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PubMed2004

[Danish battlefield surgery in the period between the birth of Christ and the year 500 AD].

Danish battlefield surgery in the period between the birth of Christ and the year 500 AD is exemplified by a reinterpretation of artefacts found in the sacrificial bogs at Thorsbjerg, Nydam, Ejsbøl, Illerup Adal, Vimose and Kragehul, reinterpreted in the light of classic European and Egyptian archaeological finds and ethno-archaeological parallels against the background of the author's years of experience as a practicing specialist in gynaecology and obstetrics. No surgical instruments from the Iron Age have previously been construed or identified as such in Denmark or Schleswig-Holstein. The purpose of this paper is to examine the possible finding and identificiation of surgical instruments - or what could be construed as a battlefield surgeons instruments - among artefacts deposited in the above-mentioned sacrificial bogs in the Iron Age. In this paper, the term 'surgical instrument' is defined as an instrument used in teh practice of medicine. Material for the study was collected in a review of illustrations in published works about these bog finds, localising these artefacts and examining them at the museums at which they were located. Also examined was museum storage of artefacts that had been excavated in the above-mentioned bogs. In an effort to reinterpret the function of the artefacts, they were compared with known surgical instruments found in the geographical areas controlled by the Greeks and later the Romans and with pictures of artefacts and a few written sources form the same area. They were also compared with ethnographic parallels. The material upon which the paper is based consists of a total of 67 artefacts, each identified as being from one of the above-mentioned bogs. Of these 67 artefacts, 40 can be indentifed and reinterpreted as being surgical instruments and 27 are toilet sets, i.e. tweezers for personal use or sets consisting of tweezers connected by a metal ring to either an ear pick or a nail cutter. Analysis of the artefacts revealed that in six of the bogs, 40 surgical instruments were found among sacrificed weapons: 29 scalpels, one pair of tweezers, five needles, more than 200 'wound thorns', three trephination saws and a double box. These instruments and the context, in which they were found, i.e. among sacrificed Iron Age weapons, indicate that the artefacts can be interpreted as being a battlefield surgeons instruments. It must be concluded that battlefield surgeons took part in local warfare, and that their equipment was sacrificed to the bogs in the Iron Age. It must also be concluded that these field surgeons gained their knowledge not only through contact with civilians but also from a close association with the military of the Roman Empire. This insight into the humanitarian care principles and philosophy of Iron Age civilisation is completely new and of substantial cultural and historical significance to the currently reigning view that the Roman Iron Age within the geographical area that is now Denmark was simply a callous and barbaric period.

Archaeology↗
PubMed1980

Use of prophylactic antibiotics in surgical procedures: peer review guidelines as a method for quality assurance.

Concomitant with the development of guidelines for the use of prophylactic antibiotics in surgery, the Veterans Administration undertook a survey of its surgical chiefs in which the likelihood of peer review guidelines being an effective method of quality assurance was assessed. The scope of the present problem was also assessed in terms of the misuse of antimicrobial agents in surgical units. The implications of this study for quality assurance are:(1) Chiefs of surgery can be influenced by peer review guidelines, but other sources can also have impact. (2) The control practices used by chiefs to influence their staffs are limited. (3) The mechanisms used by chiefs to monitor adherence to their policies are mostly informal. The implications of this study in relation to surgical antibiotic prophylaxis are: (1) The practices of surgical chiefs differ significantly from peer review guidelines. (2) The problem is far more serious for certain surgical procedures than for others. (3) Most misuse errors are errors of commission rather than omission.

Anti-Bacterial Agents↗
PubMed2002

Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis.

