Accuracy of Goldmann tonometry after refractive surgery

PURPOSE

To assess the accuracy of Goldmann tonometry after refractive surgery.

SETTING

Refractive surgery center, Sherbrooke, Quebec, Canada.

METHODS

The charts of 824 patients who had radial keratotomy (RK) and 415 who had photorefractive keratectomy (PRK) by the same surgeon were retrospectively reviewed. Of these, 306 RK and 168 PRK patients had discontinued steroid use for at least 4 weeks postoperatively and were thus eligible for evaluation of preoperative and postoperative intraocular pressure (IOP). Only one eye per patient was used for statistical analysis.

RESULTS

Preoperative data showed that age, mean keratometry, and pachymetry were related to IOP measurement with the Goldmann tonometer. Pachymetry was related to age and mean keratometry. The mean decrease in measured IOP after RK was 1.0 mm Hg +/- 3.21 (SD) (P < .05). The only positive correlation was with the number of incisions. The mean decrease in measured PRK was 2.4 +/- 3.02 mm Hg (P < .05). Men and older patients had a larger drop in IOP measurements. There was no correlation with any corneal or operative parameter.

CONCLUSION

Refractive surgery changed the accuracy of the Goldmann tonometer, causing it to underestimate IOP. The change was more marked in older men who had PRK.

Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases

BACKGROUND

Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications.

PURPOSE

A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified.

MATERIAL

From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection.

METHODS

A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method.

RESULTS

Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx.

CONCLUSION

Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.

Analysis of 676 Cases of Ductal Carcinoma in Situ of the Breast From 1971 to 1995

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

Impairment of monocyte functions in advanced head and neck cancer

Depression of cell-mediated immunity is well established in most malignancies and especially in head and neck cancers, and much information is available concerning the defect in helper T lymphocyte function. We now report on impairment of the monocyte-macrophage system. Compared with normal controls we found that patients displayed, on one hand, an increased number of peripheral blood monocytes and, on the other hand, a smaller percentage of HLA-DR+ monocytes. Such peripheral blood monocytes normally failed to secrete factors, including interleukin 1 (IL-1). In addition, we observed that the in vivo induced blastogenesis of peripheral blood lymphocytes from patients, which is spontaneously depressed, is partly restored by medium containing IL-1. We cannot exclude, however, that the observed monocyte dysfunction involves other cytokines. Whether such an immune deficiency is due to secondary malnutrition or to the malignancy (or both) remains unclear.

Conservation treatment in subareolar breast cancers

The results of centromammary conservation in 37 patients with 20 mm-median-size breast cancer, located in the subareolar area (SAA), with an infiltration of the nipple-areolar-complex (NAC) in 12 patients and a retraction in 24, are reported. Breast conservative surgery was initially performed in 30 patients; five patients were first treated with chemotherapy; two patients received initial tamoxifen. Surgery comprised tumorectomy plus axillary dissection, with complete resection of the NAC (20 patients), or partial resection (nine patients), or without resection (eight patients). Post-operatively, all patients received 50 Gy external radiotherapy, with an additional external electron boost in 13 patients; 14 patients received adjuvant tamoxifen and two patients adjuvant chemotherapy. With a median follow-up of 49 months, one patient experienced a local failure and four a metastatic failure; 5-year overall actuarial survival and disease-free survival rates were 97%, and 75%. Cosmetic results were excellent in three patients, good in 25, and poor in seven. Breast conservation appears a satisfying treatment in small breast cancer located in SAA.

Ethmoidal cancers: a retrospective study of 22 cases

From April 1978 to June 1990, 22 patients with ethmoidal cancer were treated at Fondation Bergonié by a combination of surgery and radiation therapy. The mean age was 59.6 years (range 34-79 years) and the sex ratio is 2.7 (16 males/6 females). Histologic types were: adenocarcinoma, 13 cases; squamous carcinoma, 4 cases; undifferentiated carcinoma, 3 cases and esthesioneuroblastoma, 2 cases. Exposure to wood dust was encountered in 11 patients, especially in cases of adenocarcinoma: 10/13 (77%). Staging according to the classification of the University of Florida was: Stage I, 10 patients; Stage II, 5 patients and Stage III, 7 patients. Resection was considered as complete in 16 cases and only one orbital exenteration was performed. The postoperative radiation therapy delivered a mean given dose of 55.7 Gy (range 50-70 Gy) expressed to the hot spot using a technique adapted to tumor location and extension. Complete remission was achieved in 20 cases. Median follow-up is 28 months. The 5-year overall and disease-free survival are 44% and 38%, respectively. Analysis of recurrences according to staging gives: 5/10 Stage I, 2/5 Stage II and 5/7 Stage III. Recurrence is pejorative since death occurs in all cases within an average of 6 months following salvage treatment, except for three patients still alive within less than 6 months and in second remission. Prognosis of ethmoidal cancer depends on staging and local control.

