Biomedical subjects
Publications and source records attributed to P G Watson.
Cancer rehabilitation is a practical attempt to maximize independence and dignity and to reduce the extent to which cancer interferes with an individual's physical, psychosocial, and economic functioning. The rehabilitation process should begin at the time of diagnosis or definitive medical intervention and should continue until the individual is able to maintain the desirable level of independence.
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A 66-year-old man presented with massive bilateral scleral thickening and calcification associated with a unilateral exudative retinal detachment which did not respond to systemic anti-inflammatory agents including steroids and cyclophosphamide but improved with scleral resection. This patient shows the features of both posterior scleritis and the uveal effusion syndrome, providing further evidence for the role of a thickened sclera and interference with the trans-scleral flow of fluid in the formation of such an exudative retinal detachment.
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Individuals with cancer should be assisted to achieve optimal levels of functioning before, during, and after cancer treatment. However, to reach optimal functioning a well-defined plan of action is required. This article presents an Optimal Functioning Plan (OFP) aimed at attaining the best possible outcomes for all individuals treated for cancer. The OFP centers on physical functioning, nutritional adequacy, a practical level of independence in activities of daily living, self-care competence, a realistic optimistic outlook, and effective management of side effects. The OFP is a key element of cancer rehabilitation. It represents a way of packaging cancer care in a health-oriented framework.
The clinical features of 290 patients with scleral inflammation were reviewed to determine whether a classification based on the anatomical site and clinical appearance of the disease at presentation reflected its natural history. The authors' results confirm that the majority of patients remain in the same clinical category throughout the course of their disease. Of the 104 (35.9%) patients who experienced a recurrence of their disease, only 12 had progressed from diffuse to nodular disease, and 10 patients who originally had nodular disease developed scleral necrosis. Patients with necrotizing scleritis were older than patients in the other groups and more frequently had an associated systemic disease than patients with either diffuse or nodular disease; necrotizing scleritis was the most difficult disease to treat. Diffuse anterior scleritis had a lower incidence of visual loss (9%) than either nodular scleritis (26%) or necrotizing disease (74%), and, therefore, the authors consider nodular scleritis a disease of intermediate severity between diffuse scleritis and necrotizing disease. In this series, 12% of patients presented with posterior scleritis, and visual loss was most frequent in this group (84%).
A randomised double blind trial of 2-(2-Hydroxy-4-methylphenyl) Aminothiazole Hydrochloride 0.1% (CBS 113A) versus placebo was carried out in 43 eyes with episcleritis. Our results show that CBS 113A is effective in reducing the signs of conjunctival and episcleral inflammation in mild episcleritis within the first week of administration of the drug (Day 3: Total Score p = 0.0013, Conjunctival Injection p = 0.017, Episcleral Injection p = 0.0018 and Day 7: Total Score p = 0.01, Conjunctival Injection p = 0.014, Episcleral Injection p = 0.027). CBS 113A was not effective against severe episcleritis. No significant side effects were found apart from a stinging sensation. There was no effect on intraocular pressure. The potential use of this new drug is discussed.
In corneal graft rejection, rapid reversal of the rejection process is necessary to minimise endothelial cell loss. Ten consecutive patients with acute endothelial rejection were treated with a single 500 mg pulse of methylprednisolone intravenously and topical prednisolone 1% drops hourly. The rejection episode was successfully reversed in eight (80%) of the 10 grafts. This preliminary trial indicates that cortico-steroid pulse therapy may be beneficial in the management of severe corneal graft rejection with the advantage of avoiding prolonged oral corticosteroid therapy.
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The ocular and systemic features of 10 patients whose Wegener's granulomatosis presented with corneoscleral inflammatory disease are described. Marginal corneal infiltrates were seen in all patients with anterior scleritis and were a valuable sign of disease activity. Nine out of 10 patients had symptoms of systemic vasculitis on presentation; seven had renal impairment; three had chest x-ray abnormalities. Autoantibodies against neutrophil cytoplasmic determinants (ANCA) were present in all cases. In seven patients the scleritis responded well to pulsed immunosuppressive therapy followed by long term oral steroids and cyclophosphamide. Oral steroid therapy alone failed to control severe disease. Corneoscleral disease was not a cause of visual loss. It is important to realise that inflammatory corneoscleral disease may be the presenting feature of a severe systemic vasculitis.
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The complications of trabeculectomy were studied in two groups of patients taken from a stable white population. The first group who had had their operation when it was first introduced 22 years ago, had been previously treated with prolonged medication, the second group had been operated upon recently and had had short-term pre-operative medication. This study confirmed that trabeculectomy predictably reduces the intraocular pressure to within the accepted normal range and that the pressure level below which the intraocular pressure could not be expected to fall was congruent to 14 mm/Hg. It also revealed that although some post operative abnormality was noted in two-thirds of the patients there were no long term problems which could be related to any operative or immediately post-operative complications, including shallow anterior chambers, uveitis and hyphaema. However, there was a long term reduction in the visual acuity and visual fields of about one-third of the patients, which was not related to cataract formation, macular problems, the height of the preoperative intraocular pressure, the amount by which this fell as a result of the surgery, or the amount, length or type of preoperative medication given before the operation. Although there was some increase in cataracts throughout the whole long term group this was mainly in those who had cataract prior to surgery; the increase was not related to operations or any other factor other than corneo-lenticular contact post-operatively.
Topical flurbiprofen was compared with placebo and prednisolone 0.3% in the treatment of episcleritis by a randomised double-blind trial. Seventy-seven eyes were included in the trial. Rapid spontaneous improvement in symptoms and signs was noted in the majority of cases. There was no significant difference between the cure-rates of patients treated with flurbiprofen and placebo over a 3-week trial period. The proportion of patients treated with prednisolone 0.3% who were cured was significantly higher than in either of the other groups after 3 weeks.
A clinical classification of peripheral corneal destructive disease is presented. These syndromes all start within 2 mm of the limbus and are accompanied by varying degrees of vaso-occlusion of the adjacent limbal vascular networks. Close observation of the configuration, integrity and pattern of the limbal vessels can indicate whether the disease is active, quiescent or brought under control with treatment.
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This article presents a plan for faculty research skills development. Three categories of faculty research roles are described: researcher, researcher/teacher, teacher/research team member. A faculty member elects to be placed in one of the categories based on academic credentials, research expertise, and professional goals. At the departmental level, faculty share research ideas and receive mutual support through regularly scheduled biweekly faculty research meetings. Faculty research skills are cultivated via monthly seminars. Administrative support is furnished through a research management system designed to facilitate the process of initiating research projects and responding to external funding research opportunities in a timely manner. The research management component offers: seed money for pilot studies and small projects; funds for research assistants and consultants; focused information dissemination concerning funding sources; and clerical support systems for completing and submitting grant applications.
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