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Biomedical subjects

A Garner

Publications and source records attributed to A Garner.

At least 19 recordsLinked to original sources
PubMed2001

Efficacy of prehospital critical care teams for severe blunt head injury in the Australian setting.

OBJECTIVE: To determine whether prehospital critical care teams (CCT) would result in improved functional outcomes for road trauma related severe head injury in the Australian setting, when compared with standard advanced life support measures provided by paramedics. METHODS: Retrospective review of 250 patients treated by paramedics and 46 patients treated by CCT transported directly from the accident scene, with a prehospital Glasgow coma scale (GCS)< or =8. RESULTS: CCT-treated patients had longer median prehospital times (113 versus 45 min, P<0.001), and a higher prehospital intubation rate (100% versus 36%, P<0.001) than paramedic-treated patients. On multivariate analysis, revised trauma score > or =4.45 (odds ratio [OR] 2.31, 95% CI: 1.15-4.65), lower injury severity score (OR 1.04, 95% CI: 1.02-1.06), age< or =25 years (OR 1.76, 95% CI: 1.13-2.75), absence of an acute subdural haematoma (OR 3.36, 95% CI: 1.89-5.95) and prehospital treatment by a CCT (OR 2.70, 95% CI: 1.48-4.95) independently predicted better outcome. CONCLUSION: The range of advanced interventions provided by the CCT were associated with improved functional outcome. Further studies are required to determine the individual factors responsible.

Accidents, Traffic↗
PubMed2001

Comparative analysis of multiple-casualty incident triage algorithms.

STUDY OBJECTIVE: We sought to retrospectively measure the accuracy of multiple-casualty incident (MCI) triage algorithms and their component physiologic variables in predicting adult patients with critical injury. METHODS: We performed a retrospective review of 1,144 consecutive adult patients transported by ambulance and admitted to 2 trauma centers. Association between first-recorded out-of-hospital physiologic variables and a resource-based definition of severe injury appropriate to the MCI context was determined. The association between severe injury and Triage Sieve, Simple Triage and Rapid Treatment, modified Simple Triage and Rapid Treatment, and CareFlight Triage was determined in the patient population. RESULTS: Of the physiologic variables, the Motor Component of the Glasgow Coma Scale had the strongest association with severe injury, followed by systolic blood pressure. The differences between CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment were not dramatic, with sensitivities of 82% (95% confidence interval [CI] 75% to 88%), 85% (95% CI 78% to 90%), and 84% (95% CI 76% to 89%), respectively, and specificities of 96% (95% CI 94% to 97%), 86% (95% CI 84% to 88%), and 91% (95% CI 89% to 93%), respectively. Both forms of Triage Sieve were significantly poorer predictors of severe injury. CONCLUSION: Of the physiologic variables used in the triage algorithms, the Motor Component of the Glasgow Coma Scale and systolic blood pressure had the strongest association with severe injury. CareFlight Triage, Simple Triage and Rapid Treatment, and modified Simple Triage and Rapid Treatment had similar sensitivities in predicting critical injury in designated trauma patients, but CareFlight Triage had better specificity. Because patients in a true mass casualty situation may not be completely comparable with designated trauma patients transported to emergency departments in routine circumstances, the best triage instrument in this study may not be the best in an actual MCI. These findings must be validated prospectively before their accuracy can be confirmed.

Adolescent↗
PubMed2001

Statutory and regulatory recognition for clinical nurse specialists in Oregon.

Clinical nurse specialists (CNSs) in Oregon initiated the process of achieving statutory and regulatory recognition several years ago. Throughout this process, specific phases of activity and events helped CNSs to identify what was required to achieve this goal. The resulting lessons learned are shared in this report. Statutory recognition of CNSs in Oregon occurred in 1999, and the administrative rules for CNS practice were published in 2001. These administrative rules delineate the CNS scope of practice and other aspects of CNS practice consistent with national standards.

Humans↗
PubMed2000

Regulation of cell cycle re-entry by growth, survival and stress signalling pathways.

The mitogen-activated and stress-activated protein kinases transduce signals from plasma membrane signalling machinery into the nucleus to modulate gene expression. By regulating the genomic response to environmental cues (growth factors, stresses) these pathways determine whether a cell re-enters the cell cycle, undergoes cell cycle arrest, senescence or apoptosis. We are particularly interested in how these pathways integrate with each other, and interact with the cell cycle machinery to achieve these discrete biological responses.