Supraomohyoid neck dissection in cancer of the oral cavity

BACKGROUND

In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure.

METHODS

The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure.

RESULTS

For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%.

CONCLUSIONS

SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.

Word priming with brief multiple presentation technique: preservation in amnesia

Many studies have shown relative preservation of word priming in subjects with mild amnesia, but some decrease in severe amnesia. This calls into question the degree of separation between implicit and explicit memory. Possible contamination of implicit memory tasks by impaired explicit memory strategies might be obscuring the actual dissociation between the two memory systems. We have developed a method of circumventing explicit memory contamination by using brief duration repeated primes below the awareness threshold of subjects. We have used this approach to evaluate the status of word priming in densely amnesic subjects. One group of amnesic subjects with alcoholic Korsakoff's syndrome and one group of normal elderly control subjects were tested for word priming on a speeded category membership decision task. Implicit or explicit encoding procedures were used in three different experiments. Results demonstrated that brief multiple presentation of words can offer a means of producing word priming in the absence of explicit recognition or recall of the primed words in both amnesic subjects and normal elderly control subjects. Moreover, there was no significant difference in the magnitude of the priming effect between these groups in the three experiments. These findings show that amnesic subjects can exhibit normal levels of word priming. They also suggest that amnesics retain the capacity to encode, store and retrieve information implicity, e.g. unintentionally.

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.

[Results of 10 years of a randomized trial of neoadjuvant chemotherapy in breast cancers larger than 3 cm]

AIM OF THE STUDY

The aim of this randomised trial was to determine advantages and drawbacks of neo-adjuvant chemotherapy in patients with operable breast cancers > 3 cm.

MATERIAL AND METHODS

Two hundred and seventy-two women (age 70) with operable breast cancers larger than 3 cm (T2-3/N0-1/M0) were included in a randomised trial from January 1, 1985 to April 30, 1989. Patients in group A (n = 138) were treated by mastectomy and axillary node dissection. Adjuvant chemotherapy was indicated for 104 patients with axillary node involvement (n = 82) or negative oestrogen and progesterone receptors (EPR-) (n = 22). Patients in group B (n = 134) were treated by initial chemotherapy (identical as in group A) followed by locoregional treatment according to the response. Before treatment, the average of clinical tumoural diameter was 43 mm.

RESULTS

The median follow-up was 124 months. In group B, 49 patients (36.5%) were resistant to chemotherapy; a conservative breast surgical treatment was performed in the other 84 patients sensitive to chemotherapy (62.6%). In this last subgroup, 19 (22.6%) needed a secondary mastectomy because of locoregional recurrence. Survival rates were not different in groups A and B, but loco-regional recurrences were frequent in group B. At 10 years, the overall survival rate was 60% and half of living patients in group B were free of cancer and with their breast.

CONCLUSION

Neoadjuvant chemotherapy permitted in two-thirds of cases breast conservation treatment, initially considered to be impossible. Locoregional recurrences are more frequent than after mastectomy and adjuvant chemotherapy.

[Contribution to the study of painful and functional sequellae after breast reconstruction using latissimus dorsi flap. Investigation into 149 patients]

Latissimus dorsi flap is the most commonly used among tissues transfers for breast reconstruction. If its qualities and performances are well known, few papers have studied sequellae of this flap, particularly painful. The purpose of this paper is to provide a contribution about this subject. Postulating the complexity of this step, we limited ourselves initially to an evaluation based on analysis of concise questionnaire mailed to two pools of patients with different delays since their reconstruction using latissimus flap. In the two groups of patients, announced principal embarrassment - logically associated with a gestural limitation - is the feeling of axillo-dorsal rigidity, more pregnant than the pain itself. This one is marked during the 2 to 4 first months in the majority of the patients (68 and 66 %), and can persist several years in some among them (14 %). These after-effects did not prevent almost all of the patients to take again their domestic and professional activities and to express a high level of satisfaction with respect to their reconstruction. The addition of a prospective series studying the postoperative pain after reconstruction with or without latissimus flap tends to confirm that any oncologic breast surgery, ablative or reconstructive, expose to painful sequellae more linked to individual factors than to the technique implemented.