BACKGROUND: Chronic radiation proctitis (inflammation of the rectum) may develop after the completion of pelvic radiotherapy. Presently there is no recommended standard management. OBJECTIVES: To assess the effects of various non-surgical treatment options for the management of late chronic radiation proctitis. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, issue 1, 2001, MEDLINE 1966 to 2001, EMBASE 1980 to 2001, CANCERCD 1980 to 2001, Science Citation Index 1991 to 2001, CINAHL 1982 to 2001, as well as sources of grey literature. We also hand searched relevant textbooks and contacted experts in the field. SELECTION CRITERIA: Studies (preferentially randomised controlled trials) of interventions for the non-surgical management of late radiation proctitis in patients who have undergone pelvic radiotherapy as part of their cancer treatment. DATA COLLECTION AND ANALYSIS: The inclusion criteria were independently applied by two of the reviewers (AD and EJM) and where there was disagreement this was resolved by involving a third reviewer to form a consensus. MAIN RESULTS: Six randomised controlled trials were included. None of the trials compared anti-inflammatories with placebo. However rectal sucralfate showed greater clinical improvement for proctitis than anti-inflammatories (odds ratio 14.00, 95% confidence interval 1.46 to 134.26; n=1 study), though no difference was seen for endoscopic improvement (odds ratio 2.74, 95% confidence interval 0.64 to 11.76, n=1 study). The addition of metronidazole to the anti-inflammatory regime also appeared to improve the response rate, as measured by the reduction in rectal bleeding, diarrhoea, erythema and ulceration (n=1 study). Similarly rectal hydrocortisone appeared to be more effective than rectal betamethasone for clinical improvement although no difference was seen in endoscopic improvement (n=1 study). Short chain fatty acid enemas did not appear to be effective compared to placebo (n=2 studies). In the comparison of the heater probe and bipolar electrocautery (n=1 study), there was no discernible difference for severe bleeding after one year, but the heater probe demonstrated a greater increase in the haematocrit and reduced transfusion requirements. REVIEWER'S CONCLUSIONS: Late radiation complications are a relatively rare manifestation, with many potential carers and poor diagnostic criteria. Although certain interventions look promising and may be effective (such as rectal sucralfate, adding metronidazole to the anti-inflammatory regime and heater probes), single small studies (even if well conducted) provide insufficient evidence. The episodic and variable nature of late radiation proctitis also requires placebo controlled studies to establish whether particular treatments are effective. Regional or centralised registers of radiation toxicity should be established so that interventions can be administered in the setting of multi-centre trials with specific entry criteria, formal baseline and therapeutic assessments providing standardised outcome data including quality of life evaluations.

Anti-Inflammatory Agents↗
PubMed2003

Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data.

OBJECTIVE: To design and validate a statistical method for evaluating the performance of surgical units that adjusts for case volume and case mix. DESIGN: Validation study using routinely collected data on in-hospital mortality. DATA SOURCES: Two UK databases, the ASCOT prospective database and the risk scoring collaborative (RISC) database, covering 1042 patients undergoing surgery in 29 hospitals for gastro-oesophageal cancer between 1995 and 2000. STATISTICAL ANALYSIS: A two level hierarchical logistic regression model was used to adjust each unit's operative mortality for case mix. Crude or adjusted operative mortality was plotted on mortality control charts (a graphical representation of surgical performance) as a function of number of operations. Control limits defined as 90%, 95%, and 99% confidence intervals identified units whose performance diverged significantly from the mean. RESULTS: The mean in-hospital mortality was 12% (range 0% to 50%). The case volume of the units ranged from one to 55 cases a year. When crude figures were plotted on the mortality control chart, four units lay outside the 90% control limit, including two outside the 95% limit. When operative mortality was adjusted for risk, three units lay outside the 90% limit and one outside the 95% limit. The model fitted the data well and had adequate discrimination (area under the receiver operating characteristics curve 0.78). CONCLUSIONS: The mortality control chart is an accurate, risk adjusted means of identifying units whose surgical performance, in terms of operative mortality, diverges significantly from the population mean. It gives an early warning of divergent performance. It could be adapted to monitor performance across various specialties.

Hospital Mortality↗
PubMed1994

[Surgery for epidermolysis bullosa in children: value of the association of inhalation anesthesia and locoregional anesthesia].

Due to the cutaneous and mucosal fragility associated with epidermolysis bullosa, this disease is a source of various practical problems for the anaesthesiologist concerning the surgical posture, the monitoring of vital functions, the airways control and the vascular access, as all these procedures may worsen, sometimes dramatically, the lesions in these young patients, still in a precarious health state. Basing on published studies and their own experience, the authors have used in these patients a combined locoregional and general anaesthesia. The latter was obtained with isoflurane, administered in the non intubated and spontaneously breathing patient through a closed surgical isolation container (Vi-Drape), including the patient's head and ventilated with a ventilator generating a PEEP for long procedures. The results obtained during 9 procedures in 3 children are reported and discussed. For several shorter procedures (for example wound dressing), intramuscular ketamine was used.