Animals↗
PubMed2000

Peptidergic hormones and neuropeptides, and aminergic neurotransmitters of the pancreatic islets of the Houbara bustard (Chlamydotis undulata).

Immunoreactivity to insulin (Ins), somatostatin (Som), glucagon (Glu) and pancreatic polypeptide (PP) was found in 70%, 22%, 15% and 11% respectively of Houbara pancreatic endocrine islet cells. Whilst Ins occurred centrally and SOM was observed both in peripherally and centrally located islets, the other hormones were localised in peripheral islet cells; Som was also observed in neuronal cell bodies and nerve fibres. In addition, the islet cells contained substance P (SP) (65%) in the centre and vasoactive intestinal polypeptide (VIP) (2%) at the periphery. Immunoreactivity to choline acetyltransferase (ChAT), VIP and galanin (Gal) occurred in the walls of blood vessels located mainly at the periphery of islets. Occasionally, VIP and Gal immunoreactive varicose nerve terminals and ChAT immunoreactive cell bodies were also observed in the centre of islets. SP neuronal cell bodies were not observed but prominent SP immunoreactive varicose terminals were discernible in capillary walls within the islets. Neuropeptide Y (NPY) immunoreactive neurons were detected in neuronal cell bodies located mainly peripherally. Neuronal nitric oxide synthase (nNOS) immunoreactivity occurred in neuronal cell bodies and nerve fibres mainly at the periphery and also in centrally located islet endocrine cells. Immunoreactivity to tyrosine hydroxylase (TH) was similar in distribution to that of ChAT. In comparison with other avian species, the islets of the dorsal pancreatic lobe of the bustard contain all the peptidergic hormones normally present in the islets of other avian species, but are not segregated into dark A and light B cells. Many of the insulin containing cells also contained SP. The islets also contained several neuropeptides which are probably involved in their regulation.

Animals↗
PubMed2000

Postmortem histological survey of the ocular lesions in a British population of AIDS patients.

AIMS: To study ocular pathology and systemic correlations in a series of 73 postmortem eyes from British patients who died from AIDS before the introduction of a HAART regimen. METHODS: The eyes were studied with conventional histology, special histochemical stainings, and immunohistochemistry. RESULTS: 72.6% of the cases showed chronic uveal inflammation, caused by opportunistic agents in 37.7% of them (cytomegalovirus (CMV) in 30.1%, C neoformans in 5.6%, and Gram positive bacteria in 1.8%). Cytoid bodies were noted in 10/73 eyes, three linked to CMV retinitis. Six retinal haemorrhages, four of which were secondary to CMV, were found. 14 specimens (19. 1%) showed foci of calcification, and a further 11 (15%) calcium oxalate deposits. In no cases were the calcific deposits suspected clinically. Six eyes (8.2%) did not show any abnormality. CONCLUSIONS: CMV retinitis is the most common (28.7%, 21/73) ocular infection in this series and may occur either during or in the absence of systemic dissemination. Conversely, ocular cryptococcosis appears to be an epiphenomenon of systemic and CNS disease. No other opportunistic ocular infections were present in this series. Interesting findings were the presence of intraocular precipitates of calcium oxalate and calcium phosphate or carbonate in a significant number of cases (15% and 19%, respectively), and the high prevalence of idiopathic uveal inflammation (43.8%).

AIDS-Related Opportunistic Infections↗
PubMed2000

Phase I and pharmacologic study of the specific matrix metalloproteinase inhibitor BAY 12-9566 on a protracted oral daily dosing schedule in patients with solid malignancies.

