Research: Heart of England NHS Foundation TrustHeart of England NHS Foundation TrustUnited Kingdom · Birmingham
Research: University Hospitals Coventry and Warwickshire NHSUniversity Hospitals Coventry and Warwickshire NHSUnited Kingdom · Coventry
Research: University Hospital of North StaffordshireUniversity Hospital of North StaffordshireUnited Kingdom · Stoke-on-Trent
[show abstract] [hide abstract]
ABSTRACT: A previously healthy 32-year-old Caucasian female presented with sudden-onset horizontal diplopia following a paroxysm of coughing. She had recently sustained a pubic ramus fracture during an innocuous fall and had also noted a firm lump developing at the right side of her forehead. On examination, she had a right fronto-temporal mass. Visual acuities were 6/6 bilaterally. There was reduced abduction of the right eye, bilateral white, granular corneal opacities and evidence of bilateral optic disc swelling. Haematological investigations revealed normocytic anaemia, hypercalcaemia and raised erythrocyte sedimentation rate (ESR). CT showed lytic foci throughout the skull, ribs, scapulae, spine, pelvis and upper femora. Serum protein electrophoresis revealed immunoglobulin D (IgD)-kappa paraproteinaemia; urine electrophoresis showed free light chain kappa and bone marrow biopsy demonstrated 87% plasma cells. A diagnosis of IgD multiple myeloma was made, with subsequent chemotherapeutic treatment and eventual autologous stem cell transplant resulting in resolution of neuro-ophthalmic manifestations and prolonged disease remission.Case Reports 01/2012; 2012.
Anaesthesia 03/2010; 65(3):313-4. · 2.96 Impact Factor
Matthew R Edmunds, Ioannis Kyprianou, Antonella Berry-Brincat, Yajati Ghosh, C N Sathyanarayana, Joy Beamer, Harpreet Ahluwalia[show abstract] [hide abstract]
ABSTRACT: A number of agents have previously been reported to be safe and effective for sedation and analgesia in ophthalmic surgery under local anaesthesia, but there has been no previous patient-focused assessment of this form of conscious sedation. We present a patient satisfaction survey, including a validated pain score, for patients undergoing oculoplastic procedures under local anaesthesia with alfentanil sedation. A prospective, non-randomized, questionnaire-based study of the experience, satisfaction and pain scores of consecutive patients undergoing oculoplastic procedures under local anaesthesia with alfentanil sedation at University Hospital, Coventry, UK, under the care of one Consultant Oculoplastic Surgeon between 2006 and 2009. Three hundred and sixty-seven patients were surveyed over the 3-year period. Overall, 52% were female and 89% of Caucasian ethnic origin. Mean duration of surgical procedures was 34 minutes (range 2-120 minutes). Over 90% of patients described a low pain score, both during the local anaesthetic injection and per-operatively, and 98% stated that they were happy to have this sedation technique for further oculoplastic surgery in future. Side effects related to sedation were reported in 5% of patients. There were no conversions to general anaesthesia and no day-case patients required an overnight in-patient stay. Conscious sedation with alfentanil for oculoplastic procedures under local anaesthesia results in low pain scores and high patient satisfaction with minimal complications.Orbit (Amsterdam, Netherlands) 02/2012; 31(1):53-8.
Article: Reversible branch retinal artery occlusion following intravenous cisplatin chemotherapy for cervical carcinoma.[show abstract] [hide abstract]
ABSTRACT: Cisplatin (CDDP) is a chemotherapeutic agent widely used to treat solid tumours. We present a case of reversible CDDP-associated branch retinal artery occlusion.International Ophthalmology 11/2011; 31(5):429-32.
Article: High rate of incomplete resection after primary excision of eyelid BCC: multi-staged resection rarely needs more than two procedures.[show abstract] [hide abstract]
ABSTRACT: Small, well-demarcated, biopsy-proven periocular basal cell carcinomas (BCC) are often excised in a single stage with immediate reconstruction when histology or location is considered low-risk. We investigated margin clearance in patients undergoing primary excision and immediate reconstruction (PER) versus multi-staged fast paraffin excision (MSE) and reviewed risk factors for incomplete excision. Retrospective, interventional, comparative case series of periocular BCCs excised over a 3-year period (2006-2008). Ninety consecutive patients with periocular BCC (average age 77 ± 10.1 years, 60% females) were included. 39% (35/90) underwent PER with the remainder managed by MSE (55/90, 61%). Patients undergoing MSE had larger lesions (38% > 10 mm versus 23% PER) which were more likely to involve the medial canthus (25 versus 11% PER). Incomplete histological clearance was noted in 34% (12/35) patients after PER. Only 3/55 (5%) needed third stage of excision in the MSE group with final incomplete excision in two cases (3.6%) that did not undergo a third stage excision. No significant risk factors were found likely to predict residual BCC overall, after first excision stage. Subgroup analysis for patients undergoing PER showed multiple lesions as the only statistically significant factor for incomplete excision. This study shows an unacceptably high rate of incomplete resection with primary excision and repair using a standard 3 mm margin. The majority of lesions undergoing multi-stage excision required no more than two stages for complete removal. Multi-stage excision with histological confirmation of clear margins prior to reconstruction is recommended for routine management of all periocular BCC.Orbit (Amsterdam, Netherlands) 09/2011; 30(6):275-9.