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PubMed1999

The 1998 Wendell Hughes Lecture. Evisceration: is sympathetic ophthalmia a concern in the new millennium?

PURPOSE: To investigate a possible relationship between evisceration and sympathetic ophthalmia. METHODS: Data from Mt. Sinai Medical Center and University Hospitals of Cleveland were collected and histopathologic specimens were reviewed for 51 of 90 patients who underwent evisceration between 1980 and 1996 and who returned for follow-up examinations. Additionally, a survey was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the Uveitis Society, and the Eastern Ophthalmic Pathology Society to determine the number of enucleations and eviscerations performed and the documented incidence of sympathetic ophthalmia after evisceration. RESULTS: No clinical or histopathologic evidence of sympathetic ophthalmia after evisceration was found among patients treated at the two medical centers. The collective surveys showed a strong preference for enucleation over evisceration, but did not document evidence of sympathetic ophthalmia after evisceration. CONCLUSIONS: Evisceration is an effective and safe procedure with a low risk for sympathetic ophthalmia.

Adolescent↗
PubMed1999

The 1998 Pan American Lecture. Intraocular invasion of conjunctival squamous cell carcinoma in five patients.

PURPOSE: To report five patients with intraocular invasion of conjunctival squamous cell carcinoma and to make recommendations regarding clinical recognition and treatment of this condition. METHODS: The authors reviewed the clinical records and pathology slides on five patients who had intraocular invasion of conjunctival squamous cell carcinoma, and they describe the presenting features and histopathology in these cases. RESULTS: Intraocular invasion of conjunctival squamous cell carcinoma occurred in older patients who had one or more recurrences of a previously excised conjunctival epithelial tumor located near the comeoscleral limbus. The intraocular recurrence often was heralded by the onset of low-grade inflammation and secondary glaucoma, simulating a granulomatous iridocyclitis. A white mass generally was observed in the anterior chamber angle. Histopathologic examination revealed an ingrowth of malignant epithelial cells through the limbus with diffuse involvement of the anterior segment of the eye. The reported patients were managed by modified enucleation (standard enucleation with excision of affected conjunctival tissue). Metastatic disease did not develop in any of the patients. CONCLUSIONS: The onset of signs of uveitis and glaucoma and a white mass in the anterior chamber angle in a patient with prior excision of a conjunctival squamous cell neoplasm tumor should raise suspicion of intraocular recurrence of conjunctival squamous cell carcinoma. Most affected patients require enucleation or subtotal orbital exenteration. The prognosis is good.

Aged↗
PubMed1997

Beyond survival rates and side effects: cancer nursing as therapy. The Robert Tiffany Lecture. 9th International Conference on Cancer Nursing, Brighton, UK, August 1996.

Survival rates and side effects have become the dominant constructs of cancer treatment and care, to the detriment of more supportive and patient-focused approaches. The concept of quality of life introduced to address this has failed to temper the language of oncology. Here an argument is made for the place of cancer nursing as a therapeutic enterprise in its own right, which warrants much greater recognition. Clear evidence for the therapeutic effects of cancer nursing intervention from a series of meta-analyses of cancer nursing interventions exists. Cancer nursing as therapy has the potential to operate on four levels and can effect radical change by reconstructing care, cancer services, and wider health care environments so that they are much more patient focused and offer nursing therapy as an integral part of care. These include fundamental knowledge or theory generation for therapeutic practice, therapeutic interventions for individuals or problems, developing and changing health systems or environments, or critique and reconstruction of care from a societal perspective. The features of cancer nursing as therapy can be identified and are described. Cancer nurses are encouraged to take up the challenge offered by the concept of therapeutic cancer nursing so that its potential for nurses, patients, and cancer services can be realised.

Humans↗
PubMed1999

Schering Plough clinical lecture communication: it makes a difference.

Communication is a vital component of nursing care that can improve outcomes for patients with cancer and their families in terms of psychological distress. Research indicates that nurses' communication skills have shown little improvement over the last 20 years. Communication is a practical skill that can be learned in theory from the literature or educational programs, but putting theory to practice in the clinical setting is far more problematic. Nurses need to be aware of their own communication skills by listening to themselves and learning from their mistakes. Only with this practice will skills improve. Communication can make or mar a person's illness experience. It is time for nurses to take effective communication seriously and actively accept personal responsibility for their actions because there is clear evidence showing that good communication makes a difference for patients and their families.

Communication↗
PubMed1999

The 1998 Castroviejo Lecture. New strategies in the treatment of dry-eye states.