PURPOSE: To evaluate the feasibility of administering BAY 12-9566, a matrix metalloproteinase (MMP) inhibitor with relative specificity against MMP-2, MMP-3, and MMP-9, on a protracted oral daily dosing schedule in patients with advanced solid malignancies. The study also sought to determine the principal toxicities of BAY 12-9566, whether plasma BAY 12-9566 steady state concentrations (C(ss)) of biologic relevance could be sustained for prolonged periods, and whether BAY 12-9566 affected plasma concentrations of MMP-2, MMP-9, and tissue inhibitor of MMP-2 (TIMP-2). PATIENTS AND METHODS: Patients with solid malignancies were treated with BAY 12-9566 at daily oral doses ranging from 100 to 1,600 mg. BAY 12-9566 dose schedules included 100 mg once daily, 400 mg once daily, 400 mg twice daily, 400 mg three times daily, 400 mg four times daily, and 800 mg twice daily. Plasma was collected to study the range of BAY 12-9566 C(ss) values achieved, and exploratory studies were performed to assess the effects of BAY 12-9566 on plasma concentrations of MMP-2, MMP-9, and TIMP-2. RESULTS: Twenty-one patients were treated with 47 28-day courses of BAY 12-9566. The most common side effects were headache, nausea, vomiting, abnormalities in hepatic functions, and thrombocytopenia, which were rarely clinically significant. BAY 12-9566 was well tolerated on all dose schedules, and there was no consistent dose-limiting toxicity that precluded treatment in the range of dose schedules evaluated. Instead, dose escalation was terminated because BAY 12-9566 plasma C(ss) values increased less than proportionately and plateaued as the daily dose was increased within the dose range of 100 to 1,600 mg/d, suggesting saturable drug absorption. Mean plasma C(ss) values achieved with all dose schedules exceeded BAY 12-9566 concentrations required to inhibit MMPs in vitro and in vascular invasion and tumor proliferation in vivo models. There were no consistent effects of BAY 12-9566 on the plasma concentrations of MMP-2 and MMP-9 over the continuous dosing period at any dose schedule level. However, plasma levels of TIMP-2 seemed to increase in a dose-dependent manner (r(2) =.50, P =.046). CONCLUSIONS: The recommended dose of BAY 12-9566 for subsequent disease directed studies is 800 mg twice daily, which resulted in biologically relevant plasma C(ss) values and an acceptable toxicity profile. Although exploratory studies of MMPs in plasma were not revealing, it is conceivable that some tumor types and disease settings are more likely to produce more readily quantifiable levels of activated MMPs than others. Therefore, attempts to identify and quantify surrogate markers of MMP inhibitory effects should continue to be performed in disease-directed studies in more homogenous patient populations.

Administration, Oral↗
PubMed1999

Australian disaster triage: a colour maze in the Tower of Babel.

BACKGROUND: The objective of this study was to review the systems of disaster triage used by Australian State and Territory ambulance services and compare their triage taxonomy, methodology and documentation with the Australian Council on Health Care Standard's (ACHCS) National Triage Scale, which is used in all Australian hospital emergency departments. METHODS: A postal survey of the State and Territory ambulance services during October 1996 was conducted. Details of the mass casualty incident (MCI) triage systems were then compared with the ACHCS National Triage Scale. Colours specified or used on a triage tag were checked for compliance with Standards Australia AS-2700 1996 Colour Standards for General Purposes. Participants consisted of those State and Territory ambulance services which would be the initial emergency medical service responders in the event of an MCI in an Australian capital city, and the ACHCS. The main outcome measure was the homology between the respective triage taxonomies, methodologies and documentation systems. RESULTS: All eight State and Territory ambulance services used a numerical and colour coded system to indicate triage priority during an MCI. There were five different triage tag designs for triage documentation, six different triage taxonomies and five different triage methodologies with minimal homology between the different triage systems and the National Triage Scale used in hospitals. Only two ambulance triage systems specifically triaged emotional disturbance. Several triage tags and their patient attachments were made from perishable materials and are thus likely to fail under field conditions. CONCLUSION: The multiplicity of triage systems used within Australia will result in avoidable confusion, thus hindering the medical response to an MCI, especially for incidents near State or Territory borders. There is little evidence to support the continued use of triage tags. Australia needs to develop a uniform system of patient triage as a national priority.

Australia↗
PubMed1999

An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard.

