 0.75, social ICC: 0.78, relational ICC: 0.78). However, the tool's reliability was poor for the physical environment, ICC: 0.48 and moderate for the overall rating of the quality of the dining environment, ICC: 0.67. Discussion and Implications: Although deemed more effective and practical for use in intervention studies, MTS+ has some limitations with respect to its reliability, particularly in assessing the physical environment. It is hypothesized that more extensive training of the assessors may lead to improvements in the reliability of MTS+. MTS+ can be used in intervention research when one assessor completes repeat observations of a dining area.

A comparison of higher order aberrations in eyes implanted with AcrySof IQ SN60WF and AcrySof SN60AT intraocular lenses.

PURPOSE: To evaluate the efficacy of AcrySof SN60WF aspheric intraocular lens (IOL) in decreasing spherical aberration and total higher order aberrations (HOAs) after cataract surgery compared to the spherical SN60AT lens. METHODS: Wavefront analysis was conducted on 28 eyes of 28 patients that underwent un-complicated phacoemulsification with implantation of either SN60WF (15 eyes) or SN60AT lenses (13 eyes). Eyes with a history of uveitis, retinal diseases, and previous surgery were excluded. RESULTS: SN60WF eyes had less mean absolute spherical aberration than SN60AT eyes both at 4 mm (0.04+/-0.03 vs 0.11+/-0.03 RMS, p<0.0001) and 6 mm pupils (0.09+/-0.04 vs 0.43+/-0.12 RMS, p<0.0001). Mean total HOAs was lower in the SN60WF group at 6 mm pupils (0.44+/-0.14 vs 0.56+/-0.13 RMS, p=0.0274), while no difference was seen at 4 mm pupils (0.20+/-0.10 vs 0.25+/-0.08 RMS, p=0.160). There were no clinically significant differences between the SN60WF and SN60AT IOLs both at 4 and 6 mm pupils in terms of coma (0.16+/-0.07 vs 0.18+/-0.09 RMS, p=0.514 and 0.25+/-0.12 vs 0.23+/-0.12 RMS, p=0.664) and trefoil (0.14+/-0.09 vs 0.10+/-0.05 RMS, p=0.167 and 0.28+/-0.12 vs 0.23+/-0.07 RMS, p=0.199). There were no differences be-tween groups in mean age, axial length, postoperative spherical equivalent, IOL power, or corneal curvature. CONCLUSIONS: An aspheric posterior optic IOL design with thinner center effectively reduces the positive ocular spherical aberration observed in the pseudophakic and elderly eyes, especially at larger pupillary diameters (6 mm), with no notable increase in coma. However, reduction in total ocular HOAs was only significant at 6 mm pupils.

Modern chemotherapy management of recurrent ovarian cancer: a multicentre study.

AIMS: The natural history of ovarian cancer has changed over the last 10 years due to more effective drug treatments. The aim of this multicentre audit of the management of recurrent ovarian cancer was to examine the usage of newer drugs in light of the publication of National Institute of Clinical Excellence guidance. MATERIALS AND METHODS: All patients presenting with a first or subsequent relapse of ovarian cancer between August 2001 and February 2003 in nine UK National Health Service centres were identified. Data were recorded retrospectively and prospectively from point of entry into the study and included the modality of primary cancer treatment, the treatment of each subsequent relapse and outcome. RESULTS: In total, 245 evaluable patients were entered on to the database. The mean age was 62 years. All patients received a platinum-based chemotherapy regimen as first-line treatment. One hundred and fifty-five patients (63%) went on to receive third-line chemotherapy and 82 (34%) received fourth-line chemotherapy. The median survival from first relapse was estimated to be in excess of 12 months from our data. The efficacies of the chemotherapy agents used are comparable with the results of published phase III trials. CONCLUSION: This study shows that multicentre audit is feasible and provides useful information on current clinical practice on which to base future research.

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics.

PURPOSE: To ascertain factors associated with anterior ischaemic optic neuropathy (AION) following coronary artery bypass graft (CABG) in a Lebanese population. METHODS: A retrospective chart review of consecutive CABG performed over a 5-year period (1995-1999) in one medical centre. A comparison of clinical characteristics was carried out between AION cases and subjects free from AION. The variables analysed included history of diabetes as well as preoperative, intraoperative, or postoperative values of haematocrit, blood sugar, oxygen saturation, and arterial blood pressure. RESULTS: A total of 1,594 persons were included. Three subjects experienced acute visual loss from AION following CABG, all had diabetes mellitus, and two suffered from severe postoperative anaemia. Among diabetics (n=484), the risk of AION was significantly higher in subjects with postoperative haematocrit falling below 22 (28.6%) than the rest (0.21%) (P=0.001). Blood transfusion was given in two subjects with prompt visual recovery. CONCLUSIONS: Severe anaemia in patients undergoing CABG appears to be a risk factor for AION, especially in diabetics, and needs prompt correction to prevent or reverse the ischaemic ocular events.

A unilateral twin extrauterine pregnancy occurring in a solitary fallopian tube: therapeutic choices.

A unilateral twin tubal pregnancy occurring in a solitary fallopian tube is presented. The gynecological history was notable for a previous extrauterine pregnancy in the contralateral fallopian tube and reconstructive surgery to the ipsilateral one. Radical total salpingectomy was performed. The rationale for this management is discussed and different therapeutic alternatives presented.

The conventional doses of human chorionic gonadotropins may not always be sufficient to induce ovulation in all women: a reappraisal.