PURPOSE: To review developments in dry-eye research leading to new therapeutic possibilities and to suggest a prioritizing schema. METHODS: New development in our understanding of the pathogenesis, diagnoses, and treatment of dry-eye states have been reviewed along with the possible impact on new therapeutic approaches. RESULTS: A variety of approaches to the pathogenesis and degrees of dry-eye states have emerged, giving rise to significant new approaches to the treatment of these disorders. CONCLUSION: There are now new treatment possibilities. Ranking their development based on their fundamental reversal of disease mechanisms seems a reasonable approach with early therapeutic pay-off.

Dry Eye Syndromes↗
PubMed2001

Mechanisms of corneal graft rejection: the sixth annual Thygeson Lecture, presented at the Ocular Microbiology and Immunology Group meeting, October 21, 2000.

The history of corneal transplantation reaches back over 150 years. Kissam performed one of the first penetrating keratoplasties when he transplanted a pig cornea onto a human in 1838. Only two interrupted sutures were used, and the surgery was performed without anesthesia! In retrospect, no one would be surprised to learn that the porcine corneal xenograft was rejected. Thirty years later, May transplanted rabbit corneal grafts to humans, but concluded that the failures in the first 24 attempts were the result of "imperfect technique and the inability to keep the eyes properly bandaged." The first documented report of a successful penetrating keratoplasty in a human subject was performed by Zirm in 1905. As we enter the new millennium, corneal transplantation remains the oldest, most common, and, arguably, the most successful form of solid tissue transplantation. In the United States alone, approximately 36,000 corneal transplants are performed each year. The success rate for corneal transplants is in excess of 90% in uncomplicated cases, even though HLA tissue typing is not performed and systemic immunosuppressive drugs are not administered. In spite of this extraordinary success, immune rejection remains the leading cause of corneal graft failure. Many inferences about the immunobiology of corneal graft rejection have been based on clinical observations; however, confirmation of these hypotheses requires prospective studies under controlled settings. The prudent use of animal models has fostered analytic studies on the immunobiology of corneal allografts without the complicating and confounding effects of topical steroids that are typically used on most keratoplasty patients. Although animal models of penetrating keratoplasty have been in use for almost a half-century, until recently, progress in understanding the immune mechanisms of corneal graft rejection has been slow. However, the widespread use of rodent models of orthotopic corneal transplantation has shed new light on the pathogenesis of corneal graft rejection.

Animals↗
PubMed2002

Thygeson lecture. Amniotic membrane transplantation: why is it effective?

PURPOSE: To review the uses and previously proposed mechanisms of action of amniotic membrane transplantation (AMT) and to suggest a new mechanism of action for the effectiveness of AMT in resolving a persistent epithelial defect (PED). METHODS: Significant clinical and experimental publications are reviewed. RESULTS: Evidence from the scientific literature suggests a new hypothesis for the effectiveness of AMT in the reepithelialization of a PED and the reduction of corneal stromal inflammation and continued fibrosis. CONCLUSION: It is suggested that reepithelialization of a PED, and hence the reduction of stromal inflammation and continued fibrosis following reepithelialization, is aided by the combination of oxygenation, moisture and protection of the fragile epithelium by the amniotic membrane.

Amnion↗
PubMed1998

From chimney sweeps to astronauts: cancer risks in the work place: the 1998 Lauriston Taylor lecture.

Percival Pott, in 1775, was the first to note an association between overt cancer and a carcinogen in the work place when he astutely observed an elevated incidence of scrotal cancer in small boys who assisted chimney sweeps. In their "workplace" astronauts and crew of high altitude jet-liners are exposed, not only to low linear energy transfer (LET) radiation but also to HZE (high energy + high atomic number) particles and to neutrons-for which no human epidemiological data exist. The current system of radiation protection is based on risk estimates from low LET radiations, delivered in large doses and at high dose-rate, coupled with the assumption of a linear no-threshold model. In extrapolating to low doses and dose-rates, and to high LET radiations, it would be helpful if the mechanisms of radiation carcinogenesis were known. Unfortunately that is not the case, though progress has been made toward that end. Many human leukemias and lymphomas appear to be due to specific chromosomal translocations, while solid tumors usually involve multiple mutations in oncogenes, deletions in suppressor genes, and/or chromosomal rearrangements. Genomic instability and immortality are hallmarks of cancer and it is attractive to hypothesize that this is due to a mutation in a gene or genes responsible for the stability of the genome. Examples abound of a small DNA change inactivating a gene and leading to major biological consequences. This could result from a single particle, especially a HZE particle, or a recoil proton from the absorption of a neutron. In this context the assumption of a threshold is hazardous, and the linear no-threshold hypothesis still appears to be prudent and conservative.

Astronauts↗