BACKGROUND: The purpose of this study was to create a system of mass casualty incident triage that provides a common language platform for both ambulance and hospital personnel based upon standard daily operating procedures for both groups. METHODS: An annotated literature review was conducted. RESULTS: The Homebush Triage Standard taxonomy consists of five categories: immediate, urgent, not urgent, dying and dead, which are given the phonetic alphabet designations of Alpha, Bravo, Charlie, Delta and Echo, respectively, to facilitate radio voice communications. Colours are assigned to each category: red (Homebush Red), yellow (Homebush Gold), green (Homebush Green), white and black comply with Standards Australia AS-2700 1996 Colour Standard for General Purposes, to ensure triage materials have consistent production standards. Numbers are reserved to either quantify or stratify individuals within a particular triage category. The Homebush Triage Standard methodology is based on START (Simple Triage Assessment and Rapid Transport) and SAVE (Secondary Assessment of Victim Endpoint) and documents triage priority using geographic triage with triage flags, instead of triage tags. CONCLUSION: The Homebush Triage Standard provides a basis for both seamless patient reassessment at all points along the casualty evacuation chain and the audit of the medical response to mass casualty incidents. It allows hospital and ambulance staff to keep working using familiar routines and removes fundamental barriers to good communication during a time of crisis.

Australia↗
PubMed1999

Should New South Wales hospital disaster teams be sent to major incident sites?

BACKGROUND: The aim of the present review was to assess the suitability of hospital disaster medical teams' training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. METHODS: A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. RESULTS: Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. CONCLUSION: Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter-disaster planning as the primary source of on-site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre-hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.

Air Ambulances↗
PubMed1999

Addition of physicians to paramedic helicopter services decreases blunt trauma mortality.

BACKGROUND: The authors hypothesized that the addition of critical care physicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater procedural capability and clinical judgement of the physician. METHODS: Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28-month period by the paramedic-staffed Westpac Hunter region helicopter to John Hunter Hospital, and the physician-staffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusion criteria were blunt trauma and an Injury Severity Score of > 10. Mortality was compared by trauma score-injury severity score (TRISS) methodology. RESULTS: There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the groups in age, mechanism of injury, distance transported, response, scene or transport times. Physicians intubated a greater proportion of patients (51 vs 10%; P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater volumes of fluids to hypotensive patients (median: 5035 vs 1475 mL: P < 0.001) and performed thoracic decompressions on a larger proportion of patients (12 vs 1%; P < 0.01). The Z statistic for the physician treatment group was 2.72 (P < 0.01 ) compared with -1.16 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95% CI: 7.80-19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with the paramedic group. CONCLUSIONS: Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower mortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.

Adolescent↗
PubMed1998

Age-related changes in morphology and secretory responses of male rat lacrimal gland.

This study investigates the differences in the outward appearance and morphology of lacrimal glands, the morphology within the lacrimal acinar cells and the secretion of protein from acinar cells of young (3-5 months) and aged (20 and 24 months) male rats. The appearance of the glands, as seen by the naked eye, differed between the three age-groups. The lacrimal gland of young animals was a smooth pink tissue, while the tissue from aged animals appeared lobular and white in colour, thought to result from infiltration of fatty/connective tissue. Glands from 24 month old animals had a more pronounced lobular appearance than the glands from 20 month old animals. Light microscopy studies revealed that as the animals aged there was evidence of progressive morphological changes. These changes included thickening of the connective tissue sheath, chronic inflammation with increased infiltration by mast cells, patchy destruction of ductal and vascular tissues, enlargement of lacrimal ducts, luminal swelling of the acini, and changes in acinar type. Electron microscopy (EM) studies revealed the presence of 3 types of acini in the rat lacrimal gland: acini which contained only protein secretory granules (serous acini), acini which contained protein and mucous secretory granules (seromucous acini), and acini which contained only mucous secretory granules (mucous acini). In young glands the majority of acini were serous with a few seromucous acini and even fewer mucous acini. In aged glands there were significant reductions in serous acini (ANOVA; P < 0.01) when compared to the young glands. In 20-month-old glands, there were marked increases in the percentage occurrence of seromucous acini, while in 24 month old glands, there were large increases in the relative number of mucous acini. Qualitative EM studies demonstrated that the typical acini from young glands contained numerous protein secretory granules. Ageing was associated with a progressive loss of protein (serous) secretory granules. Furthermore, marked changes and patchy destruction of the endoplasmic reticulum and Golgi apparatus were observed in acini of glands from aged rats when compared to acini of glands from young rats. Measurement of total protein output from acini revealed a significant (Student's t-test, P < 0.05) decrease in protein secretion from aged glands compared to glands from young animals. These results suggest that not only is there considerable structural damage, chronic inflammation and mast cell infiltration to the lacrimal gland with ageing, but also possible redifferentiation of acini from serous to seromucous and then to mucous acini. Furthermore, the results also suggest a reduction or an inability of the acini to synthesise and to secrete protein from glands of aged animals compared to glands of young rats. All of these changes appear to occur more rapidly as the rats mature between 20 and 24 months. These findings provide a morphological basis to explain the phenomenon of reduced tear/protein secretion with ageing.