Anesthesia, Conduction↗
PubMed2002

Effects of obesity surgery on non-insulin-dependent diabetes mellitus.

CONTEXT: Most individuals who have non-insulin-dependent diabetes mellitus are obese. The obese population has proved a frustrating entity regarding weight loss and diabetes control. Results of medical weight loss programs, medications, and behavior therapy have proved disappointing. HYPOTHESIS: Bariatric surgery is the most effective method of diabetes management and cure in the morbidly obese population. Surgical procedures to cause malabsorption provide a more dramatic effect on diabetes owing to the imparted bypass of the hormonally active foregut. DATA SOURCES: Pertinent journal articles spanning the last 40 years, as well as textbooks. CONCLUSIONS: Bariatric surgical procedures have proven a much more successful method of weight loss and diabetes control in the obese population than conservative methods. These surgical procedures have proven safe with reported mortality rates of 0% to 1.5%. Bariatric operations may be divided based on the method of weight loss and effect on diabetes. The first category is restrictive and includes vertical banded gastroplasty and adjustable silicone gastric banding. These operations improve diabetes by decreasing food intake and body weight with a slowing of gastric emptying. The second category not only contains restrictive components but also elements of malabsorption. This category includes the Roux-en-Y gastric bypass and biliary-pancreatic diversion, which bypass the foregut. Although all of the surgical procedures for obesity offer improved weight loss and diabetes control compared with conservative methods, the Roux-en-Y gastric bypass and biliary-pancreatic diversion offer superior weight loss and resolution of diabetes. The more dramatic effect seen in the surgical procedures to cause malabsorption is likely secondary to the bypass of the foregut resulting in increased weight loss and elevation of the enteroglucagon level.

Anastomosis, Roux-en-Y↗
PubMed1981

The effect of an anabolic steroid on body composition in patients receiving intravenous nutrition.

In this controlled trial we investigated the effect of an anabolic steroid, in terms of the changes in body composition that occurred in ill surgical patients requiring intravenous nutrition. Glucose was the sole non-protein energy source. The study was conducted over a 14-day study period in two comparable groups of 13 patients. The changes in body weight, fat, protein and water were measured. The control group received a nutrient solution of hypertonic dextrose and amino acids (44.8 +/- 8.2 kcal/kg/day), and the comparative group received the same solution (44.3 +/- 5.2 kcal/kg/day) and 100 mg of an intramuscular injection of nandrolone decanoate at the commencement of the study and again one week later. Over the two-week study period both groups gained body weight. In the controls this was composed of fat (0.4 kg) and water 1.5 kg). In the anabolic steroid group, weight gain was mainly water, and fat gain did not occur. Neither group gained body protein. Diuretic therapy was required more often (21 patient days compared with 5 patients days; p less than 0.001) in the anabolic steroid group to control excessive water retention. Our study has shown no benefit from an anabolic steroid when given in combination with a 14-day course of intravenous nutrition. Water retention was more of a problem with this therapy.

Aged↗
PubMed1981

Aetiology and control of chronic pyogenic osteomyelitis in Ile-Ife, Nigeria.

Fifty-six patients suffering from chronic osteomyelitis, who attended the University of Ife Teaching Hospital, Ile-Ife, Nigeria, between November 1976 and December 1977 were studied. Poor hygiene, ignorance, sickle cell disease, and minor trauma in the form of cuts, abrasions, insect bites, and thorn-pricks were the main predisposing factors. Open fractures resulting from road accidents, and infection following surgical procedures, contributed to a lesser extent and may well become the main source of chronic bone infection in the near future. Measures are suggested for the control of the disease.

Accidents, Traffic↗
PubMed1998

Nocardia farcinica sternotomy site infections in patients following open heart surgery.

Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A. A case-control study comparing case-patients (n=5) with open heart surgery patients without subsequent sternotomy site infections (n=50) identified as risk factors diabetes (4/5 vs. 11/50, P<.02) and exposure to a particular anesthesiologist (anesthesiologist A; 4/5 vs. 9/50, P<.01). Four case-patients' isolates and a hand isolate of anesthesiologist A had an identical ribotype pattern (strain 1); the remaining case-patient's isolate and multiple isolates from anesthesiologist A's hands and home had a different ribotype pattern (strain 2). An intensified hand-washing regimen, barriers (gloves, gowns), and cleaning of anesthesiologist A's house were associated with termination of the outbreak. This is the first reported nosocomial N. farcinica outbreak to document the source and person-to-person transmission epidemiologically and molecularly.