Effects of pressure on the infrared spectra of some heterocyclic organosilicon and organogermanium compounds

Measurements have been made of the infrared spectra of eight solid heterocyclic organosilicon and organogermanium compounds at pressures up to 5 GPa at normal temperature. Evidence is found of reversible conformational changes under pressure, and of phase transitions in some of the compounds. Unexpectedly, it appears that compression does not favour the transannular interaction that exists, in some cases, between the heteroatom (silicon or germanium) and a functional group on the opposite side of the ring.

The Incidence of Cancer in Contralateral Reduction Mammaplasty after Mastectomy and Reconstruction of the Removed Breast

Fourty-one patients underwent breast reconstruction after mastectomy for cancer and reduction plasty of the second breast, over a 36-month period. These plasties were performed only for reasons of asymmetry, in the absence of any positive preoperative finding. Histologic examination using semiserial sectioning of the whole excised sample detected a high frequency of unsuspected cancer 14/41 (34%). There was a strong predominance of in situ carcinomas 11/41 (27%) over invasive carcinomas 3/41 (7%). These results were compared with those of other bilateral cancer series. When such cancers were detected by random biopsies or mastectomies, the rate of in situ carcinomas was much greater than in cancers detected only by physical and mammographic examination.

Cutaneous versus myocutaneous flaps in the repair of major defects in head and neck cancer: a study of 331 flaps

A retrospective analysis was carried out of 311 reconstructions of major defects following head and neck cancer treatment. Three hundred thirty-one flaps were used; they included cutaneous flaps from 1972 to 1979 and myocutaneous flaps (MCF) after 1979. The aim of this study was to compare the healing patterns of the two types of flaps used in similar circumstances. Even though the use of myocutaneous flaps reduced necrotic complications, there was no significant improvement in overall healing. In this type of reconstruction, local conditions as well as more general factors have greater prognostic significance. Apart from considerations of reliability, other criteria have led to myocutaneous flaps being the treatment of choice in cervicofacial cancer repair. However, specific indications for the use of cutaneous flaps remain.

[Primary intraosseous carcinoma of the jaws: results of treatment of 9 cases and proposed classification]

INTRODUCTION

Primary intraosseous carcinoma of the jaws is a rare squamous cell carcinoma arising in the jaw, having no initial connection with the oral mucosa and presumably developing from residues of the odontogenic epithelium.

OBJECTIVES

To present 9 cases and to propose a staging system of primary intraosseous carcinoma of the jaws.

CASES AND METHODS

Careful assessment of the clinical, radiological and histological examination of the specimens identified 9 patients with primary intraosseous carcinoma of the jaws.

RESULTS

The male/female ratio was 8/1 and the mean age of patients at the time of diagnosis was 61.7 years. All lesions were located in the mandible. Usually, clinical symptoms had benign aspect and delay the diagnosis. Radiographic features were unilocular osteolytic lesion and ill-defined margins were usually noted with a mean tumor size of 3.4 centimeters. The mean delay of the diagnosis was 4.9 months. Surgery at the tumor site consisted of hemi-mandibulectomy in all cases. All patients but one had neck dissection. The postoperative radiotherapy mean dose was 62.6 Gy. Histologically, most squamous cell carcinomas were well differentiated with keratinization. All lymph nodes metastasis had capsular involved. Complications occurred in 2 cases. Four patients had recurrences in the mean delay of 13.8 months. The estimated overall 2-and 5-years survival was 65% and 46.5% respectively.

DISCUSSION

Primary intra-osseous carcinoma of the jaws is a rare tumor none classified by UICC with poor prognosis. We recommend an aggressive treatment with postoperative radiotherapy. We propose a computer tomographic classification: T1 (tumor strictly intra-osseous), T2 (tumor with cortical destruction without involvement of adjacent soft-tissues) and T3 (tumor involvement of adjacent soft-tissues).

[Immediate repair of urethroperineal fistulas after abdominoperineal amputation by means of a cutaneo-muscular flap of the gluteus maximus. Apropos of 2 successfully treated cases]

Although a rare complication, the development of a urethro-perineal urinary fistula immediately after abdomino-perineal amputation is a difficult problem to solve. The fragility of the membranous urethra immediately in contact with the exenterated pelvic cavity which takes several weeks to fill in makes any attempt at isolated direct suture very hazardous. Secondary repair is also frequently difficult and the "functional prognosis is far from being always favourable". The major handicap resulting from the perpetuation of this type of fistula has led us to propose an attempt at immediate repair as soon as it is diagnosed with filling of the pelvi-perineal cavity by a cutaneo-muscular flap taken from gluteus maximus. In the two cases in which this treatment was performed, the fistula was cured and a good quality functional result was obtained.