Acetylcholine↗
PubMed1998

Drug metabolizing enzyme systems in the houbara bustard (Chlamydotis undulata).

This study compared catalytic and immunochemical properties of drug metabolizing phase I and II enzyme systems in houbara bustard (Chlamydotis undulata) liver and kidney and rat liver. P450 content in bustard liver (0.34 +/- 0.03 nmol mg-1 protein) was 50% lower than that of rat liver (0.70 +/- 0.02 nmol mg-1 protein). With the exception of aniline hydroxylase activity, monooxygenase activities using aminopyrine, ethoxyresorufin and ethoxycoumarin as substrates were all significantly lower than corresponding rat liver enzymes. As found in mammalian systems the P450 activities in the bird liver were higher than in the kidney. Immunohistochemical analysis of microsomes using antibodies to rat hepatic P450 demonstrated that bustard liver and kidney express P4502C11 homologous protein; no appreciable cross-reactivity was observed in bustards using antibodies to P4502E1, 1A1 or 1A2 isoenzymes. Glutathione content and glutathione S-transferase (GST) activity in bustard liver were comparable with those of rat liver. GST activity in the kidney was 65% lower than the liver. Western blotting of liver and kidney cytosol with human GST isoenzyme-specific antibodies revealed that the expression of alpha-class of antibodies exceeds mu in the bustard. In contrast, the pi-class of GST was not detected in the bustard liver. This data demonstrates that hepatic and renal microsomes from the bustard have multiple forms of phase I and phase II enzymes. The multiplicity and tissue specific expression of xenobiotic metabolizing enzymes in bustards may play a significant role in determining the pharmacokinetics of drugs and susceptibility of the birds to various environmental pollutants and toxic insults.

Animals↗
PubMed1998

Pharmacokinetics of enrofloxacin after intravenous, intramuscular and oral administration in houbara bustard (Chlamydotis undulata macqueenii).

The in-vitro activity of enrofloxacin against 117 strains of bacteria isolated from bustards was determined. Minimum inhibitory concentrations for 72% of the Proteus spp., E. coli, Salmonella spp. and Klebsiella spp. (n = 61) and for 48% of the Streptococci spp. and Staphylococci spp. (n = 31) were < or = 0.5 microg/mL. The minimum inhibitory concentration (MIC) of 76% of Pseudomonas spp. (n = 25) was < or = 2 microg/mL. Fourteen strains were resistant to concentrations > or = 128 microg/mL. The elimination half-lives (t1/2 elim beta) (mean +/- SEM) of 10 mg/kg enrofloxacin in eight houbara bustards (Chlamydotis undulata) were 6.80 +/- 0.79, 6.39 +/- 1.49 and 5.63 +/- 0.54 h after oral (p.o.), intramuscular (i.m.) and intravenous (i.v.) administration, respectively. Enrofloxacin was rapidly absorbed from the bustard gastro-intestinal tract and maximum plasma concentrations of 1.84 +/- 0.16 microg/mL were achieved after 0.66 +/- 0.05 h. Maximum plasma concentration after i.m. administration of 10 mg/kg was 2.75 +/- 0.11 microg/mL at 1.72 +/- 0.19 h. Maximum plasma concentration after i.m. administration of 15 mg/kg in two birds was 4.86 microg/mL. Bioavailability was 97.3 +/- 13.7% and 62.7 +/- 11.1% after i.m. and oral administration, respectively. Plasma concentrations of enrofloxacin > or = 0.5 microg/mL were maintained for at least 12 h for all routes at 10 mg/kg and for 24 h after i.m. administration at 15 mg/kg. Plasma enrofloxacin concentrations were monitored during the first 3 days of treatment in five houbara bustards and kori bustards (Ardeotis kori) with bacterial infections receiving a single daily i.m. injection of 10 mg/kg for 3 days. The mean plasma enrofloxacin concentrations in the clinical cases at 27 and 51 h (3.69 and 3.86 microg/mL) and at 48 h (0.70 microg/mL) were significantly higher compared with the 3 h and 24 h time intervals from clinically normal birds. The maximum plasma concentration (Cmax)/MIC ratio was ranked i.v. (10/mg/kg) > i.m. (15 mg/kg) > i.m. (10 mg/kg) > oral (10 mg/kg), but it was only higher than 8:1 for i.v. and i.m. administrations of enrofloxacin at 10 mg/kg and 15 mg/kg, respectively, against a low MIC (0.5 microg/mL). A dosage regimen of 10 mg/kg repeated every 12 h, or 15 mg/kg repeated every 24 h, would be expected to give blood concentrations above 0. 5 microg/mL and hence provide therapeutic response in the bustard against a wide range of bacterial infections.