Aged↗
PubMed2005

Cataract surgical coverage and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria.

AIMS: To determine the coverage, outcome, and barriers to uptake of cataract surgery in leprosy villages of north eastern Nigeria. METHODS: People 30 years and above resident in eight leprosy villages were examined. Cataract blind people were questioned about the reasons they had not been treated. Subjects who had received an operation for cataract were examined to determine the outcome and, where applicable, the causes of poor outcome. RESULTS: 480 people were examined. Cataract was the commonest cause of blindness. The cataract surgical coverage (people) was 39.2% for orthodox surgery and 29.7% for couching. After surgery, visual acuity > or =3/60 had been restored to 82.1% of eyes that had had orthodox surgery, but only 58.6% of eyes that had been couched. Cost was the commonest reason given for not seeking treatment for cataract. CONCLUSIONS: Cataract is the major cause of blindness in this population but cataract surgical needs are currently not being met. There is a need for better collaboration between leprosy control and ophthalmic services, improved education of people affected by leprosy, a commitment to improving orthodox cataract surgery outcomes, and consideration of a possible role for traditional healers as sources of referral for orthodox surgical services.

Adult↗
PubMed2005

Surgical manipulation of the intestine and distant organ damage-protection by oral glutamine supplementation.

BACKGROUND: The intestine is increasingly recognized as a primary effector of distant organ damage, such as the lung, after any abdominal surgery. Earlier studies have shown that surgical manipulation of the intestine induces generation of reactive oxygen species in the intestine, resulting in mucosal and lung damage. Because glutamine is preferentially used by the small intestine as an energy source, this study examined the effect of glutamine and glutamic acid on intestinal and lung damage after surgical manipulation. METHODS: Controls and rats were pretreated for 7 days with 2% glutamine or glutamic acid, or the isonitrogenous amino acids glycine or alanine in the diet and subjected to surgical manipulation of the intestine. The intestine and lung were assessed for damage, and protection offered by various amino acids was studied. RESULTS: Surgical manipulation resulted in oxidative stress in the intestine as evidenced by increased xanthine oxidase activity and decreased antioxidant status. Enterocyte mitochondria were also functionally impaired with altered calcium flux, decreased respiratory control ratio, and increased swelling. Gut manipulation also resulted in neutrophil infiltration and oxidative stress in the lung as assessed by an increase in myeloperoxidase activity, lipid peroxidation, and antioxidant status. Glutamine or glutamic acid supplementation for 7 days before surgical manipulation showed a protective effect against the intestinal and lung damage. CONCLUSIONS: This study suggests that preoperative enteral glutamine or glutamic acid supplementation attenuates intestinal and lung damage in rats during surgical manipulation and that this effect might offer protection from postsurgical complications.

Administration, Oral↗
PubMed2026

Human vascular pythiosis: pathogenesis, diagnosis, and evidence-informed management.

SUMMARYHuman vascular pythiosis is a rare, life-threatening angioinvasive infection caused predominantly by the oomycete Pythium insidiosum. Unlike ocular or cutaneous pythiosis, the vascular form is defined by arterial wall invasion, long-segment thrombosis, limb ischemia, aneurysmal complications, and high risks of amputation and death. Although P. insidiosum is broadly distributed in freshwater environments, reported human vascular disease remains concentrated in Thailand, indicating that exposure alone is insufficient for disease development. Available evidence supports a multifactorial model centered on repeated freshwater exposure and host susceptibility, particularly hemoglobinopathies and iron dysregulation, while the rarity of comparable vascular disease elsewhere remains unexplained. Because vascular-specific mechanistic data are limited, evidence from animal pythiosis, nonvascular human disease, environmental studies, genomic analyses, and experimental models must be interpreted selectively and linked explicitly to vascular pathogenesis, diagnosis, or management. Infection usually begins at sites of skin disruption after freshwater exposure and progresses through soft tissue and perivascular planes into the arterial wall. Longitudinal intramural extension, rather than typical hematogenous dissemination, explains long-segment arterial occlusion, proximal progression, and relapse after incomplete source control. Diagnosis requires early suspicion, serology, vascular imaging, and tissue-based confirmation. Management depends on prompt and complete surgical removal of infected arterial tissue, supported by adjunctive protein-synthesis-inhibiting antibacterial therapy, particularly when residual disease is suspected. Conventional antifungals have limited activity, and Pythium antigen immunotherapy remains historically important but of uncertain independent benefit. Earlier recognition, better surgical-margin assessment, standardized diagnosis, and prospective treatment data are needed.