BACKGROUND: Failure of ovulation has occasionally been reported following the administration of conventionally recommended doses of exogenous human chorionic gonadotropins. CASE: A 25-year-old nulliparous woman with polycystic ovary syndrome underwent ovulation induction for primary infertility. Following successful ovarian stimulation, she failed to ovulate during two consecutive cycles in response to human chorionic gonadotropin doses of 5,000 and 10,000 IU. When challenged with a higher than conventional dose (15,000 IU) on the third cycle, she ovulated and conceived. CONCLUSION: Conventional doses of exogenous human chorionic gonadotropins occasionally fail to complete the ovulatory process in some women. Women with polycystic ovary syndrome appear to be particularly susceptible. Routine documentation of ovulation and individualization of the dose of exogenous human chorionic gonadotropins could therefore prove to be useful in some of these women in order to achieve the best treatment outcome.

Expression of cyclin-dependent kinase inhibitor p21(WAF1) and p53 tumour suppressor gene in laryngeal cancer.

The prognostic value of the expression of the cyclin-dependent kinase inhibitor p21 and the p53 tumour suppressor gene was examined using immunohistochemistry in 60 patients with laryngeal cancer. Multivariate analysis using Cox's proportional hazard method, showed that p21 expression (P = 0.02) and advanced T stage (P = 0.003) significantly predicted survival. It was concluded that p21 expression may be a useful prognostic indicator in laryngeal cancer.

The SCID mouse: an experimental model for endometriosis.

The purpose of this study was to validate the suitability of the severe combined immunodeficient (SCID) mouse as an experimental model for endometriosis, by defining the morphological and histological features of induced endometrial implants, and characterizing specific biochemical properties of these implants. Human secretory endometrial tissues were injected into the peritoneal cavity of SCID/SCID CB17 mature female mice. Successful peritoneal implantation was observed in 55 of 57 (96.5%) SCID mice and consisted of circumscribed elevated nodules. Haematoxylin-eosin staining of implanting lesions demonstrated the presence of endometrial glandular tissue in a mixed background of stromal and inflammatory cells. When progesterone was administered to mice, epithelial glands underwent well-defined secretory changes. Immunohistochemical analysis using polyclonal human pan-cytokeratin antibodies demonstrated selective positive staining in the glandular epithelium of the human implants with none in the surrounding stroma. In-situ hybridization analysis using complement component 3 cDNA radiolabelled riboprobes yielded significantly more intense signals in glands compared to stroma. As human endometrial implants in SCID mice were shown to retain specific histological, functional and biochemical properties, we conclude that the SCID mouse is an attractive animal model for the study of endometriosis.

P53 overexpression in head and neck carcinoma and radiotherapy results.

PURPOSE: P53 gene mutations are the common genetic changes encountered in human cancers, and there is extensive evidence that the P53 status may determine tumor response to therapy. This study was carried out to investigate whether there is any correlation between accumulation (overexpression) of P53 protein and poor prognosis in patients with head and neck carcinomas treated with radical radiotherapy. METHODS AND MATERIALS: Seventy-nine patients with head and neck carcinomas who were diagnosed and treated in 1989-90 with curative radiotherapy were studied retrospectively. Paraffin sections from archival material were studied using immunohistochemical staining (IHC) with mouse monoclonal antibodies (D0-7) to human P53 protein. Univariate and multivariate analysis of loco-regional tumor control and patient survival were performed on possible prognostic factors. RESULTS: Forty-two (53%) patients showed positive IHC staining in their tumors. Fifty-three percent of the laryngeal, 64% of the oropharyngeal, and 43% of the oral cavity carcinomas showed P53 overexpression. All tumor specimens with vascular, lymphatic, and/or sarcolemmal invasion showed P53 overexpression. The proportion of tumor-stained nuclei was higher in the poorly differentiated than in the well and moderately differentiated tumors (p < 0.05), but there was no correlation with the patient overall or disease-free 5-year actuarial survival. There was no difference in the 5-year actuarial survival and disease-free survival between patients with P53 immunostaining in their tumors and those with no immunostaining (59% vs. 65% and 57% vs. 51%, respectively). The TNM tumor stage was the most significant prognostic factor with 5-year actuarial survival of 87% for early and 14% for late stages (p << 0.0001). There was a significant correlation between immunostaining and history of smoking (p = 0.02). CONCLUSION: The data demonstrate that the P53 accumulation as detected by immunohistochemical staining in a group of head and neck carcinomas was not predictive of patient's poor survival or disease-free survival. Multivariate statistical analysis showed that the TNM tumor stage was the only significant prognostic factor. There was a significant association between P53 accumulation and smoking.

Long-term survival in adult hemispheric glioma: prognostic factors and quality of outcome.

Between 1983 and 1985 111 patients with hemispheric gliomas were treated with whole brain irradiation in the Department of Clinical Oncology in Edinburgh. Of these, 52 patients were treated with mixed photons and neutrons and 51 patients with photons only. The 5-year actuarial survival is 6.1%. Age and tumour grade were confirmed as significant prognostic factors (P less than 0.001). Assessment of all six adult survivors forms the basis of the morbidity report. All survivors had a degree of ataxia, spasticity and most of them showed radiological evidence of brain damage. Psychometric assessment confirmed impairment of cognitive function in all patients, as well as disruption of the socioeconomic units surrounding them. This could have been partially relieved if support was available.

Intestinal mucosal changes in thalassaemia major.

Ten infants and children suffering from Thalassaemia major, proven by clinical, hematological and biochemical criteria, were subjected to intestinal biopsy. Specimens were studied for histological and histochemical patterns. The histological picture showed shortening and fusion of villi with cellular infiltration. Reduced mucopolysaccharides and relatively normal alkaline phosphatase activity were demonstrated. The degree of histological and histochemical changes correlates with the degree of anemia. The effects of these changes on the iron absorption and the tissue hemosiderosis are aroused. The possibility of these changes, being non-specific and secondary to anemia and tissue hypoxia is also postulated.