Administration, Oral↗
PubMed1998

Sebaceous carcinoma of the eyelid: a clinicopathological study.

BACKGROUND: Sebaceous carcinoma of the eyelid is rare. The diagnosis might be difficult because of its ability to masquerade as other periocular lesions. Prognosis is still regarded as being poor compared with most other malignant eyelid tumours with a mortality second only to malignant melanoma. The present study retrospectively analyses clinical and histopathological findings and outcome in a series of patients with sebaceous carcinoma of the eyelid in Britain. METHODS: 43 patients with histologically confirmed sebaceous carcinoma treated at Moorfields Eye Hospital between 1976 and 1992 were subjected to retrospective analysis. Clinical data of all patients were reviewed from the charts; all surviving patients except four cases lost for follow up were re-examined. Histological specimens were reviewed in 41 cases. RESULTS: 23 females and 20 males, mean age 63 years (range 37-79), were treated. Primary therapy was surgery in 37 and radiotherapy in six cases. After a median follow up of 40 months (range 1-148) 30 patients were alive without recurrences, four patients had died from the tumour, and one was alive with local recurrence and distant metastases. Four patients had died of non-tumour related causes. Histologically, unfavourable outcome was correlated with poor tumour differentiation and extensive invasion. CONCLUSION: Early diagnosis and consequent surgical therapy of sebaceous carcinoma of the eyelid leads to a better outcome and higher survival rates than generally assumed. Even local recurrences can be treated successfully. However, sebaceous carcinoma remains a threatening disease, which leads to death in 9% and to mutilating exenteration in 23% of our patients.

Adenocarcinoma, Sebaceous↗
PubMed1997

Orbital venous anomalies.

PURPOSE: The purpose of the study is to establish the natural history, probable nature, and optimal treatment of lesions within the orbit described previously as lymphangiomas or orbital varices. METHODS: The clinical and radiologic records of 158 patients with these lesions were reviewed. Of these, 91 had surgery, and histologic specimens from 57 were re-examined. RESULTS: Most patients were infants or children with a dark blue swelling in the superomedial part of the orbit, orbital hemorrhage, or proptosis. Computed tomography showed smooth, contoured lesions denser than brain extending posteriorly. Half enlarged with the Valsalva maneuver, 31% contained phleboliths. Surgery was performed in 91 patients, mainly for cosmesis. Excised tissue included endothelium-lined channels containing blood in the orbit and clear fluid in many superficial specimens. CONCLUSIONS: The behavior of these lesions and their prevalence in infancy and childhood favor a hamartoma. The authors observed a seamless range of clinical features that they could not subdivide, particularly in relation to any connection with the orbital veins. Many bleed and enlarge permanently and need excision, but surgery is difficult and management should be as conservative as possible. The origin of these lesions cannot be determined by histopathologic analysis, although the authors have evidence of venous features in the orbit and lymphatic features more superficially. The authors' clinical findings support a venous origin. Two-thirds have either a free venous connection or phleboliths. Their distribution corresponds with that of the normal orbital veins, and at surgery they derive from or replace those veins. "Orbital venous anomaly" is the most accurate term for their description.

Adolescent↗