P. insidiosum↗
PubMed2001

Experimental and emerging therapies for sepsis and septic shock.

The underlying principles of sepsis therapy have remained unchanged for decades. These include: prompt institution of antimicrobial agents aimed at the inciting pathogen, source control directed at removal of the infection nidus whenever possible, and support of organ dysfunction. Despite advances in antibiotics, surgical techniques and organ support technology, the morbidity and mortality from sepsis-related diseases have remained substantially unchanged (30 - 50%). Immunomodulation of the inflammatory cascade has been suggested as a crucial but inadequately addressed element in the treatment of sepsis. The list of potential therapeutic targets has been growing as more and more mediators are identified in the pathogenesis of sepsis. To date, numerous anti-inflammatory agents, found to have favourable effects in animal models of septic shock, have been tested in a number of clinical trials on thousands of patients. In this first of a three part series, we go through some of the background and current strategies in sepsis therapy. In this review, we include the two novel therapies that have shown clear survival benefit in large, randomised, placebo-controlled, multi-centre trials, low-dose steroids and recombinant activated protein C. Also included in this review are studies on antithrombin III, platelet-activating factor antagonists, complement modulators, nitric oxide synthase inhibitors and caspase inhibitors (apoptosis inhibitors).

Animals↗
PubMed2000

[Transesophageal echocardiography (TEE)].

Transesophageal echocardiography (TEE) is a complementary technique to conventional echocardiography (TTE) and is used in patients in whom TTE reveals unsatisfactory image quality. The improved resolution in combination with the capability to visualize cardiac structures which are not detectable or poorly visualized by TTE has brought TEE into increasing use as a routine technique. TEE has been proven to be superior to TTE for various indications, e.g., detection of infective vegetations or perivalvular abscesses, evaluation of acute chest pain or potential embolic sources, evaluation of prosthetic valve function, evaluation of hypotensive or hypoxic patients, intraoperative monitoring of LV function or control of surgical results after correction of complex congenital heart disease or mitral valve reconstruction. TEE is an semi-invasive technique which can be performed in > 95% of patients with only minor discomfort; life threatening complications are rare (< 0.1%). TEE is a bed-side and low-cost technique which can be rapidly applied in the operation room as well as intensive care unit. TEE combines functional and morphological data with a high diagnostic accuracy and may be, therefore, an important diagnostic tool also for the next millennium despite new developments in alternative imaging techniques such as magnetic resonance.

Cost-Benefit Analysis↗
PubMed1993

Popliteal venous aneurysms.

Popliteal venous aneurysms are rarely reported but represent a potentially life-threatening condition requiring accurate diagnosis and surgical resection. Newer techniques including magnetic resonance imaging, computed tomography, and color flow duplex imaging offer new noninvasive methods to define popliteal fossa venous abnormalities. Excision of the aneurysm with venous reconstruction removes the embolic source and maintains prograde venous flow. A posterior surgical approach to the popliteal fossa is recommended to facilitate exposure. Early control of venous outflow is needed to avoid thromboembolism. This report describes the diagnosis and treatment of popliteal venous aneurysms in three patients with a review of the English-language literature.

Adolescent↗
PubMed2001

Effectiveness of the ultrasonic coagulating shears, LigaSure vessel sealer, and surgical clip application in biliary surgery: a comparative analysis.

Advancements in laparoscopic surgery are often dictated by the limitations of technical instrumentation. Energy sources other than electrosurgery have become popular with the promise of quick and effective vascular control. With their success surgeons have begun using these on structures other than blood vessels with little or no data establishing their efficacy or safety. This study evaluates alternative energy sources in sealing ductal structures for possible use in liver or gallbladder surgery. After elective cholecystectomy cystic ducts (n = 45) were resealed ex vivo with surgical clips (n = 14), ultrasonic coagulating shears (n = 16), or electrothermal bipolar vessel sealer (n = 15), and bursting pressures were measured. Nineteen additional human cystic ducts were randomized to seal by ultrasonic coagulating shears (n = 9) or electrothermal bipolar vessel sealer (n = 10) and fixed in 10 per cent buffered formalin for histologic evaluation of thermal spread (mm). After this nine adult pigs were randomized to laparoscopic ligation and transection of the common bile duct using surgical clips (n = 3), ultrasonic coagulating shears (n = 3), or electrothermal bipolar vessel sealer (n = 3). The animals underwent necropsy for assessment of seal integrity on the sixth postoperative day. In the ex vivo study the mean cystic duct bursting pressure was 621 mm Hg with surgical clips and 482 mm Hg with the electrothermal bipolar vessel sealer (P = 0.39). The mean cystic duct bursting pressure after ultrasonic coagulating shears was 278 mm Hg, which was statistically less than surgical clips (P = 0.007) and electrothermal bipolar vessel sealer (P = 0.02). The mean thermal spread was 3.5 mm for ultrasonic coagulating shears and 13.4 mm for electrothermal bipolar vessel sealer (P = 0.0002). All animals undergoing ligation and transection of the common bile duct with ultrasonic coagulating shears and electrothermal bipolar vessel sealer developed bile peritonitis by postoperative day 6 as a result of seal leak. All animals undergoing surgical clip ligation and transection of the common bile duct maintained seal integrity. The mean common bile duct pressure above the surgical clip was 12 mm Hg (range 10-14). In conclusion the acute ex vivo study demonstrated a significant difference in the cystic duct bursting pressure between surgical clips and ultrasonic coagulating shears and between electrothermal bipolar vessel sealer and ultrasonic coagulating shears. The ultrasonic coagulating shears and electrothermal bipolar vessel sealer failed to maintain seal integrity in the in vivo animal study. Given the failure of the ultrasonic coagulating shears and electrothermal bipolar vessel sealer in the animal model these energy sources should not be used for transection of the cystic duct or major hepatic ducts during hepatobiliary surgery.

Animals↗
PubMed1990

Glass bead sterilisation of surgical dental burs.

Since burs used in OMF surgery are a source of microbial contamination, sterilisation of the burs is an important aspect of infection control. A two-part study was performed to evaluate the efficacy of using the glass bead steriliser to sterilise long-shank burs. The laboratory and clinical studies indicated that the glass bead steriliser was effective in sterilising long-shank burs in 60 s.

Alloys↗
PubMed1988

Adjunctive radiotherapy with strontium-90 in the treatment of conjunctival squamous cell carcinoma.

Squamous cell carcinoma of the ocular conjunctiva is a relatively rare malignancy which is attended by a high rate of local recurrence following simple surgical excision. To date, the management of conjunctival squamous cell cancer has been controversial. From 1950 to 1985, 146 consecutive patients with superficial conjunctival squamous cell cancer were treated at the Queensland Radium Institute. All patients were treated by simple surgical excision of the visible conjunctival lesion followed by adjunctive radiotherapy. Of 140 patients with histologically confirmed squamous cell cancer, 123 were treated with a strontium-90 source, 10 with a radon "ring," and 7 with superficial X ray therapy. Standard policy since 1960 has been to deliver an incident dose of 30 Gy in a single fraction within the first 48 post-operative hours to the surgical bed using a strontium-90 source on a stand-off eye applicator. This report will largely focus on the 123 patients who were treated with a strontium-90 source, of whom 107 received 30 Gy, 14 received 40 Gy (pre 1960) and one patient each received 20 and 25 Gy incident dose. Of 131 evaluable patients, there were only 3 who developed local recurrence. All 3 local recurrences developed in elderly men who had presented with extensive superficial primary tumors. Two of the three recurrences occurred in the two patients who were treated with doses less than 30 Gy. Both early and late radiation-induced complications following ablative surgery and treatment with strontium-90 were very uncommon. Three patients developed unsightly conjunctival telangiectasia, 2 patients developed a persistent scleral ulcer and 2 patients developed clinically significant cataracts. This negligible degree of treatment-related side effects contrasts with the experience of 10 patients who had previously been treated with a radon ring, 8 of whom developed serious complications, although none developed local recurrence. On the basis of our excellent local control rates with minimal morbidity we would continue to advocate the use of simple surgical excision followed by 30 Gy beta radiation from a strontium-90 source as the definitive treatment for superficial conjunctival squamous cell cancer.

Adult↗